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MSK > Week 7 > Flashcards

Week 7 Flashcards

1
Q

The scapula is an irregular bone (commony reffered to as the shoulder blade). It sits behind the ribcage and thus its ‘costal’ surface is the anterior one facing the ribcage. What are it’s two major articulations?

A

The humerus (at the glenohumeral joint) and the clavicle (at the acromioclavicular joint)

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2
Q

On its costal (anterior) surface it has the subscapular fossa, what muscle originates from here?

A

The subscapularis

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3
Q

Be able to describe the osteology of the scapula, this is important and not something i can really test on brainscape

A

T

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4
Q

3 muscles originate/insert onto the coracoid process of the scapula. What are they?

A

Insert - Coracobrachialis, pectoralis minor

Originate - short head of the biceps brachii

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5
Q

The coracoid process and the acromium are both processes of the scapula, which is anterior and which is posterior?

A

Coracoid process - anterior

Acromium - posterior

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6
Q

Three important bony landmakrs on the LATERAL border of the scapula are the glenoid fossa, the supraglenoid tubercule and the infraglenoid tubercule. Describe their relevance

A

Glenoid fossa - The site of the glenohumeral joint where the humerus attaches
Supraglenoid tubercule - origin of the long head of the biceps brachii
infraglenoid tubercule - origin of the long head of the triceps brachii

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7
Q

On the dorsal surface of the scapula we have the spine, the supraspinous fossa and the infraspinous fossa. What muscles originate from these fossa?

A

Supraspinous fossa - Supraspinatus

Infraspinous fossa - Infraspinatus

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8
Q

Fractures of the scapula are rare but if they do occur they are indicative of severe chest trauma, give a likely mechanism of injury

A

RTA/crushing injuries/high impact sport injuries

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9
Q

The clavicle extends from the manubrium of the sternum to the acromium of the scapula. Give two of its three major function

A

Attches the upper limb to the trunk/protects the neurovasculature supplying the upper limb/transmits fores from the upper limb to the axial skeleton

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10
Q

The medial end of the scapula is referred to as the _____ end whilst the lateral end is referred to as the _____ end

A

sternal/acromial

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11
Q

The sternal end of the clavical articulates with the manubrium of the sternum. There is a small depression in the acromial end that serves as an attachment point for the two parts of the coracoclavicular LIGAMENT, this acts to strengthen the acromioclavicular joint. What are the two parts of this ligament called

A

Conoid ligament and the trapezoid ligament

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12
Q

There is one extrinsic and one intrinsic ligament that strengthens the acromioclavicular joint. Name them

A

Intrinsic - Acromioclavicular ligament

extrinsic - coracoclavicular ligament

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13
Q

The sternoclavicular joint is a very strong but also very mobile joint it permits many movemetns of the shouler. Name three that require it

A

Abduction of the arm over 90 degrees/ depression of the shoulders/protraction of the shoulders/ retraction of the shoulders/rotation of the shoulder

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14
Q

What is the shoulder joint known as anatomically?

A

The glenohumeral joint

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15
Q

Again, be able to identify the osteological features of the humerus. It will be hard to examine on here

A

T

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16
Q

The humeral head faces medially and is separated from the greater and lesser tubercules by the ___ ___

A

anatomical neck

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17
Q

The greater tubercule is ____ and the lesser tubercule is ____.

A

posterolateral/anterior

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18
Q

The greater and lesser tubercules are key because they are the insertion points of the rotator cuff muscles. What are these and which tubercules do they insert on to?

A

Greater tubercule - supraspinatus, infraspinatus and teres minor
Lesser tubercule - Subscapularis

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19
Q

Between the humeral tubercules is the intertubercular sulcus, what runs through this groove?

A

The tendon of the long head of the biceps brachii muscle

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20
Q

The intertubercular sulcus has lateral and medial lips. The muscles which insert on to this region can be remembered by the saying ‘A lady between two majors’, explain.

A

Lateral lip - Pec major inserts
Intertubercular sulcus - Latissimus dorsi inserts
Medial lip - teres major inserts

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21
Q

the surgical neck of the humerus lies at the bottom of the intertubercular sulcus much lower than the anatomical neck. It is a frequent site of fracture usually from shoulder trauma or falling onto an outretches hand. Firstly what two structures are at risk at this site?
Secondly, what will the presentation be?

A

Posterior circumflex artery
Axillary nerve

The patient will find it difficult to abduct the arm (specifically 15-90 degrees cos of deltoid innervation) and also will have impaired sensation over the regimental badge area which is the insertion of the deltoid and thus the area of the skin that the axillary nerve innervates too.

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22
Q

On the lateral side of the humerus here is a roughened surface where the ____ muscle inserts called the ___ tuberosity

A

Deltoid/Deltoid

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23
Q

The radial groove is a shallow groove on the posterior surface of the humerus. What runs in this groove?

A

The radial nerve and the profunda brachii artery

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24
Q

The extrinsic muscles of the shoulder are all sited at the back of the trunk and act on the scapula. They are organised into superficial and deep layers/ Give both compartments

A

Superficial - trapezius and latissimus dorsi

Deep - levator scapulae, rhomboid major, rhomboid minor

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25
Q

The intrinsci muscles of the shoulder all orginate from the ____ and/or clavicle and insert onto the _____

A

scapula/humerus

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26
Q

The rotator cuff muscles all originate from the scapula and attach to the ______ ____.

A

Humeral head

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27
Q

The rotator cuff muscles all have their own functions but collectively pull the humeral head into the glenoid fossa.

A

T

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28
Q

A useful mnemonic to remember where on the humeral head the rotator cuff muscles insert is SSIT

A

Subscapularis - lesser tubercule (medial)

then medially to laterally on the greater tubercule - Supraspinatus, infraspinatus, teres minor

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29
Q

The muscles of the anterior compartment of the forearm can be remembered by the mnemonic BBC - THESE ARE ALL INNERVATED BY THE MUSCULOCUTANEOUS NERVE, what are they

A

Biceps brachii
Brachialis
Coracobrachialis

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30
Q

What test is used to test the C6 myotome?

A

Biceps tendon reflex - should flex at the elbow when tabbed in cubital fossa

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31
Q

A firm lump in the lower part of the arm during flexion called ‘Popeyes sign’ suggests damage to what?

A

Long head of the biceps brachii - usuall no weakness due to action of brachialis and supinator muscles

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32
Q

What myotomes is the triceps tendon reflex used to test for?

A

C7

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33
Q

What enters the arm via the quadrangular space?

A

axiallry nerve and poserior circuflex humeral artery

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34
Q

The brachial artery is the major blood supply to the arm, it becomes the brachial artery from the axillary artery where?

A

At the inferior border of the teres major muscle

35
Q

As soon as the brachial artery is formed it gives off the profunda brachii which runs with the radial nerve in the radial groove of the humerus, what region of the arm does this suply>

A

Posterior arm structures such as the triceps brachii

36
Q

The brachial artery descends in the anterior arm and in the cubital fossa it bfurcartes to form what arteries?

A

Radial and ulnar

37
Q

Where is the brachial pulse palpated?

A

In the cubital fossa, medial to the biceps brachii tendon.

38
Q

The median nerve travels laterally to the brachial artery in the proximal arm but crosses over it to lie medially to it in the distal arm, T/F?

A

T

39
Q

What does the ‘shoudler girdle’ consist of?

A

The clavicle and the sapula - these bones connect the arm to the axial skeleton

40
Q

The shoulder joint is the glenohumeral joint. What are the other joints in the shoulder girdle?

A

Acromioclavicular joint and sternocavicular joint

41
Q

What part of the shoulders joint capsule is the weakest and why?

A

The inferior aspect because it is not reinforced by the rotator cuff muscles

42
Q

The shoulder joint is reinforced (stabilised) by the rotator cuff muscles, glenoid labrum, joint capsule, extrinsic shoulder muscles and also by ligaments what are these?

A

Superior, middle and inferior genohumeral ligaments
coracoclavicular ligament
acromioclavicular ligament

43
Q

What kind of dislocation do the glenohumeral ligaments protect against?

A

Anterior (most common)

44
Q

What are the actions of the transverse humeral ligament and the coracoacromial ligaments?

A

prevent bowstringing of the shouler muscles

45
Q

What are the two bursae in the shoulder?

A

Subacromial/subscapular

46
Q

What are the contents of the subacromial space?

A

Subacromial bursa/suprapinatus tendon/joint capsule/long head of the biceps

47
Q

The subacromial space is very small and thus during abduction there is potentail of trapping its contents leading to inflammation and irritation. What is this called?

A

impingement syndrome

48
Q

Describe each stage of shoulder abduction and what muscles are responsible for each

A

0-15 degrees - supraspinatus
15-90 degrees - deltoid
over 90 degrees - rotation of scapula through serratus anterior and trapezius muscles

49
Q

What muscles are responsible for adduction of the shoulder

A

pec major, lattisimus dorsi, teres major

50
Q

What muscles are responsible for flexion of the arm at the shoulder

A

biceps brachii, coracobrachialis, pec major, anterior fibres of the deltoid

51
Q

What muscles are responsible for extension of the shoulder?

A

Deltoid, lattisimus dorsi

52
Q

What muscles are responsible for medial rotation of the shoulder

A

subscapularis, teres major, pec major, lattisimus dorsi, deltoid anterior fibres

53
Q

What muscles are responsible for the lateral rotation of the shoulder?

A

Infraspinatus and teres minor

54
Q

What becomes the axillary artery?

A

The subclavian artery

55
Q

At what point does the subclavian artery becomes the axillary artery?

A

The lateral border of the first rib

56
Q

The nerve supply to the shoulder joint is all derived from the ____ neve.

A

axillary - other branches involved are suprascapular and lateral pecoral.

57
Q

95% of the time if the shoulder dislocates it does so anteriorly, why is this?

A

Because of a lack of muscles, the head thus dislocates anteroinferiorly

58
Q

How will a patient with an anterior shoulder dislocation present?
The normal mechanism for the first time is a blow whilst the hand is behind the head

A

Laterally rotated and abducted

59
Q

What are two features we may be able to see on an X-ray that commonly occur with an anterior shoulder dislocation

A

Bankart lesion - A part of the glenoid labrum which is commonly torn off in an anterior dislocation of the shoulder (be bale to recognise)

Hills-sachs lesion - a dent in the humeral head as it becomes jammed against the anterior lip of the glenoid fossa

60
Q

Posterior shoulder dislocations are very rare and the underlying cause should be investigated. How does the patient present?

A

Adducted and medially rotated arm (think of it as doing the opposite to what the force has tried to do to it)

61
Q

Give a cause of a posterior shoulder dislocation

Give two injuries posterior dislocations are commonly associated with

A

Lighting strike/epileptic fit/blow to the anterior shoulder

rotator cuff tears/fractures/Hills-Sachs lesions

62
Q

What is the rarest form of shoulder dislocation and give the mechanism of injury

A

Inferior dislocation

Hyperabduction of the arm

63
Q

What is the most common complication of shoulder dislocations and why?

A

Recurrent dislocation - Because of damage to the structures that stabilise the

64
Q

Name three other complications of shoulder dislocation

A

Damage to the axillary artery/damage to the axillary nerve (and thus loss of sensation over the regimental badge area)/fractures/rotator cuff muscle tears

65
Q

Clavicular fractures normally occur from falling onto an outstretched hand, what part of the clavicle is most commonly damaged?

A

Middle 1/3

66
Q

Most clavicular fractures are treated conservatively with a sling. However sometimes surgical fixation is needed. Give two examples of when this might be necessary

A

Completely displacement/Open fractures (broken the skin)/neurovascular compromise/’Floating shoulder’ (Clavicular fracture with fracture of the glenoid neck as well)

67
Q

How will an X-ray look of a displaced mid-clavicular fracture?

A

The medial segment will be elevated because of the sternocleidomastoid muscle. The arm will be adducted because the pec major will be pulling it medially

68
Q

Considering the movements of the bone in a displaced mid-clavicular fracture, what structures are likely to be damaged?

A

Suprascapular and supraclavicular nerves. Supraclavicular has C3,4 roots and thus damage would result in anterior upper chest paraesthesia

69
Q

Rotator cuff tears is a tear in one or more of the tends of the rotator cuff muscles with the supraspinatus being the one most commonly torn. They are normally the result of chronic damage over time most commonly seen in sportspeople with overhead actions. What is the most common symptom?

A

Anterolateral shoulder pain

Also possibly a weakness of shoulder abduction

70
Q

Impingement syndrome is when the supraspinatus tendon impinges (catches) on the coraco-acromial arch during abduction of the arm. What would a patient typically complain of?

A

Pain in reaching up for things/overhead arm movement

71
Q

Calcific supraspinatus tendinopathy is deposits of hydroxyapatite (crystals of calcium phosphate) in the tendon of the supraspinatus. The calcium deposits can actually be seen above the humeral head on an x-ray where it should be black. What mechanical symptoms might patients complain of as a result of the crystal deposit?

A

Stiffness/snapping sensation/catching/reduced range of movement at the shoulder

72
Q

What is adhesive capsulitis or ‘Frozen shoulder’?

A

Inflammation of the capsule of the glenohumeral joint which restricts movement and can cause chronic pain often exacerbated by cold weather or at night

73
Q

The exact cause of frozen shoulder is unknown but give some risk factors

A

Epilepsy with tonic clonic seizures/diabetes/trauma/connective tissue disease/Parkinsons disease/

Note - this can often occur alongside other shoulder problems

74
Q

What is the treatment for frozen shoulder?

A

Physiotherapy/analgesics/NSAID’s/surgical manipulation

75
Q

Osteoarthritis can occur in the shoulder too and shows the same cardinal signs on X-ray. The treatment regime is similar too, what is it?

A

Activity modification (avoiding activities which precipitate symptoms)/analgesia/NSAID’s/steroid injections into the joint/keyhole surgery can be performed to remove loose pieces of damaged cartilage too/shoulder replacement

76
Q

What are the two muscles supplied by the axillary nerve and what area os sensation does it give?

A

Deltoid and teres minor - regimental badge

77
Q

Give the innervations and actions of the rotator cuff muscles

A

Supraspinatus - abducts the arm 0-15 (suprascapular nerve)
Infraspinatus - laterally rotates (suprascapular nerve)
Teres minor - laterally rotates (axillary nerve)
Subscapularis - medially rotates the arm (upper and lower subscapular nerves

78
Q

Spend some time looking at all these muscles on a cadaver to get your bearing

A

t

79
Q 
What muscles 
elevate the scapula
depress the scapula
rotate the scapula in abduction over 90
retract the scapula
protract the scapula
A

elevate - upper fibres of trapezius/levator scapulae
depress the scapula - lower fibres of trapezius, subclavius
retract the scapula - rhomboids and middle fibres of trapezius
protract the scapula - serratus anterior
rotate the scapula in abduction above 90 degrees - middle fibres of trapezius

80
Q

What is the function of the subacromial bursa?

A

To reduce friction between the supraspinatus tendon and the acromium

81
Q

What attaches to the anatomical neck of the humerus?

What is it’s function in childhood?

A

Glenohumeral joint capsule

Marks the border of the growing epiphyseal growth plates

82
Q

What is the coracoaromial arch and what is its function?

A

fored by the inferior border of the acromium and the coracoid process with the coracoacromial ligament spanning it. Acts to prevent anterior dislocation of the shoulder joint

83
Q

What is the ‘painful arc’ and what does it indicate/

A

Pain on the abduction of the arm between 60 and 120 degrees. The pain is referred to the deltoid. Suggests a disorder of the subacromial region so calcific supraspinatus tendonitis or subacromial bursitis

MSK (11 decks)

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