Upper Extremity - Shoulder Girdle Flashcards
What are the bone landmarks on the scapula and where are they?
Superior angle: top pointy part of the scapula
Inferior angle: bottom pointy part of the scapula
Medial/Vertebral border: side of the scapula that is closest to the vertebral column
Lateral border: ends at the top, ends with the glenoid fossa
Glenoid fossa: shallow socket where the humerus rests
Supraspinous fossa: above the spine of the scapula
Infraspinous fossa: below the spine of the scapula
**Acromion process: ** extension of the spine of the scapula on the posterior side, very large (you can feel it)
Coracoid process: finger-like projection on the anterior side of the scapula (finger points forward and lateral), just superior and medial to the glenoid fossa
What are the actions performed by the shoulder girdle?
Protraction: medial sides of scapula move further apart, lateral end of the shoulder girdle moves forward, lateral end of the clavicle rotates around the SC joint and moves forwards (the medial side of the clavicle is attached)
Retraction: the medial sides of the scapula move closer together, the lateral sides of the shoulder girdle move backwards
Elevation: bringing shoulders up to ears motion, lateral point of the shoulder girdle moves up (medial side does not move because it is anchored so it pivots)
Depression: bringing shoulder back to neutral (only a small amount of depression pact neutral), lateral point of the shoulder girdle moves down (medial side does not move because it is anchored so it pivots)
How can the scapula move in the shoulder girdle?
Superior Rotation: glenoid fossa moves up, caused by elevation
Inferior Rotation: glenoid fossa moves down, caused by depression
Anterior Tilt: scapula moves up along the ribcage, the top of the scapula tilts forward slightly, caused by elevation
Posterior Tilt: scapula moves down along the ribcage, bottom of the scapula starts to tuck down, caused by depression
What is winging of the scapula, how does it happen and what prevents it from happening?
Wining of the scapula is when there is movement in the medial border and inferior angle of the scapula.
Winging can happen because the scapula and ribcage are not held together with ligaments, just muscles to allow for movement. Sometimes the muscles are not strong enough the hold the scapula down and part of the scapula can move away from the ribs (most noticeable in the medial border and inferior angle). Winging can be happen when the pectoralis minor muscle is too tight (causes too much anterior tilt) and the inferior angle of the scapula can pop off the ribcage.
Winging should be stopped by the inferior aspect of the trapezius.
Muscles that are attached to the medial border of the scapula: serratus anterior, rhomboid major and rhomboid minor
The Sternoclavicular (SC) Joint
Where the medial side of the clavicle fits into a concave surface on the manubrium of the sternum.
Made of the Anterior Sternoclavicular Ligament, Posterior Sternoclavicular Ligament and Costoclavicular Ligament.
This is the pivot point for all shoulder girdle movements - it needs to be very stable
Articular Disk: between the clavicle and the manubrium - prevents compressive and friction movements from causing damage.
Anterior Sternoclavicular (ASC) Ligament
Origin: anterior point of the manubrium
Runs: superiorly and laterally
Insertion: medial end of the clavicle
Limits: retraction of the shoulder girdle and superior movement of the medial end of the clavicle - gravity wants to pull the lateral side of the clavicle and the scapula down so the SC ligaments hold them up
Posterior Sternoclavicular (PSC) Ligament
Origin: posterior point of the manubrium
Runs: superiorly and laterally
Insertion: medial end of the clavicle
Limits: deep protraction of the shoulder girdle, and superior movement of the medial end of the clavicle - gravity wants to pull the lateral side of the clavicle and the scapula down so the SC ligaments hold them up
Costoclavicular Ligament
Origin: superior aspect of the costal cartilage of the first rib
Runs: superiorly
Insertion: inferior side of the medial end of the clavicle
Limits: superior movement of the medial end of the clavicle
Acromioclavicular (AC) Joint
The point where the acromion process of the scapula meets up the lateral end of the clavicle.
This often gets injured often. Results in a separated shoulder (step deformity) - the acromion process has separated away from the lateral end of the clavicle - lateral end is higher.
The joint surfaces are very small and shallow where the lateral end of the clavicle meets the acromion process - because there is not a lot of joint movement the main purpose is to hold them together.
Articular disk between the ends of the clavicle and acromion process
Acromioclavicular (AC) Ligament
Re-enforces the joint capsule. Thickest on the superior side of the joint.
Surrounds the AC joint.
Separated in to superior and inferior AC ligaments.
Attaches the lateral end of the clavicle to the medial side of the acromion.
Coracoclavicular Ligaments
In the coracoid process.
Pair of muscles: conoid and trapezoid ligaments.
Conoid Ligament
Part of the coracoclavicular ligaments (medial side)
Origin: coracoid process
Insertion: conoid tubercle on the inferior aspect of the clavicle
Limits: superior translation of the lateral end of the clavicle (relative to scapula) and dropping of the scapula - gravity is trying to pull the scapula down but the conoid ligament holds it up
Trapezoid Ligament
Origin: coracoid process
Insertion: conoid tubercle on the inferior aspect of the clavicle
Limits: superior translation of the lateral end of the clavicle (relative to scapula) and dropping of the scapula - gravity is trying to pull the scapula down but the conoid ligament holds it up
Coracoacromial Ligament
Origin: tip of the coracoid process
Insertion: acromion process
This does not support the AC joint because it’s origin and insertion are on the same bone
Trapezius Muscle
On the posterior side of the body.
Origin: external occipital protuberance, superior nuchal line, and down the nuchal ligament
Runs: from T1-T12 (has attachments to each spinous process it crosses)
Insertion: shoulder girdle
Function is separated into 3 separate groups because the muscle is so large and has so many functions - UFT, MFT and LFT
Nuchal Ligament
Part of the origin for the trapezius.
Origin: external occipital protuberance
Runs: vertically down the midline of the spine - connections to spinous processes from C1-C7
Insertion: C7
Limits: flexion of the cervical spine
Upper/Descending Fibers of Trapezius (UFT)
Origin: the skull and cervical spine
Fiber Direction: down
Insertion: superior aspect of the lateral 1/3 of the clavicle - stops around the AC joint
Actions: elevation of the shoulder girdle
Middle Fibers of Trapezius (MFT)
Origin: T1-T3
Fiber direction: horizontal
Insertion: AC joint to the superior aspect of the acromion process to the superior aspect of the spine of the scapula
Actions: retraction of the shoulder girdle
Lower/Ascending Fibers of Trapezius (AFT)
Origin: T3-T12
Fiber direction: up
Insertion: superior aspect of the spine of the scapula
Actions: superior rotation of the scapula (by pulling the medial side of the scapula down), depression of the shoulder girdle (if arms are raised), and posterior tilt of the scapula (caused by depression)
Levator Scapulae
Deep to Trapezius.
Origin: transverse process from C1-C4
Insertion: superior angle of the scapula and medial border of the scapula (above the spine of the scapula) - mostly the superior angle
Actions: inferior rotation of the scapula (caused by elevation of the superior angle of the scapula)
Rhomboid Major
Below Rhomboid Minor, deep to Trapezius
Origin: Spinous processes from T2-T5
Runs: Inferiorly and Laterally
Insertion: medial border of the scapula - distal to the spine of the scapula
Actions: retraction of the shoulder girdle and inferior rotation of the scapula
Rhomboid Minor
Above Rhomboid Major, deep to Trapezius.
Origin: spinous processes of C7 and T1
Runs: inferiorly and laterally
Insertion: medial border of the scapula - the root of the spine of the scapula
Actions: retraction of the shoulder girdle, and inferior rotation of the scapula
Serratus Anterior
Between the ribs and the scapula
Origin: lateral aspects of the upper 8 ribs
Runs: back (as 1 muscle belly) along the medial border of the scapula
Insertion: anterior surface of the scapula
Actions: protraction of the shoulder girdle (upper fibers pull horizontally) and superior rotation of the scapula (lower fibers pull obliquely)
Pectorialis Minor
Small, triangle shaped muscle, deep to pectoralis minor.
Origin: anterior aspect of ribs 3-5
Runs: superiorly and slightly posteriorly
Insertion: medial side of the coracoid process
Actions: protraction of the shoulder girdle, depression of the shoulder girdle, anterior tilt of the scapula
Flexion in the Sagittal Plane
Brining your arm up with the thumb pointing back, fingers pointing up
Extension in the Sagittal Plane
Bringing your arm behind you as far as it can go
Adduction in the frontal plane
Moving the arm back towards the midline of the body
Abduction in the Frontal Plane
Moving the arm away from the midline of the body
Cross flexion in the Horizontal Plane
Start Position: shoulder abducted at 90 degrees
Bring the arm as far across the front of the body as possible
Cross Extension in the Horizontal Plane
Start Position: shoulder abducted at 90 degrees
Bring the arm as far back across the body as possible
External Rotation of the GH Joint in Adduction
Start Position: elbow flexed at 90 degrees, resting at side, thumb up
Spin the humerus so it points away from the body (hand points laterally)
Internal Rotation of the GH joint in Adduction
Start Position: elbow flexed at 90 degrees, resting at side, thumb up
Spin the humerus so it points towards the body (hand points medially)
External Rotation of the GH joint in abduction
Starting Position: elbow bent at 90 degrees, abduct shoulder 90 degrees, fingers point forwards
Rotate the humerus so the fingers point up
Internal Rotation of the GH Joint in Abduction
Starting Position: elbow bent at 90 degrees, abduct shoulder 90 degrees, fingers point forwards
Rotate the humerus so the fingers point down