2. The Pectoral Girdle

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Signs and symptoms:

- Abnormally long arm - Humeral head positioned in the axilla - Pain - Dysfunction - Acromium becomes most palpable lateral bony prominence

Each half of the pectoral girdle consists of two bones:

1) Anterior clavicle 2) Posterior scapula

What are the 4 main types of shoulder stiffness:

1) Idiopathic 2) Diabetic 3) Post-surgical 4) Post-traumatic

(4) joints of the shoulder:

1) Sternoclavicular 2) Acromioclavicular 3) Glenohumeral 4) Scapulo-thoracic

The humerus is a long bone that has 2 what ends?

2 epiphyseal ends

The posterior surface divides into what?

2 unequal fossa by the spine of the scapula Projects shelf-like and posteriorly Angling upwards from the medial border

The sternoclavicular joint is capable of movements in the anterior-posterior plane movement of;

20 degrees

The acromioclavicuar joint is covered by what?

A cartilage-like fibrous tissue

What type of joint is a sternoclavicular joint?

A complicated synovial joint

The fibrous portion of the joint capsule in the upper arm forms what?

A connective tissue layer across the intertubular sulcus and converts it into an osteofibrous canal

Acromioclavicular joint is what type?

A synovial gliding

Shoulder dislocation occurs due to what movement?

Abduction & External-rotation- the joint is weakened inferiorly

Lateral end: flattened in the horizontal plane, with a small posterolateral facet which articulates with the acromion process of the scapula-->

Acromioclavicular joint

Capsule has a strengthened ligament on its superior surface-->

Acromioclavicular ligament

Sheila's Frozen Shoulder is what?

Adhesive capsulitis

The scapula has 2 surfaces:

Anterior Posterior

Most common form of GHJ dislocation?

Anterior dislocation--> limb is placed antero-inferiorly.

The proximal end forms what surface for the shoulder joint?

Articular surface for the shoulder joint

It is more suited as what?

Ball and socket type

Where is the inferior glenohumeral ligament located?

Between the SUBSCAPULARIS and the TERES MINOR

The long head of what muscle sits in the groove?

Biceps Brachii

The sternoclavicular joint is capable of movements in the superior- inferior plane:

Bof upto 60 degrees

What is it called when the head of the upper arm is completely out of the socket?

COMPLETE

Some people are born without a clavicle; this is called what?

Cleidocranial Dysplasia

How common?

Common in people aged 40-60. Affects 1 million people in the UK

What happens in posterior dislocation?

Direct blow to the front of the shoulder Partial dislocation--> head of upper arm is partially out of the socket

The articular disk does what?

Divides the space of the joint cavity in 2

More common in females or males?

Females 2:1

The socket is enlarged by what?

Fibrocartilaginous tip- the glenoidal tip

The capsule must be weak in order to permit what?

Free movement

The superior and anterior part of the capsule are thickened by what?

Glenohumeral ligaments

Exhibits what in temperature?

Increase in temperature

Diabetic how?

Increased vascularity of the capsule

The scapula has 3 angles:

Inferior Superior Lateral

Clavicles are interconnected by what ligaments?

Interclavicular ligaments

In the adducted position, the capsule hangs dependent into the what?

Into the axilla

The Glenohumeral joint cavity-->

Is a bony socket

The coracoclavicular ligament can be divided into anterolateral and posteromedial parts-->

Lateral part: the trapezoid ligament arises from the upper medial margin of the coracoid process and extends to the trapezoid line Medial part: The conoid ligament, arises from the base of the coracoid process

What is Adhesive Capsulitis?

Loss of range of motion in shoulder

It is occasionally pierced by what nerve?

Middle Supraclavicular Nerve

Do the ligaments provide stability for the shoulder?

NO! It's weak

Nerve supply to the sternoclavicular joint:

Nerve to subclavius and anterior (medial) supraclavicular nerve

Do any other bones ossify from 2 primary centres?

No

Do any other bones ossify into a membrane?

No

Does the clavicle have a medullary cavity?

No

X-Rays show what in Adhesive Capsulitis?

No arthritis/ Calcium deposits

However, it sits outside what?

Outside the synovial lining of the joint and is therefore extra-synovial

The scapula lies on the posterior thoracic wall between which ribs?

Ribs 2 & 7

What is it called when the head of the upper arm is partially out of the socket/

Subluxation

The scapula has 3 margins:

Superior Medial Lateral

The sternoclavicular joint is sometimes described as what?

Synovial saddle-joint

The costoclavicular ligament extends between what?

The 1st rib and the clavicle

The capsule of the glenohumeral joint attaches laterally to what?

The ANATOMICAL NECK OF THE HUMERUS

What is the lesion called if the glenoid labrum is torn

The Bankart lesion

The shaft of the humerus has a prominent V-shaped tuberosity on its lateral side, called what?

The Deltoid Tuberosity

The capsule of the glenohumeral joint attaches proximally to what?

The GLENOID LABRUM

This is called what???

The Subscapular Bursa

What passes between the humeral tubercles?

The TRANSVERSE HUMERAL LIGAMENT

The clavicle and scapula articulate with each other at what joint?

The acromioclavicular joint

The bone has 2 necks:

The anatomical neck which lies below the head The surgical neck at the top of the shaft Anatomical is above surgical

The capsule is slack and thick and strengthened by what?

The anterior and posterior sternoclavicular ligaments

The greater and lesser tubercle are separated by what?

The bicipital groove

The foramen between the superior and middle GH ligaments is present. It allows what?

The bursa to protrude anteriorly, which aids movement of subscapularis tendon

The acromion articulates with what??

The clavicle

Acromioclavicular joint is between what?

The clavicle and the scapula

Sternoclavicular joint is between what?

The clavicle and the sternum

Blood supply to the sternoclavicular joint:

The clavicular branch of the thoracoacromial artery

The upper portion of the GHJ capsule is partly strengthened by what?

The coracohumeral ligament and three (333333) weak GLENOHUMERAL ligaments

The coracoclavicular ligament is between what?

The coracoid process and the clavicle

The transverse humeral ligament attaches superiorly to what?

The epiphyseal line

The articular part is called what?

The head

The glenohumeral joint is between what?

The head of the humerus and the glenoid cavity of the scapula

Which ligament is largest and strongest?

The inferior glenohumeral ligament is the largest and strongest of the three

The transverse humeral ligament converts what into what?

The inter tubercular groove into a canal, and acts as a retinaculum for the short tendon of the biceps

The greater tuberosity has 3 facets for the attachment of 3 separate muscles from the scapula

The lesser tuberosity also receives a scapular muscle (subscapularis)

The medial end of the clavicle is expanded to form a large, oval facet which articulates with what?

The manubrium sterni- at the sternoclavicular joint

Posteriorly, the anterior surface of the scapula forms a connection with what?

The posterior aspect of the ribs

Posteriorly, there is a spiral groove in which what runs?

The radial nerve and the profound brachii artery

The scapulo-thoracic joint is between what?

The scapula and the rib-cage

This is called what?

The scapulo-thoracic joint

The medial end of the clavicle articulates with the manubrium of the sternum to form what joint?

The sternoclavicular joint

Anteriorly, bones are separated by what?

The sternum

The anterior (costal) surface of the scapula is taken up with the broad CONCAVE surface of what?

The sub-scapular fossa

Above the spine is what?

The supraspinous fossa

There is a gap between the glenohumeral ligaments anteriorly-->

The synovium membrane is able to escape from the confines of the capsule and form a BURSA in front of the SUBSCAPULARIS muscle

The tendon of what arises from inside the GH joint?

The tendon of the long head of the Biceps Brachii

The superior segment of the GH capsule and the CH ligament contributes to what?

The vertical stability of the humeral head

Posteriorly, there is a gap because?

They do not articulate with each other or with the vertebral column

The hyaline carriage covering the gleaned cavity is thicker where?

Thicker at the MARGINS than at the centre

Is the capsule of the glenohumeral joint WEAK or STRONG?

Weak

Is the clavicle subcutaneous?

Yes

Is the clavicle the first bone to ossify?

Yes

Is the clavicle the only long bone to lie horizontally?

Yes


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