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Anatomy 2 > The Shoulder > Flashcards

The Shoulder Flashcards

1
Q

Sternoclavicular Joint

Intra articular disc

anterior sternoclavicular ligament
posterior sternoclavicular ligament

costoclavicularligament

A

Type:
Synovial Saddle Joint

Articular surfaces:

  • sternal (medial end of the clavicle): covered in FIBROCARTILAGE, CONVEX superior to inferior, and concave AP (anterior to posterior)
  • clavicular notch of the sternum: covered in HYALINE cartilage, reciprically CONCAVE superior to inferior and convex AP
  • clavicle moves on sternum = opposite spin roll and glide

Joint Capsule:
- fibrous capsule surrounding the entire joint
- attaching to margins of clavicle and sternum
relatively strong

Structures:
Intra articular disc
O: firmly attached to the upper border of the sternal end of the clavicle
I: costal cartilage of the 1st RIB
Function:
- improve congruency of the joint
- shock absorption/force dissipation
- stabilization of SC joint

Anterior/Posterior sternoclavicular ligament

  • O: medial clavicle (anterior and posterior)
  • I: runs obliquely downwards medially to the sternum
  • A: reinforces anterior and posterior aspect of joint capsule

Costoclavicular lligament (very strong)
O: inferior surface of medial clavicle (roughened area)
I: costal cartilage of 1st rib
A: limit elevation of clavicle and prevent excess anterior/posterior movement of medial end of clavicle
- therefore limits scapular elevation, protraction, and retraction

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2
Q

Acromioclavicular Joints

A

synovial plane joint

articular surface:

  • reciprocally shaped oval facets.
  • lateral end of clavicle = convex
  • anteromedial tip of the acromion process = concave
  • both covered in fibrocartilage

Joint capsule = loose fibrous capsule attaching to margins

Superior and Inferior acromioclavicular ligaments

coracoclavicular ligament:
Conoid: (posteromedial and fan shaped)
- O: elbow of coracoid process
- I: conoid tubercle on inferior aspect of clavicle
- A: resist forward movement (scapular protraction)

Trapezoid: (anterolateral and flat quadrilateral band)

  • O: superior surface of coracoid process
  • I: trapezoid line on inferior aspect of clavicle
  • A: resist backward movement (scapular retraction
  • both prevent upward displacement of the clavicle
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3
Q

SC Joint Elevation

A

clavicle rolls superiorly and glides inferiorly

ROM = 60 degrees total

Limited by: tension in costoclavicular ligament and subclavius

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4
Q

SC joint Depression

A

clavicle rolls inferiorly and glides superiorly

ROM = 60 (total elevation and depression)

Limited by: interclavicular ligament and intra articular disc

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5
Q

AC Joint elevation

A

acromion glides superiorly

ROM = up to 15 degrees

limited by: tension in coracoclavicular lig

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6
Q

AC joint depression

A

acromion glides inferiorly
ROM = up to 15

Limited by: coracoid process coming into contact with the under surface of the clavicle

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7
Q

SC joint protraction

A

clavicle glides posteriorly (axis of movement is the costoclavicular ligament)

ROm = 35 degrees

limited by: costoclavicular and posterior SC ligament

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8
Q

SC joint retraction

A

clavicle glides anteriorly

ROM = 35 degrees

limited by: costoclavicular and anterior SC ligament

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9
Q

AC joint protraction

A

acromion glides anteriorly??

ROM = minimal

limited by: posterior AC jiont capsule and conoid ligaments

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10
Q

AC joint retraction

A

acromion glides posteriorly

ROM = minimal

llimited by: anterior AC joint capsule and trapezoid ligament

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11
Q

SC joint scap lateral rotation

A

clavicle rolls superiorly and glides inferiorly

ROM = 60 degrees

limited by: costoclavicular ligament and subclavius

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12
Q

SC joint scap medial rotation

A

clavicle rolls inferiorly and glides superiorly

ROM = 60 degrees

limited by interclavicular ligament and intra articular disc

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13
Q

AC joint scap lateral rotation

A

acromion swings upwards and outwards in relation to clavicle

ROM = 30 degrees

limited by both parts of coracoclavicular ligament

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14
Q

AC joint scap medial rotation

A

acromion medially rotates back to original position

ROM = 30 degrees

limited by both parts of coracoclaviular ligament

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15
Q

Scapulohumeral rhythm

A

coordinated rhtym between scapula and humerus during shoulder flexion and abduction

initial 25-30 degrees of flexion/abduction from the GH joint alone, then scapular lateralrotation occurs in conjunction to permit full ROM

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16
Q

articular surfaces of the GHJ

A

Hemispherical head of the humerus

  • covered in hyaline cartilage
  • faces: medially, superiorly and posteriorly at appprox 30 degrees from frontal plane

Glenoid fossa of the scapula:

  • pear shaped and covered in hyaline cartilage
  • situated on lateral aspect of scapula
  • faces anterolaterally
  • poor congruency = 1:4 ratio with head of humerus

glenoid labrum

  • deepens the glenoid fossa
  • made of fibrocartilage
  • triangular in cross section
  • attached to articular margins of glenoid fossa
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17
Q

Bursa of the GHJ

A

subscapular bursa = extends through capsule anteirorly

infraspinatus bursa = extends through the capsule posteriorly

subacromial bursa = non communicating.
- separates coracoacromial arch and the deltoid from superolateral aspect of the shoulder joint??

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18
Q

Ligaments of the GHJ

A

superior glenohumeral
middle glenohumeral
inferior glenohumeral

coroacohumeral ligament
coracoacromial ligament
transversehumeral ligament

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19
Q

Superior glenohumeral Ligament ORIANS

A

O: upper part of the glenoid labrum
I : runs laterally to upper surface of lesser tubercle
A: anterior stability of GHJ

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20
Q

Middle glenohumeral ligament

A

O: below the superior glenohumeral ligamanet on glenoid labrum
I: anterior aspect of the lesser tubercle below subscapularis insertion
A: anterior stability of GHJ

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21
Q

Inferior Glenohumeral ligament

A

O: glenoid fossa
I: anteroinferior part of the anatomical neck of the humerus
A: anterior stability of GHJ

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22
Q

Coracohumeral ligament

A

O: lateral border of coracoid process
- divides at intertubercular groove

I: two tubercles of humeral head (greater and lesser)

A: prevent downwards displacement of the humerus

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23
Q

coracoacromial ligament

A

O: coracoid process
I: acromion process
A: prevents superior displacement of the humerus
- helps dissipate forces transmitted upwards through humerus

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24
Q

transverse humeral ligament

A

O: greater tubercle of humerus
I: lesser tubercle of humerus at upper end of bicipital groove
A: holds the long head of biceps in place
- bridges the gap between the two tubercles

25
GHJ Flexion
spin and inferior glide?? (come back to this) ROM = approx 180 - later 60 is made possible by scapular lateral rotaiton limited by: - extensors and posterior capsule
26
GHJ extension
spin ??? ROM = approx 90 - last 20 degrees is made possible by medial rotation of the scapula limited by: - contact of greater tubercle of the humerus with coracoacromial arch - anterior capsule - shoulder flexors
27
abduction
ROm = 180 - last 60 is made possible by lateral rotation of scap (reduces contact between greater tubercle and coracoarcomial arch) superior roll and inferior glide limited by: - contact between greater tubercle and coracoacromial arch - tension in rotator cuff muscles and shoulder adductors
28
adduction
ROM = 30 degrees - accompanied by scapular rotation infeiror roll and superior glide limited by contact with the trunk
29
lateral rotation
rom = 80 degrees arm at side = posterior roll and anterior glide arm at 90 = spin limited by tension in medial rotators and anterior capsule
30
medial rotation
rom = 100-110 (when the forearm is taken behind the trunk arm at side = anterior roll and posterior glide arm at 90 = spin limited by lateral rotators and posterior capsule
31
why is the GHJ inherently unstable
incongruency of joint surfaces poor size ratio of articular surfaces lax capsule weak ligaments
32
what improves the GHJ stability
glenoid labrum long head of biceps tendon rotator cuffs and larger overlying muscles
33
Serratus Anterior
O: fleshy digitations from the upper 8-9 ribs and intercostal fascia R: backwards I: costal surface of the medial border of the scapula A/: protract and laterally rotate the scapula NS: long thoracic nerve C5-C7 Function: movements which drive the scapula forward - stabilizer of scap during upper llimb movements
34
Winged scapula
paralysis of serratus anterior medial border of scapula stands away from the chest wall limited lateral rotation of the scapula so arm cannot be abducted more than 90 degrees
35
pectoralis minor
O: ribs 3-5 and intercostal fascia R: superolaterally I: upper surface and medial border of the acromion process via short flat tendon A: medially rotate and depress the scapula NS: medial pectoral nerve C8-T1 Function: pull scapular down and forwards during pushing/punch accessory muscle for inspiration
36
subclavius
O: 1st rib and cartilage via short thick tendon, in front of costoclavicular ligament R: obliquely up and laterally I: subclavian groove on inferior surface of the clavicle A: depression of the clavicle + reverse origin to elevate the 1st rib NS: nerve to subclavius C4-C6 Function: stabilize clavicle during scapular movements
37
Upper trapezius
O: - medial 1/3rd of superior nuchal line and occipital bone - ligamentum nuchae - spinous processes of C7-T12 R: downwards and laterally I: posterior lateral 1/3 of clavicle A: elevation, lateral rotation, and retraction of scapula NS: motor = spinal part of cranial nerve XI (accessory nerve sensory = ventral rami of C3,4
38
middle trapezius
O: - medial 1/3rd of superior nuchal line and occipital bone - ligamentum nuchae - spinous processes of C7-T12 R: horizontally I: medial border of the acromion and upper border of the crest of the scapula spine A: retraction of scapula NS: motor = spinal part of cranial nerve XI (accessory nerve) sensory = ventral rami of C3,4
39
lower trapezius
O: - medial 1/3rd of superior nuchal line and occipital bone - ligamentum nuchae - spinous processes of C7-T12 R: up and laterally I: inferior surface of medial end of the spine of scapula (via converged tendon) A: depression, retraction and lateral rotation of scapula NS: spinal part of cranial nerve Xi (accessory nerve) and ventral rami of C3,4
40
Rhomboid major
O: spinous processes of T2-T5 and supraspinous ligament R: obliquely down and laterally I: medial border of scapula between spine and inferior angle of scapula A: retraction and medial rotation of scapula NS: dorsal scapular nerve C5 Function = scapula stabilizer
41
Rhomboid Minor
O: spinous processes of C7-T1 and supraspinous ligament R: obliquely down and laterally I: medial border of the scap at the level of the root of the spine of scapula A: retraction and medial rotation of scapula NS: dorsal scapular nerve C5 Function = scapula stabilizer
42
levator scapulae
O: Transverse processes of C1-C4 R: down and laterally I: medial border of the scapula between the superior angle and base of the spine of scape A: scapular elevation, retraction and medial rotation NS: dorsal scapular nerve C5
43
Anterior Deltoid
O: anterior border of the lateral 1/3rd of the clavicle R: obliquely down and posteriorly I: deltoid tuberosity on the lateral side of the humerus via short thick tendon A: flexion and medial rotation of the GHJ NS: axillary nerve C5-C6
44
Middle deltoid
O: lateral margin of the acromion process via 4 tendinous slips R: downwards I: deltoid tuberoisty via short thick tendon A: abduction of the GHJ NS: axillary nerve C5-C6
45
Posterior Deltoid
``` O: lower lip of the spine of the scapula R: obliquely down and anterior I: deltoid tuberosity via short thick tendon A: extend and laterally rotate the GHJ NS: axillary nerve C5-C6 ```
46
Function of the deltoid
middle fibres = main abductor after initation of supraspinatus Resist downward displacement of the humerus
47
Clavicular head of Pectoralis Major
O: medial 1/2 of the anterior surface of the clavicle R: down and laterally I: lateral lip of the intertubercular groove via flat tendon. covering the long head of the biceps tendon A: flex the GHJ joint to 90 degrees, horizontally flex the GHJ, adduct GHJ, medially rotate the GHJ NS: medial pectoral nerve (C8-T1) and lateral pectoral nerve (C5-C7)
48
Sternal head of pectoralis major
O: body of manubrium and sternum, adjacent upper 6 ribs costal cartilages, and external oblique via aponeurosis R: horizontal and superolaterally I: intertubercular groove via flat tendon (covering long head of biceps tendon) -- also forms the posterior lamina which passes upwards and behind the anterior lamina to the upper part of the groove A: extend the flexed arm (especially against resistance) back to the anatomical position adduction medial rotation NS: medial pectoral nerve (C8-T1) and lateral pectoral nerve (C5-C8)
49
corachobrachialis
O: apex of the coracoid process via rounded tendon R: inferiorly and laterally I: roughened area halfway down the medial side of the humeral shaft opposite to the deltoid tuberosity A: adduction of GHJ + may assist flexion NS: musculocutaneous nerve (C5-C7)
50
latissimus dorsi
O: spinous processes T7-T12, all lumbar and sacral vertebra via thoracolumbar fascia, intervening suprapinous and interspinous ligaments, outer lip of posterior iliac crest R: upwards and laterally I: floor of the intertubercular groove via flat thin tendon - en route, some fibres attach to the outer srface of the lower 3-4 ribs (Ribs 9-12) and inferior angle of the scapula A: extensor of flexed arm, adductor of GHJ, medial rotator of GHJ NS: thoracodorsal nerve (C6-8)
51
Teres Major
O: dorsal surface of the inferior angle of scapula (below teres minor) R: upwards, anteriorly and laterally I: medial lip of the intertubercular groove (via broad flat tendon) + tendon is separated from lats by a bursa) A: adducts GHJ, medially rotates and may assist with extension of flexed shoulder NS: lower subscapular nerve (C5-C6)
52
Rotator cuff muscles
supraspinatus, infraspinatus, teres minor, subscapularis
53
Supraspinatus
O: medial 2-3rds of the supraspinous fossa R: laterally I: upper facet on the greater tubercle of the humerus - tendon forms within the muscle as it passes laterally below trapezius, the acromion process, and the coracoacromial ligament - tendon blends with the superior aspect of the GH capsule A: initiates the first 20 degrees of abduction on GHJ NS: suprascapular nerve (C4,C5,C6)
54
Infraspinatus
O: medial 2/3rds of the infraspinous fossa R: laterally and merge to a narrow tendon I: middle facet on the greater tubercle of the humerus A: lateral rotation of the GHJ NS: suprascapular nerve (C4,5,6) Function: stabilize the head of humerus in the glenoid during GHJ movements with other rotator cuff muscles
55
Teres Minor
O: upper 2/3rds of the LATERAL BORDER of the SCAPULA R: upwards and laterally I: lowest facet on the greater tubercle of the humerus via narrow tendon which also reinforces the posterior part of the capsule A: lateral rotation of the GHJ + adducts the abducted arm NS: axillary nerve C5,6 Function: resist UPWARD displacement of head of humerus during active contraction of the deltoid
56
Subscapularis
forms most of the posterior aspect of the axilla (lies behind serratus anterior) O: medial 2/3rd of the sub scapular fossa R: fibres wind around the head of humerus anteirorly I: LESSER TUBERCLE of humerus via broad thick tendon (other 3 insert to Greater tubercle) A: medially rotate the GHJ and adduct the GHJ NS: upper and lower subscapular nerve (C4,5,6) Function: hold the head of humerus in the glenoid fossa, resisting upwards displacement during active contraction of biceps, tricpes and deltoid
57
The axilla
Apex: first rib, clavicle and scapula Base = axillary fascia Posterior = latissimus doris, teres major, subscapularis median wall = serratus anterior contents: brachial plexus, axillary artery and vein, axillary lymph nodes, and quantity of fat and loose areolar tissue
58
The axillary nerve
- arises from the ventral rami of C5, C6, the superior trunk, and the posterior cord - in the axilla, it passes posteriorly to the axillary artery and anterior to subscapularis - it passes close to the inferior aspect of the shoulder joint and through the quadrilateral space - it divides into anterior and posterior branches it then winds around the surgical neck of the humerus ``` motor = deltoid and teres minor Sensory = skin on lateral aspect of the shoulder (via lateral cutaneous nerve of the arm) ```
59
Quadrilateral space
formed by: - teres minor = superiorly - teres major = infeirorly - shaft of humerus = laterally - long head of triceps = medially - allows passage for axillary nerve and poseterior circumflex artery

Anatomy 2 (4 decks)

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