This document describes the anatomy of several muscles around the shoulder joint, including their origins, insertions, nerve supplies, and actions. It also discusses the rotator cuff muscles, quadrangular space, triangular spaces, axillary nerve, suprascapular nerve, and arterial blood supply around the shoulder joint. Key structures mentioned include the deltoid, trapezius, latissimus dorsi, levator scapulae, rhomboid muscles, and rotator cuff muscles.
Slideshow: Clavicle
The Funky Professor videos can be viewed here;
http://publishing.rcseng.ac.uk/journal/video?doi=10.1308%2Fvideo.2016.1.10&videoTaxonomy=FUNK
Atlanto occipital and atlanto axial jointShubham Singh
Anatomy:
>Atlas is the topmost vertebra and chief peculiarity of atlas is that it has no body, it is ring like and consist of anterior and posterior arch and two lateral masses.
>Axis, the 2nd cervical vertebra has a concave under side and convex from side to side. The most distinctive characteristic of this bone is strong odontoid process, the dens.
TheJoint:
>Atlanto-occipital joint (articulation between the atlas and the occipital bone) consists of a pair of condyloid joints.
>The atlanto-occipital joints are synovial socket-type joints
Ligaments:
> Posterior atlanto-occipital membrane: extend from anterior arch of atlas to posterior margin of foramen magnum.
>Anterior atlanto-occipital membrane: extend from anterior arch of atlas to anterior margin of foramen magnum.
>The ligamentam flavam join laminae of adjacent vertebral arches.
>The interspinous ligaments expand to form the ligamentum nuchae which inserts along the posterior foramen magnum and external occipital condyle.
> The following four ligaments stabilize these joints:
1.Apical ligament: Connects the dens to the foramen magnum of the occipital bone.
2.Alar ligaments: Connect the dens to the lateral margins of the foramen magnum.
3.Cruciate ligament: Attaches the dens to the anterior arch of the atlas and the body of the axis to the foramen magnum of the occipital bone.
4.Tectorial membrane: Starts at the skull and becomes the posterior longitudinal ligament.
>Atlanto-axial articular capsules are thick and loose, and connect the margins of the lateral masses of the atlas with those of the posterior articular surfaces of the axis.
Muscles:
>Flexion is produced mainly by the action of longis capitis, rectus capitis anterior and sternocleidomastoid (anterior fibres)
>Extension by the rectus capitis posterior major and minor, the obliquus capitis superior, the semispinalis capitis, splenius capitis, longissimus capitis, sternocleidomastoid and upper fibres of the trapezius
>The recti lateralis are concerned in the lateral movement, assisted by the trapezius, splenius capitis, semispinalis capitis, and the sternocleidomastoid of the same side, all acting together.
Movements:
>Flexion and extension in the Sagittal axis, which give rise to the ordinary forward and backward nodding of the head.
>Lateral flexion to one or other side in the Frontal axis(titling of head
>Lateral AAJ Movement: It is a synovial joint which allows only gliding
>Medial AAJ Movement: This joint allows the rotation of the atlas the axis i.e round the dens.
Clinical anatomy:
> Headaches can arise from many different sources including dysfunctional muscles, tears in the ligaments, misalignment of the vertebral bodies, injury to cervical facets and degenerative discs.
>Excessive flexion could rupture the supraspinous ligament.
>Posterior atlanto-occipital membrane ossification cause migraine headaches due to compression of artery.
Slideshow: Clavicle
The Funky Professor videos can be viewed here;
http://publishing.rcseng.ac.uk/journal/video?doi=10.1308%2Fvideo.2016.1.10&videoTaxonomy=FUNK
Atlanto occipital and atlanto axial jointShubham Singh
Anatomy:
>Atlas is the topmost vertebra and chief peculiarity of atlas is that it has no body, it is ring like and consist of anterior and posterior arch and two lateral masses.
>Axis, the 2nd cervical vertebra has a concave under side and convex from side to side. The most distinctive characteristic of this bone is strong odontoid process, the dens.
TheJoint:
>Atlanto-occipital joint (articulation between the atlas and the occipital bone) consists of a pair of condyloid joints.
>The atlanto-occipital joints are synovial socket-type joints
Ligaments:
> Posterior atlanto-occipital membrane: extend from anterior arch of atlas to posterior margin of foramen magnum.
>Anterior atlanto-occipital membrane: extend from anterior arch of atlas to anterior margin of foramen magnum.
>The ligamentam flavam join laminae of adjacent vertebral arches.
>The interspinous ligaments expand to form the ligamentum nuchae which inserts along the posterior foramen magnum and external occipital condyle.
> The following four ligaments stabilize these joints:
1.Apical ligament: Connects the dens to the foramen magnum of the occipital bone.
2.Alar ligaments: Connect the dens to the lateral margins of the foramen magnum.
3.Cruciate ligament: Attaches the dens to the anterior arch of the atlas and the body of the axis to the foramen magnum of the occipital bone.
4.Tectorial membrane: Starts at the skull and becomes the posterior longitudinal ligament.
>Atlanto-axial articular capsules are thick and loose, and connect the margins of the lateral masses of the atlas with those of the posterior articular surfaces of the axis.
Muscles:
>Flexion is produced mainly by the action of longis capitis, rectus capitis anterior and sternocleidomastoid (anterior fibres)
>Extension by the rectus capitis posterior major and minor, the obliquus capitis superior, the semispinalis capitis, splenius capitis, longissimus capitis, sternocleidomastoid and upper fibres of the trapezius
>The recti lateralis are concerned in the lateral movement, assisted by the trapezius, splenius capitis, semispinalis capitis, and the sternocleidomastoid of the same side, all acting together.
Movements:
>Flexion and extension in the Sagittal axis, which give rise to the ordinary forward and backward nodding of the head.
>Lateral flexion to one or other side in the Frontal axis(titling of head
>Lateral AAJ Movement: It is a synovial joint which allows only gliding
>Medial AAJ Movement: This joint allows the rotation of the atlas the axis i.e round the dens.
Clinical anatomy:
> Headaches can arise from many different sources including dysfunctional muscles, tears in the ligaments, misalignment of the vertebral bodies, injury to cervical facets and degenerative discs.
>Excessive flexion could rupture the supraspinous ligament.
>Posterior atlanto-occipital membrane ossification cause migraine headaches due to compression of artery.
THis PPT will give you knowledge about the principles of shoulder; articulating surface, motions, ligamentous structure and musculature structure that related to shoulder region.
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4. Trapezius
Origin
• Occipital bone(external occiptal
protuberunce),superior nuchal line,
ligamentum nuchae, spine of seventh
cervical vertebra, spines of all thoracic
vertebrae and their supraspinous ligament
Insertion
• Upper fibers into lateral third of clavicle;
middle and lower fibers into acromion and
spine of scapula
Nerve Supply
• Spinal part of accessory nerve (motor) and
C3 and 4 (sensory)
• XI cranial nerve (spinal part)
Action
• Upper fibers elevate and upwardly rotate
the scapula, extend the neck.
• middle fibers adduct(retracts) the scapula.
• lower fibers depress and help upper fibres
in rotating scapula.
5. Latissimus dorsi
Origin
• Iliac crest, lumbar fascia, spines
of lower six thoracic
vertebrae(T7-T12), lower three
or four ribs, and inferior angle of
scapula
Insertion
• Floor of bicipital groove of
humerus
Nerve Supply
• Thoracodorsal nerve(C6, 7, 8)
Action
• Extends, adducts, and medially
rotates the arm
• Its called the climbing muscle
• Raising of the trunk above the
arm
Important :As it winds around lower
border of teres major it forms
posterior fold of axilla its lateral
border forms a boundary of
lumbar triangle.
6. Levator scapulae
Origin
Transverse processes of
first fourth cervical
vertebrae
Insertion
Medial border of scapula
Nerve supply
C3 and 4 and dorsal
scapular nerve
Action
Raises medial border of
scapula
Important : Part of floor
of Posterior triangle
7. Rhomboid minor
and Major
Origin
(MInor)Ligamentum
nuchae and spines of
seventh cervical and
first thoracic vertebrae
(Major)T2-T5 spines
Insertion
Medial border of scapula
Nerve supply
• Dorsal scapular nerve
C4, 5
Action
• Raises medial border of
scapula upward and
medially
8. Deltoid
Origin
Lateral third
clavicle(Anterior)
Lateral border of
acromion(middle)
Spine of scapula(posterior)
Insertion
Middle of lateral surface of
shaft of humerus to
deltoid tuberosity
Nerve supply
Axillary nerve C5, 6
Action
Anterior fibers flex and
medially rotate arm
Middle fibers Abducts arm;
Posterior fibers extend and
laterally rotate arm
Abduction from 15-90
degrees
9. Applied anatomy
Intramuscular injections are
given into the deltoid .
The should be given in the lower
half of the muscle to avoid
injury to axillary nerve.
In subacromial bursitis
pressure over the deltoid
below the acromion with the
arm by the side causes pain.
However when the arm is
abducted pressure over the
same point causes no pain
because the bursa disappears
under the acromion. This is
referred to as Dawbarn’s sign.
12. Teres minor
Origin
Upper two thirds of lateral
border of scapula
Insertion
Greater tuberosity of
humerus; capsule of
shoulder joint
Nerve supply
Axillary nerve (C4), C5, 6
Action
Laterally rotates arm and
stabilizes shoulder joint
14. Teres major
Origin
Lower third of lateral border of
scapula
Insertion
Medial lip of bicipital groove of
humerus
Nerve supply
Lower subscapular nerve C6, 7
Action
Medially rotates and adducts arm
and stabilizes shoulder joint
Important : Considered
continuation of subscapularis
15. Rotator Cuff
• The rotator cuff is the
name given to the tendons
of the subscapularis,
supraspinatus,
infraspinatus, and teres
minor muscles
• Fused to the underlying
capsule of the shoulder
joint
• The cuff lies on the
anterior, superior, and
posterior aspects of the
joint
• The cuff is deficient
inferiorly, and this is a site
of potential weakness.
16. Quadrangular Space
Superiorly by the
subscapularis and capsule
of the shoulder joint
Inferiorly by the teres
major muscle
Medially by the long
head of the triceps
laterally by the surgical
neck of the humerus.
Contents
The axillary nerve and
the posterior circumflex
humeral vessels
17. Upper & Lower
Triangular spaces
Upper
Superiorly subscapularis
and teres minor
Inferiorly teres major
Laterally the long head of
the triceps
• Contains circumflex
scapular vessels.
Lower
superiorly the teres
major
medially long head of the
triceps brachii
laterally Medial head of
triceps
• Contains radial nerve and
profunda brachii artery.
18. The triangle of auscultation
• It is the site where breathing
sounds can be heard most
clearly, using a stethoscope.
Is formed by the vertebral or
medial border of the scapula,
superior border of latissimus
dorsi
the lateral border of the trapezius.
It has a floor formed by
rhomboid major.
It covers the intercostal space
between ribs 6 and 7 and rib 7.
It lies superficial to the cardiac
orifice of the stomach on the
left side, where splash of
swallowed liquids was timed in
cases of esophageal
obstruction.
It is the site where breathing sounds can be
heard most clearly, using a stethoscope.
19. The lumbar triangle
Is formed by
the posterior free border of
the external oblique,
the superior border of the
iliac crest and
the lateral border of the
latissimus dorsi.
• Its floor if formed by
internal oblique
abdominal muscle.
• It may be site of an
abdominal hernia.
20. Axillary Nerve
Arises from the posterior
cord of the brachial plexus
(C5 and 6) in the axilla
Passes backward ,through
quadrangular space with
the posterior circumflex
humeral artery
In close association with
surgical neck of humerus
and capsule of shoulder
joint
It terminates by dividing
into anterior and posterior
branches
21. Branches
Articular branch to the
shoulder joint
Anterior terminal branch
supplies the deltoid and
the skin that covers its
lower part.
Posterior terminal
branch supplies teres
minor muscle and
deltoid, then emerges
as the upper lateral
cutaneous nerve of the
arm
22. Applied Aspect
• The axillary nerve may be damaged by
dislocation of shoulder or by fracture of
surgical neck of humerus.
• The patient presents with loss of abduction of
shoulder upto 90 degrees (as deltoid is
paralysed), loss of rounded countour of
shoulder and sensory loss over lower deltoid.
23. Suprascapular nerve The suprascapular nerve
originates from Upper trunk
of the brachial plexus
It passes through
suprascapular foramen to
reach the posterior scapular
region
innervates the supraspinatus
muscle
then passes through the
greater scapular
(spinoglenoid) notch
Terminate in and innervate
the infraspinatus muscle.
Mnemonic(“Army over and
navy under the bridge”)
24. Arterial Anastomosis Around the
Shoulder Joint
Branches from the
subclavian artery
1. The suprascapular artery
is a branch of
thyrocervical trunk of
subclavian artery.
Supplies the supraspinous
and infraspinous fossae,
and their contents .
2. Deep branch of
transverse cervical artery
supplies the rhomboidei
and the medial border of
the scapula, running deep
to levator scapulae.
25. Branch from the axillary artery
3. The circumflex scapular artery, a
branch of the subscapular artery
which arises from the third part of
axillary artery
Applied aspect
• Scapular anastomoses is an
anastomoses between the first
part of subclavian and third part
of axillary artery. So it provides a
collateral circulation through
which blood can flow to the limb
in case of blockage of distal part
of subclavian artery or proximal
part of axillary artery.