Shoulder Flashcards
List 4 taught points in the shoulder and describe their location
Shoulder points
- LI15
With the arm abducted, identify the anterior tip of the acromion. To locate the point, slide down into the depression/dimple between the anterior and middle fibers of the deltoid. If patient is unable to abduct to 90 ° the point may be located with the arm by the side.
- TE14
With the arm abducted, identify the posterior tip of the acromion. To locate the point, slide down into the depression/dimple between the posterior and middle fibers of the deltoid.
- SI11
Midway on the line connecting the midpoint of the upper margin of the spine of the scapula (SI 12) and the inferior angle of the scapula. Alternatively, locate the point at the junction of the upper one third and lower two thirds on the line connecting the midpoint of the lower margin of the spine of the scapula and the inferior angle of the scapula.
- SI12
In the supraspinous fossa, directly above the midpoint of the spine of the scapula
LI15 location and needling technique
- Location
- Insertion
- Depth
LI15 location and needling technique
Location
With the arm abducted, identify the anterior tip of the acromion. To locate the point, slide down into the depression/dimple between the anterior and middle fibers of the deltoid. If patient is unable to abduct to 90 ° the point may be located with the arm by the side.
Insertion
intra-articular, toward the midpoint of the axilla (HT1)
Depth
1-1.5 cun
Describe relevant LI15 anatomy
- Muscles (2)
- Nerves (1; deeper - 1)
- Vessels (2)
LI15 anatomy
Muscles
- deltoid
- rotator cuff when the arm is hanging down
Nerves
- supraclavicular nerve (C3 and C4) in the skin
* Deeper:* - anterior branch of the axillary nerve (C5, 6)
Vessels
- & 2. Anterior circumflex humeral artery and vein
List 5 neuroanatomical LI15 indications
LI15 indications
- pain and inflammation anywhere in the shoulder joint, ligaments and tendons
- subdeltoid bursitis
- arthritis
- capsulitis
- tendonitis
TE14 location and needling technique
- Location
- Insertion
- Depth
TE14 location and needling technique
Location
With the arm abducted, identify the posterior tip of the acromion. To locate the point, slide down into the depression/dimple between the posterior and middle fibers of the deltoid.
Insertion
Intra-articular, toward the midpoint of the axilla (HT 1)
Depth
1-1.5 cun
Describe relevant TE14 anatomy
- Muscles (3)
- Nerves (3)
- Vessels (2)
TE14 anatomy
Muscles
- deltoid
- teres minor
- rotator cuff (with arm in anatomical position)
Nerves
- supraclavicular nerve
- superior lateral brachial cutaneous nerve
- posterior branch of the axillary nerve
Vessels
- & 2. posterior circumflex humeral artery and vein
List 5 neuroanatomical TE14 indications
TE14 indications
- pain and inflammation of the shoulder joint, ligaments tendon and fascia
- subdeltoid bursitis
- arthritis
- capsulitis
- tendonitis
SI11 location and needling technique
- Location
- Insertion
- Depth
SI11
Location
Midway on the line connecting the midpoint of the upper margin of the spine of the scapula (SI 12) and the inferior angle of the scapula. Alternatively, locate the point at the junction of the upper one third and lower two thirds on the line connecting the midpoint of the lower margin of the spine of the scapula and the inferior angle of the scapula.
Insertion
Oblique, medial to lateral and inferior to superior (towards the glenohumeral joint).
Nb. Deep needling on an osteoporotic scapula could produce pneumothorax.
Depth
0.5 - 1 cun
Describe relevant SI11 anatomy
- muscles (1)
- nerves (1)
- vessels (4)
SI11 anatomy
Muscles
- infraspinatus
Nerves
- lower branch of the suprascapular nerve
Vessels
- & 2. suprascapular artery and vein
- & 4. circumflex scapular artery and vein
List 3 neuroanatomical SI11 indications
SI11 indications
- myofascial pain/inflammation of infraspinatus
- impaired external rotation of the shoulder
- trigger points in infraspinatus could limit internal rotation
SI12 location and needling technique
- Location
- Insertion
- Depth
SI12 location and needling technique
Location
In the supraspinous fossa, directly above the midpoint of the spine of the scapula
Insertion
Aim towards the floor of the suprapinous fossa, down into the supraspinatus muscle.
Caution: Perpendicular insertion, posterior to anterior may cause Pneumothorax
Depth
0.5-1 cun
Describe relevant SI12 anatomy
- Muscles (2)
- Nerves (1; deeper - 1)
- Vessels (2)
SI12 anatomy
Muscles
- Trapezius
- Supraspinatus
Nerves
- supraclavicular nerve in the skin C3, 4
* Deeper* - suprascapular nerve C5, 6
Vessels
- & 2. supraclavicular artery and vein
List 4 neuroanatomical SI12 indications
SI12 indications
- Supraspinatus myofascial pain/strain
- Supraspinatus tendonitis
- Impaired shoulder abduction
- Stiff neck, pain in the scapular region
