Shoulder Region - Upper limb الجزء الثاني - MSS  أناتومي الـ

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Questions and Answers

Which muscle is primarily responsible for initiating shoulder abduction, specifically in the 0-15 degree range?

  • Infraspinatus
  • Subscapularis
  • Teres minor
  • Supraspinatus (correct)

Which of the following muscles inserts on the medial lip of the bicipital groove?

  • Supraspinatus
  • Teres minor
  • Teres major (correct)
  • Infraspinatus

The upper triangular space is bordered by the teres minor, teres major, and which other structure?

  • Long head of biceps brachii
  • Surgical neck of humerus
  • Long head of triceps brachii (correct)
  • Lateral border of scapula

Which nerve innervates both the teres minor and deltoid muscles?

<p>Axillary nerve (D)</p> Signup and view all the answers

What action is primarily associated with the posterior fibers of the deltoid muscle?

<p>Extension and lateral rotation of the arm (B)</p> Signup and view all the answers

A patient presents with weakness in lateral rotation of the arm. Which muscle is MOST likely affected?

<p>Infraspinatus (C)</p> Signup and view all the answers

Which structure passes through the quadrangular space?

<p>Axillary nerve (C)</p> Signup and view all the answers

Which combination of actions is performed by the subscapularis muscle?

<p>Adduction and medial rotation (D)</p> Signup and view all the answers

What is a primary action of the teres minor muscle?

<p>Lateral rotation of the arm (D)</p> Signup and view all the answers

The lower triangular space is bounded by the teres major, long head of triceps, and the:

<p>Shaft of the humerus (D)</p> Signup and view all the answers

Which structure travels through the lower triangular space?

<p>Radial nerve (C)</p> Signup and view all the answers

Where does the supraspinatus muscle originate?

<p>Supraspinous fossa (D)</p> Signup and view all the answers

Which of the following muscles inserts on the lesser tuberosity of the humerus?

<p>Subscapularis (D)</p> Signup and view all the answers

What combination of muscles form the posterior wall of the axilla?

<p>Subscapularis, teres major, and latissimus dorsi (D)</p> Signup and view all the answers

Which rotator cuff muscle's rupture is most likely to severely limit shoulder abduction?

<p>Supraspinatus (B)</p> Signup and view all the answers

Which nerve supplies the infraspinatus muscle?

<p>Suprascapular nerve (B)</p> Signup and view all the answers

Where does the teres major muscle originate?

<p>Lower 1/3 of the back of lateral border of scapula (D)</p> Signup and view all the answers

What action is performed by the middle fibers of the deltoid muscle?

<p>Abduction (15°-90°) (C)</p> Signup and view all the answers

Which muscle inserts on the highest impression of the greater tuberosity?

<p>Supraspinatus (B)</p> Signup and view all the answers

What combination of muscles forms the posterior axillary fold?

<p>Teres major and latissimus dorsi (D)</p> Signup and view all the answers

After a shoulder injury, a patient exhibits an inability to initiate abduction of the arm. If imaging reveals no direct damage to the supraspinatus, which secondary impairment could MOST likely be contributing to this functional deficit?

<p>Adhesions restricting normal scapulothoracic gliding, limiting upward rotation. (D)</p> Signup and view all the answers

A surgeon is repairing a complete tear of the infraspinatus tendon. Which anatomical landmark is MOST crucial to identify during the reattachment to ensure proper biomechanical function of the repaired muscle?

<p>The middle impression on the greater tuberosity for correct insertion point. (B)</p> Signup and view all the answers

During a surgical procedure involving the posterior aspect of the scapula, a surgeon must carefully dissect around the teres minor muscle. Damage to which nerve is the MOST immediate risk during this part of the surgery?

<p>The axillary nerve, as it provides direct innervation to the teres minor. (B)</p> Signup and view all the answers

A patient presents with weakness in both lateral rotation and adduction of the arm. Which of the following muscles is MOST likely affected, considering the overlapping functions?

<p>The infraspinatus, as a primary lateral rotator. (C)</p> Signup and view all the answers

Following a shoulder dislocation, a patient exhibits impaired medial rotation and adduction. Which muscle is MOST likely affected?

<p>Subscapularis (A)</p> Signup and view all the answers

A patient is diagnosed with a lesion affecting the lower subscapular nerve. Which combination of shoulder movements would be MOST affected by this injury?

<p>Adduction and medial rotation. (B)</p> Signup and view all the answers

During a physical exam, a patient is asked to abduct their arm. The examiner notes the patient can only achieve abduction beyond 15 degrees with significant hiking of the shoulder. Which muscle is MOST likely dysfunctional?

<p>Supraspinatus (D)</p> Signup and view all the answers

Damage to the axillary nerve can result in paralysis of the deltoid muscle. Which subsequent biomechanical change would MOST likely occur at the shoulder joint?

<p>Compromised control during lowering the arm from a fully abducted position (B)</p> Signup and view all the answers

A weightlifter strains their shoulder, and an MRI reveals inflammation around the musculotendinous junction of a muscle inserting on the lesser tuberosity of the humerus. Which action would MOST likely cause pain during resisted testing?

<p>Internal rotation against resistance (B)</p> Signup and view all the answers

A patient has limited shoulder abduction and also demonstrates a positive 'lift-off' test. Which combination of muscle deficits is MOST likely?

<p>Supraspinatus tendinitis and subscapularis dysfunction (D)</p> Signup and view all the answers

A patient reports difficulty reaching behind their back. Weakness during resisted internal rotation is also noted. Which muscle is MOST likely injured?

<p>Subscapularis (B)</p> Signup and view all the answers

During a surgical approach to the axilla, which anatomical structure MUST be carefully protected to prevent iatrogenic injury leading to weakness in shoulder abduction and external rotation?

<p>The axillary nerve. (C)</p> Signup and view all the answers

Which of the following scenarios would MOST likely result in a shoulder dislocation?

<p>Falling on an outstretched arm in abduction, external rotation, and extension (D)</p> Signup and view all the answers

The posterior wall of the axilla is formed by which combination of muscles?

<p>Subscapularis, teres major, and latissimus dorsi. (A)</p> Signup and view all the answers

A patient presents with a winged scapula after a surgical procedure. This is due to injury of what nerve?

<p>long thoracic (D)</p> Signup and view all the answers

Which of the following muscles is primarily responsible for abduction of the arm between 15 and 90 degrees?

<p>Middle Fibers of Deltoid (A)</p> Signup and view all the answers

Which structure is located in the upper triangular space?

<p>Circumflex scapular artery (D)</p> Signup and view all the answers

A patient is experiencing pain and limited range of motion with a suspected rotator cuff tear. Assuming a full thickness tear of the MOST commonly affected muscle, which specific movement would be MOST noticeably weak and painful?

<p>Weak and Painful Abduction (B)</p> Signup and view all the answers

Following a shoulder injury, a patient is unable to extend, laterally rotate, and adduct their arm. Which portion of the deltoid is likely impacted, and what other muscle shares the same nerve innervation that may also be affected?

<p>Posterior deltoid and teres minor (C)</p> Signup and view all the answers

Flashcards

Supra-spinatus

Located in the Supra-spinous fossa, it inserts on the highest impression of the greater tuberosity and abducts the arm from 0-15 degrees.

Infa-spinatus

Originates in the Infra-spinous fossa, inserts on the middle impression of the greater tuberosity, and adducts and laterally rotates the arm.

Teres minor

It originates from upper 2/3 of the lateral border of the scapula, inserts on the lower impression of the greater tuberosity, and adducts and laterally rotates the arm.

Teres major

It originates from the lower 1/3 of the back of the lateral border of the scapula, inserts on the medial lip of the bicipital groove, and adducts and medially rotates the arm.

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Subscapularis

Originates in the Subscapular fossa, inserts on the lesser tuberosity of the humerus, and adducts and medially rotates the arm.

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Deltoid

Composed of anterior, middle, and posterior fibers, flexing, abducting, and extending the arm respectively.

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Quadrangular space

Bounded by the teres minor, teres major, long head of triceps, and surgical neck of humerus; contains the axillary nerve.

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Upper triangular space

Bounded by teres minor, teres major, and the long head of the triceps; contains the circumflex scapular artery.

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Lower triangular space

Bounded by teres major, long head of triceps, and shaft of humerus; contains the radial nerve.

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Rotator cuff muscles

Supraspinatus, Infraspinatus, Teres Minor and Subscapularis

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Supraspinatus action

The main action of the supraspinatus muscle, responsible for initiating arm movement away from the body.

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Infraspinatus origin

The part of the scapula where the infraspinatus muscle originates.

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Nerve supply to Supraspinatus and Infraspinatus

The nerve that innervates both the supraspinatus and infraspinatus muscles.

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Teres Minor Nerve Supply

The nerve that provides innervation to the teres minor muscle.

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Shoulder dislocation direction

A common injury where the shoulder joint primarily dislocates.

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Rotator Cuff Rupture

The muscle most commonly affected when the rotator cuff is ruptured, leading to limited shoulder abduction.

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Posterior wall of axilla muscles

The muscles forming the posterior wall of the axilla.

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Posterior axillary fold

Muscles that form the posterior axillary fold.

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Anterior Deltoid Origin

The part of the clavicle from which the anterior fibers of the deltoid muscle originate.

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Middle Deltoid Origin

The bony landmark from which the middle fibers of the deltoid muscle originate.

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Posterior Deltoid Origin

The part of the scapula where the posterior fibers of the deltoid originate.

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Deltoid Nerve Supply

The nerve responsible for supplying the deltoid muscle.

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Anterior Deltoid Action

The action of the anterior fibers of the deltoid muscle.

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Middle Deltoid Action Range

The range of abduction caused by middle fibers of the deltoid muscle.

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Posterior Deltoid Action

Movement caused by the posterior fibers of the deltoid muscle.

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Study Notes

Supra-Spinatus

  • Originates in the supra-spinous fossa
  • Inserts at the highest impression of the greater tuberosity
  • Innervated by the supra-scapular nerve
  • Abduction of the arm (0°-15°)

Infa-Spinatus

  • Originates in the infra-spinous fossa
  • Inserts at the middle impression of the greater tuberosity
  • Innervated by the supra-scapular nerve
  • Action is adduction and main lateral rotation of the arm

Teres Minor

  • Originates in the upper 2/3 of the back of the lateral border of the scapula
  • Inserts at the lower impression of the greater tuberosity
  • Nervated by the axillary nerve
  • Action is adduction and lateral rotation of the arm

Teres Major

  • Originates in the lower 1/3 of the back of the lateral border of the scapula
  • Inserts at the medial lip of the bicipital groove
  • Innervated by the lower subscapular nerve
  • Action includes adduction and medial rotation of the arm

Subscapularis

  • Originates in the subscapular fossa
  • Inserts at the lesser tuberosity of the humerus
  • Innervated by the upper and lower subscapular nerves
  • Action is adduction and medial rotation of the arm

Rotator Cuff Muscles

  • Supraspinatus, infraspinatus, teres minor, and subscapularis make up the rotator cuff muscles
  • Shoulder dislocation mainly occurs inferiorly
  • Rupture of rotator cuff muscles mainly affects the supraspinatus, causing severe limitation of shoulder abduction
  • Subscapularis, teres major, and latissimus dorsi form the posterior wall of the axilla
  • Teres major and latissimus dorsi form the posterior axillary fold

Deltoid

  • Originates from the front of the lateral 1/3 of the clavicle (anterior fibers), the lateral border of the acromion (middle fibers), and the lower border of the spine of the scapula (posterior fibers)
  • Inserts at the deltoid tuberosity
  • Innervated by the axillary nerve
  • Anterior fibers cause flexion and medial rotation of the arm
  • Middle fibers cause abduction (15°-90°) of the arm
  • Posterior fibers cause extension and lateral rotation of the arm

Quadrangular Space

  • Superior border is the teres minor
  • Inferior border is the teres major
  • Medial border is the long head of the triceps
  • Lateral border is the surgical neck of the humerus
  • Contents include the axillary nerve and the posterior circumflex humeral artery

Upper Triangular Space

  • Superior border is the teres minor
  • Inferior border is the teres major
  • Lateral border is the long head of the triceps
  • Contains the circumflex scapular artery

Lower Triangular Space

  • Superior border is the teres major
  • Medial border is the long head of the triceps
  • Lateral border is the shaft of the humerus
  • Contains the radial nerve and the profunda brachii artery

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