Upper Extremity 1

Stable joint / mobile

Shoulder

Mobility of the shoulder

6 moving areas = joints

True Joint (+) bone to bone

Sternoclavicular Joint

Acromioclavicular Joint

Glenohumeral Joint

Most important true joint

Glenohumeral Joint

Joint type of GH

Synovial / Ball and socket

False Joint (-) bone to bone

Bicipital Groove

Subacromial Joint

Glenohumeral Joint

Most important false joint

Scapulothoracic Joint

Less static/structural stability

Sternoclavicular Joint

Good dynamic stability

Rotator Cuff

Long slender bone lies horizontally at the root of the neck

Clavicle

Convex anteriorly

Middle 2/3 of clavicle

Concave anteriorly

Lateral 1/3 of clavicle

Most commonly fractured bone

Clavicle

MOI of clavicular fracture

FOOSH / Medially directed blow

Associated with the clavicle

Newton’s Third Law of Motion

Medial fragment of the clavicle, tilted superiorly

Sternocleidomastoid

Lateral fragment, downward

Gravity

Lateral fragment, medially

Pectoralis Major

Between the clavicle and 1st rib

Costoclavicular Space

Contents of the costoclavicular space

Subclavian Artery

Brachial Plexus

Complete fracture management of clavicle

Surgery

Incomplete fracture management of clavicle for shoulder retraction (bandaging technique)

Figure of 8

Flat, triangular bone that lies on the posterior thoracic wall between the 2nd and 7th ribs

Scapula

Location of the scapula

Between the 2nd and 7th ribs

Superior Angle

T2

Spine of the Scapula

T3

Inferior Angle

T7

Summit of the Shoulder

Acromion

Orientation of the acromion

Posterior, Lateral, Superior (PLEASE!)

Type 1

Flat

Type 2

Curved

Type 3

Hooked

Type 4

Upturned/Convex

Type of acromion process associated with impingement syndrome

Hooked (Type III)

Painful arc for impingement

60-120 degrees

Orientation of the coracoid process

Anterior and Superior

Prevents superior translation of the humerus

Coracoidal ligament

Extension of acromion process medially

Spine of Scapula

Above

Supraspinatus Fossa

Infraspinatus Fossa

Below

Subscapular Fossa

Anterior

Spine of the scapula is used to locate these structures

Supraspinous Fossa & Infraspinous Fossa

Shallow cavity

Glenoid Fossa

Increases the depth of the fossa by 50%

Glenoid Labrum

Forms 1/3 of a sphere of the humerus (intracapsular)

Humeral Head

End attachment of the shoulder joint capsule

Anatomical Neck

Prone to fracture

Surgical Neck

Nerve usually damaged in the humerus

Axillary Nerve

Muscle tested for possible weakness

Deltoids

(+) Posterior deltoid weakness (hyperextension)

Swallow Tail Sign

Greater Tuberosity:

Location

Palpation

Muscle Attachment

Lateral

Internal Rotation

Supraspinatus, Infraspinatus, Teres Minor

Lesser Tuberosity:

Location

Palpation

Muscle Attachment

Medial

External Rotation

Subscapularis

Greater tuberosity is best viewed

External Rotation

Long head of the biceps

Bicipital Groove / Intertubercular Groove

Holds the bicipital groove in place

Transverse Humeral Ligament

Test for THL rupture

Yergason’s Test

Oblique groove at the posterior portion of the humerus

Spiral Groove / Radial Groove

Site of fracture (radial nerve damage)

Spiral Groove / Radial Groove

Nerve of the spiral groove

Radial Nerve/Musculospiral Nerve

Spared in radial nerve damage of spiral grooce

Long Head of Triceps

Convex + Concave

Ovoid

Covex + Concave + Concave + Convex

Saddle/Sellar

Saddle/Sellar

Sternoclavicular Joint

Articulation of the SC joint

Medial end of clavicle + manubriosternum

Between 2 clavicles

Limits excessive depression of distal end of clavicle

Interclavicular Ligament

1st rib to clavicle

Limits excessive elevation of distal end of clavicle

Costoclavicular Ligament

Connects sternum and clavicle

Sternoclavicular Ligament

Excessive retraction

Anterior SC Ligament

Excessive protraction

Posterior SC Ligament

Accessory Structure

Sternoclavicular Disc

Function of the SC disc

Shock absoprtion

During elevation and depression, disc becomes part

EDS - Sternum

During protraction and retraction, disc becomes part

PRC - Clavicle

Three degrees of freedom/axes

Elevation and Depression

Protraction and Retraction

Longitudinal Rotation

Contributions of the sternoclavicular joint during arm elevation

<90 degrees of arm elevation - elevation

>90 degrees of arm elevation - posterior rotation

If there is no posterior rotation of the clavicle, arm elevation is up to how many degrees?

110 degrees

Synovial plane joint

Acromioclavicular Joint

Articulation of the AC joint

Lateral end of clavicle + acromion process

Prevents inferior translation of distal clavicle

Primary ligament

Superior AC Ligament (thick)

Prevents superior translation of distal clavicle

Inferior AC ligament (thin)

Conoid and Trapezoid

Coracoclavicular ligament

Triangular

Posterior

Medial

Vertical

Conoid

Quadrangular

Anterior

Lateral

Horizontal

Trapezoid

Conoid and trapezoid ligaments connects these structures

Coracoid process to the clavicle

Fibrocartilaginous Union

AC Disc (<2 years old)

Fibrocartilaginous remnant that is meniscoid

AC Disc (>2 years old)

Horizontal curvature

External rotation and Internal rotation

Upward and downward rotation

Anterior and Posterior tilting

Synovial/ball and socket/universal joint/spheroidal joint

Glenohumeral Joint

Medial, posterior, superior

Humeral Head (MPS)

Superior, anterior, lateral

Glenoid Fossa (SAL)

Formed by the axis of the humeral head and the axis of the humeral shaft

Angle of Inclination

Normal value of the angle of inclination

130 to 150 degrees

Formed by the axis of the humeral head and axis of the humeral condyles

Angle of Torsion

Normal value of the angle of torsion

Approximately 30 degrees of retrotorsion

Coracoid process to the greater and lesser tuberosities

Coracohumeral ligament

Limits excessive ER

Prevents downward translation of the humerus

Greatly involved in Adhesive Capsulitis

Coracohumeral ligament

Limits excessive ER

Glenohumeral ligament

Superior fiber of GH ligament

0 to 45 degrees

Middle fiber of GH ligament

45 to 90 degrees