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Anatomy > Shoulder & Humerus (brian) > Flashcards

Shoulder & Humerus (brian) Flashcards

0
Q

What is the version of the glenoid? relative to what?

scapular tilt?

scapula position relative to chest wall?

A

Average 5 degrees. Range 7 retro to 10 anteverted

75% retroverted 7 degrees

25% anteverted 2-10 degrees

relative to the long axis of the scapula - on axial slice, a line connecting midpoint of glenoid with medial apex of scapula

tilted 3-5 degrees upwards

scapula positioned 30 degrees anterior relative to chest wall/coronal plane

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1
Q

What is the version of the proximal humerus in relation to the transepicondylar axis?

A

30 degrees retroverted

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2
Q

What is the neck-shaft angle of the humerus?

version? relative to what?

A

130-150 degrees (130 degrees average)

30 degrees retroverted relative to transepicondylar axis of elbow

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3
Q

What is the carrying angle in men and women?

A

Men: 10-15 degrees Women: 15-20 degrees

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4
Q

Describe Bauman’s angle. What is the normal value?

A

Angle formed by a longitudinal line down the humeral shaft and another along the open capitellar physis. Normal: 72 degrees

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5
Q

suprascapular notch: bound by what ligament?

contains what structure?

What related structure is not within the notch? relationship to the ligament?

A

Superior transverse scapular ligament. Suprascapular vessels are over the nerves “Army over Navy” “Army over, Navy under”

i.e. the notch contains the suprascapular nerve, with the ligament overlying it and the vessels just above the ligament

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6
Q

What are the muscles and nerves affected in medial/lateral scapular winging?

A

Medial winging: serratus anterior: long thoracic nerve

Lateral winging: Trapezius: CN 11, or accessory nerve

Rhomboids: dorsal scapular n

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7
Q

Name 3 anatomic variants of the shoulder labrum aside from the normal:

A

Buford complex: absence of the anterosuperior labrum with a thickened MGHL

Sublabral foramen - anterosuperior labrum appears detached from glenoid - looks like a tear

sublabral recess - superior labrum appears detached from glenoid - looks like a SLAP tear

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8
Q

describe the path of the axillary artery and its branches

A

once subclavian artery crosses first rib, becomes axillary artery

part I (1 branch): before (medial to) pec minor–gives off supreme thoracic branch

part II (2 branches): deep to pec minor–gives off thoracoacromial artery and lateral thoracic artery

part III (3 branches): lateral to pec minor–gives off subscapular artery, anterior and posterior humeral circumflex arteries

crosses teres major and becomes brachial artery

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9
Q

where does the subclavian artery become the axillary artery?

A

At the lateral edge (after) the 1st rib

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10
Q

Where does the brachial plexus become superficial?

A

At the distal end of clavicle

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11
Q

Where do the trunks of the brachial plexus lie?

A

On the anterior scalene muscles

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12
Q

What are the attachments to the greater tuberosity?

A

Superior facet: supraspinatus (s=s, super = supra) Middle facet: infraspinatus Inferior facet: teres minor

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13
Q

What is the attachment to the lesser tuberosity?

A

Subscapularis

sometimes some of supraspinatus according to 2009 JBJS paper 2009;91

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14
Q

How much of the trochlea is covered with articular cartilage? (how many degrees of the arc)

A

300 degree arc

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15
Q

Which direction is the distal humeral articulation of the elbow rotated in the axial plane? In the long (sagittal) plane? Varus/valgus (Coronal plane)?

A

Axial: 5-7deg IR Sagittal: 30deg anterior rotation 6-8deg valgus tilt

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16
Q

What is the column theory of the distal humerus?

A

3 column theory: - Medial, lateral, distal columns (like a spool in your fingers) - Medial column diverges from humeral shaft at 45 deg - Lateral column diverges from humeral shaft at 20 deg

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17
Q

What prevents AP displacement of the clavicle?

A

AC ligament

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18
Q

What ligaments are included in the sternoclavicular joint?

A

Anterior SC ligament

Posterior SC ligament

Interclavicular ligament

Costoclavicular ligament

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20
Q

What constitutes the conjoint tendon of the shoulder?

A

Coracobrachialis & Short head of biceps

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21
Q

Suprascapular notch; Compression here affects what?

A

Suprascapular nerve - Affects both supra and infraspinatus

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22
Q

What is a Buford complex?

A

Normal anatomical variant: Congenital absence of anterosuperior labrum with cord-like middle GH ligament - 2% of population - Normal variant

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23
Q

Stermocleidomastoid: OINA?

A

O: Mastoid I: sternal manubrium, 1/3 sternal end of clavicle N: Accessory nerve A: Head extension, lateral tilt, contralateral rotation

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24
Q

Trapezius: OINA

A

O: External occipital protuberance, superior nuchal line, SP C7-T12 I: Scapular spine, acromial 1/3 of clavicle N: Accessory nerve A: elevates shoulder girlde, rotate scapula

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25
Q

Rhomboids: OINA

A

O: - Major SP T2-5 - Minor SP C7-T1 I: Medial scapula I: Dorsal scapular nerve A: Scapular adduction and rotation

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26
Q

Levator Scapulae: OINA

A

O: TP C1-4 I: Superomedial scapula I: C3, C4 A; Scapular elevation and rotation

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27
Q

When does the clavicle ossify? when does it fuse?

A

ossify at 5 wks GA, fuse at 25yrs

clavicle is the first bone to ossify and last to fuse

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28
Q

4 extrinsic ligamentous attachments to the scapula?

2 intrinsic ligaments of the scapula?

A

extrinsic: CA, CH, conoid, trapezoid
intrinsic: superior and inferior transverse scapular ligaments

29
Q

17 muscular attachments to the scapula?

A

Supraspinatus

infraspinatus

teres minor

subscapularis

teres major

rhomboid major

rhomboid minor

trapezius

levator scapulae

pec minor

deltoid

latissimus dorsi

serratus anterior

biceps

coracobrachialis

omohyoid (inferior belly)

triceps long head

30
Q

spinoglenoid notch: bound by what ligament?

what structure passes through here? What muscle does it supply? distal to this point?

A

inferior transverse scapular ligament.

contains suprascapular nerve

supplies infraspinatus distal to the notch

31
Q

list all attachments to the coracoid

A

CA ligament

conoid

trapezoid

coracobrachialis

short head biceps

pec minor

32
Q

primary blood supply to the humeral head?

A

posterior humeral circumflex a.
from 2010 JBJS paper

classical teaching was the arcuate artery, from anterior humeral circumflex a., running along lateral side of bicipital groove

33
Q

shoulder joint: list the static and dynamic restraints

A

static: bony congruency, labrum, capsule, ligaments, negative pressure
dynamic: cuff, biceps,scapulothoracic movement

34
Q

boundaries of the rotator interval?

what are its contents?

A

triangular space on superoanterior shoulder bound by subscap, supraspinatus (and coracoid)

contains CHL, SGHL, biceps long head tendon, capsule

35
Q

SGHL resists what shoulder motion?

A

inferior translation, ER

36
Q

MGHL: restricts what shoulder movement?

most effective at what shoulder position?

A

limits ER, inferior translation, anterior translation

most effective at 45 degrees abduction

37
Q

IGHL: what are the two parts?

resists what shoulder motion?

most effective at what shoulder position?

A

anterior and posterior bands, i.e. AIGHL and PIGHL

AIGHL restricts anterior-inferior dislocation in 90 deg abduction and ER

PIGHL resists posterior-inferior dislocation in adduction and IR

38
Q

CHL: attachments?

restricts what shoulder motions?

A

from coracoid base to humerus anatomic neck superiorly

functions like SGHL: resists inferior translation and ER

39
Q

muscles joining upper limb to spine?

A

latissimus dorsi

rhomboid major

rhomboid minor

trapezius

levator scapulae

40
Q

muscles connecting upper limb to thoracic wall?

A

serratus anterior

subclavius

pec major

pec minor

41
Q

what muscles act on the glenohumeral joint?

A

deltoid

4 cuff muscles

teres major

42
Q

3 muscle insertions of the anterior proximal humeral shaft. proximally continuous with the bicipital groove.

from lateral to medial, what are they?

A

pec major (lateral bicipital groove), lat dorsi (floor of the groove), teres major (medial bicipital groove)

i.e. the “lady between 2 majors”

43
Q

what are the preclavicular branches of the brachial plexus?

what do they supply?

A

long thoracic nerve: serratus anterior

nerve to subclavius: subclavius

suprascapluar nerve: supraspinatus, infraspinatus

dorsal scapular nerve: rhomboids, levator scapulae

44
Q

posterior triangle of the neck: what are the boundaries?

what important structure lies here?

It emerges between which two muscles?

A

boundaries: sternocleidomastoid, clavicle, trapezius

contains brachial plexus which emerges between anterior and middle scalene muscles

45
Q

scapular winging:

which nerve affected? which muscles? what direction for each?

A

medial winging: long thoracic n, serratus anterior

lateral winging:

CN 11 (accessory n) - trapezius

OR

dorsal scapular nerve - rhomboids

46
Q

Erb’s palsy: what is it, what are the muscles involved, what is the position of the arm, and is prognosis good/moderate/poor?

A

upper trunk injury C5, C6. deltoid, rotator cuff, wrist extensors, elbow flexors

get waiter’s tip position with shoulder adducted, elbow extended, wrist flexed

good prognosis

47
Q

Klumpke’s palsy: what is it, what muscles involved, what arm position, and prognosis is good/moderate/bad?

A

lower trunk injury C8, T1

weakness of finger flexors, wrist flexors, hand intrinsics

wrist extended, fingers flexed/clawed (loss of hand intrinsics)

T1 involvement - can present with Horner’s syndrome

prognosis is moderate/poor

48
Q

total plexus palsy: what muscles affected, what arm position, and what is prognosis?

A

affects everything supplied by brachial plexus

flaccid arm

worst prognosis

49
Q

what is parsonage-turner syndrome?

A

brachial plexus neuritis

rare

sudden onset shoulder pain radiating to arm, with senosry and motor loss

commonly affects suprascapular nerve, long thoracic n, axillary n

self limited, prolonged recovery (1-2 yrs)

50
Q

Quadrangular space:

boundaries and contents

A

humerus, teres major, long head of triceps, teres minor

contains axillary nerve, posterior humeral circumflex artery

(QUAD space, 4 syllable nerve, 4-word artery)

51
Q

Triangular space: borders and contents

A

long head of triceps, teres major, teres minor

circumflex scapular artery

(TRI Space, 3-word artery with S in it)

52
Q

triangular interval: borders and contents

A

humerus, long head of triceps, teres major

radial nerve, profunda brachii artery

(TRIangular, 3-syllable nerve, 3-word artery with i in name)

53
Q

describe the path of the axillary nerve after it leaves the brachial plexus

A

runs anterior to subscap, 5cm distal to lateral acromion

passes through quadrangular space

wraps around surgical neck of humerus on underside of deltoid giving off 3 branches: anterior, posterior, articular branch

anterior branch wraps around surgical neck of humerus on undersurface of deltoid, supplying anterior deltoid

posterior branch supplies teres minor and posterior deltoid, then pierces the depe fascia and terminates as superior lateral cutaneous nerve of arm (seargent patch)

articular branch enters shoulder joint inferior to subscap

54
Q

describe the path of the radial nerve as it leaves the brachial plexus up to the elbow

A

arises from posterior cord, traveling along anterior surface of posetrior wall of axilla: on top of subscap, la dorsi, teres major

gives off 3 branches in axilla:

  1. posterior cutaneous nerve of arm, branch to long head of triceps, branch to medial head of triceps

goes through triangular INTERVAL (with profunda brachii a.) and wraps around humerus shaft in the “spiral groove” from medial to lateral, deep to triceps

in the groove, it gives off 3 branches: inferolateral cutaneous nerve of arm, posterior cutaneous nerve of forearm, lateral hhead of triceps, medial head of triceps+anconeus

exits groove around 14cm proximal to lateral epicondyle

pierces lateral intermuscular septum about 10cm proximal to trochlea surface (never less than 7.5cm)

enters anterior compartment between lateral IM septum and brachialis

emerges between BR and brachialis about 7.5cm proximal to trochlea, anterior to lateral epicondyle

branches here to lateral brachialis, BR, ECRL

stays deep to brachioradialis at elbow, divides into PIN and superficial branch…

(continued in elbow section)

55
Q

describe the path of the musculocutaneous nerve as it leaves the brachial plexus up to the elbow

A

arises from lateral cord

travels anteromedially on subscap (like the rest of the plexus branches)

pierces conjoint tendon 5-8cm distal to coracoid, from P-A

gives off branches to coracobrachialis (after piercing), then continues between brachialis and biceps

gives off branches to brachialis, biceps

pierces deep fascia lateral to distal biceps tendon and becomes terminal branch - lateral antebrachial cutaneous nerve, AKA lateral cutaneous nerve of the forearm

emerges at volar-lateral elbow between brachialis and biceps

56
Q

describe the path of the median nerve as it leaves the brachial plexus up to when it enters the elbow

A

emerges from plexus from both medial and lateral cords

travels anteromedial to humerus

travels LATERAL to brachial artery within anterior compartment

crosses over artery before the elbow and then runs MEDIAL to brachial a.

enters elbow medial to biceps, superficial to brachialis, and dives under lacertus, still MEDIAL to the artery

57
Q

describe the path of the ulnar nerve as it leaves the brachial plexus up to where it enters the elbow

A

emerges from medial cord

runs posterior-Medial to brachial artery in upper 1/2 of arm

it pierces medial IM septum and runs just posterior to it, deep to triceps at the arcade of struthers - 8cm from medial epicondyle

passes into cubital tunnel posterior to medial epicondyle and enters forearm between heads of FCU…

58
Q

where does the axillary artery become the brachial artery?

A

once it crosses the teres major

59
Q

OINA of Supraspinatus

A

O: Supraspinous fossa of scapula

I: Superior facet on greater tuberosity

N: Suprascapular nerve

A: adducts shoulder

60
Q

OINA Infraspinatus

A

O: Infraspinous fossa of scapula

I: Middle facet of GT

N: Suprascapular nerve

A: ER shoulder

61
Q

OINA of Subscapularis

A

O: Anterior wall of scapula

I: LT

N: Subscapular nerve

A: IR shoulder

62
Q

OINA Teres Minor

A

O: Lateral border of scapula

I: Inferior facet of GT

N: Axillary

A: ER shoulder

63
Q

OINA Deltoid

A

O: Distal clavicle, acromion, spine of scapula

I: Deltoid tuberosity of humerus

N: Axillary

A: Abducts shoulder, flexes and extends

64
Q

OINA Teres Major

A

O: Lateral border of scapula, inferior to teres minor

I: Medial lip of bicipital groove

N: Lower subscapular nerve

A: Adducts, IR shoudler

65
Q

OINA Latissimus Dorsi

A

O: Spinous processes of vertebrae T7-L5, thoracolumbar fascia, iliac crest, inferior 3 or 4 ribs and inferior angle of scapula

I: Floor of intertubercular groove

N: Thoracodorsal

A: Adducts, extends and IR shoulder

66
Q

OINA Triceps

A

Origin:

Long head: infraglenoid tubercle of scapula

Lateral head: Above radial sulcus

Medial head: Below radial sulcus

I: Olecranon

N: Radial

A: Extends elblwo

Long head also adducts arm

67
Q

draw the brachial plexus

A

see diagram

68
Q

What are the boundaries of the axilla?

A

Posterior wall - subscapularis and teres major

Anterior wall - pectoralis major/minor, subclavius, and clavipectoral fascia (this fascia encloses pec minor and subclavius. Below pec minor it forms the suspensory ligament of the axilla and attaches inferiorly to suspend the axillary fascia) page 39 lasts, plate 411

Medial wall - upper part of serratus anterior, the lower limit is the fourth rib

Anatomy (13 decks)

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