Upper Limb: Shoulder Region Flashcards
(125 cards)
1
Q
Which fossa is found on the costal surface of the scapula?
A. Supraspinous fossa
B. Infraspinous fossa
C. Subscapular fossa
A
C
2
Q
Which border of the scapula is located in close proximity to the vertebral column?
A
Medial border (vertebral border)
3
Q
Which bone prominence (projection) is located on the posterior aspect of the scapula?
A. Spine of scapula
B. Acromion process
C. Coracoid process
A
A
4
Q
Which of the following is a bony landmark of the proximal humerus? Select all that apply.
Inferior angle
Greater tubercle
Lesser tubercle
Spinoglenoid notch
Surgical neck
A
Greater tubercle
Lesser tubercle
Surgical neck
5
Q
The acromioclavicular joint is formed by the articulation of which two structures?
A
The acromial end of the clavicle and the acromion process of the scapula
6
Q
Which ligament prevents the scapula from being displaced medially beneath the clavicle?
A. Coracohumeral
B. Acromioclavicular
C. Coracoacromial
D. Coracoclavicular
A
D
7
Q
True or false: The glenohumeral joint is a ball and socket joint that allows two degrees of freedom (flexion/extension, adduction/abduction).
A
False
8
Q
What structures form the coraco-acromial arch? Select all that apply.
Deltoid
Acromion process
Coracoid process
Coracohumeral ligament
Coracoacromial ligament
A
Acromion process
Coracoid process
Coracoacromial ligament
9
Q
Which structure serves to deepen the glenoid cavity?
A
Glenoid labrum
10
Q
Which of the following ligaments converts the intertubercular sulcus into a canal?
A. Coracohumeral
B. Transverse humeral
C. Glenohumeral
A
B
11
Q
What is the functional significance of the three segments of the upper limb?
A
Proximal segment: Places the hand in space
Intermediate segment: Positions the hand
Terminal segment: Manipulation of the environment
12
Q
What bones form the skeleton of the upper limb?
A
Clavicle
Scapula
Humerus
Radius
Ulna
Carpals
Metacarpals
Phalanges
13
Q
What is the major joint found in the upper limb?
A
Synovial joint
14
Q
The scapulothoracic joint is the only joint of the upper limb that is NOT a synovial joint—or a TRUE joint for that matter. What type of joint is it, and why is it not a true joint?
A
Physiological joint
Bones are not articulating; the scapula glides across the muscles below it.
15
Q
What is the name of the structure that gives rise to the multi-segmental peripheral nerves that supply the upper limb?
A
Brachial plexus
16
Q
What is the name of the artery that supplies the majority of the upper limb with blood?
A
Axillary artery
17
Q
Let’s talk about the brachial plexus.
- How many roots are there? Where do they originate?
- How many trunks are there?
- How many divisions?
- How many cords?
A
- 5 roots originating from the anterior rami of C5-T5
- 3 trunks (superior, middle, inferior)
- 6 divisions (3 anterior, 3 posterior)
- 3 cords (lateral, medial, posterior)
5.
18
Q
What are the dermatomes of the upper limb? Label the yellow highlights.
A
See image
Key landmarks:
- Thumb: C6
- Pinky: C8
- Armpit: T1
19
Q
What is the origin for the supraspinatus?
A
Supraspinous fossa
20
Q
What is the origin for the infraspinatus?
A
Infraspinous fossa
21
Q
What is important about the greater tubercle of the humerus?
A
It is a point of attachment for 3 of 4 rotator cuff muscles
22
Q
What are the 4 joints of the shoulder region?
A
Acromioclavicular
Sternoclavicular
Glenohumeral
Scapulathoracic
23
Q
Why is the scapulothoracic joint a joint of the shoulder region?
A
You can’t have overhead motion without the scapula gliding out superolaterally
24
Q
What is the difference between a glenohumeral subluxation and glenohumeral dislocation?
A
Subluxation: Changes relation of humeral head to glenoid fossa but humeral head is not completely out of the glenoid fossa
Dislocation: humeral head completely out of glenoid fossa
25
What are the primary myotomes of the upper limb and their corresponding spinal nerves?
- C5: shoulder abduction
- C5, C6: elbow flexion
- C7: Elbow extension, wrist extension, finger extension
- C8: wrist flexion, finger flexion
- T1: Intrinsic muscles
26
What are the names of the bones of the shoulder region?
Clavicle
Scapula
Humerus
27
Which joint serves as the only bony link between the axial and superior appendicular skeleton?
Sternoclavicular joint
28
What ligament is important for preventing downward displacement of the scapula?
Coracoclavicular ligament
29
Which bones articulate to form the glenohumeral joint?
Glenoid fossa of scapula and humeral head
30
What structures form an arch over the glenohumeral joint?
Acromion, coracoid process, and coraco-acromial ligament
31
What is the name of the bursa that protects the supraspinatus tendon from the coraco-acromial arch?
Subacromial bursa
32
Label the bony landmarks of the clavicle.
See image
33
Label the bony landmarks of the scapula (anterior and posterior view).
See image
34
Label the bony landmarks of the scapula (superior and lateral view).
See image
35
Label the bony landmarks of the humerus.
See image
36
What are the articulations within the sternoclavicular joint?
Sternal end of clavicle, clavicular notch of the manubrium
37
What 3 ligaments are associated with the SC joint?
Anterior and posterior sternoclavicular ligaments
Costoclavicular ligament
Interclavicular ligament
38
What movements occur at the SC joint?
Elevation, depression, anterior/posterior gliding, rotation
39
What is unique about the SC joint in relation to the synovial cavity?
There are TWO synovial cavities separated by an articular disc allowing the joint to move freely (similar to a ball and socket joint)
40
What are the articulations of the acromioclavicular joint?
Acromial end of clavicle with acromion process of scapula
41
What ligaments are associated with the AC joint?
Acromioclavicular
Coracoclavicular (conoid and trapezoid)
42
What movements occur at the AC joint?
Rotation during movements of the scapula
43
What are the articulations of the glenohumeral joint?
humeral head and glenoid cavity (fossa) of scapula
44
What is the purpose of the glenoid labrum?
Deepen the cavity of the glenoid fossa
45
What are the ligaments associated with the GH joint?
Coracohumeral
Glenohumeral (superior, middle, inferior)
Transverse humeral
46
What are the two bursae associated with the GH joint?
Subacromial (most important to remember)
Subscapular
47
What movements occur at the GH joint?
Flexion and extension
Adduction and abduction
Internal and external rotation
48
What are the “articulations” of the scapulothoracic joint?
Scapula and thoracic wall (subscapularis and serratus anterior)
49
What movements occur at the ST joint?
Elevation and depression
Retraction and protraction
Upward rotation and downward rotation
50
What is adhesive capsulitis or frozen shoulder?
Inflammation causes a thickening and stiffening of the GH joint capsule and ligaments resulting in pain and decreased mobility of the shoulder.
51
Which of the following muscles can be easily palpate lateral to the sternum and inferior to the clavicle?
A. Trapezius
B. Pectoralis major
C. Deltoid
B
52
True or false: The posterior axillary fold is formed by the teres major and the tendon of the latissimus dorsi.
True
53
What structures form the boundary of the clavipectoral triangle? Select all that apply:
Clavicular portion of the pectoralis major muscle
Trapezius
Deltoid
Clavicle
Sternum
Clavicular portion of the pectoralis major muscle
Deltoid
Clavicle
54
Which of the following muscles is a muscle of the anterior axio-appendicular group of muscles? Select all that apply.
Rhomboids
Serratus anterior
Trapezius
Pectoralis minor
Deltoid
Subclavius
Serratus anterior
Pectoralis minor
Subclavius
55
Which of the following muscles will have its action on the humerus?
A. Pectoralis minor
B. Teres major
C. Rhomboids
D. Serratus anterior
A
56
Which of the following inserts on the lateral lip of the intertubercular sulcus?
A. Pectoralis major
B. Pectoralis minor
C. Subclavius
D. Serratus anterior
A
57
Which of the following muscles has an origin point on the rib cage? Select all that apply.
Serratus anterior
Subclavius
Pectoralis major
Pectoralis minor
All of them!
Serratus anterior
Subclavius
Pectoralis major
Pectoralis minor
58
Which of the following muscles will contribute to upward rotation of the scapula?
A. Serratus anterior
B. Pectoralis major
C. Subclavius
A
59
Which of the following muscles has its insertion on the clavicle, and the acromion process and spine of the scapula?
A. Latissimus dorsi
B. Rhomboids
C. Trapezius
C. Levator scapulae
C
60
Which of the following muscles originates from the spinous processes of either the cervical and/or thoracic vertebrae? Select all that apply.
Latissimus dorsi
Levator scapulae
Trapezius
Rhomboids
Latissimus dorsi
Trapezius
Rhomboids
61
Which of the following muscles will adduct, internally (medially) rotate, and extend the humerus of the GH joint?
A. Trapezius
B. Latissimus dorsi
C. Rhomboids
D. Levator scapulae
B
62
Which of the following muscles has an origin point from the clavicle and the acrimion process and spine of the scapula?
A. Deltoid
B. Supraspinatus
C. Infraspinatus
D. Subscapularis
A
63
Which of the following muscles is considered a muscle of the rotator cuff? Select all that apply.
Teres major
Teres minor
Deltoid
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Supraspinatus
Infraspinatus
Subscapularis
64
Which of the following muscles insert onto the greater tubercle of the humerus? Select all that apply.
Teres major
Teres minor
Deltoid
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
Supraspinatus
Infraspinatus
65
Which of the following muscles produces abduction, flexion, and extension of the humerus at the GH joint?
A. Teres minor
B. Deltoid
C. Teres major
D. Supraspinatus
B
66
Which of the following structures forms the quadrangular space? Select all that apply.
Teres minor
Teres major
Lateral head of triceps
Long head of triceps
Surgical neck of humerus
Teres minor
Teres major
Long head of triceps
Surgical neck of humerus
67
Which structure forms the lateral boundary of the triangular space?
Long head of triceps
68
Which structures can be seen in the quadrangular space? Select all that apply.
Radial nerve
Posterior circumflex humeral artery
Circumflex scapular artery
Axillary nerve
Profunda brachii artery
Posterior circumflex humeral artery
Axillary nerve
69
Which structures form boundaries of the apex of the cervical-axillary canal?
Clavicle, 1st rib, superior edge of scapula
70
Which structure forms the lateral wall of the axilla?
Proximal humerus (at level of intertubercular sulcus)
71
True or false: Neurovascular structures traveling between the neck and upper limb travel through the cervical-axillary canal.
True
72
Which muscle of the shoulder region is the ONLY muscle that is NOT innervated by branches of the brachial plexus? What is it innervated by?
Trapezius
CN XI (Spinal Accessory Nerve)
73
Which of the following branches of the brachial plexus supplies the serratus anterior?
A. Long thoracic nerve
B. Thoracodorsal nerve
C. Lateral pectoral nerve
D. Medial pectoral nerve
A
74
Which never innervates both the supraspinatus and infraspinatus?
Suprascapular
75
True or false: The blood supply to the muscles of the shoulder region arise from branches of the subclavian and axillary arteries.
True
76
Which of the following arteries are branches of the thoracoacromial artery? Select all that apply.
Clavicular
Lateral thoracic
Subscapular
Pectoral
Acromial
Deltoid
Clavicular
Pectoral
Acromial
Deltoid
77
Which of the following arteries supply the humeral head and GH joint with blood?
A. Anterior and posterior circumflex humeral arteries
B. Thoracodorsal and lateral thoracic arteries
C. Circumflex scapular and suprascapular arteries
A
78
Which of the following arteries network together to form anastomoses around the scapula? Select all that apply.
Lateral thoracic
Dorsal scapular
Suprascapular
Circumflex scapular
Thoracodorsal
Dorsal scapular
Suprascapular
Circumflex scapular
79
Which artery is vulnerable to damage secondary to a fracture of the surgical neck of the humerus?
Posterior circumflex humeral
80
What structures form the boundaries of the cervico-axillary canal?
First rib, scapula, superior edge of scapula
81
What forms the apex of the axilla?
Cervico-axillary canal
82
The subscapularis, teres major, and latissimus dorsi form which wall of the axilla?
Posterior
83
What do the suprascapular and nerve to subclavius have in common?
Both originate from ventral rami of C5 and C6
84
Which suprascapular nerve originates from only one spinal root?
Dorsal scapular nerve
85
Which nerve root originates from 3 spinal nerves and before the trunks of the brachial plexus?
Long thoracic nerve
86
Which muscle of the upper limb is innervated by a nerve DIFFERENT than the brachial plexus? What nerve innervates it?
Trapezius
CN IX (accessory)
87
How many suprascapular nerves are there? What are their names and origins?
1. Dorsal scapular (ventral ramus, C5)
2. Long thoracic nerve (ventral rami, C5, C6, C7)
3. Supraclavicular nerve (C5, C6 —> superior trunk)
4. Nerve to subclavius (C5-C6 —>superior trunk)
88
How many infraclavicular branches are there?
6
89
How many TERMINAL branches originate from the posterior cord of the brachial plexus and what are their names?
2
Axillary nerve
Radial nerve
90
How many NONTERMINAL branches originate from the posterior cord? What are their names?
3
Upper subscapular
Lower subscapular
Thoracodorsal
91
The intercostal brachial nerve originates from which spinal nerve? What does it supply?
T2; Axilla
92
Which artery supplies the rhomboids, levator scapulae and trapezius and contributes to scapular anastomoses?
Dorsal scapular artery
93
True or false: The thoracoacromial artery has 2 branches.
False; it has 4!
Clavicular, pectoral, acromial, deltoid
94
True or false: The subscapular artery has 2 branches.
True!
Thoracodorsal, circumflex scapular
95
What structure/s does the circumflex humeral artery supply?
Anterior and posterior head of humerus and glenohumeral joint
96
The _____________ artery supplies teres major and minor and contributes to blood supply to the entire rotator cuff vis anastomoses.
Circumflex scapular
97
Which of the following arteries form anastomoses around the scapula?
Thoracodorsal
Dorsal scapular
Thoracoacromial
Suprascapular
Circumflex scapular
Circumflex humeral
Dorsal scapular
Suprascapular
Circumflex scapular
NOTE: The circumflex humeral artery DOES anastomose, but it does so around the GH joint, NOT the scapula!
98
True or false: the scapulohumeral muscles of the shoulder region can be divided into anterior and posterior groups.
FALSE
The axio-appendicular muscles are divided into anterior and posterior groups
99
What four muscles are found in the anterior axio-appendicular shoulder region? What do they act on? What nerve/s innervate them?
Subclavius: acts on clavicle; innervated by nerve to subclavius
Serratus anterior: acts on scapula; innervated by long thoracic nerve
Pectoralis major: acts on scapula; innervated by lateral and medial pectoral nerves
Pectoralis minor: acts on humerus; innervated by medial pectoral nerve
100
True or false: The posterior axio-appendicular muscles of the shoulder region are divided into superficial and deep subgroups.
True
101
Which posterior axio-appendicular muscles of the shoulder region are superficial? What do they act on? What innervates them?
Trapezius: acts on scapula; innervated by CN XI (accessory nerve)
Latissimus dorsi: acts on humerus; innervated by Thoracodorsal nerve
102
Which posterior axio-appendicular muscles of the shoulder region are deep? What do they act on? What innervates them?
Levator scapulae: acts on scapula; innervated by dorsal scapular nerves and C3 and C4
Rhomboids: act on scapula; innervated by dorsal scapular nerve
103
Which of the following scapulohumeral muscles is NOT a muscle of the rotator cuff? Select all that apply.
A. Deltoid
B. Subscapularis
C. Supraspinatus
D. Infraspinatus
E. Teres minor
F. Teres major
A, F
104
True or false: The muscles of the rotator cuff act on the scapula.
FALSE!
They all ORIGINATE on the scapula, but insert and ACT on the humerus.
105
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Pectoralis major
**ORIGIN**: *Clavicular head*: anterior surface of medial half of clavicle. *Sternocostal head*: anterior surface of the sternum and superior 6 costal cartilages. *Abdominal head*: Aponeurosis of external oblique.
**INSERTION**: lateral lip of intertubercular sulcus of humerus
**INNERVATION**: Lateral and medial pectoral nerves
**ACTION**: Adducts and medial rotates GH joint. *Acting alone* the clavicular head flexes the shoulder and sternocostal head extends the shoulder from a flexed position.
106
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Pectoralis minor
**ORIGIN**: 3rd to 4th ribs near their costal cartilages
**INSERTION**: medial border and superior surface of coracoid process of scapula
**INNERVATION**: medial pectoral nerve
**ACTION**: stabilizes scapula by drawing it inferiorly and anteriorly against the thoracic wall (protracts scapula)
107
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Serratus anterior
**ORIGIN**: External surfaces of lateral parts of 1st through 8th ribs
**INSERTION**: Anterior (costal) surface of the medial border of the scapula
**INNERVATION**: Long thoracic nerve
**ACTION**: Protracts the scapula and holds it against the thoracic wall; rotates scapula upward
108
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Subclavius
**ORIGIN**: Junction of 1st rib and its costal cartilage
**INSERTION**: inferior surface of middle 1/3 of clavicle
**INNERVATION**: Nerve to subclavius
**ACTION**: Anchors and depresses the clavicle
109
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Trapezius
**ORIGIN**: Medial 1/3 of superior nuchal line; external occipital protuberance, nuchal ligament and spinous processes of the c7-T12 vertebrae
**INSERTION**: Lateral 1/3 of clavicle, acromion, and spine of the scapula
**INNERVATION**: CN XI (accessory nerve; motor) and c3 and c4 (pain and proprioception)
**ACTION**: elevates (superior fibers), depresses (inferior fibers), retracts (middle fibers), and upwardly rotates scapula
110
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Latissimus dorsi
**ORIGIN**: Spinous processes of inferior 6 thoracic vertebrae, thoracolumbar fascia, iliac crest, and inferior 3-4 ribs
**INSERTION**: Floor of intertubercular sulcus of humerus
**INNERVATION**: Thoracodorsal nerve
**ACTION**: extends, adducts, and medially rotates GH joint
111
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Levator scapulae
**ORIGIN**: posterior tubercles of transverse processes of c1-c4 vertebrae
**INSERTION**: superior part of medial border of scapula
**INNERVATION**: dorsal scapular nerve (motor) and c3-c4 spinal nerves (pain an proprioception)
**ACTION**: elevates and downwardly rotates the scapula
112
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Rhomboids major (minor not picture; lays superior to major)
**ORIGIN**: *Minor*: nuchal ligament and spinous processes of c7-t1 vertebrae. *Major*: spinous processes of t2-t5 vertebrae
**INSERTION**: *Minor*: medial border at level of spine. *Major*: medial border from spine to inferior angle
**INNERVATION**: Dorsal scapular nerve
**ACTION**: Retracts and downwardly rotates scapula; fixes scapula to thoracic wall
113
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Deltoid
**ORIGIN**: lateral 1/3 clavicle, acromion, and spine of scapula
**INSERTION**: Deltoid tuberosity of humerus
**INNERVATION**: Axillary nerve
**ACTION**: *Anterior*: flexes and medially rotates GH joint. *Middle*: abducts GH joint. *Posterior*: Extends and laterally rotates GH joint
114
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Subscapularis
**ORIGIN**: Subscapular fossa
**INSERTION**: Lesser tubercle of humerus and medial lip of intertubercular sulcus
**INNERVATION**: Upper and lower subscapular nerves
**ACTION**: Medially rotates GH joint; helps to hold humeral head in glenoid cavity
115
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Supraspinatus
**ORIGIN**: Supraspinous fossa
**INSERTION**: Superior facet of greater tubercle of humerus
**INNERVATION**: Suprascapular nerve
**ACTION**: initiates and assists deltoid in abduction of GH joint and acts with other rotator cuff muscles to stabilize the shoulder joint
116
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Infraspinatus
**ORIGIN**: Infraspinous fossa
**INSERTION**: Middle facet of greater tubercle of humerus
**INNERVATION**: Suprascapular nerve
**ACTION**: laterally (externally) rotates the GH joint; helps hold humeral had in glenoid cavity of the scapula
117
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Teres minor
**ORIGIN**: superior part (about 2/3s) of the lateral border of the scapula
**INSERTION**: Inferior facet of greater tubercle of the humerus
**INNERVATION**: Axillary nerve
**ACTION**: Laterally (externally) rotates the GH joint; helps hold humeral head in glenoid cavity of scapula
118
What muscle is this? Name its origin, insertion, innervation, and action.
**NAME**: Teres major
**ORIGIN**: Inferior part of the lateral border and dorsal surface of the inferior angle of scapula
**INSERTION**: medial lip of intertubercular sulcus of humerus
**INNERVATION**: Lower subscapular nerve
**ACTION**: abducts and medially rotates the GH joint
119
The ________ and __________ muscles form a force couple to abduct the humerus.
Supraspinatus
Deltoid
120
The ________ and __________ muscles together act as lateral rotators of the humerus and prevent translations of the humeral head during overhead arm movements.
Infraspinatus
Teres minor
121
If the serratus anterior is paralyzed or weak, what happens to the scapula?
“Winging”; the medial border of the scapula will lift off the thorax
122
If you have an injury to the axillary nerve and experienced paralysis of the deltoid, what would you see?
Loss of rounding of the deltoid and inability to abduct the arm past 15 degrees (that is because supraspinatus imitators abduction but deltoid takes over)
123
True or false: Teres minor acts alone in external rotation of the shoulder.
False
It works with infraspinatus
124
True or false: If the suprascapular nerve were injured, you might see paralysis in supraspinatus.
False
You would see paralysis in supraspinatus AND infraspinatus
125
__________ is the medial rotator of the humerus; coupled with the middle and inferior glenohumeral ligaments, it has been shown to be an important stabilizer of the GH joint, particularly when the arm is held at about a 45 degree abduction.
Subscapularis
