Pectoral Girdle, Shoulder & Arm

Helen & Shef

Scapula OsteologyAcromion Coracoid process

Lesser tubercle

Intertubercular (bicipital) groove(What structure runs through here?)

Greater tubercle

What structure does the medial scapula border of an abducted upper limb mark?

Spine of scapulaAcromion

Supraspinous fossa

Inferior angle

Infraspinous fossa

Medial border

Lateral border

What do the superior and inferior angles and the spine of the scapula mark?

Humerus Osteology

Capitulum Trochlea

Epicondyles

Shaft

Articular Head

Anatomical neck

Surgical neck

Supracondylar ridge Which nerve runs posteriorly to this structure?

Ligaments

Coracoacromial ligament -

Coracoclavicular ligaments

Sternoclavicular joint

Acromioclavicular (AC) Joint

What structures make up the coracoacromial arch?

How are the coracoclavicular ligaments commonly ruptured?

Mobility (+++) vs Stability (+)◦ Ball and socket joint◦ Shallow socket formed by glenoid fossa◦ Deepened by labrum

Supported by glenohumeral ligaments (x3) & rotator cuff muscles

Shoulder joint

PECTORAL MUSCLES QUIZ

Rotator cuff muscles◦ SITS:

Supraspinatus Infraspinatus Teres Minor Subscapularis

Pectoral Girdle Muscles (I)

T

I

S

S

Posterior Anterior

Pectoral Girdle Muscles (II)Muscle Innervation

1) Trapezius Accessory nerve (CN XI)

2) Latisimus dorsi Thoracodorsal nerve

3) Levator scapulae Dorsal scapula nerve

4) Rhomboid major Dorsal scapula nerve

5) Rhomboid minor Dorsal scapula nerve

6) Teres major Lower scapular nerve

7) Pectoralis major Medial and lateral pectoral nerve

8) Pectoralis minor Medial pectoral nerve

1 3

2

45

6

Clinical Vignettes

Tilly, a 67 year old female, presents to her GP with an ‘achy shoulder’.

On examination, she reports pain in her shoulder following abduction of her right arm between ~50 -130 degrees

Case I

Painful arc syndrome

Question #1: What terminology is used to describe this phenomenon?

Question #2: What causes painful arc syndrome?

Supraspinatus tendonitis / impingement Subacromial bursitis.

Grant is a 16 year old student and presented to A&E after falling onto his shoulder during a school rugby match.

As well as the severe pain, he complains that he cannot move his arm much.

This is what was seen on X-ray.

Case II

Axillary nerve damage due to anterior dislocation

Which nerve is most likely to have been damaged and why?

What signs would you expect to find on examination of Grant?

Loss of sensation over regimental badge area Arm hangs limply by side Loss of shoulder contour Paralysis of deltoid (& teres minor)

Samina, a 7 year old girl presents to A&E after a fall onto an outstretch arm during a skiing incident.

On examination, this is what was seen:

Case III

Fracture of the clavicle.

What is the most likely location for a clavicular fracture?

What is your diagnosis?

Middle+++ Medial

+

Lateral++

Explain the appearance of Samina’s presentation.

Paula, a 45 year old female is seen in the oncology clinic for a follow up appointment after her surgery.

On examination, when asked to push her hands against the wall, this is seen.

Case IV

Winging of the scapula

What is this condition known as?

What is the cause of this condition? Damage to the long thoracic nerve of

bell which innervates serratus anterior.

What surgical procedure is she likely to have just undergone?

Breast surgery involving axillary node clearance.