Shoulder And Axila: Module 3

Front 1

What are 4 joints of the shoulder complex?

Back 1

sternoclavicular, acromioclavicular, glenohumeral, scapulothoracic

Front 2

Sternoclavicular Joint

1) Articular Components
2) Joint Type
3) Associated Structures
4) Movements

Back 2

1) Sternal end of the clavicle and manubrium of sternum
2) Saddle type synovial joint
3) • Fibrocartilage disc
• Ligaments
- Sternoclavicular ligament
- Interclavicular ligament
- Costoclavicular ligament
4) - elevation/depression
- protraction/retraction
- rotation

Front 3

Acromioclavicular Joint
1) Articular Components
2) Joint Type
3) Associated Structures
4) Movements

Back 3

Articular components
• Acromial end of the clavicle and acromion process of scapula
Joint type
•Plane type synovial joint
Associated structures
• Fibrocartilage disc
• Ligaments - Acromioclavicular ligament - Coracoclavicular ligament
Movements
- rotation (scapula on clavicle)

Front 4

Glenohumeral joint
1) Articular Components
2) Joint Type
3) Associated Structures
4) Movements

Back 4

Articular components:
humeral head and glenoid fossa Joint Type
•Ball & socket type synovial joint
Movements •Flexion/extension •AB/ADduction •IR/ER
NOTE: • The genoid fossa is ~1/3 the
size of the humeral head

Front 5

What are the contractile and non-contractile aspects of the glenohumeral joint?

Back 5

Non-contractile
•Glenoid labrum •Glenohumeral ligaments •Coracohumeral ligament •Coracoacromial ligament •Transverse humeral ligament

•Contractile:
•Muscles of rotator cuff

Front 6

Describe 3 components of the glenoid labrum

Back 6

- fibrocartilagenous ring
- attaches to margin of gleniod fossa
- deepens the glenoid cavity

Front 7

1) What is the coracoacromial arch formed by?
2) What tendon passes under this arch?

Back 7

1) The coracoacromial arch is an extrinsic, protective structure formed by the smooth inferior aspect of the acromion and the coracoid process of the scapula, with the coracoacromial ligament spanning between them
This osseoligamentous structure forms a protective arch that overlies the humeral head, preventing its superior displacement from the glenoid cavity.
2) The tendon of the supraspinatus muscle passes under this arch

Front 8

1) Where is subacromal/sub deltoid located?
2) What is a bursa?

Back 8

1) located between the coracoacromial arch and the supraspinatus tendon
2) flattened sac containing synovial fluid.

Front 9

What is the scapulohumeral rhythm?

Back 9

Motion made by SC and AC joint.
Although the initial 30° of abduction may occur without scapular motion, in the overall movement of fully elevating the arm, the movement occurs in a 2:1 ratio
• For every 3° of abduction, approximately 2° occurs at the glenohumeral joint and 1° at the physiological scapulothoracic joint.
• Of the 180o of shoulder abduction, 120o is GH and 60o is scapulothoracic and this is known as scapulohumeral rhythm

Front 10

What do we have to do to get the greater tuberosity of the shoulder out of the way?

Back 10

The subacromial space is so limited that during full abduction of the arm we typically have to laterally rotate the humerus to move the greater tuberosity out of the way.

Front 11

Describe impingement

Back 11

Repetitive use of the rotator cuff muscles, or repetitive use of the upper limb above horizontal may allow the humeral head and rotator cuff to impinge on the coracoacromial arch, producing irritation of the arch and inflammation of the rotator cuff (esp. tendon of the supraspinatus muscle)

Front 12

Name the external muscles of the shoulder (superficial and deeper layer)

Back 12

Superficial: – Trapezuis
Deeper Layer: – Levator
Scapulae
– Rhomboid Major
– Rhomboid minor
– Latissimus Dorsi

Front 13

Trapezius muscle
Attachments
Action
Innervation

Back 13

• Attachments: - superior nuchal line, external
occipital protuberance, nuchal ligament, spinous processes of C7-T12
- scapula spine, acromion, lateral 1/3 clavicle
• Action: - upper: elevates and upwardly
rotates scapula - middle: adducts scapula - lower: depresses and
upwardly rotates scapula
• Innervation: - CN XI, C3, C4

Front 14

Latissimus dorsi
Attachments
Action
Innervation

Back 14

• Attachments: - spinous process T7-T12,
iliac crest, thoracolumbar fascia,
- intertubercular groove of humerus
• Action: - shoulder extension,
adduction and internal rotation (IR)
• Innervation: - thoracodorsal n.

Front 15

Levator Scapulae muscle
Attachments
Action
Innervation

Back 15

• Attachments: - transverse processes of C1-C4
- superior medial border of scapula
• Action: - elevates and downwardly
rotates scapula
• Innervation: - Dorsal scapular nerve (C5) and ventral rami of C3, C4

Front 16

Rhomboid minor and major
Attachments for both,
action, and innervation

Back 16

• Attachments (Rhomboid Minor): - spinous processes C7 and T1
- medial scapular border at the level of root of scapular spine
• Attachments (Rhomboid Major): - spinous processes T2 - T5
- medial scapular border from level of spine to inferior angle
• Action: - adducts/retracts and
downwardly rotates scapula
• Innervation: - dorsal scapular nerve

Front 17

What are the 4 anterior axioappendicular muscles of the shoulder

Back 17

– Pectoralis Major
– Pectoralis Minor
– Serratus Anterior
– Subclavius

Front 18

What are the scapulohumeral muscles (intrinsic)

Back 18

– Coracobrachialis* – Deltoid – Teres Major – Teres Minor
– Supraspinatus – Infraspinatus – Subscapularis

Front 19

Coracobrachialis
Attachments
Actions
Innervation

Back 19

• Attachments - tip of coracoid process - medial, mid-shaft of humerus
• Action: - flex and adducts shoulder
• Innervation: - musculocutaneous nerve

Front 20

Deltoid muscles
Attachments
Action
Innervation

Back 20

• Attachments - spine of scapula, acromion,
lateral 1/3 clavicle - deltoid tuberosity of humerus
• Action: - anterior: shoulder flexion
- middle: shoulder abduction - poster: shoulder extension
• Innervation: - axillary n.

Front 21

Teres Major muscle
attachment, action, innervation

Back 21

• Attachments
- inferior lateral aspect of
scapula
- intertubercular groove
of humerus
• Action
- shoulder medial/ internal
rotation (IR)
• Innervation
- lower subscapular n.

Front 22

Describe the attachments of the supraspinatus, infraspinatus, and teres minor muscles

Back 22

• Supraspinatus
- Supraspinous fossa
- Greater tubercle
• Infraspinatus
- Infraspinous fossa
-Greater tubercle
• Teres minor
- Middle part of lateral border
of scapula
- Greater tubercle

Front 23

What are the muscle attachments of the subscapularis

Back 23

- Subscapular fossa
- Lesser tubercle

Front 24

Describe the action and innervations of the supraspinatus, infraspinatus, and teres minor muscles

Back 24

• Supraspinatus - Action: shoulder abduction - Innervation: suprascapular n.
• Infraspinatus - Action: shoulder lateral/
external rotation (ER) - Innervation: suprascapular n.
• Teres minor - Action: shoulder lateral/
external rotation (ER) - Innervation: axillary n.

Front 25

1) How are the axillary nerve nad posterior humeral circumflex artery transmitted to the posterior aspect of the shoulder?
2) Name the superior, inferior, medial, and lateral boundaries of the quadrangular space

Back 25

1) via quadrangular space
2) Superior: tereis minor
inferior: teres major
medial: long head of the triceps brachii
lateral: surgical neck of humerus

Front 26

What are the actions and innervations of the subscapularis muscle

Back 26

- Action: shoulder medial/ internal rotation (IR)
- Innervation: upper subscapular nerve & lower subscaupular nerve

Front 27

1) What do the tendons of the 4 rotator cuff muscles blend with?

Back 27

1) The tendons of the 4 rotator cuff muscles blend with the fibrous capsule forming a cuff which reinforces the joint capsule and provides active GH stability

Front 28

What is the combined functioned of the rotator cuff muscles?

Back 28

• Allfourmusclesprovide compressive forces across the GH joint, and thereby provide dynamic stability to the GH joint.
• Theses muscles are extremely important in maintaining the humerus centered within the glenoid fossa.

Front 29

Name the following boundaries of the axila
1) anterior
2) posterior
3) medial
4) lateral
5) base
6) apex

Back 29

Anterior: pectoralis major and minor
Posterior: scapula,subscap. latissimus dorsi, teres major
Medial: ribs 1-4 and intercostal spaces
Lateral: intertubercular groove of the humerus
Base: skin and fascia of arm
Apex: convergence of clavicle, scapula and rib 1

Front 30

1) Where is the axillary vein formed?
2) What is it formed by?
3) What does it drain into?

Back 30

•The axillary vein is formed at the inferior border of the teres major muscle
•It is formed by the union of the:
•brachial veins (the accompanying veins of the brachial artery)
• basilic vein.
•The axillary vein drains into the subclavian vein

Front 31

1) What drains the superficial and deep venous palmer arches?
2) What is this prolonged by?
3) What does the basilic vein arise from?

Back 31

1) A dorsal venous network
2) Superficial to the metacarpus, this network is prolonged proximally on the lateral side as the cephalic vein.
3) From medial side of dorsa venous networks

Front 32

1) Where do the basilic and cephalic veins drain into?
2) Medial cubital vein?

Back 32

1) The basilic and cephalic veins ultimately drain into the origin and termination of the axillary vein, respectively.
2) The median cubital vein is the communication between the basilic and the cephalic veins in the cubital fossa.

Front 33

Where does the axillary artery come from?

Back 33

Aorta to (BT) to subclavian artery to axillary artery

Front 34

1) What is the axillary artery continuous with?
2) where does it begin and end?
3) Where is it continuous with the brachial artery?

Back 34

• The axillary artery is continuous with the subclavian artery.
• It begins at the lateral border of the 1st rib and ends at the inferior border of the teres major
• It has three distinct parts
• At the inferior border of the teres major the axillary artery is continuous withthe brachial artery.

Front 35

Describe the 3 parts of the axillary artery

Back 35

• The3partsoftheaxillary artery have a relationship to the pectoralis minor muscle.
• Part 1: located between the lateral border of the 1st rib and the medial border of the pectoralis minor.
• Part 2: lies posterior to pectoralis minor
• Part 3: extends from the lateral border of pectoralis minor to the inferior border of teres major.

Front 36

Name the branches of the axillary artery

Back 36

Axillary I:
Brachial a.
Subclavian a.
Anterior View
•Superior thoracic artery
Axillary II
•Thoracoacromial trunk •Lateral thoracic artery Axillary III •Subscapular a.
•Circumflex scapular a. •Anterior humeral circumflex •Posterior humeral circumflex

Front 37

What does the thyrocervical trunk include?

Back 37

Thyrocervicaltrunk
– Transverse cervical a. • Dorsal scapular a.
– Suprascapular a.

Front 38

Scapular Anastomosis

Back 38

Arteries can be joined to each other by an anastomosis, which makes them able to feed each other's territory *
The importance of the collateral circulation made possible by these anastomoses becomes apparent when ligation of a lacerated subclavian or axillary artery is necessary.
In this case, the direction of blood flow in the subscapular artery is reversed, enabling blood to reach the third part of the axillary artery.

Front 39

Describe the 5 main groups of the axillary lymph nodes.

Back 39

• Pectoral nodes mainly receive lymph from the anterior thoracic wall, including most of the breast.
• Subscapular nodes receive lymph from the posterior aspect of the thoracic wall and scapular region.
• Humeral nodes receive nearly all the lymph from the upper limb.
• The central group of lymph nodes is located along the 2nd part of the axillary artery and receives lymph from the pectoral, subscapular, humeral nodes.
• Vessels from the central nodes pass to the apical nodes, located along the first part of the axillary artery.