Shoulder: Muscles

Muscle Deltoid Rhomboid major and minor Supraspinatus Infraspinatus Teres minor Teres major Subscapularis Tricep brachii

Innervation Axillary nerve Dorsal scapular nerve (C4, C5) Suprascapular nerve Suprascapular nerve Axillary nerve Lower subscapular nerve Upper and lower subscapular nerves Radial n.

Function Clavicular part flexes, medially rotates arm; acromial part abducts arm (from 15-90 degrees), spinal part extends and laterally rotates arm Retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall initiates and assists deltoid in abduction of arm and acts with other rotator cuff muscles laterally rotate arm, help hold humeral head in glenoid cavity of Teres minorb middle part of lateral border scapula laterally rotate arm, help hold humeral head in glenoid cavity adducts, medially rotates arm medially rotates and adducts arm; holds humeral head in glenoid cavity Extends forearm; stabilizes elbow joint, abducts ulna during pronation

Shoulder - Ligaments

Rotator cuff Clinical correlates injury --> instability of glenohumeral joint. Rupture/tear of suprastinatus tendon is most common. Degenerative tendonitis, attrition of supraspinatus tendon --> cannot initiate abduction of upper limb. (if arm is passively abducted 15 degrees or more, then abduction can occur with deltoid) results from direct blow, "shoulder separation": severe when both AC and coracoclavicular ligaments are torn. Shoulder separates from clavicle and falls anterior dislocation occurs most often in young adults. Caused by excessive extension and lateral rotation of the humerus. Can damage axillary nerve calcific supraspinatus tendinitis: inflammation and calcification of subacromial bursa. Painful arc syndrome: pain occurs during 50-130 degrees of abduction adhesive capsulitis: adhesive fibrosis and scarring between inflamed capsule of glenohumeral joint, rotator cuff, subacromial bursa, and deltoid. Cannot abduct arm but can obtain an apparent abduction of up to 45 degrees by elevating and rotating scapula.

rotator cuff

dislocation of acromioclavicular joint dislocation of glenohumeral joint supraspinatus tendon

glenohumeral joint

Shoulder Vasculature

Affected structure nerves axillary nerve

Clinical correlate occurs when surgical neck of humerus is fractured; deltoid atrophies unilaterally, asymmetry of shoulder outlines, loss of sensation over lateral side of proximal part of arm (lateral cutaneous nerve of the arm) to stop profuse bleeding, compress artery by exerting downard pressure in the angle between the clavicle and the attachment of the SCM. dorsal scapular, suprascapular, and subscapular (via circumflex scapular) join on anterior and posterior surfaces of the scapula. Slow occlusion of an artery: allows collateral circulation to develop, ischemia will not result. Abrupt surgical ligation of axillary a. between subscapulart and profunda brachii will lead to ischemia of arm. lymphangitis: inflammation of lymphatic vessels; infections of pectoral region and breast. Most commmon site of metastases of cancer to the breast

axillary artery arteries lymph

arterial anastamoses

axillary lymph nodes

Class notes