NEw NEw

Glenohumoral joint- ball and socket, multiaxial, synovial, very unstable
Found Between the head of the humerus and glenoid fossa of scapula.

-coracoclavicular ligament that has two parts:Trapezoid and Conoid
o Acromioclavicular ligament
o Coracoacromial ligament
o Superior transverse scapular ligament

Disocation: anterior (more common) due to blow from back. Posterior is due to blow from front

• Sternoclavicular joint- between sternum and clavicle.

Sternoclavicular joint has the ligament strengthens the joint capsule anteriorly and posteriorly

Stenoclavicular very strong. Rarely injured. If injury occurs there, usually results in clavicular fracture (fall on outstretched arm)

Acromioclavicular joint- between acromion of scapula and clavicle
Dislocation is common- SHOULDER SEPARATION- from hard fall on shoulder (contact sports)

Elbow joint- ulna goes into the trochlear notch of the humerus. Radius fits next to the capitulum of the humerus and is connected to the ulna via the annular ligament

Supraspinatous will be most commonly torn rotator cuff muscle

Resting tone of these muscles act to pull the humeral head into the glenoid fossa

Anterior: pectoralis major and minor
Posterior: subscapularis, teres major, and latissumus dorsi
Medial: serratus anterior, thoracic wall (ribs)
Lateral: intertubercular sulcus of humerus
Apex: lateral border of rib 1, superior border of scapula, and posterior border of clavicle
Floor: axillary fascia and skin
Contents: axillary vessels, cords and nerves of the brachial plexus, lymph nodes (pathway to breast and upper limb)

Proximal:
1)Superior thoracic artery
Deep:
1)Thoracoacromial artery
2)Lateral thoracic artery
Distal:
1)Subscapular artery
2)Anterior circumflex humeral artery
3)Posterior circumflex humeral artery

Pectoralis MINOR

Scaphoid is most often fractured and lunate is most commonly dislocated

•Colle: fracture of the lower end of the radius with posterior displacement of the distal fragment and radial deviation of the hand at the wrist. Called dinner fork deformity

Smiths: same as colle except volar (anterior) deviation

Bartons: dislocation of distal radiocarpal joint

Scaphoid fraction: from fall of aBDucted outstretched hand complications- a vascular necrosis

Lunate fraction: from fall on aDDucted hand. Lunate dislocates anteriorly
-complications- carpal tunnel syndrome, a vascular necrosis

•Boxers: fracture neck of fifth metacarpal

Bennet: fracture of base of first metacarpal

Upper Brachial Plexus Injury: C5-6. (includes both anterior and posterior upper trunk)

Upper Brachial Plexsus Injury: Erb Duchene Paralysis- causes “waiters tip”
Cause: violent separation of the neck and shoulder OR over-stretch of infants neck during delivery
Example of how this can happen: contact sports (football)

1. Loss of abduction, 2. external rotation at the shoulder, and 3. flexion of the elbow, 4. and
extension of the wrist occur

(axillary n. [C5,6], suprascapular n. [C4,5,6]; radial
n. [C5,6,7,8])

supraspinatus, infraspinatus, biceps, coracobrachialis, deltoid , teres minor

Middle Brachial Plexus Injury. C7 mostly.RARE
Cause: interscalene anesthetic of the brachial plexus

1. ADDuction, 2. ABduction, 3. extension, and 4. lateral rotation are impaired.

Lower Brachial Plexus Injury. C8-T1 .(effects lower trunk)

Djerine-Klumpke Paralysis- Lower brachial plexsus injury
Cause: shoulder dislocations, pulling baby out by arms during delivery, scalene syndrome, and apical tumor of the lung
Injury is similar to ulnar nerve injury (ex: loss of flexion in the wrist, paralysis of these muscles (claw hand type). Inability to ADDuct due to involvement of the medial pectoral nerve.

Radial nerve (C5-8), aka “Saturday night palsy” or “crunch palsy’.
Causes Wrist Drop.
The injury occurs in the axilla region
Dislocation at the shoulder joint OR fracture to the proximal part of the humerus= MIDSHAFT.

1. unable to extend at the forearm, wrist and finger
2. unopposed flexion of wrist occurs, known as wrist-drop.

1. All four cutaneous branches of the radial nerve are affected
2. sensory loss over the lateral and posterior arm, posterior
forearm, and dorsal surface of the lateral three and a half digits

Axillary nerve Injury (C5,6)-
Cause: fracture to the surgical neck of the humerus
Result: affects deltoid and teres minor (cant do ABduction/ lateral rotation)
Recall: axillary n is content of quadrangular space so compression to the area affects it

Lateral cord injury: musculocutaneous nerve (C5,6,7)
Effect::cant flex forearm or shoulder, and sensory loss to the lateral forearm

Median Nerve Injury: C6-T1. Hand of Benediction (inability to flex digits 1-3)
Causes:
1.Damage to axilla
2.Laceration at the wrist
3.The section above the elbow
4. Supracondylar fracture of humerous
Also carpal tunnel is injury to median n.

Radial nerve

Median nerve

Ulnar nerve

Axillary nerve

Ulnar Nerve Injury:
1.Occurs bc of trauma to the medial epicondyle. Causes Claw-hand . (inability to extend fingers 4,5 at intephalangeal joints )
2.Section at the wrist - hypothenar muscles are paralyzed

If radial groove is fractured- radial n. affected
If anterior to medial epicondyle is fractured- ulnar n is affected

Medial: EPL
Lateral: APL and EPB
Proximal: styloid process of radius
Floor: scaphoid and trapezium
Roof: skin

Contents: radial artery, radial nerve, cephalic veins

• Claw hand: ulnar nerve
• Wrist drop: radial nerve
• Hand of benediction: median nerve

Lateral epicondylitis: Tennis elbow = pain and tenderness over the lateral epicondyle and the origin of the posterior muscles of the forearm via the common tendon (common extensor tendon).

Medial epicondylitis: Golfer’s elbow= painful, from repetitive use of the superficial muscles of the anterior forearm. Pain is experienced on the medial epicondyle. Repetitive motion strains the common flexor tendon

Roof: superficial fascia, bicipital aponuerosis, cubcutaneous tissue
Lateral: brachioradialis
Medially: pronator teres
Upper limit: imaginary horizontal line between medial and lateral epicondyle of humerus
Floor or Base: brachialis and supinator
Apex: neck of radius

• radial nerve (can be damaged during fracture of later epicondyle of humerus)
o The deep branch pierces supinator muscle to get to posterior forearm
• Biceps tendon
• Brachial artery
• Median nerve


the ulnar nerve is NOT a content of the fossa, but its found posterior to the medial epicondyle of the humerus

Radial artery nerve and brachial artery

axillary nerve, posterior circumflex humeral artery

circumflex scapular artery and vein

• Anterior: flexor retinaculum
• Posterior: carpal bones
Contents: median nerve (lateral), tendons of FDS, FDP, FPL

Tinel sign: when you tap the flexor retinaculum to check for tingling sensation

Phalens sign: Hands back to back

Injury to long thoracic nerve causes problem with serratus anterior muscle —> Winged scapula

C5-C6

C7-8

Anterior upper arm: flexors, innervated by musculocutaneous (C5-7)

•biceps brachii
• Brachialis
-inserts into choronoid process of the ulna
•Corachobrachialis (doesnt flex the elbow. It aDDucts the shoulder)

Posterior upper arm: extensors, innervated by radial nerve:

•triceps brachii

Anterior forarm: flexion of the wrist and digits, innervated by the median nerve except for 2 muscle (flexor carpi ulnaris and flexor digitorum profundus, which are innervated by ulnar nerve).

Deep muscles of anterior forarm: supplied by anterior interosseous nerve (branch of median nerve)

Posterior forearm: extension of the wrist and digits, innervated by radial nerve and its branch the posterior interosseous nerve

• superficial:
o Anconeus
o Brachioradialis (does flexion of the elbow and supination)
o Extensor carpi radialis longus
o Extensor carpi radialis brevis
o Extensor digitorum
o Extensor digiti minimi
o Extensor carpi ulnaris
• Deep:
o Abductor policis longus
o Extensor policis longus
o Extensor policis brevis
o Supinator
o Extensor indices

Thenar muscles: all innervated by median nerve except for 2 (part of flexor policis brevis and adductor policis- which are supplied by the ulnar nerve)

o Abductor policis brevis
o Flexor policis brevis
o Opponens policis
o Adductor policis

• Hypothenar: innervated by ulnar nerve

o Abductor digiti minimi
o Flexor digiti mini brevis
o Opponens digiti minimi

• Lumbricles: 4 lumbricals. 1-2 innervated by median nerve, 3-4 is innervation by ulnar nerve

• Interosseous muscles: (4 dorsal-abduct, 3 palmar-adduct)
o All supplied by the ulnar nerve

1. half of lumbricles
2. abductor pollicus brevis
3. opponens pollicus
4. Lumbricles 1 and 2