Anatomy Practical - Arm

Question 1

Pectoralis Major

Answer 1

A: Humeral Horizontal adduction and Internal Rotation
O: Clavicular Head: Medial half of clavicle
Sternal Head: Sternum
I: Upper shaft of humerus

Palp: Clavicular head: Patient’s arm in shoulder flexion. Patient holds medially while OT pushes laterally on the arm

Question 2

Pectoralis Minor

Answer 2

A: Draws scapula anteriorly against thoracic wall
O: Ribs 3, 4, 5 and fascia of corresponding intercostal spaces
I: Coracoid Process

Palp: Patient standing, OT at patient’s side
Place patient’s arm behind back in IR, Lift away. Palpate anteriorly over tendon & Muscle, deep to pec major

Question 3

Serratus Anterior

Answer 3

A: Prevents scapular winging, scapular protraction & downward rotation
O: Ribs 1-8
I: Superior, Medial and inferior boarder of scapula

Palp: Patient Standing, OT facing
Patient extends arm, 90 degrees or so, making a fist. Patient hold fist while OT applies resistance on fist. Palpate lateral ribs

Question 4

Anterior Deltoid

Answer 4

A: Shoulder flexion, Horizontal Adduction
O: Lateral third of clavicle
I: Deltoid Tubercle

Palp: Patient raise arm to 90 degrees flexion. Palpate anterior shoulder above deltoid tubercle. Patient holds as you provide resistance downward

Question 5

Middle Deltoid

Answer 5

A: Shoulder abduction
O: Acromion
I: Deltoid Tubercle

Palp: Patient raise arm to 50-70 degrees ABDUCTION. Palpate lateral shoulder above the deltoid tubercle, providing resistance downward

Question 6

Posterior Deltoid

Answer 6

A: Shoulder extension & horizontal abduction
O: Spine of Scapula
I: Deltoid Tubercle

Palp: Patient raises arm in 40 to 50 degrees EXTENSION. Palpate posterior shoulder above deltoid tubercle. Patient holds as you provide resistance

Question 7

Upper Trapezius

Answer 7

A: Scapular Elevation
O: Occipital protuberance
I: Lateral third of clavicle, spine of scapula

Palp: Standing. Patient elevates shoulders. Palp hand over space between occiput and acromion. Patient hold as you resist by applying pressure over acromion

Question 8

Middle Trapezius

Answer 8

A: Scapular retraction
O: Spinous process of C7-T4
I: Acromion & spine of scapula

Palp: Patient prone. Arm dangling off mat 90 deg abduction. Palp hands b/w vertebral column & spine of scapula. Patient lift elbow away from the mat

Question 9

Lower Trapezius

Answer 9

A: Scapular depression & adduction
O: Spinous process of T5-T12
I: Spine of Scapula

Palp: Patient prone on mat with arms in full flexion - superman. Palpate lower medial aspect of spine of scapula with fingers pointing diagonally downward toward vertebral column

Question 10

Rhomboids

Answer 10

A: Scapular retraction/adduction & downward rotation (opposite SA)
O: C7-T5
I: Upper medial boarder of scapula

Palp: Patient sitting. Patient place hand on small of back, palm facing outward. Palp hand b/w medial boarder of scapula and spine. Ask patient to lift hand away from back as you provide resistance at the forearm

Question 11

Supraspinatus

Answer 11

A: First 15 degrees of shoulder abduction
O: Supraspinatus fossa of scapula
I: Greater tubercle

Palp: Patient standing, OT facing patient’s back
Place hand over supraspinatus fossa. Patient’s shoulder in 20-30 degrees abduction & provide resistance to abduction with hand placed just above the elbow.

Question 12

Infraspinatus & Teres Minor (Together)

Answer 12

A: External rotation
O: Infraspinatus fossa
I: Greater tubercle

Palp: Patient standing. Ask to bend over at the hip, dangling arm. Palp fingers just into the axilla and along the anterior boarder of scapula. Ask patient to quickly rotate thumb outward (ER)

Question 13

Subscapularis

Answer 13

A: Internal rotation
O: Subscapular fossa
I: Lesser tubercle

Palp: Patient standing. Ask to bend over at the hip, dangling arm. Palp fingers just into the axilla and along the anterior boarder of scapula. Ask patient to quickly rotate thumb inward (IR)

Question 14

Teres Major

Answer 14

A: Shoulder internal rotation & adduction
O: Inferior angle of scapula
I: Intertubercular groove

Palp: Same as lats, but palpate from scapula to humerus

Question 15

Latissimus Dorsi

Answer 15

A: Internal rotation, adduction, & extension of flexed arm
O: Spinous processes of lower six thoracic and all lumbar and sacral vertebrae, posterior part of iliac crest, lower 3-4 ribs, & inferior angle of the scapula
I: bicipital groove

Palp: Patient standing, OT facing
Patient rest the pinky side of a fist on your opposite shoulder with their arm straight. Palp hand in posterior fold of axilla. Ask patient to push down

Question 16

Coracobrachialis

Answer 16

A: Adduction & flexion of shoulder
O: Coracoid process
I: Medial aspect of midshaft of humerus

Palp: Patient standing.
Extend straight arm to about 45 degrees abduction. Palp fingers in armpit area. Patient resist adduction

Question 17

Biceps Brachii

Answer 17

A: Elbow flexion, forearm supination, & shoulder flexion
O: Short head: Coracoid process, Long head: supraglenoid tuberosity.
I: Radius

Palp: Patient in 50 degrees or so of flexion. Apply resistance on forearm and palp

Question 18

Brachialis

Answer 18

A: Elbow flexion
O: Anterior humerus
I: Upper anterior ulna

Palp: Patient in 50 degrees elbow flexion with palm down. Patient hold while OT applies resistance to upper forearm. Palp fingers are on either side of biceps brachii

Question 19

Brachioradialis

Answer 19

A: Elbow flexion
O: Lateral humerus about 2 to 3 inches above joint
I: Distal lateral end of radius above radial styloid

Palp: Ask patient to push up with a fist against the underside of a table or against your resistance. Palp hand is on top of forearm on proximal third.

Question 20

Ulnar Nerve

Answer 20

Located in two places:
In the cubital tunnel b/w medial epicondyle and olecranon aka funny bone. In Guyon’s canal at wrist’s volar (palmar) surface b/w the hook of hamate & pisiform bones.
Two very common sites for impingement. Cubital Tunnel Syndrome, and Guyon’s Canal Syndrome

Question 21

Triceps Brachii

Answer 21

A: Elbow extension
O: Long head: Infraglenoid tubercle of scapula
Lateral head: Upper half of posterior humerus
Medial head: Lower half of posterior humerus
I: Olecranon

Palp: Patient standing, table at waist height. Ask patient to dip down while supporting w/their hands and stop midrange. Palp posterior upper arm in the distal third.

Question 22

Pronator Teres

Answer 22

A: Pronation & aids elbow flexion
O: Medial epicondyle
I: Middle of lateral radius

Palp: Patient sitting with elbow in flexion. OT place palp on volar side proximal third of radius. Place other thumb on patients volar distal radius and two fingers on dorsal distal ulna. Resist pronation

Question 23

Supinator

Answer 23

A: Supination
O: Lateral humeral epicondyle
I: Lateral side of proximal third of radius

Palp: Fingers over dorsum of radial head. Ask patient to rotate arm into supination