Shoulder

The shoulder proximal (closest to the body) segment of the upper limb. The top of the shoulder is the line connecting the lower edge of the pectoralis major and wide back muscles; the lower horizontal line passing over myelome shoulder. Two vertical line, drawn up from the condyles of the shoulder, conditionally divide his shoulder at the front and rear surfaces.
On the front surface of the shoulder noticeable inner and outer grooves. Bone basis shoulder - shoulder bone (Fig. 1). On it are attaching multiple muscles (Fig. 3).

humerus
Fig. 1. Humerus: 1 - cylinder; 2 - anatomical neck; 3-small tubercle; 4 - surgical neck; 5 and 6 - ridge small and large tubercles; 7 - the coronal hole; 8 and 11 of the inner and outer nadkislot; 9 - block; 10 - capitate exaltation of the humerus; 12 - beam hole; 13 - groove radial nerve;14 - deltoid roughness; 15 - a large mound; 16 - groove ulnar nerve; 17 - cubital fossa.
shoulder structure
Fig. 2. Fascial vagina shoulder: 1 - vagina kluva-shoulder muscles; 2-the radial nerve; 3 - musculo-cutaneous nerve; 4 - median nerve; 5 - ulnar nerve; 6 - vagina triceps shoulder; 7 - vagina shoulder muscles; 8 - vagina biceps muscle of his shoulder. Fig. 3. Start and attachment of muscles in the shoulder bone, right front (I), rear (b) and side (b) : 1 - supraspinatus; 2 - Chuck; 3 wide (back); 4 - a large round; 5 - kluva-shoulder; 6 - shoulder; 7 - round, torque hand inside; 8 - radial flexor brush, superficial flexor brush, a long palm; 9 - short radiation extensor brush; 10 - long radial extensor brush; 11 - shoulder-beam; 12 - deltoid; 13 - big sternal; 14 - infraspinatus; 15 - a small round; 16 and 17 - triceps shoulder (16 - lateral, 17 - medial head); 18 - muscle torque palm outside; 19 - elbow; 20 - extensor small finger; 21 - extensor fingers.

The muscles of the shoulder are divided into 2 groups: front group consists of the flexor - biceps, shoulders, kljuvovidno-shoulder muscles, back group - triceps erector arm. Brachial artery that goes under the fascia accompanied by two veins and the median nerve is located in the inner row of the shoulder. Projection line the arteries in the skin of the upper arm is from the deepest point axillary fossa by the middle of the cubital fossa. In a channel formed by the bone and triceps muscle, is the radial nerve. Ulnar nerve around the medial nadkislot, located in the same groove (Fig. 2).
Closed injuries of the shoulder. Fractures of the head and anatomical neck of the humerus - intraarticular. Without x-rays them is not always possible to distinguish from a dislocated shoulder, even a combination of these fractures with a dislocated.
Fracture Bugrov humerus is recognized only radiographically. Fracture of the diaphysis usually diagnosed without difficulty, but radiography is required to determine the form of fragments and the nature of their displacement. Naimisharanya fracture of the shoulder is often complex T-shaped or V-shaped, so that peripheral fragments is divided into two parts that can be recognized only in the picture. Possible to simultaneously dislocated elbow.
With diaphyseal fractures of the shoulder thrust deltoid muscle shifts Central fragments, moving it from the body. The offset is greater, the closer to the shoulder joint broken bone. At fracture surgery cervical often valaceline peripheral fragment in the Central, which is determined on the image and most conducive to fracture fracture. When nagmyman.com the turn of the triceps pulls peripheral fragments from the elbow to the back and upwards, and the Central fragments shifted forward and down to the elbow pit), can compress and even hurt the brachial artery.
First aid for closed fractures of the shoulder is reduced to immobilization limbs wire bus from the shoulder to the wrist (elbow bent at a right angle) and commit it to the trunk. If broken diaphysis and a sharp strain, you should try to resolve its careful thrust behind the bent elbow and forearm. At low (razmyslovich) and at high fractures of the shoulder attempts to reposition dangerous; in the first case they threaten to damage to the arteries in the second - may violate valaceline, if any. After immobilization of the affected urgently sent in traumatologic facility for x-ray examinations, reposition and further hospital treatment. It is carried out depending on features of a fracture or plaster of thoraco-brachiale bandage, or by an extension (see) onto the bus. Impacted fracture anything that is not required; the arm is fixed to the body with a soft bandages, resting on the arm roller, and in a few days begin physiotherapy. Uncomplicated closed fractures of the shoulder are converging for 8-12 weeks.
Bloody reposition and fixation (see) may be required for the infringement of between fragments (interposition) of the muscles, nerves, blood vessels, if the damage to the brachial artery, when intra-articular fractures (especially in combination with the dislocation).
Injured shoulder accompanied by life-threatening bleeding, if wounded brachial artery. Aid - finger pressure vessel from the inner edge of the biceps muscle, then - the tourniquet is at the root of a limb; it is dangerous to impose a plait in the middle third shoulder, as this may damage blood vessels and nerves. When open (including firearms) fractures transport immobilization carried out, as when closed, but after using the toilet wounds, imposing on it aseptic bandage and temporary stop bleeding (if required): the evacuation by stretcher or sitting - depending on the severity of the damage and the General condition of the wounded. Further treatment - as a General rule: the initial surgical treatment of wounds and bone fragments, reposition, the imposition of deaf plaster bandage or stretching onto the bus, antibiotics, and so on (see Fractures, Wounds, injury).
Shoulder diseases. From purulent processes the most significant acute hematogenous osteomyelitis (see). After suffering injuries may develop muscle rupture, hernia more biceps (see Muscles, pathology). From malignant neoplasms meet sarcomathat led to the amputation of his shoulder.


Shoulder (brachium) - the proximal segment of the upper limb. The upper boundary of the shoulder line connecting the lower edge of the pectoralis major and wide spinal muscles, bottom - line, passing on two cross fingers above the condyles of the humerus.
Anatomy. Leather shoulder is easily movable, it is loosely connected with the underlying tissues. On the skin side surfaces P. noticeable inner and outer grooves (sulcus bicipitalis medialis et lateralis)separating the front and back muscle groups. Own fascia P. (fascia brachii) forms the vagina muscles and neurovascular bundles. From the fascia deeply humerus depart medial and lateral intermuscular wall (septum intermusculare laterale et mediale), forming the front and back muscle receptacles, or of the bed. In front of muscle couch are two muscles - biceps and shoulders (m. biceps brachii et m. brachialis), in the rear three - headed (m. triceps). In the upper third of the shoulder there is a bed for kljuvovidno-shoulder and the deltoid muscle (m. coracobrachialis et m. deltoideus), and in the lower bed for shoulder muscles (m. brachialis). Under its own fascia P. except muscles, is still the main neurovascular bundle limbs (Fig. 1).

Fig. 1. fascial containers shoulder (scheme by A. C. Vishnevskaya): 1 - vagina kljuvovidno-shoulder muscles; 2 - the radial nerve; 3 - musculo-cutaneous nerve; 4 - median nerve; 5 - ulnar nerve; 6 - vagina triceps shoulder; 7 - vagina shoulder muscles; 8 - vagina biceps muscle of his shoulder.
Fig. 2. Right humerus front (left) and back (right): 1 - caput humeri; 2 - the word " Collum " anatomicum; 3 - tuberculum minus; 4 - coilum chirurgicum; 5 - crista tuberculi minoris; 6 - crista tuberculi majoris; 7 - foramen nutricium; 8 - facies ant.; 9 - margo med.; 10 - fossa coronoidea; 11 - epicondylus med.; 12 - trochlea humeri; 13 - capitulum humeri; 14 - epicondylus lat.; 15 - fossa radialis; 16 - sulcus n. radialis; 17 - margo lat.; 18 - tuberositas deltoidea; 19 - tuberculum majus; 20 - sulcus n. ulnaris; 21 - fossa olecrani; 22 - facies post.

On the front of the inner surface of the shoulder on his own fascia are two main superficial venous trunk limbs - radial and ulnar saphenous vein. Radiation saphenous vein (v. cephalica) goes outwards from the biceps on the outer groove, at the top of it flows into the axillary vein. Elbow saphenous vein (v. basilica) is on the internal furrow only in the lower half P., internal cutaneous nerve P. n. cutaneus brachii medialis) (printing. table, Fig. 1-4).
The muscles of the anterior shoulder region belong to the group of flexor: kljuvovidno-shoulder muscles and biceps muscle, having two heads,short and long; fibrous stretching the biceps (aponeurosis m. bicipitis brachii) intertwined in the fascia of the forearm. Under the biceps muscle lies shoulder muscle. All three of these muscles innervated by the musculo-cutaneous nerve (n. musculocutaneus). On the outer and forward-medial surface of the bottom half of the humerus begins preclusive muscle.

superficial and deep vessels and nerves front of the shoulder
superficial and deep vessels and nerves of the posterior surface of the shoulder
Fig. 1 - 4. Vessels and nerves of the right shoulder.
Fig. 1 and 2. Surface (Fig. 1) and deep (Fig. 2) vessels and nerves front of the shoulder.
Fig. 3 and 4. Surface (Fig. 3) and deep (Fig. 4) vessels and nerves of the posterior surface of the shoulder. 1 - skin with subcutaneous fat; 2 - fascia brachii; 3 - n. cutaneus brachii med.; 4 - n. cutaneus antebrachii med.; 5 - v. basilica; 6 - v. medlana cublti; 7 - n. cutaneus antebrachii lat.; 8 - v. cephalica; 9 - m. pectoralis major; 10 - n. radialis; 11 - m. coracobrachialis; 12 - a. et v. brachlales; 13 - n. medianus; 14 - n. musculocutaneus; 15 - n. ulnaris; 16 - aponeurosis m. bicipitis brachii; 17 - m. brachialis; 18 - m. biceps brachii; 19 - a. et v. profunda brachii; 20 - m. deltoldeus; 21 - n. cutaneus brachii post.; 22 - n. cutaneus antebrachii post.; 23 - n. cutaneus brachii lat.; 24 - caput lat. m. trlcipitis brachii (cut); 25 - caput longum m. tricipitls brachii.

The main arterial trunk shoulder - brachial artery (a. brachialis) - is the sequel to the axillary artery (A. axillaris) and is on the medial side of the Isthmus along the edge of the biceps on the projection line from the top of axillary holes until the middle of the cubital fossa. Two accompanying Vienna (vv. brachiales) were on the side of the artery, anastomosis between them (printing. Fig. 1). In the upper third P. outside artery lies the median nerve (n. medianus), which crosses the artery in the middle P. and then goes inside. From the top Department of the brachial artery leaves deep artery P. (a. profunda brachii). Directly from the brachial artery or from one of its muscle branches departs nutrient artery of the humerus (A. nutrica humeri), via nutrient hole penetrates into the bone.

shoulder
Fig. 1. Cross-cuts of the shoulder made at different levels.

The rear outer surface of the shoulder in the back bone-fibrous couch is triceps erector arm and consisting of three heads - long, medial and external (caput longum, mediale et laterale). Innerviruetsya triceps radial nerve. The main artery of the rear Department - deep artery P. going back and down between the outer and inner heads triceps and envelope radial nerve shoulder bone behind. In the back of the bed there are two main nerve trunk: radiation (n. radialis) and elbow (n. ulnaris). The latter is located at the top of the spine and inside from the brachial artery and the median nerve and only in the middle third Isthmus is in the back bed. As the median, the ulnar nerve at P. branches network (see Brachial plexus).
Shoulder bone (humerus, os brachii) - long bone (Fig. 2). On the outer surface is deltoid tuberosity (tuberositas deltoidea)where attached deltoid muscle on the back surface - groove radial nerve (sulcus nervi radialis). The upper end of the humerus is thickened. There are the head of the humerus (caput humeri) and anatomical cervix (the word " Collum " anatomicum). A small narrowing between the body and the upper end is called surgical neck (the word " Collum " chirurgicum). At the upper end of the bones are two of the hill: a large outside and small front (tuberculum inajus et minus). The lower end of the humerus flattened in the front to the rear. Outwards and inwards it has easily apparently under the skin tabs - namesake (epicondylus medialis et lateralis) - place of origin of most of the muscles of the forearm. Between nezmyselne is located articular surface. Medial its segment (trochlea humeri) has the shape of the block and articulates with the ulna; the lateral head (capitulum humeri) - spherical and is used for articulation with the beam. Over the unit from the front is the coronal hole (fossa coronoidea), rear - elbow (fossa olecrani). All these medial education segment of the distal end of the bone United under the General name "condyle of the humerus" (condylus humeri).