SHOULDER REGION

Development Location Features Muscles Function Scapula In cartilage Posterior wall Flat irregular bone; Shoulder musc, Transfer force (part of Spine posterior at Superior, medial, inferior tendinous cuff b/w upper limb pectoral T3 border, coracoid process, group stabilise & trunk, protext girdle) Glenoid fossa supraspinous, infraspinous and SJ, trapezius & axilla contents lateral subscapular fossa, spine, serratus a. Inferior angle at T7 acromian, glenoid fossa, supra stabilise scapula Articulate: shoulder & infra glenoid tubercle j & Key relationship: supraspinous acromioclavicular j. nerve, periscapular arterial anastomosis Clavicle In membrane Medial: sternal end Flat irregular, sternal end, Deltoid, Transfer force (part of Lateral: acromial acromial end, costoclavicular trapezius, b/w upper limn, pectoral end ligament impression, groove subclavius, scapular & girdle) Articulate: for subclavius, conoid tubercle, sternocleidomast chest wall, keep sternalclavicular j trapezoid line oid, pectoralis scapular in & major place acromialclavicular j Humerus In cartilage In arm Long, appendicular, head, Tendinous cuff Transfer force Articulate: shoulder greater & lesser & crests of musc, some ant. in arm & elbow j tubercle, intertubercular sulcus, & post. musc. to deltoid tuberosity, spiral shaft, superficial groove, medial & lateral ant. & post epicondyles & ridges, trochlea, forearm musc. to capitulum, olecranon, radial & epicondyle coronoid fossas, articular surface Key relationship: axillary, radial, ulna nerve

Joints

Joint Articulation Type Attachment Function Sternoclavicular b/w sternal end of Synovial, Costoclavicular ligament Disc (acts as ligament), clavicle & bihinge ligament & subclavius resist manibrium upward displacement of clavicle Acromiclavicular b/w acromial end of Synovial, Coracoclavicular ligament, Limit upwards displacement clavicle & acromion hinge conoid (medial), trapezoid (lateral)

Scapula movements (rotation = glenoid fossa movement) Movement Scapula movements Elevation, depression, protraction, retraction, upward rotation, downward rotation Scapulo-humeral Protraction + flexion, retraction + extension, upward rotation + rhythm abduction, downward roatation + adduction

Muscles attached to upper limb of rest of body

Muscle Movement Structure Innvervation Levator Transverse Scapula for Forms posterior Dorsal scapula scapulae process CV1 elevation, triangle floor nerve to downward rotation CV4/upper scapula border Subclavius Clavicle to Stabilises clavicle Nerve to rib 1 or rib 1, protect subclavis supply structures Pectoralis Clavicle, Shoulder j. for Forms anterior wall Lateral & major ribs 1-6 to flexion, adduction, & axilla fold medial pectoral crest medial rotation nerves Humerus greater tubercle Pectoralis Rib 3-5 to Scapula for Passes over Medial pectoral minor coracoid protraction, brachialus plexus nerve process Serratus Rib 1-8 to Scapula for Medial axilla wall anterior medial protraction, scapula upward rotation, border stabilization (pushing) Latissius Iliac crest, Shoulder j. for Forms posterior Thoracodorsal dorsi SV5 to extension, axilla fold & nerve TV7/crest of adduction, medial tendon, close to Humerus rotation e.g. climb, teres major, lesser swim, tennis Landmark: tubercle forehand boundary b/w axilla & arm, radial nerve, Rhomboid TV4 to Scapula for Dorsal scapula CV6/scapula retraction, nerve medial downward rotation border, minor superior part Trapezius Skull, Scapula for Forms border of Spinal ligamentum elevation, posterior triangle accessory nuchae, CV7 depression, nerve, part of to retraction, upward CN11 (test for TV12/spine rotation, CN11) scapula, stabilization acromion, clavicle

TOPICS OF INTEREST

UPPER LIMB FUNCTION OF THE UPPER LIMB Infant development of upper limb function – grasp, power, precision Wallace. P. S. and Whishaw. I. Q. 2003. “Independent digit movements and precision grip patters in 1-5 month old human infants…” Neuropsychologia. V41. P 1912-1918.

• During the first to fifth months of infancy the function of the hand develops due to the developing motor system. During this period spontaneous hand movement’s progress to vacuous movement and then self directed grasp. Such movements include fists, pre-precision grip digit orientation, precision grip and self-directed grasp.

SHOULDER REGION Artificial shoulder joint • Hyaline cartilage on the articular surfaces of the humeral head and glenoid fossa of the shoulder joint wears away in conditions such as arthritis. The bones rub on each other and cause pain. An artificial shoulder joint is constructed by replacing the humeral head with an artificial one by sectioning the humerus at the surgical/anatomical neck and hollowing out a portion of the proximal marrow within the shaft. The glenoid fossa is widened and lined with an artificial smooth surface. • Required for reduced pain and increased mobility

ARM AND ELBOW REGIONS Ulna nerve lesion at the elbow • The ulna nerve passes under the medial epicondyle of the Humerus near the elbow and it is in this area in which it can be pinched. This is known as cubital tunnel syndrome. • It can be caused by external trauma or internally compressed, most commonly, between the heads of FCU. It can also be caused by a deformity known as cubitus valgus where the elbow is turned outwards, causing ligaments and muscles to strain against the medial epicondyle of the Humerus. • Compression causes numbness or pain in the EJ, hand, WJ or fingers. It can lead to muscle wasting and a claw hand deformity • Ulna nerve lesions affect movements requiring flexion of the elbow joint, however extension of the elbow joint may relieve the pressure on the ulna nerve at the area. • It is treated through injects, NSAIDs or surgery.

FOREARM AND WRIST REGION Radial pulse • The radial pulse is the most common site for counting the pulse and enables both assessment of the heart rate and the quality. The radial pulse is found at lateral to the FCR and proximal to the thumb, which is the location of the radial artery at the wrist joint. The pulse is best taken with finger pads of the index and middle finger with the patient either laying down or sitting. The EJ should be flexed with the forearm and hand in the same horizontal plane with the palmer side facing superiorly.

THE HAND 1 Arthritis of the hand Sambrook. P. et al ’01. “The Musculoskeletal System”. Chapter 1 and 6. Synovial joints are susceptible to inflammatory injuries resulting in arthritis. Rheumatoid arthritis is a systemic chronic inflammatory autoimmune disease that causes nonsuppurative synovitis of the joints. In early stages, the synovial lining of