Anatomy Final Exam

In the shoulder joint complex, how does mobility relate to stability?

Increased mobility = increased instability

What does stability rely on in the shoulder joint complex?

Architecture, shape, dynamic muscles, static ligaments

Scapulohumeral Rhythm Equation/Ratio

2:1

120 GHJ + 60 STJ = 180 Elevation

What is responsible for the UE attchment to the thorax and what does it articulate with?

Clavicle articulates with the acromion and sternum

Convexity and Concavity of the Clavicle

lat 1/3 concave and medial 2/3 convex, this allows for passage for nerves and vessels

What does the clavicle act as?

A strut and holds the GHJ away from body

What muscles originate onto the clavicle?

deltoid, pectoralis major, sternocleidomastoid, and sternohyoid

What muscles insert onto the clavicle?

upper trapezius and subclavius

Where does the scapula span in relation to the ribs?

Ribs 2-7

The supraglenoid notch sperates what?

The supra and infra fossas laterally

Features of the glenoid fossa

taller than wide, smaller than head of humerus, and has supraglenoid and infraglenoid tubercle

What inserts and originates on the spine of the scapula (posterior scapula)

O: deltoids

I: lower trap

What inserts and originates on the coracoid process of the scapula (anterior scapula)

O: short head of biceps and coracobrachialis

I: pec minor

The humerus faces superior at what degree?

135

Anatomical neck of humerus features

attachment for joint capsule and poor prognosis for injuries

Surgical neck of humerus features

inferior to great and less tubercles and there is better prognosis for injuries

Where do the triceps insert?

olecranon process of ulna

Where do the biceps insert?

radial tuberosity and bicipital aponeurosis

What is the pectoralis major innervated by?

clavicular head: lateral pectoral nerve (C5-7)

sternocostal head: medial pectoral nerve (C8,T1)

What is the pectoral artery a branch of and what does it run with?

Branch of the thoracoacromial artery and runs with lateral pectoral nerve

What does the lateral thoracic artery run with?

long thoracic nerve

What are the 3 rotator cuff muscles that insert onto the greater tubercle?

supraspinatus, infrospinatus, and teres minor

What inserts onto the lesser tubercle?

subscapularis

What inserts onto the intertubercular groove

teres major, latissimus dorsi, and pectoralis major

Features of the sternoclavicular joint

30 degree shoulder elevation, diarthroidal, UE direct attachment, and its saddle shaped

What does the sternoclavicular ligament prevent?

superior, anterior, and posterior displacement

What does the interclavicular ligament limit?

superior displacement

Features of the costoclavicular ligament

anchors clavicle to 1st rib and oppposes pull of SCM

Features of the acromioclavicular joint (ACJ)

fibrocartilage, doarthroid, weak capsule, reinforced by deltoids and trapezoids

What ligament provides stability and motion?

coracoclavicular ligament

What is scapulothoracic articulation?

anterior scapula atriculates with the rib cage, increases stability and motion

Scapulothoracic rotation degree

60

What is teres major innervation and blood supply?

I: axillary nerve (C5-6)

BS: circumflex scapular and posterior humeral circumflex arteries

What is teres minor innervation and blood supply?

I: Lower subscapular nerve (C5-6)

BS: subscapular and posterior humeral circumflex arteries

Features of the glenoid labrum

increases stability, doubles depth, and acts as bumper

superior and anterior is loose but inferior is firm

What ligaments make up the joint capsule?

GH and coracohumeral ligaments

What are the restraints of the superior glenohumeral ligament?

inferior and posterior translation, and ER in adduction

What are the restraints of the middle glenohumeral ligament?

anterior translation at 45 abduction and ER at 90 abduction

What are the restraints of the inferior glenohumeral ligament?

ER at 90 abduction and IR

What ligament is related to frozen shoulder?

coracohumeral ligament

What are the restraints of the coracohumeral ligament?

inferior translation in adduction and limits ER

What are the restraints of the coracoacromial ligament?

counteracts the pull of pectoralis major and coracobrachilais and limits superior translation

What ligament is the roof of the shoulder?

coracoacromial ligament

Where are the bursae located and which are the 2 most important?

between tendon and bone

subscap and subacromial

What are the walls of axilla?

apex- cervico axillary canal

base- skin and fascia

anterior- pecs, clavipectoral, and anterior axillary fold

posterior- scap and subscap muscles and posterior axillary fold

What is associated with impingement syndrome?

greater tubercle, posterior dislocation of SCJ, and coracoacromial ligament

What is the brachial plexus former by?

ventral rami C5-8, T1

The median nerve travels with what artery?

Brachial artery

The axillary nerve travels with with artery?

Posterior circumflex humeral artery in quad space

The radial nerve travels with with artery?

Profunda artery

What is the triangle of auscultation?

Where breath sounds can be heard clearly.

Inferior angle of scapula, gap between lats, traps, and scap, and around ribs 6 and 7

What is in the Quadrangular Space?

axillary nerve and posterior circumflex humeral artery

What is in the Triangular Space?

circumflex scapular artery

What is in the Triangular Interval/Hiatus?

radial nerve and profunda brachii artery

What are the borders of the triangular space, quadrangular space, and triangular hiatus?

teres major (sup), teres minor (inf), LH of triceps (med), and humerus (lat)

What anterior upper arm muscles are innervated by musculocutaneous?

biceps brachii, coracobrachialis, and brachialis

What posterior upper arm muscles are innervated by radial?

triceps brachii and anconeous

Where does the brachial artery divide and what does it divide into?

At the cubital fossa it divides into ulnar and radial arteries

Features of the humeroulnar joint (HUJ)

hinge joint and flexion/extention

What is the carrying angle for males and females?

male: 10-15 degrees

females: >15 degrees

Features of the humeroradial joint (HRJ)

ball and socket joint, flexion/extension, pronation/supination

In HRJ, the capitellum is…

the buttress to lateral compression, especially valgus force

Features of the proximal radioulnar joint (PRUJ)

radial head with radial notch, pivot joint, pronation/supination

What transmits forces distal to proximal?

interosseous membrane

What is considered the tommy john ligament and what are its features?

Ulnar Collateral Ligament

resistes valgus stress, has an anterior, posterior, and transverse band

What stress does the radial collateral ligament resist?

varus

What ligament is a sling for the radial head?

Lateral ulnar collateral ligament

What ligament is associated with nursemaids elbow?

annular ligament

What ligament holds the radial head against the ulna?

annular ligament

What are the contents of the cubital fossa?

brachial artery, median nerve, medial antebrachial nerve, lateral antebrachial nerve, basilic vein, median cubital vein, and celphalic vein

What are the borders of the cubital fossa?

Line from medial to lateral epicondyle(sup), pronator teres (med), brachioradialis (lat), brachialis (floor)

What muscles are in the anterior superficial and intermediate group and what are they innervated by?

superficial: pronator teres, flexor capri radialis, palmaris longus, and flexor capri ulnaris

intermediate: flexor digitorum superficialis

median nerve

What muscles are in the anterior deep group and what are they innervated by?

pronator quadratus, flexor pollicus longus, and flexor digitorum profundus

AIN (FDP is AIN + Ulnar)

What muscles are in the outcropping group and what are they innervate by?

abductor pollicus longus, extensor pollicus brevis, and extensor pollicis longus

PIN

How many extensor tunnels are there?

6

What hand done is injured when falling onto an stretched hand and what does it effect?

scaphoid bone, the fracture disrupts blood proximally

What shape is the first metacarpal and what does it articulate with/allow?

saddle shape, articulates with the trapezium, and allows for ROM

What actions do the MCP joints allow?

flexion, extention, abduction, and adduction

What does the TFCC seperate?

ulna from proximal carpal bones

What joint is considered the proper wrist joint and what bones are articulating?

Radiocarpal Joint (RCJ)

radius, TFCC, scaphoid, lunate, and triquetrum

What does the radial collateral ligament resist?

ulnar deviation of RCJ

What does the ulnar collateral ligament resist?

radial deviation of RCJ

What does the plamar radiocarpal ligament do?

brings hand with radius in supination

What does the dorsal radiocarpal ligament do?

weak, reinforcement, bring hands with wrist in pronation

What are MCP joints bound by?

deep transverse MC ligaments

What is the function of hand fascia?

less slippage, protection, creates carpal tunnel

The thickening of palmar fascia in males pver 50 is called what?

Dupnytrens Contracture

A rupture in the palmar ligaments leads to what?

bowstringing, tendons move away from bones

What do the palmar ligaments do?

hold flexor tendons close to the bone

Finger flexor repair is considered what?

“no mans land”, gentle gliding and slow return to active gripping

What is trigger finger?

Synovial lining is inflamed, it cannot slide through the pulleys

What is tenosynovitis?

infamation of synovial sheath

What is mallet finger?

blow to tip of finger, rupture of extensor tendons at the base of the distal phalanx

What is boutinniere deformity?

rupture of extensor tendons at the base of the middle phalanx

What is swan neck?

volar plate rupture of PIP

What causes carpal tunnel syndrome?

median nerve compression

What are the borders and contents of carpal tunnel?

borders: flexor retinaculum (roof), scaphoid tub/trapezium tub (radial), and pisiformis/hook of hanmate (ulnar)

contents: FDS, FDP, FPL, Medial N

All of the hand muscles are innervated by the ulnar nerve except for which ones?

APB, superficial FPB, OP, and 2 lat lumbricals