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Shoulders & Joints
Rinaldi 1/28/11 lecture
111
Anatomy
Undergraduate 4
01/30/2011

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Term
bursae
Definition
sac of synovial fluid used to prevent friction in joints
Term
women wear pointy shoes that rub and irritate bursae on the feets
Definition
cause of bunions
Term
skin, superficial fascial, deep fascia, arteries
Definition
layers from superficial to deep in a general place on the body
Term
the superficial fascia
Definition
where cutaneous veins and nerves are located (also subcutaneous fat) & small arterioles
Term
platysma
Definition
A platelike muscle in the neck extending to the lower face with origin from the subcutaneous layer and fascia covering the greater pectoral and deltoid muscles at the level of the first or second rib, with insertion to the mandible, the risorius muscle and platysma of the opposite side, with nerve supply from a branch of the facial nerve, and whose action depresses the lower lip and wrinkles the skin of the neck and the upper chest.
Term
supraclavicular nerves (C3 &4 ventral rami)
Definition
nerves that are just deep to the platysma
Term
cephalic vein
Definition
vein found in the deltopectoral triangle
Term
no fat, more organized collagen, muscles in a compartment deep to it
Definition
what is found in the deep fascia
Term
deep fascia
Definition
what type of fascia is pectoral fascia
Term
brachial fascia
Definition
the pectoral fascia is continuous with this in the upper limb
Term
cephalic vein
Definition
what is located in the deltopectoral triangle
Term
it bounded medially(proximally) by the clavicle, (laterally)superiorly by the deltoid m., and (medially)inferiorly by the pectoralis major m. (depends on book)
Definition
boundaries of the deltopectoral triangle
Term
clavicle
Definition
first bone to begin ossification in development
Term
pectoral fascia
Definition
deep fascia in the shoulder, continuous with the brachial fascia in the upper limb
Term
thoracoacromial artery and lymph channels/nodes
Definition
found just lateral to the deltopectoral triangle
Term
greater tubercle
Definition
the attachment site of the supraspinatus, infraspinatus & teres minor, also attachment site for the transverse humeral ligament and pectoralis major
Term
intertubercular groove
Definition
occupied by long tendon of the biceps, also the attachment site for the tendon of the pectoralis major (lateral lip), teres major (medial lip), and latissimus dorsi (floor)
Term
lesser tubercle
Definition
attachment site for the transverse humeral ligament and teres major
Term
arteries
Definition
run deep to deep fascia unless an anomaly exists
Term
referred pain
Definition
pain originating in a visceral structure that is interpreted as originating from areas of the body surface that send sensory impulses to the same segments of the visceral structure as the spinal cord
Term
body wall, upper limb, and chest (at same dermatomes as the spinal level that innervates it)
Definition
where angina pain is felt
Term
hilton's law
Definition
a nerve supplying a joint also supplies the muscles moving the joining and the skin over the insertions of these muscles
Term
gliding joint
Definition
type of joint the sternoclavicular joint is
Term
sternoclavicular, acromioclavicular(incomplete disc)
Definition
joints of the shoulder with an articular disc (of some form)
Term
between the sternal end of the clavicle and manubrium and the 1st costal cartilage
Definition
location of the sternoclavicular joint
Term
superior
Definition
freest movement of the sternoclavicular joint
Term
costoclavicular ligament
Definition
ligament that anchors inferior surface of clavicle to first rib and costal cartilage
Term
anterior and posterior sternoclavicular ligaments
Definition
ligaments that re-enforce the sternoclavicular joint anteriorly and posteriorly
Term
gliding joint
Definition
type of joint the acromioclavicular joint is
Term
acromioclavicular joint
Definition
allows slipping between clavicle and scapula
Term
acromioclavicular ligament
Definition
strengthens the acromioclavicular joint superiorly
Term
coracoclavicular ligament
Definition
ligament that anchors the clavicle to the coracoid process
Term
coracoclavicular ligament
Definition
consists of th conoid and trapezoid ligaments
Term
coracoclavicular ligament (conoid and trapezoid)
Definition
resist upward movement of the clavicle or downward movement of the scapula
Term
conoid
Definition
which ligament is more medial, conoid or trapezoid?
Term
[image]
Definition
where are the coracoclavicular ligaments
Term
clavicle fracture
Definition
which is more common? fracturing the clavicle, or joint separation?
Term
when the ligaments tear, then the muscles will be the only thing supporting the joint and will spasm and get tired
Definition
describe joint separation (of the shoulder)
Term
glenohumeral joint
Definition
what joint is the shoulder joint proper
Term
ball and socket (allows for large range of motion, while sacrificing stability)
Definition
what type of joint the glenohumeral joint is
Term
glenoid labrum(a lip of fibrocartilage)
Definition
what deepens the glenoid cavity
Term
synovial membrane
Definition
what forms a sheath around the biceps tendon
Term
medially-glenoid margin
laterally-anatomical neck of the humerus
Definition
where does the fibrous capsule of the glenohumeral joint attach (medially and laterally)
Term
glenohumeral
Definition
ligaments that strengthen the anterior capsule
Term
coracohumeral
Definition
strengthens the glenohumeral joint superiorly
Term
transvers humeral ligament
Definition
the ligament around the glenohumeral joint that crosses the intertubercular groove
Term
its made of fibrocartilage (which allows adaptable shape) but the blood supply is bad, so it doesn't heal well
Definition
why is it bad if the glenoid labrum tears
Term
transverse humeral
Definition
what tendon acts as a seatbelt to keep the biceps tendon strapped in?
Term
thickenings of fibrous capsule around the synovial capsule?
Definition
what are the glenohumeral ligaments made from
Term
[image]
Definition
(number all the parts)

1-greater tubercle
triangle between 1 & 2- tendon of biceps
2-subscapular bursae (black)
3-(glenoid labrum)
4-glenoid labrum/glenoid fossa of scapula
5-head of humerus
6- subscapularis muscle
7-infraspinatus
8-deltoid
Term
superficial, extrinsic
Definition
where are the larger more powerful muscles for large ranges of motion, what are they called?
Term
intrinsic
Definition
shorter deeper muscles responsible for mid-range motion, stabilizing the joint, and adjusting the position of the glenoid
Term
trapezius, latissumus dorsi, rhomboid major, rhomboid minor, levator scapulae
Definition
list the extrinsic muscles
Term
rhomboid major/minor, levator scapulae
Definition
list the deep extrinsic shoulder muscles
Term
trapezius, latissimus dorsi
Definition
list the superficisl extrinsic shoulder muscles
Term
latissimus dorsi
Definition
parapalegics revers the origin of this muscle to do a "hip-hitch" motion to shuffle their hips
Term
(anterior)Subscapularis
(posterior) Infraspinatus, Teres minor, Supraspinatus

remember that the rotator cuff SITS around the head of the humerus S.I.T.S.
Definition
muscles of the rotator cuff
Term
inferiorly, no rotator cuff muscles attach there
Definition
where does dislocation of the humerus occur, and why?
Term
origin remains stable, insertion moves towards origin
Definition
which remains stable while the other side moves 9origin or insertion)
Term
rotator cuff
Definition
functions to position the humeral head within the glenoid cavity
Term
rotator cuff muscles (not the ligaments)
Definition
the most important factor in stability of the glenohumeral joint
Term
fibrous tissue doesn't heal well and may require surgery
Definition
tendons of the rotator cuff blend with the joint capsule (outside the synovial capsule) this is significant why?
Term
supraspinatus, infraspinatus, teres minor, subscapularis, deltoid, teres major
Definition
list all intrinsic muscles of the shoulder
Term
supraspinatus
Definition
initiator of shoulder abduction
Term
the tendon of the supraspinatus muscle(which blends with the joint capsule), this allows communication between the subacromial joint capsule and the bursa
Definition
most common tear in the shoulder
Term
an extension of the subacromial bursa-the subdeltoid bursa
Definition
what is between the deltoid muscle and the humerus
Term
deltoid and teres major
Definition
which intrinsic muscles are not part of the rotator cuff
Term
clavipectoral fascia
Definition
what lies anterior to the subclavian vein
Term
pectoralis minor
Definition
this muscle lies within the clavipectoral fascia
Term
long thoracic nerve-serratus anterior
Definition
this nerve(and the muscle innervated) is prone to injury from knife wounds and mastectomies
Term
winged scapula
Definition
what is seen when the serratus anterior is paralyzed
Term
have the person lean on a table and the scapula will bow out(medial part sticks out) -look for assymety
Definition
how do you test for winged scapula
Term
reaching overhead - serratus opposes levator scapula and rotates the glenoid upward
Definition
if there is damage to the long thoracic nerve, what motion cannot be performed?
Term
axilla
Definition
pyramid shaped region through which nerves, arteries, veins, and lymphatics pass from the root of the neck to the upper limb
Term
between the first rib, clavicle, and superior edge of subscapularis
Definition
describe the apex border of the axilla
Term
the skin and fascia under arm
Definition
describe the base border of the axilla
Term
pectoralis muscles
Definition
describe the anterior border of the axilla
Term
scapula and associated muscles
Definition
describe the posterior border of the axilla
Term
thoracic wall (ribs 1-4)
Definition
describe the medial border of the axilla
Term
intertubercular groove
Definition
describe the lateral border of the axilla
Term
axillary artery
Definition
what artery does the brachial plexus wrap around
Term
subclavian, after it passes the lateral border of the first rib
Definition
what artery becomes the axiallry artey and where does this occur
Term
lateral border of rib 1 to medial border of pec. minor
Definition
describe the first part of the axillary artery
Term
the part that passes directly behind pectoralis minor
Definition
describe the second part of the axillary artery
Term
lateral border of pec minor to inferior border of teres major
Definition
describe the third part of the axillary artery
Term
brachial artery
Definition
the name of the axillary artery once it passes teres major
Term
axillary artery, axillary vein, and brachial plexus
Definition
what is enclosed in the axillary sheath
Term
prevertebral layer of cervical fascia
Definition
the axillary sheath is continuous with this
Term
median nerve
Definition
what nerve passes anteriorly to the brachial artery
Term
just inferior to pectoralis minor
Definition
where do the lateral and medial cords merge to form the median nerve
Term
superior thoracic artery
Definition
the branches of the first part of the axillary artery
Term
upper intercostal spaces & tissue adjacent to the anterior lateral wall of the axilla (first part of axillary artery)
Definition
what the superior thoracic artery supplies, and where it comes off the axillary artery
Term
thoracoacromial & lateral thoracic artery
Definition
the branches of the second part of the axillary artery
Term
subscapular, anterior circumflex humeral, and posterior circumflex humeral artery
Definition
the branches of the third part of the axillary artery
Term
2nd segment, has four branches, feeds pectoral muscles and structures around the shoulder
Definition
what does the thoracoacromial artery supply and what segment of the axillary artery does it come off
Term
2nd segment, supplies the lateral thorax & lateral breast
Definition
what does the lateral thoracic artery supply and what segment of the axillary artery does it come off
Term
3rd segment, supplies blood to the posterior axilla (muscles around scapula)
Definition
what does the subscapular artery supply and what segment of the axillary artery does it come off
Term
3rd segment, it forms an anastamoses for collateral circulation around the surgical neck of the humerus -> supplies neck, head, CT, & muscle around the head
Definition
what does the anterior circumflex humeral artery supply, and what segment of the axillary artery does it come off
Term
3rd segment, contributes to collateral blood supply around the shoulder
Definition
what does the posterior circumflex artery supply, and what segment of the axillary artery does it come off
Term
anatomoses
Definition
arterial _____ form a network around the scapula
Term
either the subclavian or the transverse cervical artery
Definition
where can the dorsal scapular artery branch from
Term
dorsal scapular, suprascapular, subscapular
Definition
list the arteries the form the anastomoses around the scapula
Term
no because there is collateral circulation and the anastomoses would still be ok
Definition
is it bad if the axillary artery is blocked?
Term
yes! there is no collateral circulation for the lower arm until the profunda brachii, and this is superior to the profunda
Definition
is it bad if the brachial/axillary artey is blocked below teres major?
Term
compress the third part of the axillary artery(from pec minor to teres major) against the humerus
Definition
if someone is bleeding out in the axillary artery, where would you apply pressure
Term
axillary vein
Definition
this lies to the medial side of the axillary artery
Term
axillary vein
Definition
continuation of the basillic vein at the inferior border of teres major(becomes subclavian vein at the lateral border of rib 1)
Term
basillic vein + venae commitantes
Definition
what forms the axillary vein
Term
axillary vein
Definition
has tributaries that correspond to the tributaries of the axillary artey
Term
axillary vein
Definition
receive venae commitantes that accompany the brachial artey
Term
a pair of veins, but occasionally more, that closely accompany an artery in such a manner that the pulsations of the artery aid venous return.
Definition
what is a venae commitante
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