MSS Wk 7 L Shoulder 1 per page PDF Lecture Notes

MD1020 MSS Lecture Week 7 MSS of the Shoulder A/Prof Kate Domett [email protected] Questions to ‘Discussions’ on LearnJCU Learning Outcomes: Upper Limb 1. Describe and demonstrate the main anatomical landmarks of the clavicle, scapula, humerus, radius and ulna. Identify the bones of the wri...

MD1020 MSS Lecture Week 7 MSS of the Shoulder A/Prof Kate Domett [email protected] Questions to ‘Discussions’ on LearnJCU Learning Outcomes: Upper Limb 1. Describe and demonstrate the main anatomical landmarks of the clavicle, scapula, humerus, radius and ulna. Identify the bones of the wrist and hand and their relative positions. 2. Describe the neurovascular structures lying in close relation to the bones and joints of the upper limb which are at risk of injury following fracture or dislocation. Predict what the functional effects of such injury might be. 3. Briefly describe the origin and distribution of the major arteries and veins and their branches that supply the upper limb (see list of vessels in GLS workbook). 4. Demonstrate the sites at which pulses of the brachial and radial arteries are located. 5. Describe the anatomy of the brachial plexus from its origin in the neck to its terminal branches. Recognise some brachial plexus injuries and explain their clinical presentation. 6. Describe the origin, course and function of the axillary, radial, musculocutaneous, median and ulnar nerves in the upper limb 7. Name the major muscles and muscle groups that the axillary, radial, musculocutaneous, median and ulnar nerves supply together with their sensory distribution. Predict the consequences of injury to these nerves and describe how to test their functional integrity. 8. Describe the anatomical basis of assessment of the cutaneous sensation in the dermatomes of the upper limb 9. Briefly describe the fascial compartments enclosing the major muscle groups of the upper limb; explain the functional importance of those compartments and their contents 10. Interpret standard diagnostic images, e.g. X‐ray, MRI, CT of the lower limb to recognize major anatomical bones and bony landmarks in normal anatomy. Learning Outcomes: Week 7 1. Describe the anatomy of the pectoral girdle (clavicle and scapula), demonstrate and explain the movements of the pectoral girdle; identify the muscles responsible for these movements. Name the main attachments and nerve supply of these muscles. 2. Describe the anatomy of the gleno‐humeral joint, demonstrate and explain the movements of the gleno‐humeral joint and identify the muscles responsible for these movements. Name the main attachments and nerve supply of these muscles. 3. Describe the factors that contribute to the movement and stability of the glenohumeral joint and explain the functional and clinical consequences of its dislocation. 4. Describe the boundaries and contents of the axilla, including the major vessels and relevant parts of the brachial plexus. Bones Bones and Joints 2. Scapula 2. Acromio‐ clavicular joint 3. Clavicle 1. Gleno‐humeral joint 1. Humerus Anterior view 3. Sterno‐ clavicular joint Pectoral girdle •Clavicle •Scapula Lateral Clavicle • Acts as a strut holding the upper limb away from the trunk • Articulates with: Medial Superior view • Sternum medially at the sternoclavicular joint • Scapula laterally at the acromioclavicular joint Conoid tubercle: att. for coracoclavicular ligament Inferior view Att. for costoclavicular ligament Scapula Scapula spine Acromion • Gives attachment to many ms and is extremely mobile on the chest wall • Articulates with: • Clavicle at acromion process (acromioclavicular joint) • Humerus at the glenoid • N.B. Scapular – thoracic interaction is not an anatomical joint Inferior angle Medial border Posterior view Lateral border Muscles of the Shoulder region Move pectoral girdle Move glenohumeral joint •Trapezius •Serratus anterior •Levator scapulae •Rhomboid major and minor •Pectoralis minor •Supraspinatus •Infraspinatus •Subscapularis •Teres minor •Teres major •Deltoid •Pectoralis major •Latissimus dorsi 9 Muscles that move the pectoral girdle Pectoral Girdle movements • mvt of scapula around thorax • Protraction: Serratus anterior & pectoralis minor • Retraction: Rhomboids, Trapezius (middle) • mvt of scapula up and down thorax • Elevation: Trapezius (upper), levator scapulae, & rhomboids • Depression: Trapezius (lower) (+ pectoralis minor) • mvt of inferior angle laterally and medially • Lateral rotation: Trapezius & serratus anterior • Medial rotation: Pectoralis minor, rhomboids & levator scapulae Posterior view Palastanga et al 2002 Protraction Pectoralis minor Serratus anterior Superior view Posterior view Palastanga et al 2002 Retraction Trapezius Rhomboids Protraction and Retraction Elevation & Depression of Scapula Trapezius Levator scapulae Rhomboids Trapezius (lower) Palastanga et al 2002 McKinley & O’Loughlin 2008 Elevation and Depression Lateral Rotation of scapula Palastanga et al 2002 Trapezius Serratus anterior Medial Rotation of scapula Palastanga et al 2002 Levator scapulae Rhomboids Pectoralis minor Scapular Rotation Muscles that move the pectoral girdle Trapezius Levator scapulae Rhomboid minor Rhomboid major Posterior view Muscles that move the pectoral girdle Trapezius Pectoralis minor Serratus anterior (see Fig 7.43, pg 689) 21 Anatomical neck Greater tubercle Intertubercular groove Lesser tubercle Surgical neck Deltoid tuberosity Humerus (anterior) Coronoid fossa Radial fossa Lateral epicondyle Capitulum Trochlear Medial epicondyle Greater tubercle Deltoid tuberosity Humerus Radial groove (posterior) Olecranon fossa Lateral epicondyle Medial epicondyle Shoulder (glenohumeral) joint Shoulder Joint •Glenohumeral joint •Ball and socket joint •Multiaxial ‐ large range of movement •Flexion, extension, abduction, adduction, circumduction, rotation •Poor bony congruity Sacrificed stability for mobility Shoulder Joint  Glenoid labrum  Articular capsule  Ligaments  Muscle tendons (major stabilisers) – Rotator cuff group • Posterior: Supraspinatus, infraspinatus, teres minor, • Anterior: Subscapularis –  Biceps Brachii Bursae Subdeltoid bursa Bursae and tendon sheaths Subacromial bursa Subscapular bursa Subscapularis tendon Biceps brachii long head tendon sheath Coracoacromial ligament Subacromial bursa Clavicle Coracoid Humeral head Subscapularis bursa Capsule Green resin was injected in the capsule and bursae Capsule •Loose & thin •Inferior part is most weakest • Only part not reinforced by rotator cuff • Prone to dislocation •Weak ligaments • Extrinsic and Superior: Coracohumeral ligament • Intrinsic and Anterior: Glenohumeral ligaments Ligaments •Coracoacromial •Coracoacromial arch • Very strong • Prevents superior displacement •Glenohumeral •Superior, middle and inferior •Coracohumeral Biceps brachii Rotator cuff tendons Muscles that move the shoulder Mobility: Muscles that move the glenohumeral joint •Flexion • pectoralis major, deltoid (anterior fibers) • assisted by coracobrachialis and biceps brachii •Extension • Latissimus dorsi, teres major, triceps brachii (long head) •Abduction • Deltoid (esp. central fibers), following initiation by supraspinatus •Adduction • Pectoralis major, latissimus dorsi, • Assisted by triceps brachii (long head), teres major, coracobrachialis •Rotation • Medial: subscapularis, teres major, pectoralis major • Lateral: infraspinatus, teres minor Flexor Muscles of the Shoulder joint Deltoid (ant.) Pectoralis major Anterior view Extensor Muscles of the Shoulder joint Teres major Deltoid (post.) Long head of triceps brachii Latissimus dorsi Posterior view Posterior view Flexion & Extension of the Shoulder Deltoid (ant.) Pectoralis major Anterior view Deltoid (post.) Latissimus dorsi Posterior view Abductor Muscles of the Shoulder joint Deltoid (central) Anterior view Adductor Muscles of the Shoulder joint Pectoralis major Latissimus dorsi Posterior view Anterior view Abduction & Adduction of the Shoulder Deltoid Supraspinatus Pectoralis major Latissimus dorsi Posteriolateral view Anterior view Medial and Lateral Rotation Rotation of the Shoulder Infrapspinatus Posterior view Muscles that rotate the shoulder joint Medial rotation: Subscapularis Lateral rotation: Infraspinatus Teres minor Posterior view Anterior view Position of the Rotator Cuff muscles Greater tubercle Supraspinatus Infraspinatus Teres minor Posterior view Lesser tubercle Subscapularis Left humerus Anterior view Lateral view 44 Rotator Cuff 45 Shoulder muscles Trapezius Levator scapulae Deltoid Supraspinatus* Infraspinatus* Teres minor* Teres major Triceps brachii Rhomboid minor Rhomboid major Latissimus dorsi Posterior view * Rotator cuff group + subscapularis anteriorly Subscapularis* Coracobrachialis Teres major Latissimus dorsi Biceps brachii short head Biceps brachii long head Brachialis Anterior view Surface Anatomy BM1031/41/61 48 Learning Outcomes: Upper Limb 1. Describe and demonstrate the main anatomical landmarks of the clavicle, scapula, humerus, radius and ulna. Identify the bones of the wrist and hand and their relative positions. 2. Describe the neurovascular structures lying in close relation to the bones and joints of the upper limb which are at risk of injury following fracture or dislocation. Predict what the functional effects of such injury might be. 3. Briefly describe the origin and distribution of the major arteries and veins and their branches that supply the upper limb (see list of vessels in GLS workbook). 4. Demonstrate the sites at which pulses of the brachial and radial arteries are located. 5. Describe the anatomy of the brachial plexus from its origin in the neck to its terminal branches. Recognise some brachial plexus injuries and explain their clinical presentation. 6. Describe the origin, course and function of the axillary, radial, musculocutaneous, median and ulnar nerves in the upper limb 7. Name the major muscles and muscle groups that the axillary, radial, musculocutaneous, median and ulnar nerves supply together with their sensory distribution. Predict the consequences of injury to these nerves and describe how to test their functional integrity. 8. Describe the anatomical basis of assessment of the cutaneous sensation in the dermatomes of the upper limb 9. Briefly describe the fascial compartments enclosing the major muscle groups of the upper limb; explain the functional importance of those compartments and their contents Learning Outcomes: Week 7 1. 2. 3. 4. Describe the anatomy of the pectoral girdle (clavicle and scapula), demonstrate and explain the movements of the pectoral girdle; identify the muscles responsible for these movements. Name the main attachments and nerve supply of these muscles. Describe the anatomy of the gleno‐humeral joint, demonstrate and explain the movements of the gleno‐humeral joint and identify the muscles responsible for these movements. Name the main attachments and nerve supply of these muscles. Describe the factors that contribute to the movement and stability of the glenohumeral joint and explain the functional and clinical consequences of its dislocation. Describe the boundaries and contents of the axilla, including the major vessels and relevant parts of the brachial plexus.