Acromion
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Coracoid Process
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Superior angle of the scapula
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Suprascapular notch
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Infraglenoid tubercle
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Lateral border of the scapula
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Glenoid cavity of the scapula
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Head of humerus
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Medial epicondyle
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Trochlea
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Capitulum
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Lateral epicondyle
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Radial fossa
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Coronoid fossa
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Deltoid tuberosity
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Intertuburcular sulcus
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Surgical neck
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Lesser tubercle
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Greater tubercle
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Anatomical neck
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Supraglenoid tubercle
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Suprascapular notch
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Radial groove
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Medial supracondylar ridge
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Lateral supracondylar ridge
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Olecranon fossa
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Inferior angle of the scapula
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Medial border
Infraspinous fossa
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Spine
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Supraspinous fossa
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Head of radius
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Neck of radius
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Tuberosity of radius
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Coronoid process
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Tuberosity of ulna
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Olecranon articulating with olecranon fossa of humerus
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Manubrium of sternum
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Sternal angle
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Costal Cartilage
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Xiphoid process of sternum
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Sternal end of clavicle
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Acromial end of clavicle
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Conoid tubercle of clavicle
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Trapezoid line of clavicle
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Scapulohumeral rhythm
2/1 ratio (for flexion and abduction) glenohumeral/scapulothoracic movement
Cephalic Vein
Drains into axillary vein
Basilic vein
Drains into brachial veins
Median cubical vein
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Deltoid (anterior middle and posterior)
Origin- lateral 1/3 of the clavicle, acromion, spine of the scapula
Insertion: deltoid tuberosity of the humerus
Action: Abducts arm; anterior fibers flex and medially rotate the arm; posterior fibers extend and laterally rotate the arm
Innervation: Axill
Rotator Cuff Muscles
Important shoulder stabilizers:
Subscapularis
Supraspinatus
Infraspinatus
There's Minor
Subscapularis
Origin: Subscapular fossa
Insertion: lesser tubercle of the humerus
Action: medial rotation of the arm
Innervation: upper and lower Subscapular nerves
Supraspinatus
Origin: Supraspinatus fossa
Insertion: greater tubercle of the humerus
Action: abducts the arm (initiates abduction)
Innervation: suprascapular nerve
Infraspinatus
Origin: infraspinous fossa
Insertion: greater tubercle of the humerus
Action: laterally rotates the arm
Innervation: Suprascapular nerve
Teres Minor
Origin: upper 2/3 of the lateral border of the scapula
Insertion: greater tubercle of the humerus
Action: laterally rotates the arm
Innervation: axillary nerve
Teres Major
Origin: dorsal surface of the inferior angle of the scapula
Insertion: crest of the lesser tubercle of the humerus; medial lip of the intertubercular groove
Action: adducts the arm, medially rotates the arm, assists in arm extension
Innervation: lower Sub
Pectoralis Major
Origin: medial half of the clavicle, manubrium and body of sternum and costal cartilages of ribs 2-6
Insertion: crest of greater tubercle of humerus; lateral lip of the intertubercular groove of the humerus
Action: flexes and adducts the arm, medially rot
Pectoralis Minor
Origin: ribs 3-5
Insertion: corocoid process of the scapula
Action: draws the scapula forward, medialward, and downward
Innervation: medial pectoral nerve
Subclavius
Origin: first rib and its cartilage
Insertion: interior surface of the clavicle
Action: draws the clavicle forward and downward
Innervation: nerve to subclavius
Serratus Anterior
Origin: ribs 1-8 or 9
Insertion: medial border of the scapula on its costal (deep surface)
Action: draws the scapula forward; inferior fibers rotate the scapula superiorly
Innervation: long thoracic nerve
Order of muscle insertions- shoulder extension insertion order in intertubercular / bicipital groove
Lateral to Medial
Pectoralis major
Latissimus dorsi
Teres Major
Rotator Cuff Muscle insertion order
Anterior to posterior:
Subscapularis
Supraspinatus
Infraspinatus
Teres minor
Vertebral a.
Branch of subclavian; supplies the spinal cord and brain
Subclavian a.
Receives blood from aorta; runs from aorta to lateral aspect of the 1st rib; know one branch = VERTEBRAL atery
Axillary a.
Runs from lateral 1st rub to the inferior border of the teres major tendon; gives off posterior and anterior circumflex humeral arteries
Posterior Circumflex humeral a.
Branch of the axillary artery
Anterior circumflex humeral a.
Branch of the axillary artery
Brachial a.
Runs down the arm to the antecubital space; gives off deep artery of the arm
Rotator cuff pathology
-Repetitive movements (especially overhead) are the cause of many injuries to rotator cuff
-Degeneration- with age tendon properties change and the risk of tear increases
-Trauma- fall on outstretched hand FOOSH
-Supraspinatus most injured
-Partial versus
Boundaries of the Axilla
Medial wall: ribs and serratus anterior
Lateral wall: humerus
Anterior wall: Pec major/minor
Posterior wall: scapula, lats, and teres major
Contents of the axilla
Brachial plexus
Axillary artery and branches
Axillary vein
Lymph nodes
Brachial plexus
Purpose: Motor and sensory innervation to the upper limb
Hierarchy:
Roots
Trunks
Divisions
Cords
Branches
Brachial Plexus Roots
Landmark = anterior and middle scalenes
Ventral primary rami C5-T1, but can include C4 or T2
Subclavian artery
2 named branches =
Dorsal scapular nerve - C5
(To rhomboids and lavatory)
Long thoracic nerve - C5, C6, C7 (to serratus anterior)
Brachial Plexus Trunks
Landmarks = proximal/superior to clavicle, superior to 1st rib
-Superior/Upper Trunk- C5, C6
-Middle Trunk- C7
-Lower Trunk- C8, T1
2 Named Branches =
Nerve to subclavius C5, C6
Suprascapular nerve C5, C6 (to Supraspinatus and infraspinatus)
Brachial Plexus Divisions
Landmarks = deep to clavicle / apex of axilla
Anterior division
Posterior division
Brachial Plexus Cords
-Formed from divisions
-Landmark = deep to pec minor
Lateral cord
Lateral pectoral n C5 C6 C7 (pectoral is major)
Posterior cord
Upper Subscapular n. C5, C6 (subscapularis)
Thoracodorsal n. C6, C7, C8 (lats)
Lower Subscapular n. C5, C6 (subscapularis and teres major)
Medial cord
Medial pectoral n. C8, T1 (pec major and minor)
Medial Brachial Cutaneous n. T1 (sensory to medial arm)
Medial antebrachial cutaneous n. C8, T1 (sensory to forearm)
Terminal Branches
-Musculocutaneous n. C5 C6 C7 (biceps, brachialis, coracobrachialis)
-Axillary n. C5 C6 (deltoids and teres minor)
-Radial n. C5 C6 C7 C8 T1 (triceps, posterior forearm/hand motor and sensory)
-Median n. C5 C6 C7 C8 T1 (anteriorlateral forearm/hand motor
Lesions of the Brachial plexus
-Signs/Symptoms = pain, sensory loss, motor loss
-often originates in the c/s from stenosis or disc herniation (not the BP)
-can also reflect CNS lesions
Causes of BP lesions
Trauma
Compression/traction
Trauma during surgery
Tumors
Childbirth
Lesions of BP: TRAUMA
Motor vehicle accident
BP injuries often missed due to vascular injuries being paramount
Can arise later from post traumatic/surgical edema
Clavicle and humerus fracture
Distal fractures affect terminal branches
Lesions of BP - COMPRESSION/TRACTION
Can be due to major or minor trauma
-makela et al backpack study - Axillary, long thoracic, Suprascapular
-Saturday night palsy - radial n.
-Honeymoon palsy - radial or musculocutaneous n.
Lesions of BP - TRAUMA DURING SURGERY
Shoulder surgery
Clavicle fx/surgery
Breast surgery - elective / oncological
Positioning and direct insult to a nerve
Lymph node removal
Radiation
Long thoracic or thoracodorsal n.
Lesions of the BP - CHILDBIRTH
Erb's palsy-upper trunk loss of abduction, external rotation, supination, elbow flexion, sensation in lateral shoulder region
Klumpke's Palsy - lower trunk - claw Hand deformity
Myotomes
C5 elbow flexors (biceps, brachialis)
C6 wrist extensors (extensor carpi radial is longus and brevis)
C7 elbow extensors (triceps brachii)
C8 finger flexors (distal phalanx of middle finger (flexor digitorum profundus)
T1 finger abductors - 5th finger abd