shoulder, joint, arm
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Posterior Thoracoappendicular Muscles | Trapezius, Lattisimus dorsi, rhomboids, levator scapula.
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| trapezius attachments | spinous process of scapula, nuchal line, external occipital pertuberance, lateral 3rd of the clavical, acromion
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| latissimus dorsi attachments | thoracic vertebrea, ribs, illiac crest, thoracolumbar fascia, intertubercular groove of humerus
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| Rhomboid major attachments | spinous process t2-t5, medial border of scapula below spine
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| rhomboid minor innervation | dorsal scapula
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| rhomboid minor innervations | dorsal scapula
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| rhomboid minor attachments | nuchal ligament, medial border of scapula at or above spine
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| levator scapula innervations | dorsal scapula
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| levator scapula attachments | medial border of scapula
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| levator scapula function | elevates scapula, rotate scapula, depress glenid cavity inferiorly
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| trapezius function | suppior fibers: elevate scapula. Central fiber: retract scapula, inferior fibers depress scapula, rotates scapula
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| Latissimus dorsi function | Arm extension (down)
-Arm ADDuction
-Medial Rotation of Arm
-(Climbing muscle)
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| rhomboid functions | -Retract Scapula
-Rotates scapula
-Depress glenoid cavity
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| Anterior Thorappendicular Muscles | pectoralis major, pectoralis minor, serratus anterior, subclavical
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| pectoralis major innervation | lateral and medial pectoral nerves
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| pectoralis minor innervations | medial pectoral nerve
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| subclavius innervations | nerve to subclavius
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| serratus anterior innervation | long thoracic nerve
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| pectoralis major functions | -adduction
-medial rotate humerus
-flex and extend upper
extremity
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| pectoralis major attachmment | -Clavicular head, sternum,
superior 6 costal cartilages,
aponeurosis of external
oblique
-Intertubucular groove of
humerus
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| pectoralis minor attachment | -ribs 3- 5
-coracoid process of scapula
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| pectoralis minor function | -draw scapula inferiorly and
anteriorly (depress scapula)
-holds and stabilizes scapula
against thoracic wall
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| subclavius attachments | 1st rib and costal cartilage
-middle of 1/3 of clavicle
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| subclavius function | -anchor and depress the
scapula
-depress clavicle
-protect subclavian vessels
and superior trunk of brachial
plexus, cushioning
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| Deltoid innervation | axillary nerve
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| deltoid attachments | •Lateral 3rd of clavicle, acromion & spine of scapula
•Deltoid tuberosity of humerus
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| 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
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| rotator cuff muscles | supraspinatus, infraspinatus, subscapularis, teres minor
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| supraspinatus innervation | suprascapular nerve
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| supraspinatus attachment | •Supraspinous fossa
•Greater tubercle of humerus
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| 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)
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| infrasupranatus innervation | suprascapular nerve
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| infraspinatus attachment | •Infraspinous fossa
•Greater tubercle of humerus (just below supraspinatus)
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| infraspinatus function | •Laterally rotate arm
•Hold head of humerus in glenoid fossa (glenoid fossa is an oval surface)
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| teres minor function | •Laterally rotate arm
•Hold head of humerus in glenoid fossa
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| teres minor attachment | • Lateral border of scapula
•Greater tubercle of humerus
•Sits inferior to infraspinatus
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| teres minor innervation | axillary nerve
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| subscapularis innervation | upper and lower scapular nerves
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| subscapularis attachments | •Subscapular fossa
•Lesser tubercle of humerus – main muscle that attaches to the lesser tubercule of the muscle
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| subcapularis function | •Medially rotates and adducts humerus
•Hold humeral head in glenoid cavity
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| 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)
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| teres major innervation | Lower subscapular nerve
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| teres major function | •Adduct & medially rotates arm
•Not considered one of the rotator cuff muscles
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| Suprascapular nerve goes | around greater scapular notch & into infraspinatus, accompanied by suprascapular artery
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| Suprascapular artery goes | over the ligament and nerve goes under (Army passes over the bridge and Navy passes under the bridge)
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| 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
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| quadrangular space boundaries | teres minor (superiorly), teres major (inferiorly), humerus, long head of triceps brachii
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| Axillary nerve & posterior humeral circumflex artery are located within | quandrangular space
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| Axillary nerve goes through this space to | innervate the deltoid muscle
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| posterior humeral circumflex artery does what in quadrangular space | Artery also supplies deltoid & other tissues in the area
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| humerus fracture in quandrangular space | causes loss of strength due to loss of axillary nerve
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| Suprascapular artery | oComes off as a branch of subclavian artery
oTravels at the level of clavicle
oGoes around spinoglenoid notch & into infrascapular fossa
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| 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
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| 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
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| 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
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| 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
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| Shoulder separation = | acromioclavicular joint separation
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| grade I shoulder seperation | separation without tearing the joint – stabilization will fix it
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| Grade II shoulder seperation | tearing the acromioclavicular ligament
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| Grade III shoulder seperation | tears acromioclavicular + coracoclavicular ligaments
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| 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
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| Head of humerus held on place by | rotator cuff muscle
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| 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
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| •Ligaments of glenohumeral joint | Coracohumeral ligament, Transverse humeral ligament
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| coracohumeral ligament | Strengthens superiorly
From coracoid process
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| transverse humeral ligament | Greater to lesser tubercle of humerus
Holds long tendon of biceps brachii
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| Shoulder dislocation = | dislocation of the glenohumeral joint
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| 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
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| Coracoacromial Arch contains | Coracoacromial ligament
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| what is bursa | • Fluid filled spaces that sit between muscle-bone or muscle-ligament
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| bursa function | • Prevents abrasion/injury to muscle when they get close to the bone (rough) during movement – acts as cushion
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| bursitis | inflammation of bursa from too much rubbing/pressure
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| Subacromial/subdeltoid bursa location | o Between acromion, coracoacromial ligament & deltoid
o Between supraspinatus tendon & joint capsule of glenohumeral joint
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| Subacromial/subdeltoid bursa function | o Movement of supraspinatus under coracoacromial arch
o Movement of deltoid over joint capsule & greater tubercle
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| Subscapular bursa | o Between subscapularis & neck of scapula
o Protects the tendon from root of coracoid process & neck of scapula
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| fascia | • Compartmentalizes the portions of the arm
o Brachial fascia
o Lateral Intermuscular septum
o Medial Intermuscular septum
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| Biceps brachii attachments | Long Head
-supraglenoid tubercle of
scapula
Short head
-coracoid process
Distal
-Radial Tuberosity
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| biceps brachii innervation | Musculocutaneous Nerve
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| biceps brachii function | Supinate forearm
-Flexes supine forearm
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| Brachialis – (deep to the biceps)innervation | Musculocutaneous nerve
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| brachialis attachments | • Distal anterior humerus
• Coronoid process (also attaches bunch of other muscles)
• Tuberosity of ulna
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| brachialis function | •Flexion of forearm
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| Coracobrachialis attachments | • Coracoid process
• Middle of humerus
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| coracobrachialis innervation | musculotaneous nerve
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| coracobrachialis | • Flex & adduct arm
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| 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
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| 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
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| triceps brachii function | extend arms.
shunt muscles for glenohumeral joint
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| Aconeus innervation | radial nerve
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| aconeus attachment | • Lateral epicondyle - proximal
• Olecranon & posterior ulna - distal
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| brachial artery runs | through the anterior compartment of the arm
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| 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
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| brachial artery located at | •Inferior border of teres major to cubital fossa
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| Deep artery of the arm (arteria profunda brachii) | travels with radial nerve through radial groove
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| Collateral circulation around the elbow | Ulnar collaterals - arises from medial/ulnar side of brachial artery
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| Superior ulnar collateral | goes posteriorly behind medial epicondyle
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| Inferior ulnar collateral | short course – stays anterior to the medial epicondyle
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| • Arteries that branch of the brachial artery & supply the respective bones (collateral circulation) | o Nutrient humeral artery
o Radial
o Ulnar
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| Superficial veins : cephalic (direction) | laterally
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| Superficial veins: basilic (direction) | medially – only goes up about half way & dives deep
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| Superficial : • Median cubital (direction) | anterior to cubital fossa
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| 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
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| Nerves of the Arm: ulnar | o Goes behind medial epicondyle & then down into the forearm
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| Nerves of the Arm: Median | o Lateral then medial to brachial artery
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| Nerves of the Arm: Radial | o Between long & lateral head of triceps & crosses into forearm
o Radial groove
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| 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
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| Fractures of the Humerus:Middle | o Mid-shaft involving radial groove
Radial nerve
Deep brachial artery
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| 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.
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ksoul6
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