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Pectoral Girdle, Shoulder & Arm
Helen & Shef
Scapula OsteologyAcromion 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 scapulaAcromion
Supraspinous fossa
Inferior angle
Infraspinous fossa
Medial border
Lateral border
What do the superior and inferior angles and the spine of the scapula mark?
Humerus Osteology
Capitulum Trochlea
Epicondyles
Shaft
Articular Head
Anatomical neck
Surgical neck
Supracondylar ridge Which nerve runs posteriorly to this structure?
Ligaments
Coracoacromial ligament -
Coracoclavicular ligaments
Sternoclavicular joint
Acromioclavicular (AC) Joint
What structures make up the coracoacromial arch?
How are the coracoclavicular ligaments commonly ruptured?
Mobility (+++) vs Stability (+)◦ Ball and socket joint◦ Shallow socket formed by glenoid fossa◦ Deepened by labrum
Supported by glenohumeral ligaments (x3) & rotator cuff muscles
Shoulder joint
PECTORAL MUSCLES QUIZ
Rotator cuff muscles◦ SITS:
Supraspinatus Infraspinatus Teres Minor Subscapularis
Pectoral Girdle Muscles (I)
T
I
S
S
Posterior Anterior
Pectoral Girdle Muscles (II)Muscle Innervation
1) Trapezius Accessory nerve (CN XI)
2) Latisimus dorsi Thoracodorsal nerve
3) Levator scapulae Dorsal scapula nerve
4) Rhomboid major Dorsal scapula nerve
5) Rhomboid minor Dorsal scapula nerve
6) Teres major Lower scapular nerve
7) Pectoralis major Medial and lateral pectoral nerve
8) Pectoralis minor Medial pectoral nerve
1 3
2
45
6
Clinical Vignettes
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
Case I
Painful arc syndrome
Question #1: What terminology is used to describe this phenomenon?
Question #2: What causes painful arc syndrome?
Supraspinatus tendonitis / impingement Subacromial bursitis.
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.
Case II
Axillary nerve damage due to anterior dislocation
Which nerve is most likely to have been damaged and why?
What signs would you expect to find on examination of Grant?
Loss of sensation over regimental badge area Arm hangs limply by side Loss of shoulder contour Paralysis of deltoid (& teres minor)
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:
Case III
Fracture of the clavicle.
What is the most likely location for a clavicular fracture?
What is your diagnosis?
Middle+++ Medial
+
Lateral++
Explain the appearance of Samina’s presentation.
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.
Case IV
Winging of the scapula
What is this condition known as?
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.