Scapular Dyskinesis
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List: Bones & Bone Markings of Appendicular Skeleton and Knee
List: Bones & Bone markings of Appendicular skeleton and Knee joint Lab: Handout 4 Superior Appendicular Skeleton I. Clavicle (Left or Right?) A. Acromial End B. Conoid Tubercle C. Shaft D. Sternal End II. Scapula (Left or Right?) A. Superior border (superior margin) B. Medial border (vertebral margin) C. Lateral border (axillary margin) D. Scapular notch (suprascapular notch) E. Acromion Process F. Coracoid Process G. Glenoid Fossa (cavity) H. Infraglenoid tubercle I. Subscapular fossa J. Superior & Inferior Angle K. Scapular Spine L. Supraspinous Fossa M. Infraspinous Fossa III. Humerus (Left or Right?) A. Head of Humerus B. Anatomical Neck C. Surgical Neck D. Greater Tubercle E. Lesser Tubercle F. Intertubercular fossa (bicipital groove) G. Deltoid Tuberosity H. Radial Groove (groove for radial nerve) I. Lateral Epicondyle J. Medial Epicondyle K. Radial Fossa L. Coronoid Fossa M. Capitulum N. Trochlea O. Olecranon Fossa IV. Radius (Left or Right?) A. Head of Radius B. Neck C. Radial Tuberosity D. Styloid Process of radius E. Ulnar Notch of radius V. Ulna (Left or Right?) A. Olecranon Process B. Coronoid Process of ulna C. Trochlear Notch of ulna Human Anatomy List: Bones & Bone markings of Appendicular skeleton and Knee joint Lab: Handout 4 D. Radial Notch of ulna E. Head of Ulna F. Styloid Process VI. Carpals (8) A. Proximal row (4): Scaphoid, Lunate, Triquetrum, Pisiform B. Distal row (4): Trapezium, Trapezoid, Capitate, Hamate VII. Metacarpals: Numbered 1-5 A. Base B. Shaft C. Head VIII. Phalanges A. Proximal Phalanx B. Middle Phalanx C. Distal Phalanx ============================================================================= Inferior Appendicular Skeleton IX. Os Coxae (Innominate bone) (Left or Right?) A. -
Scapular Winging Is a Rare Disorder Often Caused by Neuromuscular Imbalance in the Scapulothoracic Stabilizer Muscles
SCAPULAR WINGING Scapular winging is a rare disorder often caused by neuromuscular imbalance in the scapulothoracic stabilizer muscles. Lesions of the long thoracic nerve and spinal accessory nerves are the most common cause. Patients report diffuse neck, shoulder girdle, and upper back pain, which may be debilitating, associated with abduction and overhead activities. Accurate diagnosis and detection depend on appreciation on comprehensive physical examination. Although most cases resolve nonsurgically, surgical treatment of scapular winging has been met with success. True incidence is largely unknown because of under diagnosis. Most commonly it is categorized anatomically as medial or lateral shift of the inferior angle of the scapula. Primary winging occurs when muscular weakness disrupts the normal balance of the scapulothoracic complex. Secondary winging occurs when pathology of the shoulder joint pathology. Delay in diagnosis may lead to traction brachial plexopathy, periscapular muscle spasm, frozen shoulder, subacromial impingement, and thoracic outlet syndrome. Anatomy and Biomechanics Scapula is rotated 30° anterior on the chest wall; 20° forward in the sagittal plane; the inferior angle is tilted 3° upward. It serves as the attachment site for 17 muscles. The trapezius muscle accomplishes elevation of the scapula in the cranio-caudal axis and upward rotation. The serratus anterior and pectoralis major and minor muscles produce anterior and lateral motion, described as scapular protraction. Normal Scapulothoracic abduction: As the limb is elevated, the effect is an upward and lateral rotation of the inferior pole of scapula. Periscapular weakness resulting from overuse may manifest as scapular dysfunction (ie, winging). Serratus Anterior Muscle Origin From the first 9 ribs Insert The medial border of the scapula. -
Thoracic Outlet and Pectoralis Minor Syndromes
S EMINARS IN V ASCULAR S URGERY 27 (2014) 86– 117 Available online at www.sciencedirect.com www.elsevier.com/locate/semvascsurg Thoracic outlet and pectoralis minor syndromes n Richard J. Sanders, MD , and Stephen J. Annest, MD Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218 article info abstract Compression of the neurovascular bundle to the upper extremity can occur above or below the clavicle; thoracic outlet syndrome (TOS) is above the clavicle and pectoralis minor syndrome is below. More than 90% of cases involve the brachial plexus, 5% involve venous obstruction, and 1% are associate with arterial obstruction. The clinical presentation, including symptoms, physical examination, pathology, etiology, and treatment differences among neurogenic, venous, and arterial TOS syndromes. This review details the diagnostic testing required to differentiate among the associated conditions and recommends appropriate medical or surgical treatment for each compression syndrome. The long- term outcomes of patients with TOS and pectoralis minor syndrome also vary and depend on duration of symptoms before initiation of physical therapy and surgical intervention. Overall, it can be expected that 480% of patients with these compression syndromes can experience functional improvement of their upper extremity; higher for arterial and venous TOS than for neurogenic compression. & 2015 Published by Elsevier Inc. 1. Introduction compression giving rise to neurogenic TOS (NTOS) and/or neurogenic PMS (NPMS). Much less common is subclavian Compression of the neurovascular bundle of the upper and axillary vein obstruction giving rise to venous TOS (VTOS) extremity can occur above or below the clavicle. Above the or venous PMS (VPMS). -
The Erector Spinae Plane Block a Novel Analgesic Technique in Thoracic Neuropathic Pain
CHRONIC AND INTERVENTIONAL PAIN BRIEF TECHNICAL REPORT The Erector Spinae Plane Block A Novel Analgesic Technique in Thoracic Neuropathic Pain Mauricio Forero, MD, FIPP,*Sanjib D. Adhikary, MD,† Hector Lopez, MD,‡ Calvin Tsui, BMSc,§ and Ki Jinn Chin, MBBS (Hons), MMed, FRCPC|| Case 1 Abstract: Thoracic neuropathic pain is a debilitating condition that is often poorly responsive to oral and topical pharmacotherapy. The benefit A 67-year-old man, weight 116 kg and height 188 cm [body of interventional nerve block procedures is unclear due to a paucity of ev- mass index (BMI), 32.8 kg/m2] with a history of heavy smoking idence and the invasiveness of the described techniques. In this report, we and paroxysmal supraventricular tachycardia controlled on ateno- describe a novel interfascial plane block, the erector spinae plane (ESP) lol, was referred to the chronic pain clinic with a 4-month history block, and its successful application in 2 cases of severe neuropathic pain of severe left-sided chest pain. A magnetic resonance imaging (the first resulting from metastatic disease of the ribs, and the second from scan of his thorax at initial presentation had been reported as nor- malunion of multiple rib fractures). In both cases, the ESP block also pro- mal, and the working diagnosis at the time of referral was post- duced an extensive multidermatomal sensory block. Anatomical and radio- herpetic neuralgia. He reported constant burning and stabbing logical investigation in fresh cadavers indicates that its likely site of action neuropathic pain of 10/10 severity on the numerical rating score is at the dorsal and ventral rami of the thoracic spinal nerves. -
An Anatomical Illustrated Analysis of Yoga Postures Targeting the Back and Spine Through Cadaveric Study of Back Musculature Hana Fatima Panakkat1, Deborah Merrick*2
ISSN 2563-7142 ORIGINAL ARTICLE An Anatomical Illustrated Analysis of Yoga Postures Targeting the Back and Spine Through Cadaveric Study of Back Musculature Hana Fatima Panakkat1, Deborah Merrick*2 Panakkat HF, Merrick D. An Anatomical Illustrated present the findings, unique hand-drawn illustrations Analysis of Yoga Postures Targeting the Back and were used to depict the musculature found to be Spine Through Cadaveric Study of Back Musculature. highly active with each Yoga posture, with the erector Int J Cadaver Stud Ant Var. 2020;1(1):33-38. spinae muscles appearing prominent throughout. The combined approach of using hand-drawn illustrations Abstract with cadaveric dissection to present the anatomical Back pain is a debilitating lifestyle disease that affects analysis has allowed a seamless understanding of a large proportion of the world’s population at some complex anatomical concepts alongside the nuances point in their life. Absences from work due to this of intricate gross anatomy. This study highlights the have a huge economic impact on the patient, their importance of the inclusion of cadaveric dissection employer and the healthcare providers who seek to as a pedagogical tool in medical curriculum through support their recovery. Unfortunately, back pain is exploring the anatomical basis of Yoga, also allowing often resistant to treatment and intervention, therefore the possibility of using the workings of Yoga to aid alternative therapies such as Yoga are being explored. anatomical teaching. A greater understanding of this Within the literature, five Yoga postures were may help guide personalized Yoga regimes, which may identified to be associated with reduced back pain allow alternative therapies to become integrated into in patients suffering from Chronic lower back pain. -
Erector Spinae Plane Block Versus Retrolaminar Block a Magnetic Resonance Imaging and Anatomical Study
Regional Anesthesia & Pain Medicine: first published as 10.1097/AAP.0000000000000798 on 1 October 2018. Downloaded from REGIONAL ANESTHESIA AND ACUTE PAIN BRIEF TECHNICAL REPORT Erector Spinae Plane Block Versus Retrolaminar Block A Magnetic Resonance Imaging and Anatomical Study Sanjib Das Adhikary, MD,* Stephanie Bernard, MD,† Hector Lopez, MD,‡ and Ki Jinn Chin, FRCPC§ As with the ESP block, it has been postulated that the clinical ef- Background and Objectives: The erector spinae plane (ESP) and fects of the retrolaminar block may be explained by spread of lo- retrolaminar blocks are ultrasound-guided techniques for thoracoabdominal cal anesthetic into the paravertebral space,6 but this mechanism wall analgesia involving injection into the musculofascial plane between has never been systematically investigated. However, there are the paraspinal back muscles and underlying thoracic vertebrae. The ESP significant anatomical and technical differences between the 2 block targets the tips of the transverse processes, whereas the retrolaminar techniques: the retrolaminar block targets the lamina instead of block targets the laminae. We investigated if there were differences in the transverse process, and thus the injection point is more medial injectate spread between the 2 techniques that would have implications and deeper. The muscle layer over the lamina and adjacent to the for their clinical effect. spinous processes is thicker, being composed of the spinalis portion Methods: The blocks were performed in 3 fresh cadavers. The ESP and of the erector spinae muscle group as well as the transversospinalis retrolaminar blocks were performed on opposite sides of each cadaver at muscle group, which comprises the multifidus, rotatores, semis- the T5 vertebral level. -
Bone Limb Upper
Shoulder Pectoral girdle (shoulder girdle) Scapula Acromioclavicular joint proximal end of Humerus Clavicle Sternoclavicular joint Bone: Upper limb - 1 Scapula Coracoid proc. 3 angles Superior Inferior Lateral 3 borders Lateral angle Medial Lateral Superior 2 surfaces 3 processes Posterior view: Acromion Right Scapula Spine Coracoid Bone: Upper limb - 2 Scapula 2 surfaces: Costal (Anterior), Posterior Posterior view: Costal (Anterior) view: Right Scapula Right Scapula Bone: Upper limb - 3 Scapula Glenoid cavity: Glenohumeral joint Lateral view: Infraglenoid tubercle Right Scapula Supraglenoid tubercle posterior anterior Bone: Upper limb - 4 Scapula Supraglenoid tubercle: long head of biceps Anterior view: brachii Right Scapula Bone: Upper limb - 5 Scapula Infraglenoid tubercle: long head of triceps brachii Anterior view: Right Scapula (with biceps brachii removed) Bone: Upper limb - 6 Posterior surface of Scapula, Right Acromion; Spine; Spinoglenoid notch Suprspinatous fossa, Infraspinatous fossa Bone: Upper limb - 7 Costal (Anterior) surface of Scapula, Right Subscapular fossa: Shallow concave surface for subscapularis Bone: Upper limb - 8 Superior border Coracoid process Suprascapular notch Suprascapular nerve Posterior view: Right Scapula Bone: Upper limb - 9 Acromial Clavicle end Sternal end S-shaped Acromial end: smaller, oval facet Sternal end: larger,quadrangular facet, with manubrium, 1st rib Conoid tubercle Trapezoid line Right Clavicle Bone: Upper limb - 10 Clavicle Conoid tubercle: inferior -
Anatomy, Shoulder and Upper Limb, Shoulder Muscles
Eovaldi BJ, Varacallo M. Anatomy, Shoulder and Upper Limb, Shoulder Muscles. [Updated 2018 Dec 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534836/ Anatomy, Shoulder and Upper Limb, Shoulder Muscles Authors Benjamin J. Eovaldi1; Matthew Varacallo2. Affilations 1 University of Tennessee HSC 2 Department of Orthopaedic Surgery, University of Kentucky School of Medicine Last Update: December 3, 2018. Introduction The shoulder joint (glenohumeral joint) is a ball and socket joint with the most extensive range of motion in the human body. The muscles of the shoulder dynamically function in performing a wide range of motion, specifically the rotator cuff muscles which function to move the shoulder and arm as well as provide structural integrity to the shoulder joint. The different movements of the shoulder are: abduction, adduction, flexion, extension, internal rotation, and external rotation.[1] The central bony structure of the shoulder is the scapula. All the muscles of the shoulder joint interact with the scapula. At the lateral aspect of the scapula is the articular surface of the glenohumeral joint, the glenoid cavity. The glenoid cavity is peripherally surrounded and reinforced by the glenoid labrum, shoulder joint capsule, supporting ligaments, and the myotendinous attachments of the rotator cuff muscles. The muscles of the shoulder play a critical role in providing stability to the shoulder joint. The primary muscle group that supports the shoulder joint is the rotator cuff muscles. The four rotator cuff muscles include:[2] • Supraspinatus • Infraspinatus • Teres minor • Subscapularis. Structure and Function The upper extremity is attached to the appendicular skeleton by way of the sternoclavicular joint. -
The Painful Shoulder Part II: Common Acute & Chronic Disorders
The Painful Shoulder Part II: Common Acute & Chronic Disorders © Jackson Orthopaedic Foundation www.jacksonortho.org Presenters AJ Benham, DNP, FNP, ONC Kathleen Geier, DNP, FNP, ONC Jackson Orthopedic Foundation 3317 Elm Street - Suite 102 Oakland, CA 94609 [email protected] [email protected] http://www.orthoprimarycare.info/ Conflict Of Interest Disclosures We hereby certify that, to the best of our knowledge, no aspect of our current personal or professional situation might reasonably be expected to affect significantly our views on the subject on which we are presenting. Objectives • 1. Differentiate among common conditions associated with shoulder pain based on history and physical exam • 2. Formulate plans for imaging and treatment of specific shoulder conditions according to evidence based guidelines. • 3. Discuss indications & appropriate communication techniques for referral of patients with shoulder conditions to services including PT, surgery, etc. Common Sites of Shoulder Pain A A good place for a chart ACUTE CHRONIC • Fractures • Impingement Syndrome Humerus • Frozen Shoulder Clavicle Adhesive capsulitis Scapula • Biceps Tendonitis • *Dislocations • Labral Injury Humerus SLAP Tear AC Joint • Osteoarthritis SC Joint Glenohumeral • *Rotator Cuff Tear Acromioclavicular S.I.T.S. Muscles • Osteolysis Distal clavicle Shoulder Landmarks A A good place for a chart More Shoulder Landmarks A A good place for a chart Musculoskeletal Exam • Inspection • Palpation * • Range of Motion • Resisted Strength • Sensation • Provocative Testing * One joint above; one below www.jacksonortho.org ACUTE CHRONIC • Fractures • Impingement Syndrome Clavicle • Frozen Shoulder Humerus Adhesive capsulitis Scapula • Biceps Tendonitis • *Dislocations • Labral Injury Humerus SLAP Tear AC Joint • Osteoarthritis SC Joint Glenohumeral • *Rotator Cuff Tear Acromioclavicular S.I.T.S. -
Anatomy and Physiology II
Anatomy and Physiology II Review Bones of the Upper Extremities Muscles of the Upper Extremities Anatomy and Physiology II Review Bones of the Upper Extremities Questions From Shoulder Girdle Lecture • Can you name the following structures? A – F • Acromion F – B B • Spine of the Scapula G – C • Medial (Vertebral) Border H – E C • Lateral (Axillary) Border – A • Superior Angle E I – D • Inferior Angle – G • Head of the Humerus D – H • Greater Tubercle of Humerus – I • Deltoid Tuberosity Questions From Shoulder Girdle Lecture • Would you be able to find the many of the same landmarks on this view (angles, borders, etc)? A • Can you name the following? – D • Coracoid process of scapula C – C D B • Lesser Tubercle – A • Greater Tubercle – B • Bicipital Groove (Intertubercular groove) Questions From Upper Extremities Lecture • Can you name the following structures? – B • Lateral epicondyle – A • Medial epicondyle A B Questions From Upper Extremities Lecture • Can you name the following landmarks? – C • Olecranon process – A • Head of the radius – B D • Medial epicondyle B A – D C • Lateral epicondyle Questions From Upper Extremities Lecture • Can you name the following bones and landmarks? – Which bone is A pointing to? • Ulna – Which bone is B pointing A to? • Radius E – C B • Styloid process of the ulna – D • Styloid process of the radius C – E D • Interosseous membrane of forearm Questions From Upper Extremities Lecture • Can you name the following bony landmarks? – Which landmark is A pointing to? • Lateral epicondyle of humerus – Which -
Section 1 Upper Limb Anatomy 1) with Regard to the Pectoral Girdle
Section 1 Upper Limb Anatomy 1) With regard to the pectoral girdle: a) contains three joints, the sternoclavicular, the acromioclavicular and the glenohumeral b) serratus anterior, the rhomboids and subclavius attach the scapula to the axial skeleton c) pectoralis major and deltoid are the only muscular attachments between the clavicle and the upper limb d) teres major provides attachment between the axial skeleton and the girdle 2) Choose the odd muscle out as regards insertion/origin: a) supraspinatus b) subscapularis c) biceps d) teres minor e) deltoid 3) Which muscle does not insert in or next to the intertubecular groove of the upper humerus? a) pectoralis major b) pectoralis minor c) latissimus dorsi d) teres major 4) Identify the incorrect pairing for testing muscles: a) latissimus dorsi – abduct to 60° and adduct against resistance b) trapezius – shrug shoulders against resistance c) rhomboids – place hands on hips and draw elbows back and scapulae together d) serratus anterior – push with arms outstretched against a wall 5) Identify the incorrect innervation: a) subclavius – own nerve from the brachial plexus b) serratus anterior – long thoracic nerve c) clavicular head of pectoralis major – medial pectoral nerve d) latissimus dorsi – dorsal scapular nerve e) trapezius – accessory nerve 6) Which muscle does not extend from the posterior surface of the scapula to the greater tubercle of the humerus? a) teres major b) infraspinatus c) supraspinatus d) teres minor 7) With regard to action, which muscle is the odd one out? a) teres -
Shoulder Shoulder
SHOULDER SHOULDER ⦿ Connects arm to thorax ⦿ 3 joints ◼ Glenohumeral joint ◼ Acromioclavicular joint ◼ Sternoclavicular joint ⦿ https://www.youtube.com/watch?v=rRIz6oO A0Vs ⦿ Functional Areas ◼ scapulothoracic ◼ scapulohumeral SHOULDER MOVEMENTS ⦿ Global Shoulder ⦿ Arm (Shoulder Movement Joint) ◼ Elevation ◼ Flexion ◼ Depression ◼ Extension ◼ Abduction ◼ Abduction ◼ Adduction ◼ Adduction ◼ Medial Rotation ◼ Medial Rotation ◼ Lateral Rotation ◼ Lateral Rotation SHOULDER MOVEMENTS ⦿ Movement of shoulder can affect spine and rib cage ◼ Flexion of arm Extension of spine ◼ Extension of arm Flexion of spine ◼ Adduction of arm Ipsilateral sidebending of spine ◼ Abduction of arm Contralateral sidebending of spine ◼ Medial rotation of arm Rotation of spine ◼ Lateral rotation of arm Rotation of spine SHOULDER GIRDLE ⦿ Scapulae ⦿ Clavicles ⦿ Sternum ⦿ Provides mobile base for movement of arms CLAVICLE ⦿ Collarbone ⦿ Elongated S shaped bone ⦿ Articulates with Sternum through Manubrium ⦿ Articulates with Scapula through Acromion STERNOCLAVICULAR JOINT STERNOCLAVICULAR JOINT ⦿ Saddle Joint ◼ Between Manubrium and Clavicle ⦿ Movement ◼ Flexion - move forward ◼ Extension - move backward ◼ Elevation - move upward ◼ Depression - move downward ◼ Rotation ⦿ Usually movement happens with scapula Scapula Scapula ● Flat triangular bone ● 3 borders ○ Superior, Medial, Lateral ● 3 angles ○ Superior, Inferior, Lateral ● Processes and Spine ○ Acromion Process, Coracoid Process, Spine of Scapula ● Fossa ○ Supraspinous, Infraspinous, Subscapularis, Glenoid SCAPULA