Transcript PTA Shoulder Joint

Heather, Riley, Tonia, and Jo
Anterior axillary fold - The
inferior border of the pectoralis major
muscle forms the anterior axillary fold
Clavicular head of pectoralis
major - The clavicular head is the
smaller top section of the bare-chested
upper-torso
Clavipectoral triangle - The
clavipectoral triangle (deltopectoral
triangle) is the depressed area just
inferior to the lateral part of the clavicle,
bounded by the clavicle superiorly, the
deltoid laterally, and the clavicular head
of the pectoralis major medially.
Sternocostal head of
pectoralis major - The sternalcostal head consists of more muscle
mass. It originates at the sternum and six
sternum costal cartilages
Surface Anatomy
Clavicle - can be felt from end to end (subcutaneous) since they produce
horizontal ridges visible at the junction of the neck to the thorax
Manubrium – the upper segment of the sternum in which the clavicles and
upper two ribs articulate
Parts of the Deltoid :
•clavicular part ( or
anterior): originates on
the lateral third of the
clavicle
•acromial part (or
middle): originates on the
acromion process
•spinal part (or posterior):
originates on the scapular
spine
Surface Anatomy
Posterior Axillary Fold – formed by the
latissimus dorsi winding around the lateral
border of the teres major muscle
Triangle of auscultation - The space
bounded by the lower border of the
trapezius, the latissimus dorsi, and the
medial margin of the scapula, used to listen
to (auscultate) the lungs because the
stethoscope can be placed close to the
thoracic wall at this location
Three areas of the Trapezius Muscle :
1. Descending Part of Trapezius (the
superior region or Upper fibers) - which
functions to support the weight of the arm
2. Ascending Part of Trapezius (the
inferior region or Lower Fibers) - which
function to rotate and or lower the
scapulae.
3. Middle Part of the Trapezius (the
intermediate region or middle fibers) which function to draw or pull the
scapulae inwards closer to the spine
Made up of
three bones:
1.Clavicle
2.Humerus
3.Scapula
1. Sternal end
2. Acromial end
3. Conoid tubercle
Greater Tubercle
Lesser Tubercle
Intertubercular Sulcus
Head
Anatomical Neck
Surgical Neck
Deltoid Tuberosity
•Angles (Superior and Inferior)
•Subscapular Fossa
•Acromion Process
•Infraspinatous Fossa
•Coracoid Process
•Supraspinatous Fossa
•Borders (superior, vertebral,
and axillary
•Spine
•Glenoid Fossa (Cavity)
Shoulder
Ligaments
 Coracohumeral ligament
 Transverse humeral ligament
 Acromioclavicular ligament
 Glenohumeral ligaments
- superior
- middle
- inferior
 Coracoclavicular ligament
- Trapezoid ligament
- Conoid ligament
 Superior transverse scapular
ligament
A bursa is a sac between two moving surfaces
that contains a small amount of lubricating
fluid, and they reduce friction where two body
parts are moving against one another and there
is no joint.
Labrum: is a type of cartilage found in the shoulder, found only
around the socket where it is attached. This cartilage is more
fibrous and rigid
Articulating Cartilage: white cartilage found on the ends of
bones, which allows the bones to glide and move on each other.
When this type of cartilage starts to wear out you get arthritis.
Synovial Membrane:
Layer of connective tissue
that lines the joints, tendon
sheaths, and bursae and
makes synovial fluid, which
has a lubricating function.
•Group of muscles and tendons
that surround the shoulder
joint
•Keep the head of your upper
arm bone firmly within the
shallow socket of the shoulder.
Supraspinatus
Infraspinatous
Teres Minor
Subscapularis
•Dull ache deep in the shoulder
•Disturb sleep, particularly if
you lie on the affected side
•Difficult to comb your hair or
reach behind your back
•Arm weakness
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•Partial tear: damages the soft tissues but does not completely sever it
•Full thickness tear or a complete tear: splits the soft tissue into two
pieces.
•Injury: Falling on an outstretched hand or lifting something too
heavy are two common injuries associated with rotator cuff tears.
•Degeneration: Repetitive stress, lack of blood supply, and bone
spurs are factors that contribute to degeneration.
Labrum Tear
Instability- One shoulder
joint moves or is forced
out of its normal
position. This condition
can result in a
dislocation of one of the
joints in the shoulder.
ImpingementCaused by excessive
rubbing of the shoulder
muscles against the top
part of the shoulder
blade (acromion)
Cervical
Plexus
Accessory (Spinal)
Nerve
Brachial
Plexus
• Medial Cord
• Lateral Cord
• Posterior Cord
Nerves
•
•
•
•
•
•
•
•
•
Lateral Pectoral
Medial Pectoral
Long Thoracic
Dorsal Scapular
Musculocutaneous
Thoracodorsal
Axillary
Subscapular
Suprascapular
Arteries
• Subclavian
• Axillary
• Transverse
Cevical
• Dorsal
Scapular
• Lateral
Thoracic
• Posterior
Circumflex
• Deep Scapular
• Suprascapular
• Circumflex
Scapular
• Subscapular
• Brachial
Origin: Superior line of the occipital bone, ligamentum
nuchae, and cervical vertebrae
 Insertion: Lateral 1/3 of clavicle and acromion process
 Action: Scapular elevation and upward rotation
 Innervation: Spinal Accessory nerve
 Roots C3 and C4
 Synergists:
-Elevation : Levator Scapulae
-Upward Rotation: Upper and Lower Trapezius
 Antagonists:
-Adduction: Rhomboids Major and Minor, Middle Trapezius
-Downward Rotation: Levator Scapula, Rhomboids Major and
Minor.

 Origin:
Spinous Processes of C7 to T3
 Insertion: Scapular Spine
 Action: Scapular Adduction (retraction)
 Innervation: Spinal Accessory Nerve
 Roots C3 and C4
 Synergists: Adduction: Rhomboids Major and
Minor
 Antagonists: Serratus Anterior, Pectoralis
Minor
Origin: Spinous Processes of Middle and Lower Thoracic
Vertebrae
 Insertion: Base of the scapular Spine
 Action: Scapular depression and upward rotation
 Innervation: Spinal Accessory Nerve
 Roots C3 and C4
 Synergists:
-Depression: Pectoralis Minor
-Upward Rotation: Upper Trapezius, Serratus Anterior
 Antagonists:
-Elevation: Levator Scapulae, Upper Trapezius, Rhomboids
Major and Minor
-Downward Rotation: Rhomboids Major and Minor, Levator
Scapulae

Origin: Transverse process of first four cervical
vertebrae
 Insertion: Vertebral border of scapula
between the superior angle and the spine
 Action: Scapular elevation and downward
rotation (Inferior rotation of Glenoid Cavity)
 Innervation: Dorsal Scapular and Cervical
nerves and Dorsal scapular artery
 Roots: Dorsal Scapular C5
-Cervical C3 and C4
 Synergists:
-Elevation: Upper Trapezius, Rhomboids Major
and Minor
-Inferior Rotation: Rhomboid Major and Minor,
Pectoralis Major
 Antagonists:
-Depression: Lower Trapezius, Pectoralis Minor
-Superior Rotation: Upper and Lower Trapezius,
Serratus Anterior
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Origin: Anterior Surface, third
through fifth Ribs
Insertion: Coracoid process of the
scapula
Action: Ribs Fixed: Draws scapula
forward (abducts) and rotates
scapula downward against the
thoracic wall
Scapula fixed: Elevates the rib
cage.
Innervation: Medial pectoral nerve,
Axillary artery
Synergists: Abduction: Serratus
Anterior
Respiration: Sternocleidomastoid,
Scalenes
Antagonists: Adduction:
Rhomboids major and minor, Middle
Trapezius
Respiration: Rectus Abdominus
Origin: Lateral Surface of the
Upper eight ribs
 Insertion: Anterior surface of the
vertebral border of the scapula
 Action: Scapular protraction and
Upward Rotation, holds scapula
against thoracic wall
 Innervation: Long thoracic nerve,
Lateral thoracic artery
 Roots C5-C7
 Synergists:
-Abduction: Pectoralis Minor
-Upward Rotation: Upper and lower
Trapezius
 Antagonists:
-Adduction: Rhomboids Major and
Minor, Middle Trapezius
-Downward Rotation: Levator
Scapulae, Rhomboids Major and
Minor


Origin: Spinous processes of T2 - T5

Insertion: Vertebral border of the
scapula between the spine and inferior
angle

Action: Adducts (retracts) Scapula,
Depresses Glenoid Cavity, Stabilizes
scapula

Innervation: Dorsal Scapular Nerve and
Dorsal Scapular Artery

Synergists:
-Adduction: Middle Trapezius
-Downward Rotation: Levator Scapulae,
Pectoralis Minor

Antagonists:
-Abduction: Serratus anterior, Pectoralis
Minor
-Upward Rotation: Upper and lower
Trapezius, Serratus Anterior
Origin: Nuchal Ligament and
spinous process of C7 and T1
 Insertion: Vertebral border of
scapula superior to spine
 Action: Adducts (retracts) Scapula,
Depresses Glenoid Cavity,
Stabilizes scapula
 Innervation: Dorsal Scapular Nerve
and Dorsal Scapular Artery
 Synergists:
-Adduction: Middle Trapezius
-Downward Rotation: Levator
Scapulae, Pectoralis Minor
 Antagonists:
-Abduction: Serratus anterior,
Pectoralis Minor
-Upward Rotation: Upper and lower
Trapezius, Serratus Anterior

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Anterior (Clavicular)
Origin: Lateral 1/3 of Clavicle
Action: Shoulder Abduction, Flexion, Medial rotation, Horizontal
Adduction
Middle (Acromial)
Origin: Acromion process
Action: Shoulder Abduction
Posterior (Spinal)
Origin: Scapular Spine
Action: Shoulder Abduction, Extension, Hyperextension, Lateral Rotation,
Horizontal Adduction
All 3 Deltoids Insert on the Deltoid Tuberosity and are Innervated
by the Axillary Nerve with Roots C5-C6
 All 3 Deltoids have the Supraspinatus as a Synergist when
performing Abduction

Origin: (clavicular head) Medial third of the clavicle, (sternal
head) sternum, costal cartilage of first six ribs and the
aponeurosis of the External Oblique
 Insertion: Lateral lip of bicipital groove of humerus
 Action: Shoulder Adduction, Medial Rotation, Draws Scapula
anteriorly and inferiorly, Clavicular Head Flexes Humerus,
Sternal Head Extends Humerus
 Innervation: Lateral and Medial Pectoral Nerve
 Roots: Clavicular C5-C6, Sternocostal C7-C8
 Synergists:
-Adduction: Latisumus Dorsi, Teres Major
-Medial Rotation: Latissumus Dorsi, Anterior Deltoid, Teres Major
-Extension: Posterior Deltoid, Latissimus Dorsi, Teres Major
 Antagonists:
-Abduction: Deltoids, Supraspinatus
-Lateral Rotation: Infraspinatus, Teres Minor, Posterior Deltoid
-Flexion: Anterior Deltoid

Origin: Spinous Processes of T7 through L5 (via dorsolumbar
fascia), posterior surface of sacrum, iliac crest, and lower
3 ribs
 Insertion: Medial lip of Intertubercular sulcus of humerus
 Action: Shoulder extension, adduction, medial rotation,
hyperextension
 Innvervation: Thoracodorsal nerve
 Roots: C6-C8
 Synergists:
-Extension: Posterior Deltoid, Teres Major, Pectoralis Major
-Adduction: Teres Major, Pectoralis Major
-Medial Rotation: Teres Major, Petoralis Major, Subscapularis,
Anterior Deltoid
 Antagonists:
-Flexion: Anterior Deltoid, Pectoralis Major
-Abduction: Deltoids, Supraspinatus
-Lateral Rotation: Infraspinatus, Teres Minor, Posterior
Deltoid


Origin: Supraspinous fossa of the
scapula

Insertion: Greater Tubercle of the
humerus

Action: Initiates and Assists the
Deltoid Abduct the arm

Innervation: Suprascapular nerve
Root: C5 and C6

Synergist
-Abduction: Deltoids

Antagonist
-Adduction: Pectoralis Major, Teres
Major and Latissimus Dorsi

Origin: Dorsal surface of inferior angle
of the scapula
 Insertion: Medial lip of intertubercular
groove of humerus
 Action: Adducts and medially rotates
 Innervation: Lower subscapular nerve
 Root: C6 and C7
 Synergist
-Adduction: Pectoralis Major, Teres Major,
Latissimus Dorsi
-Medial Rotation: Latissimus Dorsi, Teres
Major, Subscapularis, and Pectoralis Major
 Antagonist:
-Abduction: Deltoids and Supraspinatus
-Lateral Rotation: Infranspinatus, Teres
Minor, and Posterior Deltoid

Origin: Subscapular fossa of the scapula
 Insertion: Lesser tubercle of the humerus
 Action: Shoulder Medial Rotation and
adduction, also helps hold Humeral Head
in Glenoid Cavity
 Innervation: Subscapular nerve and
Subscapular Artery
 Roots: C5-C7
 Synergists:
-Adduction: Pectoralis Major, Teres Major,
Latissumus dorsi
-Medial Rotation: Latissimus dorsi, Teres
Major, Pectoralis Major, Anterior Deltoid
 Antagonists:
-Abduction: Deltoid, Supraspinatus
-Lateral Rotation: Teres Minor, Posterior
Deltoid

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Origin: Coracoid process of the
scapula
Insertion: Medial 1/3 of the humerus
Action: Helps adduct the shoulder
joint
Innervation: Musculocutaneus nerve
Roots: C6-C7
Synergists:
-Arm Flexion: Biceps Brachii, Anterior
Deltoid
-Adduction: Subscapularis, Teres major,
Pecotalis Major
 Antagonists:
-Forearm extension: Triceps Brachii,
Posterior Deltoid
-Abduction: Deltoids, Supraspinatus

Origin: Infraspinous fossa of
the scapula
 Insertion: Greater tubercle
of the humerus
 Action: External (lateral)
Rotation
 Innervation: Suprascapular
nerve
 Root: c5 and c6
 Synergist:
-Lateral Rotation: Teres Minor
and Posterior Deltoid
 Antagonist:
-Medial Rotation: Latissimus
Dorsi, Teres Major,
Subscapularis, Pectoralis Major
and Anterior Deltoid

Origin: Superior lateral border of the scapula
 Insertion: Greater tubercle of the humerus
 Action: External Rotation, weak rotation
 Innervation: Axillary nerve
 Root: c5 and c6
 Synergist
-Lateral Rotation: Infraspinatus and
the Posterior Deltoid
 Antagonist:
-Medial Rotation: Latissimus Dorsi,
Teres Major, Subscapularis,
Pectoralis Major,
and Anterior Deltoid

References
http://teachmeanatomy.info/upper-limb/misc/surface-anatomy/surface-anatomy-of-the-axillaanterior-and-posterior-axillary-folds/
http://uni-doctors.blogspot.com/search?q=clavipectoral+triangle
https://web.duke.edu/anatomy/Lab10/Lab11_preLab.html
http://www.science-art.com/image/?id=2961#.VF7jXtEtDVI
https://web.duke.edu/anatomy/Lab10/images/Grant's%20Atlas%206.30%20(1).jpg
http://www.musclesused.com/wp-content/uploads/2012/08/Trapezius-Muscle-3.jpg
http://med.uc.edu/labmanuals/ga/HEMATOLOGY%20AND%20CARDIOVASCULAR/
Clemente, Carmine D. Atlas, A regional Atlas of the Human Body. 6th edition. 2011
https://www.google.com/search?q=levator+scapulae&biw=1301&bih=641&source=lnms&tbm=i
sch&sa=X&ei=kD9hVJy7JsTuoASNp4CoBg&sqi=2&ved=0CAYQ_AUoAQ#tbm=isch&q=pectoralis+
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BLEVINS, GARY THE OFFICIAL MUSCLE SHEET. 2014