Sc13L03 The pectoral girdle and shoulder joints

Emma Allde
Flashcards by , created about 3 years ago

Medicine Y2 (Scenario 13 | Shoulder, axilla and arm) Flashcards on Sc13L03 The pectoral girdle and shoulder joints, created by Emma Allde on 09/20/2016.

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Emma Allde
Created by Emma Allde about 3 years ago
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Question Answer
What (2) bones make up the pectoral or shoulder girdle? anterior clavicle and posterior scapula (L: key, shoulder) 79f97273-4c9d-4ac1-9acd-0d6e710a5ee3.png (image/png)
What separates the shoulder girdles from each other anteriorly? the sternum 6c4af4c2-7de6-4ee5-ac54-f16dd725519d.png (image/png)
What separates the shoulder girdles of either side posteriorly? Nothing, there is a gap and they do not articulate with e/o or the spinal column 526f407b-5bd5-4964-852f-b0008a096037.png (image/png)
What is the only connection b/w the upper limb and axial skeleton? pectoral/ shoulder girdle
What does the medial end of the clavicle articulate with? the manubrium of the sternum
What is the joint b/w the clavicle and the sternum? sternoclavicular joint eefcfa36-ed95-4983-af5f-d17bfe31d336.jpg (image/jpg)
Posteriorly, the anterior surface of the scapula, along with its associated musculature, forms a connection with what? the posterior aspects of the upper ribs
What is the false joint between the scapula and ribs called? 'scapulo-thoracic' joint 0d4cb193-360f-406a-a93a-f73163d8c46d.png (image/png)
What is the joint called at the articulation b/w the clavicle and scapula? acromioclavicular joint de88782e-56a3-49e4-a43d-902a310d4f39.png (image/png)
What is the function of pectoral girdle? to brace the upper limb away from the trunk
What is the function of the scapula? give a large surface area for muscular attachments
In what genetic condition are some people born without a clavicle and are thus able to bring the upper limb across the front of the chest? Cleidocranial dysostosis (or dysplasia) cleido = L. key dystotis = L. bad bone development 7c7a9037-9751-40a9-9e52-70a5b2c1f333.jpg (image/jpg)
What is the inheritance pattern of cleidocranial dysotosis? autosomal dominant
What other bone is also affected in cleidocranial dysotosis? cranium 103df074-fe42-4285-97cf-ab05f1ba5070.jpg (image/jpg)
What is the function of the clavicle? to act as a brace
Describe the articular surface of the medial end of the clavicle: expanded to form a large, oval facet 7c05b145-3618-46ff-a124-407f2be2125b.png (image/png)
Describe the articular surface of the lateral end of the clavicle: flattened in the horizontal plane, with a small posterolateral facet which articulates with the acromion process of the scapula b9615d49-50b8-4f21-9e6e-db9441b976a3.png (image/png)
What makes the scapula the most frequently fractured bone in the body? It serves to transmit forces from the upper limb to the axial skeleton
Describe the concave/ convex points of the scapula: medial 2/3: convex towards the front lateral third: concave towards the front 393a55b4-4d82-49cd-b480-668599899443.jpg (image/jpg)
What are (7) unique features of the clavicle: (1) subcutaneous throughout (2) only horizontal long bone (3) first bone to ossify (4) only long bone to ossify in membrane (5) occasionally pierced by the middle supraclavicular nerve (6) no medullary cavity (7) only long bon to ossify from 2 primary centres
How are most clavicular fractures caused? (2) fall or direct trauma
What makes are clavicular fractures potentially dangerous? The fractured ends present a hazard to the vessels at the root of the neck (thoracic inlet)
What kind of bone is the scapula? flat bone
Where, in relation to the ribs, is the scapula found? 2nd - 7th rib
How many margins does the scapula have? df5e7cdb-11b9-4cd6-a556-e818f73a86e5.gif (image/gif) 2acffa43-10f4-4249-8503-f8de4e9b70bf.jpg (image/jpg)
How many angles does the scapula have? Where are they found? 3: inferior, superior and lateral 5e3180d6-bcc7-4883-b656-17bfd8a2fb1a.jpg (image/jpg)
Identify (anterior view) acaf7ca5-4a59-4f21-b571-9187ea585cea.png (image/png) subscapular fossa
What do the medial ridges of the anterior surface of the scapula serve as attachments for? tendinous origins of the subscapularis muscle 3a7a6209-59e5-447f-bade-f1f3e635d455.jpg (image/jpg)
What attachments does the lateral, anterior surface of the subscapular fossa serve as attachments for? fibrous attachment of subscapularis muscle aa148cd8-99a4-428e-8f95-996d721ac489.jpg (image/jpg)
Identify 5a2a27e6-8dcc-4b10-9a7c-d266506ab877.jpg (image/jpg) supraspinous fossa
Identify 84d5937b-0188-456c-910a-94b94789c818.png (image/png) infraspinous fossa
Identify 34ed29ce-365b-40b1-a985-ab035ece746a.png (image/png) spine of the scapula
The spine of the scapula projects shelf-like and posteriorly, angling upwards from the medial border to end in a free lateral process called what? 75d29bbd-c562-4a5d-8a4c-52d8b5d6f2fb.png (image/png) the acromion
What does the acromion articulate with? the clavicle
What does the medial 2/3 of the supraspinous process serve as an attachment for? 44dc1156-e252-4c2a-a3f5-4949131d0aa3.png (image/png) supraspinatus msucle
The supero-lateral angle of the scapula forms a cavity/fossa with what part of what other bone? What is the cavity/fossa called? 79d2babb-e473-4cd0-a7d3-bef103e503cf.png (image/png) head of the humerus glenoid fossa
What process arises from the superior margin of the scapula, projecting antero-laterally over the glenoid fossa? 503595b5-828e-4204-8ef6-c7737dfa8fb8.png (image/png) coracoid process
What is found medial to the base of the coracoid process? 26e53ddc-3c74-4925-a6a8-5026a718ee03.png (image/png) suprascapular notch
What does the proximal end form of the humerus form an articular surface with and what is the joint called? shoulder joint glenohumeral joint
What is the articular part of the humerus called? the head
What is unique about this bone? It has (2) heads: surgical and anatomical
Label 13e7ca81-a4f0-4c42-bc48-f4b46d3f4c5e.jpg (image/jpg) anatomical neck of the humerus
Label a58f2070-d073-4067-85ee-571f50a00b37.jpg (image/jpg) surgical neck of the humerus
What (3) features are found b/w the (2) necks of the humerus? 8a8bd96f-0ca6-4006-9b66-47d688e46369.png (image/png) 1cdb3408-0ab0-41f5-84b4-37fcd0c87221.png (image/png)
Why is the bicipital (inter-tubercular) groove called as such? b/c the long head of the biceps brachii sits in the groove, having just passed over the head and anatomical neck 948c0ca8-e89f-48d2-8f61-2c0f8874c573.png (image/png)
How many facets does the greater tuberosity have? What are the muscle attachments? 3 for the attachment of three separates muscles from the scapula supraspinatus, infraspinatus and teres minor 612b6854-8090-461d-b369-5c6ab60d1034.png (image/png)
How many facets does the the lesser the tuberosity have? Where do the muscle attachments originate? 1, from the scapular muscle (subscapularis) a9c99ec9-3d66-48a2-8e55-8b0eb8b1480c.png (image/png)
Identify What is the muscle attachment? 051a220e-16cf-4d7c-8fb1-293218ba9acf.jpg (image/jpg) Deltoid tuberosity tendon of the deltoid muscle
Identify What structures are found here? 65e89c38-7842-49f9-ae6d-87b9e4dd5ca0.png (image/png) Spiral groove Nerve (radial) and artery (profunda brachii)
Identify this joint and describe its movement a7b0077b-36ee-44e5-b346-e7023c96b107.jpg (image/jpg) Sternoclavicular joint b/w the clavicle and sternum, the only shoulder to articulate with the axial skeleton very mobile, allowing movement of the shoulder
Identify this joint and describe its movement a94d3d79-39c3-4881-8afc-c61aa239108e.gif (image/gif) Acromioclavicular joint b/w the clavicle and scapula Less mobile, only permits small gliding and rotation movements
Identify this "joint" and describe its movement 8964dbe6-8966-47ab-8fe1-67c92ce7f652.png (image/png) Scapulo-thoracic joint b/w the scapula and the rib-cage Movements here allow the upper limb to be moved around the trunk, and increase our range of hand positioning in space
Identify this joint and describe its movement ca6516f6-6d2e-4e28-977d-c2da61846f3f.jpg (image/jpg) b/w the head of the humerus and glenoid cavity of scapula allows most movement of the shoulder 677e76ee-475e-460f-a1f8-d4473aafaf8e.jpg (image/jpg)
What kind of joint is the sternoclavicular joint? synovial joint
What divides the sternoclavicular joint in two? an articular disc 204b05f0-cd1e-4860-acdd-d1d7a4791db8.jpg (image/jpg)
What are the (2) main components of the sternoclavicular joint? the concave indention of the sternum and the sternal end of the clavicle 915f4b6b-eb27-4d5f-87a7-fdd80a38a6d3.jpg (image/jpg)
How is the incongruity of the sternoclavicular joint (specifically the articular facets) adjusted a cartilage-like fibrous tissue
Describe the capsule found at the sternoclavicular joint slack and thick
What helps strengthen the sternoclavicular capsule? anterior and posterior sternoclavicular ligaments 171cca95-4116-49fe-b02a-32e540ccd541.jpg (image/jpg)
Identify and define its purpose 978b0fb6-5b97-4760-b8b3-4a8974e9eb75.png (image/png) The interclavicular ligament Connects the R. and L. clavicles
Identify and define its purpose 66db2323-db40-456c-bffd-9a6e9f01b4e1.png (image/png) Sternoclavicular ligament helps strengthen the sternoclavicular capsule Extends b/w the 1st rib and clavicle
What kind of joint is the sternoclavicular joint? ball and socket joint b5aeb832-6326-415a-8931-8f87dd11a06e.png (image/png)
How many degrees of freedom does the sternoclavicular joint have? 3
The sternoclavicular joint is capable of movements in superior-inferior (up and down) plane up to __° and in the anterior-posterior (front and back) plane up to __° 60, 20
What is the danger of posterior sternoclavicular dislocations? Whilst rare, the clavicle may compress of lacerate a lung, a great vessels, the trachea or oesophagus 259c2dee-e0be-44b5-868e-20bbae30fd7f.png (image/png)
What is the most common cause of posterior sternoclavicular dislocations? MVA, sports or a fall, with a force to the shoulder usually via an externally, laterally placed blow along the axis of the clavicle
In which direction does the clavicle move is a posterior dislocation? anteriorly/ superiorly due to the attachment of its ligament
Define ligament and define its purpose 9d09e4eb-dde3-4523-a283-553ab41b33dc.jpg (image/jpg) Acromioclavicular ligament helps strengthen the capsule at the acriomioclavicular joint (ACJ)
Define ligament and label 40972c85-2584-40f7-983b-55ba11302dd0.jpg (image/jpg) Coracoacromial ligament along with the tendon of the long head of biceps protects the top of the joint
How can the coracoacromial ligament be divided further? Antero-lateral: trapezoid ligament Postero-medial: conoid ligament 770c0f7a-15af-43ee-aa9d-6fd80c959dcf.jpg (image/jpg)
Is there a disc at the acromioclavicular joint? Yes, but it can be absent as the capsule here is very lax but small
What kind of joint is the acromioclavicular joint? synovial gliding joint
What kind of joint is the glenohumeral joint? Ball-and-socket
As the shoulder (glenohumeral) joint lacks strong ligaments, how is action maintained? by enveloping muscle making it a "muscle-dependent" joint
How is the synovial membrane of the capsule of the glenohumeral joint attached? via the glenoid lip
What structure evaginates and surrounds the synovial membrane of the glenohumeral joint like a tubular sheath? The long head of biceps brachii tendon d2e1988f-7274-4c5a-acbf-cc6829bfd059.png (image/png)
Identify this structure When it it found? f029274c-dae9-4f83-8f70-17c74c54804d.jpg (image/jpg) axillary recess when the articular capsule is slack and when the arm hangs down
What (4) structures support the upper part of the glenohumeral capsule? mainly the coracohumeral ligament also (3) weak glenohumeral ligaments f01cd106-bbd0-447d-a629-2a05b96c8573.jpg (image/jpg)
Define and know the importance of this structure 3468f196-cea6-4000-b616-91226f5a9b5c.jpg (image/jpg) glenoid labrum it serves to the deepen the glenohumeral socket
What are synovial bursae and where are they found in the shoulder? a fluid-filled sac or sac-like cavity, especially one countering friction at a joint acromial process (subacromial bursae), deltoid and subscapular bursae 7831eada-80ac-4cc6-acd4-2223dab7e1fb.png (image/png)
Which is the only bursae in direct communication with the joint cavity? subscapular bursae b968e8f4-0c9d-4fe7-b7b6-cf3dc211cd2d.jpg (image/jpg)
What does the capsule of the glenohumeral joint attach to? proximally to the glenoid labrum and laterally to the anatomical neck of the humerus cfe5b5c1-e853-4315-a5b2-c25cb9f01bb1.jpg (image/jpg)
Why does the capsule at the glenohumeral joint need to be week? esp. when? to permit free movement esp. at the inferior aspect of the joint where the capsule is tightened upon full abduction of the joint
What structure(s) thicken the superior and anterior parts of the capsule? the glenohumeral ligaments d0d9acd4-1707-4bb5-a848-1c593c888784.png (image/png)
There is a gap b/w the glenohumeral ligaments anteriorly, where the synovium membrane is able to escape from the confines of the capsule to form what? the subscapularis bursa 3ab4c553-2fbb-43ff-baf3-11fed5202731.png (image/png)
What tendon arises from inside the joint (from the supragenoid tubercle), making it intra-capsular? the long head of biceps brachii ec663167-1a48-4ee9-8c4c-cdc3aa9a1224.jpg (image/jpg)
Is the long head of biceps brachii intra-synovial too? No, it sites outside the synovial lining of the joint, making it extra-synovial
What is the long head of biceps brachii surrounded by to help protect it as the joint moves? a sheath of synovium 80fbebc9-825d-4740-bde4-7ba79c02e583.png (image/png)
What structure emerges from the synovial sheath into the biciptial groove, outside the joint, making it exposed and prone to inflammation (teno-synovitis)? the synovial sheath 91d79499-a626-4075-9fd2-8d3da6eafbdb.png (image/png)
What structures provide vertical stability to the humeral head? the glenohumeral capsule and the coracohumeral ligament ba12bc07-9810-49cf-b3df-60b02cd70f39.jpg (image/jpg)
What structures provide anterior stability to the humeral head? the anterior capsulo-ligamentous complex (but the contribution is limited)
What ligaments are simply thickenings of the capsule? the superior, middle and inferior glenohumeral ligaments 21f8c493-927e-4d36-bdb3-b1ea83f432ba.png (image/png)
What kind of structure is found b/w the superior and middle glenohumeral ligaments? a foramen
What does the small foramen b/w the superior and middle glenohumeral ligaments allow? a bursa to protrude anteriorly
What does the bursa b/w the superior and middle glenohumeral ligaments allow? movements if the tendon is in front of the joint (subscapularis tendon) 4a634bbf-4300-4b51-8269-9b79d9f83dd0.jpg (image/jpg)
Which of the glenohumeral ligaments is the largest and strongest of the three? the inferior glenohumeral ligament 2c086670-a179-4820-862d-a2d745bf79ea.jpg (image/jpg)
Where is the inferior glenohumeral ligament found? What function does it provide? b/w the subscapularis and teres minor tendons it reinforces the inferior glenohumeral capsule
What is the significance of the inferior glenohumeral ligament? beyond 90 degrees abduction, the subcapularis tendon no longer provides anterior (forward) stability of the humeral head, so the anterior stability must be provided by the axillary pouch of the inferior glenohumeral ligament 993920a0-7149-4811-9db2-3334ed179ce8.png (image/png)
Define and label 6da45920-1bb7-4e4f-95cc-4d65869c0f37.png (image/png) transverse humeral ligament passes b/w the humeral tubercles, attaching superior to the epiphyseal line It converts the intertubercular groove into a canal into a canal and acts as a retinaculum for the long tendon of the biceps
Where is the glenohumeral joint weakest? inferiorly
Which scan is the test of choice for diagnosing soft tissue injuries and is often used for assessing ongoing pain which fails to respond to traditional treatment options such as rest, physiotherapy and medication MRI
What imaging types are excellent for detecting bone injuries? x-ray and CT
What imaging is best for diagnosing soft tissue injuries such as tears of the rotators cuff or inflammation? MRI
e5d4249d-673a-4ee2-941e-dd35e8a4cd93.png (image/png) 937d7140-faa5-4639-b7d0-b6ae3ad551f0.png (image/png)
What kind of abnormality is shown? 4d5ee12a-e61a-4548-b428-448d8c4c3ec8.jpg (image/jpg) y view anterior shoulder dislocation
What kind of abnormality is shown? 7132fd1b-5c7d-4b9c-8321-83baa10e05da.jpg (image/jpg) y view posterior shoulder dislocation
What kind of abnormality is shown? 621b9376-4750-4030-ac5e-26490e2ff13e.png (image/png) Glenoid labrum tear
What kind of abnormality is shown? b3c6b042-fbd5-4474-b9fa-74d228ff206b.jpg (image/jpg) SLAP lesion Superior labrum from anterior to posterior lesion/ tear
Label and define e171777e-50fb-476f-8ccb-ac3911c351f7.jpg (image/jpg) A Bankart lesion Injury of the anterior (inferior) glenoid labrum of the shoulder due to anterior shoulder dislocation. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it.
Shoulder dislocations are brought on by a force applied when the limb is in a position of _______ and _______ rotation, e.g. trying to protect yourself in a fall from a weight when your hands are in front of your head. abduction, external 2b127d00-5d46-42dc-907d-44b3dd2bdb7e.jpg (image/jpg)
The shoulder joint is weakest ______, and hence is more easily diplaced in this direction inferiorly
The most common form of dislocation is called ______, and the limb is placed ____-______ anterior, antero-inferiorly db2a724d-e7be-4381-a0dd-6b7731f5d5bf.jpg (image/jpg)
Anterior dislocations stresses the _____ capsule, and the _____ part of the glenoid labrum. If the glenoid labrum is torn, it is referred to as a _______ _____. anterior, anterior, Bankart lesion
Shoulder joint deformity, an abnormally long arm, humeral head position in the axilla and pain and dysfunction are symptoms of what? 64b3848f-74c8-4bbd-b739-23b57ac1bdcb.png (image/png) a shoulder dislocation
What is the most physically obvious sign of shoulder dislocation? The normal rounded contour of the shoulder is lost the greater tubercle is usually the most palpable 2dd8ac67-45f5-4015-94cb-24d364e678ae.png (image/png)
What structures become palpable in a shoulder dislocation? the acromion
Movements of the dislocated shoulder are limited and painful, and hence the limb remains in a partially ____ and ____ rotated position This is because the ____ rotators of the joint (________,______) are stretched and also maintained in this position abducted, laterally lateral (infraspinatous and teres minor) 07bc471a-7cce-4b51-97ed-d5de6b5a16a6.png (image/png)
Most posterior dislocations are caused by what? 3a1458d6-a684-4d4e-ad6a-20e6c3f47643.jpg (image/jpg) a direct blow to the front of shoulder, or the violent twisting of the upper arm twisting (e.g. via direct trauma or an epileptic attack)
A shoulder can be partially dislocated (in the head of the upper arm is partially out of the shoulder socket) or completely dislocated (the head of the upper arm is completely out of the socket. A partial dislocation is know as: 001881a1-43cd-4a9c-ba3a-97904c4682cd.png (image/png) subluxation
a dislocation can result in fracture of the ______ humerus NB: nerve damage, damage to an artery or muscle is also possible
What term is used to describe a loss of range of motion in the shoulder? Frozen shoulder or "Adhesive Capsulitis"
What are the characteristics of a frozen shoulder? inflammation, associated pain, limited movement of the glenohumeral joint
Frozen shoulder is most common in what age range? 40-60
How many people in the UK are affected by frozen shoulder annually? 1 million
What is the ratio of frozen shoulder female:male? 2:I for unknown reasons
What are the four main types of shoulder stiffness? What is the most common of the four? Idiopathic, Diabetic, Post-traumatic and Post--surgical Idiopathic is the most common
What is the leading hypothesis as to why people with endocrine problems such as diabetics are more prone to shoulder stiffness? It is not entirely understood, but the main hypothesis suggests that it is linked to increased vascularity of the capsule
What is shown in the image and how does it relate to stiff shoulder? Synovitis Typically seen in stiff or frozen shoulder. Can be accompanied with scarring and adhesions that limit motion. Possible both inside and outside the joint. b5556a28-8466-4d89-a920-090bc90c7931.png (image/png)