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Shoulder - Coggle Diagram
Shoulder
Clinical Correlations
Clavicular Fractures: frequent, weakest part - junction of mid and lat 3rd. SCM elevates med fragment. Treatment - non-surgical immobilization, surgical fixation.
Humeral Fractures: elderly. Impaction: 1 frag driven into spongy bode or other. AVULSION - piece of bone pulled away. SHAFT: greenstick - children. NERVE COMPLICATION: surgical neck - ax nerve. Radial groove - radial nerve. Distal humerus - medial nerve. Medial Epicondyle - Ulnar nerve
AC joint dislocation: shoulder separation. Contact sport. AC & Coracoclavicular ligaments torn: shoulder separates from clavicle, AC capsule tears, Acromion passes inf to clavicle, Clavicle sticks up
GHJ Dislocation: mobile. Sup dislocation prevented by coracoacromial arch + sup structures. Most dislocation occur inf - anterior or posterior. Ant. dislocation: young, excessive extension and ER - overhead throwing. Inferior disclocation - greater tubercle avulsion - axillary nerve compression
Labral tears - causes: subluxations/ dislocations. Repetitive pulling of biceps tendon. Symptoms: pain during throwing, popping/snapping during abduction + ER
Adhesive Capsulitis - Frozen shoulder: fibrosis + scarring btw Capsue, RTC, subacromial bursa, deltoid. 40-60 yo, can't abduct. Shoulder hiking. Predispose - dislocation, calcified tendinitis, RTC tears, bicipital tendinitis.
Bones
Clavicle - collar bone.
Suspends scapula + arms from axial skeleton
allows scapula to move on thorax = Inc ROM. When elevated - allows rib elev during inspiration. Transmits shock to axial skeleton. Subclavian groove for subclavius muscle
No medullary cavity - instead spongy bone. 2 curves, medial - convex ant and
lateral - concave ant.
Flat AC joint
Humerus
Neck: anatomical/ surgical
Tubercles: greater, lesser, intertubercular groove (Bicipital groove)
Head
Shaft: Deltoid tuberosity, Radial Groove - supracondylar ridges, epicondyles, Capitulum and Radial Fossa Trochlea - coronoid fossa, olecranon fossa
Upper Ext - mobile, requires sync mvm for hand to function
4 parts: Shoulder, Arm, Forearm (Antebrachium), Hand - carpus, metacarpus, phalanges
SCAPULA
SPINE: - supraspinous fossa/ infraspinous fossa
BORDERS: Medial (vertebral) - 5cm lat to thx spine/ Lateral (Axillary)/ Superior - suprascapular notch
Angles: Sup, Inf, Lat - glenoid
BODY: - POsterior = cOnvex / Anterior = concAve
Acromion / Coracoid Process
Joints
SCJ - STERNOCLAVICULAR JOINT
Saddle shape, Synovial joint w capsule. Articular disc: absorbs shock trans through clavicle from arm attached to capsule.
Ligaments: Ant/ Post SC ligaments, intervlavicular, costoclavicular
ACJ - ACROMIOCLAVICULAR JOINT
Plane type joint - synovial joint: capsule, synovial membrane and fluid. Art Dis.
Ligaments: Acromioclavicular - strengthens joint superiorly. Coracoclavicular: suspends scap and UE from clavicle
SCAPULOTHORACIC JOINT
GHJ - GLENOHUMERAL JOINT
Ball + socket: 1/2 humeral head fits into glenoid. Lots of mob, not much stability. Stabilized by: muscles, lig, capsules - glenoid labrum - fribrocartilage
Capsule: GH joint ligaments embedded. Synovial membrane - sheath for biceps LH tendon
Ligaments: coracohumeral, transverse humeral, coracoacromial
Sup: resists sup dislocation. Mid: resist ant. dislocation. Inf: resist inf dislocation - anterior/posterior
Bursae: Subacromial, subdeltoid, subscapularis
Nerves
MOTOR INNERVATION
Somatic fibers travel in mix peripheral nerves
Myotome - unilat embryological muscle mass innerv. by single spinal cord segment or nerve
multiple cord seg or nerves serving muscles
CUTANEOUS NERVES - Sensory nerves
Pattern derived from position of arms developmentally w thumb positioned cranially
Lat arm innvervated by cranial seg
Med - arm innervated by caudal seg. Dermatome maps overlaps & vary
BRACHIAL PLEXUS
TRUNKS
SUPERIOR: Suprascapular, subclavian nerve
MIDDLE & INFERIOR
DIVISIONS
ANTERIOR: SUPPLY FLEXORS
POSTERIOR: SUPPLY EXTENSORS
Roots
Dorsal Scapular, Phrenic, Long Thoracic, 1st Intercostal
CORDS - named for relationship to Axillary artery
LATERAL: Lateral Pectoral Nerve
POSTERIOR: Thoracodorsal nerve, UPPER & LOWER Subscapular nerves
MEDIAL: Medial Pectoral Nerve, Med Bracial Cutaneous nerve, Med Antebracial Cut Nerve
BRANCHES
MUSCULOCUTANEOUS (C5-7)
PATH
Pierces Coracobrachialis
Descends b/w Biceps & Triceps
Becomes Lateral Cutaneous Nerve of the Forearm (Lat. Antebrachial Cutaneous Nerve)
SUPPLY
Sensation: lateral foramen
Motor: CORACHOBRACHIALIS, BICEPS BRACHII, BRACHIALIS
AXILLARY (C5-6)
SUPPLY
Sentation: superolateral shoulder
Motor: Deltoid, Teres Minor
PATH
Post. through Quadrangular Space. Gives off sup lat BRACHIAL CUTANEOUS NERVE
Around surgical neck of humerus deep to deltoid
RADIAL (C5-T1)
SUPPLY
Upper arm - Sentation - posterolateral arm
Motor: triceps, anconeus
Forearm - Sensation: post forearm & hand to prox 1/2 of digits
Motor: Post compartment muscles from Brachioradialis to Extensor Indicis
PATH
Exits axillary fossa post.
Descends humerus in Radial Groove btw med & lat heads of triceps
Gives off Post Antebrachial Cutaneous Nerve
Pierces lat intermuscular septum to enter cubital fossa
Divides into Sup & Deep Radial nerves - continue down to hand
MEDIAN (C6-T1)
PATH
Descends in arm next to Brachial Artery
Crosses medial to artery at cubital fossa
down to forearm through carpal tunnel
Gives off Recurrent Median Nerve to Thenar Muscles
SUPPLY
Sentation: lat palmar & distal dorsal hand & fingers to lat 1/2 of 4th digit
Motor: Ant compartment forearm muscles (no FCU & ulnar 1/2 of FDP) & 5 thenar muscles
ULNAR (C8-T1, sometimes C7)
PATH
Descends medial arm
Post to medial epicondyle
Descends to med forearm to hand
SUPPLY
Sensation: medial palmar & dorsal hand to med 1/2 of 4th digit
Motor: FCU, ulnar 1/2 of FDP, & most hand intrinsics
PERIPHERAL NERVES
Axilla
Superior: Cervico-axillary canal
Inferior: to arm or along thoracic wall
Anterior: Clavipectoral Triangle
Posterior: Quadrangular Space
Fascia
Shoulder Muscles
Arm Muscles
Lymphatics
Veins
Arteries
