Chapter 8 Shoulder and Elbow

The gleno-humeral (shoulder) joint is one of the most mobile of all the joints in the body. It is this mobility that predisposes the shoulder joint to injury, both acute and chronic, and heightens the joint’s dependency on muscular and capsular support. By contrast, the acromio-clavicular (AC) joint is less mobile and depends solely on ligaments for support.

At the elbow, the humero-ulnar joint (the true elbow joint) is a hinge joint similar to the knee. It sustains similar injuries, requiring the application of taping principles presented in the knee/thigh section.

The main purpose and value of taping an elbow is the prevention of full extension of the joint, with or without lateral reinforcement. Because the associated radio-ulnar (forearm) joint allows a great degree of pronation and supination (rotation), the overall effectiveness of taping for lateral ligaments is compromised.

Right shoulder from the front.

The arm is slightly abducted

• The nipple in the male (21) normally lies at thelevel of fourth intercostal space.

• The deltopectoral groove c ontaining thecephalic vein is formed by the adjacentborders of deltoid (2) and pectoralis major (5).

• The lower border of pectoralis major (6) formsthe anterior fold.

MUSCLES

1. Trapezius

2. Deltoid

3. Anterior margin of deltoid

4. Pectoralis major

5. Upper margin pectoralis major

6. Lower margin pectoralis major

7. Biceps short head

8. Coracobrachialis

9. Teres major

10. Serratus anterior

11. Triceps

TENDONS

12. Latissimus dorsi

BONES

13. Acromion of scapula

14. Acromial end of clavicles

15. Greater tuberosity of humerus

JOINTS

16. Acromioclavicular

HOLLOWS

17. Deltopectoral groove

18. Supraclavicular fossa

19. Infraclavicular fossa

MISCELLANEOUS

20. Areola

21. Nipple

The right axilla or armpit is the hollow below the shoulder.Its anterior wall is made up mainly of the fibres of pectoralismajor (4) with pectoralis minor behind. The posteriorwall consists of teres major (9) with the tendon of latissimusdorsi (12) immediately in front. Close to pectoralis major abundle of muscle made up of the short head of biceps (7)and coracobrachialis (8) runs down the arm with the cordsof the brachial plexus surrounding the axillary artery immediatelybehind. The axilla is also a very important site forlymph glands draining lymphatics from the arm and, mostimportantly, the breast.

Right shoulder, from behind

The arm is slightly abducted and the inferior angle of the scapula (14) has beenmade to project backwards by attempting to flex the shoulder joint againstresistance.

• The inferior angle of the scapula (14) usually lies at the level of the seventhintercostal space. It is overlapped by the upper margin of the latissimus dorsi (10).

• The axillary nerve (17) runs transversely under cover of the deltoid (4) behindthe shaft of the humerus at a level 5-6 cm below the acromion (15).

• Latissimus dorsi (10) and teres major (9) form the lower boundary of theposterior wall of the axilla.

MUSCLES

1. Trapezius – upper fibres

2. Trapezius – middle fibres

3. Trapezius – lower fibres

4. Deltoid

5. Rhomboid major

6. Supraspinatus

7. Infraspinatus

8. Teres minor

9. Teres major

10. Latissimus dorsi

11. Triceps

BONES

12. Spine of scapula

13. Vertebral border of scapula

14. Inferior angle of scapula

15. Acromion of scapula

16. Acromial end of clavicle

NERVES

17. Axillary nerves posterior to humerus

JOINTS

18. Acromioclavicular

Right shoulder, arm elevated. While maintaining good postural control of thetrunk, the right arm has been abducted throughsome 180°. The left scapula remains in a normalresting position but with firm muscle control,the glenoid pointing laterally. The right scapulahas been rotated through some 70-75° underthe activity of trapezius with the remaining armmovement occurring at the shoulder joint. Activityis obvious in deltoid (4), the major abductor at theshoulder joint, and no doubt in supraspinatus (6),though this muscle is masked by trapezius (2).

Shoulder joint: anterior aspect.1 Costoclavicular ligament. 2 Conoid ligament. 3 Trapezoidligament. 4 Coracohumeral ligament. 5 Short head of biceps.6 Coracobrachialis. 7 Pectoralis minor. 8 Long head ofbiceps. 9 Subscapularis. 10 Anterior capsule of shoulderjoint with opening of subscapular bursa. 11 Long head ofbiceps. 12 Latissimus dorsi. 13 Pectoralis major.

Posterior aspect of the shoulder and upper arm: bonesand muscles of the shoulder girdle. Right, superficialmuscles; left, deep muscles. 1 Acromion. 2 Spine of scapula.3 Medial border of scapula. 4 Inferior angle of scapula.5 Medial angle of scapula. 6 Superior angle of scapula.7 Glenoid fossa. 8 Humerus. 9 Trapezius. 10 Deltoid.11 Latissimus dorsi. 12 Levator scapulae. 13 Rhomboideusminor. 14 Rhomboideus major. 15 Supraspinatus.16 Infraspinatus. 17 Teres major. 18 Teres minor.

a. Left elbow from the front. There is an M-shaped pattern of superficial veins. Cephalic(9) and basilic (8) veins are joined by a mediancubital vein into which drain two small medianforearm veins. The order of the structures in thecubital fossa from lateral to medial is biceps tendon(4), brachial artery (13) and median nerve (6).

Forearm from the front.

MUSCLES

1. Biceps

2. Brachio Radialis

3. Pronator Teres

4. Biceps

5. Flexor carpi Radialis

NERVES

6. Median

FASCIA

7. Bicipital Aponeurosis

VEINS

8. Basilic

9. Cephalic Vein

10. Median Cephalic Vein

11. Median Basilic Vein

12. Median Forearm Vein

ARTERIES

13. Brachial

BONES

14. Medial Epicondyle of Humerus

15. Lateral Epicondyle of Humerus

Elbow joint: anterior aspect. 1 Anterior bandof medial ligament. 2 Oblique band of medialligament. 3, 4 Anterior capsule. 5 Lateral ligament.6 Annular ligament. 7 Tendon of biceps

Cubital fossa: soft tissues. 1 Biceps. 2 Bicipitalaponeurosis. 3 Brachialis. 4 Brachioradialis. 5Pronator teres. 6 Common flexor origin.

Posterior aspect of the elbow and forearm:superficial muscles. 1 Brachioradialis.2 Extensor carpi radialis longus. 3 Anconeus.4 Extensor carpi radialis brevis. 5 Extensordigitorum. 6 Extensor carpi ulnaris. 7 Extensordigiti minimi. 8 Abductor pollicis longus. 9 Extensorpollicis brevis. 10 Extensor pollicis longus.11 Ulnar nerve. 12 Flexor carpi ulnaris.

Left elbow from behind.

With the elbow fully extended, the extensor muscles form a bulge in the lateral side. In the adjacenthollow can be felt the head of the radius (14) and the capitulum of the humerus (11) which indicatesthe line of the radio-humeral part of the elbow joint. The lateral and medial epicondyles (9, 10) of thehumerus are palpable on either side. Wrinkled skin lies at the back of the prominent olecranon of theulna (12). In this arm the margin of the olecranon bursa (16) is outlined. A very important structure in thisregion is the ulnar nerve (15) which is palpable as it lies in contact with the humerus behind the medialepicondyle (10). The posterior border of the ulna (13) is subcutaneous throughout its whole length.

• With the elbow extended, the medial and lateral epicondyles and the olecranon are on the same levelbut with flexion of the elbow, the olecranon moves to a lower level.

• The subcutaneous position of the ulnar nerve behind the medial epicondyle makes it easily palpable.Here it can be easily injured, causing paraesthesia (tingling) in the distribution of the ulnar side of thehand. This area is commonly referred to as the ‘funny bone’.

The back of the forearm

The superficial extensor muscles take a commonorigin from the lateral epicondyle and thesupracondylar ridge. Brachioradialis (1), the musclecoming from higher up the ridge, has beendescribed with the anterior muscles in view of itsrole as a flexor muscle. Extensor carpi radialislongus (2) also comes from the supracondylar ridgebelow brachioradialis and below that, the extensorcarpi radialis brevis (3) which arises from theepicondyle. These muscles can be identified quiteeasily running down the radial side of the back ofthe forearm.

MUSCLES

1. Brachioradialis

2. Extensor carpi radialis longus

3. Extensor carpi radialis brevis

4. Extensor digitorum

5. Extensor carpi ulnaris

6. Triceps

7. Flexor carpi ulnaris

8. Anconeus

BONES

9. Lateral epicondyle of humerus

10. Medial epicondyle of humerus

11. Capitulum of humerus

12. Olecranon of ulna

13. Posterior border of ulna

14. Head of radius

NERVES

15. Ulna

< div class='tao-gold-member'>

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

Epilogue Taping Objectives Basic Pathology Wrist and Hand Knee and Thigh Foot and Ankle

Stay updated, free articles. Join our Telegram channel

Join

Full access? Get Clinical Tree