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Pectoral region and back BONE Bone Articulation Muscle insertion Muscle or...

Pectoral region and back BONE Bone Articulation Muscle insertion Muscle origins Function Picture epost lad on Csup. medial 3rd) 20  + axial skeleton =  Trapezius muscle  Sternocleidomastoid  Transmit force form upper · S sternoclavicular (SC)  Subclavius muscle  Pectoralis major limb to axial skeleton -fractual joint muscle Cant medialbrd).  Acts as movable bar holding  + scapula =  Sternohyoid muscle the arm gInsertion Clavicle acromioclavicular (AC)  Deltoid muscle  Form one of bony boundaries joint Canteriorly on of cervico-axillary canal smooth S lateral snd) * superior  Provide muscular : CC of se it : inferior rough gdislocation of attachments * : sait- ② anhylosis A2 t & dislocation of - Clinical correlation  Fracture always occur at weakest point, junction between medial 2/3rd and lateral 1/3rd  Usually due to fall with outstretched hand to avia  Medial fragment pulled upward due to sternocleidomastoid muscle while lateral fragment pulled downward by weight of arm, medial and forward by adductors of the shoulder medical fragment ↑ 2d/ + Sternodeidomectoid) , lateral pulled + zweight of arm)  + humerus =  Pectoralis minor (coracoid process) CIS palpable parts : glenohumeral joint  Coracobrachialis (coracoid process) CO) Ospine  + clavicle =  Serratus anterior (anterior surface of the acromioclavicular joint ② acromion medial border) [F)  Subscapularis (subscapular fossa) 20) ③ tip of corewid process  Trapezius (spine of scapula) C) situated zun below  Rhomboid major (medial border) jx. of clamale. To Scapula   Rhomboid minor (medial border) Levator scapulae (medial border) j(i) ① vertebral border traced costal S downward from spire to  3 Deltoid (spine of scapula) inferior angle  Supraspinatus (supraspinous fossa) 20) can  Infraspinatus (infraspinatus fossa) agle & from inferior border  Teres minor (lateral border) trace axillary upward thich muscular through  Teres major (lateral border) coverig  Latissimus dorsi (inferior angle) Clinical correlation  Dislocation of acromioclavicular joint is due to contact sports, hard fall on shoulder, fall on outstretched limb  Result in tearing of coracoclavicular ligament  Acromion falls under clavicle resulting shoulder separation - sharders ~ superior medial lateral - Features - : - sangles - lateral &inferior anterior - (subscapulan's fossa) + 2 surfaces - costal -supraspinous fosss foss 3 posterior dorsal - infraspinous  (subclavius Anterior Thoracoappendicular - S PPSS-cage I - scholah paps pergi = serratus anterior) (Dec - major) (pecminor MUSCLES scapuls CATM) Anterior Thoracoappendicular muscle C more pectoral girde clavicle) # Muscle Origin Insertion Nerve Action ① Pectoralis major  Medial half of clavicle Bicipital groove of Lateral & medial pectoral 1. Adduction & medial rotation of humerus  sternum humerus nerves 2. Clavicular head helps flex extended arm d  Upper 6 costal cartilage 3. Sternocostal head helps extend flexed arm  Aponeurosis of external ~ oblique muscle (anterior abdomen wall) ② Pectoralis minor & coracidea nei 3rd – 5th ribs close to costal Coracoidprocess of Medial pectoral nerve (C8, 1. 2. Depresses shoulder Stabilizes scapula by withdrawing it against cartilage scapula T1) C column thoracic wall. 3 vert Cervica thoracic - - 7 c T - 12 & = - 4 c ④ Subclavius 1st rib (bawah clavide Subclavian groove Nerve to subclavius (from 1. Fixes clavicle during movement of shoulder uppertrunk of branchial plexus) ⑪ Serratus anterior First 9 ribs Anterior aspect of medial Long thoracic nerve 1. Draws scapula forward border and inferior angle 2. Fixes scapula against thoracic wall - of scapula 3. Rotates scapula outwards in abduction the arm above 90 degree ( Clinical correlate of vessels & nerves  protection I Winging of scapula due to lesion od long thoracic nerve (serratus anterior) of abscess from  Medial border of scapula will positioned outward, while inferior angle protrudes out spread to mech C-limit & in ninor  Appeared like a wing and pect ↓ medicala.  Patient will have difficulty in raising arm above shoulder daripectoral fascis > - encloses subulsvicue In he pierce entral v thoraco-acromiala. protected * * cep halic u gels ① lymp  Tolong/alLepasni/R ombau/Rumah. Rhom Rhom &.. TrapeziusLat: pile major minor CPTm) Posterior Thoracoappendicular muscle Muscle Origin Insertion Nerve Action ① Trapezius  Medial 3rd superior nuchal line  Lateral 1/3 ofclavicle ① Motor =  Elevate scapula i  External occipital  Acromion Accessory nerve (CN XI)  Depressing scapula i n t e re protuberance  Medial end of spine of scapula  Rotating scapula  Spinous C7 – T12 ② Sensory =  Retracting scapula ventral rami of C3, C4 use Clinical correlate - SUPERFICIAL  Drop shoulder due to paralysis of trapezius muscle  Due to lesion to spinal accessory nerve  ②Latissimus dorsi  Vertebral spines of T7 – T12 Extension, adduction, and medial  Inferior 3-4 ribs rotation of arm  Thoracolumbar fascia  Elevates trunk when climbing along  Iliac crest Floor of bicipital groove of humerus Thoracodorsal nerve with pectoralis major me  climbing muscle [C6 - 28]  swimmer’s muscle – backstroke swimming ③ Levator scapulae * Transverse processesof C1 – C4 # Elevates scapula Superior part of medial border of scapula ⑪ Rhomboid minor Inferior end of Ligament nuchae C7 – T1 Retracts & fixes scapula to thoracic wall Dorsal scapular nerve DEEP use Medial border of scapula ③ Rhomboid major Spines of vertebrae T2 – T5 Clinical correlate  lesion to dorsal scapular nerve will affect rhomboids major and minor muscle.  On the side that it is affected, the scapula will locate further from the midline.  scapula yX humerus CScapulohumeralSmuscle Muscle Origin Insertion Nerve Action ① Deltoid * ① Anterior fiber - Lateral 1/3 ofclavicle Deltoid tuberosity of humerus Axillary nerve * 1. All - Abduction of shoulder crounded ② Middle fiber – multipennate fibers contour) from acromion of scapula humerus3 2. CAnterior - Flex & medial rotation of ③ Posterior fibers – lower margin of - abductors of armC 3. CMiddle(2 spine of scapula 4. CPosteriorx- Extend & lateral rotation of arm Lbelakang) (bawah) ② Teres Major Posterior surface of inferior angle of Bicipital groove of humerus Lower subscapular nerve CAdduction & medial rotationSof arm scapula & middle border of scapula en ↑ ③ Teres Minor * - greatit Superior 2/3rd ofElateral border of Axillary nerve * CLateral rotation(ofhumerus scapula 3 contracts, ? laterally rotate the arm ⑪ Supraspinatus spine L ESupraspinatus fossa3of scapula  &Rotation&of arm Catas spine) Eapula Greater tubercle of humerus Cposterior  Capsule shoulder joint view Suprascapular nerve scapula) ⑦ Infraspinatus &Infraspinous fossa3of scapula 2Lateral rotator& of arm Cbawah spine interin Subscapularis ESubscapular fossa3of scapula Lesser tuberosity of humerus Upper & lower subscapular CMedial rotationSof humerus nerve · Clinical correlate nicipital  Triangle of Auscultation, thinning of musculature of the back supricotat  Allows for improved listening to the lungs. lat dorsi  Bound by superior horizontal border of latissimus dorsi, medial border of scapula, inferolateral border of trapezius Mnemonic (from the back to the front) S – supraspinatus I – infraspinatus T – teres minor and major S – subscapularis 3 ROTATOR CUFF MUSCLES  Arm 11 humerus BONE Bone Articulation Muscle insertion Muscle origins Description Picture  + scapula =  Supraspinatus   Characteristic to identify the glenohumeral joint  Infraspinatus side are by head for upward  + ulnar at medial  Teres minor and medial, lesser tuberosity trochlea  Teres major for anterior part, olecranon  + radius at lateral  Subscapularis fossa for posterior part capitulum  Deltoid (deltoid  Existence of transverse tuberosity) humeral ligament (a broad band passes from the lesser Humerus to the greater tubercle) holds the tendon of long head of brachii muscle in the intertubercular groove Clinical correlation Shoulder dislocation or humeral neck fracture can injured axillary nerve and posterior circumflex vessels as they wind around the surgical neck of humerus. n Injured of radial nerve would cause wrist drop Supracondylar fracture is usually due to fall on an outstretched hand. This injured the bracial artery, result in ischemia  Volkmann’s ischemic contracture (uncontrolled flexion due to fibrotic and short flexor muscle) Parts that connect to nerves are surgical neck = axillary nerve, radial groove = radial nerve, = distal end = medial nerve, medial epicondyle = ulnar nerve & ~ Golfer’s elbow = medial epicondylitis Tennis elbow = lateral epicondylitis Zshaft How to identify shaft ? * deltoid tuberosityCanterolateral) Extra CC : * radial groove (posterior surface) particulatew I shallow grenoid cavity scapul [for wide range of movement) (1/3 sphere) ~  Muscle Anterior compartment of the arm CBBC) Muscle Origin Insertion Nerve Action - 2 heads ! ① Biceps brachii f Long head: Supraglenoid Tuberosity of radius and fascia of ①Long head: flex supinates , tubercleof scapula forearm via bicipital aponeurosis CFlexes&forearm CSupinates(forearm 2 Short head: Tip of coracoid CResists dislocation of shoulder( process of scapula ②Short head: flex adduct , CHelps flex and adduct(the arm CResists dislocation of shoulder( Clinical correlate  Dislocation of long head of biceps brachii due to prolonged tendinitis or forceful flexion of the arm against excessive resistance, look like Popeye arm Musculocutaneous nerve (C5, C6, C7)  Result in tendon rupture of long head of biceps brachii.  Biceps tendinitis usually due to repetitive microtrauma involving sports of throwing or using racquet  Patient will feel pain, tenderness and crepitus  ② Coracobrachialis Tips of coracoid process of Middle third of medialside of shaft  HelpCflex and adduct arm & scapula oh humerus  Resist dislocation of shoulder ③ * * Brachialis Distal half of the anterior Coronoid process of ulna Musculocutaneous nerve (C5, C6) and LMain flexor of the forearm,( flexes in all position surface of humerus radial nerve (C5, C7) & * *  Posterior compartment of the arm (T A). > - TunkuAhmad Muscle Origin Insertion Nerve Action ① Triceps brachii oLong head: Infraglenoidtubercle Olecranon process of ulna Radial nerve Extension of forearm&at elbow joint C 7 lateral of scapular *some individual will have axillary nerve innervate the long head &Lateral head: humerus (superior < medial head to radial groove) 3Medial head: humerus (inferior W long head to radial groove) decorati > - a - ⑪ Anconeus Lateral epicondyle of humerus Lateral surface of olecranon Radial nerve  elbow extension S Assist inC and superior part of  C Stabilizes the elbow joint3 posterior surface of ulna F = E Cubital fossa CCC biceps reflex)   : Lateral border – brachioradialis muscle Medial border – pronator teres muscle E -  Superior border – horizontal line drawn between epicondyles of humerus  Roof – bicipital aponeurosis, fascia, subcutaneous fat and skin ↑  Floor – brachialis and supinator Media Lateral   Content (lateral to medial) = radial nerve, biceps tendon, brachial artery, brachial vein, median nerve Medial cubital vein is a common site for venipuncture I - =  Content can be damaged in supracondylar fracture of humerus i Nerves : CUTANEOUS INNERVATION OF ARM brachial major artery : artery ① musculocutaneous n. > - profunda brachi ; ② median n. to humems > - nutrient artery ② ulnar n. > - superior ulnar collateral a ① radial n > - inferior unnarcollateral a C4 shoulder 16 Thumb , C7 Middle : : : point , finger C8 : Little finge  cutaneous innervation : > - medial (Brachial plexus) > - Lateral (Musculontaneous) Forearm > - Posterior(Rudia 1) BONE Bone Articulation Muscle insertion Muscle origins Description Picture  + humerus    Does not reach wrist and not  + radius participate in radiocarpal 7 Ulna joint Cmedia 1  Interosseous membrane connect radius and ulna ;’  Biceps tendon  + humerus  Can pivot ulna, thus supination and pronation are possible V  Interosseous membrane Radius connect radius and ulna Clateral) Clinical correlation Fractures of the radius or ulna are often incomplete in young children called greenstick fractures. In adult, direct injury usually produces transverse fractures at the same level, usually in the middle third of the bone. Isolate fracture of ulna or radial may occur, likely to be associated with dislocation of nearest joint. Colles fracture and dinner fork deformity of hand is a complete transverse fracture of the distal 2cm of the radius. Common in adult above 50 y/o Occur frequently in women with secondary osteoporosis. The distal fragment is displaced dorsally (dinner fork deformity) and often comminuted (broken in pieces) The fracture result from forced extension of the hand, usually as the result of trying to ease a fall by outstanding upper limb. Colles fracture would make the position of styloid-tips reversed.  um medial epicondyle - flexor muscles promation Lateral epicondyle -> extensor muscles [ Innervation : median ns ulnar n. Y (8) Muscle Anterior compartment of the forearm (flexor-pronator muscle) Canteromedially) Muscle CFCU)S Origin Insertion Nerve Artery Action  Medial epicondyle I Pronator Teres CPronates&  Coronoid process of Pronator tuberosity (PT) ulna  Flexes forearm Flexor Carpi Bases of 2nd 3Flexes metacarpal Cjani telurjak) CFCR) Median n. Radialis CI Abducts SUPERFICIAL Medial epicondyle -) Flexes hand Palmaris Longus CPL)  Flexor retinaculum CTenses palmar Callbenalas ,  Palmar aponeurosis aponeurosisS Medial epicondyle &medial Ulnar a. aspect of olecranon process,  Pisiform bone Flexor Carpi (F(u)  Flexes Ulnaris posterior border of ulna  Base of 5th metacarpal Ijatighing( Ulnar n. CAbducts ( - # 2 Flexor Digitorum Medial epicondyle &medial CFlexes middle & proximal phalanges & Superficialis margin of coronoid process Middle phalanx Cjarihantu) Median n. ( Flexes PIP joint3 INTER CFOS) *it split and attached to middle phalange Clinical correlate  Fascial plane between deep and intermediate layers make up primary neurovascular plane, the main neurovascular bundles located within it 3 1. Flexion of DIP ofmedial 4 fingers Lateral half: Anterior Muscle divides into 4tendons, - 2. Helps in flexion ofPIP & MCP of  Upper ¾ ulna shaftanterior interosseus n.(branch piercing tendon of FDS & medial 4 fingers Flexor Digitorum surface ofemedian n.) Anterior interosseus inserted into medial 4 fingers - 3. Helps in flexion ofhand at the wrist Profundus CFDP)  Adjoining part ofinterosseus a.Ulnar a. membrane distal phalanges bases - C Medial half: Ulnar n. - Joint FOP-pass through ↓ Eps *pass through tendon of flexor digitorum attach to superficialis and attached to distal distal phalages phalange DEEP Flexor Pollicis Middle anterior surfaceof shaft of Base of distalphalanx Flexes distal phalanx Longus (FPL) radius Anterior interosseus Median n. *FPL tendon passes deep to flexor = a. retinaculum, enveloped its own synovial sheath and attached to distal phalange of the thumb. *only muscle that flexes the interphalangeal joint of the arm Pronator Lower ¼ ulna shaftanterior Lower ¼ radius shaftanterior Quadratus (PO) surface surface -- Pronates forearms CC : compartment syndrome dani distal janke frunh " Tx emergency tele note : : proximal (nearer fasciotomy Hifmahl  ↓ Innervation : Radial n. (12) Posterior compartment of the forearm (extensor-supinator muscle) Muscle Origin Insertion Nerve Artery Action 1.[Flexor of forearm inmid-prone Lateral supracondylarridge Lateral side of radius,above position J Brachioradialis Radial recurrent a. supraepicondylar styloid process 2.[Supinate & I ridge pronatesJ Olecranon process(lateral) & [Weak extensor of elbow (helps triceps)7 SUPERFICIAL Interosseousrecurrent Anconeus Lateral epicondyle upper ¼ a. posterior surface of ulna Ext. Carpi CECRL) Lower 1/3 lateral Dorsum base 2nd Radialis Longus supracondylar ridge metacarpus 1.[Extension of wrist7 Radial a. Ext. Carpi CECRE) Dorsum base 3rd 2.[Abduction of wristJ Radialis Brevis metacarpus Extensor Interosseus recurrent a. CEOL) expansions &Posterior [Extension of IP &MCP wrist joint3 Ext. Digitorum Lateral epicondyle medial fingers Il Dorsal digital expansion interosseus a. Longus 4 CEOM) [Extension of little finger at MCP & IP Joins the tendon of ED for5th digit Interosseusrecurrent Ext. Digiti Minimi jointsJ a. Radial n. Lateral epicondyle,Middle 1.[Extension ofwristJ CECU) half of posterior border of 2.[Abduction of Ext. Carpi Ulnaris Base of 5th metacarpal Ulnar a. ulna wrist7. Lateral epicondyle ofhumerus, Lateral surface of radius,upper 1/3 Recurrent interosseus Supinator supinator a. 2Supination 7 2 crest of ulna Upper parts of posterior DEEP Abductor PollicisLongus surfaces ofradius & ulna and 7at EAbduction & extension of thumb interosseous Base of 1st metacarpal CMC joint CAPL) membrane Ext. Pollicis Posterior surface of Base of distal phalanx of Posterior interosseous a. [Extension all joints longus CEPL) ulna below APL thumb of thumbJ [Extends proximalphalanx & Ext. PollicisBrevis Posterior surface ofradius Dorsal surface of base ofproximal metacarpal of CEPB) below APL phalanx thumb7. Ext. Indicis Posterior surface of Joins tendon of ED for [Extension of index ulna below EPL index finger fingerJ Clinical correlation  Extensor tendons are held in place in the wrist region by the extensor retinaculum, prevent bowstringing of the tendons (protruding beyond the contour) when hand is extended at the wrist joint  As the tendon pass over the dorsum of the wrist, they are provided with synovial sheath that reduce friction. Boundaries : # Laterally - tendons of APL + Epp # medially - tendon of EPL  BONE OF HAND Description Bone Picture (look-a- like) Lid cap Scaphoid a boat mate · (She) riquetom Proximal carpal bone hi ime Pistor · , E Lunate CLooks) luna moon T ↳ S - · Triquetrum 3-cornered CToo) Pisiform Pea ! (Proud) Trapezium 4 sided, table-like CTry) Distal carpal bone : Trapezoid CTO) A wedge-shaped bone that resembles trapezium Capitate A head-shaped bone (Catch) Hamate A little hook (hammer), a wedge shaped bone CHer) Clinical correlation Fractures of scaphoid is the most frequent, result from fall on the palm when hand is abducted. The fracture occurring across the narrow part of the scaphoid. On palpation, the pain is produced in the anatomical snuff box Fracture usually misdiagnosed as sprained wrist. Due to poor blood supply to the proximal part of the scaphoid, it may takes at least 3 months to union Avascular necrosis of the proximal fragment of the scaphoid may occur  Crushing injuries of the distal phalanges are common, because of highly developed sensation in the fingers, the injuries are extremely painful  Fracture of a distal phalanx is usually comminuted and a painful hematoma soon develops.  Fracture of proximal and middle phalanges are usually the result of crushing or hyperextension injuries  Because of the close relationship of phalangeal fracture to flexor tendons, the bone fragments must be carefully realigned to restore normal fx. *Dupuytren contracture is a palmar fascia disease resulting in progressive shortening, thickening, and fibrosis of palmar fascia and aponeurosis. CMCP) *The fibrous degeneration of the longitudinal bands on the medial side of the hand pulls the 4th and 5th fingers into partial flexion at the metacarpophalangeal and (PIP) proximal interphalangeal joints. *The treatment is usually involves surgical excision of all fibrotic parts of the palmar fascia to free the fingers.  INTRINSIC MUSCLES OF HAND Muscle Origin Insertion Nerve Artery Action  Tubercle of scaphoid Abductor Pollicis Brevis Abduction of thumb atMCP &  Tubercle of trapezium CAbPB)  Flexor retinaculum Base of proximal phalanx of thumbs CMC j. Flexor Pollicis Brevis CFPB) = Median n. Radial n. Flexion of thumb  Tubercle of trapezium Opponens (pincher 7 Pollicis COP)  Flexor retinaculum 1st metacarpal Opposition of thumb THENAR  Oblique head: Capitate bone & 2nd& 3rd metacarpal bones ① Adductor Pollicis CAP)  Transverse head: 3rdmetacarpal Deep palmar bone Proximal phalanx Adducts the thumb (adductor compartment)② (palmar surface) arterial arch a. ② Abductor Digiti Abduction of little ③ Minimi CAOM) Pisiform bone finger Proximal phalanx oflittle finger HYPOTHENAR Flexor Digiti Minimi  Hook of hamate 3 Ulnar n. Flexion of little finger Brevis (FDMB)  Flexor retinaculum Ulnar a.  Draws the 5th metacarpal Opponen Digiti Minimi  Hook of hamate boneanteriorly 5th metacarpal bone CODM)  Flexor retinaculum  Rotates it laterally * 1ST 2nd Dorsal digital expansions of medial 4 (unipennate)= Superficial palmar Tendons of flexor digitorum  Flexion of MCP Lumbricals ⑪ fingers median nerve arterialarch a. central profundus  Extension of IP j. tment) compartment) 21s + &2nd) (3rd B4+ b) Proximal phalanx ofindex, ring & little =3rd 4th (bipennate)= ulnar nerve 3 Palmar Interosseus I Medial side of base of 2nd, 4th & 5th Palmar finger Adduction metacarpal Call inserted into extensor pansion) metacarpal a.  1st & 2nd: Lateral sides of bases of INTEROSSEUS proximal phalangesof middle & ring  Abduction of index, middle & fingers ring fingers ey 4 Dorsal Interosseus Adjacent sides of metacarpal  Flexion of their  3rd & 4th: Medial sideof bases of Ulnar n. 4 bones proximal phalanges o middle & ring metacarpophalangealjoints cm(p) Dorsal & Palmar  Extension of their ② fingers interphalangeal joints (IP)  Extensor expansions of index ring & metacarpal a. little fingers - THENAR _ Clinical correlate  Tenosynovitis due to injuries of the fingers that causing infection of the digital synovial sheaths.  When inflammation of tendon and synovial sheath happen, digits swells and movement become painful  The tendons of the 2nd, 3rd, and 4th fingers nearly always have separate synovial sheaths, the infection is usually confined to the infected finger.  The synovial sheath of the little finger is usually continuous with the common flexor sheath, tenosynovitis in this finger may spread to the common flexor sheath and through the palm and carpal tunnel to the anterior forearm, draining into the space between the pronator quadratus and the overlying flexor tendons (Parona space).  Likewise, tenosynovitis in the thumb may spread via the continuous synovial sheath of the FPL (radial bursa). Synovial cyst of wrist  Sometimes a nontender cystic swelling from synovial sheath appears on the hand, most commonly on the dorsum of the wrist. (Synovial cyst of wrist)  The thin-walled cyst contains clear mucinous fluid, and it may be painful.  A cystic swelling of the common flexor synovial sheath on the anterior aspect of the wrist can enlarge enough to produce compression of the median nerve by narrowing the carpal tunnel (carpal tunnel syndrome). Carpal tunnel syndrome  Carpal tunnel syndrome is increasing size of any of its contents or synovial sheath due to fluid retention, infection and excessive exercise that causing swelling of tendon or synovial sheaths  Compression of structures within it causing pain, paresthesia, hypoesthesia, anesthesia in hand  Cutaneous innervation at thenar eminence is not affected  For carpal tunnel release: partial or complete surgical division of flexor retinaculum  ARTICULAR NERVE PASSED JOINTS TYPES LIGAMENTS BLOOD SUPPLY MOVEMENT SURFACES THROUGH PECTORAL / SHOULDER GIRDLE  Clavicle  Sternoclavicular lig. (A & P) Suprascapular a. & - Supraclavicular n. 1. Elevation ofscapula  Sternum  Interclavicular lig. internal thoracica. - Nerve to subclavius 2. Depression Sternoclavicular Saddle  1st costal cartilage  Costoclavicular lig. 3. Protraction 4. Retraction Clinical correlation 5. Forward - Dislocation rare, costoclavicular lig. And articular disc are effective at absorbing and transmitting force away from the joint into sternum. rotation - Anterior dislocation happen following a blow to the anterior shoulder which rotates backwards - Posterior dislocation happen from a force driving the shoulder forwards or from direct impact to the joint - In young people, as epiphyseal plate isn’t fully close, dislocation usually accompanied by a fracture through the plate.  Clavicle  Coracoclavicularlig. (main) Suprascapular a. & - Suprascapular n.  Acromion process  Trapezoid lig. + conoid Thoraco-acromiala. - Lateral pectoral n. Acromioclavicular Plane lig.(to connect coracoid - Axillary nerve process to clavicle) Clinical correlation - Acromioclavicular joint dislocation (also known as a separated shoulder) occurs when the two articulating surfaces of the joint are separated, associated with joint soft tissue damage. - It commonly occurs from a direct blow to the joint, or a fall on an outstretched hand, more serious if ligamental rupture occurs (acromioclavicular or coracoclavicular). - If the coracoclavicular ligament is torn, weight of the upper limb is not supported, and the shoulder moves inferiorly, increases the prominence of the clavicle. - Management of AC joint dislocation is dependent on injury severity and impact on quality of life. The treatment options range from ice and rest, to ligament reconstruction surgery. - Note: this injury is not to be confused with shoulder dislocation – an injury affecting the glenohumeral joint.  M: Glenoid cavity  Glenohumeral lig. 1. Anterior circumflex 1. Suprascapular n. 1. Flexion  L: Head of humerus  Coracoacromial lig. humeral a. 2. Axillary n. 2. Extension Ball &  Coracoclavicular lig. 2. Posterior circumflex 3. Adduction Glenohumeral socket  Transverse Humerallig. humeral a. 4. Abduction 3. Suprascapular a. 5. Medial rotation 6. Lateral rotation Clinical correlation - Dislocations at the shoulder are described by where the humeral head lies in relation to the infraglenoid tubercle. Anterior dislocations are the most prevalent. - Superior movement of the humeral head is prevented by the coraco-acromial arch. - An anterior dislocation is usually caused by excessive extension and lateral rotation of the humerus. The humeral head is forced anteriorly and inferiorly – into the weakest part of the joint capsule. Tearing of the joint capsule is associated with an increased risk of future dislocations. - The axillary nerve runs in close proximity to the shoulder joint, and can be damaged in the dislocation. Injury to the axillary nerve causes paralysis of the deltoid, and loss of sensation over regimental badge area.  NERVE PASSED JOINTS TYPES ARTICULAR SURFACES LIGAMENTS BLOOD SUPPLY MOVEMENT THROUGH  Radial collateral lig. Proximal: Ulnarcollateral 1. Ulnar n. 1. Flexion Humeroulnar Hinge  Ulnar collateral lig. a. 2. Radial n. 2. Extension  Annular lig. Radial collateral 3. Median n.  Quadrate lig. a. & middle 4. Musculocutaneous n. Elb ow Ball & collateral a. Humeroradial Distal: Radial a. & socket Ulnar a. Clinical correlate Bursitis - Subcutaneous bursitis: Repeated friction and pressure on the bursa can cause it become inflamed. Because this bursa lies relatively superficially, it can also become infected (e.g cut from a fall on the elbow), and this would also cause inflammation - Subtendinosus bursitis: This is caused by repeated flexion and extension of the forearm, commonly seen in assembly line workers. Usually flexion is more painful as more pressure is put on the bursa. Dislocation - An elbow dislocation usually occurs when a young child falls on a hand with the elbow flexed. The distal end of the humerus is driven through the weakest part of the joint capsule, which is the anterior side. The ulnar collateral ligament is usually torn and there can also be ulnar nerve involvement - Most elbow dislocations are posterior,