1. Helen & Shef

2. Acromion Coracoid process Lesser tubercle Intertubercular (bicipital) groove (What structure runs through here?) Greater tubercle What structure does the medial scapula border of an abducted upper limb mark? Spine of scapula Acromion Supraspinous fossa Inferior angle Infraspinous fossa Medial border Lateral border What do the superior and inferior angles and the spine of the scapula mark?

3. Capitulum Trochlea Epicondyles Shaft Articular Head Anatomical neck Surgical neck Supracondylar ridgeWhich nerve runs posteriorly to this structure?

4. Coracoacromial ligament - Coracoclavicular ligaments Sternoclavicular joint Acromioclavicular (AC) Joint What structures make up the coracoacromial arch? How are the coracoclavicular ligaments commonly ruptured?

5.  Mobility (+++) vs Stability (+) ◦ Ball and socket joint ◦ Shallow socket formed by glenoid fossa ◦ Deepened by labrum  Supported by glenohumeral ligaments (x3) & rotator cuff muscles

7.  Rotator cuff muscles ◦ SITS:  Supraspinatus  Infraspinatus  Teres Minor  Subscapularis T I S S Posterior Anterior

8. MuscleInnervation 1) TrapeziusAccessory nerve (CN XI) 2) Latisimus dorsiThoracodorsal nerve 3) Levator scapulaeDorsal scapula nerve 4) Rhomboid majorDorsal scapula nerve 5) Rhomboid minorDorsal scapula nerve 6) Teres majorLower scapular nerve 7) Pectoralis majorMedial and lateral pectoral nerve 8) Pectoralis minorMedial pectoral nerve 13 2 4 5 6

10. Tilly, a 67 year old female, presents to her GP with an ‘achy shoulder’. On examination, she reports pain in her shoulder following abduction of her right arm between ~50 -130 degrees

11.  Painful arc syndrome  Supraspinatus tendonitis / impingement  Subacromial bursitis.

12. Grant is a 16 year old student and presented to A&E after falling onto his shoulder during a school rugby match. As well as the severe pain, he complains that he cannot move his arm much. This is what was seen on X-ray.

13.  Axillary nerve damage due to anterior dislocation  Loss of sensation over regimental badge area  Arm hangs limply by side  Loss of shoulder contour  Paralysis of deltoid (& teres minor)

14.  Samina, a 7 year old girl presents to A&E after a fall onto an outstretch arm during a skiing incident.  On examination, this is what was seen:

15. Fracture of the clavicle. Middle +++ Medial + Lateral ++

16.  Paula, a 45 year old female is seen in the oncology clinic for a follow up appointment after her surgery.  On examination, when asked to push her hands against the wall, this is seen.

17.  Winging of the scapula What is the cause of this condition?  Damage to the long thoracic nerve of bell which innervates serratus anterior. What surgical procedure is she likely to have just undergone?  Breast surgery involving axillary node clearance.