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shoulder, joint, arm

Posterior Thoracoappendicular Muscles Trapezius, Lattisimus dorsi, rhomboids, levator scapula.
trapezius attachments spinous process of scapula, nuchal line, external occipital pertuberance, lateral 3rd of the clavical, acromion
latissimus dorsi attachments thoracic vertebrea, ribs, illiac crest, thoracolumbar fascia, intertubercular groove of humerus
Rhomboid major attachments spinous process t2-t5, medial border of scapula below spine
rhomboid minor innervation dorsal scapula
rhomboid minor innervations dorsal scapula
rhomboid minor attachments nuchal ligament, medial border of scapula at or above spine
levator scapula innervations dorsal scapula
levator scapula attachments medial border of scapula
levator scapula function elevates scapula, rotate scapula, depress glenid cavity inferiorly
trapezius function suppior fibers: elevate scapula. Central fiber: retract scapula, inferior fibers depress scapula, rotates scapula
Latissimus dorsi function Arm extension (down) -Arm ADDuction -Medial Rotation of Arm -(Climbing muscle)
rhomboid functions -Retract Scapula -Rotates scapula -Depress glenoid cavity
Anterior Thorappendicular Muscles pectoralis major, pectoralis minor, serratus anterior, subclavical
pectoralis major innervation lateral and medial pectoral nerves
pectoralis minor innervations medial pectoral nerve
subclavius innervations nerve to subclavius
serratus anterior innervation long thoracic nerve
pectoralis major functions -adduction -medial rotate humerus -flex and extend upper extremity
pectoralis major attachmment -Clavicular head, sternum, superior 6 costal cartilages, aponeurosis of external oblique -Intertubucular groove of humerus
pectoralis minor attachment -ribs 3- 5 -coracoid process of scapula
pectoralis minor function -draw scapula inferiorly and anteriorly (depress scapula) -holds and stabilizes scapula against thoracic wall
subclavius attachments 1st rib and costal cartilage -middle of 1/3 of clavicle
subclavius function -anchor and depress the scapula -depress clavicle -protect subclavian vessels and superior trunk of brachial plexus, cushioning
Deltoid innervation axillary nerve
deltoid attachments •Lateral 3rd of clavicle, acromion & spine of scapula •Deltoid tuberosity of humerus
deltoid functions • Mostly abduction (most effective 15-90, after 90 other muscles that move scapula kick in) •Clavicular head: flexes & medially rotates arm •Acromial head: abducts arm •Spinal head: extends & laterally rotates arm
rotator cuff muscles supraspinatus, infraspinatus, subscapularis, teres minor
supraspinatus innervation suprascapular nerve
supraspinatus attachment •Supraspinous fossa •Greater tubercle of humerus
supraspinatus function •Initiates abduction of arm (initiates means get the arm 15 away before deltoid muscle kicks in) •If injured, shoulder dips to abduct arm (gravity dips shoulder to make the 15 rotation)
infrasupranatus innervation suprascapular nerve
infraspinatus attachment •Infraspinous fossa •Greater tubercle of humerus (just below supraspinatus)
infraspinatus function •Laterally rotate arm •Hold head of humerus in glenoid fossa (glenoid fossa is an oval surface)
teres minor function •Laterally rotate arm •Hold head of humerus in glenoid fossa
teres minor attachment • Lateral border of scapula •Greater tubercle of humerus •Sits inferior to infraspinatus
teres minor innervation axillary nerve
subscapularis innervation upper and lower scapular nerves
subscapularis attachments •Subscapular fossa •Lesser tubercle of humerus – main muscle that attaches to the lesser tubercule of the muscle
subcapularis function •Medially rotates and adducts humerus •Hold humeral head in glenoid cavity
Teres major attachment •Inferior angle of scapula •Intertubercular groove of humerus – latissimus dorsi & pectoralis major also attach here – tendon of the long head of biceps sits here (THEY LIKE TO ASK ABOUT IT)
teres major innervation Lower subscapular nerve
teres major function •Adduct & medially rotates arm •Not considered one of the rotator cuff muscles
Suprascapular nerve goes around greater scapular notch & into infraspinatus, accompanied by suprascapular artery
Suprascapular artery goes over the ligament and nerve goes under (Army passes over the bridge and Navy passes under the bridge)
rotator cuff •SITS muscles: Supraspinatus, Infraspinatus, Teres minor, Subscapularis •Form musculotendinous cuff around head of humerus •Reinforce capsule •Hold humeral head in glenoid fossa •All rotate except supraspinatus
quadrangular space boundaries teres minor (superiorly), teres major (inferiorly), humerus, long head of triceps brachii
Axillary nerve & posterior humeral circumflex artery are located within quandrangular space
Axillary nerve goes through this space to innervate the deltoid muscle
posterior humeral circumflex artery does what in quadrangular space Artery also supplies deltoid & other tissues in the area
humerus fracture in quandrangular space causes loss of strength due to loss of axillary nerve
Suprascapular artery oComes off as a branch of subclavian artery oTravels at the level of clavicle oGoes around spinoglenoid notch & into infrascapular fossa
Scapulothoracic Joint •Scapula moves along the ribs on the back of the thorax to make other movements oElevation by levator scapular oDepression by trapezius oProtraction by seratus anterior oRetraction by rhomboids oRotation (superior & inferior) by trapezius
Sternoclavicular Joint • Very stable joint, not usually separated, less than 3% of joint separations •Joint capsule •Two ligaments: o Anterior & posterior sternoclavicular ligaments o Costoclavicular ligament
function of the two ligaments in sternoclavicular joint and subscapula • Both ligaments + subclavius muscle strengthens the joint o Attached to clavicle & first rib, keeps clavicle toward midline & stabilizes joint
acromioclavicular joint is stabalized by o Acromioclavicular ligament o Coracoclavicular ligament – two parts that help stabilize the clavicle  Conoid (not coronoid) ligament – medial part  Trapezoid ligament – lateral part
Shoulder separation = acromioclavicular joint separation
grade I shoulder seperation separation without tearing the joint – stabilization will fix it
Grade II shoulder seperation tearing the acromioclavicular ligament
Grade III shoulder seperation tears acromioclavicular + coracoclavicular ligaments
Glenohumeral Joint- glenoid labrum o Connective tissue that helps deepen the glenoid socket o Can be torn anteriorly (posterior & superior too in baseball pitchers or quarterbacks) – there is a whole series of classifications
Head of humerus held on place by rotator cuff muscle
glenohumeral joint capsule o Weakest inferiorly  Head is broader, neck is narrower  Hard to dislocate head if tissue is present in the capsule that strengthens the joint
•Ligaments of glenohumeral joint Coracohumeral ligament, Transverse humeral ligament
coracohumeral ligament  Strengthens superiorly  From coracoid process
transverse humeral ligament  Greater to lesser tubercle of humerus  Holds long tendon of biceps brachii
Shoulder dislocation = dislocation of the glenohumeral joint
dislocation of the glenohumeral joint is o Head of the humerus driven inferior & anterior (95%) o Treatment: closed or open reduction o Sports injuries – impact on superior aspect of shoulder – it drives the shoulder away from the head region
Coracoacromial Arch contains Coracoacromial ligament
what is bursa • Fluid filled spaces that sit between muscle-bone or muscle-ligament
bursa function • Prevents abrasion/injury to muscle when they get close to the bone (rough) during movement – acts as cushion
bursitis inflammation of bursa from too much rubbing/pressure
Subacromial/subdeltoid bursa location o Between acromion, coracoacromial ligament & deltoid o Between supraspinatus tendon & joint capsule of glenohumeral joint
Subacromial/subdeltoid bursa function o Movement of supraspinatus under coracoacromial arch o Movement of deltoid over joint capsule & greater tubercle
Subscapular bursa o Between subscapularis & neck of scapula o Protects the tendon from root of coracoid process & neck of scapula
fascia • Compartmentalizes the portions of the arm o Brachial fascia o Lateral Intermuscular septum o Medial Intermuscular septum
Biceps brachii attachments Long Head -supraglenoid tubercle of scapula Short head -coracoid process Distal -Radial Tuberosity
biceps brachii innervation Musculocutaneous Nerve
biceps brachii function Supinate forearm -Flexes supine forearm
Brachialis – (deep to the biceps)innervation Musculocutaneous nerve
brachialis attachments • Distal anterior humerus • Coronoid process (also attaches bunch of other muscles) • Tuberosity of ulna
brachialis function •Flexion of forearm
Coracobrachialis attachments • Coracoid process • Middle of humerus
coracobrachialis innervation musculotaneous nerve
coracobrachialis • Flex & adduct arm
triceps brachii innervation Radial nerve Blood supply: deep radial artery Radial nerve found in the triangular interval made by lateral & long heads Midshaft fracture Saturday Night Palsy, Bar Stool Palsy – passing out in the wrong position
triceps brachii attachments • Long head: infraglenoid tubercle (long head splits the teres minor & major) • Lateral head: superior to radial groove • Medial head: Inferior to radial groove • Distal attachment: olecranon process of the ulna
triceps brachii function extend arms. shunt muscles for glenohumeral joint
Aconeus innervation radial nerve
aconeus attachment • Lateral epicondyle - proximal • Olecranon & posterior ulna - distal
brachial artery runs through the anterior compartment of the arm
brachial artery is the Continuation of the axillary artery (Axillary artery started at 1st rib) o 1st part = supreme thoracic artery o 2nd part = lateral thoracic artery o 3rd part = anterior & posterior humeral circumflex & subscapular o At inferior border of teres major, it continues into brachium & becomes the brachial artery
brachial artery located at •Inferior border of teres major to cubital fossa
Deep artery of the arm (arteria profunda brachii) travels with radial nerve through radial groove
Collateral circulation around the elbow Ulnar collaterals - arises from medial/ulnar side of brachial artery
Superior ulnar collateral goes posteriorly behind medial epicondyle
Inferior ulnar collateral short course – stays anterior to the medial epicondyle
• Arteries that branch of the brachial artery & supply the respective bones (collateral circulation) o Nutrient humeral artery o Radial o Ulnar
Superficial veins : cephalic (direction) laterally
Superficial veins: basilic (direction) medially – only goes up about half way & dives deep
Superficial : • Median cubital (direction) anterior to cubital fossa
Nerves of the arm • Continuation of brachial plexus • Musculocutaneous o Pierces coracobrachialis o Innervates muscles of anterior compartment o Continues distally then… o Becomes lateral antebrachial cutaneous nerve
Nerves of the Arm: ulnar o Goes behind medial epicondyle & then down into the forearm
Nerves of the Arm: Median o Lateral then medial to brachial artery
Nerves of the Arm: Radial o Between long & lateral head of triceps & crosses into forearm o Radial groove
Fractures of the Humerus:Proximal o Surgical neck  Axillary nerve – abduction is weaker or absent – loss of innervation to deltoid muscle  Posterior humeral circumflex artery – bleeding
Fractures of the Humerus:Middle o Mid-shaft involving radial groove  Radial nerve  Deep brachial artery
Fractures of the Humerus: Distal o Supracondylar  Median nerve (runs anteriorly) – if stretched, neuropathy – loss of innervation = cannot flex index & middle finger  hand of Benediction.when break their fall, the force pushes through the ulna & into humerus. Distal is the weakest.
Created by: ksoul6