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Shoulder and Arm

Topographical Views

Ball-and-socket joint which allows for great ROM. But the freedom of movement can come at a large price

Exploring the Skin and Fascia

What is Fascia?

Bones of the Shoulder and Arm

Shoulder Complex: Clavicle, Scapula & Humerus

Bony Landmarks

Plays a vital role in stabilization & movement of the arm

Bony Landmarks

Fossa = depression

Scapulothoracic Joint False Joint

Attachment site for 16 different muscles

Bony Landmarks

Humerus bone of the arm

Proximal Humerus Articulates with glenoid fossa of scapula (GH Joint) Synovial, ball & socket joint Surrounded by deltoid & numerous tendons

Nodule, or small eminence

Epi = Upon Condyle = rounded articular area

Bony Landmarks
Hint: All of the bones and muscles we will examine throughout the semester will be on the right side

Bony Landmarks
Clavicle = Collar Bone
Superficial Runs horizontally along the top of the chest at the base of the neck Articulates Laterally with acromion (AC Joint) & Medially with sternum (SC Joint) Both synovial joints Most common & most movable joint in the body Snapple Fun Fact of the Day The clavicle is the 1st bone to ossify in a human fetus, yet is the last to completely develop May explain why it is one of the the most frequently broken bones in the body

Bony Landmark Trails

Bony Landmark Trails

Trail 1 Along the Edges

Spine of the Scapula
Superficial ridge located just off the top of the shoulder Attachment site for posterior deltoid & middle and lower fibers of the traps

Medial Border
Long edge that runs parallel to vertebral column 5-7long Attachment site for rhomboids & serratus anterior Deep to the trapezius

Inferior Angle
Superficial Located at the medial borders lower end

Superior Angle
Located at the superior end of the medial border Inferior attachment site for the levator scapula muscle May not be as easy to isolate as the inferior anlgle Located deep to the trapezius

Lateral Border
Extends superiorly & laterally from the inferior angle toward the axilla (armpit) Attachment site for teres major & teres minor May not be as clearly defined as the medial border

Infraglenoid Tubercle
Located at the most superior aspect of the lateral border Not a distinguishable point, but a small spot which serves as the attachment site for the long head of the triceps brachii May cause tenderness in the surrounding tissues

Trail 2 In the Trenches

Infraspinous Fossa
Fossa = Depression Designed to accommodate a muscle belly and it tendinous attachements Infraspinous fossa inferior to the spine of the scapula

Supraspinous Fossa
Located superior to the spine of the scapula Small, yet deep Difficult to directly access

Subscapular Fossa
Located on the anterior portion of the scapula, next to the rib cage Attachment site for the subscapularis muscle and serratus anterior Challenging to access (to say the least)

Trail 3 Springboard Ledge

Acromion
Lateral aspect of the spine of the scapula Located at the top of the shoulder Has a flat surface & articulates with the clavicles lateral end Attachment site for the trapezius & deltoid muscles

Clavicle
Lies horizontally across the upper chest S shape Both ends are superficial & easily accessible

Acromioclavicular Joint

Articulation between the acromion of the scapula & the acromial end of the clavicle

Sternoclavicular Joint
Articulation between the sternal end of the clavicle & the sternum Wedge shaped Cotains a small, impalpable fibrous disk Rest = only the inferior portion of the sternal end makes contact with the sternum Elevation = sternal end pivots on the sternum

Coracoid Process
Beak-like projection of the scapula Found inferior to the shaft of the clavicle Can be tender when palpated so WATCH OUT!

Deltoid Tuberosity
Lateral side of mid-humeral shaft Attachment site for the deltoid muscle

Trail 4 Two Hills and a Valley

Greater Tubercle

Located inferior & lateral to the acromion Shaped more like a low mound than a pointy hill Attachment site for supraspinatus, infraspinatus & teres minor

Intertubercular Groove and Lesser Tubercle

Smaller than greater tubercle Attachment site for subscapularis Intertubercular Groove space in between the greater & lesser tubercles Tendon of the long head of the biceps brachii lies inside Ouch!

Questions on Bones of the Shoulder & Arm?

Review your anatomy Thursday we talk muscles! Have a great day!

Muscles of the Shoulder and Arm

Muscles of the Shoulder and Arm

Muscles of the Shoulder and Arm

Synergists Muscles Working Together

Shoulder
(glenohumeral joint)

Shoulder
(glenohumeral joint)

Shoulder
(glenohumeral joint)

Shoulder
(glenohumeral joint)

Shoulder
(glenohumeral joint)

Shoulder
(glenohumeral joint)

Scapula
(scapulothoracic joint)

Scapula
(scapulothoracic joint)

Scapula
(scapulothoracic joint)

Deltoid

Also the insertion of the trapezius

Deltoid
1. 2. 3. The cap of the shoulder Anterior fibers Middle fibers Posterior fibers

All 3 ABD the humerus ANT/POST = antagonists in Flexion/Extension & IR/ER

Trapezius

Lies superficially along the upper back & neck Broad, thin fibers blanket the shoulders attaching to the occiput, lateral clavicle, scapula & spinous processes of the thoracic vertbrae 1. Upper fibers = descending 2. Middle fibers 3. Lower fibers = ascending

Trapezius

Upper, Middle and Lower Fibers of the Trapezius

Latissimus Dorsi

Latissimus Dorsi

Broadest muscle of the back Both ends are difficult to isolate Middle portion next to the lateral border of the scapula is easy to grasp

Teres Major
Lats little helper

Latissimus Dorsi and Teres Major

Rotator Cuff Muscles

SITS Muscles

Only Rotator Cuff muscle not involved in shoulder rotation

Rotator Cuff Muscles

Rotator Cuff Muscles

Rotator Cuff Muscles

Only Rotator Cuff muscle that attaches to the lesser tubercle

Rotator Cuff Muscles

Encompass & therefore, Stabilize the glenohumeral joint All attach on the head of the humerus

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

Rotator Cuff Tendons

Supraspinatus Tendon

Supraspinatus Tendon

Infraspinatus and Teres Minor Tendons

Subscapularis Tendon

Rhomboid Major and Minor

Rhomboids
Located between the scapula & vertebral column Major > Minor Difficult to distinguish individually

Levator Scapula

Levator Scapula
Located along the lateral and posterior sides of the neck Dont compress a nerve of the brachial plexus!

Levator Scapula

Serratus Anterior

Superhero Muscle

Serratus Anterior

Breast Tissue
Text

Pectoralis Major

Pectoralis Major
Broad, powerful muscle located on the chest Upper fibers = flex shoulder, Lower fibers = ext shoulder Its an antagonist to itself!

Pectoralis Minor

Pectoralis Minor
Lies next to the rib cage deep to the pec major Fibers run perpendicular to the pec major fibers Aerobics = pec minor helps elevate the rib cage for inhalation Brachial plexus, axillary artery & vein run underneath Potential for neurovascualr compression

Subclavius

Biceps Brachii

Biceps Brachii
Lies superficially on the anterior arm Long Head = passes through intertubercular groove of the humerus Helps to stabilize the tendon as it rises over the top of the shoulder

Triceps Brachii

Triceps Brachii
Only muscle located on the posterior arm Extends elbow & shoulder Long Head = infraglenoid tubercle of the scapula Lateral Head = lies superficially beside the deltoid Medial Head = lies mostly underneath the long head

Coracobrachialis
Armpit Muscle

Other Structures of the Shoulder and Arm

Axilla

Armpit

Lateral Wall

Posterior Wall

Anterior Wall

Medial Wall

Other Structures of the Shoulder and Arm

Axilla

Other Structures of the Shoulder and Arm

Axilla

Sternoclavicular Joint

Ligaments of the Shoulder and Glenohumeral Joint

Ligaments of the Shoulder and Glenohumeral Joint

Glenohumeral Joint

Glenohumeral Joint

Coracoclavicular Ligament
Composed of 2 smaller ligaments 1. Trapezoid 2. Conoid Provide stability for the acromioclavicular joint & form a strong bridge between the scapula and clavicle

Coracoacromial Ligament
Attaches coracoid process to its acromion Along with the acromion, this ligament forms the coracoacromial arch across the top of the shoulder Helps protect the rotator cuff tendons & subacromial bursa from direct trauma by the acromion

Subacromial Bursa

A.k.a., Subdeltoid bursa Lateral portion = creates smooth surface for the acromion & deltoid to glide over the head of the humerus & rotator cuff tendons Medial portion = cushions the coracoacromial ligament from the supraspinatus tendon Extend the shoulder = bursa moves forward Pain & tenderness with shoulder ABD = subacromial bursitis

Axillary Lymph Nodes

Located in axilla Dont tickle! Dont impinge!

Brachial Artery
Continuation of axillary artery Runs between the biceps & triceps brachii

When do we use this?

Questions?
That was a lot!