Orthopedic clinical exam (Cleland) Basic Anatomy of TMJ and Shoulder Flashcards Preview

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Flashcards in Orthopedic clinical exam (Cleland) Basic Anatomy of TMJ and Shoulder Deck (58):
1

TMJ: Ligaments (3)

  1. Temporomandibular
  2. Sphenomandibular
  3. Stylomandibular

2

Attachment and function of temporomandibular ligament

  • Temporomandibular- thickening of anterior joint capsule extending from  neck of mandibe to zygomatic arch (strengthens the TMJ laterally)

3

Attachment an function of Sphenomandibular ligament (TMJ)

  • Sphenoid bone to mandible (serve as a fulcrum and reinforcement to TMJ motion)

4

Attachment and function of Stylomandibular ligament (TMJ)

  • Styloid process to angle of the mandible

5

Temporalis muscle (TMJ)

  • Prox- temporal fossa
  • Dist- Coronoid process and anterior ramus of mandible
  • Nerve and segmental level- Deep temporal branches of mandiular nerve
  • Action- Elevate mandible

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Masseter

  • Prox- Inferior and medial aspects of zygomatic arch
  • Dist- Coronoid process and lateral ramus of mandible
  • Nerve and segmental level- Mandibular nerve via masseteric nerve
  • Action- Elevate and protrude mandible

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Medial Pterygoid (TMJ)

  • Prox- Medial surface of lateral pterygoid plate and tuberosity of maxilla
  • Dist- Medial aspect of mandibular ramus
  • Nerve and segmental level- Mandibular nerve via medial pterygoid nerve
  • Action- Elevate and protrude mandible

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Lateral Pterygoid (TMJ)

  • Prox- (Superior head) Lateral surface of greater wing of sphenoid bone/ (Inferior head) Lateral surface of lateral pterygoid plate
  • Dist- Neck of mandible, articular disc, and TMJ capsule
  • Nerve and segmental level- Mandibular nerve via lateral pterygoid nerve
  • Action- Acting bilaterally: protrude and depress mandible. Acting unilaterally: laterally deviate mandible

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Digastric muscle (TMJ)

  • Prox- (Anterior belly) Digastric fossa of mandible/ (Posterior belly) Mastoid notch of temporal bone
  • Dist- Intermediate tendon of hyoid bone
  • Nerve and segmental level- Mylohyoid nerve (anterior) and Facial nerve (posterior)
  • Action- Depresses mandible, raises and stabilizes hyoid bone

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10

TMJ nerves

  1. Mandibular (motor-temporalis, masseter, lateral and medial pterygoid, digastric, mylohyoid/sensory-skin of inferior third of face)
  2. Nerve to mylohyoid (motor- mylohyoid/no sensory)
  3. Buccal (no motor/ sensory-cheek lining of gingiva))
  4. Lingual (no motor/ sensory- anterior tounge and floor of mouth)
  5. Maxillary (no motor/ sensory- skin of middle third of face)
  6. Opthalmic (no motor/ sensory-skin of superior third of face)

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TMJ Exam History: 

Jaw crepitus and pain during mouth opening and closing

  • OA
  • Capsulitis
  • Internal derangement consisting of anterior disc displacement without reduction

12

TMJ Exam History:

Patient reports jaw clicking and pain during opening and closing of the mouth

  • Internal deragement consiting of anterior disc displacement with reduction

13

TMJ Exam History:

Patient reports limited motion to about 20 mm with no joint sounds

  • Capsulitis
  • Internal deragement consiting of an anterior disc displacement without reduction

14

Shoulder joints (4)

  1. Glenohumeral
  2. Sternoclavicular
  3. AC
  4. Scapulothoracic

15

Shoulder:

Closed packed positions

  1. GH- Full abduction and ER
  2. SC- Arm abducted to 90 degrees
  3. AC- Arm abducted to 90 degrees
  4. ST- NA

16

 Shoulder:

Capsular Patterns

  1. GH- ER
  2. SC- NR
  3. AC- NR
  4. ST- NR

17

Shoulder:

Ligaments (8)

  1. Glenohumeral
  2. Coracohumeral
  3. Coracoclavicular (trapezoid & conoid)
  4. Acromioclavicular
  5. Coracoacromial
  6. Sternoclavicular
  7. Interclavicular
  8. Costoclavicular

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Glenohumeral igament (shoulder)

  • Attach- glenoid labrum of humerus
  • Function- reinforce anterior GH joint capsule

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Coracohumeral ligament (shoulder)

  • Attach- Corocoid process to greater tubercle of humerus
  • Function- strengthen superior glenohumeral joint capsule

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20

Coracoclavicular ligament (shoulder)

  • Attach- (trapezoid) superior aspect of coracoid process to inferior aspect of clavicle/ (conoid) coracoid process to conoid tubercle on inferior clavicle
  • Function- Anchor clavicle to corocoid process

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Acromioclavicular ligament (shoulder)

  • Attach- acromion to clavicle
  • Function- Strengthen AC joint superiorly

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22

Coracoacromial ligament (shoulder)

  • Attach- coracoid process to acromion
  • Function- Prevent superior displacement of humeral head

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23

Sternoclavicular ligament (shoulder)

  • Attach- clavicular notch of manubrium to medial base of clavicle anteriorly and posteriorly
  • Function- reinforce SC joint anteriorly and posteriorly

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Costoclavicular ligament (shoulder)

  • Attach- superior aspect of costal cartilage of 1st rib to inferior border of medial clavicle
  • Function- Anchor medial end of clavicle to 1st rib

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Upper trapezius

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Middle trapezius

27

Lower trapezius

28

Levator scapulae

29

Rhomboids

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Latissimus Dorsi

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Serratus anterior

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Deltoid

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Pectoralis Major

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Pectoralis Minor

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Supraspinatus

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Infraspinatus

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Teres minor

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Subscapularis

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Teres major

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Radial nerve

Segmental levels- C5-T1

Sensory- Posterior aspect of forearm

Motor- Triceps brachii, anconeus, brachioradialis, extensor mm of forearm

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Ulnar nerve

Segmental levels- C7, C8, T1

Sensory- Medial hand including medial half of 4th digit

Motor- Flexor carpi ulnaris, medial half of flexor digitorum profundus, and most of small muscles in hand

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Musculocutaneous nerve

Segmental levels- C5, C6, C7

Sensory- Becomes lateral antebrachial cutaneous nerve

Motor- Coracobrahialis, biceps brachii, brachialis

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Axillary nerve

Segmental levels- C5, C6

Sensory- Lateral shoulder

Motor- Teres minor, deltoid

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44

Suprascapular nerve

Segmental levels- C4, C5, C6

Sensory- No sensory

Motor- Supraspinatus, Infraspinatus

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45

Dorsal scapular nerve

Segmental levels- ventral rami, C4, C5

Sensory- No sensory

Motor- Rhomboids, levator scapulae

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46

Lateral pectoral nerve

Segmental levels- C5, C6, C7

Sensory- No sensory

Motor- Lateral and Medial pectoralis

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47

Medial pectoral nerve

Segmental levels- C8, T1

Sensory- No sensory

Motor- Pectoralis minor

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48

Long thoracic nerve

Segmental levels- Ventral rami, C5, C6, C7

Sensory- No sensory

Motor- No serratus anterior

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49

Upper subscapular nerve

Segmental levels- C5, C6

Sensory- No sensory

Motor- Subscapularis

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50

Lower subscapular nerve

Segmental levels- C5, C6

Sensory- No sensory

Motor- Teres major, Lower subscapularis

51

Medial cutaneous nerve of forearm

Segmental levels- C8, T1

Sensory- Medial arm

Motor- No motor

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52

Shoulder exam history:
Patient reports lateral/anterior shoulder pain with overhead activities or deomonstration of a painful arc

  • possible subacromial impingement
  • possible tendonitis
  • possible bursitis

53

Shoulder exam history:

Patient report of instability, apprehension, and pain with activities most often when shoulder is abducted and externally rotated

  • shoulder instability
  • possible labral tear if clicking present

54

Shoulder exam history:
Decreased ROM and pain with resistance

  • possible rotator cuff or long head of the biceps tendonitis

55

Shoulder exam history:

Patient reports of pain and weakness with muscle loading, night pain, age >60

  • possible rotator cuff tear

56

Shoulder exam history:

Patient complaints of poorly located shoulder pain with occasional radiation into elbow. Pain is usually aggravated by movement and relieved by rest. Age >45. Females often affected more than males.

  • possible adhesive capsulitis

57

Shoulder exam history:

Patient reports of a fall on the shoulder followed by pain over AC joint

  • possible AC sprain

58

Shoulder exam history:

Patient complaints of UE heaviness or numbness with prolonged postures and when lying on involved side

  • possible TOS
  • possible cervical radiculopathy