Humerus

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Humerus Shoulder

• Land of Brachial Plexus

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Brachial Plexus Straddles the Shoulder and
Humerus
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External appearance
Infraspinatus
Middle Deltoid
Pec Major
Triceps
Post. Deltoid
Teres Major
Biceps
Latissiums dorsi
Ant. Deltoid
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Rip off the skin
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2 Layer
Biceps LH
Subscap
Pect Minor
Biceps SH
Coracobrachialis
Serratus Ant
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2 Layer
Supraspinatus
Infraspinatus
Teres minor
Teres major
Lat
Long Head Triceps
Lateral Head Triceps
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Shoulder
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Bones Ligaments
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Humerus
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Diagram Brachial Plexus
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Triangles and Spaces
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Triangles and Spaces

• Quadrangular Space
• Borders Humerus, Tri-LongHead, Teres Major,
  Teres Minor
• Contents Axillary nerve, posterior humeral
  circumflex artery
• Triangular Space
• Borders Teres Major, Teres Minor, TriLongHead
• Contents Circumflex Scapular Artery
• Triangular Interval
• Borders Humerus, Tri-LongHead, Teres Major
• Contents Radial Nerve, Deep Brachial Artery

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Axillary Nerve
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Injuries the Brachial Plexus

• Proximal Humerus Fx
• Rotator cuff tear
• Others of interest
• Bursitis
• Impingement
• Clavicle Fx
• AC Separation
• GH Dislocation
• Hills-Sachs/Bankart
• Biceps Tendonitis
• Biceps Tendon Rupture
• SLAP

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Anatomical vs. Surgical Neck

• Anatomical
• through the physis
• Surgical
• weak point

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Axillary Nerve
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Surgical Neck Fx

• Trauma
• Axillary/Radial Nerve injury
• Neer classification
• based on parts(shaft, head, GT, LT) displacement
  gt10mm or gt45 degree angulation. (Neer CS II,
  JBJS 197052A1077).
• The neck-shaft inclination angle averages 145
  degrees. The humeral head is retroverted an
  average of 30 degrees.
• Primary blood supply to humeral head
• Ascending (arcuate) branch of anterior humeral
  circumflex artery
• Runs in the bicipital groove. (Jaberg, JBJS
  74A5081992) Less significant supplies include
  the posterior humeral circumflex artery and small
  vessels entering through the rotator cuff
  insertions.

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Rotator Cuff Tear

• Supraspinatus is most common
• Etiology Impingement (75)
• Instability (15)
• Trauma (10)Wheeless
• ROM is reduced
• Supraspinatus is first 15 deg of abduction of
  shoulder
• OBriens, Neer

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Bursitis
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Impingement
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Acromion Types
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Impingement Evaluation

• Impingement Sign (Neer)
• Forward Flex greater than 90 deg.
• Hawkins Sign
• Forward Flex 90 deg, elbow 90 deg., IR
• OBriens
• Forward Flex 90 deg, max IR, Ad flex
• XR Trauma series then MRI

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Clavicle Fx
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Clavicle Fx
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AC Separation
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GH Dislocation
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GH Dislocation

• TUBS (Trauma, Unilateral, Bankart, Surgery)
• gt90 are anterior
• Jobe (relocation) test 90 deg abd, full ER,
  posterior force on humeral head relives
  apprehension
• XR Trauma Series (AP,L, Y)
• Lateral can be done with w/ Axillary View
• AMBRI (Atraumatic, Multidirectional, Bilateral,
  Rehab-responsive, Inferior capsule Repair)
• XR Trauma Series
• Sulcus Sign Arm to side, inferior traction
  increased acromiohumeral sulcus

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Bankart

• Anterior-Inferior glenoid tear

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Hills-Sachs

• Posterior Lateral depression fx of humeral head
  from impact into Glenoid

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SLAP

• Superior Labrum, Anterior to Posterior
• Repeated overhead motion, around biceps tendon
• OBriens is the best test

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Biceps Tendonitis/Subluxation

• Speed Test Resistance to Forward Flexion
• Yergason Resistance to Supination

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Biceps Tendon Rupture

• Proximal Long Head of the Biceps

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Take Home

• Websites
• www.wheelessonline.com
• www.eorif.com
• Supraspinatus is the most commonly torn Rotator
  Cuff muscle
• Watch for Axillary and Radial Nerve injury in
  surgical neck fx
• Biceps Tendonitis is pretty common