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110 Cards in this Set
- Front
- Back
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Articulations of the shoulder
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Sternoclavicular Joint
Acromioclavicular Joint Scapulo-Thoracic Articulation Glenohumeral Joint |
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Thoracic Cage
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Sternum
Ribs (24) Costal Cartilages Thoracic Vertebrae |
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Features of the clavicle
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Sternal End
Acromial End Trapezoid line - at anterior acromial end, where trapezoid ligament attaches Conoid Tubercle - attachment site for ligament |
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Features of the scapula
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Superior Angle
Inferior Angle Coracoid Process Subscapular Fossa Scapular Notch Superior Border Axillary Border Vertebral Border Scapular Spine Acromion Process Supraspinatus Fossa Infraspinatus Fossa lateral: Glenoid Fossa Acromion Process Coracoid Process Supraglenoid Tubercle Infraglenoid Tubercle |
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Features of the distal anterior humerus
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Coronoid Fossa
Radial Fossa Capitulum Trochlea Look at pictures! |
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Features of the distal posterior humerus
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Medial Epicondyle
Lateral Epicondyle Supracondylar Ridges Olecranon Fossa |
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Features of the radius
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Head
Neck Radial Tuberosity Ulnar Notch Shaft Radial Styloid Process Carpal Articular Surface |
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Features of the ulna
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Shaft
Olecranon Process Coronoid Process Radial Notch Ulnar Tuberosity Ulnar Styloid Process Head |
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Muscles of the shoulder girdle
6 |
Trapezius
Levator Scapulae Rhomboid Minor Rhomboid Major Pectoralis Minor Serratus Anterior |
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Trapezius
O I N A |
O = Occip protuberance, Lig nuchae, spin proc C7 thru T1-12
I = Spine of scapula, acromion and lateral 3rd of clavicle N = Spinal Acessory n. (CN XI), C3-C4 (spinal nerve branches from) A= Upper Elevation Middle Retraction Lower Depression Upper & Lower Work together to rotate scapula |
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Levator Scapula
O I N A |
O = Trans proc, C1-4
I = Sup angle and prox med scapula N = C3-4, Dorsal scapular n. (C5) A = Elevate scapula; Laterally Flex C-Spine |
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Rhomboid Major and minor
O I N A |
O = Spin proc C7, T1-5
I = Vertebral border N = Dorsal Scapular n., (C4,5) A = Elevate, retract and downwardly rot scapula |
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Pectoralis Minor
O I N A |
O = Ant ribs 3-5
I = Coracoid process N = Med Pectoral n. (C6-8, T1) A = Depress, protract & downwardly rot scapula |
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Serratus Anterior
O I N A |
O = Anterior lateral Ribs 1-8
I = Med border of ant. scapular surface N = Long thoracic n. (C5-7) A = Protract, depress and upwardly rot scapula |
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Glenohumeral joint muscles
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Deltoid
Pectoralis Major Latissimus Dorsi Teres Major Subclavius* Supraspinatus Infraspinatus Teres Minor Subscapularis Coracobrachialis |
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Deltoid
O I N A |
O =
Lat 3rd of clavicle (anterior) Acromion (middle) Spine of scapula (posterior) I = Deltoid tuberosity N = Axillary n. (C5-6) A = Abduct arm (all 3 sections) Anterior = Flex & Int rot arm Posterior = Ext & Ext rot arm |
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Pectoralis Major
O I N A |
O = Med 2/3 of clavicle, sternum, costal cartilages of ribs 1-6
I = Lat lip of intertubercular groove (prox humerus) N = Med & Lat Pectoral n. (C7-8, T1 and C5-7) A = Adduct & Int rot arm Clavicular = Flex arm Sternal = Ext |
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Latissimus Dorsi
O I N A |
O = Spin proc T6-12, Lumbar and Sacrum, post iliac crest
Thoracolumbar fascia I = Med lip and floor of bicipital groove (prox humerus) N = Thoracodorsal n. (C6-8) A = Ext, Add, Int rot of arm With fixed UE, may raise trunk towards arm |
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Teres Major
O I N a |
O = Inferior angle of scapula
I = Med lip of intertubercular groove N = Lower Subscapular n. (C5-6) A = Add, Ext and Int rot of arm |
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Subclavius
O I N A |
O = 1st rib
I = Undersurface of clavicle N = Nerve to Subclavius (C5-6) A = Depress clavicle, stabilize SC joint |
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Coracobrachialis
O I N A |
O = Coracoid process
I = Middle 1/3 of medial humerus N = Musculocutaneous n. (C5-7) A = Flex and add of arm |
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Rotator cuff muscles
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Supraspinatus
Infraspinatus Teres minor Subscapularis "SITS" muscle Individual actions Combined function = Stabilization |
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Supraspinatus Muscle
O I N A |
O = Supraspinatus fossa
I = Greater tubercle of humerus N = Suprascapular n. (C5-6) A = Abducts arm Stabilization of GH jt |
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Infraspinatus
O I N A |
O = Infraspinatus fossa
I = Greater tubercle of humerus Below supraspinatus N = Suprascapular n. (C5-6) A = Ext rot of arm Stabilization of GH jt |
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Teres Minor
O I N A |
O = Upper 2/3 of axillary border of scapula
I = Greater tubercle of humerus Below infraspinatus N = Axillary n. (C5-6) A = Ext rot of arm Stabilization of GH jt |
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Subscapularis
O I N A |
O = Subscapular fossa
I = Lesser tubercle of humerus N = Upper and Lower subscapular n. (C5-6) A = Int rot of arm Stabilization of GH jt |
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Scapulothoracic "articulation"
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Not true synovial joint
Attached to axial skeleton Indirectly via muscle attachments Via Acromio-Clavicular joint attachment Scapula → clavicle Clavicle → Sternum |
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The main function of the clavicle is:
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To guide scapular movement and allow free upper limb motion
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What things does pec minor cross
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Relationship of Pectoralis Minor to:
Axillary Artery Brachial Plexus Tension creates Thoracic Outlet syndrome |
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Borders and contents of the axilla
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Borders:
First Rib and Thoracic Wall Pectoralis Major and Minor Subscapularis, Teres Major, Latissimus Dorsi Humerus Contents: Brachial Plexus Axillary Artery Lymph Nodes Fat |
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Upper Extremity Blood Supply
“The journey of a drop of blood” |
Subclavian Artery
Axillary Artery Brachial Artery Ulnar Artery Radial Artery Palmar Arteries |
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Three main branches of subclavian artery
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3 MAIN BRANCHES
Vertebral Thyrocervical Trunk Transverse Cervical Dorsal Scapular Suprascapular Internal Thoracic |
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3 portions of axillary artery
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Part I
Between 1st rib and superior pec min Has 1 main branch Part II Under pec minor Has 2 main branches Part III Between inf pec minor and sup teres major Has 3 main branches |
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1st part of axillary artery
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Part I (between 1st rib and superior Pec Min)
One Branch Supreme Thoracic ("sixties" teens love sex and pot) |
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Part 2 of axillary artery
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Part II (under Pec Min)
2 Branches Thoracoacromial Trunk Lateral Thoracic "teens love" |
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3rd part of axillary artery
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Part III
Between inf Pec Min and Teres Major Three Branches Subscapular -Circumflex Scapular -Branch to Latissimus dorsi Anterior Circumflex Humeral Posterior Circumflex Humeral "sex and pot" |
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Borders and contents of triangular space
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Borders:
Teres Minor Long Head of Triceps Brachii Teres Major Contents: Circumflex Scapular Artery |
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Borders and contents of quadrangular/quadrilateral space
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Borders:
Teres Minor Long Head of Triceps Brachii Shaft of the Humerus Teres Major Contents: Axillary Nerve Posterior Circumflex Artery |
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Brachial artery
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Deep (Profunda) Brachial
Superior Ulnar Collateral Inferior Ulnar Collateral radial artery ulnar artery (bifurcates) |
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Radial artery
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Radial Recurrent
Carpal Arch Princeps Pollicis Deep Palmar Arch Superficial Palmar Arch |
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Ulnar artery
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Anterior Ulnar Recurrent
Posterior Ulnar Recurrent Common Interosseous -Anterior Interosseous -Posterior Interosseous Carpal Arch Deep Palmar Arch Superficial Palmar Arch |
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Venous system of the arm
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Deep
Same names as the arteries Superficial Cephalic Basilic - Median Antibrachial Median Cubital |
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Borders and contents of cubital fossa
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Borders:
Brachioradialis Pronator Teres Line between Humeral Epicondyles Contents: Medial Cubital Vein Biceps Tendon Brachial Artery Median Nerve |
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Divisions/segments of the brachial plexus
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Roots
Trunks Divisons Cords Nerves (real therapists drink corona? deeply care? real therapists don't coddle newts) |
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Nerve roots of the brachial plexus
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C5, C6, C7, C8, T1
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3 Trunks of brachial plexus
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superior, middle and inferior
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Division of the brachial plexus
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3 anterior divisions and 3 posterior divisions
(one of each from each trunk) |
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Cords of the brachial plexus
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lateral
posterior medial |
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Peripheral nerves of the brachial plexus
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Long Thoracic
-Serratus Anterior Dorsal Scapular -Rhomboids -Levator Scapulae Suprascapular -Supraspinatus -Infraspinatus Nerve to Subclavius -Subclavius Lateral Pectoral -Pectoralis Major Medial Pectoral -Pectoralis Major -Pectoralis Minor Upper Subscapular -Subscapularis Thoracodorsal -Latissimus Dorsi Lower Subscapular -Subscapularis -Teres Major Musculocutaneous -Biceps Brachii -Brachialis -Coracobrachialis Axillary -Deltoid -Teres Minor |
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Terminal branches (nerves) of the brachial plexus
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Musculocutaneous nerve (C5,6,7)
Axillary nerve (C5,6) Radial nerve (C5-8, T1) Median nerve (C5-8, T1) Ulnar Nerve (C7,8, T1) |
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Median nerve
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Median Nerve
Combination of the Medial and Lateral Cords of the Brachial Plexus Innervates: Flexors of the Forearm Muscles of the Thenar Eminence of the Hand |
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Ulnar Nerve
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Ulnar Nerve
Continuation of the Medial Cord of the Brachial Plexus Innervates: Flexor Muscles of the Wrist Muscles of the Hypothenar Eminence of the Hand Ulnar Intrinsic muscles of the Hand |
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Radial Nerve
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Radial Nerve
Continuation of the Posterior Cord of the Brachial Plexus Innervates: Extensor Muscles of the Arm Extensor Muscles of the Wrist |
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Cutaneous innervation of the anterior shoulder and arm
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Supraclavicular (c3,4)
Lateral Brachial Cutaneous Upper (Axillary) (c5,6) Lower (Radial) Intercostobrachial (T2) Medial Brachial Cutaneous (T1, T2) Posterior Brachial Cutaneus (Radial) |
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Cutaneous innervation of the forearm
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Medial Antebrachial
Posterior Antebrachial (Radial) Lateral Antebrachial (Musculocutaneous) |
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Cutaneous innervation of the hand
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Ulnar - pinky and half of 4th
Radial - back half of thumb and dorsal surface of hand to half of ring finger and out to PIP joints Median - palm: half of thumb, 2,3, and half of 4, dorsal: underside of thumb and 2, 3, 1/2 4 up until PIPs |
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Branches off superior trunk of brachial plexus
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suprascapular (C5,6)
nerve to subclavius (C5,6) |
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Branches off posterior cord of brachial plexus
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Upper subscapular nerve (C5,6)
Thoracodorsal (middle subscapular) nerve (C6, 7, 8) Lower subscapular nerve (C5, 6) |
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Branches off medial cord of brachial plexus
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Medial Pectoral nerve (C8, T1)
Medial Brachial Cutaneous (T1) Medial Antebrachial Cutaneous (C8, T1) |
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What is biomechanics?
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The study of the mechanics of a living body, especially of the forces exerted by muscles and gravity on the skeletal structure”
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Sternoclavicular joint
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SC jt
Synovial (diathrodal) Joint Double-Saddle Shaped Contains a Fibrocartilage Disc |
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Ligaments of the SC joint
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Interclavicular
Anterior Sternoclavicular Posterior Sternoclavicular Costoclavicular |
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Motions of the SC joint
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Elevation / Depression
Protraction / Retraction Rotation |
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Elevation/depression of the SC joint
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Refers to movement of lateral end of clavicle
Jt movment around Anterior-Posterior axis ~45o of elevation <15o of depression Arthrokinematics: Superior / inferior translation |
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Protraction/retraction of the SC joint
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Refers to movement of lateral end of clavicle
~15o in each direction Accompanies pro/retraction of scapula Joint movement around vertical axis Arthrokinematics: Anterior/ posterior translation |
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Anterior/posterior rotation of the SC joint
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Spins around its long axis
50o posterior rotation <10o anterior rotation |
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SC joint movement during shoulder movements
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Elevation of arm and scapula
1st 30 ° upward rotation of scapula Elevation of clavicle at SC jt Further upward rotation of scapula (30 - 60°) Requires rotation of clavicle at SC jt Protraction / Retraction of scapula Associated with protraction and retraction at SC jt |
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Acromioclavicular joint
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AC
Synovial Joint Convex Clavicle and Concave Acromion May have an intra-articular disc Purpose: Maintain relationship between clavicle and scapula during arm movements Allow scapula free motion during arm movement |
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Reinforcement and Stability of AC joint
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Acromioclavicular ligament
Coracoclavicular -Conoid (medial) -Trapezoid (lateral) Joint is also reinforced superiorly by Upper Trapezius and Deltoid |
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AC joint ligaments
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Acromioclavicular ligament
Coracoclavicular ligament -Trapezoid (lateral) Vertical orientation -Conoid (medial) More horizontal orientation |
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Acromioclavicular Joint Sprain
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(“Separated Shoulder”)
looks gnarly, tear ligaments |
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Motions of the AC joint
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Upward / Downward Rotation
Anterior / Posterior tilting (tipping) Internal / External rotation |
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Upward/downward rotation of the AC joint
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Upward / Downward Rotation
Causes glenoid fossa to face upward or downward Closely tied with rotation of clavicle Posterior rotation of clavicle puts coracoclavicular ligament on slack and allows upward rotation |
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Anterior / Posterior Tilting (tipping) of the AC joint
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Anterior / Posterior Tilting (tipping)
Forward / Backward tilt of glenoid fossa Purpose: Keeps scapula in contact with thorax Allows the glenoid fossa to follow the humeral head |
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Internal / External Rotation of the AC joint
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Internal / External Rotation
Causes glenoid to face anteromedially / posterolaterally Purpose: Keeps the scapula in contact with the thorax Allows the glenoid fossa to follow the humeral head |
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Scapulothoracic articulation motions
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Not a “True” Joint
Motion is actually the result of the combination of S-C and A-C joint motion Motions: Upward / Downward rotation Elevation / Depression Protraction / Retraction |
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upward/downward rotation of the scapula
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Occurs as a result of combined:
SC elevation/depression SC posterior/anterior rotation AC upward/downward rotation Total of ~ 60° of upward rotation First 30°of motion: Axis is at base of spine Last 30 degrees of motion: Axis is at A-C joint |
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Muscles causing scapular rotation
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Upward Rotation:
Serratus Anterior Upper Trapezius Lower Trapezius Downward Rotation: Rhomboids Pectoralis Minor Levator Scapulae |
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Elevation/depression of the scapula
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Occurs as a result of combined:
SC elevation/depression AC anterior / posterior tilt AC internal / external rotation |
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Muscles causing Elevation/depression of the scapula
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Elevation
Upper Trapezius Levator Scapulae Rhomboids Depression Lower Trapezius Pectoralis Minor Serratus Anterior |
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Protraction/retraction of the scapula
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Occurs as a result of combined:
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Muscles causing Protraction/retraction of the scapula
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Protraction
Serratus Anterior Pectoralis Minor Pectoralis Major (clavicular portion) Retraction Rhomboids Middle Trapezius |
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Abnormal movements of the scapula
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Winging - Prominence of the Vertebral Border
Tipping - Prominence of the inferior angle, postural fault or muscle weakness |
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Glenohumeral joint
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“Ball and Socket”
3 degrees of freedom Flexion / Extension Abduction / Adduction Internal / External Rot. Articulation of: Concave Glenoid fossa with Convex Humeral head |
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Humeral orientation
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130-150 degrees in the frontal plane
30 degrees posterior in the transverse plane “Retroverted” Proposed reason why external rotation typically > internal rotation Implications of excess retroversion? |
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Glenoid labrum
Function |
Ring shaped fibrocartilage structure which surrounds glenoid fossa
Blends with the joint capsule superiorly GH ligaments and Long Head of Biceps attach here Increases stability of GH joint: Serves to deepen the glenoid fossa Controls mild to moderate translation forces 50% increase in depth Acts as “suction cup” to hold humeral head in place Surface tension created by synovial fluid Negative osmotic pressure |
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Glenohumeral joint capsule
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Large and Loose
Allows for much free movement Taut superiorly Lax inferiorly & anteriorly Reinforced: STATICALLY: By ligaments DYNAMICALLY: By muscle & tendons of rotator cuff except inferiorly – weakest here Synovial fluid produces adhesion / cohesion Disrupted if the capsule is compromised |
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Ligaments of GH joint
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Glenohumeral ligaments
Superior Middle Inferior Form a “Z” on anterior portion of GH capsule Coracohumeral ligament Coracoacromial ligament |
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Superior Glenohumeral Ligament
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Superior Glenohumeral Ligament
Purpose: Anterior and Inferior stabilizer with arm by side Taut in external rotation |
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Middle Glenohumeral ligament
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Middle Glenohumeral
Absent in 30% of individuals Purpose: Anterior stabilizer with arm in 0-60o of abduction Inferior stabilizer with arm in adduction Taut in external rotation |
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Inferior Glenohumeral ligament
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Inferior Glenohumeral
Resembles a Hammock Anterior Band Posterior Band Axillary Pouch Strong stabilizer beyond 45o of abduction Anterior stabilizer with arm in abduction and external rotation (position of dislocation) Anterior Band Axillary Pouch (fans out) Posterior stabilizer with arm in flexion and internal rotation Posterior Band |
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Coracohumeral ligament
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Coracohumeral
Taut in: External Rotation Extension Anterior fibers Flexion Posterior fibers Provides passive support against gravity, especially with adduction and external rotation |
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anterior shoulder dislocation
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Potential to secondary injury
Hill Sacs injury Axillary nerve damage |
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Coracoacromial arch
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Formed by the Acromion and Coracoacromial ligament
Functions to: Protect the humeral head Protect muscle and tendons crossing over the humeral head Prevent superior dislocation But … plays a major Role in causing Shoulder Impingement |
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Bursae about the shoulder
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Subacromial
Subdeltoid Subcoracoid Subscapular |
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Rotator cuff tear
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Most commonly affects the supraspinatus
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Scapulohumeral rhythm during shoulder elevation
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ROM of the Shoulder complex is comprised of movement at the:
Scapulothoracic articulation (~60 degrees) S-C Joint A-C Joint G-H joint (~120 degrees) Ratio of GH: ST movement is ~2:1 |
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Scapulo-Humeral Rhythm Breakdown (from 0-180o of shoulder elevation)
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0o – 30o (Setting Phase)
Scapular motion is minimal and inconsistent Primarily humeral contribution Stress or resistance to arm ↑s scapular contribution 30o – 90o Significant increase is scapular contribution Ratio of 2 to 2.75:1 90o – 160o Relatively equal contributions Ratio of 1:1 |
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Scapulo-Humeral Rhythm
Function and Purpose: |
Allows larger ROM with maximum stability
Allow the glenoid fossa to be in an optimal position to receive the humeral head Permits SITS muscles maintain optimal length-tension relationship |
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Osteokinematics (aka: physologic motion)
of the Glenohumeral Joint |
Flexion / Extension
Internal / External Rotation Greater range is available when the humerus is abducted Abduction Limited if humerus is internally rotated Greater Tubercle contacts the Acromion |
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Arthrokinematics (accessory motions)
of the Glenohumeral Joint |
Accessory Motions
The Humeral Head Undergoes: Rotation or spin Roll Glide or Translation From 30o – 60o of arm elevation (scapular plane), the Humeral head rolls superiorly ~3mm This centers the head since it was already inferior Once centered, the humeral head undergoes pure inferior glide and follows the convex/concave rule. |
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What happens if GH capsule is “tight”?
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Law of Capsular Restraint
The direction of humeral head translation is influenced by the relative tightness of the capsule Glide is “pushed” opposite of capsular tightness Tight posterior capsule during flexion Pushes humeral head anteriorly |
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Static Stability of the Shoulder
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With the arm by the side, no muscle activity is required to resist gravity’s pull
Superior Joint Capsule Coracohumeral Ligament Inclination of glenoid The Supraspinatus and Posterior Deltoid are only recruited with added load |
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Role of Muscles About the Shoulder
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Role of Muscles About the Shoulder
Move the Humerus Produce Intra-articular gliding * Maintain opposition of joint surfaces * * Required for Dynamic Stability |
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DYNAMIC Stability of the Shoulder
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During movement:
Ligaments provide some support but … shoulder muscles provide DYNAMIC STABILITY !!! Participants: Force of Prime Mover Force of Gravity Force of Steerers Force of Friction Joint Reaction Forces |
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Prime mover of shoulder
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Prime Mover (Mainly Deltoid)
Rotatory Component Upward Translation Component Acts as a de-stabilizing force !!! If unopposed, the humerus will impact the acromion |
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Dynamic stability of supraspinatus
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Supraspinatus
Upward translation Joint compression Resultant force is abduction Its large moment arm makes it a significant abductor |
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Dynamic Stability: steering muscles of shoulder
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Infraspinatus, Teres, Minor, Subscapularis (ITS)
Downward translation component Joint compression |
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Subacromial Impingement Anatomy
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What does the impinging?
Under surface of acromion Tip of coracoid Greater tubercle What can be impinged? Supraspinatus tendon Infraspinatus tendon Biceps tendon Subacromial bursa Subscapularis |
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Causes of Subacromial Impingement
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Dynamic stability
Rotator cuff musculature Scapular musculature Structural factors Acromion type Degenerative changes at coracoacromial arch Postural factors Hypermobility Hypo-mobility |
