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Flashcards in Quiz 1 Deck (68):

Overview of Muscle Function

-muscles that attach to scapula with other attachment superior to scapula can elevate scapula
-muscles that attach to scapula with other attachment inferior to scapula can depress the scapula
-muscles that attach to the scapula with the other attachment medial to the scapula can retract (adduct) the scapula
-muscles that attach to the scapula with the other attachment lateral to the scapula can protract (abduct) the scapula
-always talking about glenoid in reference to what's moving of the scapula as a whole i.e. if the glenoid elevates, the scapula is elevating


Scapula Features

-triangle shaped flat bone
-medial, lateral, and superior borders
-inferior and superior angles
-4 fossa: glenoid, supraspinous, infraspinous, subscapular
-2 processes: acromion and coracoid
-suprascapular notch


Thoracolumbar Fascia

-Dense irregular CT (aponeurosis)
-3 layers: posterior to spinous processes, middle to transverse processes, anterior to transverse processes
-come together to form lateral raphe
-broad, flat, heavy duty, tendinous structure
-all in one lateral and as they come medially they split into layers
-one of his favorite


Muscles Attach to TL Fascia

-latissimus dorsi
-internal oblique
-transverse abdominis
-all part of core
-important to know what muscles come off of here-->tighten these, tighten the TL fascia-->more support


Glenohumeral Joint

-most flexible joint in the body
-180 degrees of motion
-no scapula-->120 degrees
-no GH joint-->60 degrees


Capsular Ligaments

-at bottom of GH joint
-allow extra space for when humeral head needs to move inferiorly like when the arm is raised completely


Relative Distances of Muscles to Joints

-if really close to the joint it's a good stabilizer
-if it's really far it's a good mover


Subacromial Space

-there is a bursa in there and the tendons from the rotator cuff pass through
-tendons can get impinged in here and cause pain


Glenoid Labrum

-made of fibrocartilage
-makes glenoid slightly deeper


Innervated vs. Not Innervated Cartilage

-articular cartilage is not innervated
-muscles of disc and inner annular rings are not innervated but outer rings are
-fibrocartilage is, not very much, but it is innervated


Breast/Mammary Glands

-Cooper's ligaments-suspensory ligament of breast that hold up breast; come off clavicle and pectoral region and go all the way into the breast; attach to the skin, stretch over time
-gland lobules for milk production
-surrounded by fatty tissue
-areola-pigmented area around nipple, which can vary from person to person
-lactiferous sinus: widened opening of ducts
-lactiferous ducts: tube from lobules to nipple


Male Differences in the Breast

-have breast tissue that cannot produce milk directly behind nipple (can produce under very specific circumstances)
-small ducts
-do not develop lobules for milk production
-testosterone suppresses development
-can develop breast cancer (1%)


Which muscles attach to coracoid process? Which ligaments?

-short head of biceps
-pectoralis minor
-coracoacromial ligament: roof over GH joint
-coracoclavicular ligaments: conoid ligament and trapezoid ligament


Sternoclavicular Joint

-proximal clavicle with manubrium
-divided by articular disc (very small, fibrocartilage, shock absorber)
-anterior and posterior sternoclavicular ligaments; anterior taut with retraction and posterior taut with protraction
-interclavicular ligament: clavicle, manubrium, clavicle; becomes taut with depression
-costoclavicular ligament: inferior medial clavicle to first rib; taut with elevation
-elevation/depression, protraction/retraction
-taut=primary restriction
-ligaments that go to and from same bone do not restrict movement but instead provide support or stability


Apex of Axilla

-cervico-axillary Canal-passageway to neck
-first rib
-superior scapula


Base of Axilla

-concave skin and fascia
-arm to thoracic wall to about 4th rib
-bounded by anterior and posterior axillary folds


Borders of Axilla

-anterior: pectoralis major and pectoralis minor
-posterior: scapula, subscapularis, serratus anterior, teres major and latissimus dorsi
-medial wall: serratus anterior, ribs
-lateral wall: humerus, long head of triceps, coracobrachialis


Contents of Axilla

-brachial plexus at cord level and nerve branches
-axillary artery
-axillary vein
-lymph nodes
-arteries and nerves are within a sheet of CT surrounding them (veins can sometimes be inside or outside) which helps with movement-lubricated sheet keeps them protected and allows sliding movements


Cords and Nerves off Cords

-lateral cord: lateral pectoral nerve
-posterior cord: upper subscapular nerve, thoracodorsal nerve, lower subscapular nerve
-medial cord: medial pectoral nerve, medial cutaneous nerve of arm, medial cutaneous nerve of forearm


Axillary Artery Branches

-begins at lateral border of first rib
-continuation of subclavian artery (becomes axillary when in armpit)
-passes posterior to pectoralis minor
-becomes brachial artery after inferior border of teres major
-divided into three parts


Parts of Axillary Artery: Part 1

-lateral border of first rib and medial pectoralis minor
-has one major branch: superior thoracic artery-1st and 2nd intercostal spaces and serratus anterior


Parts of Axillary Artery: Part 2

-posterior to pectoralis minor
-has 2 major branches
-thoracoacromial artery: pectoral, deltoid, acromial, clavicular branches
-lateral thoracic artery: lateral to pectoralis minor to breast (main blood supply to breast)


Parts of Axillary Artery: Part 3

-lateral border of pectoralis minor to inferior border of teres major
-3 major branches
-subscapular artery: into circumflex scapula and thoracodorsal
-anterior circumflex humeral artery
-posterior circumflex humeral artery: anastomosis with each other around surgical neck
-proximal humeral fracture disturbs this blood supply so humeral head dies and needs to be replaced


Axillary Arteries

-run near surgical neck not anatomical neck


Axillary Vein

-extremely variable branches
-brachial vein: deep with brachial artery
-basilic vein: superficial from forearm and hand
-axillary vein becomes subclavian vein
-cephalic vein: superficial from lateral forearm and lateral arm and hand and runs between deltoid and pectoralis major into subclavian vein
-superficial veins drain into main venous system eventually


Axillary Lymph Nodes

-many in this area and are grouped
-then go to subclavian lymphatic trunk-->lymphatic duct-->subclavian veins


Shoulder Joint Complex

-for every 3 degrees of movement 2 degrees come from the GH and 1 from thorax (120 from GH and 60 from scapula moving on thorax)
-GH joint
-acromioclavicular joint
-sternoclavicular joint
-scapulothoracic joint (not a true synovial joint)


Glenohumeral Joint

-glenoid fossa of scapula with humeral head
-joint capsule (always made of fibrous tissue and makes synovial fluid and surrounded by sheath)
-key ligaments: superior glenohumeral, middle glenohumeral, inferior glenohumeral (fingers on shoulder in three; all 3 interconnected and really just a thickening of the capsule), coracohumeral


Superior Glenohumeral Ligament

-stabilizes when doing nothing; tension/taut when at side
-stroke patients: weight of arm can dislocate shoulder because there is too much stress on this ligament as well as coracohumeral ligament


Middle Glenohumeral Ligament

-especially most important and most likely to be injured
-provides anterior stability


Inferior Glenohumeral Ligament

-stops humeral head from sliding down too far


Coracohumeral Ligament

-base of coracoid right over top to anterior greater tubercle
-taut when arm hanging at side


Transverse Humeral Ligament

-holds long head of biceps and tendon in place
-doesn't limit joint movement but excessive tendon movement
-from greater tubercle to lesser tubercle


Glenoid Fossa

-shallow: deepened by glenoid labrum: fibrocartilage attached at periphery of glenoid
-joint capsule into rim of glenoid, labrum and anatomical neck of humerus
-long head of biceps into supraglenoid fossa and labrum into bone of fossa and labrum
-long head of triceps into infraglenoid fossa
-ligament=passive stabilizer
-tendon=dynamic stabilizer


Proximal Humerus

-head: spherical shape, articulates with glenoid fossa
-anatomical neck: just below head, attachment of GH joint capsule
-surgical neck: narrowing distal to head and tubercles, common site of fractures
-greater tubercle: lateral has 3 facets, attachment of supraspinatus on superior facet, infraspinatus on middle facet and teres minor on inferior facet
-lesser tubercle: medial, attachment of subscapularis
-crest of greater tubercle: attachment of pectoralis major
-crest of lesser tubercle attachment of teres minor
-intertubercular groove: attachment of latissimus dorsi, long head of biceps slides through, held down by transverse humeral ligament
-groove indicates anterior surface of humerus


Subdeltoid Bursa (Subacromial)

-between supraspinatus and acromion process


Acromioclavicular Joint

-distal clavicle with acromion process
-very stable joint with small amount of motion in 3 directions
-wedge shaped articular disc
-acromioclavicular ligament-superior, inferior
-coracoclavicular ligaments-conoid and trapezoid


Sternoclavicular Joint

-proximal clavicle with manubrium
-divided by articular disc
-anterior and posterior sternoclavicular ligaments
-interclavicular ligament-clavicle, manubrium, clavicle
-costoclavicular ligament-inferior medial clavicle to first rib
-elevation/depression, protraction/retraction


Scapulothoracic Joint

-not true joint
-scapula sliding on thorax
-muscles in between: subscapularis and serratus anterior (helps hold scapula against rib cage)
-protraction/retraction, elevation/depression, upward rotation/downward rotation (putting arm over head=upward rotation; getting up out of chair and pushing on arms of char=downward rotation)
-scapula winging and tipping: happens when scapula gets weak; medial border sticks out posteriorly-->weakness in serratus may happen because of damage to long thoracic nerve (has no sensory pattern)


Types of Tissues



Connective Tissue

-supports, connects, or separates
-cells: fibroblasts
-fiber: collagen, elastin
-extracellular matrix: fluid-ground substance containing GAGS and proteoglycans; GAGS are hydrophilic molecules, draw in water-->less gas, less mobile, less flexible, have fewer in old people


Types of Collagen

-28 different
-type 1: most abundant, tensile forces, tendon, ligaments, skin, vascular bone
-type 2: tensile and compressive forces, high in GAGS, articular cartilage, fibrocartilage
-type 3: more extensible, skin, lung vascular tissue, granulation tissue, high in elastin


Epithelial Tissue

-lines cavities and surfaces through body
-forms glands: endocrine and exocrine
-some vascular, some avascular


Integumentary System

-prevent dehydration
-heat regulation
-synthesis and storage of vitamin D
-epidermis: keratinized epithelium, avascular, outer layer, nutrition from dermis below, some sensory nerve endings
-dermis: dense layer of collagen and elastic fibers; contains hair follicles, smooth erector muscles, sebaceous glands, sweat glands, small capillaries, sensory nerve endings
-subcutaneous tissue: loose connective tissue, fat, sweat glands, blood vessels, lymphatic vessels, cutaneous nerves
-fat distribution varies greatly according to individual, location and gender
-skin ligaments-from deep fascia to dermis



-connective tissue wrapping of structures of the body
-superficial and deep
-deep=dense and organized
-forms compartments around organs or muscles, groups of muscles (intermuscular septa)



-closed sacs or envelopes with potential space that are usually flat
-inner lining has synovial membrane that produces synovial fluid
-found in areas of friction to help tissue glide
-synovial sheaths around tendons
-sac surrounding internal organs such as heart or lungs



-fibrocartilage-annulus fibrosis, symphysis pubis (type 1 and 2 collagen)
-articular cartilage (hyaline cartilage) semi rigid, shock absorbing, ends of bone, found in synovial joints, avascular, aneural (type 2 collagen)


Articular Cartilage

-chondrocytes: development, maintenance and repair
-four zones: superficial (diminshes shear), middle (compressive forces), deep (compressive forces), calcified (anchored to bone)



-periosteum: outer most layer, highly vascular and neural supply, attachment for ligaments and tendons (sharpey's fibers)
-compact bone: strength for weigh bearing
-spongy bone: softer bone
-medullary cavity: marrow
-types: long, short, flat, irregular, sesamoid


Bone Development

-intramembranous: direct ossification of mesenchyme in embryonic development
-endocondral: cartilage model of bone initially forms from mesenchyme and is replaced over time by bone
-primary ossification center: diaphysis (shaft of long bone)
-secondary ossification center: epiphysis (rounded end of long bone), metaphysis (wider portion near epiphyseal plate, site of growth in childhood), epiphyseal plate (hyaline cartilage plate in metaphyseal)
-epiphyseal line: remnant of plate in adult


Vascular and Nerve Supply of Bone

-nutrient arteries via nutrient foramina
-haversian system: canal system for blood supply
-periosteal nerves: outer layer of bone most innervated


Synovial Joints

-joint capsule, blood supply, nerve innervation, synovial membrane, joint cavity, synovial fluid, articular cartilage
-may also have capsular ligaments, fibrocartilage, plica


Fibrous Joints (Synarthrosis)

-bones united directly by fibrous tissue
-3 types
-syndesmosis (between long bones)
-gomphosis (teeth and maxilla or mandible)


Skeletal Muscle

-origin: proximal attachment
-insertion: distal attachment
-innervation: peripheral nerve
-action: when muscle contracts concentrically what muscle action occurs?
-contractile portion and non contractile portion
-types: flat, pennate (shaped like feather), fusiform (wider and cylindrically shaped in center and taper off at end), convergent (ex: pec major), quadrate, circular or sphincteral, multiheaded or multi-bellied
-noncontractile made of dense CT
-epimysium surrounds whole muscle
-perimysium surrounds bundles of muscle
-endomysium surrounds muscle fibers


Tendons and Ligaments

-dense regular CT: all fibers in one direction
-dense irregular CT: fibers in multiple directions
-tendon: muscle to bone; round, flat, aponeurosis
-ligaments: bone to bone; round, flat, aponeurosis



-brain and spinal cord
-membrane layers of CT (meninges)
-dura mater: dense, outermost layer, contains CSF
-arachnoid mater: intermediate layer, thicker, CSF flows through
-pia mater: delicate layer of CT closest to brain and spinal cord, contains CSF


Peripheral NS CT

-epineurium: outermost layer, tube of dense irregular CT surrounding nerve
-perineurium: surrounds fascicles of nerves
-endoneurium: innermost layer, tube of delicate CT surrounds myelin sheath and axon


Somatic NS

-parts of CNS and PNS providing sensory and motor innervation to all parts of the body
-sensory: touch, pain, temp, position
-muscle: to all skeletal muscle



-afferent and efferent to smooth muscle, cardiac muscle, regulate visceral function
-visceral pain
-sympathetic: thoracolumbar region, regulate blood flow
-parasympathetic: craniosacral region, head, internal organs, sexual function


Afferent and Efferent Nerves

-skin-->afferent nerve-->spinal cord-->efferent nerve-->muscle
-afferent: carry impulses to CNS; sensory nerve impulses to CNS from peripheral organs or sensors
-efferent nerves: carry impulses away from CNS; motor nerves, impulses from CNS to muscles or organs
-mixed nerves: contain both afferent and efferent components



-cranial from cranium out (12)
-spinal nerves: from spinal cord through vertebral column, exit intervertebral foramen
-anterior or ventral root: efferent fibers
-posterior or dorsal root: afferent fibers



-skin innervated by same nerve root



-muscles innervated by same nerve root
-must know when one nerve root is involved


Peripheral Nerves

-innervate a muscle or group of muscles
-must know when one peripheral nerve is involved


Layers of Blood Vessels

-tunica externa: outermost layer, anchors blood vessels to organs or surrounding tissues
-tunica media: middle layer, contains smooth muscle and elastic fibers
-tunica intima: innermost layer of artery or vein



-large arteries: smooth muscle and elastic fibers
-medium muscular
-small arteries to arterioles to capillaries
-anastomoses: communication of arteries



-large veins: contain smooth muscle
-medium veins: venous valves, especially in lower extremities
-venules: drain capillaries


Lymphoid System

-lymphatic plexuses: network of lymphatic capillaries, absorb interstitial fluid
-lymphatic vessels: carry lymph to lymph nodes or veins
-lymph: similar to blood plasma, contains WBC
-lymph nodes: oval shaped organs of immune system, acts as filter, contain WBC