Exam 3 -- Weeks 9 & 10

what makes up the shoulder complex?

scapula, clavicle, sternum, humerus, rib cage

origin of deltoid

lateral 1/3 of clavicle, acromion, spine of scapula

insertion of deltoid

deltoid tuberosity of humerus

innervation of deltoid

axillary (C5,C6)

action of deltoid

anterior: flexes and medially rotates; middle: abducts humerus; posterior: extends and laterally rotates humerus

teres major origin

dorsal surface of inferior angle of scapula

insertion of teres major

Medial lip of intertubercular groove of humerus

innervation of teres major

lower subscapular nerve

action of teres major

adducts and medially rotates, extend arm

origin of infraspinatus

infraspinatus fossa of scapula

insertion of infraspinatus

greater tubercle of humerus, superior facet

innervation of infraspinatus

suprascapular n.

action of infraspinatus

lateral rotator

teres minor origin

superior part of lateral border of scapula

teres minor insertion

greater tubercle of humerus, inferior facet

teres minor innervation

axillary nerve

action of teres minor

lateral rotator

subscapularis origin

subscapular fossa

insertion of subscapularis

lesser tubercle of humerus

innervation of subscapularis

upper and lower subscapular n.

action of subscapularis

medially rotates and adducts

origin of trapezius

external occipital protuberance, ligamentum nuchae, spinous processes of C7 to T12

insertion of trapezius

posterior border of lateral third of the clavicle, acromion process, and spine of the scapula

innervation of trapezius

Accessory nerve (CN XI)

action of trapezius

upper: elevation, middle: retraction, lower: depression

origin of latissimus dorsi

spinous processes of the vertebrae T7-L5, thoracolumbar fascia, iliac crest, inferior 3 to 4 ribs and inferior angle of the scapula

insertion of latissimus dorsi

Medial lip of intertubercular groove of humerus

innervation of latissimus dorsi

thoracodorsal nerve

origin of levator scapulae

posterior tubercle of transverse processes of C1-C4 vertebrae

insertion of levator scapulae

superior part of the medial border of the scapula

innervation of levator scapulae

dorsal scapular nerve (C4,C5), and ventral rami of spinal nerves C3/4

rhomboid major origin

spinous process of T2-T5 vertebrae

rhomboid major insertion

medial border of the scapula from the level of the spine to the inferior angle

rhomboid major innervation

Dorsal scapular nerve (C4, C5)

rhomboid major action

retraction of scapula, downward rotation of scapula

origin of rhomboid minor

spinous processes of C7-T1 and ligamentum nuchae

insertion of rhomboid minor

medial border of scapula from level of spine to inferior angle

innervation of rhomboid minor

Dorsal scapular nerve (C4, C5)

What is the most common area of the UE to be injured in adults?

shoulder

What is the most common area of the UE to be injured in children?

forearm

What are the most common work related MSK disorders for the UE?

carpal tunnel syndrome, tendinitis, RC injuries, epicondylitis, trigger finger, muscle strains, overexertion injuries

What is the lifetime prevalence of shoulder conditions?

up to 70%

What is the most common shoulder condition?

rotator cuff disorders

What are the keys to best practice PT related to the management of UE conditions?

- screening and differential diagnosis

- anatomy and biomechanics

- exam and interventions

- be efficient and effective!

How many joints are there in the shoulder?

4: glenohumeral, sternoclavicular, acromioclavicular, scapulothoracic

What type of joint is the glenohumeral joint?

ball and socket - synovial

How many degrees of freedom does the shoulder have?

3: flex/ext, aBd/aDd, IR/ER

the GH joint does not have much abduction when _________ rotated due to

internal; greater tubercle aligned underneath acromion

what insertions on the greater tubercle?

supraspinatus, infraspinatus, and teres minor

what inserts onto the lesser tubercle

subscapularis

What is joined by the GH joint?

head of humerus and glenoid fossa

In the GH joint, the superior portion of the labrum blends with which tendon?

tendon of long head of biceps brachii

the labrum acts to deepen the

glenoid and provide support of humerus

What is the angle of inclination btw shaft and head of humerus at the GH joint?

135°

What is the retroversion angle of the GH joint?

30°

overhead throwers or athletes tend to have how much retroversion?

40-45 degrees

What type of capsule is the shoulder joint?

fibrous

What is the main purpose of the shoulder joint capsule?

allows for wide ROM

How many glenohumeral ligaments are there?

3: superior, middle, inferior (anterior and posterior)

the inferior GH ligament has two bands:

anterior and posterior

What do the GH ligaments do?

function to strengthen the anterior capsule of the joint; provides anterior and inferior stability but is not a primary stabilizer

What motion does the superior GH ligament prevent?

ER and inferior translation

What motion does the middle GH ligament prevent?

45-90°abduction with ER

What motion does the inferior GH ligament prevent?

90 degrees abduction, (ER (anterior), and IR (posterior)

What is the nerve supply to the GH joint?

suprascapular n., axillary n., lateral pectoral n.

What is the blood supply to the GH joint?

posterior humeral circumflex, anterior humeral circumflex, subscapular, suprascapular

what is the rotator interval?

Triangular region that allows rotational motion around the coracoid process

what is the rotator interval defined by?

Base: coracoid process at its

Superior: anterior margin of supraspinatus

Inferior: superior margin of subscapularis tendon

the rotator interval has reinforcement externally by

coracohumeral ligament

the rotator interval has reinforcement internally by

band of glenohumeral ligament

What type of joint is the sternoclavicular joint?

saddle type synovial joint

The clavicle is usually (convex/concave) superior/inferior and (convex/concave) anterior/posterior

convex, concave

The sternum is usually (convex/concave) superior/inferior and (convex/concave) anterior/posterior

concave, convex

what is special about the SC joint?

Is the only articulation between upper limb and axial skeleton

What ligaments support the sternoclavicular joint?

anterior and posterior sternoclavicular ligaments and costoclavicular ligament

What is the blood supply to the SC joint?

internal thoracic and suprascapular arteries

What is the nerve supply to the SC joint?

branches of suprascapular n and n. to subclavius

interclavicle ligament strengthens SC joint

anteriorly

costoclavicular ligament

connects first rib to clavicle

What type of joint is the acromioclavicular joint?

plane synovial

articulation of AC joint

lateral end of clavicle to acromion process of scapula

the AC joint is strengthened superiorly by

acromioclavicular ligament

Which ligaments support the AC joint?

acromioclavicular, coracoclavicular (trapezoid, conoid)

the coracoclavicular ligament is made up of which two ligaments?

trapezoid (lateral) and conoid (medial)

the coracoclavicular ligament strengthens ______ end of clavicle by attaching to clavicle

lateral

the integrity of AC joint is maintained by

extrinsic ligaments distant from joint

muscles that attach to coracoid process

pectoralis minor, coracobrachialis, short head of biceps brachii

What is the blood supply to the AC joint?

suprascapular and thoracoacromial arteries

What is the nerve supply to the AC joint?

lateral pectoral and axillary nerves

What is the resting position of the shoulder?

55 deg ABD, 30 deg ADD

What is another term for the resting position of the shoulder?

scaption

What is the close packed position of the shoulder?

full ABD and full ER

What is the capsular pattern of the shoulder?

ER > ABD > IR

What is the norm for GH joint flexion?

100-115

What is the norm for shoulder complex flexion?

165-180

What is the norm for GH joint extension?

20-25

What is the norm for shoulder complex extension?

50-60

What is the norm for GH joint ABD?

90-125

What is the norm for shoulder complex ABD?

170-180

What is the norm for GH joint ER?

80-90