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PBL 6
anatomy of the shoulder, Ligaments and tendon, Inflammatory response, AC distrup
| Question | Answer |
|---|---|
| What is the appendicular skeleteon? | refers to bones of the upper and lower limbs, and the pectoral and pelvic girdles |
| What does the upper limb consist of? | the arm, the forearm and hand all connected to the axial skeleton by pectoral girdle |
| Pectoral girdle? | is formed by the clavicle and scapula, which lie anteriorly and posteriorly to the ribcage |
| Scapula | A large, flat triangular bone that lies obliquely on the back and side of the thorax |
| What articulations does the scapula form? | Acromio-clavicular joint with the acromial end of the clavicle Glenohumeral joint with the head of the humerus |
| Acromion | The expanded lateral end of the spine of the scapula. It has an oval facet for articulation with the clavicle |
| Coronoid process | A large, finger-like bony spur that projects upwards from the upper-aspect of the neck of scpaula. |
| What does the coronoid process give attatchment to? | Coracobrachials, short head of bicepts, pectoralis minor, coraco-clavicular ligaments. |
| Glenoid fossa | A shallow socket that articulates witht he head of the humerus. Is pear-shaped; its depth is increased by the glenoid labrum, which is attatched to the periphery. Lined with hyaline cartilage for articulation. |
| Inferior angle | The medial and lateral borders of the scapula meet at the inferior angle which overlies the seventh rib; with abduction of the arm it moves around the chest wall. |
| Infraspinosous fossa | A large depression if the dorsal aspect of the scapula, below the spine. It gives attatchment to infraspinatus, one of the four rotator cuff muscles. |
| Lateral border | Thick, runs from the infraglenoid tubercle to the inferior angle. |
| Medial Border | Thin, it runs between the superior and inferior angles. |
| Neck of the glenoid | A constriction between the glenoid and the body of the scapula |
| Spine | Triangular ridge of the bone that crosses the back of the scapula from the acromion to the medial border |
| Superior angle | The junction between the superior and medial borders |
| Superior borders | Thin and sharp, it is separated from the coracoid process by the supraglenoid notch. |
| Subscapular fossa | Slightly ridged fossa on the inner surface of the scapula |
| Supraspinosous fossa | A deep fossa located on the back of the scapula, above the spine. |
| Subscapular notch | A dip in the superior border, just medial to the coracoid process |
| What two articulations does the scapula form? | Acromio-clavicular joint with the acromion of the scapula Sterno clavicular joint with the manubrium of the sternum |
| Sternal end of scapula | The medial end of the clavicle that articulates with the sternum |
| Acromial end | The lateral end of the clavicle that articulates acromion of the scapula |
| Coroid tubercle | Small projection from the posterior edge; gives attatchment to the coroid part of the coraco clavicular |
| What three articulations does the humerus form? | Glenohumeral joint, humeroulnar joint, humeroradial joint |
| What type of joint is the shoulder? | Ball and socket joint |
| Superior angle | The junction between the superior and medial borders |
| Superior borders | Thin and sharp, it is separated from the coracoid process by the supraglenoid notch. |
| Subscapular fossa | Slightly ridged fossa on the inner surface of the scapula |
| Supraspinosous fossa | A deep fossa located on the back of the scapula, above the spine. |
| Subscapular notch | A dip in the superior border, just medial to the coracoid process |
| What two articulations does the scapula form? | Acromio-clavicular joint with the acromion of the scapula Sterno clavicular joint with the manubrium of the sternum |
| Sternal end of scapula | The medial end of the clavicle that articulates with the sternum |
| Acromial end | The lateral end of the clavicle that articulates acromion of the scapula |
| Coroid tubercle | Small projection from the posterior edge; gives attatchment to the coroid part of the coraco clavicular |
| What three articulations does the humerus form? | Glenohumeral joint, humeroulnar joint, humeroradial joint |
| What type of joint is the shoulder? | Ball and socket joint |
| What are the anatomical components of the shoulder? | Articular capsule, Coracohumeral ligament, glenohumeral ligament, glenohumeral ligament, transverse humeral ligament, glenoid labrum, Four bursae: Subscapular, subdeltoid, subacromial, subcoracoid |
| Muscles that move the pectoral girdle can be classified into two groups based on their location in the thorax. What are these two groups? | Anterior and posterior thoracic muscles |
| What are the anterior thoracic muscles that move the pectoral girdle | Subclavius, Pectoralis minor, serratus anterior |
| Subclavius | Small cyclinderical muscle under the clavicle that extends from the clavicle to the first rib. Depresses and moves clavicle anteriorly and stabilises |
| Pectorallis minor | Insertion- Coracoid process of scapula. Abducts scapula and rotates it downwards; elevates third through fifth ribs during forced inhalation |
| Serratus anterior | Large, flat fan shaped muscle between the ribs and scapula. Abducts scapula and rotates it upwards; elevates ribs when scapula stabilised |
| What are the posterior thoracic muscles? | Trapezius, levatator scapulae, rhomboid major, rhomboid minor |
| Trapezius | Flat, largem triangular sheet of muscle extending from the skull to vertebral collumn to pectoral girdle laterally. Elevates scapula, help extend head. |
| Levatator scapulae | Elevatos scapula and rotates it downwards |
| Rhomboid major and rhomboid minor | lies deep to the trapezius, Rhomoid major = T2-T5 Rhomboid minor= C7-T1, elevatos and adducts scaupla and rotates it downwards. |
| Which AXIAL muscles move the HUMERUS? | pectorallis minor, latissimus dorsi |
| pectorallis minor | Adducts and medially rotates arm at shoulder joint; clavicular head flexes arm, and sternal costal head extends the flexed arm to the side of trunk |
| latissimus dorsi | Extends adducts, and medially rotates arm at shoulder joint, drwas arm inferiorly and posteriorly |
| What are the SCAPULAR muscles that move the humerus? | Deltoid, Subscapularis, Supraspinatus, infraspinatus, teres minor, teres major, coracobrachials |
| Inflammation can be? | Acute or chronic |
| Acute inflammation | Is a rapid in onset and of short duration, lasting from a few minutes to as long as a few days, and is characteriszed by fluid and plasma proteins. |
| Chronic inflammation | Lasts longer than acute, more insidious, typified by influx of lymphocytes+macrophages, Vascular proliferation, scarring. |
| what are the five characteristic signs of inflammation? | Redness, Heat, pain and swelling, loss of function |
| What type of response is inflammation? | Non-specific immune response |
| what are the three basic stages of the inflammatory response? | 1. vasodilation and increased permeability of blood vessels 2. emigration of phagocytes from the blood into interstitual fluid 3. tissue repair |
| Vasodilation and increased permeability of capillaries | Increased permeability means substances normally retained in blood are permitted to pass from the blod vessels. vasodilation= more blood flow to the area |
| What three symptoms of inflammation does vasoldilation and increased permeability give rise to? | Heat, redness, swelling. |
| Emigration of phagocytes | After 1 hour, phagocytes appear. neutrophils stick to inner surface of enothelium. Neutrophils squeeze through to reach injured area. Depends on chemotaxis. |
| Mechanism of acromio-clavicular joint distruption | usually follows trauma, eg due to a direct blow to the acromion with the humerus adducted, as in collision in high-impact contact sports, or after a fall on to the apex of the shoulder. Injury may occur as consequence of throwing sports or weightlifting |
| Type 1 joint distruption | joint sprained without tear of either ligament |
| Type 2 joint distruption | Ac ligaments torn but CC ligaments still intact. lateral end of clavicle not elevated |
| Type 3 joint distruption | AC and CC ligaments torn >5mm elevation of AC joint in X-ray |
| Type 4 joint distruption | lateral clavicle separated and impaled posteriorly into trapezial fascia. |
| Type 5 joint distruption | complete separation of clavicle and scapula with gross upward clavicular displacement. |
| How are type 1 and 2 injuries managed? | with ice, a sling for 1-3 weeks and non-steroidal anti-inflammatory drugs (NSAIDs) followed by physiotherapy to strengthen muscles and ligaments after the acute phase. |
| how are type 3 and 4 injuries managed? | •Type III injuries should be managed conservatively but carefully selected cases may benefit from surgical intervention if conservative therapy fails |
| What is the difference between a tendon and a ligament? | Tendons attach muscle to bone. Ligaments attach bone to bone |
Created by:
Taryn Miller
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