module 5-8 content

What does the shoulder girdle include?

the clavicle and scapula

How can you tell which view of the shoulder girdle is anterior or posterior?

• the anterior side of the scapula is smooth

• the posterior side of the scapula has a spine

What lies between the scapula and humerus?

the shoulder joint

What are the 4 landmarks of the clavicle?

• acromial end - more lateral

• sternal end - more medial

• conoid tubercle - closer to acromial head on the inferior surface

• subclavian groove - ridge on inferior surface

What are the landmarks of the scapula?

• glenoid fossa

• coracoid process

• acromion

• spine

• supraspinous fossa

• infraspinous fossa

• subscapular fossa

• medial border (vertebral)

• lateral border (axillary)

• superior angle

• inferior angle

During what years do the clavicle and scapula mature?

during the college years

What part of the clavicle matures last?

the sternal end (between 20-25 years)

What are the landmarks of the humerus?

• humeral head

• surgical neck

• greater and lesser tubercles

• intertubercular groove

• deltoid tuberosity

• medial and lateral epicondyles

• trochlea

• capitulum

• coronoid fossa

• olecranon fossa

• lateral supracondylar ridge

When is the humerus mature by?

high school graduation

What is an epiphyseal line?

the solid bone remnant left behind when a child’s growth plate finishes growing and turns completely into bone

What is the anatomical neck?

the epiphyseal line of the humerus

What is the anatomical name for the “shoulder” joint?

glenohumeral joint

What joints are included in shoulder articulations?

• sternoclavicular joint

• acromioclavicular joint

• glenohumeral joint

• scapulothoracic joint

Which joints involved in shoulder articulation are synovial joints?

• sternoclavicular joint

• acromioclavicular joint

• glenohumeral joint

What joint functionally attaches the shoulder girdle to the axial skeleton?

the sternoclavicular joint

What type of joint is the sternoclavicular joint?

“ball and socket” synovial joint with a meniscus in the joint space

• saddle joint → 3 planes of motion

What ligaments maintain the integrity of the sternoclavicular joint?

• anterior sternoclavicular ligament

• posterior sternoclavicular ligament

• interclavicular ligament

  • between the clavicles

• costoclavicular ligament

  • attachment from clavicle to the 1st rib

The clavicle can fracture with a blow to what part?

the shoulder

What ligaments reinforce the acromioclavicular joint?

• acromioclavicular ligament

• coracoclavicular ligament

  • trapezoid portion (more lateral)

  • conoid portion (more medial)

• coracoacromial ligament

What type of joint is the acromioclavicular joint?

non-axial synovial joint that is involved in nearly all shoulder motions

What plane does the scapula lie in?

lies in a plane ~ 40 degrees from the frontal plane

• allows for smooth movement

What occurs during a “shoulder separation”?

the ligaments supporting the acromioclavicular joint are damaged

How does shoulder separation injury occur directly and indirectly?

• directly - from direct blows to the shoulder

• indirectly - from impact on an outstretched arm

In what order are the ligaments damaged in increasing severities of shoulder separation injuries?

acromioclavicular ligament → coracoclavicular ligament

What ligaments reinforce the glenohumeral joint?

• coracohumeral ligament

• glenohumeral ligament

What type of joint is the glenohumeral joint?

highly mobile, ball and socket synovial joint

What deepens and widens the socket of the glenohumeral joint, adding joint stability?

fibrocartilage rim called the glenoid labrum

What injury occurs when the humerus impinges on the scapula with abduction of the glenohumeral joint?

shoulder impingement → decrease in the subacromial space

What are some other structures that can be impinged during glenohumeral movements?

• bursa sac

• rotator cuff

• biceps tendon

• glenoid labrum

What is injured in a SLAP (superior labrum/anterior-posterior) tear?

glenoid labrum

What movement causes SLAP injuries?

repeated overhead movement (ie. tennis, vollyball, baseball, etc.)

How many types of SLAP tears are there?

10 types → some requiring surgery

Why is the glenohumeral joint prone to dislocation?

relatively poor bony fit

What is the most common type of shoulder dislocation?

anterior dislocations (90%) form falling backwards onto the hand

Movement of the scapula with respect to the thorax occurs at what “joint”?

scapulothoracic “joint” → not synovial

What movements occur at each of the following joints : acromioclavicular, sternoclavicuar, scapulothoracic?

• acromioclavicular

  • gliding (limited)

• sternoclavicular

  • elevation-depression

  • protraction-retraction

  • anterior-posterior rotation

• scapulothoracic

  • elevation-depression

  • protraction-retraction

  • upward-downward rotation

Upward rotation of the scapula is named for the upward motion of what bony landmark on the scapula?

glenoid fossa

Coupled motions of the scapula and humerus help do what?

• maintain the glenoid fossa in an optimal position

• increases joint range of motion

  • 120 degrees of motion come from glenohumeral joint

  • 60 degrees of motion come from scapulothoracic “joint”

What are the seven landmarks on the ulna?

• olecranon process

• ulnar styloid process

• coronoid process

• trochlear notch

• radial notch

• ulnar tuberosity

• head

What does the trochlear notch on the ulna articulate with on the humerus?

the trochlea

Where does the olecranon process of the ulna fit into the humerus?

the olecranon fossa

What are the 5 landmarks on the radius?

• head

• neck

• radial tuberosity

• radial styloid process

• ulnar notch

What does the radial head articulate with on the humerus?

the capitulum

Which forearm bone is lateral?

the radius

Where is the ulnar notch and radial notch?

• ulnar notch

  • medially located at the distal aspect of the radius

• radial notch

  • laterally located at the proximal aspect of the ulna

During what years do the ulna and radius mature?

college years

What are the 27 bones in the hand?

• carpals (8)

  • proximal row (4) - scaphoid, lunate, triquetrum, pisiform

  • distal row (4) - trapezium, trapezoid, capitate, hamate

• metacarpals (5)

• phalanges (14)

  • proximal (1-5)

  • middle (2-5)

  • distal (1-5)

What is formed by the carpal bones and is covered by the transverse carpal ligament?

the carpal tunnel

What occurs in Carpal Tunnel Syndrome?

the median nerve and other vessels in the carpal tunnel are compressed

What are metacarpals sometimes called?

rays

What are the 3 landmarks on the metacarpals?

• head (distal)

• shaft

• base (proximal)

Which landmark of the metacarpal corresponds to the “knuckles”?

the head of the metacarpal

Does the thumb have a middle phalanx?

no

Are the metacarpals still growing in first grade?

yes

What are the landmarks on the phalanges?

• head (distal)

• shaft

• base (proximal)

By when are phalanges mature?

by high school graduation

What are the articulations in the upper limb?

• elbow joint complex

• wrist joint complex

• carpometacarpal joints (CMC)

• metacarpophalangeal joints (MCP)

• interphalangeal joints (IP)

What does the Elbow Joint Complex consist of?

three articulations inside one synovial joint capsule

The articulations between humerus and ulna/radius form what type of joint?

hinge joint → allows for flexion and extension

What articulates at the humeroulnar joint?

• trochlea (humerus) - trochlear notch (ulna)

• ulnar collateral ligament

What articulates at the humeroradial joint?

• capitulum (humerus) - radial head (radius)

• radial collateral ligament

What type of joint does the articulation between the proximal ulna and radius form?

pivot joint → pronation and supination

What type of joint lies between the radial notch on the ulna and the head of the radius?

synovial joint

What ligaments reinforce the Elbow Joint Complex?

• radial collateral ligament

• ulnar collateral ligament

• annular ligament

• joint capsule

Which ligament is at risk during pitching?

ulnar collateral ligament

What movements do the Wrist Joint Complex allow for?

• flexion/extension

• radial/ulnar deviation

What are characteristics of the radiocarpal joint?

• between radius and scaphoid, lunate, triquetrum

• condyloid synovial joint

• has a meniscus (ulnar head - triquetrum)

• enables 40% of wrist motion

What are characteristics of the intercarpal joints?

• gliding synovial joints

• enables 60% of wrist motion

What type of joints are the carpometacarpal joints?

synovial → mobility differs between thumb and fingers

What are the differences between the fingers and the thumb carpometacarpal joints

• 2-5

  • gliding synovial joints

  • have limited movement

• thumb

  • saddle synovial joint

  • has 2 degrees of freedom

    • flexion-extension

    • abduction-adduction

What does motion at the 1st CMC enable?

opposition of the thumb

What type of joints are the metacarpophalangeal joints?

synovial → mobility differs between thumb and fingers

What are the differences between the fingers and the thumb metacarpophalangeal joints?

• 2-5

  • condyloid synovial joints

  • have 2 degrees of freedom

    • flexion-extension

    • abduction-adduction

• thumb

  • hinge synovial joint

  • has 1 degree of freedom

    • flexion-extension

What type of joints are the interphalangeal joints?

hinge synovial joints → allow flexion and extension

What are the differences between the fingers and the thumb interphalangeal joints?

• 2-5

  • distal interphalangeal joints (DIP)

    • lie between middle and distal phalanges

  • proximal interphalangeal joints (PIP)

    • lie between proximal and middle phalanges

• thumb

  • interphalangeal joints (IP)

    • lie between proximal and distal phalanges

What do the lower extremities include?

• the pelvic girdle

• bones of the thigh, leg and foot

What bones form the pelvic girdle?

• coxal bones (appendicular skeleton)

  • also known as the innominate bone

• sacrum (axial skeleton)

What three bones fuse to form the coxal bone?

• ilium - superior

• ischium - posterior

• pubis - anterior

What landmark is formed by all 3 of the coxal bones?

acetabulum → hip socket which is oriented laterally

What landmark is formed by the ischium and the pubis?

obturator foramen

What are the 10 landmarks on the ilium?

• ala

• ilian crest

• iliac fossa

• gluteal lines

• auricular surface

• greater sciatic notch

• anterior & posterior superior iliac spine

• anterior & posterior inferior iliac spine

What are the 4 landmarks on the ischium?

• ischial spine

• lesser sciatic notch

• ischial tuberosity

• ischial ramus

What are the 3 landmarks on the pubis?

• superior pubic ramus

• inferior pubic ramus

• body of pubis

During what years do the coxal bones mature?

• during college years

  • acetabulum → 12-16 years

  • ischial tuberosity → 15-26 years

What is the pelvic girdle formed by?

the sacrum and coxal bones

What type of joints bind the pelvic girdle together?

synovial and fibrocartilaginous joints with limite motion

Which pelvic joints are non-axial synovial joints?

sacroiliac joints

What pelvic joints are fibrocartilaginous joints?

pubic symphysis

What happens to the pubic symphysis during childbirth?

it can separate

Which ligaments reinforce the sacroiliac joint?

• anterior sacroiliac ligament

• posterior sacroiliac ligament

• sacrotuberous ligament

• sacrospinous ligament

What are the sex differences in the shape of the pelvis?

• female pelvis

  • pelvic inlet transversely oval

  • pubic symphysis shorter

  • pubic arch wider

  • ischial spines farther apart

  • iliac wings more flared

• male pelvis

  • pelvic inlet anterior-posteriorly oriented

  • pubic symphysis taller

  • pubic arch narrower

  • ischial spines closer

  • iliac wings less flared

The size and shape of the pelvis indicate what?

the function

What are the landmarks on the femur

• head

• fovea capitis

• neck

• greater trochanter

• lesser trochanter

• intertrochanteric crest

• gluteal tuberosity

• linea aspera

• medial condyle

• lateral condyle

• medial epicondyle

• lateral epicondyle

• intercondylar notch

• adductor tubercle

• patellar facet

What is the angle between the neck and shaft of the femur in the frontal plane called?

the inclination angle

What is the typical inclination angle?

125 degrees

What do the different inclination angles indicate?

• coxa vara - less than 125 degrees

• coxa valga - greater than 125 degrees

By what years are the femur typically fused?

by early college years

• proximal femur fused by age 18

• distal femur fused by age 20

What type of joint is the hip joint?

ball and socket synovial joint