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Clinical Anatomy > 3.2 Shoulder Complex > Flashcards

3.2 Shoulder Complex Flashcards

1
Q

Resting Scapula Position

A
  • Medially rotated (30 to 45 from Coronal Plane)
  • Anteriorly tilted (10 to 20 from vertical plane)
  • Superiorly rotated (5 to 10 from longitudinal axis)
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2
Q

Normal resting position of GH Joint

A

Slight retroverted humerus (head points slightly posterior and medially and superiorly) centers humeral head against glenoid cavity, aligned with scapula axis

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3
Q

Retroverted humerus

A

head faces more posterior, two dots closer

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4
Q

Anteverted humerus

A

head faces more anterior, greatest gapping of dots

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5
Q

GH Reinforcement

A

Capsule, and Reinforcing ligaments

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6
Q

GH capsule

A
  • strength of capsule changes with age

- older pt., thinner joint capsule

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7
Q

GH capsule limits…

A

anterior/inferior and some posterior translation

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8
Q

Reinforcing ligaments

A
  • Glenohumeral ligament
  • Coracohumeral ligament
  • Biceps Brachii Long Head
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9
Q

GH Ligament

A

decreases lateral rotation

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10
Q

Coracohumeral ligament reinforces…

A

reinforces superior pt of capsule

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11
Q

Biceps Brachii Long Head Origin-

A

O- supraglenoid tubercle (scapula)

  • fibers blend with SUPERIOR GLENOID LABRUM
  • functions to stabilitze GHJ (prevents superior glide of humeral head)
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12
Q

+Adhesive Capsulitis

A

Frozen shoulder syndrome

-Stiff, painful GHJ- results in loss of mobility

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13
Q

Adhesive capsulitis sx:

A
  • may last months to 2 years
  • 3/4 stages
    1) Painful (freezing) Stage
    2) Frozen stage
    3) Thawing Stage
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14
Q

Adhesive capsulitis stage 1

A

Painful (Freezing) Stage ( couple weeks to 9 months)
-Pain both passive & active
>Palpation, ext. rotation & Abd (&flexion?)
-synovitis; SITS Tendinitis?

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15
Q

Ad. capsulitis st. 2

A 
Frozen stage (4-6 months)
-pain resolving
-stiffness; poor Scapulohumeral rhythm
-Dec. ROM
(P at night , ROM much worse than st. 1 and not as painful)
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16
Q

Ad. capsulitis st. 3

A

Thawing Stage (6month-2 years)

  • improvement
  • end capsular feel for them, NO ROM
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17
Q

Causes of Ad. Cap.

A
  • etiology unknown
  • capsule thickens & tightens, adhesions formed
  • prolonged immob. (more likely to get Ad. Cap.)
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18
Q

Risk Factors of Ad. Cap.

A
  • Women (~70%)- 20-30% will repeat in other shoulder
  • 40+ years
  • stroke, mastectomy
  • diabetes; hypo/hyperthyroidism
  • TB; CVD; Parkinson’s
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19
Q

TX of Ad. Cap.

A
  • NSAIDS; Narcotics (Dec. P to mobilize Jt.)
  • PT
    • Inc. ROM
    • Tensile Stresses (Inc. fiber length to provide more mob.)
  • Injections
    • Steroids (chemical ablation): early intervention!
    • Joint Distension (Sterile H20)
  • Surgery RARE
    • closed manipulation
    • arthroscopic (remove adhesions and scar tissue)
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20
Q

SLAP Labral Tear

A

Superior Labrum Anterior and Posterior Tear

  • Superior labrum attached to Biceps Brachii Long Head Muscle
  • Named for regions of Labral tears
    • Superior labrum (tears on either side of attachment, both anterior and posterior to attachment)
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21
Q

Causes of SLAP labral tear

A
  • car accident/acute trauma
  • fall on outstretched arm
  • overuse & repetitive overhead activities
  • dislocation
  • over 40 y.o. (normal aging wear and tear)
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22
Q

SLAP sx

A
  • locking, popping, grinding
  • pain w movement
  • pain w elevation overhead
  • reduced strength in shoulder and ROM
  • guarding
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23
Q

SLAP tx

A
  • NSAIDS
  • PT
    • restrengthen stabilizing muscles, stretching, ROM
  • Surgery
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24
Q

Muscles of Shoulder Complex

A

Scapulohumeral Muscles (intrinsic)

Anterior Axio-appendicular Muscles

Posterior Axio-appendicular Muscles (extrinsic)

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25
Q

Scapulohumeral Muscles (intrinsic)

A

Scapulohumeral Muscles (intrinsic)

  • O: clavicle &/or scapula
  • I: humerus
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26
Q

Anterior Axio-appen. Muscles

A

Anterior Axio-appendicular Muscles

  • O: clavicle, sternum &/or anterior ribs
  • I: girdle or humerus
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27
Q

Posterior Axio-appendicular Muscles (extrinsic)

A

Posterior Axio-appendicular Muscles (extrinsic)
O: vertebrae &/or Cranium
I: girdle or humerus

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28
Q

Glenohumeral Reinf.

A

Scapulohumeral (Intrinsic) Muscles

  • Deltoid Muscle
  • Teres Major Muscle
  • Rotator Cuff muscles (SITS)
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29
Q

Scapulohumeral (intrinsic) muscles:

1. Deltoid Muscle (_, _)

A

Deltoid (C5,6)

  • Acts as “shunt” muscle to stabilitze GHJ
    - prevents downward pull
  • Deltoid pull= long axis of humerus
    • can’t abduct when fully adducted (for first 15 degrees)
  • Needs supraspinatus muscle to abduct first 15 deg, then deltoid can abduct
  • ant/post fibers= fixators
  • performs all movements possible (everything)
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30
Q

Scapulohumeral (intrinsic) muscles:

2. Teres Major Muscle (_, _)

A

Teres Major (c5,c6)

  • thick muscle
  • combines w latissimus dorsi m. at insertion
  • forms part of posterior axillary fold
  • O: at thick scapular inferior angle (post. surface)
  • I: Medial border of intertubercular groove
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31
Q

N. to deltoid mm.

A

axillary n.

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32
Q

N. to teres major mm.

A

lower subscapular n.

33
Q

SITS muscles

A
  • tendons form fibrous “cuff” over humeral head
  • ROTATORS of the humerus (fibers of GHJ capsule blends with fibers of rotator cuff tendons
  • main stabilizers for GHJ (both at rest and during movement
34
Q

Supraspinatus mm. (,,_)

A

C4, C5, C6
O: supraspinous fossa
I: greater tubercle of humerus
A: -abduct humerus first 15 deg. for deltoid
-stabilize humeral head and prevents inferior glide of humerus (opposite of all other SITS muscles) because all others prevent superior glide

35
Q

N. to supraspinatus muscle (,,)

A

c4, C5, c6 suprascapular n.

36
Q

Infraspinatus mm. (,,_)

A 
c4, C5, c6
O: infraspinous fossa
I: Greater tubercle of humerus
A: -externally rotate humerus 
-stabilitze humeral head
-prevents superior glide, when flexed
37
Q

Teres minor muscle (,)

A 
C5, c6
O: middle lateral border of scapula 
I: greater tubercle of humerus
A: externally rotates humerus, and weak adductor
-stabilize humeral head
38
Q

Subscapularis mm. (,,_)

A

c5, C6, c7
O: subscapular fossa
I: LESSER tubercle of humerus
A: adducts & internally rotates humerus (only one)
-stabilize humeral head
-prevents superior glide of humerus when flexed or abducted

39
Q

N. to subscapularis mm.

A

c5, C6, c7

Upper and lower subscapular n.

40
Q

Rotator Cuff Tear+

A

Tearing one of the SITS muscles

  • insertion on tubercles- supraspinatus mm is MOST common!
  • Tears- Forms Hole:
    • partial tear
    • full thickeness tear (complete tear off insertion)
41
Q

Sx of rotator cuff tear:

A
  • P at rest and motion
  • weakness & P raising arm overhead, AB- or ADduction, or rotating
  • crepitus or crackling when moving
  • arm drop test!
42
Q

Causes of rotator cuff tear:

A
  • Acute Tear
    • trauma
  • Degenerative Tear
    • repetitive use injury
    • aging
      • avascular necrosis
      • osteophyte fraying (bone spurs)
43
Q

Tx of Rotator Cuff Tears

A
  • Non-surgical (~50%)
    • NSAIDS
    • PT (maintain ROM, and strengthen)
    • steroid injections dec. inflamm.
  • Surgery
    • only way to return strength or prevent increase in tear size
44
Q

Humeral Head Dislocation +

A

Dislocation due to:

  • sports injuries
  • car/motorcycle accident trauma
  • falls
  • FORCED:
    • abduction
    • extension
    • external rotation
45
Q

Population affected by humeral head dislocations

A
  • high energy dislocations:
    • males, late teens early 20s
  • low energy dislocations:
    • elderly
46
Q

Humeral head dislocations may occur w/

A
  • avulsion of G. tubercle

- no superior and medial pull from missing mm.

47
Q

Humeral head dislocations may spontaneously relocate with …

A

too much laxity

48
Q

What prevents superior dislocation of humeral head?

A

coracoacromial arch

49
Q

Anterior dislocation (95-98%)

A
  • subcoracoid- most common (front bulge)
  • subglenoid
  • subclavicular
  • intrathroacic- very rare
50
Q

Posterior dislocation occurs in…

A

-4% very rare!

51
Q

Direct Inferior occurs in…

A

-1%!

52
Q

most dislocations will be…

A

anterior and inferior!!

53
Q

humeral head dislocation tx:

A
  • closed reduction—-turn it medially and slowly!
  • immobilization for ~6 weeks
  • PT- to strengthen stabilizing SITS
  • Surgery:
    • open- “capsular shift”
    • arthroscopic *heat
  • high risk of repeated dislocations or subluxations!
    • MDI (sulcus sign)
54
Q

MDI=

A

multidirectional instability

55
Q

Anterior Axioappendicular Muscles (thoracoappendicular/pectoral muscles)

A
  1. pectoralis major
  2. pec minor
  3. subclavius mm.
  4. serratus anterior mm.
56
Q

Pectoralis Major

A

c5, C6, C7, C8, t1

  • 3 heads
    • clavicular head (girdle to forearm)
    • sternocostal head (Rafi)
    • abdominal head (not in everyone)
  • forms anterior axillary fold!!
57
Q

with deltoid mm. pectoralis major forms…

A
  • Deltopectoral groove
    • cephalic vein
  • Clavipectoral triangle
    • palpate coracoid process here!!
58
Q

Deltopectoral groove holds…

A

cephalic vein!

59
Q

Pectoralis minor mm. (c8, t1)

A
  • mostly covered by pec major mm.

- anterior border of cervicoaxillary canal (brachial plexuas and BV lie posterior)

60
Q

subclavius mm. (,)

A

C5, c6

  • runs horizontally
  • ACTS TO depress and stabilize clavicle
  • protects-
    - subclavian a/v & brachial plexus
    - ensheathed in clavipectoral fascia
61
Q

n. to sublavius mm.

A

subclavius n.

62
Q

Serratus anterior mm. forms…

A

medial wall of axilla (thoracic cage)

-extremely!! strong protractor

63
Q

Serratus anterior also known as

A

boxer’s muscle- used when punching fwd

64
Q

serratus anterior acts as a

A
  • inferior fibers important in upward rotation of scapula (?)
  • anchor for scapula
    - holds flat against thorax
    - important for pushing against resistance!
65
Q

paralysis of serratus anterior mm. +

Testing-

A 
Testing- serratus anterior mm.
long thoracic nerves
   -flex arm
   -press against wall or resistance
   -should be able to palpate digitation at lateral thoracic wall
66
Q

if weak serratus anterior mm.

A

pronounced winging! - medial border!

67
Q

paralysis of serratus anterior mm. damage to the ….

A

LONG THORACIC N.

  • Causes:
    • usually due to trauma or injury to lateral thoracic wall
      • stabbling, car accident, thorocotomy, etc.
    • post-infectious neuritis (n. could be damaged)
    • abnormal pressure on n.
      - sports, anatomical structures, etc.
    • mastectomy
    • idiopathic
68
Q

sx of paralysis of serratus anterior mm.

A
  • scapula
    - medial border “winging”
    • anterior tilting (inferior angle protrudes)
  • shoulder drop
    - stretched middle and lower trapezius fibers
  • weak and reduced abduction and flexion
69
Q

posterior axioappendicular mm.

  • superficial posterior extrinsic mm.
  • deep posterior extrinsic mm.
A
  • trapezius m. (superficial)
  • latissimus dorsi m. (superficial)
  • levator scapulae m. (deep)
  • rhomboid major m. (deep)
  • rhomboid minor m. (deep)
70
Q

Superficial posterior extrinsic mm.

Trapezius mm. (,)

A

c3,c4

  • directly attaches the girdle to the trunk
  • act “scapulothoracic joint”
  • has 3 parts
71
Q

3 parts of trapezius mm.

A
  1. descending fibers
    - mainly attached to ligamentum nuchae
  2. middle fibers
    - upper thoracic spinous process
  3. ascending fibers
    - lower thoracic spinous process
72
Q

n. to trapezius mm.

A

c3, c4
Accessory nerve (CN XI)- motor
C3 and C4- somatic sensory

73
Q

Latissimus Dorsi mm (c6,c7)

A
  • “widest of the back”
  • trunk to humerus
    - acts on GHJ
  • Action:
    • extends, adducts, & medially rotates humerus
    • retracts shoulders
    • some downward rotation of the scapula, thru adduction of humerus
74
Q

N. to latissimus dorsi m.

A

thoracodorsal n.

75
Q

Posterior axioappen. mm. (deep posterior extrinsic mm.)

-Deep are innervated by…

A
  • DEEP posterior extrinsic mm. are innervated by
    • dorsal scapular n.
  • Directly attach scapula to axial skeleton**
76
Q

Levator scapulae mm. (c4, c5)

-Action

A

Primary:
-Elevates scapula
-rotates w/ other mm.
-Extend and laterally flex cervical vertebrae
Secondary:
-Fix scapula (resists depression when carrying load)

77
Q

Rhomboid mm. (c4,c5)

are important in…

A

rhomboids are important in preventing winging

-fix scapula in forced extension (hammering, pull ups, etc.)

78
Q

Rhomboid minor location:

A

superior

79
Q

Rhomboid major location:

A

inferior; 2x larger

Clinical Anatomy (8 decks)

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