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Shoulderandupperarm
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18 CHAPTER 2 . Shoulder and Upper Arm
Figure 2-1. A-C, Anterior shoulder and upper arm. A, clavicle; H, sternoclav
icular joint; C, sternocleidomastoid muscle; D, acromioclavicular joint; £,
acromion; F, coracoid process; G, pectoralis major; H, deltoid; /, deltoid tuber
cle; /, biceps brachii; K, supraclavicular fossa.
Figure 2-2. Fractured left clavicle.
fractures occur in the middle third of the clavicle and
produce an obvious swelling or deformity (Fig. 2—2).
Acute fractures or chronic nonunions can be distin
guished from healed fractures by the accompanying ten
derness. In the case of an acute injury, ecchymosis is
usually present. At the medial end of the clavicle lies the
sternoclavicular joint, a synovial articulation between the
clavicle and the sternum. The sternocleidomastoid mus
cle connects the proximal clavicle and adjacent sternum
with the corresponding mastoid processes of the skull.
The two sternocleidomastoid muscles combine to pro
duce the characteristic V shape seen in the anterior neck,
with the superior sternal notch constituting the angle of
the V (Fig. 2-3).
Sternoclavicular Joint. The sternoclavicular joint is
bound together by strong ligaments. Considerable
motion occurs here, particularly during active abduction
of the shoulder. The joint is very superficial and easily
seen in most patients. Swelling and deformity overlying
this joint may signify a fracture of the medial clavicle near
the joint, a dislocation of the joint itself, or an arthritis of
various etiologies (Fig. 2-A). In an anterior sternoclavic-
Figure 2-3. Sternal notch.
CHAPTER 2 Shoulder and Upper Arm 19
Figure 2-4. Swollen sternoclavicular joint due to a fracture of the
medial end of the left clavicle.
ular dislocation, the proximal clavicle
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