Scapular Region and Posterior Brachium ppt

Osteology:

• Shoulder includes Scapula and Humerus

• Flat area superior to Scapular Spine: Supraspinous fossa

• Flat area inferior to Scapular Spine: Infraspinous fossa

• Flat area on the anterior side (Costal Surface) of Scapula: Subscapular fossa

• Muscles that arise from these Fossas have a name related to the fossa it attaches

• Suprascapular notch has an Artery, vein and nerve that run through it

• “Army over Navy”: Suprascapular artery travels over the superior transverse scapular ligament, Nerve travels under it

• Glenoid fossa only when there is no cartilage attached to it

• SITS muscles: The Rotator cuff

  • Great Tubercle of the Humerus has 3 facets:

    • Superior- Supraspinatus muscle attachment

    • Middle- Infraspinatus muscle attachment

    • Inferior- Teres minor muscle attachment

  • Lesser tubercle is attachment site for Subscapularis muscle

• Torn rotator cuff is usually supraspinatus muscle tendon as it approaches the Superior facet of the Greater Tubercle of Humerus

• Radial nerve travels through the Radial (spiral) groove

• Olecranon= a part of the ulna (elbow)

• Groove for the Ulnar nerve = the funny bone

  • mostly fibers of C8, which is why you get numbness and tingling in the medial aspect of hand

• Upper portion of the arm is referred to as the Arm, as well as the Brachium

• Lower portion of the arm is referred to as Forearm, as well as Antebrachium

Cutaneous Nerves:

• Supraclavicular nerves: supplies the top of the shoulder, some anterior, some posterior

  • From Cervical Plexus (C3-C4)

• Lateral brachial cutaneous nerve

  • Superior lateral brachial cutaneous nerve (terminal branch of Axillary nerve) (C5-C6)

• Intercostobrachial nerve (T2): emerges from between the 2nd and 3rd ribs and supplies part of the arm and thorax

• Medial brachial cutaneous nerve

• Posterior antebrachial cutaneous nerve

• medial antebrachial cutaneous nerve

• Lateral antebrachial cutaneous nerve

• Superficial branch of the Radial nerve

• Dorsal cutaneous branch of the Ulnar nerve

• Superficial branch of the ulnar nerve

• Median Nerve= affected by CTS (will have pain and numbness in thumb and first two fingers)

Scapulohumeral muscles: muscles that attach to the humerus and the scapula

• Deltoid

• supraspinatus

• infraspinatus

• teres minor

• Teres major

• subscapularis

Deep Scapular Region:

• Infraspinatus

• teres minor

• teres major

• Triceps Brachii:

  • Lateral Head

  • Long head

  • Medial Head

Learn the O, I, N, Act and Art of these muscles!!!

Each head of the Triceps Brachii is innervated by the Radial Nere, but they each have a predominant spinal level

• Lateral head= C6

• Long head= C7

• Medial head= C8

Medial and Lateral rotators of the Glenohumeral joint is often on Boards

3 spaces of the scapular region:

• Triangular space

  • Contents: circumflex scapular artery

  • Boarders: teres minor, teres major, and long head of triceps brachii

• Quadrangular space

  • Contents: Posterior circumflex humeral artery and axillary nerve

  • Boarders: teres minor, teres major, long head of triceps brachii, and humerus

• Triangular interval

  • Contents: Profunda brachii artery and radial nerve

  • Boarders: Teres major, long head of triceps brachii, lateral head of triceps brachii

Cubital tunnel:

• is a space through which the ulnar nerve passes posterior to the medial epicondyle of the humerus

• Contents:

  • Ulnar nerve

  • Posterior Ulnar recurrent artery

  • Adipose

• Boundaries:

  • Roof=

    • cubital tunnel retinaculum (aka ligament or band of Osborne) (extends from the olecranon to the medial epicondyle)

    • Anconeus epitrochlearis (not everyone has one)

  • Lateral=

    • olecranon process

  • Medial=

    • medial epicondyle

  • Floor=

    • Elbow joint capsule

    • posterior band of ulnar (medial) collateral ligament of the elbow joint

• issues here are usually in people that keep their elbow flexed often

Anconeus Epitrochlearis:

• an accessory muscle on the medial aspect of the elbow

• Not everyone has one:

  • only present in 3-28% of the population

• also known as the accessory anconeus muscle

• should NOT be confused with the anconeus muscle which is present on the lateral aspect of the elbow

• the muscle may be unilateral or bilateral in 1 of 4 patients with cubital tunnel syndrome

Arterial network of the scapula

• There’s a lot of blood supply going to the Shoulder and arm

• We will cover more of this later

If you strengthen the Lateral rotators of the Humerus, it will help avoid a rotator cuff tear

• common in:

  • baseball players

  • Smokers due to poor blood circulation

Pectoral Region ppt

Osteology:

• Thorax:

  • True ribs=1-7

  • False ribs= 8-12

  • Floating ribs= 11 &12

  • True ribs vs false ribs

    • true ribs join costal cartilage (attaches to the sternum)

    • false ribs 8-10 join a costal cartilage that is fused to rib 7’s costal cartilage

    • floating ribs don’t join any other costal cartilage. it’s just a little tab that doesn’t articulate

  • Rib 10 floats in 35%-75% of people

  • Clavicle articulates with the manubrium of sternum at the Sternoclavicular joint

  • Manubriosternal joint= joint between manubrium and body of sternum

    • this creates the sternal angle

  • Costochondral joint = where rib attaches to the sternum

  • Infrasternal (or subcostal) angle= base of the sternum with costal cartilage

  • Sternum is comprised of 3 parts

    • manubrium

    • body (comprised of 4 fused bones, leaving transverse ridges)

    • xiphoid process

    • They will all fuse together eventually to form one bone

  • Manubrium at spinal level of T3-T4

  • Clavicular notch where the clavicle articulates

  • Jugular notch (or Suprasternal notch) = top of the manubrium

  • Costal notches

  • Sternal angle (angle of louis) at spinal level of T4-T5

  • Body of sternum at spinal level of T9

  • Xiphoid process of spinal level of T10

  • 2nd rib articulates at the level of the manubriosternal joint

  • 7th rib articulates at the level of the Xiphisternal joint

  • Determine age based on sternal bone fusion:

    • 3 & 4 @ 15 years

    • 2 & 3 @ 20 years

    • 1 & 2 @ 25 years

    • 4 & Xiphoid @ 40 years

    • 1 & Manubrium @ >60 years

  • Ligament from clavicle to another = interclavicular ligament

  • anterior and posterior sternoclavicular ligament= where clavicle attaches to sternum

    • There is also an articular disc there, deep to these ligaments

  • Costoclavicular ligament = between clavicle and 1st rib

  • Interchondral joints= run between costal cartilages

    • Hyaline cartilage

  • Costoxiphoid ligament= between costal cartilage and xiphoid

  • When ribs fracture its usually on the lateral aspect

  • Coracoid process is the anterior knob coming off the scapula

  • Clavicle:

    • Sternal end is rounded with a sternal facet

    • Acromial end is lateral end with posterior acromial facet

    • superior surface is smooth

    • inferior surface has “bumps” medial to lateral along shaft:

      • Impression for costoclavicular ligament

      • Subclavian groove

      • conoid tubercle (sticks up)

      • Trapezoid line

  • Shoulder:

    • Coracooclavicular ligament

      • Trapezoid part (lateral)

      • Concoid part (medial)

    • Acromioclavicular ligament

    • coracoacromial ligament

    • Tendon of supraspinatus

    • Transverse humeral ligament

      • holding the tendon of the biceps brachii in place

    • Glenoid Labrum

      • makes the glenoid cavity deeper

      • not nearly as deep as the hip, which is why shoulder dislocations are more common than hip

    • Articular capsule

  • Muscular landmarks

    • Deltoid

    • sternocleidomastoid

    • Trapezius

    • Pectoralis major

      • Clavicular head

      • Sternal head

    • Latissmus Dorsi

    • Anterior (pec major) and posterior (lat dorsi) axillary folds

      • forming Axillary fossa

      • The also form lines that relate to the fold

        • anterior axillary line

        • posterior axillary line

        • Medial axillary line

    • Serratus Anterior

    • external abdominal oblique

    • rectus abdominis

• Dermatomes:

  • no T1 in the thorax, just in the arm

  • the nipple is T4 on men, T4-T6 on women

  • T10 umbilicus

  • L1 inguinal

• Landmark: inferior costal margin is the margin of the infrasternal angle

• Thoraco-abdominal nerves (T7-T11)

• Lateral and Anterior cutaneous branches of subcostal nerves = T12

• Iliohypogastric nerve = L1

• Ilio-inguinal nerve= L1

• Intercostal spaces will have the same number as the rib superior to it

  • ie. the 1st intercostal space is between the 1st and 2nd ribs

Pectoral Fascia:

• Platysma (anterior aspect of the neck

  • supraclavicular nerves are imbedded in this

• Pectoralis major is deep to pectoral fascia

Deltopectoral Triangle:

• Boundaries:

  • Superolateral= Deltoid

  • Superomedial= Clavicle

  • Inferomedial= Clavicular head of pectoralis major

• Contents:

  • Cephalic Vein

Cephalic vein can have some variations bilaterally.

• Typically, the larger side was the dominant side

Female breast:

• contains a lot of Adipose

• lymph nodes are in the in the “tail area” called the Axillary Process of breast

• Areola is the outer darker pigmented region surrounding the nipple

Learn the O, I, N, Art and Act of the Pectoral region muscles

Pectoralis Minor is deep to Pectoralis Major

Subclavius muscle is inferior and deep to clavicle

Serratus Anterior originates and covers the upper 9 ribs on the lateral aspect

Latissmus Dorsi rotates 180* before inserting on to the Floor of the Intertubercle groove of humerus

Brachial Plexus= “Really Tired Drink Coffee Today”

• Roots

• Trunks

• Divisions

• Cords

• Terminal branches

medial and lateral pectoral nerves are named after the cord they come off of, NOT the area of pec minor where they emerge

intercostal muscles run the same direction as your fingers in your pockets

• External intercostal muscles run perpendicular

4 branches of the Thoracoacromial Trunk (arteries):

• Acromial= Deltoid, glenohumeral joint and acromion

• Pectoral= pectoralis major, pectoralis minor and the breast

• Clavicular= subclavius and sternoclavicular joints

• Deltoid= pectoralis major and Deltoid

Winged Scapula:

• results from a damaged long thoracic nerve

• Causes:

  • can be congenital

  • blunt force trauma

  • traction of the neck

  • improper use of crutches