Presentation on theme: "WINDSOR UNIVERSITY SCHOOL OF MEDICINE St.Kitts"— Presentation transcript:
1 WINDSOR UNIVERSITY SCHOOL OF MEDICINE St.Kitts DEPARTMENT OF ANATOMYUPPER LIMBSHOULDER
2 SHOULDERThe shoulder is the region of upper limb attachment to the trunk and neck.
3 1A large muscle that arises from two heads flexes and medially rotates the arm. It is innervated by nerves arising from different cords of the brachial plexus. This is the:A.Latissimus dorsiB.TrapeziusC.DeltoidD.SubscapularisE.Pectoralis major
4 Bones of the Shoulder Girdle Clavicle and scapula, which form the pectoral girdle (shoulder girdle)The proximal end of the humerus.
6 Anterior Axioappendicular Muscles of the Upper Limb PECTORALIS MAJORPECOTORALIS MINORSUBCLAVIUSSERRATUS ANTERIOR
7 PECTORALIS MAJOR N. supply: Medial and lateral pectoral nerves Origin: Clavicle, sternum, and upper six costal cartilagesInsertion : Lateral lip of bicipital groove of humerusN. supply: Medial and lateral pectoral nervesAction : Adducts arm and rotates it medially; clavicular fibers also flex arm
9 PECOTORALIS MINOR N. supply: Medial pectoral nerve Origin: Third, fourth, and fifth ribsInsertion : Coracoid process of scapulaN. supply: Medial pectoral nerveAction: Stabilizes scapula by drawing it inferiorly
10 SUBCLAVIUS N. supply: Nerve to subclavius Origin: First costal cartilageInsertion : ClavicleN. supply: Nerve to subclaviusAction: Depresses the clavicle
11 SERRATUS ANTERIOR N. supply: Long thoracic nerve Origin: Upper eight ribsInsertion :Anterior surface of medial border of scapulaN. supply: Long thoracic nerveAction: Protracts scapula and rotates scapula
12 Paralysis of the Serratus Anterior(winged scapula ) Due to loss of Innervation-long thoracic nerveWhen the serratus anterior is paralyzed owing to injury to the long thoracic nerve, the medial border of the scapula moves laterally and posteriorly away from the thoracic wall, giving the scapula the appearance of a wing.
13 2All the following muscles have a relationship to the scapula. If paralyzed, which muscle results in winging of the scapula with inability to elevate the arm above the horizontal? A .Serratus anterior B. Latissimus dorsi C .Levator scapulae D. Rhomboid major E .Deltoid
14 Posterior Axioappendicular Muscles The posterior axioappendicular muscles attach the superior appendicular skeleton (of the upper limb) to the axial skeleton (in the trunk).1.Trapezius2.Latissimus dorsi3. Rhomboid major and minor4. Levator scapulae
15 Trapezius N. supply: Spinal part of accessory nerve (motor) Origin: Occipital bone, ligamentum nuchae, spine of seventh cervical vertebra, spines of all thoracic vertebraeInsertion : Upper fibers into lateral third of clavicle; middle and lower fibers into acromion and spine of scapulaN. supply: Spinal part of accessory nerve (motor)Action: Upper fibers elevate the scapula; middle fibers pull scapula medially; lower fibers pull medial border of scapula downward
17 Injury of the Accessory Nerve (CN XI) The primary clinical manifestation of accessory nerve palsy is a marked ipsilateral weakness when the shoulders are elevated (shrugged) against resistance.
18 Latissimus dorsi N. supply:Thoracodorsal nerve Origin: Iliac crest, lumbar fascia, spines of lower six thoracic vertebrae, lower three or four ribs, and inferior angle of scapulaInsertion: Floor of bicipital groove of humerusN. supply:Thoracodorsal nerve
19 Latissimus dorsi Action: Extends, adducts, and medially rotates the arm
20 Injury of the Thoracodorsal Nerve Surgery in the inferior part of the axilla puts the thoracodorsal nerve supplying the latissimus dorsi at risk of injury.With paralysis of the latissimus dorsi, the person is unable to raise the trunk with the upper limbs, as occurs during climbing.
21 Levator Scapulae N. supply:dorsal scapular nerve Origin: Transverse processes of first four cervical vertebraeInsertion: Medial border of scapulaN. supply:dorsal scapular nerveAction:Elevates scapula
22 Rhomboids minor and major N. supply: Dorsal scapular nerveAction: Retracts scapula
23 1.An 34 year old man, bleeding from a stab wound in the neck, is brought to the emergency department. After the bleeding has been controlled, further examination indicates that her left shoulder is lower than the right shoulder. Which of the following nerve is most likely injured?A Long thoracicB Dorsal scapularC AxillaryD SuprascapularE Spinal accessory
24 2.A 22 year old woman sustains a traumatic injury to the axilla that severely damages the thoracodorsal nerve. Which of the following movements is most likely affected in this patient? a AdductionB. FlexionC Lateral rotationD ProtractionE Supination
25 Scapulohumeral Muscles The six scapulohumeral muscles are relatively short muscles that pass from the scapula to the humerus and act on the glenohumeral joint.1.Deltoid2.Teres major3.Teres minor4.Supraspinatus5.Infraspinatus6.Subscapularis
26 Deltoid N. supply: Axillary nerve Origin: Lateral third of clavicle, acromion, spine of scapulaInsertion: Middle of lateral surface of shaft of humerusN. supply: Axillary nerve
27 DeltoidAction:Anterior part: flexes and medially rotates arm Middle part: abducts arm Posterior part: extends and laterally rotates arm
28 Testing deltoid muscle The examiner resists the patient's abduction of the limb by the deltoid.If the deltoid is acting normally, contraction of the middle part of the muscle can be palpated.
29 Injury to the Axillary Nerve The deltoid is a common site for the intramuscular injection of drugs.The axillary nerve runs transversely under cover of the deltoid at the level of the surgical neck of the humerus.The deltoid atrophies when the axillary nerve (C5 and C6) is severely damaged.
31 Teres Major N. supply:Lower subscapular nerve Origin: Lower third of lateral border of scapulaInsertion:Medial lip of bicipital groove of humerusN. supply:Lower subscapular nerveAction:Adducts and medially rotates arm
33 Rotator Cuff MusclesFour of the scapulohumeral muscles supraspinatus, infraspinatus, teres minor, and subscapularis (referred to as the SITS muscles) are called rotator cuff muscles because they form a musculotendinous rotator cuff around the glenohumeral joint.
34 Supraspinatus N. supply: Suprascapular nerve Origin: Supraspinous fossa of scapulaInsertion: Superior facet of greater tubercle of humerusN. supply: Suprascapular nerveAction: Initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles.
35 Infraspinatus N. supply: Suprascapular nerve Origin: Infraspinous fossa of scapulaInsertion: Middle facet of greater tubercle of humerusN. supply: Suprascapular nerveAction: Laterally rotates arm and stabilizes shoulder joint
36 Teres minor N. supply:Axillary nerve Origin: Middle part of lateral border of scapulaInsertion: Inferior facet of greater tubercle of humerusN. supply:Axillary nerveAction:Laterally rotates arm and stabilizes shoulder joint
37 Subscapularis N. supply: Upper and lower subscapular nerves Origin: Subscapular fossa (most of anterior surface of scapula)Insertion: Lesser tubercle of humerusN. supply: Upper and lower subscapular nervesAction: Medially rotates and adduct arm
38 Rotator Cuff Injuries and the Supraspinatus Trauma may tear or rupture one or more of the tendons of the SITS muscles; that of the supraspinatus is most commonly involved.
39 1.Which of the following muscles listed below is the rotator cuff muscle involved in medial rotation of the humerus?A SupraspinatusB SubscapularisC InfraspinatusD Teres minorE Teres major
40 2.A 31 year old man is unable to raise his right arm above his head 3 weeks after dislocating his shoulder in a foot ball game. Examination shows absence of rounded contour of the shoulder. Which of the following nerves was most likely injured?A. MusculocutaneousB. MedianC. AxillaryD. UlnarE.Radial
45 Quadrilateral Space Syndrome Quadrilateral space syndrome usually happens from overuse, especially with overhead sports like throwing and swimming. The syndrome can also be caused by an injury, like a shoulder dislocation.
46 TRIANGULAR [upper] space LATERAL BORDER:Long Head of the TricepsUpper border:Teres Minor and subscapularisLower border:Teres MajorCONTENTSCircumflex Scapular Branchof the Subscapular artery
47 Lower Triangular Space Mediallylong head of the triceps brachiiLatterlyshaft of the humerusSuperiorlyteres major