Unit II Flashcards
Trapezius Origins
EOP
superior nuchal line
ligamentous nuchae
spines of the thoracic vertebrae
Trapezius Insertions
Clavicle
acromion process
Trapezius actions
stabilizes scapula and holds it in anatomical postion
upper portion elevates scapula
lower and middle portions adduct the scapula
Trapezius nerve supply
CN X for motor
C4 and C5 for sensory
Weakness of the Trapezius is called
Trapezius palsy
What will Trapezius palsy look like?
deepening of shoulder and should drop on affected side
What is the clinical examination for Trapezius palsy?
have the patient shrug against resistance
Rhomboid Major origin
spines/upper thoracic vertebrae
Rhomboid Major insertion
vertebral border of scapula
Rhomboid Major Actions
elevates scapula
Stabilizes scapula
adducts scpula
Rhomboid Major nerve supply
dorsal scapular nerve (C5)
Rhomboid Minor Origin
spines/lower cervicals and first thoracic
Rhomboid Minor insertion
vertebral border/scapula
Rhomboid Minor actions
elevates scapula
Stabilizes scapula
adducts scpula
Rhomboid Minor nerve supply
dorsal scapular nerve (C5)
Levator scapula origin
transverse processes/upper cervicals
Levator scapula insertion
superior angle/scapula
Levator scapula nerve supply
dorsal scapular nerve (C5)
Describe damage to the dorsal scapular nerve
difficult complete adduction
and scapula will be farther away from mid-line on affected side
Latissimus dorsi origins
Spines/lower thoracics and lumber vertebrae
thoracodorsal fascia
crest/illium
lower ribs
Latissimus dorsi insertion
intertubercular groove/humerus
Latissimus dorsi actions
Extends, adducts, and medially rotates humerus
involved with forced expiration
Latissimus dorsi nerve supply
thoracodorsal (C6-8)
Describe what weakness of the Latissimus dorsi would look like
forward displacement of the shoulder
What is the lumbar triangle bounded by?
latissimus dorsi, crest/illium, and external oblique muscle
What is the clinical significance of the lumbar triangle?
a hernia of the posterior abdominal wall may develop here
What is the triangle of auscultation bounded by?
latissimus dorsi, trapezius, and vertebral border of the scapula
What is the clinical significance of the triangle of auscultation?
it allows lungs to be more easily listened to
How can the triangle of auscultation be enlarged?
by having the patient fold their arms across their chest (abduct their scapula)
serratus anterior origin
upper ribs
Serratus anterior insertion
vertebral border/scapula
Serratus anterior actions
abducts (protracts) scapula
stabilizes scapula (most important)
involved with forced inspiration only when humerus is abducted
Serratus anterior nerve supply
long thoracic (C5-C7)
Describe Winged scapula
patient cant keep vetebral border and inferior angle of scapula next to posterior thoracic wall when abducting against resistance
they may not be able to raise hand above head
some pain around shoulder
What may be some causes of winged scapula?
trauma to C5-C7
dislocation of the shoulder joint
being in the same position for a long time
Which muscles comprise the rotator cuff?
teres minor, infraspinatus, supraspinatus, and subscapularis
What are the criteria for muscles to be rotator cuff muscles?
tendon of insertion makes a cuff around head of humerus
they participate in either medial or later rotation of humerus
Deltoid origins
clavicle (anterior)
acromion process (middle)
spine of scapula (posterior)
Deltoid insertion
deltoid tuberosity
Deltoid Actions
anterior-flexes and medially rotates humerus
middle-abducts the humerus
posterior-extends and laterally rotates humerus
Deltoid nerve supply
axillary nerve (C5-C6)
Describe Crutch paralysis
shoulder has a flat appearance
loss of sensation of lateral aspect of arm
abduction of arm impaired
What could be causes of Crutch paralysis?
damage to the axillary nerve
fracture of surgical neck
dislocation of joint
pressure of a crutch on the axilla
Supraspinatus origin
supraspinatus fossa
Supraspinatus insertion
greater tuberosity
Supraspinatus actions
initiates abduction of humerus (first 30-40 degrees)
laterally rotates humerus
stabilizes shoulder joint
Supraspinatus nerve supply
suprascapular (C5-C6)
Describe rotator cuff tendonitis
irritation and inflammation of supraspinatus tendon
pain is sharp or aching on lateral/anterior aspect of shoulder
may feel like a twinge
shoulder movement may be weaker
Common causes of rotator cuff tendonitis
genetic; born with a hooked acromion
weakness of cuff causes humerus to ride up and compress tendons
excess stress and repetition
trauma injury
calcium deposits
Describe rotator cuff tears
tendon usually ruptures at or near insertion
in young people, usually from traumatic injury
in old only need a minor injury
patients will have issues with abduction
Describe the drop test for rotator cuff tears
have patient lower fully abducted arm and it should drop all of the sudden
Describe bursitis
inflammation of a shoulder bursa that seperates the tendon from the acromion process
Infraspinatus origin
infraspinatus fossa
Infraspinatus insertion
greater tuberosity
Infraspinatus actions
laterally rotates humerus
stabilizes the shoulder joint
Infraspinatus nerve supply
suprascapular (C5-C6)
Subscapularis origin
subscapular fossa
Subscapularis insertion
lesser tuberosity
Subscapularis actions
medialy rotates
stabilizes shoulder joint
Subscapularis nerve supply
upper and lower subscapular (C5-C6)
Teres Minor origin
axillary border/scapula
Teres minor insertion
greater tuberosity
Teres minor actions
laterally rotates humerus
stabilizes shoulder joint
Teres minor nerve supply
axillary (C5-C6)
Teres Major origin
inferior angle/scapula
Teres major insertion
medial lip of the intertubercular groove
Teres major actions
adducts and medially rotates the humerus
stabilizes shoulder joint
Teres major nerve supply
lower subscapular (C6)
What is the location of quadrilateral space?
the more lateral space between the teres minor and major
What structures does the quadrilateral space contain?
axillary nerve and humeral circumflex blood vessels
What is the location of triangular space?
the more medial space between the teres minor and major
What structures are in the triangular space?
the circumflex scapular branch of the subscapular artery
What is the most stable joint of the upper extremity?
the sternoclavicular joint
List the articulations of the sternoclavicular joint
sternal end of clavicle
clavicular and costal notches of sternum
medial end of first rib
What is the function of the articular disc in the sternoclavicular joint?
the prevent the clavicle from being displaced from the sternum
act as a shock absorber
What is the classification of sternoclavicular joint?
plane gliding
What is the sternoclavicular joint innervation?
supraclavicular and subclavius
What actions do the Anterior and Posterior Sternoclavicular ligament prevent?
excessive forward or backward movement (retraction and protraction)
Describe the anterior and posterior sternoclavicular ligament
it reinforces the capsular ligament
extrinsic and acts like a wall
What actions does the interclavicular ligament prevent?
displacement of the clavicle when one is carrying a heavy object
Describe the interclavicular ligament
its attached to both sternal ends of clavicle
extrinsic and acts as a rope
What actions does the costoclavicular ligament prevent?
elevation at medial end of clavicle
Describe the costoclavicular ligament
attached at costal impression of clavicle and first rib
reinforces capsular ligament
extrinsic and acts as a rope
Describe a dislocation of the sternoclavicular joint
usually from direct trauma to the anterior aspect of the sternal end of the clavicle
can be life threatening from compression of trachea or blood vessels in neck
List the articulations of the Acromioclavicular joint
acromion process and lateral end of clavicle
What is the classification of the acromioclavicular joint?
plane gliding
What is the nerve supply of the acromioclavicular joint?
dorsal scapular, suprascapular, and axillary nerves
What do the inferior and superior acromioclavicular ligaments prevent?
the clavicle from losing contact with the acromion process
Describe the superior and inferior acromioclavicular ligaments
they reinforce the capsular ligament
extrinsic and acts as a rope
What is the function of the coracoclavicular ligament?
holds and suspends the weight of the scapula from the clavicle
limits protraction, elevation, and rotation of scapula
Describe the coracoclavicular ligament
connects clavicle with coracoid process
divided into conoid and trapezoid portion
extrinsic and acts as a rope
Describe a dislocation of the acromioclavicular joint (shoulder separation)
usually occurs from a severe blow to the shoulder
the lateral end of clavicle is displaced and acromion process is more palpable than normal
Describe a grade III dislocation of the acromioclavicular joint
both acromionclavicular and coracoclavicular ligaments are ruptured and clavicle separates from scapula
How can one tell if the subclavian artery is compromised in a dislocation of the acromioclavicular joint?
a diminished brachial or radial pulse
What are the articulations of the glenohumeral joint?
head of the humerus and glenoid cavity/scapula
What purpose does the glenoid labrum serve in the glenohumeral joint?
to deepen the cavity to accommodate to the head of the humerus
What is the classification of the glenohumeral joint?
ball and socket joint
What is the nerve supply to the glenohumeral joint?
the axillary and suprascapular nerve
Describe the capsular ligament for the glenohumeral joint
it has an opening infero-laterally placed for long head of biceps brachii to pass through
is superiorly strengthened by ligaments and rotator cuff muscle tendons
What does the glenohumeral ligament prevent?
lateral rotation
Describe the glenohumeral ligament
strengthens anterior aspect of capsule
intrinsic and acts as a rope
Describe the transverse humeral ligament
spans intertuburcular groove making it a canal
keeps long head of biceps brachii in place
What does the coracohumeral ligament limit?
lateral rotation of the humerus
Describe the coracohumeral ligament
strengthens ligament from above
extrinsic and acts as a rope
What does the coracoacromial ligament prevent?
upward displacement of the head of the humerus
Describe the cracoacromial ligament
attaches coracoid and acromion processes to the scapula
is extrinsic and acts as a wall
Describe the suprascapular ligament
spans the scapular notch
What is primarily responsible for keep the shoulder joint from separating?
mostly muscles (rotator cuff muscles)
Describe an anterior dislocation of the glenohumeral joint
most common and at the inferior aspect of the capsular ligament
usually caused by excessive extension and lateral rotation of the humerus
rounded shoulder appearance is lost and deltoid tuberosity can no longer be palpated
loss of sensation on lateral aspect of arm due to injury of the musculocutaneous and axillary nerves
What happens to the humerus in an anterior dislocation of the should joint?
head of the humerus is forced thru the anterior part of the capsular ligament and ends up below the coracoid process (subcoracoid dislocation)
Levator Scapula actions
elevates scapula
Stabilizes scapula
adducts scpula
