Module 30: Upper Extremity II - Bones and Joints/Pectoral Girdle and Arm

what is the purpose of the pectoral girdle?

articulates with the trunk and supports upper limbs

(lecture) where is all the landmarks of the scapula? (be able to draw it)

look at picture

4 (part2). what is the bone of the forearm? a) what are the articulations of these 2 bones? b) what are the muscle/tendon attachment sites of these 2 bones?

a) ulna articulations 1. trochlear notch 2. radial notch 3. head radius articulations 1. head 2. ulnar notch b) ulna muscle/tendon attachment sites 1. olecranon process 2. coronoid process 3. styloid process radius muscle/tendon attachment sites 1. radial tubercle 2. styloid process

2. (part 1) a) How does the clavicle articulate with the thoracic cage? b) What motions are available in this joint?

a) - articulates medially with the manubrium of sternum - articulates laterally with the acromion b) 1. elevation 2. depression 3. retraction 4. protraction 5. posterior rotation

VERY LONG QUESTION 4. (part1). What structures attach (originate or insert) to the bony landmarks of the scapula? a. What are the borders and angles of the scapula, where are they, and what attaches to them? b. What are the fossa of the scapula, where are they, and what attaches to them? c. What are the acromion and coracoid process, where are they, and what attaches to them? d. What is the spine of the scapula, and where is it found? e. What are the tubercles and notch of the scapula, what are they and what attaches to them?

a) 1. Medial border: Attachment for the levator scapulae, rhomboid major, rhomboid minor, & serratus anterior (anterior portion of the medial border) 2. Lateral border: Attachment for teres minor 3. Superior border: No attachments 4. Inferior angle: Attachment site for the teres major muscle 5. Superior angle: Attachment for the levator scapulae b) 1. Glenoid fossa: Articulates with the head of the humerus 2. Subscapular fossa: Fossa on the anterior scapula that holds the subscapularis muscle 3. Supraspinous fossa: Fossa on the posterior surface that holds the supraspinatus 4. Infraspinous fossa: Fossa on the posterior surface that holds the infraspinatus c) 1. Coracoid processAttachment site for the coracobrachialis, short head of the biceps brachii, & pectoralis minor muscles & coracoclavicular ligament 2. Acromion process: Articulates with the clavicle, attachment for the middle part of the deltoid d) 1. Scapular spine: Separates the supraspinous and infraspinous fossa, attachment for the deltoid and trapezius muscles e) 1. Supraglenoid tubercle: Attachment for the long head of the biceps brachii 2. Infraglenoid tubercle: Attachment for the long head of the triceps 3. Suprascapular notch: Passageway for the suprascapular nerve

list the muscles that move the GH joint a) GH extension b) GH flexion c) GH lateral rotation d) GH abduction e) GH adduction f) GH medial rotation

a) 1. latissimus dorsi 2. posterior fibers deltoid 3. triceps brachii (long head only) 4. teres major b) 1. pectoralis major 2. anterior fibers deltoid 3. coracobrachialis 4. biceps brachii c) 1. infraspinatus 2. teres minor 3. posterior fibers deltoid d) 1. middle fiber deltoid 2. supraspinatus e) 1. latissimus dorsi 2. pectoralis major 3. coracobrachialis 4. teres major 5. teres minor 6. infraspinatus d) 1. subscapularis 2. latissimus dorsi 3. pectoralis major 4. anterior deltoid 5. teres major

list the muscles that move the scapula a) scapular elevation b) scapular depression c) scapular retraction d) scapular inferior rotation e) scapular superior rotation f) scapular protraction

a) 1. superior fibers trapezius 2. levator scapulae 3. rhomboid major 4. rhomboid minor b) 1. pectoralis minor 2. inferior trapezius c) 1. rhomboid major 2. rhomboid minor 3. middle fibers trapezius d) 1. rhomboid major 2. rhomboid minor 3. levator scapulae e) 1. serratus anterior 2. superior fiber trapezius f) 1. serratus anterior 2. pectoralis minor

(lecture) a) how many carpal bones are in the wrist? b) how many metacarpals are in the palm? c) how many phalanges are in the fingers?

a) 8 b. 5 c. 14

2 (part3). how many bones are in the wrist (carpals)? a. Can you list the bones sequentially proximal row lateral to medial and distal row lateral to medial?

- 8 bones in total a) from left to right Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate acronym 1. Some (Scaphoid) 2. lovers (lunate) 3. try (triquetrum) 4. positions (pisiform) 5. that (trapezium) 6. they (trapezoid) 7. can't (capitate) 8. handle (hamate)

1 (part2). What bones articulate to form the acromioclavicular joint? a) what is the ligaments of this joint?

- acromion and clavicle a) 1. acromioclavicular 2. coracoclavicular 3. coracoacromial

5. Define what bones articulate to form the joints of the wrist and hand?

1. Radiocarpal: radius and carpal bones (wrist joint) 2. carpometacarpal: Base of metacarpal bone and distal end of carpal bone 3. metacarpophalangeal (MP or MCP): metacarpals and proximal phalange (my knuckles) 4. interphalangeal (IP): joint between proximal and distal phalanges of the thumb ONLY 5. promixal interphalangeal (PIP): joint between the proximal and middle phalanges 6. distal interphalangeal (DIP): joint between the middle and distal phalangies

What are the muscles of the rotator cuff?

1. supraspinatus, 2. infraspinatus 3. teres minor 4. subscapularis

2 (part2). Explain what the scapulothoracic joint is? a. Why is this joint considered a functional joint?

1. a joint between the ventral surface of the scapula and the posterior thoracic wall a) its a functional joint because it: 1. no capsule or bony union 2. elevation/depression 3. protraction/retraction 4. upward/downwaard rotation

3 (part3). how many bones are in the palms (metacarpals)?

5

(lecture) What are the muscles that move the arm? a. Anterior vs. lateral vs. posterior

anterior muscles 1. pectoralis major 2. deltoid (anterior fibers) 3. coracobrachialis 4. biceps brachii 5. brachioradialis** 6. brachialis lateral muscle 1. deltoid (middle fibers) posterior muscles 1. latissimus dorsi 2. teres major 3. deltoid (posterior fibers) 4. triceps brachii 5. supraspinatus 6. infraspinatus 7. teres minor 8. subscapularis

1 (part1). What are the bones of the pectoral girdle and arm?

pectoral girdle: 1) sternum (manubrium) 2) clavicle arm: 3) scapula 4) humerus

3 (part1). What are the muscles that move the pectoral girdle? a. Posterior vs. Anterior

posterior muscles: 1. levartor scapulae 2. rhomboid major 3. rhomboid minor 4. trapezuis anterior muscles 1. pectoralis minor 2. subclavius 3. serratus anterior

1 (part3). What bones articulate to make the elbow joint? a. What type of joint is the elbow joint? i. what are the movements? b. What ligaments provide stability to the elbow joint? i. Which is medial, and which is lateral? c. What is the purpose of the annular ligament?

- humerus, ulna, radius a) hinge joint with multiple articulations i. flexion/extension b) 1. radial (lateral) collateral: prevents varus force 2. ulnar (medial) collateral: prevents valgus force 3. anular ligament c) annular purpose is to Wraps around the head of the radius so it connects the head of the radius to the ulna which is how we get pronation and supination

3 (part1). What bones articulate to make the glenohumeral (shoulder) joint? a. What is the glenoid labrum? b. What is the purpose of bursae around a joint? c) what are the motions of the glenohumeral joint?

- scapula and humerus (ball and socket joint) a) glenoid labrum: fibrocartilaginous rim b) burase reduces friction c) 1. flexion/extension 2. abduction/adduction 3. medial/lateral rotation 4. circumduction

What is the scapula? a) the bony landmarks are sites for what?

- shoulder blade that overlies ribs 2-7 dorsally a) 1. muscle/tendon attachment 2. articulations 3. passsage of neurovascular structures

3 (part2). what is the bone of the arm? a) what are the articulations of this bone? b) what are the passageways of this bone? c) what are the muscles/tendons attached to this bone?

- the humerus a) 1. head 2. capitulum 3. trochlea b) 1. surgical neck 2. intertubercular groove 3. radial groove c) 1. greater tubercle 2. intertubercular groove 3. lesser tubercle 4. deltoid tubercle 5. lateral epicondyle 6. medial epicondyle

2 (part1). What is the significance of the bony landmarks of the scapula?

1. Glenoid fossa: Articulates with the head of the humerus 2. Coracoid process: Attachment site for the coracobrachialis, short head of the biceps brachii, & pectoralis minor muscles & coracoclavicular ligament 3. Acromion process: Articulates with the clavicle, attachment for the middle part of the deltoid 4. Scapular spine: Separates the supraspinous and infraspinous fossa, attachment for the deltoid and trapezius muscles 5. Medial border: Attachment for the levator scapulae, rhomboid major, rhomboid minor, & serratus anterior (anterior portion of the medial border) 6. Lateral border: Attachment for teres minor 7. Superior border: No attachments 8. Inferior angle: Attachment site for the teres major muscle 9. Superior angle: Attachment for the levator scapulae 10. Subscapular fossa: Fossa on the anterior scapula that holds the subscapularis muscle 11. Supraspinous fossa: Fossa on the posterior surface that holds the supraspinatus 12. Infraspinous fossa: Fossa on the posterior surface that holds the infraspinatus 13. Supraglenoid tubercle: Attachment for the long head of the biceps brachii 14. Infraglenoid tubercle: Attachment for the long head of the triceps 15. Suprascapular notch: Passageway for the suprascapular nerve

2 (part1). What is the significance of the bony landmarks of the humerus?

1. Head: Articulates with the glenoid fossa of the scapula 2. Anatomical neck: Just distal to the head of the humerus 3. Surgical neck: Common site for fractures of the humerus 4. Deltoid tuberosity: Attachment for the deltoid muscle 5. Lesser tubercle: Attachment for the subscapularis muscle (and teres major) 6. Greater tubercle: Attachment for the supraspinatus, infraspinatus, and teres minor 7. Intertubercular sulcus (groove): Passageway for the tendon of the long head of the biceps; attachment for the latissimus dorsi and teres major muscles 8. Radial groove: Radial nerve travels here on its course around the posterior humerus 9. Medial epicondyle: Attachment site for muscles of the anterior forearm (flexors and pronator teres) 10. Lateral epicondyle: Attachment site for muscles of the posterior forearm (extensors and supinator) 11. Lateral supracondylar ridge: Attachment site for some posterior forearm muscles 12. Medial supracondylar ridge: Attachment site for some anterior forearm muscles 13. Capitulum: Articulates with the head of the radius 14. Trochlea: Articulates with the ulna 15. Radial fossa: Space for radius during elbow flexion 16. Coronoid fossa: Space for the coronoid process of the ulna during elbow flexion 17. Olecranon fossa: Space for the olecranon process of the ulna during elbow extension

(lecture) what are the different joints of the pectoral girdle? a) what are the bones that are articulating? b) what is the joint classification? (saddle joint? functional joint? etc...) c) what are the motions?

1. sternoclavicular (SC) joint a) sternal end of the clavicle and the manubrium of sternum b) saddle joint c) -elevation/depression -protraction/retraction -posterior rotation 2. acromiclavicular (AC) joint a) acromial end of the clavicle and the acromion process of the scapula b) plane joint c) gliding 3. scapulothoracic joint a) NOT an articulation - scapula and thoracic cage b) functional joint c) -elevation/depression -protraction/retraction -superior/inferior rotation 4. glenohumeral joint a) glenoid fossa of the scapula and the heada of the humerus b) ball-and-socket joint c) -flexion/extension -abduction/adduction -medial/lateral rotation -cicumduction

1. (part1) a) What bones make up the pectoral girdle? b) What bones make up the brachium? c) What bones make up the antebrachium?

a) clavicle and scapula b) humerus c) radius and ulna

(lecture) a) what is the articulation of the sternoclavicular joint? b) What motions are available in this joint?

a) sternum and clavicle b) 1. protraction/retraction 2. elevation/depression 3. posterior rotation

(lecture) What nerves innervate the muscles of the anterior/lateral/ posterior arm?

anterior muscles 1. pectoralis major: lateral and medial pectoraal nerves 2. deltoid (anterior fibers): axillary nerve 3. coracobrachialis: musculocutaneous nerve 4. biceps brachii: musculocutaneous nerve 5. brachioradialis**: radial nerve 6. brachialis: musculocutaneous nerve lateral muscle 1. deltoid (middle fibers): axillary nerve posterior muscles 1. latissimus dorsi: thoracodorsal nerve 2. teres major: lower subscapular nerve 3. deltoid (posterior fibers): axillary nerve 4. triceps brachii: radial nerve 5. supraspinatus suprascular nerve 6. infraspinatus: suprascular nerve 7. teres minor: axillary nerve 8. subscapularis: upper and lower subscapular nerves

4 (part3). how many bones are in the fingers (phalanges)? a. Can you differentiate proximal, middle, and distal phalanges?

each finger has 3 (except thumb, which only has distal and proximal) a) 1. proximal (closest to metacarpals 2. middle 3) distal (tip of finger)

4 (part1). What nerves innervate the muscles of the posterior/anterior pectoral girdle?

posterior muscles: 1. levartor scapulae: dorsal scapulae nerve 2. rhomboid major: dorsal scapulae nerve 3. rhomboid minor: dorsal scapulae nerve 4. trapezuis: accessory nerve anterior muscles 1. pectoralis minor: medial pectoral nerve 2. subclavius: nerve to subclavius 3. serratus anterior: long thoracic nerve