Rhodes Study Material Part 4

Shoulder Complex, Elbow and Forearm, Wrist Complex

shoulder girdle

scapula, clavicle, sternum

joints of the shoulder girdle

sternoclavicular, acromioclavicular, scapulothoracic ,

sternoclavicular joint

saddle/sellar/triaxial

where clavicle meets the sternum

absorbs shock, improves congruency 

elevation/depression, protraction/retraction 

acromioclavicular joint 

acromion and clavicle

plane joint

upward and downward rotation 

acromioclavicular - reinforce capsule of ac joint 

coracoclavicular - reinforce joint capsule, 2 divisions 

coracocromial -  forms roof over humerus, protects heads of humers, limits superior translation of humerus 

joint actions of scapula

elevation/depression, protraction/retraction, upward rotation/downward rotation

shoulder separation

acromioclavicular separation, dislocate AC joint (shoulder separation), tear of the acromioclavicular ligament and the coracoclavicular ligaments, caused by tramua 

shoulder dislocation

due to weak anterior glenohumeral bands, humerus will displace anteriorly, total loss of joint congruity caused by tramua

shoulder subluxation 

partial loss of joint congruity, inferior displacement of the humeral head in the joint capsule, caused by muscle weakness/paralysis (supraspinatus and deltoids unable to hold the humerus of the head in the joint capsule), compromised integrity of ligaments 

winging scapula

when the scapula pulls away from the thoracic cage, damage to long thoracic nerve, weak serratus anterior

upper trapezius

origin: external occipital protuberance, ligamentum nuchae

insertion: lateral 1/3 of clavicle 

action: scapular elevation and upward rotation 

nerve: cranial nerve XI 

middle trapezius 

origin: spinous process of C7-T5

insertion: acromion 

action: retraction 

nerve: cranial nerve XI 

lower trapezius

origin: spinous process of T6-T12

insertion: spine of scapula 

action: depression, upward rotation and retraction 

nerve: cranial nerve XI 

levator scapula

origin: transverse process C1-C4

insertion: medial border of scapula between superior angle and root of scapular spine 

action: elevation and downward rotation 

nerve: dorsal scapular 

rhomboids 

origin: spinous processes of C7-T5 

insertion: medial border of scpaula between root and inferior angle 

action: retraction, elevation, and downward rotation 

nerve: dorsal scapular 

serratus anterior

origin: lateral first 9 ribs

insertion: medial border of scapula 

action: protraction, upward rotation holds scapula against the posterior thorax 

nerve: long thoracic 

pectoralis minor

origin: anterior surface of ribs 3-5

insertion: coracoid process of scapula 

action: protraction, downward rotation and depression 

nerve: medial pectoral 

shoulder joint

scapula and humerus

shoulder joint joint

glenohumeral

glenohumeral joint

head of humerus (convex), glenoid fossa (concave)

ball/socket, enarthrodial, spheroidal, triaxial 

ligaments of shoulder joint

glenohumeral bands, transverse humeral ligament, coracohumeral ligament

glenohumeral bands

protect anterior shoulder, poorly developed, thickening portion of ant. shoulder

transverse humeral ligament

holds biceps tendon in bicipital groove

coracohumeral ligament

helps strengthen superior portion of the shoulder joint

labrum 

tissue attached to rim of glenoid fossa, keeps ball of joint in place 

labrum tears occur

completely off bone, along edge of the labrum, where the bicep tendon attache s

scapulohumeral rhythm

motion of the scapula synchronous with motions of the humerus to allow full range of motion 

forced couple

if the deltoid muscles acted alone, they would pull the humeral head upward and impinge it under the coracoacromial ligament, as abduction occurs the humeral head must be pulled in and downward, supraspinatus pulls humeral head into glenoid fossa, subscapularis, infraspinatus, and teres minor pull humeral head down 

rotator cuff tendonitis/impingement sydnrome

when the force couple fails to keep the humerus from jamming into the coracohumeral ligament/subacromial space where the supraspinatus runs through (rotator cuff muscle)

when the rotator cuff is torn

patient will shrug their shoulder when asked to perform shoulder abduction

as a PTA do a lot of verbal, tactical, and visual cueing to prevent shrugging and encourage engagement of the rotator cuff muscles 

scaption

used to describe movements that occur in the plane of the scapula rather than a sagittal or frontal plane

laterally rotated

complete range of abduction can only be achieved if the shoulder joint is joint ___

infraspinatus and teres minor

move greater tubercle away from acromion process

shoulder subluxation

partial dislocation of shoulder where ball partially slips out of socket

shoulder dislocation

head of upper arm bone pops out of shoulder socket, usually occurs from fall or injury

impingement syndrome 

compression of acromial arch, head of humerus, coracohumeral ligament, rotator cuff muscles, long head of the biceps, subacromial bursa, comes from loss of scapulohumeral rhythm with ABD, overuse, and weakness of rotator cuff muscles 

adhesive capsulitis (frozen shoulder)

inflammation of the shoulder joint capsule

torn rotator cuff

tear involving one of the rotator cuff muscles, supraspinatus is the most common due to its tendon being compressed under the coracohumeral ligament 

biceps tendonitis

inflammation of biceps tendon

anterior deltoid

origin: lateral 1/3 of clavicle

insertion: deltoid tuberosity 

action: flex, add, ir, abd

nerve: axillary 

middle deltoid

origin: acromion

insertion: deltoid tuberosity 

action: abd 

nerve: axillary 

posterior deltoid

origin: scapular spine

insertion: deltoid tuberosity 

action: ext, abd, er, 

nerve: axillary 

pectoralis major

origin: anterior, medial clavicle, lateral sternum, and first 6 ribs

insertion: bicipital groove 

action: internal/medial rotation, flexion, add 

nerve: lateral/medial pectoral 

latissimus dorsi

origin: thoracolumbar fascia, spinous processes of lower thoracic and all lumbar vertebra, posterior crest of the ilium 

insertion: bicipital groove of humerus 

action: extension/hyperextension, medial/interal rotation, add 

nerve: thoracodorsal 

teres major 

origin: inferior angle of scapula 

insertion: lesser tubercle of humerus 

action: extension/hyperextension, internal/medial rotation, add 

nerve: subscapular 

coracobrachialis

action: flexion and add

nerve: musculocutaneous 

rotator cuff muscles (shoulder joint)

supraspinatus, infraspinatus, teres minor, subscapularis

supraspinatus

origin: supraspinous fossa

insertion: greater tubercle of humerus

action: abduction

nerve: suprascular 

infraspinatus

origin: infraspinous fossa

insertion: greater tubercle of humerus 

action: lateral/external rotation 

nerve: suprascapular 

teres minor

origin: lateral border of spaula close to interior angle

insertion: greater tubercle of humerus 

action: lateral/ external rotation 

nerve: axillary 

subscapularis

origin: subscapular fossa

insertion: lesser tubercle of the humerus 

action: internal, medial rotation 

nerve: subscapular 

prime movers of shoulder flexion

anterior deltoid and pec major

prime movers of shoulder extension

lats

prime movers of medial/internal rotation

subscapularis

prime movers of shoulder lateral/external rotation 

infraspinatus and teres minor 

prime movers of shoulder abduction 

deltoids and supraspinatus 

prime movers of horizontal abduction

posterior deltoid

prime movers of horizontal adduction

pec major

bicipital tendonitis

inflammation of the biceps tendon, most commonly at origin

biceps rupture

biceps tendon tear (typically at origin)

nursemaid’s elbow 

when radial head is pulled from annular ligament 

ulnar nerve compression (cubital tunnel syndrome)

compression of the ulnar nerve that causes tingling and numbness in the 4th and 5th fingers 

elbow dislocation

when the ulna subluxes from humerus

medial epicondylitis (golfers elbow)

inflammation all the tendons that originate at the medial epicondyle from overuse

lateral epicondylitis (tennis elbow)

inflammation of all the tendons that originate at the lateral epicondyle from overuse

little league elbow

overuse syndrome from throwing motions that causes stress on the growth plate of young children

humeroulnar joint 

trochlea of humerus (convex) and trochlear notch of the ulna (concave) 

ginglymus 

flexion and extension 

humeroradial joint

capitulum of the humerus (convex) and head of the radius (concave) 

ginglymus 

flexion and extension 

proximal radioulnar joint

head of radius (convex) and radial notch of the ulna (concave)

trochoid (pivot) 

pronation and supination 

distal radioulnar joint

head of ulna and ulnar notch of radius

trochoid (pivot)

pronation and supination 

elbow ligaments

humeroulnar joint (medial ulnar collateral)

humeroradial joint (lateral radial collateral) 

annular ligament

wraps around the head of the radius and holds it to the ulna

brachialis

origin: anterior distal ½ of humerus

insertion: coronoid process/ulnar tuberosity 

action: elbow flexion in pronation 

nerve: musculocutaneous 

biceps brachii

origin: long head - supraglenoid tubercle, short head - coracoid process

insertion: radial tuberosity 

action: elbow flexion in supination, supination, shoulder flexion 

nerve: musculocutaneous 

brachioradialis 

origin: lateral supracondylar ridge 

insertion: styloid process of radius 

action: elbow flexion in neutral 

nerve: radial 

triceps

origin: long head - infraglenoid tubercle, lateral head - posterior, lateral humerus, medial head - posterior, medial humerus 

insertion: olecranon process

action: elbow extension, some shoulder extension (long head) only 

nerve: radial 

pronator teres

origin: medial epicondyle

insertion: mid, lateral radius

action: pronation 

nerve: median 

pronator quadratus

action: pronation

nerve: median

supinator

origin: lateral epicondyle

insertion: anterior proximal radius 

action: supination 

nerve: radial 

prime movers of elbow flexion

biceps, brachialis, brachioradialis

prime movers of elbow extension

triceps

prime movers of forearm pronation

pronator teres, pronator quadratus

prime movers of forearm supination

biceps and supinator

radiocarpal joint

distal radius, disc, scaphoid, lunate, triquetrum

ellipsoidal

flexion/extension, abd (radial deviation), add (ulnar deviation)

midcarpal

between proximal and distal row

plane joint

helps increase ROM to wrist

ligaments of wrist

distal ulnar collateral, distal radial collateral, dorsal radiocarpal, palmar radiocarpal

distal ulnar collateral ligament

restricts radial deviation

distal radial collateral ligament

restricts ulnar deviation

dorsal radiocarpal ligament

restricts wrist flexion 

palmar radiocarpal ligament

restricts wrist extension

flexor carpi radialis

origin: medial epicondyle

insertion: base of 2nd and 3rd metacarpal 

action: wrist flexion and radial deviation 

nerve: median 

palmaris longus

origin: medial epicondyle

insertion: carpal ligament/palmar fascia 

action: wrist flexion 

nerve: median 

flexor carpi ulnaris

origin: medial epicondyle

insertion: base of 5th metacarpal and pisiform bone 

action: wrist flexion and ulnar deviation 

nerve: ulnar 

extensor carpi radialis longus 

origin: lateral epicondyle 

insertion: base of 2nd metacarpal 

action: wrist extension and radial deviation 

nerve: radial 

extensor carpi radialis brevis

origin:lateral epicondyle

insertion: base of 3rd metacarpal 

action:wrist extension 

nerve: radial 

extensor carpi ulnaris

origin: lateral epicondyle

insertion: base of 5th metacarpal 

action: wrist extension and ulnar deviation 

nerve: radial 

prime mover of wrist flexion

flexor carpi ulnaris, felxor carpi radialis, palmaris longus

prime mover of wrist extension

extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis brevis

prime mover of wrist ulnar deviation

flexor carpi ulnaris and extensor carpi ulnaris

prime mover of wrist radial deviation

flexor carpi radialis, flexor carpi radialis longus, flexor carpi radialis brevis