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74 Cards in this Set

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What does the spine of the scapula divide?
1. The posterior side of the scapula
2. The supraspinous fossa from the infraspinous fossa.
What attaches the supraspinous fossa and the infraspinous fossa?
1. Spinoglenoid notch
What is the acromion?
The lateral end of the scapular spine
What is the glenoid fossa?
A shallow receptacle for the head of humerus.
What is the subscapular fossa?
A depression where the subscapularis muscle arises.
What is the coracoid process?

Why is it a good landmark?
(Coracoid means beak-like)
1. a fairly big tubercle that is deep to the deltoid muscles
2. Just a few centimeters inferior lies axillary artery, vein, & Brachial plexus
Scapula has 3 borders.
1. Superior border
2. Medial (vertebral) border
3. Lateral (axillary) border
Scapula has 3 angles.
1. Superior angle.
2. Inferior angle.
3. Lateral angle.
What is associated with the suprascapular notch?
1. Suprascapular ligament bridges the notch.
2. Suprascapular artery lies supperior to ligament
3. Suprascapular nerve lies inferior to ligament
Circumflex scapular artery
Circumscribes the scapula by running on the lateral surface.
What does the spine of the scapula divide?
1. The posterior side of the scapula
2. The supraspinous fossa from the infraspinous fossa.
What attaches the supraspinous fossa and the infraspinous fossa?
1. Spinoglenoid notch
What is the acromion?
The lateral end of the scapular spine
What is the glenoid fossa?
A shallow receptacle for the head of humerus.
What is the subscapular fossa?
A depression where the subscapularis muscle arises.
What is the coracoid process?

Why is it a good landmark?
(Coracoid means beak-like)
1. a fairly big tubercle that is deep to the deltoid muscles
2. Just a few centimeters inferior lies axillary artery, vein, & Brachial plexus
Scapula has 3 borders.
1. Superior border
2. Medial (vertebral) border
3. Lateral (axillary) border
Scapula has 3 angles.
1. Superior angle.
2. Inferior angle.
3. Lateral angle.
What is associated with the suprascapular notch?
1. Suprascapular ligament bridges the notch.
2. Suprascapular artery lies supperior to ligament
3. Suprascapular nerve lies inferior to ligament
Circumflex scapular artery
Circumscribes the scapula by running on the lateral surface.
Type of movement & muscles involved:
Adduction
Abduction
1. Retraction - uses Trapezius & both rhomboid major and minor
2. Protraction - usees serratus anterior
Type of movement & muscles involved:
Elevation
Depression
1. Move scapula up - Trapezius & Levator scapulae
2. Move scapula down - Trapezius & Pectoralis minor
Type of movement & muscles involved:
Medial rotation
Lateral rotation
Rotation refers to inferior angle of scapula
1. Trapezius & Serratus anterior
2. Serratus anterior & Trapezius--needed to rotate past 120 degrees
Humerus has 2 heads
1. Anatomical neck
2. Surgical neck
Anatomical Neck
1. Located at the circumference of the head
2. Some shoulder joint ligaments attach here
Surgical Neck
1. Distal to greater & lesser tubercles.
2. Most frequently fractured part of humerus
3. Axillary nerve is associated with surgerical neck which may be endangered by a fracture in this area
Where does radial nerve run?
In the radial groove.
Greater & Lesser Tubercles
1. Lies btwn the anatomical neck & surgical neck
2. Each has a crest; the crest of the greater & lesser tubercles, which extend inferiorly
3. Intertubercular groove lies between the tubercles
Where does the deltoid muscle insert?
Deltoid tuberosity.
Deltoid:
1. Three types of fibers
2. Corresponding type of rotation
3. Attachments
1. Posterior fibers - extension of shoulder joint & lateral rotation
2. Anterior fibers - flexion & medial rotation
3. Middle fibers - most powerful abduction component of glenohumeral joint
--spine of scapulla, acromionm & anteriorly to lateral 1/3 of clavicle (same as trapezius)
Rotator cuff muscles
1. Supraspinatus
2. Infraspinatus
3. Terres Minor
4. Subscapularis muscle
1. Location of rotator cuff
2. Function of rotator cuff
1. Around glenohumeral joint (shoulder joint proper)
2. SITS muscles act to rotate joint
3. Protect glenohumeral joint superiorly, anteriorly, posteriorly, but NOT inferiorly!!

-Dislocation is almost always inferiorly
Supraspinatus muscle:
1. Attachments
2. Function
1. Arised from supraspinatus fossa, extends laterally (posterior to the GH joint) to upper facet if greater tubercle
2. Most frequently torn cuff muscle
3. Important in the first 15 degrees of abduction
Infraspinatus muscle
1. Attachments
2. Function
1. Passes posteriorly across glenohumeral joint & attaches to middle facet of the greater tubercle
2. Main lateral (external) rotators
Teres Minor Muscle
1. Attachments
2. Function
1. Attaches to lower of 3 facets of the greater tubercle
2. Main lateral (external) rotators
Subscapularis Muscle
1. Attachments
2. Function
Large muscle on anterior side of scapular
1. Arises from the subscapular fossa passing across the glenohumeral joint and inserts into the lesser tubercle.
2. Powerful internal rotator
Serratus Anterior Muscle
1. Attachments
2. Function
3. Other details
4. Innervation/blood supply
Shaped like a saw
1. Attaches to medial aspect of the scapula & lateral surfacesif the upper eight ribs
2. Many of the fibers converge at the inferior angle, which helps lateral rotation of scapula-->allows abduct arm to 120 degrees
2b. Holds scapula against thoracic wall
3. Not divided into superior/inferior
3b. Called "boxer's muscle"
4. Long Thoracic Nerve/Lateral thoracic artery
Long thoracic nerve & Thoracodorsal nerve
Two high axillary motor nerves that must be reflected to remove axillary lymph nodes.
Common board examination question: If the long thoracic nerve was not functioning & you asked a patient to push against the wall (protracting against resistance), what would happen?
The scapula would protrude and it would look like a wing. The term 'wing scapula' refers to someone whose serratus anterior is not functioning.
Teres Major Muscle:
1. Attachments
2. Function
1. Arises from the inferior 1/3 of the lateral border of the scapula and passes around anteriorly to attach to the medial lip ir creast of the intertubercular groove.
2. It is a powerful extensor, adductor, and medial rotator (same as latissimus dorsi)
Study Question: Is it the medial crest of the greater tubercle or the lesser tubercle that the teres major attaches to?
Lesser Tubercle
Triceps muscle is 3-headed
1. Lateral Head
2. Long Head
3. Deep Head (not seen on slide)
Long Head of Triceps
1. Attachments
Passes between the teres major and teres minor and divides that space into 2 areas
Two spaces formed by long head of triceps.
1. Lateral space = Quadrangular space
2. Medial space = Triangular space
Quadrangular space:
1. Formed by what muscles?
2. What is found in this area?
1. Teres Major, Teres Minor, Long Head of Triceps, & Surgical Neck of Humerus
2. Axillary Nerve, Posterior Circumflex Humeral Artery
Triangular space:
1. Formed by what muscles?
2. What is found in this area?
1. Teres Major, Teres Minor, & Long Head of Triceps
2. A cutaneous branch of the circumflex scapular artery
Note: If you look from the anterior side & substitute subscapularis muscle for teres minor, the other boundaries are the same
Triangular Interval:
1. Formed by what muscles?
2. What is found in this area?
1. Formed by the long and lateral heads of the triceps
Radial Groove
1. What is its purpose?
Radial Nerve is so deep in arm, it has own groove
Subclavian Artery becomes...

What brances off the subclavian artery?
1. Changes names to Axillary artery at the outer surface of the 1st rib
2. Transverse cervical artery & Suprascapular artery,
Axillary Artery becomes...

If axillary artery becomes occluded, what happens?
1. Brachial artery at the distal surface of the teres minor muscle.
2. Upper limb remains viable b/c a system of junctioning of the arteries (blood supply takes alternate path)
What branches off the subscapular artery?
Circumflex scapular artery.
Plexus
Network of nerves or just a network.
Bracial plexus
1. Definition
2. Two portions
3. Location
1. Refers to a network of ventral rami which supply the upper limb
2. Supraclavicular portion;infraclavicular portion.
3. Initial portions can be seen in posterior triangle of the neck
Nerves to Identify in LAB
1. Radial Nerve
2. Axillary Nerve
3. Suprascapular Nerve
4. Dorsoscapular
5. Long thoracic
6. Medial Pectoral
7. Lateral Pectoral
8. Thoracodorsal Nerve to Latissimus
Pectoral Muscles
1. Attachments
1. Bony and cartilaginous attachments: sternum, clavicle, Costal cartilages, Coracoid process, Upper Ribs
Pectoralis Major Muscle has what heads?
1. Clavicular head
2. Sternal costal head
NOTE: 2 Heads can be surgically separated due to different innervation patterns
Clavicular Head
1. Attachments
2. Innervation
3. Function
1. Arises from medial half of the interior surface of clavicle
2. Lateral pectoral nerve
Sternal Costal Head
1. Attachments
2. Innervation
3. Function
1. Arises from the upper 6 costal cartilages and the sternum
2. Supplied by Medial & Laternal pectoral nerves
NOTE: Used to be removed in radical masectomy
Cephalic Vein
1. Location
2. Function
1. Runs in deltopectoral groove
2. Used to put a central line in
What runs in deltopectoral groove?
1. Cephalic vein
2. Deltoid branch of thoracoacromial artery (arterial trunk)
Deltopectoral Triangle
1. Cephalic Vein
2. Thoracoacromial artery
3. Lateral pectoral nerve
Pectoralis Minor
1. Attachments
2. Innervation
1. Variable origin ususally given as 3,4,5 ribs and inserts into coracoid process
2. Medial Pectoral nerve

-Usually surrounded by clavipectoral fascia
Shoulder Joint:
1. Type of joint
2. Supportive Muscles
3. What bones compose the joint?
Glenohumeral joint
1. Ball & socket, synovial
2. Mainly by rotator cuff muscles
3. Glenoid fossa of scapula & Head of humerus
Synovial Joints
1. Composition
2. Intrinsic vs Extrinsic
1. Synovial cavity with synovial fluid (viscosity of runny honey), Articular cartilage, Fibrous capsule, Intrinsic & Extrinsic Ligaments.
2. Intrinsic ligaments are a thickening of the fibrous capsule whereas extrinsic support joint but are NOT part of the fibrous capsule!
Why is the supraspinatus muscle the most commonly torn rotator cuff muscle?

How Prevent this?
1. What undergoing contraction or excursion, it runs underneath the acromion and above the head of the humerus. If done frequently, the supraspinatous tendon is going to undergo wear & tear.
2. Bursa (filled with fluid) lies btwn Supraspiunatus tendon & acromion--to minimize friction and attrition
Glenohumeral joint
1. Size
2. Location
1. 2nd largest synovial joint in body
2. Goes all the way out distally and surrounds the long head of the biceps tendon
Glenoid Cavity
1. Depth
2. How is that increased.
1. Shallow-provides some stability
2. Deepened by glenoid labrum
Protection of GH joint
1. Superiorly by supraspinatus
2. Posteriorly by infraspinatus & teres minor
3. Anteriorly by Subscapularis

-Note: when dislocated, palpate for coracoid process and go inferior. If you can feel head of humerus, then dislocated.
Coracohumeral ligament
Superiorly, Intrinsic ligament formed by the thickening of superior aspect of fibrous capsule
-NO posterior ligament
Glenalhumeral ligament
Anteriorly, intrinsic ligament formed by the thickening of anterior part of fibrous capsule.
They add stability to anterior aspect.
Coracoacromial Ligament
Extrinsic ligament that helps prevent upward dislocation of the shoulder joint
Transverse humeral ligament
Intrinsic ligament formed by the thickening of the fibrous capsule
Acromuiclaviclular Joint (AC Joint)
1. Referred to in shoulder separation.
2. Bones involved are clavicle & acromion of the scapula.
What nerve lies inferiorly to glenakhumeral joint?
Axillary Nerve (affected by dislocation)