Shoulder Region Flashcards
1
Q
Which bones make up the shoulder girdle?
A
manubrium (sternum), clavicle, scapula
2
Q
Which joint connects the upper appendicular skeleton to the axial skeleton?
A
- sternoclavicular joint
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)
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)
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
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
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
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
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)
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
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
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
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
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)
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
15
Q
What muscles are responsible for flexion of the glenohumeral joint?
A
- Pectoralis major (clavicular head)
- deltoid (clavicular and anterior acromial parts)
16
Q
What muscles are responsible for extension of the glenohumeral joint?
A
- deltoid (spinal part)
17
Q
What muscles are responsible for abduction of the glenohumeral joint?
A
- deltoid (as a whole but really acromial part)
18
Q
What muscles are responsible for adduction of the glenohumeral joint?
A
- Pectoralis major
- latissimus dorsi
19
Q
What muscles are responsible for external rotation of the glenohumeral joint?
A
- infraspinatus
- teres minor
20
Q
What muscles are responsible for internal rotation of the glenohumeral joint?
A
- subscapularis
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
22
Q
What nerve would be injured if there was an injury at the surgical neck of the humerus?
A
Axillary nerve
23
Q
What nerve would be injured if there was an injury around the radial groove?
A
Radial nerve
24
What nerve would be injured if there was an injury at the distal humerus?
Median nerve
25
What nerve would be injured if there was an injury at the medial epicondyle?
Ulnar nerve
26
What structures are usually injured during an AC joint dislocation?
- AC & coracoclavicular ligaments torn
- shoulder separates
- clavicle usually sticks out
27
What structures are usually injured during a GHJ dislocation (anteroinferior)?
Anterior dislocations
- tearing of the capsule
Inferior dislocations
- greater tubercle avulsion
- axillary nerve compression/injury
28
What is adhesive capsulitis?
"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
List the muscles in the anterior axio-appendicular group of the shoulder/arm
- pectoralis major
- subclavius
- serratus anterior
30
List the muscles in the posterior axio-appendicular group of the shoulder/arm
Superficial
- trapezius
- latissimus dorsi
Deep
- levator scapula
- Rhomboids
Scapulohumeral
- deltoid
- teres major
- rotator cuff
31
List the muscles in the rotator cuff group of the shoulder/arm
- Supraspinatus
- infraspinatus
- teres minor
- subscapularis
32
List the muscles in the anterior compartment of the shoulder/arm
- musculocutaneous nerve
- flexors of elbow
- Biceps Brachii
- Brachialis
- coracobrachialis
33
List the muscles in the posterior compartment of the shoulder/arm
- radial nerve
- extensors of the elbow
- Triceps
- anconeus
34
List the muscles that perform elevation of the scapula
- TRAPEZIUS (descending part)
- levator scapulae
- rhomboids
35
List the muscles that perform depression of the scapula
- GRAVITY
- pectoralis major (inferior sternocostal head
- latissimus dorsi
- trapezius (ascending part)
- serratus anterior (inferior part)
- pectoralis minor
36
List the muscles that perform protraction of the scapula
- SERRATUS ANTERIOR
- pectoralis major
- pectoralis minor
37
List the muscles that perform retraction of the scapula
- TRAPEZIUS (middle part)
- rhomboids
- latissimus dorsi
38
List the muscles that perform upward rotation of the scapula
- TRAPEZIUS (descending part)
- SERRATUS ANTERIOR (inferior part)
- trapezius (ascending part)
39
List the muscles that perform downward rotation of the scapula
- LATISSIMUS DORSI
- levator scapulae
- rhomboids
- pectoralis minor
- pectoralis major (inferior sternocostal head)
- gravity
40
Describe Bicipital tendonitis
- acute inflammation of the Bicep long head tendon
- movement within the intertubercular groove causes degeneration & inflammation
- due to repetitive microtraumas
41
Describe dislocation of the biceps long head
- traumatic epiphyseal separation of humerus
- tendon usually pops in and out of the groove
42
Describe a rupture of the biceps long head
- 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
What is calcific tendonitis?
- 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
What is the "workhorse" of the arm?
- brachialis
- main elbow flexor
45
Why is the bicep brachii considered a 3-joint muscle?
- 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
When talking about the suprascapular notch, what nerve, ligament and artery is associated with this structure?
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
What motor supply is cut off if the suprascapular nerve is compressed?
- supraspinatus
- infraspinatus
- both will atrophy
48
List the muscle groups supplied by the musculocutaneous branch of the brachial plexus
Sensory
- lateral forearm
Motor
- coracobrachialis
- biceps brachii
- brachialis
49
List the muscle groups supplied by the axillary branch of the brachial plexus
Sensory
- superolateral shoulder
Motor
- deltoid
- teres minor
50
List the muscle groups supplied by the radial branch of the brachial plexus
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
List the muscle groups supplied by the median branch of the brachial plexus
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
List the muscle groups supplied by the ulnar branch of the brachial plexus
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
What is the definition of a myotome?
- an unilateral embryological muscle mass innervated by a single cord segment/nerve
54
List the nerve roots for the shoulder flexion myotome
- C5
55
List the nerve roots for the shoulder abduction myotome
- C5
56
List the nerve roots for the elbow flexion myotome
- C5
-C6 is MAIN
57
List the nerve roots for the elbow extension myotome
- C6
- C7 is MAIN
58
What is a peripheral nerve?
- a named nerve that breaks off the brachial plexus and is more specific than a dermatome
59
What is the roadmap of arteries from the aorta and ending at the elbow?
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
What is the road map of veins from the elbow and ending at the SVC?
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
What are the 5 groups of axillary nodes and where are they located?
- 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
What is the flow of lymph from the axilla?
- pectoral & subscapular & humeral -> central -> apical -> suprascapular -> subclavian lymphatic trunk -> right lymphatic duct/ thoracic duct
63
What are the effects if the long thoracic nerve is injured?
- serratus anterior impaired
- scapular winging
- difficulty reaching overhead
64
What are the effects if the thoracodosral nerve is injured?
- latissimus dorsi
- can't raise trunk on fixed arms (climbing, can't use axillary crutches)
65
What are the effects if the dorsal scapular nerve is injured?
- rhomboids & levator scapula
- can't retract, elevate, or downwardly rotate scapula
- scapula sits further abducted from spine on affected side
66
What are the effects if the axillary nerve is injured?
- 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
What are the effects if the superior brachial plexus is injured?
- 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
What are the effects if the cords of the brachial plexus is injured?
- cords compressed b/w coracoid coracoid & pectoralis minor
- pain radiates down arm, paresthesia, hand weakness
- could be due to excessive hyperabduction
69
What are the effects if the inferior brachial plexus is injured?
- C8 and T1 structures affected
- hand muscles are affected
- could be from a sudden superior pull on arm
70
What are the 3 areas of compression for Thoracic Outlet Syndrome?
- scalenes
- clavicle
- pectoralis minor
Symptoms:
- UE paresthesia
- arm feels heavy
- cold to touch or blanching of skin distally from arterial compression
