Pectoral Girdle and Shoulder

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<ul><li> 1. COLLEGE OF ALLIED HEALTH AND SCIENCE HERMIZAN HALIHANAFIAH Bsc Biomedicine (Hons) UKM PECTORAL GIRDLE</li></ul><p> 2. Pectoral/shoulder Girdle Upper Limb Pelvic Girdle Lower LImb 3. Pectoral Girdles </p> <ul><li>Attach the bones of upper limb to the axial skeleton. </li></ul><ul><li>Consistclavicleandscapulabones. </li></ul><ul><li>The pectoral girdles does not articulate with the vertebral column. Held in position by complex of muscle attachment. </li></ul><p> 4. Pectoral Girdles 5. </p> <ul><li>S shape </li></ul><ul><li>Also known as a collarbone </li></ul><ul><li>Classified as a long bone. </li></ul><ul><li>Medial 2/3 convex anteriorly and lateral 1/3 concave anteriorly. </li></ul><ul><li>Situated lies horizontally in the superior and anterior part of the thorax, superior to the 1 strib. </li></ul><p>CLAVICLE 6. </p> <ul><li>It acts as a strut to keep the scapula in position so the arm can hang freely. </li></ul><ul><li>Palpable region because most of the region cover by skin (subcutaneous). </li></ul><ul><li>Have several function: </li></ul><ul><li>- rigid support for the scapula and upper limb suspended. This arrangement keep upper limb (arm) away from thorax maximum ROM </li></ul><p>CLAVICLE 7. </p> <ul><li>Covers the cervicoaxillary canal (passageway between the neck and arm), through which several important structures pass (brachial plexus, artery etc) </li></ul><ul><li>Transmits physical impacts from the upper limb to the axial skeleton.</li></ul><ul><li>Provide some muscles attachment. (Deltoid, subclavius, trapezius, pec major etc) </li></ul><p>CLAVICLE 8. Clavicle 9. 10. CLAVICLE 11. CLAVICLE 12. </p> <ul><li>The medial end of the clavicle called sternal end is rounded shape articulate with clavicular notch of manubrium of sternum to form sternoclavicular joints. </li></ul><ul><li>The lateral end of the clavicle called acromial extremity is broad and flat and articulate with acromion process of scapula to form acromioclavicular joint. </li></ul><p>CLAVICLE 13. Sternoclavicular Joint 14. Acromioclavicular Joint 15. </p> <ul><li>The conoid tubercle on the inferior surface of the lateral end of the clavicle is a point attachment for the conoid ligament (coracoclavicular lig) . </li></ul><ul><li>The costal tuberosity on the inferior surface of the medial end is point attachment for the costoclavicular ligament. </li></ul><p>CLAVICLE 16. SCAPULA </p> <ul><li>Shoulder blade </li></ul><ul><li>Large bone </li></ul><ul><li>Triangular </li></ul><ul><li>Flat</li></ul><ul><li>Irregular </li></ul><p> 17. 18. 19. 20. SCAPULA </p> <ul><li>Situated in the superior part of the posterolateral aspectof the thorax between the levels of the 2 ndand 7 thribs. </li></ul><ul><li>The medial border of scapula lie about 5cm from the vertebral column. </li></ul><p> 21. Anterior View Posterior View 22. </p> <ul><li>Consist 3 border; superior, lateral (axillary) and medial (vertebra) border. </li></ul><ul><li>Consist 3 angle; superior angle, inferior angle and lateral angle. </li></ul><ul><li>Consist 3 fossa; supraspinous and infraspinous fossa (posterior) and subscapular fossa (anterior). </li></ul><p>Scapula 23. </p> <ul><li>Spine , runs diagonally across the posterior of the scapula separate supraspinous and infraspinous fossa. </li></ul><ul><li>The lateral end of spine projects as a flattened, expanded process called theacromion process . </li></ul><p>Scapula 24. </p> <ul><li>Acromion process articulate with the acromial extremity of clavicle to formacromioclavicular joint . </li></ul><ul><li>Inferior to the acromion process is a shallow depression calledglenoid cavity . </li></ul><ul><li>This cavity accepts the head of humerus to formglenohumeral joint . </li></ul><p>Scapula 25. </p> <ul><li>Medial (vertebral) border thethin edgeof the bone near to the vertebral column. </li></ul><ul><li>Lateral (axillary border) thethick edgecloser to the arm. </li></ul><ul><li>Medial border join the lateral border at theinferior angle . </li></ul><p>Scapula 26. </p> <ul><li>The superior edge of scapula , called superior border joins the vertebral border at the superior angle. </li></ul><ul><li>The scapular notch is a prominent indentation along the superior border through which the subscapular nerve passes. </li></ul><p>Scapula 27. </p> <ul><li>At the lateral end of the superior border is projection of the anterior surface calledcoracoid process , which the tendons and muscle attach. </li></ul><ul><li>Superior and inferior to the spine are two fossae;supraspinousand i nfraspinous fossa , surfaces of attachment of muscles and tendons. </li></ul><ul><li>On the anterior surface is a slightly hollowed out area calledsubscapularfossa . </li></ul><p>Scapula 28. Movements of the Scapula 29. Movements of the Scapula 30. Elevation of Scapula Superior movement of the shoulder girdle; moving the scapula up. 31. Depression of Scapula Inferior movement of the shoulder girdle; moving the scapula down. 32. Movements of the Scapula 33. Upward Rotation of Scapula Rotary movement of the scapula; moving inferior angle of scapula laterally and upward 34. Downward Rotation of Scapula Rotary movement of the scapula; moving inferior angle of scapula medially and downward. 35. Movements of the Scapula 36. Abduction/Protraction of Scapula Forward movement away the midline of the body; moving the scapula away from the spine during protraction of the shoulder girdle. 37. Adduction/Retraction of Scapula Backward movement toward the midline of the body; moving the scapula back toward the spine during retraction of the shoulder girdle. 38. Movement of the Scapulaas a Whole </p> <ul><li>Movement of the pec girdle serve to increase the range of movement (ROM) of the shoulder jt. </li></ul><ul><li>Remember!!! movements of the pectoral girdle accompany virtually to all movements of the shoulder joint. </li></ul><p> 39. Pairing of Pec Girdle andShoulder Jt Movements Abduction (protraction) Horizontal adduction Adduction (retraction) Horizontal abduction Adduction (retraction) External rotation Abduction (protraction) Internal rotationDepression / downward rotation ExtensionElevation / upward rotation FlexionDownward rotation AdductionUpward rotation Abduction Shoulder Girdle Shoulder Jt 40. Orientation Muscles of thePectoral Girdle </p> <ul><li>Muscles of the thorax that move the pectoral girdle </li></ul><ul><li><ul><li>Anterior thoracic muscles </li></ul></li></ul><ul><li><ul><li>Posterior thoracic muscles </li></ul></li></ul><ul><li>Muscles of the thorax that move the humerus. </li></ul><ul><li><ul><li>Axial muscles that move the humerus </li></ul></li></ul><ul><li><ul><li>Scapular muscles that move the humerus. </li></ul></li></ul><p> 41. Muscles of the Thorax Move the Pectoral Girdle </p> <ul><li>Anterior thoracic muscles </li></ul><ul><li>Subclavius </li></ul><ul><li>Pectoralis minor </li></ul><ul><li>Serratus anterior </li></ul><ul><li>Posterior thoracic muscles </li></ul><ul><li>Fiber of trapezius </li></ul><ul><li>Levator scapulae </li></ul><ul><li>Rhomboid minor </li></ul><ul><li>Rhomboid major </li></ul><p> 42. Muscles of the Thorax that Move the Humerus </p> <ul><li>Axial muscles </li></ul><ul><li>Pectoralis major </li></ul><ul><li>Latissumus dorsi </li></ul><ul><li>Scapular muscles </li></ul><ul><li>Fiber of deltoid </li></ul><ul><li>Rotator cuff </li></ul><ul><li>Teres major </li></ul><ul><li>Coracobrachalis </li></ul><ul><li>Long &amp; short head of biceps </li></ul><ul><li>Long head of triceps </li></ul><p> 43. ORIGIN, INSERTION, ACTIONS AND NERVE SUPPLY 44. Subclavius Muscle </p> <ul><li>Origin 1 strib </li></ul><ul><li>Insertion lower surface of clavicle </li></ul><ul><li>Action</li></ul><ul><li><ul><li>Depression and move clavicle anteriorly</li></ul></li></ul><ul><li><ul><li>Helps stabilize pectoral girdle </li></ul></li></ul><ul><li>Nerve supply </li></ul><ul><li><ul><li>Subclavian nerve </li></ul></li></ul><p>Subclavius 45. Pectoralis Minor </p> <ul><li>Origin</li></ul><ul><li><ul><li>2 nd- 5 thribs, 3 rd 5 thribs or 2 nd 4 thribs. </li></ul></li></ul><ul><li>Insertion </li></ul><ul><li><ul><li>Coracoid process of scapula </li></ul></li></ul><ul><li>Action </li></ul><ul><li><ul><li>Abduction scapula and rotates it downward </li></ul></li></ul><ul><li><ul><li>Elevate the ribs during forced inhalation. </li></ul></li></ul><ul><li>Nerve supply </li></ul><ul><li><ul><li>Medial pectoral nerve </li></ul></li></ul><p> 46. Pectoralis Minor 47. Serratus Anterior </p> <ul><li>Origin Superior 8 or 9 ribs </li></ul><ul><li>Insertion vertebral border and inferior angle of scapula </li></ul><ul><li>Action</li></ul><ul><li><ul><li>Abduction and rotates the scapula upward </li></ul></li></ul><ul><li><ul><li>Elevate ribs when scapula stabilized. </li></ul></li></ul><ul><li><ul><li>Also known as boxers muscles </li></ul></li></ul><ul><li>Nerve supply </li></ul><ul><li><ul><li>Long thoracic nerve </li></ul></li></ul><p> 48. Fiber of Trapezius </p> <ul><li>Consists 3 fibers </li></ul><ul><li>Superior or upper fiber, middle fiber and inferior or lower fiber. </li></ul><ul><li>Important for move the scapula. </li></ul><ul><li>Nerve supply - accessory nerve and cervical spinal nerve . </li></ul><p> 49. Upper / SuperiorFiber of Trapezius </p> <ul><li>Origin medial one third ofthe superior nuchal line, external occipital protuberance and ligamentum nuchae. </li></ul><ul><li>Insertion posterior border of the lateral one third of the clavicle. </li></ul><ul><li>Action scapular elevation </li></ul><p> 50. Middle Fiber of Trapezius </p> <ul><li>Origin spinous process of T1 T5 </li></ul><ul><li>Insertion medial border of the acromion process of scapula, and superior border of the spine of the scapula. </li></ul><ul><li>Action scapular adduction . </li></ul><p> 51. Lower / Inferior Fiber of Trapezius </p> <ul><li>Origin spinous process of T6-T12 </li></ul><ul><li>Insertion spine of the scapula </li></ul><ul><li>Action scapular depression and adduction </li></ul><p> 52. 53. Levator Scapulae </p> <ul><li>Origin transverse process of Superior four or five cervical vertebrae. </li></ul><ul><li>Insertion superior vertebral border of scapula </li></ul><ul><li>Action Elevates scapula and rotates it downward. </li></ul><ul><li>Nerve supply dorsal scapular nerve and cervical spinal nerve </li></ul><p> 54. Rhomboid Major </p> <ul><li>Origin Spine of 2 ndto 5 ththoracic vertebrae </li></ul><ul><li>Insertion vertebral border of scapula inferior to spine of scapula </li></ul><ul><li>Action elevates and adducts scapula and rotate it downward; stabilize scapula </li></ul><ul><li>Nerve dorsal scapular nerve </li></ul><p> 55. Rhomboid Minor </p> <ul><li>Origin Spine of 7 thcervical and 1 stthoracic vertebrae. </li></ul><ul><li>Insertion Vertebrae border of scapula superior to spine </li></ul><ul><li>Action elevates and adducts scapula and rotate it downward; stabilize scapula </li></ul><ul><li>Nerve dorsal scapular nerve </li></ul><p> 56. Clavicle origin ofPectoralis Major </p> <ul><li>Origin medial half of anterior clavicle </li></ul><ul><li>Insertion greater tubercle and intertubercular sulcus of humerus </li></ul><ul><li>Action Flexion, adduction and medial rotation arm at shoulder joint. </li></ul><ul><li>Nerve supply </li></ul><ul><li><ul><li>Medial and lateral pectoral nerve </li></ul></li></ul><p> 57. Sternal origin of Pectoralis Major </p> <ul><li>Origin anterior surface of sternum, costal cartilage of 2 nd-6 thribs. </li></ul><ul><li>Insertion greater tubercle and intertubercular sulcus of humerus </li></ul><ul><li>Action extend arm at shoulder joint. </li></ul><ul><li>Nerve supply </li></ul><ul><li><ul><li>Medial and lateral pectoral nerve </li></ul></li></ul><p> 58. Latissimus Dorsi </p> <ul><li>Origin Spines of inferior 6 thoracic vertebrae (T6-T12), lumbar vertebrae (L1-L5), crest of sacrum and illiac crest of hip bone and inferior four ribs. </li></ul><ul><li>Insertion Intertubecular sulcus of humerus </li></ul><ul><li>Action </li></ul><ul><li><ul><li>Extends, adduction and medial rotation arm at shoulder joint. </li></ul></li></ul><ul><li>Nerve supply - Thoracodorsal nerve </li></ul><p> 59. Latissimus Dorsi 60. Fiber of Deltoid </p> <ul><li>Consists 3 fibers </li></ul><ul><li>Anterior, middle and posterior fibers. </li></ul><ul><li>Responsible for movements of the humerus at GH joint </li></ul><ul><li>Nerve supply axillary nerve. </li></ul><p> 61. Anterior Fiber of Deltoid </p> <ul><li>Origin anterior border of the lateral one third of the clavicle </li></ul><ul><li>Insertion deltoid tuberosity</li></ul><ul><li>Action flexion and middle rotation arm at GH joint. </li></ul><p> 62. Middle fiber of Deltoid </p> <ul><li>Origin lateral border and superior surface of the acromion process of the scapula </li></ul><ul><li>Insertion deltoid tuberosity </li></ul><ul><li>Action abduction arm at GH joint </li></ul><p> 63. Posterior Fiber of Deltoid </p> <ul><li>Origin inferior lip of the crest of the spine of the scapula </li></ul><ul><li>Insertion deltoid tuberosity </li></ul><ul><li>Action extension and lateral rotation arm at GH joint. </li></ul><p> 64. Rotator Cuff Muscles </p> <ul><li>Consists 4 muscles </li></ul><ul><li>S Supraspinatus </li></ul><ul><li>I Infraspinatus </li></ul><ul><li>T teres minor </li></ul><ul><li>S Subscapularis </li></ul><ul><li>Group of muscles that stabilize GH joint . </li></ul><p> 65. 66. Supraspinatus Muscle </p> <ul><li>Origin supraspinous fossa of scapula </li></ul><ul><li>Insertion Greater tubercle of humerus (anterior aspect) </li></ul><ul><li>Action initially abduction (15 degrees) at shoulderjoint, stabilizing shoulder joint </li></ul><ul><li>Nerve supply - Suprascapular nerve </li></ul><p> 67. Infraspinatus Muscle </p> <ul><li>Origin Infraspinous fossa of scapula </li></ul><ul><li>Insertion Greater tubercle of humerus (posterior aspect) </li></ul><ul><li>Action Laterally rotation and adduction arm at shoulder joint </li></ul><ul><li>Nerve supply - Suprascapular nerve </li></ul><p> 68. Teres Minor </p> <ul><li>Origin Inferior lateral border of scapula </li></ul><ul><li>Insertion Greater tubercle of humerus (inferior aspect) </li></ul><ul><li>Action Laterally rotation, extends and adduction arm at shoulder joint </li></ul><ul><li>Nerve supply axillary nerve </li></ul><p> 69. Subscapularis Muscle </p> <ul><li>Origin subscapular fossa of scapula </li></ul><ul><li>Insertion lesser tubercle of humerus </li></ul><ul><li>Action Medial rotation arm at shoulderjoint </li></ul><ul><li>Nerve supply upper and lower subscapular nerve </li></ul><p> 70. Teres Major </p> <ul><li>Origin Inferior angle of scapula </li></ul><ul><li>Insertion Intertubecular sulcus of humerus </li></ul><ul><li>Action </li></ul><ul><li><ul><li>Extends arm at shoulder joint </li></ul></li></ul><ul><li><ul><li>Assist in adduction and medial rotation of arm at shoulder joint. </li></ul></li></ul><ul><li>Nerve supply </li></ul><ul><li><ul><li>Lower subscapular nerve </li></ul></li></ul><p> 71. Coracobrachialis </p> <ul><li>Origin - Coracoid process of scapula </li></ul><ul><li>Insertion - Middle of medial surface of shaft of humerus. </li></ul><ul><li>Action - Flexion and adduction arm at shoulder joint. </li></ul><ul><li>Nerve supply - Musculocutaneous nerve </li></ul><p> 72. Biceps Brachii </p> <ul><li>Consists 2 head </li></ul><ul><li>Long head and short head of biceps </li></ul><p> 73. Short head of Biceps </p> <ul><li>Origin Coracoid process of scapula </li></ul><ul><li>Insertion radial tuberosity of radius</li></ul><ul><li>Action Flexion forearm at elbow joint, flexion arm at GH joint and supination at radioulnar joint. </li></ul><ul><li>Nerve supply - Musculocutaneous nerve </li></ul><p> 74. Long head of Biceps </p> <ul><li>Origin Tubercle above the glenoid cavity of scapula (supraglenoid tubercle) </li></ul><ul><li>Insertion Radial tuberosity of radius </li></ul><ul><li>Action flexion forearm at elbow joint, flexion arm at GH joint and supination forearm at radioulnar joint. </li></ul><ul><li>Nerve supply - Musculocutaneous nerve </li></ul><p> 75. Long head of Triceps </p> <ul><li>Origin tubercle below to glenoid cavity of scapula (infraglenoid tubercle) </li></ul><ul><li>Insertion Olecranon of ulna </li></ul><ul><li>Action- Extends forearm at elbow joint , Extends arm at shoulder joint </li></ul><ul><li>Nerve supply - Radial nerve </li></ul><p>Posterior View 76. Sternomastoid / Cleidomastoid </p> <ul><li>Join together to form sternocleidomastoid muscle </li></ul><ul><li>Origin</li></ul><ul><li>(i) Sternomastoid - upper part of the anterior surface of the manubrium of sternum. </li></ul><ul><li>(ii) Cleidomastoid - superior border and anterior surface of the medial third of the clavicle. </li></ul><p> 77. </p> <ul><li>Insertion Mastoid process of the mastoid portion of temporal bone. </li></ul><ul><li>Action - Acting together, flexes the neck, raises the sternum and assists in forced inspiration. </li></ul><ul><li>Nerve supply accessory nerve (cranial nerve XI) </li></ul><p>Sternomastoid / Cleidomastoid 78. 79. 80. 81. Joints on Pectoral Girdle </p> <ul><li>There is two type of joint: </li></ul><ul><li>Sternoclavicular joint </li></ul><ul><li>Acromioclavicular joint </li></ul><p> 82. 83. Sternoclavicular Joint </p> <ul><li>Articular components </li></ul><ul><li><ul><li>Between sternal end of clavicle and clavicular notch of manubrium of sternum. </li></ul></li></ul><ul><li>Classification </li></ul><ul><li><ul><li>Synovial joint (planar) </li></ul></li></ul><ul><li>Movements </li></ul><ul><li><ul><li>Gliding, with limited movements in nearly every direction.(backward, upward, forward, downward, circumduction) </li></ul></li></ul><p> 84. 85. 86. Cont </p> <ul><li>Sternoclavicular joint strengthen by series of ligaments: </li></ul><ul><li>The Articular Capsule</li></ul><ul><li>The Anterior Sternoclavicular</li></ul><ul><li>The Posterior Sternoclavicular</li></ul><ul><li>The Interclavicular</li></ul><ul><li>The Costoclavicular</li></ul><p> 87. Sternoclavicular Ligaments 88. Articular Capsule </p> <ul><li>The articular capsule surrounds the articulation and varies in thickness and strength.</li></ul><ul><li>In front and behind it is of considerable thickness, and forms the anterior and posterior sternoclavicular ligaments; but above, and especially below, it is thin and partakes more of the character of areolar than of true fibrous tissue. </li></ul><p> 89. Anterior Sternoclavicular Ligament </p> <ul><li>The anterior sternoclavicular ligament is a broad band of fibers </li></ul><ul><li>Covering the anterior surface of the articulation</li></ul><ul><li>attachedaboveto the upper and front part of the sternal end of the clavicle, and, passing obliquely downward and medialward, is attached below to the front of the upper part of the manubrium sternum. </li></ul><p> 90. Posterior Sternoclavicular Ligament </p> <ul><li>The posterior sternoclavicular ligament is a similar band of fibers, covering the posterior surface of the articulation </li></ul><ul><li>attached above to the upper and back part of the sternal end of the clavicle, and, passing obliquely downward and medialward, is fixed below to the back of the upper...</li></ul>

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