test 2 Flashcards
__________ and ___________ move as an unit.
scapula, clavicle
______________
articulation with sternum is only bony link to axial skeleton
clavicle’s
bony landmarks of shoulder girdle
Manubrium Clavicle
Coracoid process Acromion process Glenoid fossa Lateral border Inferior angle Medial border
__________moves on the rib cage
scapula
joint motion occurs at ___________ __________ and to lesser at the acrimioclavicular joint
strenoclavicular joint
- (multiaxial) arthrodial classification
- Movements
- anteriorly 15 degrees with protraction
- posteriorly 15 – degrees with retraction
- superiorly 45 degrees with elevation
- inferiorly 5 degrees with depression
strenoclavicular joint (SC)
Ligamentous support
- anteriorly by the anterior SC ligament
- posteriorly by the posterior SC ligament
- costoclavicular & interclavicular ligaments provide stability against superior displacement
strnoclavicular joint (SC)
- arthrodial classification
- 20 to 30 degree total gliding and rotational motion accompanying other shoulder girdle and shoulder joint motions.
- supported by
- coracoclavicular ligaments
- Superior acromioclavicular ligament
- inferior acroioclavicular ligament
- often injured
Acromioclavicular
- not a true synovial joint
- does not have a regular synovial features
- movement depends on SC & AC joints which allow the scapula to move
- 25 deg. abduction-adduction
- 60 deg. upward- downward rotation
- 55 deg. elevation-depression
- supported dynamically by its muscles
- no ligamnetous support
scapulathoracic
shoulder girdle movements=
scapula movements
scapula moves laterally away from spinal column
Abduction (protraction)
scapula moves toward spinal column
Adduction (retraction)
–returning inferior angle
inferomedially toward spinal column & glenoid fossa to normal position
Downward rotation
turning glenoid fossa upward & moving inferior angle superolaterally away from spinal column
Upward Rotation
downward or inferior movement as in, returning to normal position
Dpression
upward or superior movement , as in shrugging shoulders
Elevation
•________ _____ & _______ ______
together in carrying out upper extremity activities
shoulder joint and shoulder girdle
•Shoulder _____ movement is not dependent upon the shoulder joint & its muscles
girdle
- Stablize scapula so the shoulder joint muscles will have a stable base from which to exert force for moving the humerus–Contract to maintain scapula in a relatively
static position during shoulder joint actions–Contract to move shoulder girdle and to enhance movement of upper extremity when shoulder goes through extreme ranges of motion
Shoulder girdle muscles
For some shoulder girdle movements, scapula must rotate or ___ on ___ ____
tilt on its axis
–during abduction
–scapula rotates about its vertical axis resulting in posterior movement of medial border & anterior movement of lateral border
lateral tilt (outward tilt)
–during extreme adduction
–scapula rotates about its vertical axis resulting in anterior movement of medial border & posterior movement of lateral border
Medial Tilt ( return from lateral tilt, inward tilt)
rotational movement of scapula about frontal axis occurring
during glenohumeral hyperextension
–superior border moving anteroinferiorly & inferior angle
moving posterosuperiorly
Anterior tilt (upward tilt)
rotational movement of scapula about frontal axis occurring
during glenohumeral hyperflexion
–superior border moving posteroinferiorly & inferior angle
moving anterosuperiorly
posterior tilt
Without the accompanying scapula movement humerus can aproximately __ degrees of total shoulder abduction & _______
90 degrees : flexion
– as _____ _____ goes through more extreme ranges of motion, scapular muscles contract to move shoulder girdle so that its _____ ______will be in a more appropriate position from which the humerus can move
shoulder joint; glenoid fossa
5 muscles involved in shoulder girdle movements
- trapezius (upper, middle, lower)
- Rhomboid (deep)
- Levator scapula
- serratus anterior
- pectoralis minor (deep)
- abduction & upward rotation
- Posterior & Laterally
Serratus Anterior
abduction, downward rotation & depression
-Subclavian depression
Pectoralis minor
–Upper fibers: elevation & extension of the head
–Middle fibers elevation
adduction & upper rotation
–Lower fibers: Adduction,
depression & upper rotation
trapezius (upper, middle, lower)
adduction, downward rotation, elevation
rhomboid (deep)
shoulder girdle muscle responsible for elevation
Levator Scapulae
Shoulder girdle muscles primarilyinnervated by _______ & _______ plexus
cervical, brachial
Branches of C3 & C4
trapezius, Levator Scapula
Spinal Accesory Nerve
Trapezius
Dorsal scapula nerve, levator scapula, rhomboid
C5
Long thoracic nerve originating from __, __, __
- Serratus Anterior
C5, c6, C7
Medial Pectoral nerve originating from __ & __
-Pec. Minor
C8, T1
Upper fibers: elevation of scapula, extension & rotation of head
Middle fibers: elevation, upward rotation & adduction
Lower fibers: depression, adduction & upward rotation
trapezius muscle
Elevates the medial margin of the scapula
Levator Scapulae muscle
_______ _____ & ________ ________
muscles work together
Adduction (retraction): draw scapula toward spinal column
Rhomboid major & minor
Downward rotation: from upward rotated position they draw scapula in downward rotation
Elevation: slight upward movement accompanying adduction
Rhomboid muscles (major & minor)
Abduction (protraction): draws medial border of scapula away from vertebrae
Upward rotation: longer, lower fibers tend to draw inferior angle of scapula farther away from vertebrae, thus rotating scapula upward slightly
Serratus Anterior muscle
Abduction (protraction): draws scapula forward & tends to tilt lower border away from ribs
Downward rotation: as it abducts, it draws scapula downward
Depression: when scapula is rotated upward, it assists in depression
Pectoralis MInor muscle
Stabilization & protection of sternoclavicular joint
Depression
Abduction
subclavious muscle
-Lifting scapula without rotation in anatomic position
- shoulder shrug
Agonist: levator scapulae, upper trapezius, rhomboid
scapula Elevation
EX. Dip
Agonist: lower trap, pectoralis minor
Scapula Depression
scapula move laterally away from spinous processes without rotation.
EX. Push-up & bench press
Agonist: pectoralis minor, Searratus anterior
scapula abduction
-return from abduction
-occurs with retractions
Agonist: middle trapezius, rhomboids
Scapula Adduction
- Downward & Medial Movement
- Glenoid Fossa is rotated downward when downward mivement of shoulder joint occurs.
- Ex. Lat Pulls pulling weight down.
- Agonist: Pec. Minor, Rhomboid
Scapula Downward Rotation
lateral & upward movement
agonist: middle trapezius, lower trapezius, serratus anterior
Scapula Upward Rotation
Shoulder joint is attached to axial skeleton via the ________ at SC Joint
clavicle
scapula movement usually occurs with movement of -_______
humerus
Humeral flexion & abduction require scapula ______ , rotation upward & _________
elevation
abduction
Humeral _______ & ______ results in scapula depression rotation downward and adduction
adduction& extension
Scapula _______ occurs with humeral internal rotation & horizontal adduction
abduction
Scapula _______ occurs with humeral external rotation & horizontal abduction
adduction
Wide range of motion of the _____ _______in many different planes requires a significant amount of laxity
shoulder joint
common instabilty problems with shoulder joint
ROTATOR CUFF IMPINGEMENT
SUBLOXATIONS & DISLOCATIONS
The price of mobility is _______ _________
reduced stability
The more mobile a joint is, the less stable it is, and the more stable it the _____ _______
less mobile
_______, _________, ________ serve as attachments for shoulder joint muscles
Scapula, Clavicle, & Humerus
HUMERAL LANDMARKS
HEAD, GREATER TUBERICLE, LESSER TUBERICLE, INTERTUBERCULAR TUBE, DELTOID TUBEROSITY
glenohumeral joint is what type of joint?
multiaxial, ball and socket, and earthrodial
gleenoid labrum slightly enhances _______
stability
glenohumeral ligamnet provide ________
stabilty
especially anteriorly & inferiorly
inferior glenohumeral ligament
Ligaments are quite lax until extreme ______ __ ______ reached due to wide range of motion involved
ranges of motion
stabilty is scarificed to gain ________
mobility
(glenohumeral Joint)
Determining exact range of each movement is difficult due to accompanying ________ _________ movement
shoulder girdle
glenohumeral joint has __ to__ degrees of abduction
__ degrees adduction
__ degrees anterior to trunk
90-95degrees
0 degrees adduction
75 degrees to trunk
glenhumeral joint
__ to __ degrees of extension
__ to ___ degrees of flexion
40-60 degrees ext.
90-100 degrees flex.
__ to __ degrees of internal and external rotation
70-90degrees
Glenohumeral joint is Frequently injured due to anatomical design and…….
- shallowness of glenoid fossa
- laxity of ligamentous structures
- lack of strength & endurance in muscles
- anterior or anteroinferior glenohumeral subluxations & dislocations -common
- posterior dislocations- rare
- posteror instability problems somewhat common
GIRD
GLENOHUMERAL INTERNAL ROTATION DEFICIT (GIRD)
overhead athletes with GIRD of greater __% had a higher risk of injury
20%
stretching exercise recommended to regain _______ ________
internal rotation
4 rotator cuff muscles
supraspinatus: attaches to greater tubericle from above (abduct)
infraspinatus: attches to greater tubericle (ext. rot.)
Teres Minor: attaches to greater tubericle posteriorly
Subscapularis:attach to lesser tubericle anterior (int. rot.)
glenohumeral flexion
Agonist:
anterior deltoid, upper pectoralis major
glenohumeral extension agonist
TERES MAJOR, LAT. DORSI, LOWER PECTORALIS MAJOR
GLENOHUMERAL ABDUCTION AGONIST:
DELTOID, SUPRASPIINATUS UPPER PECTORALIS MAJOR
GLENOHUMERAL ADDUCTION:
EX. LAT PULL DOWN
AGONIST:
-LatissimusDorsi
–Teres Major
– Pectoralis Major
GLENOHUMERAL INTERNAL ROTATION
AGONIST:
–Latissimus Dorsi, Teres Major, Subscapularis, Pectoralis Major
ALL ATTACH ANTEROMEDUIALLY ON HUMERUS
Glenohumeral External Rotation
Agonists
BOTH ATTACH POSTERIORLY ON GREATER TUBERICLE
Infraspinatus Teres Minor
GLENOHUMERAL HORIZONTAL ABDUCTION
AGONIST:
POSTERIOR DELTOID, MIDDLE DELTOID, INFRASPINATUS, TERES MINOR.
GLENIHUMERAL HORIZONTAL ADDUCTION
AGONIST
ANTERIOR DETOID, PEC. MAJOR, CORACOBRACHIALIS
GLENOHUMERAL DIAGONAL ABDUCTION
AGONIST:
POSTERIOR DELTOID, INFRASPINATUS, TERES MINOR, TRICEPS BRACHII (LONG HEAD)
GLENOHUMERAL DIAGONAL ADDUCTION
AGONIST (LOW AND HIGH)
ANT. DELTOID, CORACOBRACHIALIS, BICEPS BRACHII (SHORT HEAD), PEC. MAJOR UPPER AND LOWER.
______ _____ movements may be clearly distinguished from those of the radioulnar joints
ELBOW JOINT
_________ ________ movements may be distinguished from those of the wrist
Radioulnar joint
ULNA IS MUCH LARGER _______ THAN RADIUS
PROXIMALLY
RADIUS IS MUCH LARGER _______ THAN ULNA
DISTALLY
________ & _________ SERVE AS
proximal attachments for muscles that flex & extend the elbow
SCAPULA & HUMERUS
ULNA AND RADIUS SERVE AS ______ ATTACHEMENTS FOR THESE SAME MUSCLES
DISTAL
______ &________ &_____ SERVE AS
proximal attachments for muscles that pronate & supinate the radioulnar joints
SCAPULA, HUMERUS,ULNA
Key bony landmarks for wrist & hand muscles
lateral epicondyle, LATERAL supracondylar ridge, MEDIAL EPICONDYLE
GINGLYMUS OR HINGE TYPE JOINTS ALLOW 2 KINDS OF MOVEMENT
FLEXION AND EXTENSION
2 INTERRELATED GINGLYMUS JOINTS
HUMEROULNAR JOINT, RADIOULNAR JOINTS
ELBOW MOTIONS
Primarily involve movement between articular surfaces of humerus & ulna
–specifically humeral trochlear fitting into ulna trochlear notch
–radial head has a relatively small amount of contact with capitulum of humerus
–As elbow reaches full extension, olecranon process is received by olecranon fossa •increased joint stability when fully extended
As elbow flexes__ degrees or more, its bony stability is unlocked, allowing for more side-to-side laxity
20 DEGREES
______ __ ______ is more dependent on the lateral (radial collateral ligament) & the medial or (ulnar collateral ligament)
Stability in flexion
________ ______ _______ is critical in providing medial support to prevent elbow from abducting when stressed in physical activity
Ulnar collateral ligament
Many contact sports & throwing activities place stress on ______ _____of joint, resulting in injury
medial aspect
particularly crucial to high-velocity sporting activities requiring optimal medial elbow stability like baseball pitching
ulnar collateral ligament
UCL surgical reconstruction using a tendon graft such as palmaris longus tendon
Tommy John procedure
ligament provides lateral stability & is rarely injured
RADIAL COLLATERAL LIGAMENT
provides a sling effect around radial head for stability
ANNULAR LIGAMENT
Elbow moves from __ degrees of extension to ___ - ___ degrees of flexion
0,
145 to 150
Joint between shafts of radius & ulna held tightly together between proximal & distal articulations by an interosseus membrane (syndesmosis)
RADIOULNAR JOINT
As the radioulnar joint goes through its ROM, glenohumeral & elbow muscles ______ to ______ or assist in the effectiveness of movement at the radioulnar joints
contract, stabilize
when tightening a screw with a screwdriver which involves ________ _________, we tend to externally rotate & flex the glenohumeral & elbow joints, respectfully
radioulnar supination
Conversely, when loosening a tight screw with _______, we tend to internally rotate & extend the elbow & glenohumeral joints, respectfully
pronation
we depend on both the ______ & ______ in the surrounding joints to assist in an appropriate amount of stabilization & assistance with the required task
agonists & antagonists
movement of forearm to shoulder by bending the elbow to decrease its angle
FLEXION
movement of forearm away from shoulder by straightening the elbow to increase its angle
EXTENSION
Internal rotary movement of radius on ulna that results in hand moving from palm-up to palm-down position
PRONATION
external rotary movement of radius on ulna that results in hand moving from palm-down to palm-up position
SUPINATION
ELBOW FLEXORS
–Biceps brachii
–Brachialis
–Brachioradialis
–Weak assistance from Pronator teres
ELBOW EXTENSOR
–Triceps brachii
–Anconeus provides assistance
Radioulnar pronators –
–Pronator teres
–Pronator quadratus
–Brachioradialis
RADIOULNAR SUPINATORS
–Biceps brachii
–Supinator muscle
–Brachioradialis
-common problem usually involving extensor digitorum muscle near its origin on lateral epicondyle
–known lateral epicondylitis
–associated with gripping & lifting activities
“Tennis elbow”
–somewhat less common
–known as golfer’s elbow
–associated with medial wrist flexor & pronator group near their origin on medial epicondyle
–Both conditions involve muscles which cross elbow but act primarily on wrist & hand
MEDIAL EPICONDYLITIS
ANTERIOR
Primarily flexion & pronation
- Biceps brachii
- Brachialis
- Brachioradialis
- Pronator teres
- Pronatorquadratus
- Triceps brachii
- Anconeus
- Supinator
PRIMARILY EXTENSION & SUPINATION (POSTERIOR)
ALL _____ & ______ JOINTS MUSCLES ARE INNERVATED from median, musculotaneous, & radial nerves of brachial plexus
ELBOW AND RADIOULNAR
RADIAL NERVE ORIGINATES FROM
- TRICEPS BRACHII
- BRACHIORADIALIS
- SUPINATOR
- ANCONEUS
- SENSATION TO POSTEOLATERAL ARM, FOREarm, &hand
C5, C6,C7, & C8
MEDIAN NERVE ___ & __DERIVED FROM
- pronator teres
- pronator quadratus
- sensation to palmar aspect of radial side of fourth finger dorsal aspect of index & long fingers
C6 & C7
MUSCULATANEOUS NERVE BRANCHES FROM__ & ____
- biceps brachii
- brachialis
C5 & C6
Long head: extension of shoulder joint; adduction of shoulder joint; horizontal abduction All heads: extension of elbow
triceps brachii muscle
extension of elbow
anconeus muscle
- pronation of forearm
- weak flexion of elbow
pronator teres muscle
pronation of forearm
pronator quadratus muscle
supination of forearm
- lateral surface of proximal radius just below head
- neighbring posterior part of ulna
supinator muscle
agoinst muscles in elbow flexion (curl)
biceps brachii, brachialis, brachiradialis
agonist muscles in elbow extension (push-up)
triceps brachii, anconeus
agonist muscles in radioulnar pronation
pronator teres, pronator quadratus, brachioradialis