Shoulder: Muscles

Muscle Innervation Function

Clavicular part flexes, medially rotates arm; acromial
Deltoid Axillary nerve part abducts arm (from 15-90 degrees), spinal part
extends and laterally rotates arm
Rhomboid major Dorsal scapular nerve Retract scapula and rotate it to depress glenoid cavity;
and minor (C4, C5) fix scapula to thoracic wall
initiates and assists deltoid in abduction of arm and acts
Supraspinatus Suprascapular nerve
with other rotator cuff muscles
laterally rotate arm, help hold humeral head in glenoid
Infraspinatus Suprascapular nerve cavity of Teres minorb middle part of lateral border
scapula
laterally rotate arm, help hold humeral head in glenoid
Teres minor Axillary nerve
cavity
Lower subscapular
Teres major adducts, medially rotates arm
nerve
Upper and lower medially rotates and adducts arm; holds humeral head
Subscapularis
subscapular nerves in glenoid cavity
Extends forearm; stabilizes elbow joint, abducts ulna
Tricep brachii Radial n.
during pronation
Shoulder - Ligaments
Rotator cuff Clinical correlates
injury --> instability of glenohumeral joint. Rupture/tear of suprastinatus tendon is
most common. Degenerative tendonitis, attrition of supraspinatus tendon -->
rotator cuff
cannot initiate abduction of upper limb. (if arm is passively abducted 15 degrees
or more, then abduction can occur with deltoid)
dislocation of
results from direct blow, "shoulder separation": severe when both AC and
acromioclavicular
coracoclavicular ligaments are torn. Shoulder separates from clavicle and falls
joint
dislocation of anterior dislocation occurs most often in young adults. Caused by excessive
glenohumeral joint extension and lateral rotation of the humerus. Can damage axillary nerve

supraspinatus calcific supraspinatus tendinitis: inflammation and calcification of subacromial

tendon bursa. Painful arc syndrome: pain occurs during 50-130 degrees of abduction

adhesive capsulitis: adhesive fibrosis and scarring between inflamed capsule

of glenohumeral joint, rotator cuff, subacromial bursa, and deltoid. Cannot abduct
glenohumeral joint
arm but can obtain an apparent abduction of up to 45 degrees by elevating and
rotating scapula.
 Shoulder – Vasculature

Affected
  Clinical correlate
structure
occurs when surgical neck of humerus is fractured; deltoid atrophies
nerves

axillary nerve unilaterally, asymmetry of shoulder outlines, loss of sensation over lateral
side of proximal part of arm (lateral cutaneous nerve of the arm)

to stop profuse bleeding, compress artery by exerting downard pressure in

axillary artery
the angle between the clavicle and the attachment of the SCM.
arteries 

dorsal scapular, suprascapular, and subscapular (via circumflex

scapular) join on anterior and posterior surfaces of the scapula. Slow
arterial
occlusion of an artery: allows collateral circulation to develop, ischemia will
anastamoses
not result. Abrupt surgical ligation of axillary a. between subscapulart and
profunda brachii will lead to ischemia of arm.

lymphangitis: inflammation of lymphatic vessels; infections of pectoral

lymph

axillary lymph
region and breast. Most commmon site of metastases of cancer to the
nodes
breast
Class notes