Scapular And Pectoral Regions; Shoulder Joint

Front 1

What are the parts of the upper limb?

Back 1

Shoulder
Arm (brachium)- shoulder to elbow
Forearm (antebrachium)-elbow to wrist
Hand

Front 2

What are the bones in the shoulder?

Back 2

Pectoral girdle (Clavicle, Scapula)
Humerus

Front 3

What are the joints in the shoulder?

Back 3

Sternoclavicular joint
Acromioclavicular joint
Glenohumeral (shoulder) joint

Front 4

What is the function of the pectoral girdle?

Back 4

For attachment of the upper limb to the trunk. Provides strength, support, and mobility for the upper limb.

Front 5

What are the bones of the pectoral girdle?

Back 5

Clavicle and Scapula

Front 6

Where does the Clavicle articulate?

Back 6

Articulates with the axial skeleton (sternum).
Articulates with the scapula (acromion).

Front 7

Where does the Scapula articulate?

Back 7

Attached to axial skeleton (ribs) by muscles.
Articulates with the clavicle and with the head of the humerus.

Front 8

Where does the humerous articulate in the shoulder?

Back 8

Articulates with the glenoid fossa of the scapula.

Front 9

Describe fractures of the clavicle.

Back 9

Fractures of the clavicle are common, and occur between the middle and lateral 1/3 of the clavicle.

Front 10

Describe Fractures of the Scapula

Back 10

rare, and usually occur at the acromion.

Front 11

Describe Fractures of the Humerus

Back 11

common, and usually occur at the surgical neck or proximal shaft of the humerus.

Front 12

What can cause a fracture to the clavicle?

Back 12

Fall onto the shoulder or outstretched hand.
Direct blow to the clavicle.
The most commonly fractured bone in the body.
Break usually occurs at the junction of the middle and outer thirds.

Front 13

What are the symptoms of a clavicle fracture?

Back 13

Pain, swelling, bruising.
Deformity or “bump” over the fracture site.
Sagging shoulder (down and forward).
Lateral fragment is depressed by the weight of the limb, and pulled medially and anteriorly by the strong pectoralis major muscle.
Medial fragment is tilted upward by the sternocleidomastoid muscle.

Front 14

Where does the Rhomboid Minor attach?

Back 14

Rhomboid minor attaches to the root of the scapular spine at the medial border

Front 15

What is contained in the suprascapular notch?

Back 15

the Suprascapular Nerve and Suprascapular Artery travel through the suprascapular notch

Front 16

Describe the Sternoclavicular Joint type.

Back 16

Saddle synovial joint

Front 17

Describe movement in the Sternoclavicular Joint

Back 17

Anterior-posterior and vertical planes; some rotation.

Front 18

What are the ligaments of the Sternoclavicular Joint?

Back 18

Anterior and posterior sternoclavicular ligaments.
Interclavicular ligament
Costoclavicular ligament

Front 19

What is the articluation of the Sternoclavicular Joint?

Back 19

Manubrium articulates with clavicle.

Front 20

Describe the Acromioclavicular Joint type

Back 20

Plane synovial joint

Front 21

Describe the Acromioclavicular Joint articulation.

Back 21

Acromium of scapula articulates with clavicle

Front 22

Describe the movement of the Acromioclavicular Joint.

Back 22

Anterior-posterior and vertical planes; some axial rotation.

Front 23

What are the ligaments of the Acromioclavicular Joint?

Back 23

Acromioclavicular (AC) ligament
Coracoclavicular ligaments (Trapezoid ligament and Conoid ligament)
Coracoacromial ligament

Front 24

What is a Grade 1 Acromioclavicular Joint Separation? (Shoulder Separation)

Back 24

Acromioclavicular ligament is sprained.

Front 25

What is a Grade 2 Acromioclavicular Joint Separation? (Shoulder Separation)

Back 25

Acromioclavicular ligament is torn; trapezoid ligament is sprained.

Front 26

What is a Grade 3 Acromioclavicular Joint Separation? (Shoulder Separation)

Back 26

Acromioclavicular, trapezoid, and conoid ligaments are torn.
Complete separation.

Front 27

What muscles are responsible for retraction of the scapula?

Back 27

Trapezius, Rhomboids

Front 28

Name the movements of the Scapula

Back 28

Elevation, Depresion, Protraction, Retraction, Medial Rotation, Lateral Rotation

Front 29

What defines rotation of the scapula?

Back 29

Where the inferior angle goes.

Front 30

What is the Glenohumeral (Shoulder) Joint type?

Back 30

Ball and Socket

Front 31

Describe the articulation of the Glenohumeral (Shoulder) Joint

Back 31

glenoid fossa of scapula with head of humerus; surfaces covered by hyaline (articular) cartilage.

Front 32

What are the movements of the Glenohumeral (Shoulder) Joint?

Back 32

Flexion/extension, abduction/adduction, rotation, circumduction

Front 33

Describe the Articular fibrous capsule of the Glenohumeral (Shoulder) Joint

Back 33

contains 2 openings for
(1) tendon of long head of biceps brachii muscle
(2) communication between synovial cavity and subscapular bursa

Front 34

What are the ligaments of the Glenohumeral (Shoulder) Joint?

Back 34

Glenohumeral ligaments (Superior, middle, inferior)
Coracohumeral ligament

Front 35

What is the function of the Transverse Humeral Ligament?

Back 35

holds tendon of long head of the biceps brachii m. in intertubercular groove.

Front 36

What is the Coracoacromial Arch?

Back 36

formed by acromion, coracoid process, and AC & coracoacromial ligaments; protects shoulder joint superiorly.

Front 37

Where are the strengths and weaknesses of the Glenohumeral (Shoulder) Joint?

Back 37

Weakest inferiorly.
Strengthened anterior, posterior, and superior by ligaments and rotator cuff muscles:

Front 38

Describe Shoulder Dislocation

Back 38

Humerus dislocates inferiorly. However, shoulder dislocations are designated as ‘anterior’ or ‘posterior’ depending on the location of the dislocated humeral head relative to the glenoid fossa.

Front 39

How are shoulder dislocations designated?

Back 39

designated as anterior or posterior depending on location of humeral head relative to glenoid labrum after dislocation

Front 40

What does a shoulder dislocation put at risk?

Back 40

Axillary Nerve

Front 41

What is a Bursa?

Back 41

Sac-like structure containing a film of synovial fluid, located between tendons and bone, ligaments, or other tendons, or where skin moves over a bony prominence.

Front 42

What are the Bursae of the Shoulder?

Back 42

Subscapular Bursa
Subacromial (Subdeltoid) Bursa

Front 43

What is the location of the Subscapular Bursa?

Back 43

between subscapularis muscle and neck of scapula; extension of joint cavity through articular capsule.

Front 44

What is the location of the Subacromial (subdeltoid) Bursa?

Back 44

between deltoid muscle and supraspinatus tendon & joint capsule.

Front 45

Describe Subacromial Bursitis

Back 45

Irritation and inflammation of the subacromial bursa due to bone spurs on the inferior surface of acromion process or by calcification of the supraspinatus tendon.

Front 46

What are the movements of the shoulder?

Back 46

Flexion/Extension, Abduction/Adduction, Medial/Lateral Rotation, Circumduction

Front 47

Name the Scapulohumeral Muscles

Back 47

Deltoid m.
Supraspinatus m
Infraspinatus m.
Teres minor m.
Teres major m.
Subscapularis m

Front 48

Where does the trapezius attach to the scapula?

Back 48

The trapezius is inserted into the upper border of the crest of the spine and into the medial border of the acromion.

Front 49

Where does the deltoid attach to the scapula?

Back 49

The deltoid arises from the lower border of the crest of the spine and from the lateral border of the acromion.

Front 50

Where does the supraspinatus attach to the scapula?

Back 50

The supraspinatus arises from the medial two thirds of the supraspinous fossa (including the upper surface of the spine).

Front 51

Where does the infraspinatus attach to the scapula?

Back 51

The infraspinatus arises from the medial two thirds of the infraspinous fossa

Front 52

Where does the teres minor attach to the scapula?

Back 52

The teres minor arises from the upper two thirds of the rough strip on the dorsal surface along the lateral border.

Front 53

Where does the Teres Major attach to the Scapula?

Back 53

The teres major arises from the lower one third of the rough strip on the lateral aspect of the lateral border.

Front 54

Where does the subscapularis attach to the scapula?

Back 54

The subscapularis arises from the medial two thirds of the subscapular fossa.

Front 55

What is the innervation of the Deltoid?

Back 55

Axillary Nerve

Front 56

What are the actions of the Deltoid?

Back 56

Abducts, flexes, extends, medially and laterally rotates the humerus at the shoulder

Front 57

Name the attachments of the Deltoid

Back 57

Lateral third of clavicle; acromion and spine of scapula
Deltoid tuberosity of humerus

Front 58

Innervation of the Supraspinatus

Back 58

Suprascapular Nerve

Front 59

Actions of the Supraspinatus

Back 59

Stabilizes shoulder joint; initiates abduction of the humerus.
Supraspinatus is responsible for first 30 degrees of abduction

Front 60

Innervation of the Infraspinatus

Back 60

Suprascapular nerve

Front 61

Name the actions of the Infraspinatus

Back 61

Stabilizes shoulder joint; laterally rotates humerus.

Front 62

Innervation of the Teres Minor

Back 62

Axillary Nerve

Front 63

Name the actions of the teres minor

Back 63

Stabilizes shoulder jt; laterally rotates humerus

Front 64

Innervation of the Teres Major

Back 64

Lower subscapular Nerve

Front 65

Name the actions of the teres major

Back 65

Adducts, extends, and medially rotates humerus.

Front 66

Innervation of the Subscapularis

Back 66

Upper and Lower Subscapular Nerves

Front 67

Name the actions of the subscapularis

Back 67

Stabilizes shoulder joint; medially rotates the humerus

Front 68

What is the only thing that attaches to the lesser tubercle of the humerus?

Back 68

Subscapularis muscle

Front 69

Name the Rotator Cuff Muscles

Back 69

SITS
Supraspinatus m.
Infraspinatus m.
Teres minor m.
Subscapularis m.

-NOT teres major

Front 70

Describe the actions of the rotator cuff muscles

Back 70

Blend with articular capsule; stabilize shoulder joint.

Front 71

Name two types of rotator cuff tears

Back 71

1. Full thickness tear of supraspinatus tendon
2. Torn subscapularis tendon

Front 72

Describe the nerves of the scapular region

Back 72

Branches from the upper trunk and posterior cord of the brachial plexus (C5-8,T1).

Front 73

Describe the arteries of the scapular region

Back 73

Branches from the subclavian and axillary arteries.

Front 74

What are Scapular Region Spaces?

Back 74

Spaces between muscles that allow transmission of vessels and nerves from the axilla to the scapular region.

Front 75

Describe the Quadrangular Space

Back 75

Boundaries: Teres minor, teres major, long head of triceps brachii, and humerus
Contents: Axillary nerve; posterior circumflex humeral artery and vein.

Front 76

Name the Scapular Region Spaces

Back 76

Quadrangular Space
Triangular Space
Triangular Interval

Front 77

Describe the Triangular Space

Back 77

Boundaries: Teres minor, teres major, and long head of triceps brachii
Contents: Circumflex scapular a/v.

Front 78

Describe the Triangular Interval

Back 78

Boundaries: Teres major, long and lateral heads of triceps brachii
Contents: Radial nerve; deep brachial artery
Triangular interval more like a window, Nerve and artery don’t come through

Front 79

What are Scapular Anastomoses?

Back 79

A network of arteries around the scapula form a collateral circulation for the shoulder and upper limb.

Front 80

What vessels contribute to Scapular Anastomoses?

Back 80

Subclavian artery (Dorsal scapular a.
and Suprascapular a.)

Axillary artery (Circumflex scapular artery from subscapular artery)

Intercostal arteries may contribute thru anastomoses with dorsal scapular and thoracodorsal arteries

Front 81

What are the anatomical lines of the pectoral region?

Back 81

Anterior median (midsternal) line (AML)
Midclavicular line (MCL)
Midaxillary line (MAL)

Front 82

Name the Fascias of the Pectoral Region

Back 82

Pectoral Fascia
Clavipectoral Fascia
Serratus Fascia

Front 83

Describe the Pectoral Fascia

Back 83

deep fascia that invests the pectoralis major muscle

Front 84

Describe the Clavipectoral Fascia

Back 84

deep to pectoral fascia; invests subclavius and pectoralis minor muscles

Front 85

Describe the Serratus Fascia

Back 85

deep fascia invests the serratus anterior muscle

Front 86

Describe the Surface Anatomy of the Female Breast

Back 86

In subcutaneous tissue overlying pectoralis muscles.
Nipple is surrounded by the circular pigmented areola.
Axillary tail (of Spence) extends toward axillary fossa.
Intermammary cleft between breasts.

Front 87

Describe Retromammary Space

Back 87

space between breast tissue and pectoral fascia

Front 88

Describe fascia of the Breast

Back 88

Rests on bed of pectoral fasica (2/3) and serratus fascia (1/3)

Front 89

Describe the Structure of the Female Breast

Back 89

Composed of glandular and supporting fibrous tissue within a fatty matrix

Front 90

Name structural features of the female breast

Back 90

Mammary glands are modified sweat glands.
Suspensory ligaments (of Cooper) attached to dermis of skin.
Lactiferous ducts drain mammary lobules.
Lactiferous sinus is a dilation of the lactiferous duct deep to the areola.

Front 91

Name the arteries of the Breast

Back 91

Internal Thoracic Artery (Medial mammary branches)
Axillary Artery (Lateral mammary branches)
Posterior Intercostal arteries (Lateral mammary branches)

Front 92

Name the Nerves of the Breast

Back 92

Supraclavicular Nerves (C3,C4)
Intercostal Nerves (T4-T6) (Lateral and medial mammary branches)
Fibers convey sensory and sympathetic innervation.

Front 93

Describe the route of Lymph in the Breast

Back 93

Lymph first drains to subareolar lymphatic plexus. Most lymph then drains to axillary lymph nodes.
Remaining lymph drains to parasternal nodes, to opposite breast, or to inferior phrenic nodes.

Front 94

Describe the route through the axillary lymph nodes of the breast

Back 94

Anterior (pectoral)
Posterior (subscapular)
Lateral (humeral)
Central
Apical – receives lymph from all the others (subclavian lymphatic trunk and right lymphatic duct or (left) thoracic duct)

Front 95

What is breast cancer?

Back 95

Malignant tumors of the lactiferous ducts or lobules

Front 96

Describe metastasis in breast cancer.

Back 96

Lymph vessels carry cancer cells from the breast to lymph nodes.
Axillary lymph nodes are the most common site of metastasis.

Front 97

Name the Thoracoappendicular Muscles of the Pectoral Region

Back 97

Pectoralis Major
Pectoralis Minor
Subclavius
Serratus Anterior

Front 98

Innervation of the Pectoralis Major Muscle

Back 98

Medial and Lateral Pectoral Nerves

Front 99

Actions of the Pectoralis Major Muscle

Back 99

Flexes, adducts, and medially rotates the humerus at the shoulder.

Front 100

Name the two heads of the Pectoralis Major Muscle

Back 100

Clavicular Head and Sternocostal Head

Front 101

Innervation of the Subclavius

Back 101

Nerve to subclavius

Front 102

Actions of the Subclavius Muscle

Back 102

Stabilizes sternoclavicular joint

Front 103

Innervation of the Pectoralis Minor Muscle

Back 103

Medial and Lateral Pectoral Nerves

Front 104

Actions of the Pectoralis Minor Muscle

Back 104

Protracts the scapula and depresses shoulder.

Front 105

What three muscles attach to the Coracoid Process?

Back 105

Short head of the biceps
Coracorobrachialis
Pectoralis Minor

Front 106

Innervation of the Serratus Anterior Muscle

Back 106

Long Thoracic Nerve

Front 107

Actions of the Serratus Anterior Muscle

Back 107

Protracts and laterally rotates inferior angle of the scapula.
Holds scapula close to the body

Front 108

Describe Symptoms of Winged Scapula

Back 108

Medial border of the scapula protrudes outward (winging) due to paralysis of the serratus anterior muscle.

Front 109

Name the Causes of Winged Scapula

Back 109

Injury to the long thoracic nerve which innervates the serratus anterior muscle
Damage to long thoracic nerve can happen during a masectomy

Front 110

Name the Functional Deficits of Winged Scapula.

Back 110

Unable to abduct above horizontal plane due to inability of serratus anterior m. to rotate glenoid fossa superiorly.

Front 111

External Oblique Attachments

Back 111

Attached to ribs 5-12

Front 112

Rectus Abdominis Attachments

Back 112

Attached to xiphoid process and costal cartilages 5-7

Front 113

Describe the path of Nerves and Arteries of the Pectoral Region

Back 113

Nerves and arteries pierce the clavipectoral fascia.

Front 114

Describe the Nerves of the Pectoral Region

Back 114

Nerves from brachial plexus:
Lateral Pectoral Nerve
Medial Pectoral Nerve (comes through the pectoralis minor)

Front 115

Describe the arteries of the Pectoral Region

Back 115

Arteries from axillary artery:
Thoracoacromial trunk
Lateral Thoracic Artery