back and chest

Question 1

Pectoralis minor

Answer 1

Proximal: Anterior surfaces of 3rd- 5th ribs

Distal: Coracoid process

Innervation: Medial pectoral nerve

actions: Depresses and anteriorly tilts scapula, elevates ribs 2 to 5

Palpation: Put the arm behind the back and get patient to lift the arm off the back.

Question 2

Pectoralis major

Answer 2

Proximal:
2 parts:
Inferior and medial clavicle,

2nd - 6th costacartilages, sternum

Distal: Lateral lip of intertubercular sulcus

Innervation: Medial and lateral pectoral nerve

actions: Clavicular head:adducts, medial rotates and horizontally adducts GH joint, flexes GH joint
Sternocoastal head: adducts, medial rotates and horizontally adducts GH joint, extends GH joint from fully flexed position

Palpation:
In Supine:
1. horizontal adduction
2. punch arms forwards (clavicular head) 3. punching downwards (sternocostal head)

Question 3

Sternocleidomastoid

Answer 3

Proximal: Upper border of manubrium and upper border of clavicle

Distal: Mastoid process of temporal bone and superior nuchal line of occipital bone

Innervation: Spinal accessory nerve (XI) C1-C3

actions:
bilaterally: flexes neck

unilaterally: contralaterally rotates neck, ipsilaterally laterally flexes neck and extends head and neck

Palpation: If want to see right side, get patient to turn to the left and tilt and looks at the shoulder

Question 4

Rectus abdominis

Answer 4

Proximal: Xiphoid process of sternum & adjacent costal cartilages

Distal: Pubic bones, near the symphysis pubis

Innervation: Ventral portions of intercostal nerves T5-T12

actions: flexes trunk

Palpation: supine
Arm in front and lift the shoulder blade off the ground

Question 5

External oblique

Answer 5

Proximal: Anterolateral ribs

Distal: Aponeurosis to the linea alba, iliac crest

Innervation: Ventral portions of intercostal nerves T5-T12

actions: contralateral rotates ipsilaterally laterally flexes trunk

Palpation: Supine
Arm infont and lift and rotate the trunk to the opposite side

Question 6

Serratus Anterior

Answer 6

Proximal: 1st - 8th/9th ribs

Distal: Anterior surface of vertebral border of scapula

Innervation: Long thoracic nerve

actions: protracts and upwardly rotates scapula

Palpation: Sitting up
Punching forward

Question 7

Upper trapezius

Answer 7

Proximal: External occipital protuberance, superior nuchal line, ligamentum nuchae and the spinous processes from C7 to T12

Distal: Lateral aspect of the clavicle

Innervation: Spinal accessory nerve

actions: elevates and upward rotates scapula, extends lateral flexes and contralateral rotates back

Palpation: Prone
Get patient to raise the shoulders

Question 8

Middle trapezius

Answer 8

Proximal: External occipital protuberance, superior nuchal line, ligamentum nuchae and the spinous processes from C7 to T12

Distal:
Acromion

Innervation: Spinal accessory nerve

actions: upward rotates and adducts scapula

Palpation: Prone
- Get patient to put his arm in 90 degree.
- Lift the arm - horizontal abduction
Scapular goes into retraction

Question 9

Lower trapezius

Answer 9

Proximal: External occipital protuberance, superior nuchal line, ligamentum nuchae and the spinous processes from C7 to T12

Distal: Spine of scapula

Innervation: Spinal accessory nerve

actions: upward rotates, adducts and depresses scapula

Palpation: Prone
-Get patient to lift the arm next to their ear.
Lift the arm up

Question 10

Rhomboid Minor/ Rhomboid major

Answer 10

Proximal: C7 - T1 - T2 -T5 spinous processes

Distal: Medial border scapula/ Root of scapular spine

Innervation: Dorsal scapular nerve

actions: Elevates, retracts and downward rotates scapula

Palpation: Hand behind back, patient move hand away from back

Question 11

Levator scapulae

Answer 11

Proximal: C1 - C4 transverse processes

Distal: Superior angle of scapula

Innervation: Cervical nerve C3 - C4 and dorsal scapular nerve

actions: elevates and downward rotates scapula; lateral flexes and ipsilateral rotates cervical spine

Palpation: Turn the head and look at the armpit, with hand at the back

Question 12

Supraspinatus

Answer 12

Proximal: Supraspinous fossa

Distal: Superior facet of greater tubercle

Innervation: Suprascapular nerve

actions: abducts GH joint

Palpation:

Prone
Hold patient’s arm 90 degree

Hang the patients arm 90 degree and get patient to push against ur hand

Question 13

Infraspinatus

Answer 13

Proximal: Infraspinous fossa

Distal: Middle facet of greater tubercle

Innervation: Suprascapular nerve

actions: Lateral rotates and adducts GH joint

Palpation: Prone
One hand on the scapular, patient to turn the palm outwards

Question 14

Teres minor

Answer 14

Proximal: Lateral border of scapula

Distal: Inferior facet of greater tubercle

Innervation: Axillary nerve

actions: Lateral rotates and adducts GH joint

Palpation: Prone
Patient to turn the palm inwards

Question 15

Subscapularis

Answer 15

Proximal: Subscapular fossa

Distal: Lesser tubercle

Innervation: Subscapular nerve

actions: Medial rotates GH joint

Palpation: Hold at the armpit, rotate the arm

Question 16

Teres major

Answer 16

Proximal: Inferior angle to bottom two-thirds lateral border of scapula

Distal: Lesser tubercle

Innervation: Lower subscapular nerve

actions: Medial rotates, adducts, and extends GH joint

Palpation:
Prone… arm over the pllinth.. arm 90 degree.. Do a medial rotation

Palpate inferior angle near the axillary border with patient in prone, arm over the plinth.
Medial rotate to palpate teres major, laterally rotate to palpate teres minor.

Question 17

Latissimus dorsi

Answer 17

Proximal: Thoracolumbar fascia, lower 6 thoracic vertebrae and five lumbar vertebrae, caudal-most 3 or 4 ribs, iliac crest and inferior spine of scapular

Distal: Floor of intertubercular sulcus

Innervation: Thoracodorsal nerve

actions: Medial rotates, extends and adducts GH joint, depresses scapula, elevates pelvis

Palpation: Sitting up
- get patient to do a “choo-choo” action –> pulling down the arm

Question 18

Erector spinae

Answer 18

Proximal: Spinous processes, transverse processes, and posterior ribs from the occiput to the sacrum and ilium

Distal: Transverse processes of C4 - C6, angles of upper ribs and transverse process of C7, transverse processes of L1 - L4, angle of 4 - 12 ribs and thoracolumbar fascia

Innervation: Mainly dorsal rami of spinal nerves

actions: bilaterally: extends spine

Unilaterally: ipsilaterally laterally flexes and rotates spine

Palpation: prone

Get patient to lift the chest off the surface.