Podcast
Questions and Answers
What is the primary function of the subacromial bursa?
What is the primary function of the subacromial bursa?
Which muscle initiates the abduction of the arm to 15°?
Which muscle initiates the abduction of the arm to 15°?
What is the normal range of external rotation at the shoulder joint?
What is the normal range of external rotation at the shoulder joint?
Which of the following muscles is involved in the external rotation of the arm?
Which of the following muscles is involved in the external rotation of the arm?
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Identify the nerve that innervates the Teres minor muscle.
Identify the nerve that innervates the Teres minor muscle.
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What is NOT a function of the rotator cuff muscles?
What is NOT a function of the rotator cuff muscles?
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Which muscle is responsible for internal rotation of the arm?
Which muscle is responsible for internal rotation of the arm?
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How many degrees of flexion are considered normal for shoulder movement?
How many degrees of flexion are considered normal for shoulder movement?
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Which two nerves are primarily associated with the brachial plexus in the shoulder and arm?
Which two nerves are primarily associated with the brachial plexus in the shoulder and arm?
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What type of joint is the shoulder joint classified as?
What type of joint is the shoulder joint classified as?
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What is the role of the glenoid labrum in the shoulder joint?
What is the role of the glenoid labrum in the shoulder joint?
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Which muscle acts as a minor depressor of the humeral head to contribute to shoulder stability?
Which muscle acts as a minor depressor of the humeral head to contribute to shoulder stability?
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What ligament is associated with reinforcing the shoulder joint capsule?
What ligament is associated with reinforcing the shoulder joint capsule?
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Which statement accurately describes the stability conditions of the shoulder joint?
Which statement accurately describes the stability conditions of the shoulder joint?
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What connects the axial skeleton and the appendicular skeleton in the upper limb?
What connects the axial skeleton and the appendicular skeleton in the upper limb?
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Which of the following is a characteristic of the shoulder joint capsule?
Which of the following is a characteristic of the shoulder joint capsule?
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What type of joint is the sternoclavicular joint?
What type of joint is the sternoclavicular joint?
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Which ligaments are considered intrinsic ligaments of the sternoclavicular joint?
Which ligaments are considered intrinsic ligaments of the sternoclavicular joint?
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Which muscle primarily functions to stabilize the clavicle during movements of the pectoral girdle?
Which muscle primarily functions to stabilize the clavicle during movements of the pectoral girdle?
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What is the function of the acromioclavicular joint?
What is the function of the acromioclavicular joint?
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Which nerve innervates the sternoclavicular joint?
Which nerve innervates the sternoclavicular joint?
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Which blood vessels supply the sternoclavicular joint?
Which blood vessels supply the sternoclavicular joint?
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Which movements are associated with the acromioclavicular joint?
Which movements are associated with the acromioclavicular joint?
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What is one characteristic of the scapula?
What is one characteristic of the scapula?
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What is the primary function of the muscles in the anterior compartment of the lower arm?
What is the primary function of the muscles in the anterior compartment of the lower arm?
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Which of the following muscles is NOT part of the superficial group in the anterior compartment?
Which of the following muscles is NOT part of the superficial group in the anterior compartment?
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Which structures do the ulnar collateral ligament attach to?
Which structures do the ulnar collateral ligament attach to?
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Which nerve supplies the flexor carpi ulnaris?
Which nerve supplies the flexor carpi ulnaris?
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What type of movements do the muscles of the posterior compartment primarily facilitate?
What type of movements do the muscles of the posterior compartment primarily facilitate?
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Which of these muscles is included in the deep group of the anterior compartment?
Which of these muscles is included in the deep group of the anterior compartment?
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Which muscle group is mainly responsible for the abduction of the wrist?
Which muscle group is mainly responsible for the abduction of the wrist?
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Which of the following muscles is found in the superficial part of the posterior compartment?
Which of the following muscles is found in the superficial part of the posterior compartment?
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Which bone in the proximal row of carpal bones articulates on the anterior surface of the triquetrum?
Which bone in the proximal row of carpal bones articulates on the anterior surface of the triquetrum?
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What is the mnemonic used to remember the carpal bones in the proximal row?
What is the mnemonic used to remember the carpal bones in the proximal row?
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Which of the following is located in the distal row of carpal bones?
Which of the following is located in the distal row of carpal bones?
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What is the function of intrinsic muscles of the hand?
What is the function of intrinsic muscles of the hand?
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Which mnemonic refers to the thenar muscles of the hand?
Which mnemonic refers to the thenar muscles of the hand?
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Which muscle's short head originates from the apex of the coracoid process of the scapula?
Which muscle's short head originates from the apex of the coracoid process of the scapula?
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Which muscle group includes the Flexor digitorum superficialis?
Which muscle group includes the Flexor digitorum superficialis?
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What characterizes the hook of the hamate?
What characterizes the hook of the hamate?
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Which of the following ligaments is part of the distal radioulnar joint?
Which of the following ligaments is part of the distal radioulnar joint?
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What structure is included in the triangular fibrocartilage complex?
What structure is included in the triangular fibrocartilage complex?
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Which of the following ligaments is categorized as a dorsal ligament of the wrist?
Which of the following ligaments is categorized as a dorsal ligament of the wrist?
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The proper collateral ligaments are associated with which joint type?
The proper collateral ligaments are associated with which joint type?
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Which of the following is NOT a ligament associated with the wrist joint?
Which of the following is NOT a ligament associated with the wrist joint?
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What type of joint movement occurs primarily at the midcarpal joint?
What type of joint movement occurs primarily at the midcarpal joint?
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Which ligament is not considered a part of the intercarpal joints?
Which ligament is not considered a part of the intercarpal joints?
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Which nerve is associated with the posterior interosseous branch?
Which nerve is associated with the posterior interosseous branch?
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Which ligaments contribute to the stabilizing structure of the radiocarpal joint?
Which ligaments contribute to the stabilizing structure of the radiocarpal joint?
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The ulnar nerve has which type of branches?
The ulnar nerve has which type of branches?
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Study Notes
Housekeeping and Questions
- If behind on assignments, contact the instructor as soon as possible.
- Students will give short presentations (1-2 slides) to the class.
- Topics for mini presentations include:
- Tissue inflammation
- Tissue proliferation
- Tissue remodeling
- Aging in muscles
- Aging in bones
- Exercise effects on muscles
Mistakes and Solutions
- Key mistakes in learning include:
- Lack of a plan
- Insufficient time investment
- Believing in myths or misinformation
- Not adequately adapting learning style
- Not seeking help when needed
- Not visualizing information or seeing the big picture
- Passive learning instead of active learning
- Solutions:
- Develop a study plan
- Invest enough time
- Challenge myths/understand accurate information
- Adapt learning style
- Ask for help if needed
- Visualize and create mental maps of information
- Engage with active learning strategies (quizzes, visual aids, etc.)
Schedule
- Week 8: Muscle Physiology, Lower Limb Surface Anatomy, Group Work
- Week 9 Muscles and Joints (Upper Limb), Mini Presentation
- Week 10: Muscles and joints (Lower Limb), Group work,
- Week 11: Muscles and joints (Spine), Presentation
- Week 12: Muscles in action, Group Work, Presentation
- Week 13: Exam Preparation, Exam prep class
- Week 14: MCQ Exam (in person)
Kahoot
- A learning activity
Joints
- Three main types of joints categorized by movement:
- Synarthroses (immovable): These joints, also known as fibrous joints, have no movement. Skull sutures are an example.
- Amphiarthroses (slightly movable): These joints, also known as cartilaginous joints, allow limited movement. Vertebrae are good examples.
- Diarthroses (freely movable): Also called synovial joints, these are the most common type and allow significant movement. Examples include the knee and shoulder.
Joints Anatomy
- Bones: The framework for the body providing support and connection tissue.
- Tendons: Tough connective tissue that connects muscles to bones enabling movement control.
- Ligaments: Tough elastic bands of connective tissue that surround a joint giving support and limiting movement.
- Cartilage: Covers surfaces of bones at joints, reducing friction.
- Meniscus: Curved cartilage found in knee and other joints.
- Synovial membrane: Secretes synovial fluid, lubricating the joint.
- Bursae: Fluid-filled sacs cushioning joints to reduce friction.
- Synovial fluid: A clear, sticky fluid secreted by the synovial membrane.
Types of Joints
- Ball and socket: The rounded head of one bone moves within a cup-shaped socket. Examples include shoulder and hip.
- Hinge: Opening and closing in one direction. Examples are the elbow and knee.
- Pivot: One bone rotates within a ring formed by another. Examples include neck between atlas and axis.
- Gliding: Flat surfaces that slide over one another. Examples include the carpal bones of the wrist.
- Condyloid: Allows movement but no rotation.
- Saddle: Allow movement back and forth and side to side.
Shoulder; Parts of the Joint
- Articulating surfaces
- Joint capsule
- Ligaments
- Bursae
- Movements
- Muscles
- Nerves
Shoulder; Articulating Surfaces
- The glenohumeral joint (GH jt) is formed by the glenoid (part of the scapula) and the humerus.
- The socket (glenoid) is shallow and flat.
- Rimmed with soft tissue (labrum) that makes a deeper socket to fit the humeral head.
More on the Joint
- The socket (glenoid) is shallow and flat.
- Soft tissue (labrum) rims the socket deepening it to accommodate the humeral head
Shoulder Joint Capsule
- The capsule is attached to the glenoid cavity (above) and anatomical neck of the humerus (below).
- Capsule is thick above and below but lose in the middle.
- Allows bone separation (2.5cm).
Ligaments
- Glenohumeral ligaments: Reinforce the joint capsule, stabilizing the anterior aspect.
- Coracohumeral ligament: Supports the superior part of the joint capsule
- Coracoacromial ligament: Arch-like structure resisting superior displacement of the humeral head.
- Transverse humeral ligament: Holds the tendon of the long head of the biceps.
Shoulder Joint - Bursa
- Subacromial bursa: Protects underlying supraspinatus muscle from wear between the humeral head and the acromion.
Shoulder Movements - What's Normal
- Flexion: 180 degrees
- Extension: 45-60 degrees
- Internal rotation: 70-90 degrees
- External rotation: 90 degrees
- Adduction (to midline)
- Abduction: 150 degrees
Muscles of the Shoulder
- Rotator cuff muscles (SITS):
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
Other Muscles
- Teres major
- Serratus anterior
- Levator scapulae
- Rhomboid major
- Rhomboid minor
- Pectoralis major
- Pectoralis minor
- Coracobrachialis
- Latissimus dorsi
- Brachialis
- Biceps brachii
- Triceps brachii
Shoulder Nerves
- The nerves in the shoulder area originate from the brachial plexus.
- The brachial plexus gives rise to the suprascapular and axillary nerves.
Blood Supply
- Artery: Axillary artery
- Veins: Brachial veins, basilic and cephalic veins.
Shoulder Joint Facts
- Mobility:
- Ball and socket joint type.
- Shallow glenoid cavity and large humeral head creates disproportion.
- Lax joint capsule.
- Stability:
- Rotator cuff muscles surround the joint, compressing the humeral head into the glenoid cavity.
- Glenoid labrum deepens the cavity for a secure fit with the humeral head.
- Ligaments reinforce the joint capsule.
- Biceps tendon helps depress the humeral head.
SC Joint
- Synovial saddle joint; multiaxial
- Articulating surfaces: Sternal end of clavicle, clavicular notch of sternum, superior surface of 1st costal cartilage; intra-articular fibrocartilaginous disk.
- Ligaments: Intrinsic ligaments (anterior & posterior) & extrinsic ligaments (interclavicular & costoclavicular).
- Innervation: Medial supraclavicular nerve, and nerve to subclavius.
- Blood supply: Suprascapular artery (and internal thoracic artery).
- Movements: Elevation, depression, protraction, retraction.
SC Joint Muscles
- Subclavius
- Deltoid
- Pectoralis
- Trapezius
- Sternocleidomastoid: Pulls clavicle toward the sternum/stabilizes clavicle during pectoral girdle movements.
Acromioclavicular (AC) Joint
- No muscles directly act on it.
- Movements are passive and secondary to the connection with other parts of the upper limb.
- Transfers forces from the upper limb to the clavicle.
AC Joint
- Synovial plane joint; multiaxial
- Articulating surfaces: Acromion of scapula, acromial end of clavicle
- Ligaments: Superior acromioclavicular, inferior acromioclavicular, coracoclavicular (conoid & trapezoid).
- Innervation: Lateral pectoral nerve, suprascapular nerve.
- Blood supply: Thoracoacromial artery, suprascapular artery
- Movements: Protraction, retraction, elevation, depression, axial rotation.
Scapula
- Important point of muscle attachment for the arm and shoulder.
- Articulates with humerus and clavicle (glenohumeral and acromioclavicular joints).
- Medial aspect not directly attached to axial skeleton, connected by muscles.
- Allows free movement across the thoracic cavity.
Scapula
- Borders: Superior, lateral, and medial
- Angles: Lateral, superior, inferior
- Surfaces: Anterior (subscapular fossa), posterior (supraspinous fossa, infraspinous fossa)
- Processes: Coracoid, acromion
- Muscles originating from scapula: Deltoid, supraspinatus, infraspinatus, triceps brachii, teres minor, teres major, latissimus dorsi, coracobrachialis, biceps brachii, sub scapularis etc
- Muscles attaching to scapula: Trapezius, levator scapulae, rhomboids (major & minor), serratus anterior, pectoralis minor
- Vascularization: Suprascapular, posterior circumflex humeral, circumflex scapular, transverse cervical arteries.
Muscles of the Scapula
- Protraction (Pectoralis minor & Serratus anterior)
- Retraction (Rhomboid & lower fibers of Trapezius)
- Omohyoid
- Rhomboid minor
- Serratus anterior
Elbow
- Two articulations:
- Humeroulnar (trochlear notch of ulna & trochlea of humerus)
- Humeroradial (Head of radius & capitulum of humerus)
- Share a joint capsule.
Elbow
- Bones: Humerus, radius, ulna
- Joints: Humeroulnar, humeroradial, proximal radioulnar
- Ligaments: Ulnar collateral, radial collateral, annular
- Movements: Flexion, extension, supination, pronation
Ligaments (Elbow)
- Medial collateral: Extends from the medial epicondyle of the humerus. It attaches to the coronoid processes and olecranon processes of the ulna.
- Lateral collateral: Extends from the lateral epicondyle of the humerus. Attaches to the annular ligament.
- Annular: Forms a 'collar' around the radial head.
Muscles of the Lower Arm
- Anterior compartment (flexion): Pronator teres, flexor carpi radialis, flexor carpi ulnaris, palmaris longus, flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, pronator quadratus
- Posterior compartment (extension): Brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris, extensor digiti minimi, supinator, abductor pollicis longus,extensor pollicis brevis, extensor pollicis longus,extensor indicis.
Anterior Compartment
- Superficial group: Pronator teres, flexor carpi radialis, flexor carpi ulnaris, palmaris longus, and flexor digitorum superficialis.
- Deep group: Flexor digitorum profundus, flexor pollicis longus, pronator quadratus
- Innervation: Primarily median nerve (except for flexor carpi ulnaris and the ulnar half of flexor digitorum profundus, which is supplied by the ulnar nerve).
- Function: movements (flexion, abduction, adduction, pronation) of the forearm, hand, and fingers.
Posterior Compartment
- Superficial: Brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris, extensor digiti minimi.
- Deep: Supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis).
- Innervation: Primarily radial nerve for the superficial compartments and the posterior interosseous nerve for the deep compartment.
- Function: Primarily extension of the hand and digits.
RadioUlnar Joints
- Proximal (near the elbow): Radius and ulna are connected by an interosseous membrane and ligaments. This allows pronation and supination.
- Distal (near the wrist): Interosseous membrane, ligaments, and a fibrocartilaginous disk hold radius & ulna together, separated from wrist joint, supination/pronation occur at this joint.
Proximal RadioUlnar Joint
- Located distally to the elbow.
- Formed by the head of the radius and the radial notch of the ulna.
- Held in place by the annular ligament.
- Movement: Rotation within the annular ligament results in supination/pronation..
Distal RadioUlnar Joint
- Proximal to the wrist joint.
- Articulation between the ulnar notch of the radius and ulna head.
- Strengthened by ligaments(anterior and posterior) and the fibrocartilaginous triangular disk, which separates it from the wrist joint.
- Allows for pronation & supination,.
Hand Bones
- Carpals: 8 small bones in the wrist (proximal & distal rows).
- Metacarpals: 5 long bones forming the palm of the hand.
- Phalanges: 14 long bones forming the fingers (proximal, middle, distal).
The Wrist
- Ellipsoidal (condyloid) type synovial joint
- . Distal end of radius and proximal row of carpal bones (except pisiform) articulate via an articular disc.
- The ulna does not directly articulate with carpal bones except for the distal radio-ulnar joint.
- Movement: Wrist flexion and extension, abduction, adduction.
Wrist
- Highly mobile, prone to injury
- Intrinsic carpal ligaments provide stability, but are easily injured through damage.
- Extrinsic ligaments (radial and ulnar collateral) stabilise the wrist.
- Blood supply from dorsal/palmar carpal arches (derived from radial and ulnar arteries).
- Innervation: Median, radial, and ulnar nerves and their branches.
Wrist Ligaments
- Many interconnecting ligaments.
- They include radiocarpal, intercarpal, interosseous, and collateral ligaments.
- Intrinsic and extrinstic ligaments contribute to wrist stability and movements.
Hand Muscles
- Intrinsic muscles are intricate, responsible for fine movements.
- No individual muscle descriptions
Carpal Bones
- A method of remembering the carpal bones includes mnemonic devices utilizing their shape and relative positions.
Upper Limb Muscles
- Scapula muscles: Supraspinatus, infraspinatus, teres minor, subscapularis, teres major, serratus anterior, levator scapulae, rhomboids (major & minor), trapezius
- Shoulder muscles Pectoralis major, pectoralis minor, deltoid, latissimus dorsi
- Arm muscles: Brachialis, biceps brachii, coracobrachialis, triceps brachii
- Forearm flexors: Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, pronator quadratus
- Forearm extensors: Supinator, extensor digitorum, extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis brevis, extensor indicis, extensor digiti minimi, brachioradialis
- Hand muscles: Thenar muscles (abductors, opponens, flexor pollicis brevis), hypothenar muscles (abductors, opponens, flexor digiti minimi brevis), interossei muscles (dorsal and palmar), lumbricals
Biceps
- Origin: Short head - coracoid process of the scapula, long head - supraglenoid tubercle of the scapula
- Insertion: Radial tuberosity of the radius
- Innervation: Musculocutaneous nerve (C5-C6)
- Blood supply: Branches of brachial artery
- Function: Flexion and supination of the forearm at the elbow, weak flexion of the arm.
Group Learning
- Groups will work on a list of upper limb muscles (4 in each group). Learning origin, insertion, action for presentations.
- Worksheets for further practice are there
- Quick quiz at the end.
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Description
This quiz tests your knowledge on the anatomy and functions related to the shoulder joint, including the roles of various muscles and ligaments. It covers topics such as the rotator cuff, shoulder joint types, and nerve innervation, providing an in-depth look at shoulder biomechanics.
