Upper Extremity Notes - Shoulder and Axilla

Median, ulnar, musculocutaneous, radial, and axillary nerves.

It helps to absorb force/shocks from the upper extremity and supports the joint anteriorly and posteriorly.

Specialized immune system structures containing lymphoid follicles and lymphocytes, placed to increase antigen-immune cell interactions.

The major nerve network supplying the upper limb, beginning in the neck and ending in the axilla.

Increases in the neck/shoulder angle or a compressive force like a heavy backpack; Erb-Duchenne palsy (waiter's tip position) can result.

The costoclavicular ligament, which anchors the clavicle to the 1st rib.

The scapulohumeral muscles, including the deltoid, teres major, and the muscles of the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis).

Dorsal scapular, long thoracic, suprascapular, and nerve to subclavius.

Stability.

It is drawn superiorly by the SCM (sternocleidomastoid) muscle.

The sternal end forms the sternoclavicular joint, and the acromial end forms the acromioclavicular joint.

For attachment of the trapezoid ligament.

A roughened portion medially for attachment of the costoclavicular ligament.

Place the hand in the proper position for grasping and manipulating.

1. Forms a strut to keep the arm and scapula away from the body during movements, 2) Provides protection for neurovascular structures passing from the thorax to the upper limb, 3) Transmits shocks from the limb to the axial skeleton.

Extending the arm and laterally rotating the arm.

Into the thoracic duct.

The transverse ligament of the scapula.

Pectoralis major, pectoralis minor, subclavius, and serratus anterior.

For attachment of the conoid ligament, part of the coracoclavicular ligament.

For attachment of the subclavius muscle.

Understanding the brachial plexus and the distribution of C5-T1 nerve fibers.

Paralysis of the serratus anterior muscle or injury to the long thoracic nerve.

To protect the supraspinatus tendon from wear against the inferior surface of the acromion.

Supraspinatus, infraspinatus, teres minor, and subscapularis.

Subscapularis.

By the merging of two brachial veins and the basilic vein.

Deltoid atrophy, a hollow just inferior to the acromion, and lateral, proximal anesthesia.

It holds the humeral head in place, preventing inferior slipping from the glenoid cavity.

From proximal to distal, broken down by regions: shoulder, axilla, brachium, cubital fossa/elbow, antebrachium, and wrist/hand.

At the junction of the middle and lateral thirds of the bone.

They are the only points of attachment for the upper limbs to the trunk and function as a ball-and-socket joint.

Clavicular head (flexes the humerus and is a powerful horizontal adductor) and sternocostal head (extends the humerus from a flexed position).

Draws the scapula anteriorly and inferiorly against the thoracic wall.

The cervicoaxillary canal, found between the 1st rib, superior edge of the scapula, and the clavicle.

The intertubercular groove of the humerus.

The superior, middle, and inferior glenohumeral ligaments.

The first part has 1 branch, the second part has 2 branches, and the third part has 3 branches.

The subscapular artery bifurcates into the thoracodorsal artery, which supplies the latissimus dorsi muscle, and the circumflex scapular artery, which supplies blood to posterior scapular muscles and participates in scapular anastomoses.

Radial nerve and profunda brachii artery.

A pyramid-shaped, fat-filled space inferior to the glenohumeral joint and between the lateral thoracic wall and the upper extremity.

Adducting and medially rotating the arm, and stabilizing the humeral head.

To support, stabilize, and move the pectoral girdle.

Paralysis and anesthesia.

The shallow, ball-and-socket glenohumeral joint and the conceptual scapulothoracic joint.

The interclavicular ligament, which attaches the medial ends of the clavicles with the superior border of the manubrium of the sternum.

By their relation to the axillary artery in the axilla: medial, lateral, and posterior.

Protracts the scapula and rotates the scapula so that the glenoid tips superiorly when the inferior fibers are isolated.

The medial edge of the scapula protrudes posteriorly, appearing like a wing, especially when the patient leans forward against a wall.

The coracohumeral ligament.

Most dislocations are inferior, though they are referred to as 'anterior' or 'posterior' according to their relative position with the long head of the triceps on the infraglenoid tubercle.

The anterior and posterior circumflex humeral arteries, which encircle the surgical neck of the humerus.

The subclavian vein.

To provide a passageway for neurovascular structures from the upper extremity to the neck and vice versa.

Arm abduction.

Flexing the arm and medially rotating the arm.

The lateral cord.

The subscapular nerves (upper, middle, lower).

Force on an outstretched arm or at the shoulder.

The supraspinatus muscle.

The sternoclavicular joint.

The medial pectoral nerve, medial cutaneous nerve of the arm, and medial cutaneous nerve of the forearm.

To evaluate the status of a malignancy, usually breast cancer.

Elevation/depression, protraction/retraction, and superior/inferior rotation.

Superior (C5-6), middle (C7), and inferior (C8-T1).

Anchors and depresses the clavicle.

In the loose connective tissue layer, immediately deep to the skin.

The axillary artery and vein, cords of the brachial plexus, and lymphatic vessels.

Medially to the margin of the glenoid and laterally to the anatomical neck of the humerus.

The ratio of movement in shoulder elevation, with 2 degrees at the glenohumeral joint for every 1 degree at the scapulothoracic joint.

The thoracoacromial trunk has 4 branches: deltoid, clavicular, pectoral, and acromial. It emerges from the proximal second part of the axillary artery, medial to the pectoralis minor muscle.

Circumflex scapular artery.

Supraspinatus.

The deltoid muscle has unipennate fibers (anteriorly and posteriorly) and multipennate fibers (middle part).

The scapula and clavicle.

Supraspinous, infraspinous, and subscapular fossae.

The upper extremity sacrifices stability for mobility, while the lower extremity sacrifices some mobility for stability.

Pectoralis major, pectoralis minor, subclavius, and serratus anterior.

Powerful adduction and medial rotation.

Superior, inferior, medial, lateral, anterior, and posterior.

Their sources in the brachial plexus, not their relative positions in the body.

The axillary artery is a continuation of the subclavian artery as it crosses the lateral border of the 1st rib.

Into 3 parts.

Supraspinatus.

Suprascapular artery, dorsal scapular artery, posterior intercostal arteries, and circumflex scapular artery.

The apical nodes.

In the axilla or infraclavicular region.

Clearing the filtrate from capillary beds and returning extravascular fluid to the venous circulation in the neck.

The medial half is convex anteriorly, and the lateral half is concave anteriorly.

Lymphedema, caused by the inability to clear lymph in the subcutaneous tissues normally.

The anterior rami of the caudal 4 cervical spinal nerves (C5-C8) and the first thoracic spinal nerve (T1).

By deep fascial coverings, including the brachial and antebrachial fascia, septa, and an interosseous membrane.

They are largely responsible for holding the humeral head in the joint.

Because the glenoid cannot rotate superiorly.

An extrinsic structure consisting of the bony parts and the coracoacromial ligament, preventing the humeral head from becoming displaced superiorly.

The superior (or supreme) thoracic artery, which supplies the subclavius muscle, intercostal muscles, some of the serratus anterior, and pectoral muscles.

A communication between arteries.

In 5 distinct groups: humeral, subscapular, pectoral, central, and apical.

The tickle reflex.

11 side branches.

The thoracodorsal nerve.

Subclavian vein puncture for central catheter insertion.

Trauma when the upper limb is suddenly pulled superiorly, stretching the axilla; Klumpke paralysis can result, affecting the short muscles of the hand and causing a 'claw hand'.

Sternoclavicular joint movement is coupled to scapular movements.

A plane-type synovial joint.

The axillary artery.

The pectoralis major and minor muscles and the associated fascia (pectoral and clavipectoral).

To bridge over the intertubercular groove and hold the tendon of the long head of the biceps in place.

To form a cuff around the humeral head and keep it in the glenoid cavity.

Posterior circumflex humeral artery and axillary nerve.

Inferior border of teres major and lateral/long heads of the triceps brachii.

The axilla virtually flattens, leaving its contents vulnerable to damage.

The conoid ligament and the trapezoid ligament.

The thoracic wall (ribs 1-4, intercostal muscles) and the overlying serratus anterior muscle.

To protect the subscapularis tendon from excessive wear.

The AC ligament is not as strong as the CC ligament, and a 'separation' occurs when the CC ligament is ruptured, causing the humeral head to fall away from the glenoid, the acromion to become more prominent, and the distal clavicle to appear elevated.

The lateral thoracic artery supplies the pectoral muscles, serratus anterior muscle, intercostal muscles, and the lateral aspect of the breast. It comes from the distal second part of the axillary artery, lateral to the pectoralis minor.

Teres minor, teres major, and medial border of the long head of the triceps brachii.

Humerus fractures at the surgical neck, dislocations of the humeral head, and incorrect crutch use.

Skin, subcutaneous tissue, and axillary fascia from the arm to about the 4th rib.

The scapula/subscapularis muscle, and more inferiorly, the teres major and latissimus dorsi muscles.

A conceptual or 'physiologic' joint involving the movement of the anterior surface of the scapula gliding across the surface of the ribs.

Caused by throwing or other overhead repeated, strenuous movements, usually in the anterosuperior aspect of the labrum. Symptoms include pain with the throwing motion, and abduction/lateral rotation may cause a popping or snapping.

Superiorly: inferior border of teres minor; inferiorly: superior border of teres major; laterally: surgical neck of the humerus; medially: lateral border of the long head of the triceps brachii.

Repetitive motion activities such as baseball, weightlifting, and swimming.

The arrangement of the humeral head with a small area of articulation in the shallow glenoid cavity.

It ends at the brachial artery, which continues off the axillary artery at the inferior border of the teres major muscle.

One for the passage of the tendon of the long head of the biceps brachii muscle and the other as a communication with the subscapular bursa.

Pectoralis minor muscle.

Infraspinatus and teres minor.

They provide alternate pathways of blood flow if the normal blood flow is compromised.

Inflammation and tendinitis.