Shoulder joint (398-410)

Question 1

What muscles are responsible for flexion of the shoulder?;

Answer 1

Anterior fibres of deltoid (most important), pectoralis major and coracobrachilis.

Question 2

Which muscles are responsible for extension of the shoulder?;

Answer 2

Posterior fibres of deltoid (most important), latissmus dorsi, teres major.

Question 3

Which muscles are responsible for internal and external rotations of the shoulder?;

Answer 3

Internal rotation- subscapularis. External rotation- infraspinatus & tere minor.

Question 4

What is the blood supply to the shoulder joint?;

Answer 4

Branches of axillary artery - anterior and posterior circumflex humeral arteries. Contributions from suprascapular artery (branch of the thyrocervical trunk)

Question 5

What is the nerve supply to the shoulder joint?;

Answer 5

Sensory- axillary and suprascapular nerves

Question 6

Describe the levels of axillary lymph nodes;

Answer 6

Axillary lymph nodes (level 1-3)
[Level 1- below pectoralis minor]
[Level 2- underneath/posterior to pectoralsis minor]
[Level 3- above/medial to pectoralis minor]

Question 7

Name the structures that can be damaged during axillary node clearance surgery;

Answer 7

Nerves- intercoastalbrachial nerve (sensation to lateral chest, medial arm and axilla - most commonly injured as superficial), thoracodorsal nerve, long thoracic nerve (winged scapula). Lateral thoracic artery and vein

Question 8

Name the branches of the axillary artery;

Answer 8

1st part (proximal to pectoralis minor)- superior thoracic artery.
2nd part (posterior to pectoralis minor) - thoracoacrominal artery, lateral thoracic artery.
3rd part (distal to pectoralsis minor)- subscapular artery, anterior circumflex artery, posterior circumflex artery.

Becomes brachial artery once passes teres major.

(Screw The Lawyer Save A Patient)

Question 9

Name the structures that pass (pierce) through the clavipectoral fascia;

Answer 9

Cephalic vein, Lateral pectoral nerve, Thoraco-acrominal artery, lymphatics (clavipectoral fascia lies below pectoralis major- fills space between clavicle and pectoralis minor)

Question 10

Name the muscles that attach to the medial and lateral lips of the intertubercular groove (bicipital groove) of the humerus;

Answer 10

Teres major- medial lip. Latissimus dorsi attaches in between. Pectoralis major- lateral lip. A LADY BETWEEN TWO MAJORS.

Question 11

Which nerves are susceptible to injury following a fracture of the humerus at different levels?:

Answer 11

Surgical neck- axillary nerve injury.
Spiral groove (shaft of humerus)- radial nerve injury.
Supracondylar area- median nerve injury.
Medial epicondyle- ulnar nerve injury.

(A R M)
Axillary (upper 1/3rd) Radial (middle 1/3rd) Median (lower 1/3rd)

Question 12

What would be the signs and symptoms in a patient with axillary nerve injury?:

Answer 12

Sensory- regimental badge area numbness. Motor- unable to abduct shoulder beyond 30 degrees (deltoid affected). Weakness in flexion and extension of shoulder (deltoid affected). Weakness in external rotation (teres minor affected)

Question 13

Describe how injury to the radial nerve at different levels of the arm (above the elbow) presents clinically;

Answer 13

In axilla: Motor- triceps and muscles in posterior compartment affected, unabke to extend forearm, wrist and finers, wrist drop. Sensory- loss sensation lateral and posterior arm, posterior forearm and dorsal surface lateral three and a half digits.

In radial groove: Motor- tricpes mauy be weakened but not paralysed, posterior compartment muscles affected. Sensory- cutaneous branches to arm and forearm already arisen but there will be sensory loss to dorsal surface of lateral three and half digits. In forearm- depends which branch affected (superficial [sensory] or deep [motor]). Upper arm sparred.