THE SHOULDER GIRDLE Maribel G. Castro-Enano, M.D. CPU College of Medicine
Introduction <ul><li>Man phylogenetically follows the development of the vertebrate species. </li></ul><ul><li>Pinching, h...
A. Skeletal System <ul><li>1. Clavicle </li></ul><ul><li>- a long bone,  clavius  (“little key”) </li></ul><ul><li>- strut...
<ul><li>2. Scapula </li></ul><ul><li>- a flat bone with 2 surfaces, a  coastal  (anterior) and a  dorsal  (posterior) </li...
<ul><li>2. Scapula cont…. </li></ul><ul><li>- free border or  crest of the spine  ends superior to the shoulder joint in a...
<ul><li>3. Humerus </li></ul><ul><li>- glenohumeral joint – where most of the movements of the shoulder will occur </li></...
<ul><li>3. Humerus cont….. </li></ul><ul><li>- between the greater and the lesser tubercles is the  bicipital groove  (int...
The Humerus
Bones of the Shoulder Girdle
B. Joints/Articulations <ul><li>1. Sternoclavicular Joint </li></ul><ul><li>- ligaments keep the joint stable </li></ul><u...
<ul><li>1. Sternoclavicular Joint cont…. </li></ul><ul><li>f. coracoacromial ligament – between the coracoid process and a...
<ul><li>3. Glenohumeral Joint </li></ul><ul><li>- stabilized by muscles and a  glenohumeral ligament </li></ul><ul><li>4. ...
C. Muscular System <ul><li>1. The Pectoralis Muscles  –  pectus  (chest) </li></ul><ul><li>a. pectoralis major  </li></ul>...
<ul><li>2. The  Superficial Extrinsic Back Muscles  </li></ul><ul><li>a. trapezius </li></ul><ul><li>- origin: skull and s...
<ul><li>b. pectoralis minor </li></ul><ul><li>- origin: ribs (3 rd , 4 th  5 th  ) </li></ul><ul><li>- insertion: coracoid...
<ul><li>2. The Back Muscles cont…. </li></ul><ul><li>b. latissimus dorsi  </li></ul><ul><li>- widest muscle of the back </...
<ul><li>3. The Deep Extrinsic Back Muscles </li></ul><ul><li>a. levator scapulae  </li></ul><ul><li>- origin: transverse p...
<ul><li>4. The Intrinsic Muscles  </li></ul><ul><li>a. deltoideus </li></ul><ul><li>- origin: lateral 3 rd  of the clavicl...
<ul><li>4. The Intrinsic Muscle cont….. </li></ul><ul><li>c. infraspinatus </li></ul><ul><li>- origin: infraspinatus fossa...
<ul><li>4. The Intrinsic Muscles cont….. </li></ul><ul><li>f. teres major </li></ul><ul><li>- origin: dorsum of the inferi...
<ul><li>Rotator Cuff Muscles </li></ul><ul><li>(supraspinatus, infraspinatus, teres minor, subscapularis) </li></ul><ul><l...
 
 
D. Bursae Associated with the Shoulder Joint <ul><li>Lined by synovial fluid </li></ul><ul><li>Lessens friction between a ...
<ul><li>1. Subscapularis Bursa </li></ul><ul><li>- lies between the subscapularis tendon and the neck of the scapula </li>...
<ul><li>2. Subacromial Bursa </li></ul><ul><li>- lies between the deltoid muscle, supraspinatus tendon, & the fibrous caps...
E. The Axilla <ul><li>- has 4 walls (anterior, posterior, medial, lateral) </li></ul><ul><li>-  Anterior wall:  pectoralis...
F. The Brachial Plexus <ul><li>- A plexus is a network of nerves </li></ul><ul><li>- Arise from the ventral rami of C5-8, ...
F. The Brachial Plexus
 
 
 
G. The Vascular System <ul><li>- great axillary vessels  (and nerves)  </li></ul><ul><ul><li>enveloped in the  axillary sh...
<ul><li>A. The Axillary Artery </li></ul><ul><li>- divided into 3 parts by the pectoralis minor </li></ul>
<ul><li>Branches per Region: </li></ul><ul><li>1. supreme thoracic artery </li></ul><ul><li>2. thoracoacromial a.  – large...
<ul><li>2. The Axillary Vein </li></ul><ul><li>- lies on the medial or concave side of its artery </li></ul><ul><li>- cont...
<ul><li>3. The Axillary Lymph Nodes </li></ul><ul><li>- “checkpoints” which prevent the spread of infection </li></ul><ul>...
The Axillary Lymph Nodes
Thank  You!
Upcoming SlideShare
Loading in …5
×

Shoulder girdle1

6,264 views
6,171 views

Published on

Published in: Health & Medicine
1 Comment
1 Like
Statistics
Notes
No Downloads
Views
Total views
6,264
On SlideShare
0
From Embeds
0
Number of Embeds
384
Actions
Shares
0
Downloads
491
Comments
1
Likes
1
Embeds 0
No embeds

No notes for slide

Shoulder girdle1

  1. 1. THE SHOULDER GIRDLE Maribel G. Castro-Enano, M.D. CPU College of Medicine
  2. 2. Introduction <ul><li>Man phylogenetically follows the development of the vertebrate species. </li></ul><ul><li>Pinching, holding and grasping are the 3 basic motor functions of the hand. </li></ul><ul><li>The hand has a rich sensory innervation and is thus the organ of feeling. </li></ul><ul><li>In relation to the telencephalon, the hand is also an organ of expression. Other animals cannot do this. </li></ul><ul><li>Greek/Latin terms: </li></ul><ul><li>arm – brachium </li></ul><ul><li>elbow – cubitus </li></ul><ul><li>forearm - antibrachium </li></ul><ul><li>wrist - carpus </li></ul><ul><li>hand - manus </li></ul>
  3. 3. A. Skeletal System <ul><li>1. Clavicle </li></ul><ul><li>- a long bone, clavius (“little key”) </li></ul><ul><li>- strut bone – gives a good range of motion to the shoulder </li></ul><ul><li>- first bone to ossify </li></ul><ul><li>- the only bony connection of the upper extremity to the axial skeleton </li></ul><ul><li>- attachment of muscles </li></ul><ul><li>- transmits force from upper extremity to the axial skeleton </li></ul><ul><li>- one of the most commonly fractured bones </li></ul>
  4. 4. <ul><li>2. Scapula </li></ul><ul><li>- a flat bone with 2 surfaces, a coastal (anterior) and a dorsal (posterior) </li></ul><ul><li>- triangular in shape with 3 borders (superior, lateral and vertebral) and 3 angles (superior, inferior and lateral) </li></ul><ul><li>- the lateral angle is the glenohumeral joint </li></ul><ul><li>- superior angle = T2, inferior angle = T7 </li></ul><ul><li>- in the superior border is the suprascapular notch through which some vessels pass through </li></ul><ul><li>- has 2 processes the coracoid and the spine (T3) </li></ul><ul><li>- the spine of the scapula divides it into a smaller supraspinatus & a larger infraspinatus fossa; the 2 fossae communicate with each other at the spinoglenoid notch </li></ul>
  5. 5. <ul><li>2. Scapula cont…. </li></ul><ul><li>- free border or crest of the spine ends superior to the shoulder joint in a free, flattened expanded piece of bone, the acromion </li></ul><ul><li>- the acromion articulates with the clavicle </li></ul><ul><li>- on the lateral angle is a round-shaped shallow facet, the glenoid </li></ul><ul><li>- the glenoid articulated with the head of the humerus , the glenohumeral joint </li></ul>
  6. 6. <ul><li>3. Humerus </li></ul><ul><li>- glenohumeral joint – where most of the movements of the shoulder will occur </li></ul><ul><li>a. head – covered with cartilage, directed superomedially </li></ul><ul><li>b. anatomical neck – fibrous capsule of the joint is attached </li></ul><ul><li>c. lesser tubercle – points anteriorly, insertion for the subscapularis </li></ul><ul><li>d. greater tubercle – bulges laterally beyond the acromion; gives the shoulder its roundness; insertion for the supraspinatus, infraspinatus & teres minor </li></ul><ul><li>e. surgical neck – between the head and the tubercles proximally and the body distally; completely encircled by the circumflex humeral vessels and partly by the axillary nerve </li></ul>
  7. 7. <ul><li>3. Humerus cont….. </li></ul><ul><li>- between the greater and the lesser tubercles is the bicipital groove (intertubercular groove) where the tendon of the biceps attach </li></ul><ul><li>- the deltoid tuberosity in the shaft is the attachment of the deltoid m. </li></ul><ul><li>- above the deltoid tuberosity is the spiral groove where the radial nerve will course through </li></ul><ul><li>- into the crest of the greater tubercle the pectoralis major is inserted </li></ul><ul><li>- into the crest of the lesser tubercle the teres major is inserted </li></ul>
  8. 8. The Humerus
  9. 9. Bones of the Shoulder Girdle
  10. 10. B. Joints/Articulations <ul><li>1. Sternoclavicular Joint </li></ul><ul><li>- ligaments keep the joint stable </li></ul><ul><li>a. thick articular disc of fibrocartilage between the joint prevents the clavicle from being displaced medially </li></ul><ul><li>b. anterior and posterior sternoclavicular ligaments </li></ul><ul><li>c. costoclavicular ligament – ligament from the first rib to the clavicle </li></ul><ul><li>d. interclavicular ligament – ligament between calvicles; homologous to the “wishbone” </li></ul><ul><li>e. coracoclavicular ligament – between the coracoid process and the clavicle; is in 2 parts: a conoid & a trapezoid </li></ul><ul><li>1.) prevents the scapula from being driven medially </li></ul><ul><li>2.) it is the mainstay of the acromioclavicular joint and, so long as it is intact, the joint may , indeed, undergo subluxation, but the acromion cannot be driven inferior to the clavicle </li></ul><ul><li>3.) suspends the scapula </li></ul><ul><li> </li></ul>
  11. 11. <ul><li>1. Sternoclavicular Joint cont…. </li></ul><ul><li>f. coracoacromial ligament – between the coracoid process and acromion </li></ul><ul><li>g. coracohumeral ligament – between the coracoid process and the humerus </li></ul><ul><li>2. Acromioclavicular Joint </li></ul><ul><li>- a synovial joint </li></ul><ul><li>- strong parallel fibers form a complete capsule and a small articular disc hangs into the cavity </li></ul><ul><li>1.) prevents the scapula to move vertically on the chest wall when the pectoral girdle rises and falls </li></ul><ul><li>2.) permits the scapula (with the glenoid cavity) to glide forward and backward on the clavicle and so to face directions convenient to eh head of the humerus </li></ul><ul><li>3.) its freedom is essential to free elevation of the limb </li></ul><ul><li>- vulnerable to injury in contact sports </li></ul>
  12. 12. <ul><li>3. Glenohumeral Joint </li></ul><ul><li>- stabilized by muscles and a glenohumeral ligament </li></ul><ul><li>4. Scapulothoracic Articulation </li></ul><ul><li>- actually not a joint </li></ul><ul><li>- scapula is not attached to the thoracic wall but can glide and move </li></ul>
  13. 13. C. Muscular System <ul><li>1. The Pectoralis Muscles – pectus (chest) </li></ul><ul><li>a. pectoralis major </li></ul><ul><li>- covers almost the entire chest </li></ul><ul><li>- origin : it has 2 heads: </li></ul><ul><li>1.) clavicular – from the clavicle </li></ul><ul><li>2.) sternocostal – from the sternum and ribs </li></ul><ul><li>insertion : inserted by means of a folded aponeurosis into the crest of the greater tubercle of the humerus (lateral lip of the bicipital groove) </li></ul><ul><li>- action : adducts the humerus and rotates it medially </li></ul>
  14. 14. <ul><li>2. The Superficial Extrinsic Back Muscles </li></ul><ul><li>a. trapezius </li></ul><ul><li>- origin: skull and spinous processes of the cervical vertebrae via the ligamentum nuchae and all 12 thoracic spines </li></ul><ul><li>- insertion: lateral 3 rd of the clavicle, acromion and crest of the spine of the scapula, and tubercle on the inferior lip of the crest of the spine </li></ul><ul><li>- action: suspensory muscles of the shoulder girdles; square the shoulders and elevate the shoulder girdle </li></ul>
  15. 15. <ul><li>b. pectoralis minor </li></ul><ul><li>- origin: ribs (3 rd , 4 th 5 th ) </li></ul><ul><li>- insertion: coracoid process </li></ul><ul><li>- action: stabilizes scapula in the thoracic cage </li></ul><ul><li>c. subclavius </li></ul><ul><li>- origin: rib 1 </li></ul><ul><li>- insertion: inferior surface of middle 3 rd of clavicle </li></ul><ul><li>- action: draws scapula medially </li></ul><ul><li>d. serratus anterior </li></ul><ul><li>- origin: outer surfaces of the the first 8 ribs </li></ul><ul><li>- insertion: medial border of scapula </li></ul><ul><li>- action: protract the scapula anteriorly </li></ul><ul><li>- “winged scapula” – results from paralysis of the serratus anterior </li></ul>
  16. 16. <ul><li>2. The Back Muscles cont…. </li></ul><ul><li>b. latissimus dorsi </li></ul><ul><li>- widest muscle of the back </li></ul><ul><li>- origin: by an aponeurosis (thoracolumbar fascia), from the inferior 6 thoracic, all lumbar and sacral spines, & the outer lip of the iliac crest, also arises from ribs 9-12 </li></ul><ul><li>- insertion: lesser tubercle of the humerus and medial lip of the intertubercular sulcus </li></ul><ul><li>- action: extends, medially rotates and adducts the humerus; brings the outstretched arm from above the head to behind the back </li></ul>
  17. 17. <ul><li>3. The Deep Extrinsic Back Muscles </li></ul><ul><li>a. levator scapulae </li></ul><ul><li>- origin: transverse processes of the cervical vertebrae 1-4 </li></ul><ul><li>- insertion: superior angle of scapula </li></ul><ul><li>- action: elevates the scapula </li></ul><ul><li>b. rhomboideus (minor and major) </li></ul><ul><li>- origin: ligamentum nuchae and the spines of cervical and 1 st 4 thoracic vertebrae </li></ul><ul><li>- insertion: medial border of scapula </li></ul><ul><li>- action: retracts/depresses the shoulder </li></ul>
  18. 18. <ul><li>4. The Intrinsic Muscles </li></ul><ul><li>a. deltoideus </li></ul><ul><li>- origin: lateral 3 rd of the clavicle, the lateral border of the acromion, and the whole length of the spine of the scapula </li></ul><ul><li>- insertion: deltoid tuberosity </li></ul><ul><li>- action: abducts, flexes and extends the shoulder </li></ul><ul><li>b. supraspinatus </li></ul><ul><li>- origin: supraspinatus fossa </li></ul><ul><li>- insertion: greater tubercle </li></ul><ul><li>- action: with the deltoid elevate the arm </li></ul>
  19. 19. <ul><li>4. The Intrinsic Muscle cont….. </li></ul><ul><li>c. infraspinatus </li></ul><ul><li>- origin: infraspinatus fossa </li></ul><ul><li>- insertion: greater tubercle </li></ul><ul><li>- action: depress the arm </li></ul><ul><li>d. teres minor </li></ul><ul><li>- origin: lateral border of the scapula </li></ul><ul><li>- insertion: greater tubercle </li></ul><ul><li>- action: lateral rotation of the humerus </li></ul><ul><li>e. subscapularis </li></ul><ul><li>- origin: subscapular fossa (anterior surface of scapula) </li></ul><ul><li>- insertion: lesser tubercle </li></ul><ul><li>- action: medial rotation & adduction of the humerus </li></ul>
  20. 20. <ul><li>4. The Intrinsic Muscles cont….. </li></ul><ul><li>f. teres major </li></ul><ul><li>- origin: dorsum of the inferior angle of the scapula </li></ul><ul><li>- insertion: crest of the lesser tubercle tubercle anteriorly </li></ul><ul><li>- action: adducts and medially rotates arm </li></ul>
  21. 21. <ul><li>Rotator Cuff Muscles </li></ul><ul><li>(supraspinatus, infraspinatus, teres minor, subscapularis) </li></ul><ul><li>they form a musculotendinous rotator cuff for the shoulder joint </li></ul><ul><li>a mass of tendons fused with the lateral part of the capsule of the shoulder joint </li></ul><ul><li>all except supraspintus are rotators of the humerus </li></ul><ul><li>Protects the shoulder joint and gives it stability by holding the head of the glenoid cavity of the scapula </li></ul>
  22. 24. D. Bursae Associated with the Shoulder Joint <ul><li>Lined by synovial fluid </li></ul><ul><li>Lessens friction between a muscle and a bone, or sometimes between the skin and a bony prominence </li></ul>
  23. 25. <ul><li>1. Subscapularis Bursa </li></ul><ul><li>- lies between the subscapularis tendon and the neck of the scapula </li></ul><ul><li>- protects the subscapularis tendon where it passes inferior to the root of the coracoid process and over the neck of the scapula </li></ul><ul><li>- usually communicates with the cavity of the shoulder joint through an opening in its fibrous capsule </li></ul>
  24. 26. <ul><li>2. Subacromial Bursa </li></ul><ul><li>- lies between the deltoid muscle, supraspinatus tendon, & the fibrous capsule of the shoulder joint </li></ul><ul><li>- does not normally communicate with the cavity of the shoulder </li></ul><ul><li>- facilitates movement of the deltoid muscle over the fibrous capsule of the shoulder joint and the supraspinatus tendon </li></ul>
  25. 27. E. The Axilla <ul><li>- has 4 walls (anterior, posterior, medial, lateral) </li></ul><ul><li>- Anterior wall: pectoralis major (pectoralis minor and subclavius) </li></ul><ul><li>- Posterior wall: subscapularis, teres major, and latissimus dorsi </li></ul><ul><li>- Lateral wall: the intertubercular sulcus </li></ul><ul><li>- Medial wall: intercostal muscles covered with serratus anterior </li></ul>
  26. 28. F. The Brachial Plexus <ul><li>- A plexus is a network of nerves </li></ul><ul><li>- Arise from the ventral rami of C5-8, T1 </li></ul><ul><li>a. sensory nerves go to the dorsal root and motor nerves go to the ventral root </li></ul><ul><li>b. the venral rami is a mixed nerve ( sensory and motor) </li></ul><ul><li>c. the dorsal rami provide for some of the deep muscles of the back </li></ul>
  27. 29. F. The Brachial Plexus
  28. 33. G. The Vascular System <ul><li>- great axillary vessels (and nerves) </li></ul><ul><ul><li>enveloped in the axillary sheath which is continuous with the prevertebral fascia of the neck </li></ul></ul><ul><ul><li>enter the axilla at its apex through the triangle formed by the clavicle, 1 st rib and superior border of the scapula </li></ul></ul><ul><li>- Great Arterial Trunk of the limb </li></ul><ul><li>- called the subclavian artery until it reaches the inferior border of the 1 st rib </li></ul><ul><li>*Sources of Blood Supply to the Scapular Area from the Subclavian A. </li></ul><ul><li>1. suprascapular artery </li></ul><ul><li>2. transverse cervical a. </li></ul><ul><li>- in the axilla, it is known as the axillary artery </li></ul><ul><li>- in the arm, it becomes the brachial artery </li></ul>
  29. 34. <ul><li>A. The Axillary Artery </li></ul><ul><li>- divided into 3 parts by the pectoralis minor </li></ul>
  30. 35. <ul><li>Branches per Region: </li></ul><ul><li>1. supreme thoracic artery </li></ul><ul><li>2. thoracoacromial a. – large branch which sends 1 branch each to the thorax, deltoid and acromion </li></ul><ul><li> lateral thoracic a. – accompanies the long thoracic n. </li></ul><ul><li>3. anterior humeral circumflex a. </li></ul><ul><li> posterior humeral circumflex a. – goes around the surgical neck of the humerus; accompanies the axillary n. </li></ul><ul><li> subscapular a. – follows the inferior border of the pectoralis minor; source of collateral circulation in case the axillary artery becomes occluded </li></ul><ul><li> - sends a large branch to the dorsum of the scapula, the circumflex scapular artery </li></ul>
  31. 36. <ul><li>2. The Axillary Vein </li></ul><ul><li>- lies on the medial or concave side of its artery </li></ul><ul><li>- continuation of the basilic vein </li></ul><ul><li>- at the 1 st rib becomes the subclavian vein </li></ul><ul><li>- receives tributaries corresponding to the 6 branches of the axillary artery </li></ul><ul><li>- receives the 2 venae comitantes of the brachial artery and the cepahalic vein </li></ul>
  32. 37. <ul><li>3. The Axillary Lymph Nodes </li></ul><ul><li>- “checkpoints” which prevent the spread of infection </li></ul><ul><li>- arranged in several main groups </li></ul><ul><li>a. lateral nodes – receive lymph vessels that ascend along the medial side of the arm and they empty into the </li></ul><ul><li>b. apical (infraclavicular) nodes – all the vessels of the limb drain either directly or indirectly into this group, and it in turn drains into the subclavian lymph trunk , which ends in the right lymph duct or (on the left) the thoracic duct </li></ul><ul><li>c. pectoral (anterior) nodes - lie along the inf. border of the pectoralis minor with the lateral thoracic vein </li></ul><ul><li>d. subscapular (posterior) nodes – lie along the subscapular veins </li></ul><ul><li>e. central nodes – lie between the layers of the fascia at the base of the axilly or in the fat deep to it </li></ul><ul><li>f. deltopectoral nodes – occasional; small nodes along the cephalic vein </li></ul>
  33. 38. The Axillary Lymph Nodes
  34. 39. Thank You!

×