Upper Limb Flashcards
Describe the features of the scapula
Glenoid cavity with supraglenoid tubercle and infraglenoid tubercle. Medial and lateral borders. Spine of the scapula with greater scapular notch. Supraspinous fossa and infraspinous fossa. Acromion and coracoid process. Superior angle and suprascapular notch. Costal surface.
What is the structure of the proximal humerus?
Head, anatomical neck, surgical neck, greater and lesser tubercles and the superior half of the shaft of the humerus
What is the structure of the greater tubercle?
Superior facet for attachment of the supraspinatus muscle
Middle facet for attachment of the infraspinatus muscle
Inferior facet for attachment of teres minor muscle
What lies between the greater and lesser tubercle?
The intertubercular groove
What is the lateral lip of the intertubercular groove continuous with inferiorly?
A large V-shaped deltoid tuberosity
What is in approximately the same position as the deltoid tubercle but on the medial surface of the humerus?
A thin vertical roughening for the attachment of the coracobrachialis muscle
What is important about the surgical neck of the humerus?
It is a common site of fracture and directly posterior is where the axillary nerve and posterior circumflex humeral artery pass in to the deltoid region from the axilla so can be damaged by a fracture in this area.
What deepens the glenoid cavity?
The glenoid labrum - a fibrocartilaginous collar which is continuous superiorly with the tendon of the long head of the biceps brachii muscle
What are the rotator cuff muscles?
Supraspinatus, infraspinatus, teres minor and subscapularis
What is the vascular supply to the glenohumeral joint?
Anterior and posterior circumflex humeral arteries and suprascapular arteries
What is the relationship between the trapezius and deltoid muscles?
Trapezius insertion is the origin of the deltoid muscle. They are the two most superficial muscles of the shoulder. The spine of the scapula, acromion and clavicle can be palpated between them.
Deep to the trapezius, what are the three muscles that attach the scapula to the vertebral column?
Levator scapulae, rhomboid major and rhomboid minor
What is the origin of the trapezius muscle?
Superior nuchal line
External occipital protuberance
Medial margin of the ligamentum nuchae
Spinous processes of C7 to T12 and the related supraspinous ligaments
What is the insertion of the trapezius muscle?
Superior edge of the spine of the scapula
Acromion
Posterior border of lateral one-third of the clavicle
What is the innervation of trapezius?
Motor spinal part of accessory (CNXI) nerve
Sensory (proprioception) anterior rami of C3 and C4
What is the function of trapezius?
Elevates the scapula, rotates the scapula during abduction of the humerus, middle fibres retract the scapula and lower fibres depress the scapula
What is the origin of the deltoid muscle?
Inferior edge of the spine of the scapula
Acromion
Anterior border of lateral one-third of the clavicle
What is the insertion of deltoid?
Deltoid tuberosity
What is the innervation of the deltoid muscle?
Axillary nerve (C5, C6) - branch of the posterior cord of the brachial plexus
What is the action of deltoid?
Abduction of the arm after the first 15 degrees is done by supraspinatus
Posterior fibres assist in extending arm
Anterior (clavicular) fibres assist in flexing arm
What is the origin of levator scapulae?
Transverse processes of C1-C4
What is the insertion of levator scapulae?
Posterior surface of the medial border of the scapula from superior angle to root of spine of scapula
What is the innervation of levator scapulae?
Dorsal scapular nerve (C4, C5) and directly from anterior rami of C3 and C4 spinal nerves
What is the action of levator scapulae?
Elevates the scapula
What is the origin of rhomboid minor?
Lower end of the ligamentum nuchae and spinous processes of C7 and T1
What is the insertion of rhomboid minor?
Medial border of the scapula at the root of the spine of the scapula
What is the innervation of rhomboid minor?
Dorsal scapular nerve (C4, C5)
What is the action of rhomboid minor?
Elevates and retracts the scapula
What is the origin of rhomboid major muscle?
Spinous processes of T2-T5 and intervening supraspinous ligaments
What is the insertion of rhomboid major muscle?
Medial border of scapula from root of the spine of the scapula to the inferior angle
What is the innervation of rhomboid major?
Dorsal scapular nerve (C4, C5)
What is the action of rhomboid major?
Elevates and retracts the scapula (same as rhomboid minor)
What is the origin of the supraspinatous muscle?
Supraspinous fossa
What is the insertion of the suprapinatous?
Superior facet on the greater tubercle of the humerus
What is the innervation of supraspinatous?
Suprascapular nerve (C5 and C6) - a branch of the superior trunk of the brachial plexus
What is the action of supraspinatous?
First 15 degrees of abduction (rotator cuff muscle)
What is the origin of infraspinatous?
Medial two thirds of the infraspinous fossa
What is the insertion of infraspinatous?
Middle facet on the greater tubercle of the humerus
What is the innervation of the infraspinatous muscle?
Suprascapular nerve (C5, C6)
What is the action of the infraspinatous muscle?
Lateral rotation of the arm
What is the origin of teres minor?
Posterior surface of the scapula immediately adjacent to the lateral border of the scapula below the infraglenoid tubercle
What is the insertion of teres minor?
Inferior facet on the greater tubercle of the humerus
What is the innervation of teres minor?
Axillary nerve (C5, C6)
What is the origin of teres major muscle?
Oval area on the posterior surface of the inferior angle of the scapula
What is the action of teres minor?
Lateral rotation of the arm
What is the insertion of teres major?
Medial lip of the intertubercular groove on the anterior surface of the humerus
What is the innervation of teres major?
Inferior subscapular nerve (C5, C6, C7) - a branch of the posterior cord of the brachial plexus
What is the action of teres major?
Medial rotation of the arm and extension of the arm
What is the origin of the long head of triceps brachii?
Infraglenoid tubercle on scapula
What is the insertion of the long head of triceps brachii?
Common tendon of insertion with medial and lateral heads on the olecranon process of the ulna
What is the innervation of the long head of the triceps muscle?
Radial nerve (C6, C7, C8)
What is the action of the long head of the triceps brachii?
Extension of the forearm at the elbow joint
Accessory adductor and extensor of the arm at the glenohumeral joint
What is the route through which structures pass from the base of the neck to the posterior scapular region?
Suprascapular foramen, formed by the suprascapular notch and the superior transverse scapular (suprascapular) ligament which converts the notch in to a foramen.
What passes through the suprascapular foramen?
Suprascapular nerve. Suprascapular artery and suprascapular vein follow the same course as the nerve but usually pass superior to the superior transverse scapular ligament and not through the foramen
What is the passageway between anterior regions (axilla) and the posterior scapular region?
The quadrangular space and triangular space
What are the borders of the quadrangular space?
Superiorly is the lower border of teres minor
Medially is the lateral border of the long head of triceps brachii
Inferiorly is the superior margin of teres major
Laterally is the surgical neck of the humerus
What passes through the quadrangular space?
Axillary nerve and posterior circumflex humeral artery and vein
What are the borders of the triangular interval?
Superiorly is the inferior border of teres major
Laterally is the shaft of the humerus
Medially is the lateral border of the long head of the triceps brachii
What passes through the triangular interval?
Profunda brachii artery and associated veins and the radial nerve
What are the boundaries of the triangular space?
Laterally is the medial margin of the long head of triceps brachii
Superiorly is the inferior border of teres minor
Inferiorly is the superior border of teres major
What passes through the traingular space?
Circumflex scapular artery and vein
What passes through the greater scapular notch?
Suprascapular nerve and suprascapular artery
What is the main branch of the axillary nerve?
The superior lateral cutaneous nerve of the arm which supplies skin over the inferior part of the deltoid (regimental badge area)
What are the borders of the three parts of the subclavian artery?
1st part is medial to scalene muscle
2nd part is posterior to scalene muscle
3rd part is lateral to scalene muscle
What are the branches of the subclavian artery?
1st part (3): Vertebral artery, internal thoracic artery and thyrocervical trunk 2nd part (2): Costocervical artery and Dorsal scapular artery 3rd part (0)
What are the branches of the thyrocervical trunk that pass in to the posterior scapular region?
Transverse cervical artery which has a deep branch which travels around the medial border and inferior angle of the scapular
Suprascapular artery
What is the circumflex scapular artery a branch of?
Subscapular artery which is a branch of the third part of the axillary artery
