Week Oct 7-11: Shoulder, Arm and Elbow

3B.1 Shoulder
●​ Bones of the pectoral girdle
○​ What bones make it up: this is the clavicle, and the spine of the scapula
○​ Their orientation to one another: they are in an ax orientation- where the humerus
is the handle, the clavicle and scapula make the head of the ax
○​ Clavicle
■​ How we can distinguish left or right clavicles: there is the acromial end
which attaches to the acromial process on the scapula, and a sternal end.
The sternal end is medial and acromial is lateral
●​ You can tell if it is superior or inferior based on the grooves- the
inferior side is more rough looking. Based on this I usually flip it in
my mind to see the superior side and then will use the curvature in
which the medial sternal end will be more anterior (curving
outward rather than inward)
■​ Acromial end vs sternal end

●​ Scapula
○​ *include diagram of the different surfaces (i.e. notches, fossa etc.) of the scapula
■​ Ex; supraspinous fossa
○​ Palpable surface landmarks
■​ Which levels of the spine does the scapula exist between from spine of
scapula to the inferior angle: Spine of the scapula is at T3 and the inferior
angle of the scapula is T8
●​ Easy way to make the scapula present is making an L with your
hand and putting it behind your back
○​ Scapulothoracic joint
■​ What bones does it involve: area between scapula and thorax
■​ Features (ex; type of joint): this is not a synovial joint since it is not
between bones- thus not really a joint.
■​ Movement: movement happens here but it is not to be considered
happening at this joint- it is at the sternoclavicular joint. This area will
allow for full range of motion when abducting your arm - it allows for the
lateral and medial rotation of the scapula
■​ Where it exists in comparison to other joints of shoulder (ex;
acromioclavicular joint, sternoclavicular joint, etc.): this is between the ribs
and the scapula, it is more medial than the other joints.
○​ Movements of the scapula:
■​ Elevation and depression
■​ Lateral (upward) rotation
■​ Medial (downward) rotation
■​ Protraction and retraction
●​ Clavicular ligaments
 ○​ Where they are found; what bones are involved, if applicable what joints are
involved
■​ Ligaments will restrict external separation. There are the easy ones-
acromioclavicular ligament at the acromioclavicular joint (between
acromion process and acromial end), sternoclavicular ligament at the
sternoclavicular joint (between sternal end and sternum/manubrium).
There is also costoclavicular (between rib 1 and inferior of clavicle),
coracoacromial lig (between coracoid process and acromion process),
and coracoclavicular (between coracoid process and clavicle).
○​ Where are they in relation to one another using anatomical terminology (distal,
proximal etc.)
■​ ASK A QUESTION ON THIS.
●​ Shoulder separation
○​ What ligaments it implicates, their function, and what happens to each of them
with shoulder separation (NOT dislocation): This is when the acromioclavicular
ligament between scapula and clavicle tears, also when the coracoclavicular
ligament tears (again between scapula and clavicle). Why it is called a separated
shoulder since the scapula and thus the arm is not attached to the body
●​ Humerus:
○​ Features of the humerus (ex. Lesser and greater tubercle) and where they exist
in relation to one another
■​ Head of humerus, there is the greater tubercle which is lateral to the
lesser tubercle
■​ Then there is the shaft of the humerus which has an intertubercular
groove on the anterior side and a deltoid tuberosity on the posterior side.
Also on the posterior side is the radial groove
●​ Glenohumeral joint
○​ (shoulder joint) with the head of humerus and glenoid cavity of scapula- there is a
glenohumeral labrum which cradles the head of the humerus
○​ Features and their significance
■​ Subacromial space: this is between the acromion process of the
scapula at the head of the humerus. This is a site of a muscle we will
go over soon- the supraspinatus muscle.
■​ Synovial membrane:
■​ Tendon biceps brachii (long head): this will pass through the joint cavity
and attach above the glenoid fossa- which means it crosses this
glenohumeral joint- important for movement
■​ multiaxial/ ball and socket joint- this is just what the joint
is/movements
○​ Glenohumeral joint capsule
■​ Characteristics of capsule (ex; thin but supported by ligaments)
■​ Features and significance
●​ Synovial: this is synovial joint- ball in socket
 ●​ Bursae: allow muscles to glide smoothly (know there are lots
of bumps and grooves on bones, like the tubercles and head
of humerus- this helps them with moving over it)
■​ Glenohumeral ligaments (4): Superior to inferior: coracohumeral ligament
(on the greater tubercle of humerus), superior, middle and inferior
glenohumeral ligament- they are from the glenoid fossa to the humerus)
○​ Glenohumeral joint movements- include a picture
■​ Movements and what that looks like
●​ Flexion vs extension
●​ Circumduction
●​ Rotation
●​ Adduction vs abduction
●​ Shoulder dislocation: describe the type and what type of neurovascular structures it can
affect
○​ Anterior/superior dislocation - lateral cord → musculocutaneous nerve (impact
sensation in the forearm (ASLM- american sign language member)
○​ Inferior dislocation - posterior cord → axillary nerve ( meaning it will impact
sensation on the deltoid area) ( IPA)

** for the muscles; ONLY need to memorize information from the muscles via the chart at the
end of lecture – reference that to giving students accurate information regarding what is
important **

Extra: All muscles pull not push. Muscle can only cause an action at a joint it crosses

** we are only going to include the need to know; please be familiar with the in-depth content,
but focus on the need-to-know**
AT THE END
●​ Range of motions and joints: for each of the following muscles, include where they are
located, their range (ex; 0-15 degrees), and their nerve innervation (ex, suprascapular
nerve)
○​ Glenohumeral joint
■​ Supraspinatus muscle: does the first 0-15 degrees, innervated by
supraspinatus nerve
■​ Deltoid muscle: does the 15-90, which is innervated by the axillary nerve
○​ Sternoclavicular and scapulothoracic joints
■​ Trapezius: 90-160 degrees, innervated by the spinal accessory nerve
■​ Serratus anterior: 160-180, innervated by the serratus anterior nerve

While playing football someone charged at Johnny causing him to get whiplash and damage a
nerve. Which of the following statements is correct
 a)​ Damage to the axillary nerve would weaken the supraspinatus muscle and thus
abducting 0-15 degrees would be difficult.
b)​ Damage to the serratus anterior nerve would weaken the serratus anterior muscle and
thus abducting 90-160 degrees would be difficult.
c)​ Damage to the spinal accessory nerve would weaken the trapezius and thus abducting
the arm past 90 degrees would be difficult.
d)​ Damage to a nerve would not affect the muscle function, it would only affect the
cutaneous innervation.

We learned a few different injuries, which of the following is the correct pairing
a)​ Popeye Sign- Tear in the distal biceps tendon
b)​ Winged Scapula- Damage to the long thoracic nerve
c)​ Painful Arc Syndrome- Pinch to the subscapularis muscles
d)​ Radial Head Subluxation- Pinch to the radial collateral ligament

Susan fell and hit the medial side of her elbow, which injury could we expect.
a)​ Pain in the brachioradialis muscle
b)​ Pain in the pronator teres muscle
c)​ Damage to the radial nerve
d)​ Damage to the median nerve

1)​ A&C
2)​ A&D
3)​ B&C
4)​ B&D

What are the PLT muscles (muscles that insert on the intertubercular groove)
a)​ Pectoralis Minor, Latissimus Dorsi, Trapezius
b)​ Pectoralis Minor, Levator Scapulae, Teres Minor
c)​ Pectoralis Major, Latissimus Dorsi, Teres Major
d)​ Pectoralis Major, Levator Scapulae,Teres Minor

●​ Rotator cuff: include the location/origin, insertion (ex. Proximal humerus), main actions,
and innervation for the following
** Is the S.I.T.S Muscle
○​ Subscapularis muscle: origin on anterior scapula, insertion on lesser
tubercle (think that it is anterior and lesser tubercle we know is more
medial and anterior- makes sense- front to front muscle)- innervated by
upper and lower subscapular nerves. This does medial rotation.
○​ Supraspinatus muscle: origin on supraspinous fossa and inserts on
greater tubercle (superior facet)- innervated by suprascapular nerve. This
does abduction
 ■​ Runs in the subacromial space which means it can be pinched-
causing painful arc syndrome
○​ Infraspinatus muscle: origin on infraspinous fossa, inserts on greater
tubercle (middle facet). Innervated by suprascapular nerves. Lateral
rotation (external)
○​ Teres minor muscle: origin on lateral border of scapula, insertion on
greater tubercle on inferior facet. Innervation by the axillary nerve. Also
lateral or external rotation
●​ Thoracoappendicular: include an image, the location/origin, insertion, main actions, and
innervation for the following
○​ Shoulder
■​ Deltoid muscle: origin in pectoral girdle, inserts on deltoid tuberosity,
innervated by axillary nerve
●​ Action:
●​ THESE ARE THE DAM MUSCLES
■​ Pectoralis major muscle: origin in clavicle, sternum, ribs. Insertion on
lateral lip of intertubercular groove. Innervated by pectoral nerves
●​ Action
■​ Pectoralis minor muscle: origin is ribs and insertion is coracoid process of
scapula. Innervation is pectoral nerves.
●​ Action: protraction and depression- will help with forced inhalation
■​ Subclavius muscle: origin on rib one, and inserts on clavicle. Innervated
by subclavius nerve
●​ Action
■​ Serratus anterior muscle: origin on lateral ribs, insertion on medial border
of scapula. Innervation by long thoracic
●​ Action: does protraction and rotation of scapula (upward and
downward). This also helps with forced inhalation.
○​ Paralysis of this gives winged scapula
SR. A TIS
SCapula, ribs, and thoracic InnervateS
RIP SAW
Otatuon, installation, protraction. See a Wing when long thoracic is damaged
■​ Teres major muscle: origin on lateral border and inferior angle of scapula,
inserts on medial lip of intertubercular groove. Innervated by lower
subscapular nerve- back to front muscle
●​ Action
○​ Extrinsic back- also known as thoracoappendicular muscles since they originate
on thorax and insert on the upper limb
■​ Latissimus dorsi muscle: origin thoracolumbar fascia, insertion on floor of
intertubercular groove of humerus. Innervated by thoracodorsal nerve
●​ Actions:
■​ Trapezius muscle: Origin on vertebral column, insertion on pectoral
girdle. Innervation by spinal accessory nerve
 ●​ Action:
■​ Levator scapulae muscle: origin on transverse processes of vertebrae,
insertion on superior angle of scapula- innervated by dorsal scapular
nerve.
●​ Action:
■​ Rhomboid major: spinous process of vertebra, inserts on medial border of
scapula. Innervation by dorsal scapular
■​ Rhomboid minor: spinous process of vertebrae, inserts medial border of
scapular. Innervation by dorsal scapular
** Helpful tips to touch on, PLT sandwich (pectoralis major, latissimus dorsi, teres
major)
-​ The pectoralis major, latissimus dorsi and teres major. They are inserted
on the intertubercular groove. From lateral to medial

3B.2 Arm and Elbow

●​ Osteology
○​ Joint articulations and muscle attachments of the bone in the distal humerus,
radius and ulna
■​ Ex; capitulum, trochlea, coronoid process, etc
○​ Capitulum: will articulate with the head of the radius (Head with Cap)
○​ Trochlea: will articulate with the Ulna- which has the coronoid process anteriorly,
and the olecranon process posteriorly- these will limit hyperextension and
hyperflexion.
■​ The olecranon process will posteriorly articulate with the olecranon fossa
○​ There is a medial condyle
●​ Elbow joints; where they are located in relation to one another
○​ Cubital joint: this is the humeroradial and humeroulnar joint together- can get
dislocation when the ligaments break- the ulna and radius will stay together due
to the radioulnar joint.
○​ Humeroradial joint: This is the head with cap articulation-this is lateral
○​ Humeroulnear joint: This is the ulna and trochlea- this is medial
○​ Proximal Radioulnar joint: this is between radius and ulna
●​ Elbow ligaments: where they are located on the elbow and relative to one another, and
their significance - ask which is medial vs lateral
○​ Annular ligament radius: between radius and ulna
○​ Ulnar collateral ligament: ulna to humerus- preventing addiction of elbow
○​ Radial collateral ligament: radius to humerus- preventing abduction of the elbow
●​ Radial head subluxation: when an arm is pulled and twisted. This is when the head
of the radius detaches from the ulna and the capitulum. When it gets back in place
it will pinch the annular ligament (this is the ligament holding ulna and radius
together)
*** Include the following information, the extra details or omitted information, please be aware
of, but try not to include them as we want to ensure students are memorizing priority
information. **

●​ Compartments of the arm: image, origin/location, insertion, main actions, and flexion vs
extension, and innervation - these can have compartment syndrome- pain and
inflammation- they have an intermuscular septum which separates anterior from
posterior
○​ Posterior compartment (P.R)
■​ Triceps brachii: They are the extensors and they are innervated by radial
nerves- think how the radial groove is on the posterior of the humerus.
This has two origins but one insertion: olecranon
●​ Origin of the long head is the infraglenoid tubercle of the scapula.
○​ Medial head is shaft of humerus below radial groove
○​ Lateral head is shaft of humerus above radial groove
○​ Anterior compartment: these flex the arm- innervated by musculocutaneous
(A.M) - this nerve will go through the coracobrachialis and innervate the whole
anterior arm. This will terminate as the lateral cutaneous nerve of the forearm
which innervates the skin of the forearm.
■​ Biceps brachii muscle: 2 heads- insertion on radial tuberosity and bicipital
aponeurosis. Main action is supination. Secondarily it does flexion
●​ Long head: origin supraglenoid tubercle
●​ Short Head: origin on coracoid process
■​ Coracobrachialis muscle: Origin on coracoid process and insertion on
humerus.
■​ Brachialis muscle: main flexor in forearm. Origin on shaft of humerus,
insertion on ulnar tuberosity.
●​ Popeye sign
○​ Torn tendon of the long head biceps brachii muscle- it will bunch distally
○​ Reverse popeye sign
■​ Torn biceps brachii tendon (distal)- it bunches proximal
●​ General map of where the axillary, radial and musculocutaneous nerve are found in
reference to the anterior and posterior arm.
○​ Axillary is deltoid region, radial is posterior arm and forearm, musculocutaneous
is lateral forearm
●​ Cubital fossa
MP LB SE ABA PSB
○​ What the 5 borders are
■​ Medial: pronator teres
■​ Lateral: brachioradialis
■​ Superior: imaginary line between medial and lateral epicondyles
■​ Anterior: bicipital aponeurosis
■​ Posterior: Supinator and brachialis
 ○​ What nerves it contains: It has the median nerve running through, here the radial
nerve splits into its deep and superficial branches, the brachial artery will also
split into ulnar and radial
○​ Where it is located: in the elbow region

Week Oct 21-25: Forearm and Hand

3C.1 Forearm and Wrist
●​ Osteology
○​ Radius vs ulna styloid processes
●​ Radioulnar joints
○​ Movement (supination vs protonation)
○​ Ligaments
○​ Interosseous membrane
■​ Function
●​ Wrist and hand bones
○​ Where they are located
●​ Wrist ligaments
○​ name and function
●​ Hand joints
○​ Carpometacarpal joints
○​ Metacarpophalangeal joints
○​ Proximal interphalangeal joints
○​ Distal interphalangeal joints
​ ** include the tip: I DIP, you PIP, we IP (to remember hand joints)
●​ Rheumatoid arthritis vs osteoarthritis
○​ Difference and where/which joints they occur in
*** Include the following information, the extra details or omitted information, please be aware
of, but try not to include them as we want to ensure students are memorizing priority
information. **
●​ Compartments of the forearm: include their image, location, origin (attachments),
insertion (attachments), functions and innervation
○​ Posterior compartment
■​ Supinators
●​ Supinator muscle
■​ Wrist extensors
●​ Extensor carpi radialis longus muscle
●​ Extensor carpi radialis bravis muscle
●​ Extensor carpi ulnaris muscle
■​ Digit extensors
●​ Extensor digitorum muscle
●​ Extensor digiti minimi muscle
 ●​ Extensor pollicis longus muscle
●​ Extensor pollicis brevis
●​ Abductor pollicis
●​ Extensor indices
■​ Other
●​ Anconeus muscle
●​ Brachioradialis muscle
○​ Anterior compartment
■​ Protonators
●​ Protonator teres muscle
●​ Protonator quadratus muscle
■​ Wrist flexors
●​ Flexor carpi radoalis muscle
●​ Palmaris longus muscle
●​ Flexor carpi ulnaris muscle
■​ Digit flexors
●​ Flexor digitorum superficialis muscle
●​ Flexor digitorum profundus muscle
●​ Flexor pollicis longus muscle

3C.2 Hand
●​ Transverse view of a digit
○​ Includes where extensor digitorum, flexor digitorum and flexor digitorum
superficialis are located relative to one another
●​ Palmar vs dorsal terminology with the hand
●​ Interpahalngeal joints vs metacarpophalangeal joints
○​ Types of joints that each is
●​ Actions of the fingers
○​ Flexion vs extension
■​ Metacarpophalangeal joints
■​ Interphalangeal joints
○​ Abduction and adduction
■​ Metacarpophalangeal joints
●​ Actions of the thumb
○​ Extension and flexion
■​ Metacarpophalangeal joint and interphalangeal joint
○​ Opposition and reposition
■​ Carpometacarpal joint
○​ Abduction and adduction
■​ Carpometacarpal joints (saddle)
** Include the following information, the extra details or omitted information, please be aware of,
but try not to include them as we want to ensure students are memorizing priority information. **

Muscle summary: include their origin and insertion (attachments), functions, and innervation
 ●​ Thenar eminence
○​ Abductor pollicis brevis muscle
○​ Flexor pollicis brevis muscle
○​ Opponens pollicis muscle
○​ Adductor pollicis muscle
●​ Hypthenar eminence
○​ Abductor digiti minimi muscle
○​ Flexor digiti minimi muscle
○​ Opponens digiti minimi muscle
●​ Central compartment
○​ Lumbricals
●​ Interosseus compartment
○​ Palmar interossei muscle
○​ Dorsal interossei muscle
●​ Other
○​ Palmar brevis muscle

Potential questions: do an X ray of a separated or dislocated shoulder- with ligaments torn

Ex. Separated shoulder with acromoclavicular ligament torn
Dolocated shoulder with coracolacivualr torn
PaTCH

PaTCH

PicS- P

Biceps: scapula to radius

Brachialis: main flexor

AM BBC
PR T
 EP BBBS

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