Muscle Trapezius

Deltoid

Action Elevates the scapula; rotates scapula during aBduction of humerus above horizontal; middle fibers: retract scapula; lower fibers: depress scapula Major aBductor of arm from 15 deg to 90 deg; clav fibers assist in arm flex; post fibers assist in extending arm Elevates the scapula Elevates and retracts scapula

Shoulder region (muscle anatomy) Innervation Blood supply Spinal accessory nerve Superficial branch of [XI] transverse cervical

Lymphatic

Clinical Correlate -Shoulder shrugging

Axillary nerve (C5, C6)

Posterior circumflex humeral artery

-May be affected if the humerus is injured; the axillary nerve passes around posterior surgical neck of humerus - Fracture in medial border, pt present scapula retracted (abducted) laterally on affected side - Fracture in medial border, pt present scapula retracted (abducted) laterally on affected side Notes -Only attachment between the trunk and the upper limb -Easily palpated -Lateral border thick -Medial border thin -aDduction, aBduction, depression, elevation, upward and downward rotation -Surgical neck is weak

Levator scapulae Rhomboid minor

Dorsal scapular nerve (C5) Dorsal scapular nerve (C4, C5)

Dorsal scapular artery Dorsal scapular artery

Rhomboid major

Elevates and retracts scapula

Dorsal scapular nerve (C4, C5)

Dorsal scapular artery

Bones Clavicle Scapula

Shoulder (regional anatomy) Components Features -Lateral 3rd of the clavicle has the conoid tubercle; -Acromial end is lateral -Lateral roughening or trapezoid line important for -Sternal end is medial coracoclavicular ligament -Superior is smooth, the inferior is rough -Glenoid cavity: site of articulation with humerus -3 angles: lat, sup, inf -Spine of scapula: divides horizontally -3 borders: lat, sup, med -Acromion: arches over gleno-humeral joint, and -2 surfaces: costal and posterior articulates with clavicle -3 processes: acromion, spine, coracoid -Suprascapular notch: indentation on superior -3 fossas: subscapular fossa, intraspinous fossa, border supraspinous fossa -Head: half-sphere towards the medial, and -Intertubercular sulcus: deep groove which

Proximal humerus

articulates in glenoid cavity -Anatomical neck: narrow band/constriction around base of the head -Greater tubercle: more lateral; superior facet: supraspinatus muscle; middle facet: infraspinatus muscle; inferior facet: teres minor -Lesser tubercle: more anteromedial, attachment for subscapularis muscle -Deltoid tuberosity: V-shaped lateral surface of humerus, where deltoid inserts -Surgical neck: horizontally oriented band between head and shaft Joints Sternoclavicular joint Acromioclavicular joint Description/Components -Formation between the clavicle and the manubrium of sternum -Synovial joint, separated by an articular disc -Formation between the acromion and the clavicle -Synovial joint

separates the greater and lesser tubercles; site of insertion for pectoralis major, teres major, and lat dorsi

> common site of fractures; which can further damage axillary nerve or posterior circumflex humeral artery

-Axillary nerve and posterior circumflex humeral artery pass through (to deltoids) posterior to surgical neck Ligaments/Tendons/Features -Costoclavicular ligament: laterally to the joint; links the underside of clavicle to the 1st rib -Acromioclavicular ligament: superior/adjacent to the joint -Coracoclavicular ligament: attaches clavicle to superior edge of the coracoid process > trapezoid ligament: lateral > conoid ligament: more medial Clinical Correlate -movement of clavicle in the vertical plane, with some rotation -movement of clavicle in the vertical plane; with some axial rotation - Unless the acromioclavicular ligament is torn, nothing will show up on radiograph; the coracoclavicular is merely a downward anchor for middle part of clavicle -movements include: flexion, extension, aBduction, aDuction, medial rotation, lateral rotation, cicumduction -many movement types, less stability -the constant movement of upper limb creates friction; synovial bodies or BURSA lie just below

Glenohumeral join

-Formation between the head of the humerus and the glenoid cavity -Synovial, ball/socket joint

-Tendon of the long head of biceps brachii muscle passes through head of humerus to attach to base of coracoid process -Subacromial bursa and subdeltoid bursa lie above the joint > synovial membranes are meant to reduce the friction between a tendon and joint capsule/bone *TENDONS hold head of humerus in place ant < Subscapularis tendon pos > Supraspinatous tendon pos > Infraspinatous tendon

pos > Teres minor tendon *LIGAMENT > transverse humeral ligament: covers the notch through which the tendon of the long head of the bicep brachii muscle passes through > prevents upward movement of humeral head

acromion are extremely commonly inflamed in injury -the sub bursa lies just below the acromion, and above the supraspinatous tendon; tends to get inflamed very commonly -Anterior dislocation [most common]; if in the antero-inferior direction, the axillary nerve may be injured or compressed -Posterior dislocation, may be due to prolonged condition, like epilepsy

DIAGRAMS -Movements of the arm at the glenohumeral joint