Upper Limb Landmarks, Joints and Movements Flashcards
Relevant Bones of the Upper Limb
-Sternum
-Clavicle
-Scapula
-Humerus
-Ulna
-Radius
-Carpals
-Metacarpals
-Phalanges
Shoulder
-Scapula, Clavicle
-a.k.a. Pectoral girdle, Thoracic girdle
-Junction between the arm and the trunk
Arm
-Humorous
Forearm
-Ulna, Radius
Wrist
-Carpals
Hand
-Metacarpals
Fingers
-Phalanges
Axial Skeleton
Scull, Vertebral Column, Sternum, Ribs
Appendicular Skeleton
Shoulders, Upper Limbs, Hips, Lower Limbs
Clavicle
-First bone in body to ossify
-Shaped like S (lateral concave anteriorly, medial convex anteriorly)
-Lateral 1/3rd is flattened (most common location for fracture)
-Connects upper limb to axial skeleton
-Acromial end: end that connects to the scapula
-Sternal end: End that connects to the manubrium (top of breast bone)
Acromial end of the Clavicle
End that connects to the scapula
Sternal end of the Scapula
End that connects to the manubrium - top of the breastbone
Scapula
-Relatively flat, triangular bone
-Sits flat against rib cage from (approx.) 2nd-7th ribs (whan standing in anatomical position with proper posture)
-Connects the clavicle to the humerus
Scapula Landmarks
-Acromion (tip of the shoulder)
-Coracoid process (ravens beak)
-Glenoid Fossa (a.k.a. Glenoid cavity) (where head of humerus articulates with scapula)
-Supraglenoid tubricle
-Infraglenoid tubricle
-Lateral border (a.k.a. axillary border)
-Inferior angle (easily palpated, good place to start for many palpations)
-Subscapular fossa
-Medial border (a.k.a. vertebral border)
-Superior angle
-Suprascapular notch
-Spine (of scapula)
-Supraspinous fossa
-Infraspinous fossa
-Root of spine (medial end of spine)
Scapulothoratic Joint
a.k.a. S-T Joint
*Not a true joint - is a functional joint
What is the only joint that is NOT a true joint?
Scapulothoratic Joint
Scapulothoratic Joint (Movements)
-Elevation: Gliding motion with the scapula moving superiorly
-Depression: Gliding motion with the scapula moving inferiorly
-Retraction/Adduction: Gliding motion with the scapula moving toward the spine
-Protraction/Abduction: Gliding motion with the scapula moving away from the spine
Rotation: Glenoid fossa is the point of reference
Upward/Lateral Rotation: Glenoid fossa moves superiorly (inferior angle moves laterally) (ant-post axis, frontal plane)
Downward/Medial Rotation: Glenoid fossa moves inferiorly (inferior angle moves medially)
Sternoclavicular Joint
a.k.a. S-C Joint
Sternal end articulates with the manubrium
-Saddle
-Synovial
There is an articular disc
-Disk prevents medial displacement of the clavicle and helps dissipate forces
Sternoclavicular Joint (Movements)
-Superior/Inferior Glide
-Anterior/Posterior Glide
-Rotation (M-L axis)
-Scapular Depression: Sternal end of the clavicle moves superiorly
-Scapular Elevation: Sternal end of the clavicle moves inferiorly
What type of joint is Sternoclavicular Joint?
-Saddle
-Synovial
The ___________________ Joint is the only true articulation between the upper limb and the axial skeleton.
Sternoclavicular Joint
The Sternoclavicular Joint has an articular disk that helps __________________.
Absorb Shock
What are the ligaments of the Sternoclavicular Joint?
-Anterior Sternoclavicular Ligament
-Posterior Sternoclavicular Ligament
-Interclavicular Ligament
(These reinforce the capsule)
-Costoclavicular Ligament
Acromioclavicular Joint
a.k.a. A-C Joint
Acromial end of the clavicle articulates with the acromion of the scapula
-Plane
-Synovial
What type of joint is the Acromioclavicular Joint?
-Plane
-Synovial
Acromioclavicular Joint (Movements)
-Anterior/Posterior Glide
-Some mild rotation
What are the ligaments of the Acromioclavicular Joint?
-Acromioclavicular Ligament
-Coracoacromial Ligament
-Coracoclavicular Ligament
Coracoacromial Ligament
Coracoid Process <-> Acromion
Coracromial arch is formed by the coracoid process, the coracoacromial ligament and the acromion (clinically relevant!)
Acromioclavicular Ligament
Clavical <-> Acromion
Coracoclavicular Ligament
Coracoid Process <-> Clavicle
Costoclavicular Ligament
Inferior Clavicle <-> 1st Rib
Humerus (Anterior View) Landmarks
-Head
-Anatomical Neck
-Greater Tubercle
-Lesser Tubercle
-Surgical Neck (common fracture site)
-Bicipital Groove (a.k.a. intertubercular groove, intertubercular sulcus)
-Deltoid tuberosity
-Lateral Supracondylar Ridge
-Lateral Condyle
-Radial fossa
-Lateral epicondyle
-Capitulum
-Coronoid Fossa
-Trochlea
-Medial epicondyle
-Medial Condyle
-Medial Supracondylar Ridge
Humerus (Posterior View) Landmarks
-Radial groove (a.k.a. spiral groove)
-Olecranon Fossa
-Groove for the Ulnar Nerve
Glenohumeral (GH) Joint
The Glenoid Fossa of the scapula articulates with the head of the humerus
What type of joint is the Glenohumeral (GH) Joint?
-Ball and Socket
-Synovial
Glenohumeral (GH) Joint (Movements)
-Abduction/Adduction
-Flexion/Extension
-Internal/External Rotation
-Horizontal Abduction/Horizontal Adduction
-Circumduction
-Scaption
Glenoid Labrum (GH Joint)
Fibrocartilagenous ring that attaches to the glenoid fossa it deepens the joint (the joint is like a golf ball tee which is unstable) (glenoid fossa articulates with about 1/3rd of the humeral head)
Joint Capsule (GH Joint)
-Thin and loose
-Weakest inferiorly at the axillary recess
-Weak spot in the capsule anteriorly called the Foramen of Weitbrecht
What are the ligaments of the GH Joint?
-Coracohumeral Ligament
-Glenohumeral (capsular) ligaments
Coracohumeral Ligament (Attachments)
Coracoid process <-> Greater Tubricle
What are the bursas of the GH Joint?
-Subacromial Bursa
-Subdeltoid Bursa
*Subdeltoid and Subacromial bursa are often used interchangeably
Subacromial Bursa
Between the acromion and the joint capsule
Subdeltoid Bursa
Between the deltoid muscle and the joint capsule often connected with the subacromial bursa
Scaption (Movement)
-Scapula sits at an angle of approx. 45deg relative to the frontal and sagittal planes
-Movement of the arm in this plane is termed scaption
-There is less tension on the capsule and greater elevation is possible than with pure frontal or sagittal plane elevation
-Neither internal nor external rotation of the humerus is needed to prevent impingement
-Many functional activities occur in this plane
Scapulohumeral Rythm
-Abduction of the arm involves movement at the glenohumeral (GH) joint, the scapulothoracic (ST) articulation, the acromioclavicular (AC) Joint, and the sternoclavicular (SC) joint.
-During normal abduction range , there is a specific relationship in the amount of movement at the GH joint, compared to the ST articulation.
-0-15 deg: no movement of the scapula
-15-120 deg: 2:1 ratio (GH:ST)
-120-180 deg: 1:1 ratio (GH:ST)
-Another way to look at it is that between 15 and 120 deg of abduction, for every 3 deg of movement, 2 deg comes from the GH and 1 deg comes from ST.
Biomechanics of Abduction
-During abduction of the humerus, the humerus must undergo external rotation (this usually happens around 90deg of abduction)
-This helps the greater tubercle clear the coracoaromial arch (preventing impingement)
-Note: how many structures are in a relatively small space
Spine
Spine is comprised of several individual bones called vertebrae and divided into 5 different segments
How many segments of the spine are there?
5 segments
What are the 5 segments of the spine?
-Cervical Spine has 7 Vertebrae
-Thoracic Spine has 12 Vertebrae
-Lumbar Spine has 5 Vertebrae
-Sacrum is Considered 1 Bone (made of 5 fused vertebrae)
-Coccyx is considered 1 Bone (made of (usually) 4 fused vertebrae)
How many Vertebrae are in the Cervical Spine?
7
How many Vertebrae are in the Thoracic Spine?
12
How many Vertebrae are in the Lumbar Spine?
5
How many Vertebrae are in the Sacrum?
1 Bone (5 fused vertebrae)
How many Vertebrae are in the Coccyx?
1 Bone (made of (usually) 4 fused vertebrae)
Posterior prominences of the spine are called?
Spinous Processes
Lateral prominences of the spine are called?
Transverse Processes
Spine (Available Movements)
-Flexion
-Extension
-Rotation (left,right)
Lateral flexion or side bending (left, right)
The __________________ fascia is extensive fascia in the low back that covers from the ________________ to the ________________.
Thoracolumbar, 12th Rib, Iliac Crest
What muscles connect upper limb to the spine?
-Upper/middle/lower trapezius
-Latissimus dorsi
-Rhomboids
-Levator Scapula
Upper Trapezius (Attachments)
-Superior Attachment: Middle 1/3rd of the superior nuchal line, external occipital protuberance (inion) to the C7 SP via the nuchal ligament
-Inferior Attachment: Lateral clavicle, acromion, superior lip of the spine of the scapula
Upper Trapezius (Action)(Head/Neck Fixed)
-Action: S-T elevation
-Action: S-T upward rotation
Upper Trapezius (Action)(Scapula Fixed)
-Action: head/neck extension (bilaterally contracting)
-Action: head/neck ipsilateral lateral flexion
-Action: head/neck contralateral rotation
Middle Trapezius (Attachment)
Medial Attachment: C7-T5 SPs
Inferior Attachment: Superior lip of the spine of the scapula
Middle Trapezius (Action)
Action: S-T Retraction
Lower Trapezius (Attachment)
Medial Attachment: T6-T12 SPs
Inferior Attachment: Root of the spine of the scapula
Lower Trapezius (Action)
-Action: S-T Depression (when acting with pectoralis minor
-Action: S-T upward rotation
Latissimus Dorsi (Attachment)
-Medial Attachment: SP T6-Iliac crest, lumbar and sacral vertebrae via the thoracolumbar fascia, ribs 9-12, inferior angle of the scapula (this is an inconsistent attachment)
-Lateral Attachment: Floor of the bicipital groove
Latissimus Dorsi (Action)
-Action: G-H Internal rotation
-Action: G-H extension
-Action: G-H adduction
Rhomboids (Attachment)
-Medial Attachment: SP C7-T5
-Lateral Attachment: Root of the spine of the scapula to the inferior angle of the scapula
Rhomboids (Action)
-Action: S-T Retraction
-Action: S-T Downward Rotation
-Action: S-T Elevation
-Action: Help Serratus Anterior Hold the Scapula against the ribs
*Used when forcibly lowering raised upper limbs
Levator Scapula $ (Attachment)
-Superior Attachment: TVP’s of C1-C4
-Inferior Attachment: Superior angle to the root of the spine of the scapula
*Twists from one attachment to the other (this can make it easier to palpate)
Levator Scapula $ (Action) (Head/Neck Fixed)
-Action: S-T elevation
-Action: S-T downward rotation
Levator Scapula $ (Action) (Scapula Fixed)
-Action: Head/Neck Extension (when bilaterally contraction)
-Action: Head/Neck ipsilateral lateral flexion
-Action: Head/Neck ipsilateral rotation
Muscles of the Pectoral Region
-Pectoralis Major
-Pectoralis Minor
-Subclavius
-Serratus Anterior
Pectoralis Major
2 Divisions: Upper fibers (clavicular head) and lower fibres (sternocostal head)
Pectoralis Major (Attachment)
-Medial Attachment (upper fibres: Medial 1/2 of the anterior clavicle
-Medial attachment (lower fibres): sternum, anterior costal cartilages of ribs 2-6
-Lateral Attachment (both heads): Lateral lip of the bicipital groove
Pectoralis Major (Action)
-Action: G-H Medial Rotation
-Action: G-H adduction
-Action: G-H flexion (from deep extension)
-Action: G-H extension (from deep flexion)
-Action: G-H horizontal adduction
Pectoralis Minor (Attachment)
Superior Attachment: Coracoid Process
Inferior Attachment: Ribs 3-5
Pectoralis Minor (Action)
-Action: S-T protraction
-Action: S-T depression (when acting with lower trapezius)
-Action: S-T downward rotation
-Action: If the scapula is fixed, pectoralis minor help to elevate the ribs with forced inhalation
Tipping Scapula
Inferior angle of the scapula moves posteriorly off of the rib cage (this is likely due to a short pectoralis minor)
Force Couple
MM working in equal but opposite directions resulting in one turning motion
Serratus Anterior (Attachment)
-Medial Attachment: Anterior surface of the medial border of the scapula
-Lateral Attachment: Lateral Surfaces of the upper 8 ribs
*Keeps the medial border of the scapula flat against the ribs - if this muscle is weak, a winging scapula can present (the medial border of the scapula moves off the ribcage)
Serratus Anterior (Action)
Action: S-T Protraction
Action: S-T Upward Rotation (low fibres only)
Winging Scapula
The medial border of the scapula moves posteriorly off of the ribcage ( this is likely due to a weak serratus anterior)
Tight Pectoralis Minor
Tipping Scapula
Weak Serratus Anterior
Winging Scapula
