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Anatomy II Fall 2023 > Shoulder Region > Flashcards

Shoulder Region Flashcards

1
Q

Which bones make up the shoulder girdle?

A

manubrium (sternum), clavicle, scapula

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2
Q

Which joint connects the upper appendicular skeleton to the axial skeleton?

A
  • sternoclavicular joint
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3
Q

What are some important characteristics of the clavicle?

A
  • increases scapular ROM
  • subclavian groove for subclavius muscle
  • allows ribs to elevate during inspiration
  • transmits shock from UE to axial skeleton
  • NO medullary cavity
  • 2 curves: Medial (convex anteriorly) & lateral (concave anteriorly)
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4
Q

What are some important characteristics of the scapula?

A
  • lives from T2-T7
  • includes: spine, supraspinous fossa, infraspinous fossa, acromion, subscapular fossa
  • boards: medial, lateral, superior (suprascapular notch)
  • angles: superior, inferior, lateral (glenoid)
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5
Q

What are some important characteristics of the humerus?

A
  • 2 necks: anatomical & surgical
  • Greater (lateral) & Lesser (medial) tubercles; between these two runs the intertubercular groove (Bicipital groove)
  • deltoid tuberosity
  • radial groove
  • Medial/lateral epicondyle
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6
Q

What are the defining characteristics and ligaments of the sternoclavicular joint (SCJ)?

A
  • saddle shaped
  • connects axial & appendicular skeleton
  • synovial joint
  • articular discs
  • Ligaments: anterior and posterior SC, interclavicular, costoclavicular
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7
Q

What are the defining characteristics and ligaments of the acromioclavicular joint (ACJ)?

A

plane type joint, synovial joint w/ articular discs

Ligaments:
- acromioclavicular (supports superiorly),
- coracoclavicular: conoid, trapezoid

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8
Q

What are the defining characteristics and ligaments of the Glenohumeral Joint (GHJ)?

A
  • ball and socket
  • 1/3rd humeral head fits into glenoid
  • A LOT of mobility but not a lot of stability
  • capsule is synovial membrane forms sheath for biceps Long head tendon (attaches to labrum)
  • some ligaments embedded into capsule

-ligaments: coracohumeral, transverse humeral, coracoacromial

-bursa: subacromial, subdeltoid, subscapularis

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9
Q

Talk about the Brachial Plexus in terms of its roots, trunks, divisions, cords, and branches

A
  • 5 roots (C5-T1)
  • 3 trunks (Superior C5-C6, Middle C7, Inferior C8-T1)
  • 6 divisions (3 anterior, 3 posterior)
  • 3 cords [lateral (ant. superior & middle), medial (ant. inferior), posterior (post. superior, middle, inferior)
  • 5 branches (musculocutaneous, axillary, radial, median, ulnar)
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10
Q

What are the 5 branches of the brachial plexus and what nerve roots do they come from?

A
  • musculocutaneous: C5,6,7
  • Axillary: C5,6
  • Radial: C5,6,7,8, sometimes T1
  • Median: C6,7,8, sometimes T1
  • ulnar: sometimes C7,8,T1
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11
Q

What are the 5 nerve roots of the brachial plexus and what nerves branch off of them in order?

A
  • C5 -> nerve to longus colli & scalene -> contribution from C4 -> long thoracic nerve -> dorsal scapular nerve (C5) -> to phrenic nerve

-C6 -> nerve to longus colli & scalene -> long thoracic nerve

-C7 -> nerve to longus colli & scalene -> long thoracic nerve

-C8 -> nerve to longus colli & scalene

  • T1 -> contribution to T2 -> 1st intercostal nerve
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12
Q

What are the 3 trunks of the brachial plexus and what nerves branch off of them?

A

EACH TRUNK SPLITS INTO AN ANTERIOR AND POSTERIOR SECTION

  • superior -> subclavius nerve (C5,6) -> suprascapular nerve (C5,6)
  • middle -> N/A
  • inferior -> N/A
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13
Q

What are the 3 cords of the brachial plexus and how are they made up?

A
  • lateral: anterior superior and middle trunks
  • posterior: posterior superior, middle, and inferior trunks
  • medial: anterior inferior trunk
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14
Q

What nerves come off of the 3 cords of the brachial plexus?

A
  • lateral cord -> lateral pectoral nerve (C5,6,7) WITH communicating nerve to medial cord
  • posterior cord -> upper subscapular nerve (C5,6) -> Thoracodorsal (middle subscapular) nerve (C6,7,8) -> lower subscapular nerve (C5,6)
  • medial nerve -> COMMUNICATINGER NERVE w/ lateral cord & medial pectoral nerve (C8, T1) -> medial brachial cutaneous nerve (T1) -> medial antebrachial cutaneous nerve (C8,T1)
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14
Q

What cords do the terminal branches of the brachial plexus come from?

A
  • musculocutaneous: lateral cord
  • axillary: posterior cord
  • radial: posterior cord
  • median: lateral and medial cord
  • ulnar: medial cord
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15
Q

What muscles are responsible for flexion of the glenohumeral joint?

A
  • Pectoralis major (clavicular head)
  • deltoid (clavicular and anterior acromial parts)
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16
Q

What muscles are responsible for extension of the glenohumeral joint?

A
  • deltoid (spinal part)
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17
Q

What muscles are responsible for abduction of the glenohumeral joint?

A
  • deltoid (as a whole but really acromial part)
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18
Q

What muscles are responsible for adduction of the glenohumeral joint?

A
  • Pectoralis major
  • latissimus dorsi
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19
Q

What muscles are responsible for external rotation of the glenohumeral joint?

A
  • infraspinatus
  • teres minor
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20
Q

What muscles are responsible for internal rotation of the glenohumeral joint?

A
  • subscapularis
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21
Q

What are the different types of humeral fractures?

A
  • Impaction: 1 fragment driven into spongy bone of other fragment
  • Avulsion: piece of bone pulled away (usually greater tubercle)

Shaft:
- greenstick: one side is broke while the other side is bent
- transverse: straight across, deltoid pulls on something laterally
- spiral/oblique: any falls, wraps around the shaft
- Intercondylar: separates the medial/lateral condyles from the shaft

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22
Q

What nerve would be injured if there was an injury at the surgical neck of the humerus?

A

Axillary nerve

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23
Q

What nerve would be injured if there was an injury around the radial groove?

A

Radial nerve

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24
Q

What nerve would be injured if there was an injury at the distal humerus?

A

Median nerve

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25
Q

What nerve would be injured if there was an injury at the medial epicondyle?

A

Ulnar nerve

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26
Q

What structures are usually injured during an AC joint dislocation?

A
  • AC & coracoclavicular ligaments torn
  • shoulder separates
  • clavicle usually sticks out
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27
Q

What structures are usually injured during a GHJ dislocation (anteroinferior)?

A

Anterior dislocations
- tearing of the capsule

Inferior dislocations
- greater tubercle avulsion
- axillary nerve compression/injury

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28
Q

What is adhesive capsulitis?

A

“Frozen shoulder”
adhesive fibrosis & scarring b/w:
- capsule
- rotator cuff
- subacromial bursa
- deltoid

  • usually can’t abduct and results in “hiking” of the shoulder
29
Q

List the muscles in the anterior axio-appendicular group of the shoulder/arm

A
  • pectoralis major
  • subclavius
  • serratus anterior
30
Q

List the muscles in the posterior axio-appendicular group of the shoulder/arm

A

Superficial
- trapezius
- latissimus dorsi

Deep
- levator scapula
- Rhomboids

Scapulohumeral
- deltoid
- teres major
- rotator cuff

31
Q

List the muscles in the rotator cuff group of the shoulder/arm

A
  • Supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis
32
Q

List the muscles in the anterior compartment of the shoulder/arm

A
  • musculocutaneous nerve
  • flexors of elbow
  • Biceps Brachii
  • Brachialis
  • coracobrachialis
33
Q

List the muscles in the posterior compartment of the shoulder/arm

A
  • radial nerve
  • extensors of the elbow
  • Triceps
  • anconeus
34
Q

List the muscles that perform elevation of the scapula

A
  • TRAPEZIUS (descending part)
  • levator scapulae
  • rhomboids
35
Q

List the muscles that perform depression of the scapula

A
  • GRAVITY
  • pectoralis major (inferior sternocostal head
  • latissimus dorsi
  • trapezius (ascending part)
  • serratus anterior (inferior part)
  • pectoralis minor
36
Q

List the muscles that perform protraction of the scapula

A
  • SERRATUS ANTERIOR
  • pectoralis major
  • pectoralis minor
37
Q

List the muscles that perform retraction of the scapula

A
  • TRAPEZIUS (middle part)
  • rhomboids
  • latissimus dorsi
38
Q

List the muscles that perform upward rotation of the scapula

A
  • TRAPEZIUS (descending part)
  • SERRATUS ANTERIOR (inferior part)
  • trapezius (ascending part)
39
Q

List the muscles that perform downward rotation of the scapula

A
  • LATISSIMUS DORSI
  • levator scapulae
  • rhomboids
  • pectoralis minor
  • pectoralis major (inferior sternocostal head)
  • gravity
40
Q

Describe Bicipital tendonitis

A
  • acute inflammation of the Bicep long head tendon
  • movement within the intertubercular groove causes degeneration & inflammation
  • due to repetitive microtraumas
41
Q

Describe dislocation of the biceps long head

A
  • traumatic epiphyseal separation of humerus
  • tendon usually pops in and out of the groove
42
Q

Describe a rupture of the biceps long head

A
  • usually a pop or snap of the bicep tendon
  • can be from degeneration, forceful flexion against resistance or prolonged tendonitis that weakens the tendon
43
Q

What is calcific tendonitis?

A
  • calcium deposits in supraspinatus tendon from unusual or excessive use of the shoulder

Effects:
- increased pressure & pain during abduction (50-130 degrees is the pain arc)
- from supraspinatus contacts acromion & pain radiates to hand
- subacromial bursitis

44
Q

What is the “workhorse” of the arm?

A
  • brachialis
  • main elbow flexor
45
Q

Why is the bicep brachii considered a 3-joint muscle?

A
  • its actions include shoulder flexion, elbow flexion, and proximal radial-ulnar joint supination
  • long head attaches to the supraglenoid tubercle
  • short head attaches to the coracoid process
  • attaches to the radius distally
46
Q

When talking about the suprascapular notch, what nerve, ligament and artery is associated with this structure?

A

Superior transverse scapular ligament runs across the suprascapular notch

Suprascapular nerve runs UNDER the superior transverse scapular ligament

Suprascapular artery runs OVER the superior transverse scapular ligament

47
Q

What motor supply is cut off if the suprascapular nerve is compressed?

A
  • supraspinatus
  • infraspinatus
  • both will atrophy
48
Q

List the muscle groups supplied by the musculocutaneous branch of the brachial plexus

A

Sensory
- lateral forearm

Motor
- coracobrachialis
- biceps brachii
- brachialis

49
Q

List the muscle groups supplied by the axillary branch of the brachial plexus

A

Sensory
- superolateral shoulder

Motor
- deltoid
- teres minor

50
Q

List the muscle groups supplied by the radial branch of the brachial plexus

A

Sensory
- Upper: posterolateral arm
- Lower: posterior forearm, hand to proximal half of lateral digits

Motor
- Upper: triceps, anconeus
- Lower: posterior compartment muscles from brachioradialis to extensor indicis

51
Q

List the muscle groups supplied by the median branch of the brachial plexus

A

Sensory
- lateral palmar
- distal dorsal hand
- fingers to lateral 1/2 4th digit

Motor
- anterior compartment forearm muscles (except FCU & ulnar 1/2 of FDP)
- 5 thenar (thumb) muscles

52
Q

List the muscle groups supplied by the ulnar branch of the brachial plexus

A

Sensory
- medial palmar
- dorsal hand to medial 1/2 4th digit

Motor
- Flexor carpi ulnaris (FCU)
- ulnar 1/2 of flexor digitorum profundus (FDP)
- most hand intrinsics

53
Q

What is the definition of a myotome?

A
  • an unilateral embryological muscle mass innervated by a single cord segment/nerve
54
Q

List the nerve roots for the shoulder flexion myotome

A
  • C5
55
Q

List the nerve roots for the shoulder abduction myotome

A
  • C5
56
Q

List the nerve roots for the elbow flexion myotome

A
  • C5
    -C6 is MAIN
57
Q

List the nerve roots for the elbow extension myotome

A
  • C6
  • C7 is MAIN
58
Q

What is a peripheral nerve?

A
  • a named nerve that breaks off the brachial plexus and is more specific than a dermatome
59
Q

What is the roadmap of arteries from the aorta and ending at the elbow?

A

Aorta -> aortic arch -> subclavian -> Axillary artery (after clavicle) -> Brachial artery (inferior boarder of teres major)

Axillary artery:
1) superior thoracic artery (before pectoralis minor)
2) thoracoacromial artery & lateral thoracic artery (posterior to pectoralis minor)
3) subscapular artery, anterior circumflex humeral, posterior circumflex humeral

  • Subscapular artery -> circumflex scapular artery & thoracodorsal artery

Brachial artery:
1) profundus brachii -> middle/radial collateral
2) superior ulnar collateral
3) inferior ulnar collateral

60
Q

What is the road map of veins from the elbow and ending at the SVC?

A

dorsal venous network (hand) -> cephalic (lateral) & basilic (medial) vein -> Axillary vein (cephalic joins but basilic & brachial veins create it) -> subclavian vein -> brachiocephalic vein -> SVC

61
Q

What are the 5 groups of axillary nodes and where are they located?

A
  • pectoral (anterior): medial wall of axilla & medial boarder of pectoralis minor
  • subscapular (posterior): posterior axillary fold
  • humeral (lateral): lateral wall of axilla
  • central (deep): deep to pectoralis minor
  • apical (apex)
62
Q

What is the flow of lymph from the axilla?

A
  • pectoral & subscapular & humeral -> central -> apical -> suprascapular -> subclavian lymphatic trunk -> right lymphatic duct/ thoracic duct
63
Q

What are the effects if the long thoracic nerve is injured?

A
  • serratus anterior impaired
  • scapular winging
  • difficulty reaching overhead
64
Q

What are the effects if the thoracodosral nerve is injured?

A
  • latissimus dorsi
  • can’t raise trunk on fixed arms (climbing, can’t use axillary crutches)
65
Q

What are the effects if the dorsal scapular nerve is injured?

A
  • rhomboids & levator scapula
  • can’t retract, elevate, or downwardly rotate scapula
  • scapula sits further abducted from spine on affected side
66
Q

What are the effects if the axillary nerve is injured?

A
  • deltoid & teres minor atrophy and could see sulcus under acromion
  • loss of sensation in lateral deltoid
  • could be from improper use of crutches or anterior dislocation of humeral head
67
Q

What are the effects if the superior brachial plexus is injured?

A
  • C5-6 structures affected
  • “waiter’s tip”: arm adducted, internally rotated
  • “Erb’s Palsy”: arm adducted, internally rotated, elbow extended
  • could be from excessive angle b/w neck and shoulder and/or chronic microtrauma
68
Q

What are the effects if the cords of the brachial plexus is injured?

A
  • cords compressed b/w coracoid coracoid & pectoralis minor
  • pain radiates down arm, paresthesia, hand weakness
  • could be due to excessive hyperabduction
69
Q

What are the effects if the inferior brachial plexus is injured?

A
  • C8 and T1 structures affected
  • hand muscles are affected
  • could be from a sudden superior pull on arm
70
Q

What are the 3 areas of compression for Thoracic Outlet Syndrome?

A
  • scalenes
  • clavicle
  • pectoralis minor

Symptoms:
- UE paresthesia
- arm feels heavy
- cold to touch or blanching of skin distally from arterial compression

Anatomy II Fall 2023 (11 decks)

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