back and chest Flashcards
Pectoralis minor
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.
Pectoralis major
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)
Sternocleidomastoid
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
Rectus abdominis
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
External oblique
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
Serratus Anterior
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
Upper trapezius
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
Middle trapezius
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
Lower trapezius
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
Rhomboid Minor/ Rhomboid major
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
Levator scapulae
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
Supraspinatus
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
Infraspinatus
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
Teres minor
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
Subscapularis
Proximal: Subscapular fossa
Distal: Lesser tubercle
Innervation: Subscapular nerve
actions: Medial rotates GH joint
Palpation: Hold at the armpit, rotate the arm
Teres major
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.
Latissimus dorsi
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
Erector spinae
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.
