Week 1 Flashcards
Shoulder region
Pectrol gridle
scapula and clavicle
Upper limb
pectoral gridle + free upper limb
Musculocutaneous nerve
C5, C6, C7
Median Nerve
C6 , C7, C8 AND T1
radial nerve
C5, C6, C7, C8 and T1
ulnar nerve
C7,8, T1
There are 3 areas of transition
Axilla, cubital fossa, and carpal tunnel
Clavicle Bone
- Superior Surface
1. Anterior ( tend to be R)- Sternal end
- Shft
- Acromial end
- Posterior ( tends to be ^)
- Sternal facet, (articular surface)
- Inferior Surface
1. Posterior Surface
-Sternal facet- Conoid tubercle
- Impression for costoclavicular ligament
- Subclavian groove
- Trapezoid line
- Anterior Surface
- Acromial facet
how do you differentiate between a left and a right clavicle
on the inferior surface where you cna see the impression for the costoclavicualr ligament and the conoid tubercle, if the medial end (which is always at the sternal next to the impression) goes towards the left, then it is a left clavicle and vice versa.
Scapula has
2 surfaces
3 fossae
3 angles
3 processes
Scapula has 2 surfaces
- Costal surface
- Posterior Surface
Scapula has 3 angles
- Superior Angle (medial end )
- Inferior Angle (by itself)
- Lateral Angle
Scapula has 3 borders
- Medial Border ( between the superior angle and the inferior angle)
- Lateral Border (between the lateral angle and the inferior angle)
- Superior Border (between the superior angle and the lateral angle)
Scapula has 3 processes
- Acromion
- Coracoid Process
- Glenoid Cavity
Scapula has 3 fossae
- Subscapular fossa ( on the costal surface towrads the anterior)
- Supraspinous fossa (on the posterior surafce)
- Infraspinous fossa (on the posterior surafce)
infraglenoid tubercle
which is under the glenoid cavity
attachment of long head of triceps brachii
supraglenoid tubercle
which is above the glenoid cavity.
attachment of long head of biceps brachii
Humerus proximal end
the humerus articulates with the glenoid cavity of the scapula
tubercles of the humerus
are attachment of the rotator cuff muscles
Intertubercular sulcus (bicipital groove)
found on the anterior view.
tendon of long head of biceps brachii passes through
the humerus has lateral lip, floor and medial lip of intertubercular sulcus
where there is attachment of pectoralis major, latissimus dorsi, and teres major respectively
the humerus also has deltoid tuberosity laterally and coracobrachialis medially
deltoid tubersity is where the deltoid attaches
at the posterior view of the humerus
there is superior facet - attachment for supraspinatus
middle facet- attachment for infraspinatus
inferior facet- attachment for teres minor
Joints of the shoulder region includes
- Sternoclavicular
-Acromioclavicular
-Shoulder (glenohumeral)
-Scapulothoracic (physiological joint)
Movements of the scapula incldues
- Elevation/depression
- Protraction/Retraction
- Upwrad rotation/downward rotation
Movements at the shoulder
- Flexion/Extension
- Medial Rotation/Lateral Rotation
- Circumduction
- Adduction/Abduction
Sternoclavicular Joint
Classificitaion: Synovial, Saddle
Articulating surfaces: sternal end of clavicle, manubrium of sternum and part of 1st costal cartilage, articular disc divides cavity into 2 hence enhancing stability
Ligaments: anterior sternoclavicular, posterior sternoclavicular, costoclavicular which is important for stability, interclavicular
Movements: allows movement of the clavicle, predominantly in anterior/posterior and vertical planes, some rotation
Acromioclavicular Joint
Classification: synovial, plane
Articulating surfaces: lateral aspect of clavicle (oval shaped facet), medial aspect of acromion
Ligaments: acromioclavicular, coracoclavicular (2parts - trapezoid and conoid ligaments)
Movements: allows movement of clavicle, predominantly in A-P and vertical planes, some axial rotation
Shoulder glenohumeral joint
Classification: synovial, ball and socket
Articulating surfaces: glenoid cavity of scapula, head of humerus
Ligaments: glenoid labrum, glenohumeral (superior, middle, and inferior - capsular thickening), coracohumeral, transverse humeral
Movements: flexion, extension, abduction, adduction, medial rotation, lateral rotation, circumduction
Associated bursae: subtendinous bursa of subscapularis, subacromial (subdeltoid), around other tendons associated with joint
Important factors enhancing stability : the rotator cuff muscles, coraco-acromial arch
Blood supply: branches of anterior and posterior circumflex humeral and suprascapular
Innervation: branches from posterior cord of the brachial plexus, suprascapular, axillary, lateral pectoral
Glenohumeral ligamnets
capsular ligamnets
three sets of fibres:
-superior
-middle
-inferior
reinforce the anterior part of the joint capsule
Coracohumeral ligament
capsular ligament
base of the coracoid process to anterior aspect of greater tubercle
Transverse Humeral Ligament
Superior end of the inter-tubercular groove
Bridges the gap between greater and lesser tubercles
Holds the tendon of ling head of biceps brachii in the inter-tubercular groove
Coracoacromial Arch
coracoacromial ligament (accessory) + coracoid process + acromion = osseofibrous bridge
Protective arch superior to head of humerus
Prevents superior dislocation of the shoulder
Bursae
- Subscapular bursa
- Tendon of subscapularis and neck of scapula, fibrous capsule
- Communicates with joint cavity - Subacromial bursa (subdeltid bursa)
- Deltoid, CA arch, supraspinatus, and fibrous capsule
- Does not normally communicate with joint cavity
Stability of the shoulder joint
Bones (articular surfaces)
Ligaments
Muscles
Shoulder dislocation
- Anterior dislocation
- Posterior dislocation
Scapulothoracic “Joint”
- Elevation and depression
- Protraction and retraction
3.Upward and downward rotation
Muscles of shoulder region includes
- Muscles moving the arm
- Muscles moving the scapula
Muscles moving the arm at the shoulder region
- Pectoralis major
- Latissimus dorsi
- Deltoid
- Supraspinatus
- Infraspinatus
- Teres major
- Teres minor
- Subscapularis
- Serratus anterior
- Biceps
- Coracobrahcialis
- Triceps (long head)
Muscles moving the scapula at the shoulder region
- Serratus anterior
- Pectoralis minor
- Levator scapulae
- Rhomboid major and minor
- Trapezius
- Subclavius
Anteriorly you would find the following muscles
Pectoralis major
pectoralis minor
subclavius
anterolateral you would find the following muscles
serratus anterior
laterally you would find
deltoid
posteriorly you woud find
trapezius
levator scapulae
rhomboid minor
rhomboid major
latissimus dorsi
supraspinatus
infraspinatus
teres minor
teres major
subscapularis
Pectoralis Major
Origin: clavicular head; anterior surface of medial half of clavicle; sternocostal head; anterior surface of sternum, first 7 costal cartilages, sternal end of 6th rib, aponeurosis of external obliques
Insertion: lateral lip of intertubercular sulcus of humerus
Innervation: lateral and medial pectoral
Action: flexion, adduction, medial rotation of the arm
Pectoralis minor
origin; anterior surface ribs 3-5
insertion: coracoid process
innervation: medial pectoral nerve
action: stabilises and protracts scapula
subclavius
origin: rib 1 at costochondral junction
insertion: groove on inferior surface of middle third of clavicle
innervation: nerve to subclavius
action: pulls clavicle medially for stabilisation
Poland Syndrome
Serratus anterior
origin: lateral surfaces of upper 8-9 ribs
insertion: costal surface on medial border of scapula
innervation: long thoracic nerve
action: protraction and rotation of the scapula
winged scapula
deltoid
origin: inferior edge of spine of scapula, acromion, anterior border of lateral third of clavicle
insertion: deltoid tuberosity of humerus
innervation: axillary nerve
action: abduction of arm, flex and extend, medially and laterally rotate arm at the shoulder joint
trapezius
origin: superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of C7-T12 and supraspinous ligaments
insertion: superior edge of spine of scapula, acromion, posterior border of lateral third of clavicle
innervation: accessory nerve (CNXI) and C3-4
action: elevate, depress, retract and rotate scapula
testing accessory nerve
levator scapulae
origin: transverse processes C1-4
insertion: medial border of scapula from superior angle to root of spine
innervation: dorsal scapular nerve, C3-4
action: elevates scapula
rhomboid minor
origin: ligamentum nuchae and spinous processes C7-T1
insertion: medial border at root of spine
innervation: dorsal scapular nerve
action: elevates and retracts scapula
rhomboid major
origin: spinous processes T2-5
insertion: medial border from spine root to inferior angle
innervation: dorsal scapular nerve
action: elevates and retracts scapula
latissimus dorsi
origin: spinous process of lower 6 thoracic vertebrae and interspinous ligs, thoracolumbar fascia to spinous processes of the lumbar vertebrae and interspinous ligs, iliac crest, lower 3-4 ribs
insertion: floor of intertubercular sulcus
innervation: thoracodorsal nerve
action: adduction, medial rotation, extension of the arm at the shoulder
supraspinatus
origin: supraspinous fossa
insertion: superior facet of greater tubercle of the humerus
innervation: suprascapular nerve
action: abduction of arm, RCM
infraspinatus
origin: infraspinous fossa
insertion: middle facet of greater tubercle of humerus
innervation: suprascapular nerve
action: lateral rotation of arm ,RCM
teres minor
origin: upper 2/3 of lateral border of scapula
insertion: inferior facet of greater tubercle of humerus
innervation: axillary nerve
action: lateral rotation of arm, RCM
Teres major
origin: inferior angle of scapula
insertion: medial lip of intertubercular sulcus
innervation: inferior subscapular nerve
action: medial rotation and extension
subscapularis
origin: subscapular fossa
insertion: lesser tubercle of the humerus
innervation: upper and lower subscapular nerves
action: medial rotation of arm at the shoulder joint, RCM
Rotator Cuff Muscles
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
scapular-humeral mechanism
for ever 3 degrees of abduction, a 2 degree abduction occurs in the shoulder joint and 1 degrees occurs by rotation of the scapula. at ~ 120 degrees of abduction the greater tuberosity of the humerus hits the lateral edge of the acromion. elevation of the arm above the head is accomplished by rotating the humerus and scapula
axilla
formed by clavicle, scapula, upper thoracic wall, humerus and related muscles
Contents of Axilla
proximal parts of biceps brachii and coracobrachialis
axillary artery and its branches
axillary vein and its tributaries, including the cephalic vein
brachial plexus
lymph nodes
axillary process of the mammary gland
