Unit 2 Exam. Flashcards
What group of muscles cover the upper part of the anterior thoracic region and spread posteriorly to cover most of the posterior thoracic region?
shoulder muscles
The shoulder muscles are divided into three distinct groups based on what?
where they originate and insert
Where do the groups of shoulder muscles originate?
vertebral column or skull, thoracic wall, and scapula
Where do the groups of shoulder muscles insert?
shoulder girdle and humerus
What muscles originate on the vertebral column or skull?
trapezius, rhomboid major, rhomboid minor, levator scapula, and latissimus dorsi
What muscle is a large muscle which covers the posterior cervical and thoracic region?
trapezius
What muscle is named because the right and left muscles form a four sided figure known as a trapezoid?
trapezius
Where does the trapezius originate?
external occipital protuberance (EOP),
superior nuchal line,
ligamentous nuchae,
spines of the thoracic vertebrae C7 to T12.
Where does the trapezius insert?
clavicle,
acromion process and spine of the scapula
What are the three actions of the trapezius?
stabilizes the scapula (holds it in normal anatomical position),
upper portion elevates the scapula, and
middle and lower portions adduct (retractions) the scapula
What is the motor nerve supply to the trapezius?
spinal accessory nerve (CN XI)
What is the sensory nerve supply to the trapezius?
C3 and C4
What condition shows a deepening of the shoulder on the affected side?
trapezius palsy
C3 and C4
A weakness of the trapezius muscle, shoulder drops on effected side. Seen with damage to cranial nerve XI and Whiplash injuries
Trapezius Palsy
C3 and C4
What condition shows a shoulder drop on the affected side?
Trapezius Palsy
C3 and C4
What muscle is frequently involved in neck injuries during auto accidents and what is that injury called?
superior portion of the trapezius and a whiplash injury
C3 and C4
The clinical examination to test for the __ cranial nerve is to ask the patient to elevate their shoulders (shrug) against resistance and both sides should be tested at the same, so weakness of one side can be evaluated relative to the other side.
XI (spinal accessory nerve)
What muscle is a flat, thin muscle which is rhomboid in shape and lies deep to the trapezius?
rhomboid major
What is the origin of the rhomboid major?
spine/upper thoracic vertebrae
What is the insertion of the rhomboid major?
vertebral border of the scapula
What muscle lies superior and parallel to the rhomboid major, with which it is sometimes fused?
rhomboid minor
Is the rhomboid major superior to the rhomboid minor?
no its inferior
Is the rhomboid minor superior to the rhomboid major?
yes
What is the origin of the rhomboid minor?
spines/lower cervicals and first thoracic vertebrae
What is the insertion of the rhomboid minor?
vertebral border/scapula
What is a muscle found on the side of the neck, deep to the superior portion of the trapezius?
levator scapula
What is the origin of the levator scapula?
transverse processes/upper cervical vertebrae
What is the insertion of the levator scapula?
superior angle/scapula
What are the three actions of the rhomboids and levator scapula?
elevates, adducts, and stabilizes the scapula
What is the nerve supply to rhomboid major?
dorsal scapular nerve (C5)
What is the nerve supply to rhomboid minor?
dorsal scapular nerve (C5)
What is the nerve supply to levator scapula?
dorsal scapular nerve (C5)
What three muscles of the neck are supplied by the dorsal scapular nerve (C5)?
rhomboid major, rhomboid minor, and levator scapula
Difficulty in completely adducting the scapula is a sign of damage to what nerve?
dorsal scapular nerve and/or C5
A scapula on an affected side further from the midline is a sign of damage to what nerve?
dorsal scapular nerve and/or C5
What muscle is a large, flat muscle which is found over the lower posterior thoracic and lumbar region?
latissimus dorsi
What is the widest muscle of the back region?
latissimus dorsi
What muscle’s tendon of insertion, along with that of teres major, helps to form the posterior fold or border of the axilla?
latissimus dorsi
What is the origin of the latissimus dorsi?
spines/lower thoracic and lumbar vertebrae,
thoracodorsal fascia,
crest/illium, and lower ribs
What is the insertion of the latissimus dorsi?
intertubercular groove (lesser tubercle)/humerus
What are the actions of the latissimus dorsi?
extends,
adducts,
and
medially rotates the humerus and is involved with forced expiration
What is the nerve supply to the latissimus dorsi?
thoracodorsal (C6, C7, and C8)
Forward displacement of the shoulder is a sign of damage to what muscle?
latissimus dorsi
What is a depression found at the lower portion of the latissimus dorsi?
lumbar triangle
What is bounded by the latissimus dorsi, crest of the ilium, and the external oblique muscle?
lumbar triangle
What is the lumbar triangle bounded by?
latissimus dorsi, crest of the ilium, and the external oblique muscle
What is the clinical significance of the lumbar triangle?
a hernia of the posterior abdominal wall may develop here
What is a depression found at the superior border of the latissimus dorsi (medial to the inferior angle of the scapula)?
triangle of auscultation
What is bounded by the latissimus dorsi, trapezius, and vertebral border of the scapula?
triangle of auscultation
What is the triangle of auscultation bounded by?
latissimus dorsi, trapezius, and vertebral border of the scapula
Why is the triangle of auscultation clinically significant?
the relatively thin layer of tissue here allows lung sounds to be easily heard with a stethoscope
How can the triangle of auscultation be enlarged?
abducting the scapula (folding the person’s arms across the his or her chest)
What muscle is a broad muscular sheet, which passes posteriorly around the thoracic cage from an extensive costal attachmnet to a more limited attachment on the scapula?
serratus anterior
What muscle’s anterior portion lies immediately beneath the skin, just below the axilla and can be easily seen in muscular individuals, especially when they abduct their scapula against resistance?
serratus anterior
What is the origin of the serratus anterior?
upper ribs
8 or 9.
What is the insertion of the serratus anterior?
vertebral border/scapula
What are the actions of the serratus anterior?
abducts the scapula (prime mover), stabilizes the scapula, and is involved with forced respiration (but only when the humerus is abducted)
What is the nerve supply to the serratus anterior?
long thoracic (C5, C6, and C7)
Common Side for posterior abdominal hernia.
Lumbar Triangle
Bounded by: Latissimus Dorsi, Crest illium, external Oblique muscle
Lumbar Triangle
Relatively thin layer of tissue, allows lung sounds to be easily heard.
Triangle of ossification
Bounded by:Latissimus Dorsi, crest illuim, external Oblique of scapula.
Triangle of ossification
What is the condition in which the serratus anterior muscle is weakened due to damage to the long thoracic nerve or C5, C6, and C7?
long thoracic nerve palsy (winged scapula)
What is the most important clinical sign for winging of the scapula?
patient will have difficulty keeping the vertebral border and inferior angle of the scapula against the posterior thoracic wall when carrying out abduction against resistance
Patients who experience difficulty in abducting their scapula and thus have problems in raising the extremity over their head show signs of what condition?
long thoracic nerve palsy (winged scapula)
What is a symptom of long thoracic nerve palsy?
patients may or may not develop pain around the shoulder region
What are the causes of long thoracic nerve palsy?
trauma/subluxation (affecting C5, C6, and C7), traction injuries involving the shoulder joint,
Surgical Procedures, example removal of breast tumors to procedures.
What are the 6 scapular muscles?
deltoid, supraspinatus, infraspinatus, subscapularis, teres major, and teres minor
Weakening of the serratus anterior muscle, causing the scapula to protrude of the chest wall.
Long Thoracic nerve Palsy
May be due to traction of the long thoracic nerve
Long thoracic nerve palsy.
What are the 6 scapular muscles?
deltoid, supraspinatus, infraspinatus, subscapularis,
teres major,
and
teres minor
What muscles are a part of the subgroup of scapular shoulder muscles known as the rotator cuff muscles?
supraspinatus, infraspinatus, subscapularis, and teres minor
What are the two criteria that allows a muscle to be part of the rotator cuff group?
its tendon of insertion must contribute to forming a cuff around the proximal part of the humerus and they participate in either lateral or medial rotation of the humerus
What muscle is a large, complex muscle which is named for its resemblance to the greek letter delta (∆)?
deltoid
How many portions is the deltoid divided into?
3
What muscle is a common site for intramuscular injections?
deltoid
What are the origins of the deltoid?
clavicle (anterior portion), acromion process (middle portion), and spine of scapula (posterior portion)
What is the insertion of the deltoid?
deltoid tuberosity/humerus
What is the origin of the anterior portion of the deltoid?
clavicle
What is the origin of the middle portion of the deltoid?
acromion process/scapula
What is the origin of the posterior portion of the deltoid?
spine of scapula
What are the actions of the anterior deltoid?
anterior portion flexes and medially rotates the humerus,
What are the actions of the middle deltoid?
middle portion abducts the humerus,
What are the actions of the Posterior deltoid?
the posterior portion extends and laterally rotates the humerus
What is the nerve supply to the deltoid?
axillary nerve (C5 and C6)
what nerve damage is atrophy of the deltoid (crutch paralysis) an indication of?
axillary nerve
What condition is fracture of the surgical neck of the humerus (injury to nerve may be immediate or occur during healing) a common cause of?
atrophy of the deltoid (crutch paralysis)
What condition is dislocation of the shoulder joint a common cause of?
atrophy of the deltoid (crutch paralysis)
What condition is pressure of a crutch in the axilla a common cause of?
atrophy of the deltoid (crutch paralysis)
What condition gives the shoulder a flattened appearance, since the rounded contours of the shoulder disappear?
atrophy of the deltoid (crutch paralysis)
What condition will loss of sensation over the lateral aspect of the arm occur and why?
What condition will loss of sensation over the lateral aspect of the arm occur and why?
In what condition is abduction of the arm greatly impaired?
atrophy of the deltoid (crutch paralysis),
What muscle occupies the supraspinatus fossa and is deep to the trapezius?
supraspinatus
What muscle’s tendon of insertion passes under the acromion process and over the top of the shoulder to reach its insertion on the humerus?
supraspinatus
What muscle’s tendon of insertion is separated from the acromion process by the subacromial and subdeltoid bursa?
supraspinatus
What is the origin of the supraspinatus?
supraspinatus fossa/scapula
What is the insertion of the supraspinatus?
greater tuberosity/humerus
What are the actions of the supraspinatus?
initiates abduction of the humerus, laterally rotates the humerus, and stabilizies the shoulder joint
What is required to be deemed a “shoulder joint staibilizer?”
the muscle must insert to the proximal part of the humerus
What is the nerve supply to the supraspinatus?
suprascapular (C5 and C6)
What condition is an irritation and inflammation of the supraspinatus tendon?
rotator cuff tendonitis
What is one of the most common causes of shoulder pain?
rotator cuff tendonitis
What is shoulder impingement syndrome another term for?
rotator cuff tendonitis
What is another term for rotator cuff tendonitis?
shoulder impingement syndrome
What kind of pain is experienced in rotator cuff tendonitis (shoulder impingement syndrome) and where is it?
sharp or aching and usually occurs in the anterior and/or lateral aspect of the shoulder
At first, rotator cuff tendonitis may feel like a “______” in the ________ area, but can progress to pain ______ and _____ activity.
twinge; shoulder; during; after
In what condition does shoulder movement feel weaker than normal, and may even notice a hot or burning feeling in the shoulder area?
rotator cuff tendonitis
What are the 5 common causes of rotator cuff tendonitis?
genetic (being born with a “hooked” acromion process)
weakness around the rotator cuff (which causes the humerus to ride up and compress the tendons of the cuff)
excess stress and repetition (most common cause in athletic individuals),
trauma/injury,
calcium deposits in the tendon (common in the elderly)
What condition is associated with being born with a “hooked” acromion process?
rotator cuff tendonitis
What is the most common cause of rotator cuff tendonitis in athletic individuals?
excess stress and repetition
What is the most common cause of rotator cuff tendonitis in elderly?
calcium deposits
What condition occurs if the tendon of the supraspinatus is weakened by a combination of multifactorial conditions (age, repeated episodes of trauma, steroid injection, etc.)?
rotator cuff tears
What part of the supraspinatus’ tendon usually ruptures in rotator cuff tears?
near its insertion
________ rotator cuff tears in _____ individuals are almost always from a single traumatic injury (i.e. a shoulder dislocation).
complete; young
How can rotator cuff tears occur over the age of 50?
with only minor trauma
What is the main difference in symptoms of rotator cuff tendonitis and rotator cuff tears?
with a significant tear, patients will have difficulty carrying out abduction of the arm
What test is used to evaluate a patient that one suspects of having a rotator cuff tear?
drop test
What is the drop test?
with this test the patient is asked to lower the fully abducted limb slowly, and the limb will drop suddenly to the patient’s side in an uncontrolled manner if the tendon is torn
What are the bursas involved in shoulder bursitis?
subdeltoid and subacromial
What condition may actually be more common than rotator cuff tendonitis, but may be difficult to distinguish the two?
bursitis
Inflammation of supraspinatus tendon, causes pain in anterior and or lateral aspect of shoulder and arm.
Rotator Cuff tendonitis
AKA shoulder impingement syndrome. Due to an overuse injury or Ca++ deposit within tendons
Rotator Cuff tendonitis
Rupture of a rotator cuff tendon at or near its insertion?
Rotator Cuff Tear
Symptoms similar to tendonitis but with difficulty Abducting the arm.
Rotator Cuff Tear
Evaluates rotator cuff tears. Patient slowly lowers a fully abducted arm, the arm suddenly drops with difficulty due to dysfunction of the supraspinatus.
Drop Test
Inflammation of deltoid and or sub acromial bursae. More common that rotator Cuff Tendonitis.
Bursitis
What muscle occupies the infraspinatus fossa of the scapula and is deep to the skin?
deep to the skin?
infraspinatus
What muscle is often fused with the teres minor muscle?
infraspinatus
What is the origin of the infraspinatus?
infraspinatus fossa/scapula
What is the insertion of the infraspinatus?
greater tuberosity/humerus
What are the actions of the infraspinatus?
laterally rotates the humerus and stabilizes the shoulder joint
What is the nerve supply to the infraspinatus?
suprascapular (C5 and C6)
What muscle occupies the ventral surface (subscapular fossa) of the scapula?
subscapularis
What is the origin of the subscapularis?
subscapular fossa/scapula
What is the insertion of the subscapularis?
lesser tuberosity/humerus
What are the actions of the subscapularis?
medially rotates the humerus and stabilizes the shoulder joint
What is the nerve supply to the subscapularis?
upper and lower subscapular (C5 and C6)
What muscle is a narrow muscle which is found parallel to the axillary border of the scapula, between the infraspinatus (with which it is sometimes fused) and the teres major
sometimes fused) and the teres major?
teres minor
What is the origin of the teres minor?
axillary border/scapula
What is the insertion of the teres minor?
greater tuberosity/humerus
What are the actions of the teres minor?
laterally rotates the humerus and stabilizes the shoulder joint
What is the nerve supply of the teres minor?
axillary (C5 and C6)
What muscle is a well developed muscle which, along with the latissimus dorsi, helps form the posterior wall (fold) of the axilla?
teres major
What is the origin of the teres major?
inferior angle/scapula
What is the insertion of the teres major?
medial lip of the intertubercular groove/humerus
What are the actions of the teres major?
adducts and medially rotates the humerus and stabilizes the shoulder joint
What is the nerve supply to the teres major?
lower subscapular (C6)
The space between the teres major and the teres minor is divided by the ____ ____ of the ______ _______ into ___ smaller pieces.
long head; triceps brachii; two
Is the quadrilateral space more lateral than the triangular space?
yes
Is the quadrilateral space more medial than the triangular space?
no
What is contained inside the quadrilateral space?
axillary nerve and humeral circumflex blood vessels
What is contained inside the triangular space?
circumflex scapular branch of the subscapular artery
What are the two classifications of ligaments?
extrinsic and intrinsic
What type of ligaments are found superficial to the capsular ligament?
extrinsic
What type of ligaments are found deep to the capsular ligament?
intrinsic
How do ligaments prevent movement?
by acting either as a rope or as a wall
What is the only joint by which the upper limb articulates with the axial skeleton?
sternoclavicular joint
What is the most stable joint of the upper extremity?
sternoclavicular joint
What are the articulations of the sternoclavicular joint?
sternal end of the clavicle, clavicular and costal notches of the sternum (manubrium), and medial end of the first rib
What joint is articulated at the sternal end of the clavicle?
sternoclavicular joint
What joint is articulated at the clavicular and costal notches of the sternum (manubrium)?
sternoclavicular joint
What joint is articulated at the medial end of the first rib?
sternoclavicular joint
How is the poorly adapted articulating surfaces of the sternoclavicular joint overcome?
by a piece of cartilage known as the articular disc, which is found in the middle of the joint cavity, dividing the joint cavity into two separate parts
The articular disc is found in the ______ of the joint cavity and divides it into ___ separate parts.
middle; two
What are the functions of the articular disc of the sternoclavicular joint?
prevent the clavicle from being displaced at its articulation with the sternum (stabilizes) and acts as a shock absorber for forces being transmitted along the clavicle
Whats function is to prevent the clavicle from being displaced at its articulation with the sternum (stabilizes)?
sternoclavicular joint’s articular disc
Whats function is to act as a shock absorber for forces being transmitted along the clavicle?
articular disc
What is the sternoclavicular joint’s classification?
plane gliding joint (but can act as a ball and socket to some degree)
What part of the joint is very strong and completely surrounds the joint?
capsular ligament
What is the nerve supply to the sternoclavicular joint?
supraclavicular and nerve to the subclavius
Does the sternoclavicular joint allow any movement?
yes (elevation, depression, protraction, retraction, and rotation), but most of these movements are passive and occur when the scapula moves
What are the functions of the anterior and posterior sternoclavicular ligaments?
reinforce the capsular ligament, prevent excessive forward/protraction (anterior movement), prevent excessive backward/retraction (posterior movement), and act like a wall
What is the classification of the anterior and posterior sternoclavicular ligaments?
extrinsic (acts like a wall)
What is the functions of the interclavicular ligament?
prevent displacement of the clavicle when one is carrying a heavy object and acts like a rope
What ligament is attached to the sternal ends of both clavicles?
interclavicular ligament
What is the classification of the interclavicular ligament?
extrinsic (acts like a rope)
What is a strong ligament which is attached to the costal impression of the clavicle and the first rib?
costoclavicular ligament
What is the function of the costoclavicular ligament?
reinforces the capsular ligament and limits elevation at the medial end of the clavicle (as when one hangs by their limbs) and acts like a rope
What is the classification of the costoclavicular ligament?
extrinsic (acts like a rope)
What joint is rarely dislocated because of the strength of the ligaments, the articular disc?
sternoclavicular joint
Why is the sternoclavicular joint rarely dislocated?
the strength of the ligaments, the articular disc, and how forces are transmitted along the clavicle
What is the cause to most dislocations of the sternoclavicular joint?
direct trauma to the anterior aspect of the sternal end of the clavicle (i.e. when one hits their chest wall against the steering wheel or dash in an automobile accident or when one is at the bottom of a “pile on” in football)
What type of injuries can happen to the sternoclavicular joint?
from a mild sprain (grade I) to a complete dislocation (grade III)
Why can a dislocation of the sternoclavicular joint be life threatening?
damage or compression of the trachea or blood vessels of the neck
What are the articulations for the acromioclavicular joint?
acromion process of the scapula and the lateral (acromial) end of the clavicle
What is the acromioclavicular joint classified as?
plane gliding joint
The capsular ligament is ____ and ____ in the acromioclavicular joint.
thin; weak
What must the acromioclavicular joint have, because it is thin and weak, in order to maintain the integrity of the joint?
reinforcing ligaments
