week 3 movement Flashcards
to what point is your arm?
from your shoulder to your elbow
What point is your forearm?
from your shoulder to your hand
what is your axillia?
your arm pits
what is important about Cubital fossa ?
region above your elbow where you take blood
what are the two components of the pectoral grindle?
scapula and clavicle
what is another name of the shoudler joint and what is its positioning?
glenohumeral joint and Located between glenoid fossa of scapula and head of humerus
what does the glenohumural joint hold?
holds the upper limb to the trunk of the body
how is the pectorial grindle completed anteriorly?
completed by the manubrium-> clavicle articulates with the mandibular of the sternum –> sternoclavicular joint
is the pectorial grindle compeleted anteriorly or posteriorly?
anteriorly
what is the sternoclavicular joint?
where the pectoral girdle forms a bony attachment with the trunk of the body only bony attachment
what muscles are involved in stabilising the scapula by attatching it to the trunk?
Rhomboids (major and minor)
Levator scapulae
Trapezius
Serratus anterior
what are the three pairs of movements of the pectorial grindle?
elevation/depression
protraction/retraction
upwards rotation (lateral) and downwards rotation ( medially)
what is the origion insertion and function of the upper fibres of the trapezius?
Origin: external occipital protuberance, superior nuchal line, ligamentum nuchae & spinous process of 7th cervical vertebrae
Insertion: lateral 1/3 of clavicle and acromion process
Function: Elevate scapula
what is the origion insertion and function of the middle fibres of the trapezius?
Origin: spinous process of 1st - 5th thoracic vertebrae; Insertion: superior border of spine of scapula (lateral 2/3)
Function: Retract scapula
what is the origion insertion and function of the inferior fibres of the trapezius?
Origin: spinous process of 6th to 12th thoracic vertebrae; Insertion: medial 1/3 of spine of the scapula
Function: Depress scapula
what is the innervation of the upper, middle and lower fibres of trapezius?
Motor: Accessory nerve (CNXI
what is the origion, insertion. innervation and function of levator scapulae?
Origin: Transverse processes C1-C4
Insertion: medial border of scapula superior to root of spine
Function: elevate scapula and rotates scapula medially (downwards)
innervation : dorsal scapular nerve (C5)
what is the origion, insertion, innveration and function of Rhomboid major and minor
Origin: Minor – spinous processes C7-T1
Major – spinous processes T2-T5
Insertion: Minor – medial border of scapula at level of spine
Major – medial border of scapula inferior to level of spine
Function: retract the scapula medially and superiorly. Used in squaring the shoulders
innervation: dorsal scapular nerve (C5)
what is the origion, insertion, innveration and function of serratus anterior?
Origin: Ribs 1-8
Insertion: Medial border of scapula
Functions:
Protracts scapula (with pectoralis minor) hence sometimes called the “boxers muscle”
Rotates scapula laterally (inferior portion)
Essentially holds scapula flat against the thoracic wall
Innervation: long thoracic nerve (C5-C7
how do you get winged scapula
it is caused by damage to the long thoracic nerve –>
the medial border and inferior angle of the scapula moves away from the posterior thoracic wall
what are potential causes of winged scapula?
Penetrating injuries when arm abducted e.g. knife wound
Accidentally e.g. insertion of chest drain, during breast surgery (iatrogenic)
Neuritis (inflammation of the nerve)
describe the glenohumeral joint?
between the head of the humerus and the glenoid fossa of the scapula
with what percentage of the head of the humurus does the glenoid fossa contract with?
1/3rd of the humerus
does the gelnoid fossa and humerus fit well?
No the fossa is a shallow depression and the humerus does not connect proeprly and therefore get a lot of flexibility and the weakest point is inferiorly
how is the stability of glenohumeral joint improved?
Glenoid labrum
Ligaments,
Biceps tendon,
Rotator cuff muscles
name the 3 glenohumeral ligaments?
superior, middle and inferior glenohumeral ligaments
what is the coracohumeral?
from the humorous to the scapula ( projection to the front which is coracoid process )
what makes the Coraco-acromial arch?
acromion process, coracoid process and the coracoacromial ligament
why is the Coraco-acromial arch important?
prevents superior dislocation –> superior support
what is bursa?
it is a synovial fluid filled sac that reduces the friction between the tissues and bones
what is the importance of Subscapular bursa?
reduces the friction between the bursa and the carcoid process
what ist he importance of Subacromial bursa?
it reduces the friction bteween the bursa and acromial process
what is the significance of inflammation and damage of the bursa?
causes pain and limits movement of the joint, the subacromial bursa is usually affected –> subacromial bursitis. Inflammation of the bursa can lead to calcification –> calcification bursitis –> stones–> painful
what is the painful arc syndrome?
typical develops in males over 50
caused by inflammation after excessive use of glenohumeral joint
very painful between 50-130° of abduction – painful arc
subacromial bursa is in contact with the inferior surface of thea acromion
what does the pain reduce after 130 degrees in the painful arc syndrome?
the rotation of the scapula relieves pressure of the subacromial bursa
name the 4 rotator cuff muscles
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
what do the rotator cuff muscles do?
stabalise the joints –> Tendons act as a “ligament”
keeping head of humerus
pressed into glenoid fossa
what three of the rotator cuff muscles visible on the back of the scapula and what do they attatch to?
suprasinatus
teres minor
infraspinatus
attatch to the greater tubercle
what is the subscapularis attached too?
the lesser tubercle
what is the action, origin, innervation and test of Supraspinatus?
Origin: Supraspinous fossa of scapula
Action: Initiates abduction of arm (first 15°)
Stabilize glenohumeral joint
Innervation: Suprascapular nerve
Test: Abduct arm against resistance (from 0°)
what is the action, origin, innervation and test of infraspinatus?
Infraspinatus
Origin: Infraspinous fossa of scapula
Action : Lateral rotator of humerus
Stabilize glenohumeral joint
Innervation: Suprascapular nerve
Test: Laterally rotate arm against resistance
(With elbow flexed and arm adducted)
what is the action, origin, innervation and test of teres minor?
Teres minor
Origin: Middle part of lateral border of scapula
Action: Laterally rotates and adducts humerus (with infraspinatus)
Stabilize glenohumeral joint
Innervation: Axillary nerve
Test: Same as infraspinatus
what is the action, origin, innervation and test of subscapular neve?
Subscapularis
Origin: Subscapular fossa
Action: Medial rotator and adductor of humerus
Stabilizes glenohumeral joint
Innervation: Upper and lower subscapular nerves (C5-C6).
Test: Place the dorsum of hand to the mid-lumbar spine, then lift the dorsum of the hand off of the back.
does teres major contribute to the rotator cuff muscle?
no it does not
what is the action, origin, innervation and test of teres major?
Origin: Inferior angle of scapula
Insertion: Medial lip of intertubercular of humerus
Function: Adducts and medially rotates humerus
Innervation: Lower subscapular nerve (C5 – C6)
what is rotator cuff tear?
when one or more of the tendons rupture commonly supraspinatous tendon. Symptoms is pain and weakness when arm is above the head
how do you test for rotator cuff tear?
you life the arm above the head and ask for it to be moved slowly down. When the arm reaches 90 degrees it will fall suddenly –> this is mainly a test of supraspinatous tendon
what is the usual cause of dislocation of the glenohumeral joint?
Most often seen in young adults
Usual cause: excessive extension and lateral rotation of humerus
what is the most common direction of glenohumeral dislocation?
95% –> anteroinferior direction –> movement of the fossa
how can the axillary nerve get damaged during glenohumeral dislocation?
it occurs in 3%. Due to the axillary nerve wrapping around the inferior border of the glenohumeral joint –> neck of the humures –> stretch and damage the nerve
what muscle is affected by the damage of axillary nerve?
the deltoid muscle is affected –> will get atrophy and wastage of the muscle –> flattened muscle
give examples of shoulder movement
flexion/extension
adduction/abduction
medial roation and lateral roation
put them all together circumduction
why is supraspinatous important for abduction?
it initates the first 10-15 degress of abduction
What role does deltoid muscle take place in abduction?
it is strong enough to move the arm above the head
what muscles are invovled when the arm is abducted greater than 90 degrees and what is the action?
Laterally rotate humerus
teres minor
- Rotate scapula laterally
trapezius
serratus anterior
As well as the deltoid muscle
what is the consequence of paralyzed Supraspinatus ?
In this case patient can produce first 10-15 degrees of abduction by leaning to one side and letting joint abduct passively
what is the consequence of paralyzed deltoid ?
Cannot go above 90 as deltoid is strong abducted muscle
what are the boundaries of quadrilateral space?
Lateral – surgical neck of humerus
Medial - long head of tricpes brachii
Inferior – Teres major
Superior – Teres minor
what is the content of the quadrilateral space?
the axillary nerve and
posterior circumflex artery and vein
what is the Quadrangular Space Syndrome?
growth of fibrous bands in the space –> will damage the nerve –> get pain and weakness of the delta muscle –> also block the posterior circumflex artery –> parasethesia of the arm/hand
what muscles are involved in the elevation of the pectoral girdle?
trapezius ( superior), levator scapula, rhomboids
what muscles are involved in the depression of the pectoral girdle?
trapezius (inferior), latimuss dorsi, serratus anterior, pectoralis minor and major, gravity
what muslces are invovled in the protraction of the pectoral girdle?
serratus anterior, pectoralis minor and major
what muscles are invovled in the retraction of the pectoral girdle?
latimuss dorsi, trapezius ( middle) and rhomboids
what muscles are invovled in upwards rotation (lateral) of the pectoral girdle?
trapezius inferior and superior, seratus anterior
what muscles are invovled in downards rotation (medial) of the pectoral girdle?
levator scapula, latismuss dorsi, rhomboids, pectoralis minor and major and gravity
what is the glenoid fossae/cavity surrounded by?
glenoid labrium
what is the acromioclavicular joint?
joint between the acromion process of the scaupula and the clavicle
what happens when there is damage to the axillary nerve?
deltoid atrophy
how is the axillary nerve damaged?
by inferior dislocation of the glenohumeral joint –> 3%
what is the symptoms of damage to the axillary nerve –> deltoid atrophy?
prominant acromion process
prominant humeral head
flattened shoulder
what are all the terminal branches of the brachial plexus?
musculocutaneous ulna radial median axillary
what is the nerve root for musculocutaneous?
C5-C7
what is the nerve root for median nerve?
C6-T1
what is the nerve root for axillary?
C5-C6
what is the nerve root for ulna?
C7-T1
what is the nerve root for radial?
C5-T1
how is subscapularis paralyzed ?
by scapula fracture
how is deltoid mscle parlayzed?
by shoulder dislocation -> surgical neck of the humerus is fractures and this damages the axillary nerve –. C5-C6
what ribs does the scapula sit between?
the 2nd and 7th rib
what positions can the inferior angle of the scapula move?
because of the free movement of the scapula over the chest wall –> inferior angle can be moved lateral and cranially from the anatomical possition
where doe the long head of the bicep attach to on the scapula?
the supraglenoid tubercle
what attaches to the infraglenoid tubercle on the scapula?
the long head of the tricep
what does the long head of tricep brachi attach to on the scapula?
infraglenoid tubercle
which compartment of the flexor and extensor attach to the scapula ?
long head of bicep brachii
long head of tricep
what is the lateral border of the axillia?
the intertubercular sulcus
what is the medial border of the axillia?
rib 4, serratus anterior and upper thoracic wall
what is the anterior border of axillia?
pectoralis minor and major, subclavius and clavicopectorial fascia
what is the posterior border of axillia?
teres major, latismuss dorsi, subscapularis and scapula
what is the inferior border of axillia?
the skin and fascia of armpit
what is the route in which the neurovascular bundle enters the arm?
via the apex of the axillia after running between the 1st rib and clavicle?
what does the neurovascular bundle contain?
the brachail plexus, axilliary artery and vein, lymph nodes
what is the importance of the lymph nodes passing through the axillia?
they drain around 75% of the lymph in the breast
of the 75% of draining of the breast by lymph node what group of nodes is mainly drained?
anterior pectoral group drains most of the 75% but there is posterior pectorial, central and apical nodes.
what part of the breast is drained by the pectoral lymph nodes?
the lateral part of the breast
what part of the breast is drained by the central lymph nodes?
the tail of the breast and collects lymph from other groups
what part of the breast is drained by the apical lymph nodes?
recieves lymph from all other groups and sits in the apex of the axilla
