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Anatomy 2 > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

Sternoclavicular Joint

Intra articular disc

anterior sternoclavicular ligament
posterior sternoclavicular ligament

costoclavicularligament

A

Type:
Synovial Saddle Joint

Articular surfaces:

  • sternal (medial end of the clavicle): covered in FIBROCARTILAGE, CONVEX superior to inferior, and concave AP (anterior to posterior)
  • clavicular notch of the sternum: covered in HYALINE cartilage, reciprically CONCAVE superior to inferior and convex AP
  • clavicle moves on sternum = opposite spin roll and glide

Joint Capsule:
- fibrous capsule surrounding the entire joint
- attaching to margins of clavicle and sternum
relatively strong

Structures:
Intra articular disc
O: firmly attached to the upper border of the sternal end of the clavicle
I: costal cartilage of the 1st RIB
Function:
- improve congruency of the joint
- shock absorption/force dissipation
- stabilization of SC joint

Anterior/Posterior sternoclavicular ligament

  • O: medial clavicle (anterior and posterior)
  • I: runs obliquely downwards medially to the sternum
  • A: reinforces anterior and posterior aspect of joint capsule

Costoclavicular lligament (very strong)
O: inferior surface of medial clavicle (roughened area)
I: costal cartilage of 1st rib
A: limit elevation of clavicle and prevent excess anterior/posterior movement of medial end of clavicle
- therefore limits scapular elevation, protraction, and retraction

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2
Q

Acromioclavicular Joints

A

synovial plane joint

articular surface:

  • reciprocally shaped oval facets.
  • lateral end of clavicle = convex
  • anteromedial tip of the acromion process = concave
  • both covered in fibrocartilage

Joint capsule = loose fibrous capsule attaching to margins

Superior and Inferior acromioclavicular ligaments

coracoclavicular ligament:
Conoid: (posteromedial and fan shaped)
- O: elbow of coracoid process
- I: conoid tubercle on inferior aspect of clavicle
- A: resist forward movement (scapular protraction)

Trapezoid: (anterolateral and flat quadrilateral band)

  • O: superior surface of coracoid process
  • I: trapezoid line on inferior aspect of clavicle
  • A: resist backward movement (scapular retraction
  • both prevent upward displacement of the clavicle
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3
Q

SC Joint Elevation

A

clavicle rolls superiorly and glides inferiorly

ROM = 60 degrees total

Limited by: tension in costoclavicular ligament and subclavius

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4
Q

SC joint Depression

A

clavicle rolls inferiorly and glides superiorly

ROM = 60 (total elevation and depression)

Limited by: interclavicular ligament and intra articular disc

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5
Q

AC Joint elevation

A

acromion glides superiorly

ROM = up to 15 degrees

limited by: tension in coracoclavicular lig

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6
Q

AC joint depression

A

acromion glides inferiorly
ROM = up to 15

Limited by: coracoid process coming into contact with the under surface of the clavicle

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7
Q

SC joint protraction

A

clavicle glides posteriorly (axis of movement is the costoclavicular ligament)

ROm = 35 degrees

limited by: costoclavicular and posterior SC ligament

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8
Q

SC joint retraction

A

clavicle glides anteriorly

ROM = 35 degrees

limited by: costoclavicular and anterior SC ligament

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9
Q

AC joint protraction

A

acromion glides anteriorly??

ROM = minimal

limited by: posterior AC jiont capsule and conoid ligaments

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10
Q

AC joint retraction

A

acromion glides posteriorly

ROM = minimal

llimited by: anterior AC joint capsule and trapezoid ligament

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11
Q

SC joint scap lateral rotation

A

clavicle rolls superiorly and glides inferiorly

ROM = 60 degrees

limited by: costoclavicular ligament and subclavius

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12
Q

SC joint scap medial rotation

A

clavicle rolls inferiorly and glides superiorly

ROM = 60 degrees

limited by interclavicular ligament and intra articular disc

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13
Q

AC joint scap lateral rotation

A

acromion swings upwards and outwards in relation to clavicle

ROM = 30 degrees

limited by both parts of coracoclavicular ligament

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14
Q

AC joint scap medial rotation

A

acromion medially rotates back to original position

ROM = 30 degrees

limited by both parts of coracoclaviular ligament

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15
Q

Scapulohumeral rhythm

A

coordinated rhtym between scapula and humerus during shoulder flexion and abduction

initial 25-30 degrees of flexion/abduction from the GH joint alone, then scapular lateralrotation occurs in conjunction to permit full ROM

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16
Q

articular surfaces of the GHJ

A

Hemispherical head of the humerus

  • covered in hyaline cartilage
  • faces: medially, superiorly and posteriorly at appprox 30 degrees from frontal plane

Glenoid fossa of the scapula:

  • pear shaped and covered in hyaline cartilage
  • situated on lateral aspect of scapula
  • faces anterolaterally
  • poor congruency = 1:4 ratio with head of humerus

glenoid labrum

  • deepens the glenoid fossa
  • made of fibrocartilage
  • triangular in cross section
  • attached to articular margins of glenoid fossa
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17
Q

Bursa of the GHJ

A

subscapular bursa = extends through capsule anteirorly

infraspinatus bursa = extends through the capsule posteriorly

subacromial bursa = non communicating.
- separates coracoacromial arch and the deltoid from superolateral aspect of the shoulder joint??

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18
Q

Ligaments of the GHJ

A

superior glenohumeral
middle glenohumeral
inferior glenohumeral

coroacohumeral ligament
coracoacromial ligament
transversehumeral ligament

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19
Q

Superior glenohumeral Ligament ORIANS

A

O: upper part of the glenoid labrum
I : runs laterally to upper surface of lesser tubercle
A: anterior stability of GHJ

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20
Q

Middle glenohumeral ligament

A

O: below the superior glenohumeral ligamanet on glenoid labrum
I: anterior aspect of the lesser tubercle below subscapularis insertion
A: anterior stability of GHJ

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21
Q

Inferior Glenohumeral ligament

A

O: glenoid fossa
I: anteroinferior part of the anatomical neck of the humerus
A: anterior stability of GHJ

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22
Q

Coracohumeral ligament

A

O: lateral border of coracoid process
- divides at intertubercular groove

I: two tubercles of humeral head (greater and lesser)

A: prevent downwards displacement of the humerus

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23
Q

coracoacromial ligament

A

O: coracoid process
I: acromion process
A: prevents superior displacement of the humerus
- helps dissipate forces transmitted upwards through humerus

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24
Q

transverse humeral ligament

A

O: greater tubercle of humerus
I: lesser tubercle of humerus at upper end of bicipital groove
A: holds the long head of biceps in place
- bridges the gap between the two tubercles

25
Q

GHJ Flexion

A

spin and inferior glide?? (come back to this)

ROM = approx 180
- later 60 is made possible by scapular lateral rotaiton

limited by:
- extensors and posterior capsule

26
Q

GHJ extension

A

spin ???

ROM = approx 90
- last 20 degrees is made possible by medial rotation of the scapula

limited by:

  • contact of greater tubercle of the humerus with coracoacromial arch
  • anterior capsule
  • shoulder flexors
27
Q

abduction

A

ROm = 180
- last 60 is made possible by lateral rotation of scap (reduces contact between greater tubercle and coracoarcomial arch)

superior roll and inferior glide

limited by:

  • contact between greater tubercle and coracoacromial arch
  • tension in rotator cuff muscles and shoulder adductors
28
Q

adduction

A

ROM = 30 degrees
- accompanied by scapular rotation

infeiror roll and superior glide

limited by contact with the trunk

29
Q

lateral rotation

A

rom = 80 degrees

arm at side = posterior roll and anterior glide
arm at 90 = spin

limited by tension in medial rotators and anterior capsule

30
Q

medial rotation

A

rom = 100-110 (when the forearm is taken behind the trunk

arm at side = anterior roll and posterior glide
arm at 90 = spin

limited by lateral rotators and posterior capsule

31
Q

why is the GHJ inherently unstable

A

incongruency of joint surfaces
poor size ratio of articular surfaces
lax capsule
weak ligaments

32
Q

what improves the GHJ stability

A

glenoid labrum
long head of biceps tendon
rotator cuffs and larger overlying muscles

33
Q

Serratus Anterior

A

O: fleshy digitations from the upper 8-9 ribs and intercostal fascia
R: backwards
I: costal surface of the medial border of the scapula
A/: protract and laterally rotate the scapula
NS: long thoracic nerve C5-C7

Function: movements which drive the scapula forward
- stabilizer of scap during upper llimb movements

34
Q

Winged scapula

A

paralysis of serratus anterior
medial border of scapula stands away from the chest wall
limited lateral rotation of the scapula so arm cannot be abducted more than 90 degrees

35
Q

pectoralis minor

A

O: ribs 3-5 and intercostal fascia
R: superolaterally
I: upper surface and medial border of the acromion process via short flat tendon
A: medially rotate and depress the scapula
NS: medial pectoral nerve C8-T1

Function:
pull scapular down and forwards during pushing/punch
accessory muscle for inspiration

36
Q

subclavius

A

O: 1st rib and cartilage via short thick tendon, in front of costoclavicular ligament
R: obliquely up and laterally
I: subclavian groove on inferior surface of the clavicle
A: depression of the clavicle + reverse origin to elevate the 1st rib
NS: nerve to subclavius C4-C6

Function: stabilize clavicle during scapular movements

37
Q

Upper trapezius

A

O:
- medial 1/3rd of superior nuchal line and occipital bone
- ligamentum nuchae
- spinous processes of C7-T12
R: downwards and laterally
I: posterior lateral 1/3 of clavicle
A: elevation, lateral rotation, and retraction of scapula
NS:
motor = spinal part of cranial nerve XI (accessory nerve
sensory = ventral rami of C3,4

38
Q

middle trapezius

A

O:
- medial 1/3rd of superior nuchal line and occipital bone
- ligamentum nuchae
- spinous processes of C7-T12
R: horizontally
I: medial border of the acromion and upper border of the crest of the scapula spine
A: retraction of scapula
NS:
motor = spinal part of cranial nerve XI (accessory nerve)
sensory = ventral rami of C3,4

39
Q

lower trapezius

A

O:
- medial 1/3rd of superior nuchal line and occipital bone
- ligamentum nuchae
- spinous processes of C7-T12
R: up and laterally
I: inferior surface of medial end of the spine of scapula (via converged tendon)
A: depression, retraction and lateral rotation of scapula
NS: spinal part of cranial nerve Xi (accessory nerve)
and ventral rami of C3,4

40
Q

Rhomboid major

A

O: spinous processes of T2-T5 and supraspinous ligament
R: obliquely down and laterally
I: medial border of scapula between spine and inferior angle of scapula
A: retraction and medial rotation of scapula
NS: dorsal scapular nerve C5

Function = scapula stabilizer

41
Q

Rhomboid Minor

A

O: spinous processes of C7-T1 and supraspinous ligament
R: obliquely down and laterally
I: medial border of the scap at the level of the root of the spine of scapula
A: retraction and medial rotation of scapula
NS: dorsal scapular nerve C5

Function = scapula stabilizer

42
Q

levator scapulae

A

O: Transverse processes of C1-C4
R: down and laterally
I: medial border of the scapula between the superior angle and base of the spine of scape
A: scapular elevation, retraction and medial rotation
NS: dorsal scapular nerve C5

43
Q

Anterior Deltoid

A

O: anterior border of the lateral 1/3rd of the clavicle
R: obliquely down and posteriorly
I: deltoid tuberosity on the lateral side of the humerus via short thick tendon
A: flexion and medial rotation of the GHJ
NS: axillary nerve C5-C6

44
Q

Middle deltoid

A

O: lateral margin of the acromion process via 4 tendinous slips
R: downwards
I: deltoid tuberoisty via short thick tendon
A: abduction of the GHJ
NS: axillary nerve C5-C6

45
Q

Posterior Deltoid

A 
O: lower lip of the spine of the scapula
R: obliquely down and anterior
I: deltoid tuberosity via short thick tendon
A: extend and laterally rotate the GHJ
NS: axillary nerve C5-C6
46
Q

Function of the deltoid

A

middle fibres = main abductor after initation of supraspinatus

Resist downward displacement of the humerus

47
Q

Clavicular head of Pectoralis Major

A

O: medial 1/2 of the anterior surface of the clavicle

R: down and laterally

I: lateral lip of the intertubercular groove via flat tendon. covering the long head of the biceps tendon

A: flex the GHJ joint to 90 degrees, horizontally flex the GHJ, adduct GHJ, medially rotate the GHJ

NS: medial pectoral nerve (C8-T1) and lateral pectoral nerve (C5-C7)

48
Q

Sternal head of pectoralis major

A

O: body of manubrium and sternum, adjacent upper 6 ribs costal cartilages, and external oblique via aponeurosis

R: horizontal and superolaterally

I: intertubercular groove via flat tendon (covering long head of biceps tendon)
– also forms the posterior lamina which passes upwards and behind the anterior lamina to the upper part of the groove

A: extend the flexed arm (especially against resistance) back to the anatomical position
adduction
medial rotation

NS: medial pectoral nerve (C8-T1) and lateral pectoral nerve (C5-C8)

49
Q

corachobrachialis

A

O: apex of the coracoid process via rounded tendon

R: inferiorly and laterally

I: roughened area halfway down the medial side of the humeral shaft opposite to the deltoid tuberosity

A: adduction of GHJ + may assist flexion

NS: musculocutaneous nerve (C5-C7)

50
Q

latissimus dorsi

A

O: spinous processes T7-T12, all lumbar and sacral vertebra via thoracolumbar fascia, intervening suprapinous and interspinous ligaments, outer lip of posterior iliac crest

R: upwards and laterally

I: floor of the intertubercular groove via flat thin tendon
- en route, some fibres attach to the outer srface of the lower 3-4 ribs (Ribs 9-12) and inferior angle of the scapula

A: extensor of flexed arm, adductor of GHJ, medial rotator of GHJ

NS: thoracodorsal nerve (C6-8)

51
Q

Teres Major

A

O: dorsal surface of the inferior angle of scapula (below teres minor)

R: upwards, anteriorly and laterally

I: medial lip of the intertubercular groove (via broad flat tendon) + tendon is separated from lats by a bursa)

A: adducts GHJ, medially rotates and may assist with extension of flexed shoulder

NS: lower subscapular nerve (C5-C6)

52
Q

Rotator cuff muscles

A

supraspinatus, infraspinatus, teres minor, subscapularis

53
Q

Supraspinatus

A

O: medial 2-3rds of the supraspinous fossa
R: laterally
I: upper facet on the greater tubercle of the humerus
- tendon forms within the muscle as it passes laterally below trapezius, the acromion process, and the coracoacromial ligament
- tendon blends with the superior aspect of the GH capsule
A: initiates the first 20 degrees of abduction on GHJ
NS: suprascapular nerve (C4,C5,C6)

54
Q

Infraspinatus

A

O: medial 2/3rds of the infraspinous fossa
R: laterally and merge to a narrow tendon
I: middle facet on the greater tubercle of the humerus
A: lateral rotation of the GHJ
NS: suprascapular nerve (C4,5,6)

Function: stabilize the head of humerus in the glenoid during GHJ movements with other rotator cuff muscles

55
Q

Teres Minor

A

O: upper 2/3rds of the LATERAL BORDER of the SCAPULA
R: upwards and laterally
I: lowest facet on the greater tubercle of the humerus via narrow tendon which also reinforces the posterior part of the capsule
A: lateral rotation of the GHJ + adducts the abducted arm
NS: axillary nerve C5,6

Function: resist UPWARD displacement of head of humerus during active contraction of the deltoid

56
Q

Subscapularis

A

forms most of the posterior aspect of the axilla (lies behind serratus anterior)

O: medial 2/3rd of the sub scapular fossa

R: fibres wind around the head of humerus anteirorly

I: LESSER TUBERCLE of humerus via broad thick tendon (other 3 insert to Greater tubercle)

A: medially rotate the GHJ and adduct the GHJ

NS: upper and lower subscapular nerve (C4,5,6)

Function: hold the head of humerus in the glenoid fossa, resisting upwards displacement during active contraction of biceps, tricpes and deltoid

57
Q

The axilla

A

Apex: first rib, clavicle and scapula

Base = axillary fascia

Posterior = latissimus doris, teres major, subscapularis

median wall = serratus anterior

contents: brachial plexus, axillary artery and vein, axillary lymph nodes, and quantity of fat and loose areolar tissue

58
Q

The axillary nerve

A
  • arises from the ventral rami of C5, C6, the superior trunk, and the posterior cord
  • in the axilla, it passes posteriorly to the axillary artery and anterior to subscapularis
  • it passes close to the inferior aspect of the shoulder joint and through the quadrilateral space
  • it divides into anterior and posterior branches
    it then winds around the surgical neck of the humerus
motor = deltoid and teres minor
Sensory = skin on lateral aspect of the shoulder (via lateral cutaneous nerve of the arm)
59
Q

Quadrilateral space

A

formed by:

  • teres minor = superiorly
  • teres major = infeirorly
  • shaft of humerus = laterally
  • long head of triceps = medially
  • allows passage for axillary nerve and poseterior circumflex artery

Anatomy 2 (4 decks)

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