ANATOMY-SURGERY: CLAVICLE, SHOULDER,
AXILLA
CLAVICULAR FRACTURE
- MOST COMMONLY FRACTURED BONE
IN THE BODY
- FIGURE OF 8 SPLINT
CLEIDOCRANIAL DYSTOSIS
- “DYSPLASIA CLEISOCRANIAL OR MARIE-
SAINTON DISEASE”
- DEFECTIVE INTRAMEMBRANOUS
OSSIFICATION
- AGENESIS OF THE CLAVICLE AND SKULL
CAP
PECTORAL GIRDLE
- SCAPULA
o SUPERIOR ANGLE→ 2ND RIB
o SPINE→ 3RD RIB
o INFERIOR ANGLE→ 7TH RIB
o SUPRACAPSULAR FORAMEN→
TRANSMIT THE
SUPRACAPSULAR NERVE
o ACROMION→ POINT OF THE
SHOULDER
FRACTURES
SCAPULAR FRACTURE
- RESULT SEVERE TRAUMA
- RUN-OVER ACCIDENTS VICTIMS,
VEHICUAR CRASHES
- REQUIRE LITTLE TREATMENT
STERNOCLAVICULAR JOINT
- SADDLE JOINT
- ONLY TRUE JOINT BETWEEN THE UPPER
EXTREMITY AND AXIAL SKELETON
ACROMIOCLAVICULAR JOINT
- STABILIZED BY ACROMIOCLAVICULAR
LIGAMENT
SHOULDER SEPARATION
- ACROMIOCLAVICULAR JOINT
DISLOCATION
- CORACOCLAVICULAR LIGAMENT TEAR
(CCL)
- HPE
o TACKLING IN FOOTBALL
o FALL ON TIP OF SHOULDER
SHOULDER DISLOCATION
ANTERIOR DISLOCATION
- MORE COMMON
- HUMERAL HEAD IN THE
SUBARACHNOID POSITION
- AXILLARY NERVE CAN BE DAMAGED
POSTERIOR DISLOCATION
- HUMERAL HEAD IN THE SUBGLENOID
POSITION
NERVE/S THAT CAN BE INJURED
- AXILLARY NERVE→” ILL FITTED
CRUTCHES”
- RADIAL NERVE
MOST COMMON LOCATION:
SHOULDER- ANTERIOR
ELBOW- POSTERIOR
HIP- POSTERIOR
GLENOHUMERAL JOINT→ MOST COMMONLY
DISLOCATED JOINT
- ANTERIOR> POSTERIOR
BANKART LESION→ TEAR IN GLENOID LABRUM
HILL-SACH’S LESION→ COMPRESSION
FRACTURE OF THE HUMERAL HEAD
TX→ CLOSED REDUCTION
“STIMSON/HIPPOCRATIC TECHNIQUE”
SHOULDER
- PROXIMAL HUMERUS
o SURGICAL NECK
▪ AXILLARY NERVE
 ▪ POSTERIOR HUMERAL ROTATOR CUFF MUSCLES
CIRCUMFLEX ARTERY - ALL INSERTS INTO GREATER TUBEROSITY
o MIDSHAFT SPIRAL GROOVE EXCEPT SUBSCAPULARIS (LESSER
▪ RADIAL NERVE TUBEROSITY)
▪ PROFUNDA BRACHII - SUPRASPINATUS ABDUCTS
o BICIPITAL/INTERTUBERCULAR - INFRASPINATUS AND TERES MINOR
GROOVE LATERALLY ROTATES
▪ LONG HEAD OF BICEPS - SUBSCAPULARIS MEDIALLY ROTATES
BRACHII
SHOULDER JOINT SHOULDER
- CLENOID LABRUM SLIGHTLY DEEPENS QUADRANGULAR SPACE
GLENOID CAVITY - AXILLARY NERVE
- STABILIZED BY ROTATOR CUFF MUSCLE - POSTERIOR CICUMFLEX HUMERAL
- WEAKEST AREA→ INFERIOR (PRONE TO VESSELS
DISLOCATION - BORDER:
o SUPERIOR: SUBSCAPULARIS
ROTATOR CUFF MUSCLES o LATERAL: HUMERUS
- SUPPORTS THE HUMERAL HEAD TO THE o INFERIOR: TERES MAJOR
GLENOID FOSSA o MEDIAL: TRICEPS (LONG HEAD)
- SITS MUSCLE TRIANGULAR INTERVAL
o SUPRASPINATUS→ INITATES - RADIAL NERVE
ABDUCTION (FIRST 15 DEG) - PROFUNDA BRACHII ARTERY
▪ ABDUCTOR TRIANGULAR SPACE
▪ SUPRASCAPULAR N. - SCAPULAR CIRCUMFLEX VESSELS
o INFRASPINATUS
▪ LATERAL/EXTERNAL ABDUCTION→ 180 DEGRESS
ROT - ANY OF THESE MUSCLE IS DAMAGE,
▪ SUPRASCAPULAR N YOU WILL NOT ABLE TO ABDUCT
o TERES MINOR SHOULDER
▪ LATERAL EXTERNAL - SHOULDER JOINT→ 120 DEGRESS
ROTATOR o SUPRASPINATUS INITATES ARM
▪ AXILALRY N. ABDUCTION
o SUBSCAPULARIS o DELTOID CONTINUES AFTER THE
▪ MEDIAL/ INTERNAL ROT FIRST 15 DEGREES
▪ UPPER SUBSCAPULAR - SCAPULAR ROTATION 60 DEGREES
N. o SERRATUS ANTERIOR→ LONG
o DELTOID (NOT PART OF SITS THORACIC NERVE
BUT PART OF INTRINSIC o TRAPEZIUS→ INNERVTAED BY
MUSCLE) CN 11 ACESSORY NERVE FOUND
▪ ABDUCTOR IN POSTERIOR TRIANGLE OF
▪ AXILLARY N. THE NECK

SUPRASPIANTUS TENDINITIS AND RUPTURE

SUPRASPINATUS TENDINITIS
- AKA SUBRACROMIAL BURSITIS,
PERICAPSULITIS
- PAINFUL ARC
SUPRASPINATUS RUPTURE
- CANNOT INITATE ABDUCTION
DORSAL SCAPULAR NERVE
- RHOMBOID MINOR
- RHOMBOID MAJOR
- LEVATOR SCAPULAE
DUPRASCAPULAR NERVE
- SUPRASCAPULAR FORAMEN
- SUPRASPINATUS
- INFRASPINATUS
PECTORAL NERVES
LATERAL PECTORAL NERVE
- PECTORAL MAJOR
MEDIAL PECTORAL NERVE
- PECTORALIS MINOR
- PECTORALIS MAJOR
UPPER AND LOWER SUBSCAPULAR NERVES
SUBSCAPULARIS
- UPPER SUBSCAPULAR NERVE
- LOWER SUBSCAPULAR NERVE
TERES MAJOR
- LOWER SUBSCAPULAR NERVE
MIDDLE SUBSCAPULAR NERVE
- “THORACODORSAL NERVE
- LATISSIMUS DORSI
THORACODORSAL NERVE INJURY
HPE
- BREAST CA SURGERY “MASTECTOMY”
- PATIENT CANNOT USE AXILLARY
CRUTCHES
BLOOD SUPPLY:
SUBCLAVIAN ARTERY FROM ARCH OF AORTA
- DIVIDED INTO 3 PARTS BY SCALENOUS
ANTERIOR MUSCLE
FIRST PART
- VERTEBRAL
- THYROCERVIAL
- INTERNAL THORACIC
SECOND PART
- COSTOCERVICAL
THIRD PART
AXILLARY SHEATH
- CONTENTS: AXILLARY VESSELS AND
BRACHIAL PLEXUS
- EXTENSION OF PREVERTEBRAL LAYER
OF DEEP CERVICAL FASCIA
- AXILLARY SHEATH IS CONTINOUS WITH
THE PREVERTEBRAL FASCIA
AXILLARY ARTERY FROM SUBCLAVIAN A.
- DIVIDED INTO 3 PARTS BY PECTORALIS
MINOR MUSCLE
ST
1 PART→ SUPERIOR THORACIC
2ND PART→ THORACOACROMIAL AND LATERAL
THORACIC
3RD PART: SUBSCAPULAR ANTERIOR CICUMFLEX
AND POSTERIOR CIRCUMFLEX
BRACHIAL ARTERY “BM”
- CONTINOUS WITH THE AXILLARY
ARTERY LOWER BORDER OF TERES
MAJOR
- PROFUNDA BRACHII
- TRAVELS WITH MEDIAN NERVE
- LIES MEDIAL TO HUMERUS
COLLATERAL CIRCULATION OF SHOULDER
- SUPRASCAPULAR ARTERY
- SUBSCAPULAR ARTERY
VENOUS DRAINAGE BRACHIAL PLEXUS
SUPERFICIAL VEIN “CLBM” - C5-T1
- DORSAL VENOUS ARCH - C5-C6→ UPPER BRACHIAL PLEXUS
o CEPHALIC VEIN→ LATERAL - C8-T1→ LOWER BRACHIAL PLEXUS
o BASILIC VEIN→ MEDIAL
o MEDIAN CUBITAL VEIN ERBS POINT
- DEEP VEINS - 2-3CMS ABOVE THE CLAVICLE
o VENAE COMMOTANTES ANTERIOR TO C6 TRANSVERSE PROCES

VENOUS DRAINAGE ERB’S PALSY→ UPPER BRACHIAL PLEXUS

- AXILLARY VEIN TRIBUTARIES (THINK- - C5-C6
“ABC”) - FORCEFUL PULLING OF HEAD DURING
o ACCOMPANYING VEINS OF THE DELIVERY
BRACHIAL ARTERY - DOWNWARD DISPLACEMENT OF THE
o BASILIC VEIN ARM→ WAITERS TIP
o CEPHALIC VEIN
KLUMPKE’S→ LOWER BRACHIAL
CEPHALIC VEIN→ AXILLARY VEIN - C8-T1
BASILIC VEIN + BRACHIAL VEIN= AXILLARY VEIN - FORCED ABDUCTION OF THE ARM
AXILLARY VEIN→ SUBCLAVIAN→ - CLAW HAND + APE HAND DEFORMITY
BRACHIOCEPHALIC - _ - HORNER SYNDROME (T1)

BASILIC VEIN→ VEIN OF CHOICE FOR CENTRAL WRISTDROP

VEIN CATHERIZATION - RADIAL NERVE
IN DIRECT LINE WITH AILLARY ENRVE
RADIAL NERVE PALSY
AXILLARY VEIN - SATUDAY NIGHT PALSY
- FORMED BY VENAE COMITANTES OF - LOSS OF EXTENSION OF FINGERS,
BRACHIAL ARTERY W/ BASILIC VEIN THUMB AND WRIST
- ASCENDS ALONG MEDIAL BORDER TO - NUMBNESS OVER 1ST DORSAL
FIRST RIB INTEROSSEUS MUSCLE
- RECEIVES TRIBUTARIES
CORRESPONDING TO BRANCHES OF THE HUMERAL SHAFT FRACTURE
AXILLARY ARTERY - RADIAL NERVE
- ALSO RECEIVES CEPHALIC VEIN - WRIST DROP

CENTRAL VENOUS CATHETERIZATION VIA MEDIAN NERVE

PERIPHERAL ACCESS - APE HAND
- BASILIC VEIN - ATROPHY THENAR EMENENCE
- MEDIAN BASILIC VEIN
CARPEL TUNNEL SYNDROME
- MEDIAN NERVE

POPE’S BLESSING
 - MEDIAN NERVE
TINEL’S SIGN
- CARPAL TUNNEL SYNDROME
o PHALEN’S SIGN→ FLEXING
BOTH WRIST
LONG THORACIC NERVE
- WING OF SCAPULA
- SERRATUS ANTERIOR
AXILLARY NERVE INJURY
- SURGICAL NECK OF HUMERUS
- INJURY TO QUADRANGULAR SPACE
o AXILLARY NERVE
o POSTERIOR CICUMFLEX
- DELTOID ATROPHY
CLAW HAND
- ULNR NERVE
THORACODORSAL NERVE
- MIDDLE SUBSCAPULAR NERVE
- LATISSIMUS DORSI
FROMENT SIGN
- WHEN PINCHING A PIECE OF PAPER
BETWEEN THE THUMB AND INDEX
FINGER, THE THUMB IP JOINT WILL FLEX
IF THE ADDUCTOR POLLICIS MUSCLE
WEAKNESS
- ULNAR NERVE PALSY
FINKENLSTEIN SIGN
- DE QUERVAIN’S TENOSYNOVITIS
INTERCOSTOBRACHIAL NERVE -T2
- CHEST PAIN REFERRED TO MEDIAL SIDE
OF ARM AND ARMPIT
VOLKMANN’S CONTRACTURE
- SUPRACONDYLAR FRACTURE
- PERMANENT FLEXION CONTRATURE OF
THE HAND AND WRIST (CLAWLIKE
DEFORMITY)
- FLEXION, ADDUCTED THUMB,
DUPUYTEN’S CONTRACTURE
- THICKENING OF THE PALMAR
APONEUROSIS
TENNIS ELBOW
- LATERAL EPICONDYLTIS
GOLFER’S ELBOW
- MEDIAL EPICONDYLITIS
CUBITAL FOSSA
BASE- LATERAL TO MEDIAL EPICONDYLE
LATERAL- BRACHIORADIALIS
MEDIAL PRONTOR TERES
- AXILLARY ARTERY ENTERS CUBITAL
FOSSA AND WHEN EXIT IT WILL
BECOMES RADIAL ARTERY PASS THRU
ANATOMICAL SNUFFBOX AND WILL
BECOME ULNAR ARTERY
UPPER EXTRIMITIES
ELBOW
- MOST COMMON FRACTURE→
POSTERIOR
- COMMON IN CHILDREN
SUPRACONDYLAR FRACTURE
- SIMIAN
- MEDIAN NERVE INJURY
o APE HAND (FLATTENING OF
THENAR EMINENCES
- BRACHIAL ARTERY INJURY
o PULSELESS HAND
o PAIN, PARESTHESIA, PALLOR
o TX: FASCIOTOMY
- VOLMAN’S ISCHEMIC CONTRACTURE→
ISCHEMIC CONTRACTURE ASSOCIATED
WITH SUPRACNDYLAR FRACTURE
o CUT IN THE BLOOD SUPPLY→
BRACHIAL ARTERY
o FLEX-ON OF THE ELBOW,
PRONATED FOREARM, WRIST
 FLEION OF INTERPHALEGEANL, POSTERIOR DISLOCATION
EXTENSION OF MP - HUMERAL HEAD IN THE SUBGLENOID
POSITION
CUBITUS VARUS
- GUNSTOCK DEFORMITY
- COMPLICATION OF SUPRACONDYLAR NERVES THAT CAN BE INJURED
FRACTURE - AXILLARY NERVE
- RADIAL NERVE→ “ILL FITTED
CUBITUS VALGUS CRUTCHES”
- COMPLICATION OF LATERAL CONDYLAR
FRACTURE DELTOPECTORAL GROOVE
RADIUS AND ULNAR FRACTURE DISLOCATION - BLOOD VESSEL TRAVERSING→
“GRIMUS” CEPHALIC VEIN

GALLEAZZI AXILLARY ARTERY

- RADIAL FRACTURE - PECTORALIS MINOR→ DIVIDES ARTERY
- INFERIOR DISLOCATION INTO 3 PARTS
MONTEGIA
- ULNAR FRACTURE PECTORALIS MINOR SUPPLIED BY→
- SUPERIOR DISLOCATION - MEDIAL PECTORAL NERVE- C8 T1

NIGHTSTICK FRACTURE→ ISOLATED ULNAR SERRATUS ANTERIOR→ LONG THORACIC NERVE

SHAFT FRACTURE - INJURY→ WINGGING OF SCAPULA

COLLE’S FRACTURE→ DINNER FORK OR A SILVER FLEXORS OF ARM

DEFORMITY BICEPS BRACHII→ FLEXOR ELBOW, SUPINATES
FOREARM, WEAK FLEXION SHOULDER
BUCKLE FRACTURE OF THE FOREARM→ TORUS - ORIGIN
FRACTURE o LONG HEAD→ SUPRAGLENOID
TUBERCLE OF SCAPULA
CLAVICLE→ FRIST TO OSSIFY o SHORT HEAD→ CORACOID
- INTRAMEMBRANOUS OSSIFICATION PROCESS OF SCAPULA
- MUSCULOCUTANEOUS NERVE
JUNCTION OF THE MIDDLE AND LATERAL
THIRD→ MOST COMMON SITE O FCLAVICULAR CORACOBRACHIALIS→ FEXES ARM, WEAK
FRACTURE ADDUCTOR
- ORIGIN→ CORACOID PROCESS OF
SHOULDER DISLOCATION SCAPULA
- PIERCE BY MUSCULOCUTANEOUS
ANTERIOR DILOCATION NERVE
- MORE COMMON
- HUMERAL HEAD IN SUBCORACOID BRACHIALIS→ ELBOW FLEXOR
POSITION - INSETION→ CORONOID PROCESS
- MUSCULOCUTANEOUS NERVE
CUBITAL FOSSA
BOUNDERIES
- BRACHIORADIALIS- LATERAL
- PRONATOR TERES- MEDIALLY
- IMAGINARY LINE BETWEEN
EPICONDYLES OF HUMERS- BASE

CARPAL BONES

PROXIMAL (LAT TO EMDIAL)

“SCARED LOVERS TRY POSITION
- SCAPHOID→ M.C FRACTURED “RADIAL
NERVE “ANATOMICAL SNUFFBOX”
- LUNATE→ M.C DILOCATED
- TRIQUETRIUM
- PISIFORM

DISTAL (LAT TO MEDIAL)

THAT THEY CAN’T HANDLE”
- TRAPEZIUM
- TRAPEZOID
- CAPITATE
- HAMATE→ IF FRACTURES, WILL
INJURED ULNAR NERVE
o DIFFICULTY IN GRIP STRENGTH

ANATOMICAL SNUFFBOX
BOUNDERIES
ULNAR (MEDIAL) BORDER→ TENDON OF
EXTENSOR POLLICIS LONGUS
RADIAL (LATERAL) BORDER→ TENDONS OF THE
EXTENSOR POLLICIS BREVIS AND ABDUCTOR
POLLICIS LONGUS
PROXIMAL BORDER→ STYLOID PROCESS OF THE
RADIUS

KIEN BOCKS DISEASE→ SCAPHOID FRACTURE