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What bones make up the shoulder girdle?
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What are the joints of the shoulder girdle?
- scapulothoracic
- sternoclavicular
- acromioclavicular
- glenohumeral
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What joint attaches the UE to the axial skeleton?
sternoclavicular
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What is the purpose of the shoulder girdle?
provides mobility and stability for the UE
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Describe the clavicle
- connects manubrium and rib one to the acromion of scapula
- acts as a strut to hold UE free of trunk
- shaped like an "s" to improve strength
- transmits force from UE to axial skeleton
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Where is the most common clavicular fracture and describe what happens to it
- medial 2/3 and lateral 1/3 meet (where clavicle starts to flatten)
- falls directly onto shoulder or onto outstretched hand
- lateral fragments tend to drop down
- medial piece help up by SCM
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Describe the scapula
- covers about ribs 2-7
- concave anteriorly
- convex posteriorly
- connects to clavicle at AC joint and humerus at GH joint
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What joint does the scapula connect to the clavicle?
AC joint
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What joint does that scapula connect to the humerus?
GH joint
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Describe the proximal humerus
- head articulates at the glenoid fossa of the scapula
- greater and lesser tubercles are separated by the bicipital groove
- has anatomical and surgical neck
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Where is the most common location for a fracture on the humerus?
- occur around the surgical neck
- children may fracture epipheseal plate
- neres and circumflex artery are at risk when Fx
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Describe all the walls of the axilla
- apex: convergence of clavicle, scapula and rib 1
- base: fascia and skin of armpit
- anterior wall: pectoral muscles, anterior axillary fold - pec major
- posterior wall: scapula and subscapularis muscle, posterior axillary fold - latissimus dorsi and teres major
- lateral wall: humerus
- medial wall: ribcage
- neurovascular bundle: brachial plexus runs through the axilla
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What are the arteries in the shoulder girdle?
- brachiocepahlic: neck (big arch)
- subclavian: under clavicle
- axillary: into armpit
- superior thoracic: towards ribs
- thoracoacromial: towards acromion
- lateral thoracic: outside of ribs
- subscapular: between superior and lateral thoracic
- ant/post humeral circumflex: blood to head of humerus
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Describe the ST joint
- scapulothoracic joint
- articulations of scapula and thorax
- not a true anatomic joint
- movments are linked to SC and AC joint
- movment available at ST joint
- --elevation/depression
- --abduction/adduction (protract/retract)
- --upward/downward rotation
- glenoid is source of reference
- protected by muscle
- --keep scapula following the contour of thorax as it moves
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What is the normal range for upward rotation of the ST joint?
60 degrees
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Why does the scapula need to move when the ST joint moves?
to keep glenoid fossa and head of humerus aligned and provide stability
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Scapulohumeral rhythm
- coordinated movment of the GH and ST joint
- rhythm occurs at a 1:2 ratio
- --for every 3o of movement, 1o is generated by ST joing and 2o by the GH joint
- GH joint always moves first
- --1st 60o in flexion
- --1st 30o in abduction
- whether it is in the 1st 30o of GH abduction or its the fors 60o in flexion, the scapula is fixating itself in that it will proide a good BoS for furthuer motion
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What are the abnormal movements of the ST joint?
- winging: lateral tilt
- movement of the vertebral border of the scapula away from the thorax
- tipping: upwards tilt
- movement of the inferior angle of scapula away from the thorax
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Describe the SC Joint
- sternoclavicular joint
- only bony attachment of the shoulder girdle to the axial skeleton
- plane synovial joint with 3 DoF
- --elevation/depression
- --protraction/retraction
- --rotation
- has sternoclavicular disc (fibrocartilage) to increase the contact of fairly inconfruent surfaces and acts as pivot point for movement and also help with force absorption
- convex and concave joint surfaces allow for elevation/depression and protraction/retraction
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What are the 4 ligaments of the SC Joint?
- anterior sternoclavicular
- posterior sternoclavicular - check ant/post movment of head of clavicle
- costalclavicular - check elevation and superior glide
- interclavicular ligament - check depression and downward glide
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Describe the AC Joint
- acromioclavicular joint
- lateral end of clavicle and acromion process of scapula
- plane synovial joint with 3 DoF
- --small gliding and rotating movements
- maintains connection between clavicle and scapula
- helps scapula respond to movment and tild the glenoid cavity up or down
- also allows for winging or tipping
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What are the 4 main ligaments of the AC joint?
- helps maintain stability
- superior acromioclavicular
- inferior acromioclavicular: controls horizontal stability
- coraclavicular: connects clavicle and coracoid process
- --divided into 2 parts - trapizoid (lateral) and coronoid (medial)
- coracoacromial ligament
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Describe the GH joint
- glenohumeral joint
- ball and socket joint with 3 DoF
- --flexion/extention
- --rotation in horizontal plane
- --rotation in the sagittal plane
- humeral head is at an angle to shaft of bone (angle of inclination) and points slightly posterior (angle of torsion)
- capsule is taut superiourly and slack inferiorly and is reinforced to most on the anterior side
- capsule is tighet when arm is down
- anterior capsule is arranged in a "z" pattern
- --superior, middle, inferior
- coracohumeral ligament: connects coracoid process with greater tubercle and help support humerus against pull of gravity
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What is the glenoid labrum and its function?
glenoid labrum is a connective tissue attached to edges of the glenoid cavity that serves to deepend to articular surface
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Where is the subacromial bursa?
seperates supraspinatus tendon and head of humerus from the acromion process
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Where is the subscapular bursa?
seperates scapula from ribcage
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What is the coracoacromial arch?
- formed by acromion andcoracoacromial ligament
- protects the trop of humeral head, the muscles, tendons, and bursae from trauma from above like the strap of a bookbag
- also helps prevent the head of the humerus from slidingg superiorly if pushed upward
- aka: 5th joint of shoulder
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What muscles are considered in the pectorial group?
- pectorialis major
- pectorialis minor
- subclavius
- serratus anterior
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pectorialis minor
- origin: outersurface of upper margin of ribs 3-5
- insertion: coracoid process
- action: lowers lateral angle of scapula, pulls shoulder forward
- innervation: medial pectoral
- blood supply: thoracoacromial
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pectorialis major
- origin: sternal half of clavicle, sternume to 7th rib, cartilages of the true ribs, aponeurosis of external obliques
- insertion: lateral lip of bicipital groove of humerus
- action: adducts shoulder, flexes and medially rotates
- innervation: medial and lateral pectoral
- blood supply: thoracoacromial
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Subclavius
- origin: upper border of 1st rib and its cartilage
- insertion: groove on under surface of clavicle
- action: draws clavicle down and forward
- innervation: nerve to subclavius
- blood supply: thoracoacromial
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serratus anterior
- origin: outersurface of upper 8 or 9 ribs
- insertion: costal surface of vertebral border of scapula
- action: abducts and upwardly rotates scapula and raises ribs when scapula is fixed
- innervation and blood supply: long thoracic
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What muscles are in the superficial back?
- trapezius
- latissimus dorsi
- levator scapulae
- rhomboid major
- rhomboid minor
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trapezius
- upper fibers elevate scapula
- middle bifers retract scapula
- lower fibers upwardly rotate the scapula
- origin: external occipital protuberance, superior nuchal line, nuchal ligament from spines of C7-12
- insertion: lateral 1/3 of clavicle, spine of scapula, acromion
- action: adducts scapula, tilts chin
- innervation: spinal accessory
- blood supply: descending scapula
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latissimus dorsi
- orgin: spines of T6-16, lumbodorsal fascia, crest of ilium, muscular slips of lower 3 or 4 ribs
- insertion: floor of bicipital groove or humerus
- action: adducts, extends, and medially rotates shoulder
- innervation: thoracodorsal
- blood supply: descending scapula, subscapular
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levator scapulae
- origin: transverse process of C1-C4
- insertion: vertebral border of scapula between superior angle and root of spine of scapula
- action: elevates scapula, ipsilateral lateral neck flexion if scapula is fixed
- innervation: sorsal scapula
- blood supply: descending scapula
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rhomboid major
- origin: spinous process of T2-T5
- insertion: medial border of scapula between spine and inferior angle
- action: adduction and downward rotation of scpula
- innervation: dorsal scapular
- blood supply: descending scapula
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rhomboid minor
- origin: ligamentum nuchae, sping of C7-T1
- insertion: root of spine of scapula
- action: adduction and downward rotation of scapula
- innervation: dorsal scapular
- blood supply: descending scapular
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scapular stabilization
traps and rhomboids combine to stabilize the scapula
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What muscles are in the shoulder?
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anterior deltoid
- origin: lateral 1/3 of clavicle
- insertion: deltoid tuberosity
- action: flexion and medial rotation of arm
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middle deltoid
- origin: acromion
- insertion: deltoid tuberosity
- action: abduction of the GH joint
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posterior deltoid
- origin: spine of the scapula
- insertion: deltoid tuberosity
- action: extension and lateral rotation of humerus
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teres major
- origin: dorsal surface of inferior angle of the humerus
- insertion: medial lip of bicipital groove
- action:adductss, medially rotates and extends arm
- innervation: lower subscapular
- blood supply: scapular circumflex
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What muscles are in the rotator cuff?
- teres minor
- supraspinatus
- infraspinatus
- subscapularis
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teres minor
- origin: upper 2/3 lateral border of scapula
- insertion: lowest facet of greater tuberosity below infraspinatus
- action: lateral rotation of GH joint
- innervation: lower subscapular
- blood supply: scapular circumflex
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supraspinatus
- origin: supraspinous fossa of scapula
- insertion: superior facet of greater tuberosity
- action: assist deltoid in abducting upper arm, fixates head of humerus in glenoid cavity, secondary external rotation of head of humerus
- innervation: suprascapular
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infraspinatus
- origin: infraspinous fossa of scapula
- insertion: middle facet of greater tuberosity
- action: ER
- innervation: suprascapular
- blood supply: suprascapular and scapular circumflex
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subscapularis
- origin: subscapular fossa
- insertion: lesser tuberosity and capsule of shoulder joint
- action: medially rotates humerus, draws if forward and down when raised
- innervation: upper and lower subscapularis
- blood supply: lateral thoracic and subscapularis
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What are the actions of the GH joint?
- flexion/extension
- abduction/adduction
- internal/external rotation
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What are the actions of the AC joint?
- upward and downward rotation
- rotation in horizontal plane
- reotation in sagittal plane
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What are the actions of the ST joint?
- elevation/depression
- protraction/retraction
- upward and downward rotation
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What are the actions of the SC joint?
- elevation/depression
- protraction/retraction
- rotation
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What provides blood to the surgical neck of the humerus?
circumflex artery
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