Shoulder
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1
What is the primary function of the shoulder girdle?
Placement of the hand to manipulate our environment
2
Which anatomical joints and functional articulation make up the shoulder complex?
Sternoclavicular joint, acromioclavicular joint, glenohumeral joint, and scapulothoracic articulation
3
What type of joint classification is the sternoclavicular (SC) joint?
Sellar (saddle-shaped) synovial joint
4
How many degrees of freedom does the SC joint have?
\$3^\circ\$ of freedom
5
What are the shapes of the SC joint articular surfaces superior-to-inferior?
Clavicle is convex; manubrium is concave
6
What are the shapes of the SC joint articular surfaces anterior-to-posterior?
Clavicle is concave; manubrium is convex
7
Which ligament of the SC joint limits protraction, retraction, and elevation?
Costoclavicular ligament
8
Which ligament limits anterior-posterior movement of the clavicular head at the SC joint?
Sternoclavicular ligaments
9
Which ligament limits inferior movement of the clavicular head at the SC joint?
Interclavicular ligament
10
What are the primary functions of the SC joint articular disc?
Improves congruity and stability, prevents medial dislocation, and acts as a hinge
11
What is the normal range of motion for SC joint elevation and depression?
\$45^\circ\$ elevation and \$15^\circ\$ depression
12
Where is the axis of rotation located for SC joint elevation and depression?
Sagittal axis at the costoclavicular ligament
13
In which direction does the clavicle slide during SC joint elevation?
Inferiorly
14
In which direction does the clavicle slide during SC joint depression?
Superiorly
15
What is the normal range of motion for SC joint protraction and retraction?
\$15^\circ\$ in each direction
16
In which direction does the clavicle slide during SC joint protraction?
Anteriorly
17
In which direction does the clavicle slide during SC joint retraction?
Posteriorly
18
How many degrees of posterior rotation occur at the SC joint during arm elevation?
\$30^\circ\text{–}50^\circ\$
19
At what degree of arm elevation does posterior rotation of the clavicle begin?
\$90^\circ\$ of arm elevation
20
To what degree is arm elevation limited without the SC joint rotary component?
\$120^\circ\$
21
What type of joint is the acromioclavicular (AC) joint?
Plane synovial joint
22
What are the shapes of the articulating surfaces of the AC joint?
Acromion is concave; distal clavicle is convex
23
What are the three osteokinematic degrees of freedom at the AC joint?
Upward/downward scapular rotation, anterior/posterior tipping, and medial/lateral rotation
24
What is the accessory motion rule for the AC joint during scapular movement?
The acromion slides in the same direction as scapular movement
25
Which two ligaments make up the coracoclavicular ligament?
Trapezoid ligament and conoid ligament
26
What is the normal distance of the medial border of the scapula from the spinous processes in neutral?
\$5\text{–}6\text{ cm}\$
27
Between which vertebral levels does the resting scapula normally lie?
Between T2 and T7
28
How many degrees is the scapula anteriorly tipped in the sagittal plane in neutral position?
\$10^\circ\text{–}20^\circ\$
29
What is the angle of the resting scapula from the frontal plane (scapular plane)?
\$30^\circ\$
30
How many total muscles attach to the scapula?
17 muscles
31
Which 6 muscles are classified as intrinsic (scapulohumeral) shoulder muscles?
Supraspinatus, infraspinatus, teres major, teres minor, subscapularis, and deltoid
32
Which 7 muscles are classified as extrinsic (axio-appendicular) shoulder muscles?
Trapezius, latissimus dorsi, levator scapulae, rhomboid major, rhomboid minor, serratus anterior, and pectoralis minor
33
Which 4 muscles attach to the scapula but are neither intrinsic nor extrinsic shoulder muscles?
Biceps brachii, triceps brachii (long head), coracobrachialis, and omohyoid
34
What are the 4 primary passive restraints of the glenohumeral (GH) joint?
Bony geometry, glenoid labrum, negative intra-articular pressure, and capsuloligamentous structures
35
What clinical sign indicates superior GHL pathology and loss of negative intra-articular pressure?
The sulcus sign
36
What is the normal superior tilt of the glenoid fossa?
\$5^\circ\$ superior tilt
37
What is the normal retroversion of the glenoid fossa relative to the plane of the scapula?
\$7^\circ\$ retroversion
38
What mechanical analogy describes the stabilizing function of the glenoid labrum?
"Chock Block"
39
What structural function does the glenoid labrum serve to preserve negative joint pressure?
A gasket effect that acts as a seal
40
Which tendons reinforce the glenoid labrum?
Long head of biceps brachii and long head of triceps brachii
41
Which part of the glenohumeral joint capsule is the weakest?
The inferior portion
42
What movement occurs at the humeral head when a normal anterior capsule becomes taut in abduction and ER?
Posterior translation of the humeral head
43
What are the 3 parts of the inferior glenohumeral ligament (IGHL)?
Anterior band (AB), posterior band (PB), and axillary pouch (AP)
44
Where do the glenohumeral ligaments originate and insert?
Originate from the glenoid labrum at the supraglenoid tubercle and insert into the anatomical neck of the humerus
45
What is the primary stabilizer of the GH joint when the arm is at the side?
Superior glenohumeral ligament (SGHL)
46
What motions are restrained by the middle glenohumeral ligament (MGHL)?
ER in \$45^\circ\text{–}75^\circ\$ abduction, anterior translation in \$60^\circ\text{–}90^\circ\$ abduction, and inferior translation at \$0^\circ\$ abduction
47
At what joint position does the anterior band of the IGHL act as the primary restraint?
\$90^\circ\$ abduction
48
At what joint position does the posterior band of the IGHL act as the primary restraint?
\$90^\circ\$ abduction while in external rotation
49
What is the function of the transverse humeral ligament?
Bridges the intertubercular groove to hold the tendon and sheath of the long head of the biceps brachii in place
50
Where does the coracohumeral ligament originate and insert?
Base of coracoid process to anterior aspect of greater tubercle of humerus
51
What three structures form the coraco-acromial arch?
Acromion, coracoid process, and coraco-acromial ligament
52
What displacement of the humeral head does the coraco-acromial arch prevent?
Superior displacement
53
What are the 4 anterior axio-appendicular muscles?
Pectoralis major, pectoralis minor, subclavius, and serratus anterior
54
What are the proximal attachments of the two heads of pectoralis major?
Clavicular head: anterior medial half of clavicle; Sternocostal head: anterior sternum, superior 6 costal cartilages, and external oblique aponeurosis
55
Where does the pectoralis major insert?
Lateral lip of the intertubercular sulcus of the humerus
56
What is the innervation of the pectoralis major?
Lateral pectoral nerve (\$C_5\text{–}C_7\$) and medial pectoral nerve (\$C_8, T_1\$)
57
What are the primary actions of the pectoralis major?
Adducts and medially rotates the humerus, and draws the scapula anteriorly and inferiorly
58
What independent action is performed by the clavicular head of the pectoralis major?
Flexes the humerus
59
What independent action is performed by the sternocostal head of the pectoralis major?
Extends the humerus from a flexed position
60
What is the arterial blood supply to the pectoralis major?
Pectoral branches of thoracoacromial artery and perforating branches of internal thoracic artery
61
What are the proximal and distal attachments of the pectoralis minor?
Proximal: 3rd–5th ribs near costal cartilages; Distal: medial border and superior surface of coracoid process
62
What nerve innervates the pectoralis minor?
Medial pectoral nerve (\$C_8, T_1\$)
63
What is the primary action of the pectoralis minor?
Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall
64
What is the arterial blood supply to the pectoralis minor?
Thoracoacromial artery, superior thoracic artery, and lateral thoracic artery
65
What are the proximal and distal attachments of the subclavius?
Proximal: junction of 1st rib and its costal cartilage; Distal: inferior surface of middle third of clavicle
66
What is the innervation and action of the subclavius?
Innervated by nerve to subclavius (\$C_5, C_6\$); anchors and depresses the clavicle
67
What are the proximal and distal attachments of the serratus anterior?
Proximal: external surfaces of lateral parts of ribs 1–8; Distal: anterior surface of medial border of scapula
68
What nerve innervates the serratus anterior?
Long thoracic nerve (\$C_5, C_6, C_7\$)
69
What are the primary actions of the serratus anterior?
Protracts the scapula, holds it against the thoracic wall, and upwardly rotates the scapula
70
What is the arterial blood supply to the serratus anterior?
Thoracodorsal artery, superior thoracic artery, and lateral thoracic artery
71
What is the normal linear displacement of scapular elevation and depression?
\$10\text{–}12\text{ cm}\$
72
What is the normal range of movement for scapular protraction and retraction?
\$40^\circ\text{–}45^\circ\$; \$15\text{ cm}\$
73
What is the normal angular rotation of scapular upward and downward rotation?
\$60^\circ\$
74
How much linear displacement occurs at the inferior and superior angles during scapular rotation?
Inferior angle: \$10\text{–}12\text{ cm}\$; superior angle: \$5\text{–}6\text{ cm}\$
75
What muscles produce scapular elevation?
Trapezius (descending part), levator scapulae, and rhomboids
76
What muscles produce scapular depression?
Pectoralis major (inferior head), latissimus dorsi, trapezius (ascending part), serratus anterior (inferior part), and pectoralis minor
77
What muscles produce scapular protraction?
Serratus anterior, pectoralis major, and pectoralis minor
78
What muscles produce scapular retraction?
Trapezius (middle part), rhomboids, and latissimus dorsi
79
What muscles produce scapular upward rotation?
Trapezius (descending part), trapezius (ascending part), and serratus anterior (inferior part)
80
What muscles produce scapular downward rotation?
Levator scapulae, rhomboids, latissimus dorsi, pectoralis minor, and pectoralis major (inferior head)
81
What are the proximal attachments of the deltoid muscle?
Lateral third of clavicle, acromion, and spine of scapula
82
Where does the deltoid insert?
Deltoid tuberosity of the humerus
83
What nerve innervates the deltoid?
Axillary nerve (\$C_5, C_6\$)
84
What are the actions of the three parts of the deltoid?
Anterior: flexes and medially rotates; Middle: abducts; Posterior: extends and laterally rotates
85
What are the four rotator cuff muscles (S.I.T.S.)?
Supraspinatus, infraspinatus, teres minor, and subscapularis
86
What are the proximal and distal attachments of the supraspinatus?
Proximal: supraspinous fossa of scapula; Distal: superior facet of greater tubercle of humerus
87
What nerve innervates the supraspinatus?
Suprascapular nerve (\$C_4, C_5, C_6\$)
88
What is the primary action of the supraspinatus?
Initiates and assists deltoid in arm abduction and stabilizes the GH joint
89
What are the proximal and distal attachments of the infraspinatus?
Proximal: infraspinous fossa of scapula; Distal: middle facet of greater tubercle of humerus
90
What nerve innervates the infraspinatus?
Suprascapular nerve (\$C_5, C_6\$)
91
What is the primary action of the infraspinatus?
Laterally rotates the arm and provides GH stability
92
What are the proximal and distal attachments of the teres minor?
Proximal: middle part of lateral border of scapula; Distal: inferior facet of greater tubercle of humerus
93
What nerve innervates the teres minor?
Axillary nerve (\$C_5, C_6\$)
94
What is the primary action of the teres minor?
Laterally rotates the arm and provides GH stability
95
What are the proximal and distal attachments of the subscapularis?
Proximal: subscapular fossa; Distal: lesser tubercle of humerus
96
What nerves innervate the subscapularis?
Upper and lower subscapular nerves (\$C_5, C_6, C_7\$)
97
What is the primary action of the subscapularis?
Medially (internally) rotates the arm and provides GH stability
98
What are the proximal and distal attachments of the teres major?
Proximal: posterior surface of inferior angle and lower third of lateral border of scapula; Distal: medial lip of intertubercular sulcus
99
What nerve innervates the teres major?
Lower subscapular nerve (\$C_5, C_6\$)
100
What are the primary actions of the teres major?
Adducts and medially rotates the arm
101
Which arteries provide the primary blood supply to the glenohumeral joint?
Anterior and posterior circumflex humeral arteries
102
Which nerves provide sensory innervation to the glenohumeral joint?
Suprascapular nerve, axillary nerve, and lateral pectoral nerve
103
What are the anatomic borders of the quadrangular space?
Medial: long head of triceps; Lateral: humeral shaft; Superior: teres minor; Inferior: teres major
104
What structures are contained within the quadrangular space?
Axillary nerve and posterior circumflex humeral artery
105
What are the anatomic borders of the triangular space?
Superomedial: teres minor; Inferomedial: teres major; Lateral: long head of triceps
106
What structure is contained within the triangular space?
Scapular circumflex artery
107
What are the anatomic borders of the triangular interval?
Medial: long head of triceps; Lateral: lateral head of triceps; Superior: teres major
108
What structures are contained within the triangular interval?
Radial nerve and deep brachial (profunda brachii) artery
109
What ligament bridges the scapular notch through which the suprascapular nerve passes?
Superior transverse scapular ligament
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