Superficial Back, Shoulder and Upper Arm Flashcards
the upper limb
-Characterized by its mobility and its ability to conduct fine motor skill –> by having so much mobility we sacrifice stability
-Stability sacrificed to gain mobility
-Stability through boney structures,
ligaments and muscles
-Hand function and position dependent on ability to place it in the proper position by movements at the shoulder, elbow, and wrist joints
what are the major segments of the upper limb
-shoulder, pectoral region, arm, forearm and hand
shoulder regions
-pectoral (ant.) region
-scapular (post.) region
-deltoid (lat.) region
what joint has the most mobility in the body
the shoulder
what bones are included with the shoulder?
-clavicle
-scapula
-proximal and body of the humerus
-other boney structures
the clavicle
-collarbone
-connects upper limb to the trunk
articulations of the clavicle
-manubrium (creates the SC joint –> hold everything to the axial skeleton –> very strong)
-acromion (makes the AC joint)
surfaces and landmarks of the clavicle
-sternal end (more knob like)
-acromial end (flatter)
-superior surface
-inferior surface (conoid tubercle, trapezoid line, subclavian groove)
-anterior surface
-posterior surface
scapula
-shoulder blade
-triangular flat bone that lies on the posterolateral aspect of the thorax
scapula articulations
-clavicle (AC joint)
-Humerus (glenohumeral joint (shoulder joint))
injuries including the scapula
-shoulder separation (happens at the AC joint)
-shoulder dislocation (happens at the GH joint)
surfaces and landmarks of the scapula
-anterior surface
-posterior surface
-borders
-angles
-glenoid cavity
-coracoid process
-suprascapular notch
anterior surface of the scapula
-costal surfaces
-subscapular fossa
posterior surface of the scapula
-spine
-acromion
-supraspinatus fossa
-infraspinatus fossa
borders of the scapula
-medial
-lateral
-superior
angles of the scapula
medial, lateral, superior
glenoid cavity of the scapula
-supraglenoid tubercle
-infraglenoid tubercle
humerus
-proximal and body is apart of the upper arm region
-largest bone of the upper limb
articulations of the humerus (upper)
scapular –> GH joint
surfaces and landmarks of the humerus (upper)
• Head
• Anatomical neck
• Greater tubercle
• Lesser tubercle
• Bicipital groove
• Surgical neck
• Anterior border
• Medial border
• Lateral border
• Anteromedial surface
• Anterolateral surface
• Deltoid tuberosity
• Posterior surface
• Radial groove
head of the humerus
articulation with the scapula
anatomical neck of the humerus
holds the head of the humerus up
bicipital groove of the humerus
in b/w the tubercles
surgical neck of the humerus
common site for fractures
radial groove of the humerus
-if a fracture happens here, there could be damage to the nerve –> injury to the muscles the radial nerve innervates
other boney structures of the upper region
-occipital bone
-vertabrae
-nuchal ligament
-ilium
the occiptal bone in the upper region
-back of the head
-external occipital protuberance
-superior nuchal line (on both sides lateral of the external occipital protuberance)
vertebrae in relation to the upper region
-body
-pedicles (holds up laminae)
-laminae (comes together to make the spinous process)
-transverse processes
-articular processes
-spinous processes (sticks out posteriorly, cervical spine –> bifid)
-vertebral foramen/canal (individually –> foramen, multiple vertebrae –> canal)
-vertebral notches (individually: superior and inferior notches, multiple together: intervertebral foramen in which the spinal nerves come through)
nuchal ligament of the upper region
a triangular membrane that forms a median fibrous spetum b/w the muscles of the 2 sides of the neck
ilium as a part of the upper region
-largest part of the hip bone
-iliac crest (in line with L4 spinous process)
trapezius muscle
-provides a direct attachment of the pectoral girdle to the trunk
-3 parts (descending, transverse and ascending)
-parts are labeled on how the fibers run
-superficial
origin of the descending part of the trapezius muscle
O: occipital bone and spinous process C1-C7
insertion of the descending part of the trapezius
I: clavicle (lateral 1/3)
innervation of the trapezius muscle
spinal accessory nerve (cranial nerve 11)
action of the descending part of the trapezius
A: draws scapula obliquely upward, rotates glenoid cavity superiorly, tilts the head to the side sides, rotates the head to the opposite side
origin of the transverse part of the trapezius
O: aponeurosis at T1-T4 spinous process
insertion of the transverse part of the trapezius
I: acromion
action of the transverse part of the trapezius
A: draws scapula medially
origin of the ascending part of the trapezius
O: spinous process of T5-T12
insertion of the ascending part of the transverse process
I: scapular spine
action of the ascending part of the trapezius
A: draws scapula medially downward
latissimus dorsi
-widest muscle in the back
-4 parts (vertebral part, scapular part, costal part, iliac part)
-superficial
origin of the vertebral part of the latissimus dorsi
O: spinous process of T7-T12
origin of the scapular part of the latissimus dorsi
O: inferior angle of the scapula
origin of the costal part of the latissimus dorsi
O: ribs 9-12
origin of the iliac part of the latissimus dorsi
O: iliac crest (posterior 1/3)
insertion of latissimus dorsi
I: floor of the intertubercular groove of the humerus
innervation of the latissimus dorsi
thoracodorsal nerve (C6-C8)
actions of the latissimus dorsi
A: IR, ADD, EXT, respiration (cough muscle)
origin of the levator scapulae
O: transverse processes of C1-C4
insertion of the levator scapulae
I: scapula (superior angle, medial border, b/w the superior angle and the superior portion of the spine)
innervation of the levator scapulae
dorsal scapular nerve (C4-C5)
actions of the levator scapulae
A: draws scap medially upward, move the inferior angle medially, inclines neck to the same side
origin of rhomboid minor
O: spinous process of C6-C7
insertion of rhomboid minor
I: posterior medial border of scap at level with the scap spine
innervation of the rhomboid minor
dorsal scapular nerve (C4-C5)
action of the rhomboid minor
A: steadies scapula, draws scap medially upward, retracts the scap and tilts the glenoid cavity inferiorly
origin of the rhomboid major
O: spinous processes T1-T4 vertebrae
insertion of rhomboid major
I: medial border of the scap below the scap spine
innervation of the rhomboid major
dorsal scapular nerve (C4-C5)
action of the rhomboid major
A: steadies scapula, draws scapula medially upward
deltoid muscle
-thick, powerful, coarse-textured muscle covering the shoulder
-3 parts (clavicular, acromial, spinal)
origin of the clavicular part of the deltoid muscle
(anterior part)
O: lateral 1/3 of the clavicle
origin of the acromial part of the deltoid
O: acromion
origin of the spinal part of the deltoid
O: scapular spine
insertion of the deltoid
I: deltoid tuberosity of the humerus
innervation of the deltoid
axillary nerves (C5-C6)
actions of the clavicular part of the deltoid
A: Flexion, IR and ADD
actions of the acromial part of the deltoid
A: ABD
actions of the spinal part of the deltoid
A: extension, ER, ADD
origin of the teres major
O: inferior angle of the scap
insertion of the teres major
I: medial lip of the intertubercular sulcus of humerus
innervation of teres major
lower subscapular nerve (C5-C7)
action of teres major
A: IR, ADD, EXT
what are the rotator cuff muscles
-subscapularis
-supraspinatus
-infraspinatus
-teres minor
which RC muscle is most commonly torn and why
-supraspinatus
-repetitive bad mechanics
origin of supraspinatus
O: supraspinous fossa of the scap
insertion of the supraspinatus
I:greater tuberosity of the humerus
innervation of the supraspinatus
suprascapular nerve (C4-C6)
action of the supraspinatus
A: ABD (first 30 degrees)
(only muscle that does not contribute to rotation)
origin of infraspinatus
O: infraspinous fossa of scap
insertion of infraspinatus
I; greater tuberosity of humerus
innervation of infraspinatus
suprascapular nerve (C4-C6)
actions of infraspinatus
A: ER
origin of teres minor
O:lateral border of scap
insertion of teres minor
I: greater tuberosity of the humerus
innervation of teres minor
axillary nerve (C5-C6)
actions of teres minor
A: ER, weak ADD
origin of subscapularis
O: subscapular fossa of scapula
insertion of subscapularis
I: lesser tuberosity of humerus
innervation of subscapularis
upper and lower subscapular nerves (C5,C6)
actions of subscapularis
A: IR
what is the deep (thoracolumbar) fascia
-extensive facial complex attached to the vertebral column
-think and strong in the lumbar region
-attached to the latissimus dorsi
arteries of the upper region
subclavian artery –> thyrocervical trunk –> suprascapular –>
-travels with suprascapular nerve
-found in the scapular notch
-supplies supraspinatus and infraspinatus
Dorsal scapular –> deep branch
-supplies the rhomboids
nerves of the upper region
cranial nerve 11 –> spinal accessory nerve
-motor innervation to the trapezius muscle
what are the spaces of the upper region
quadrangular space and triangular space
quadrangular space of the upper region
-boundaries (superior, medial, inferior, lateral)
-contents (axillary nerve and posterior circumflex humeral artery)
what is the superior boundary of the quadrangular space
teres minor
what is the medial boundary of the quadrangular space
long head of triceps
what is the inferior boundary of the quadrangular space
teres major
what is the lateral boundary of the quadrangular space
lateral head of the triceps (or humerus)
triangular space
-boundaries (superior, inferior, lateral)
-contents (circumflex scapular artery)
what is the superior boundary of the triangular space
teres minor
what is the inferior boundary space of the triangular space
teres major
what is the lateral boundary of the triangular space
long head of triceps
superior transverse scapular ligament
suprascapular artery
-over the ligament (ARMY goes over the bridge)
suprascapular nerve
-goes under the ligament (NAVY goes under the bridge)
inferior transverse scapular ligament
dorsal scapular artery and nerve go under the ligament
what is the pectoral region
-external to the anterior thoracic wall
-anchors the upper limb to the trunk
what does the pectoral region consist of
a superficial and deep compartment
superficial compartment of the pectoral region
contains the skin, superficial fascia and breasts
deep compartment of the pectoral region
muscles and associates structures
what do the breasts consist of
-consist of glandular and supporting fibrous tissue embedded w/in a fatty matrix
what is the most prominent superficial structure in the anterior thoracic wall
-breasts
-especially in women
what are the external factors of the breast
-areola
-nipple
what is the areola
-contains numerus sebaceous glands
what are sebaceous glands
enlarge during pregnancy and secrete oily substance that provides a protective lubricant
what is the nipple
-conical or cylindrical prominences in the centers of the areolae
-composed mostly of circulatory arranged smooth muscle fibers
what is the internal composition of the breast
-glandular tissue
-connective tissue framework
glandular tissue of the breast
-the lactiferous ducts give rise to buds that develop into 15-20 lobules of the mammary gland
-constituted the parenchyma (functional
substance) of the mammary gland
connective tissue framework of the breast
-suspensory ligaments –> fibrous connective tissue that helps support the lobes and lobules of the mammary gland
where is the sternum
lies in the anterior midline of the thorax
parts of the sternum
-manubrium
-body
-xyphoid process
manubrium
-on the sternum
-“knife handle”
-superior section (“knot of necktie”)
-2 articulations –> manubriosternal joint and the sternal angle
body of the sternum
-midportion
-makes up the bulk of the sternum
-articulations (2) –> sternoclavicular joints and the clavicular notch (really strong joint)
xyphoid process
-on the sternum
-“sword like”
-forms the inferior end of the sternum
what articulation of the sternum is related to the ribs
sternocostal joints (articulation)
landmarks of the sternum
-jugular notch
-sternal angle
-epigastric fossa (either side of the xiphoid process)
describe the ribs
-12 pairs of ribs
-form the sides of the thoracic cage
-all ribs attach to the thoracic vertebrae
-run anterioinferiorly to reach the front of the chest
what are the true ribs
-ribs 1-7
-attach directly to the sternum
-vertebrosternal
what are the false ribs
-ribs 8-10
-have the costal cartilage but attach to rib 7 (indirectly attach to sternum)
what are the floating ribs
-ribs 11-12
-no anterior connections to the sternum
surfaces and landmarks of the ribs
-shaft/body
-costal groove
-head of rib
-neck of the rib
-tubercle
costal groove of the rib
-inner face of the rib
-intercostal nerves and vessels run in this groove
what does the 1st rib have a groove for
subclavian artery and vein
how does the head of the rib articulate with vertebral bodies
-2 facets –> super and inferior costal facets
neck of the rib
-short
-constricted region
-just lateral to the head
costal tubercle
-knoblike
-articulates w/ transverse process of thoracic vertebrae of the same number
how many parts does the pec major have
-3 parts (clavicular, sternocostal, abdominal)
origin of the clavicular part of the pec major
clavicle (medial half)
origin of the sternocostal part of the pec major
O: sternum and costal cartilage of ribs 1-6
origin of the abdominal part of the pec major
O: rectus sheath (anterior layer)
insertion of the pec major
I: lateral border of crest of the bicipital groove
innervation of pec major
medial and lateral pectoral nerves (C5-T1)
actions of the pec major
A: shoulder ADD and IR
-clavicular and sternocostal parts –> shoulder flexion and assist in respiration when the shoulder is fixed
pectoralis minor
-directly beneath pec major
-flat and thin
origin pec minor
O: ribs 3-5 near costal cartilage
insertion pec minor
I: coracoid process
innervation of pec minor
medial pectoral nerve (C6-T1)
actions of pec minor
A: draws scap downward (inferior angle moves posteromedially), rotates glenoid inferiorly, assists in respiration
subclavius
-small cylindrical muscle extending from the first rib to the clavicle
origin of subclavian
O: first rib
insertion of subclavian
I: inferior surface of the clavicle
innervation of subclavian
nerve to subclavius (C5,C6)
action of subclavian
A: steadies the clavicle in the SC joint
serratus anterior
-fan shaped
-lies deep to scap (underneath)
-deep and inferior to pec muscles on lateral rib cage
-3 action points (superior, inferior, entire muscle)
origin of the serratus anterior
O: 1st to 9th ribs
insertion of the serratus anterior
I: costal aspect of the medial border of the scap
innervation of serratus anterior
long thoracic nerve (C5-C7)
actions of the serratus anterior
-superior part –> lowers the arm
-inferior part –> rotates scapula laterally
-entire muscle –> draws scap laterally forward and elevates the ribs when the shoulder is fixed
what is scapular winging
-weakness of the serratus anterior
-injury to the long thoracic nerve
-cannot ABD arm above the horizontal place
deep fascias of the pectoral region
-pectoral fascia
-clavipectoral fascia
pectoral fascia
-deep fascia of the pectoral region
-invests the pec major
-continuous inferiorly with the fascia of the anterior abdominal wall
clavipectoral fascia
-Deep fascia of the pectoral region
-deep to the pectoral fascia
-descends from the clavicle, enclosing the subclavius and pec minor –> becoming continuous inferiorly with the axillary fascia
arteries of the pectoral region
axillary
veins of the pectoral region
cephalic and axillary vein
nerves of the pectoral region
-supraclavicular
-anterior cutaneous branches ventral rami (C5)
-intercostal nerves (T2-T12)
spaces of the pectoral region
deltopectoral triangle
deltopectoral triangle boundaries
-superior –> clavicle
-medial –> pec major
-lateral –> deltoid
contents of the deltopectoral triangle
-cephalic vein
-deltoid branch of the thoracoacromial trunk
