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OITE > Shoulder/Arm Anatomy > Flashcards

Shoulder/Arm Anatomy Flashcards

1
Q

first bone to ossify

A

clavicle at 5 weeks gestation

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2
Q

when does the medial epiphysis of the clavicle fuse?

A

25 years of age

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3
Q

what type of joint is the AC?

A

gliding fibrocartilagenous

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4
Q

maximum rotation of the AC joint

A

5-8° (with shoulder elevation)

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5
Q

which displacement does the AC ligament prevent?

A

AP displacement

*the conoid and trapezoid prevent superior displacement

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6
Q

6 types of AC joint injuries

A

1 = sprain, no ligamentous disruption

2 = AC disrupted, CC intact, < 50% subluxation

3 = AC and CC disruption with dislocated AC joint

4 = through trapezius

5 = detachement of deltoid and trapezius, extreme elevation of clavicle

6 = inferior displacement of clavicle

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7
Q

what type of joint is the SC?

A

diarthroidal with intraarticular disk

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8
Q

what is the ROM of the SC joint?

A

30° superior/inferior/AP

45° rotational

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9
Q
A

interclavicular ligament

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10
Q
A

anterior sternoclavicular ligament (there is also a posterior, not seen here)

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11
Q
A

costoclavicular ligament

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12
Q
A

suproglenoid notch

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13
Q
A

glenoid notch

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14
Q
A

spinoglenoid notch

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15
Q

6 ligaments that attach to scapula

A

CC x 2

CA

CH

superior transverse scapular ligament (army over, navy under)

inferior transverse scapular ligament (spinoglenoid notch)

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16
Q

orientation of the scapula in space

A

30° anterior in the axial plane

3° upward tilt

7° glenoid retroversion in most (75%) people (interestingly, the other 25% have varying degrees of anteversion at 2-10°)

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17
Q

neck-shaft angle of humerus

A

130-150°

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18
Q

retroversion of the humerus compared to the transepicondylar axis

A

30°

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19
Q

what comprises the conjoint tendon of the shoulder?

A

the coracobrachialis and short head of biceps as they attach to the coracoid process

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20
Q
A

deltoid tuberosity

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21
Q
A

subscapularis

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22
Q
A

lat dorsi

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23
Q
A

teres major

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24
Q
A

coracobrachialis

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25
Q
A

brachialis

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26
Q
A

brachioradialis

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27
Q
A

deltoid

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28
Q
A

pec major

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29
Q
A

supraspinatus

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30
Q
A

transverse humeral ligament

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31
Q
A

supraspinatus

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32
Q
A

infraspinatus

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33
Q
A

teres minor

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34
Q
A

triceps brachii

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35
Q
A

deltoid

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36
Q
A

brachialis

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37
Q
A

triceps medial head

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38
Q
A

radial groove

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39
Q

major blood supply to the humeral head

A

arcuate artery from the anterior circumflex humeral artery, which comes off the axillary artery

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40
Q

17 muscles that attach to the scapula

A

rhomboid major

rhomboid minor

levator scapula

trapezius

lat dorsi

serratus anterior

supraspinatus

infraspinatus

teres minor

teres major

subscapularis

omohyoid

pec minor

coracobrachialis

biceps

triceps long head

deltoid

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41
Q
A

trapezius

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42
Q
A

deltoid

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43
Q
A

triceps long head

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44
Q
A

teres minor

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45
Q
A

teres major

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46
Q
A

lat dorsi

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47
Q
A

rhomboid major

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48
Q
A

infraspinatus

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49
Q
A

rhomboid minor

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50
Q
A

supraspinatus

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51
Q
A

levator scapulae

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52
Q
A

omohyoid

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53
Q
A

pec minor

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54
Q
A

serratus anterior

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55
Q
A

subscapularis

56
Q
A

conjoint tendon (coracobrachialis and biceps short head)

57
Q

describe the glenoid

A

pear-shaped

35 mm vertical height

25 mm transverse width

1/3 the surface area of the humeral head

58
Q

what is the function of the glenoid labrum?

A

increases depth of joint 50%

anchor point for capsuloligamentous structures

59
Q

4 static restraints of the glenohumeral joint

A

bony anatomy

labrum

negative pressure

capsular ligaments

60
Q

3 dynamic restraints of the glenohumeral joint

A

rotator cuff

biceps tendon

scapulothoracic motion

61
Q
A

long head of biceps tendon

62
Q
A

SGHL

63
Q
A

subscapularis tendon

64
Q
A

IGHL

65
Q
A

MGHL

66
Q
A

weitbracht’s foramen

67
Q

draw the brachial plexus

A
68
Q

SGHL origin and insertion

A

originates with the superior labrum and biceps tendon

inserts to LT

69
Q

function of SGHL

A

resists inferior translation in adducted arm

70
Q
A

SGHL

71
Q
A

MGHL

72
Q
A

anterior band of IGHL

73
Q
A

IGHL

74
Q
A

posterior band of IGHL

75
Q

MGHL origin and insertion

A

arises deep to subscapularis insertion

inserts anterior humerus adjacent to LT

76
Q

function of MGHL

A

effective at 45°

limits ER, inferior translation, anterior translation

77
Q

function of IGHL

A

prevents anterior, inferior and posterior translation at 90° abduction

*anterior band prevents anterior-inferior dislocation

*posterior band prevents posterior-inferior dislocation

78
Q

what is the coracohumeral ligament?

A

from base of coracoid to anatomic neck of humerus

assists SGHL

restricts external rotation in adduction and inferior translation in adduction

79
Q

what is a buford complex?

A

2% of population

congenital absence of anterosuperior labrum

MGHL becomes cord-like to replace it

can be misinterpreted as a labral tear

80
Q

where is the rotator interval?

A

triangular portion of the capsule between supraspinatus and subscapularis tendons

reinforced by CHL and SGHL

81
Q

4 muscles connecting thoracic wall to upper limb

A

pec minor

pec major

subclavius

serratus anterior

82
Q

6 muscles connecting the vertebral column to the upper limb

A

trapezius

lat dorsi

rhomboid minor

rhomboid major

lev scap

SCM

83
Q

SCM origin and insertion

A

origin: medial 1/3 clavicle and sternum
insertion: mastoid process

84
Q

trapezius origin and insertion

A

origin: EOP, nuchal line, SPs of C7-T12
insertion: spine scapula, distal 1/3 clavicle

85
Q

rhomboids origin and insertion

A

origin: major from T2-5 SP, minor from C7-T1 SP
insertion: medial scapula

86
Q

lev scap origin and insertion

A

origin: TP C1-4
insertion: superomedial scapula

87
Q

lat dorsi origin and insertion

A

origin: SP T6-S5
insertion: crest of LT

88
Q

pec origin and insertion

A

origin: major from calvicle, sternum, ribs 1-7, minor from ribs 1-3
insertion: crest of GT and coracoid respectively

89
Q

serratus anterior origin and insertion

A

origin: all ribs
insertion: medial scapula

90
Q

subclavius origin and insertion

A

origin: rib 1
insertion: inferior clavicle

91
Q

deltoid origin and insertion

A

origin: clavicle, acromion, spine of scapula
insertion: deltoid tuberosity

92
Q

teres major origin and insertion

A

origin: lateral border of scapula
insertion: crest of LT

93
Q

insertion of subscapularis

A

LT

94
Q

insertion of coracobrachialis

A

proximal medial 1/2 humerus

95
Q

brachialis origin and insertion

A

origin: anterior distal 1/2 humerus
insertion: ulnar tuberosity

96
Q

origin of lateral triceps head

A

superolateral humerus

97
Q

origin of medial head triceps

A

inferomedial humerus

98
Q

2 posterior cord branches of the brachial plexus

A

radial

axillary

99
Q

nerve arising from the lateral cord

A

musculocutaneous

100
Q

the brachial plexus arises from between which two muscles?

A

anterior and middle scalene

101
Q

function of the dorsal scapular nerve

A

lev scap

rhomboid major

rhomboid minor

102
Q

function of the suprascapular nerve

A

supraspinatus

infraspinatus

103
Q

function of the LTN

A

serratus anterior

104
Q

function of nerve to subclavius

A

subclavius

105
Q

course of the suprascapular nerve

A

through the scapular notch then the spinoglenoid notch to innervate supra and infra

*also supplies sensory function to the shoulder joint

106
Q

where does the LTN travel?

A

superficial to serratus anterior on the chest wall

107
Q

what is Horner syndrome?

A

avulsion/compression of C8-T1 roots

leads to anhydrosis, ptosis and miosis

108
Q

medial scapular winging

A

LTN palsy

109
Q

lateral scapular winging

A

either dorsal scapular nerve or accessory nerve palsy

110
Q

where is the nerve to subclavius?

A

anterior to plexus but posterior to clavicle

111
Q

5 short branches of the brachial plexus that leave inferior to the clavicle (i.e. at cord level)

A

subscapular

thoracodorsal

medial and lateral pectoral

MBC

MABC

112
Q

source of subscapular nerve

A

C5-6 via the posterior cord

travels on subscapularis

113
Q

source of thoracodorsal nerve

A

C6-8 via posterior cord between the upper and lower subscapular nerves

runs inferolateral along posterior axillary wall to lat dorsi

114
Q

source of pec nerves

A

C5-T1

115
Q

discuss musculocutaneous nerve

A

from C5-7

to coracobrachialis, biceps and brachialis

lateral antebrachial cutaneous nerve sensation lateral forearm

articular branches to anterior joint capsule

arises from lateral cord

pierces CB 5-8 cm distal to coracoid

travels between biceps and brachialis

116
Q

discuss axillary nerve

A

from C5-6

for deltoid, teres minor

sense for herald patch (superior lateral brachial cutaneous nerve)

from posterior cord

wraps around surgical neck

through quad space

gives off superior and inferior branches to delt and T minor respectively

117
Q

discuss radial nerve

A

C5-T1

from posterior cord

joins deep brachial artery in triangular interval

goes posterior 10-14 cm from lateral condyle

goes medial to lateral in the spiral groove

enters anterior compartment

travels between brachialis and brachioradialis

emerges anteriorly and bifurcates at radiocapitellar joint

deep branch goes into supinator canal and continues as PIN

superficial branch follows the radial artery along brachioradialis

contributes to brachialis* + all extensors

is functionally PIN for ECRB and everything distal

sensory to shoulder, wrist, 4 MCP joints

sensory post BC, inf lat BC, post ABC, dorsal digitals, ulnar comm branch

118
Q

discuss ulnar nerve

A

from C8-T1

sensory for capsule of elbow and CMC joints

sensory for dorsal digital nerves, palmar branch to common and proper palmar branches

arises from medial cord

pierces medial intermuscular septum 8 cm from medial condyle to go posterior

behind medial epicondyle in the cubital tunnel

travels between FCU heads

penetrates the deep flexor-pronator aponeurosis

travels deep to FDS and FCU on FDP

enters the wrist at Guyon’s canal

119
Q

discuss median nerve

A

C6-T1

from medial and lateral cords

runs along anterior surface of medial intermuscular septum

crosses medial to brachial artery in cubital fossa

passes between 2 heads of pronator teres

runs between FDS and FDP

through carpal tunnel

muscles of hand direct from median, FPL, PQ and 1/2 FDP are AIN

sensory for elbow and wrist joints

sensory via palmar branch, comm branch, common and proper digital nerves

120
Q

what is Erb palsy?

A

C5/6 lesion

results in deltoid/ anterior arm weakness as the axillary and MSK nerves are taken out

looks like a waiter’s tip because of unopposed extensors and pronators

121
Q

what is klumpke palsy?

A

C8-T1 lesion

results in unopposed flexion, loss of intrinsic hand strength and possible Horner’s syndrome

will look like flexed arm with clawed hand

122
Q

which portion of the axillary artery is most vulnerable to injury?

A

third part - lateral to pec minor

123
Q

5 important branches of the axillary artery

A

supreme thoracic

thoracoacromial

lateral thoracic

subscapular

anterior and posterior circumflex humeral

124
Q
A

thoracoacromial artery

125
Q
A

supreme thoracic artery

126
Q
A

lateral thoracic artery

127
Q
A

subscapular artery

128
Q
A

posterior and anterior humeral circumflex arteries

129
Q
A

quadrangular space

130
Q
A

triangular interval

131
Q
A

triangular space

132
Q

borders of the quadrangular space

A

superior: teres minor
inferior: teres major
lateral: humerus
medial: long head of triceps

133
Q

what passes through the quadrangular space?

A

axillary nerve

posterior humeral circumflex artery

134
Q

borders of the triangular space

A

superior: teres minor
inferior: teres major
lateral: long head triceps

135
Q

what travels through the triangular space?

A

circumflex scapular artery

136
Q

borders of the triangular interval

A

superior: teres major
lateral: humerus
medial: long head triceps

137
Q

what passes through the triangular interval?

A

radial nerve

profunda brachii artery

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