Shoulder Flashcards
1
Q
What are the 3 angles of the scapula?
A
- Superior
- Inferior
- Lateral
2
Q
What are the 3 borders of the scapula?
A
- Superior
- Medial
- Lateral
3
Q
What are the 3 processes protruding from the scapula?
A
- Spine
- Acromion
- Coracoid
4
Q
What is the structure of the ventral surface of the scapula?
A
It is a large concavity called the subscapular fossa which articulates with the thoracic cage.
5
Q
What is the one muscle which uses the subscapular fossa as an attachment?
A
Subscapularis
6
Q
What is the structure of the dorsal surface of the scapula?
A
The dorsal surface is split into a supraspinous fossa and an infraspinous fossa by the spine of the scapula.
7
Q
How is the structure of the coracoid process often described?
A
It is described as hook-like.
8
Q
At the base of the coracoid process there is a notch which becomes a foramen thanks to which ligament running across it?
A
Transverse scapular ligament
9
Q
Which nerve runs through the foramen created by the coracoid notch and the transverse scapular ligament?
A
Subscapular nerve
10
Q
From which angle of the scapula does the glenoid cavity form?
A
Lateral
11
Q
What movements can the scapula undergo?
A
- Elevation and depression in the coronal plane
- Protraction and retraction in the transverse plane
- Medial and lateral rotation in the coronal plane
12
Q
When thinking about medial and lateral rotation of the scapula, which landmark should be used?
A
The inferior angle of the scapula. When this moves upwards and outwards it is lateral rotation, when it moves downwards and inwards it is medial rotation
13
Q
What is the name for the kinematic interaction between the scapula, humerus and clavicle required for full flexion or abduction of the shoulder?
A
Scapulohumeral rhythm
14
Q
What are the key muscles involves in regulating the scapulohumeral rhythm?
A
- Serratus anterior
- Rhomboids
- Levator scapulae
- Trapezius
15
Q
What ratio of movement is there between the scapula and the glenohumeral joint in scapulohumeral rhythm?
A
1:2
16
Q
What are the 3 phases of the scapulohumeral rhythm?
A
- Setting phase of the scapula
- 2:1 phase
- Final phase
17
Q
What occurs during the setting phase of the scapula in scapulohumeral rhythm?
A
The first 30 degrees of flexion/abduction come almost entirely from the glenohumeral joint with 0-5 degrees from clavicular movement at the SC and AC joints.
18
Q
What occurs during the 2:1 phase of scapulohumeral rhythm?
A
Up to 90 degrees of flexion/abduction there is approximately 40 degrees glenohumeral movment and 20 degrees lateral scapula rotation. In response to the scapular rotation, the clavicle rises by 15 degrees.
19
Q
What occurs during the final phase of the scapulohumeral rhythm?
A
From 90 degrees to 180 degrees flexion/abduction:
* The humerus abducts 60 degrees further and laterally rotates 90 degrees to prevent impingment between the greater tuberosity of the humerus and the acromion.
* The scapular laterally rotates 30-40 degrees more.
* The clavicle rotates 40-50 degrees posteriorly and elevates a further 15 degrees
20
Q
What is the importance of scapulohumeral rhythm?
A
It helps to maintain the length-tension relationship of glenohumeral muscles during the full range of movement.
21
Q
What is scapulohumeral dyskinesia?
A
This is a dysfunction in scapulohumeral rhythm due to altered positioning of the scapula in relation to the humerus.
22
Q
How does scapulohumeral dyskinesia classically present?
A
- Medial border and inferior angle dominance
- Early scapula elevation during flexion/abduction
- Rapid downward/medial rotation during lowering of th arms
- Scapular protraction
23
Q
What are potential causes of scapulohumeral dyskinesia?
A
- Increased thoracic kyphosis
- Tightness in pectoralis minor or biceps brachii
- Weakness in serratus anterior or lower trapezius
- Fractured clavicle
- Acromioclavicular arthrosis
24
Q
What is the name for increased prominence of the medial border and inferior angle of the scapula during scapulohumeral dyskinesia?
A
Scapular winging
25
Why do people with scapular dyskinesia often end up with hypertrophy in upper trapezius fibres?
Atrophy of lower trapezius fibres means that the shrugging motion is more important to flexion and abduction of the shoulder and so the upper fibres, responsible in part for this shrug, undergo hypertrophy.
26
Weakness in which muscle is said to cause scapular winging?
Lower fibres of trapezius, weakness means they can no longer anchor the scapula down
27
What percentage of people with glenohumeral instability have altered scapular positioning?
Two-thirds
28
What is the long bone of the upper arm called?
Humerus
29
What is the proximal articulation of the humerus?
The head of the humerus interacts with the glenoid fossa of the acromion to form the glenohumeral joint.
30
What is the groove between the greater and lesser humeral tuberosities called?
Intertubercular sulcus
31
Which muscles does the greater tuberosity of the humerus provide attachment for?
* Supraspinatous (superior facet)
* Infraspinatous (middle facet)
* Teres minor (inferior facet)
32
Which muscle attaches to the lesser tuberosity of the humerus?
Subscapularis
33
What structure passes through the intertubercular sulcus of the femur?
The tendon of the long head of biceps brachii
34
Which muscles attach to the lip of the intertubercular groove/sulcus of the humerus?
* Pectoralis major
* Teres major
* Latissimus dorsi
35
Which two bones are connected by the clavicle?
* Manubrium
* Acromion
36
What are the 3 functions of the clavicle?
1. It attaches the upper limb to the axial skeleton as part of the shoulder girdle.
2. It provides protection for neurovascular structures supplying the upper limb.
3. It transmits force from the upper limb to the axial skeleton.
37
What shape is the clavicle?
S-shaped
38
What is the structure of the medial end of the clavicle?
It has a large convex facet for articulation with the manubrium. It also has a rough ovular depression on its inferior aspect which serves as the attachment point for the costoclavicular ligament.
39
Which muscles attach to the shaft of the clavicle?
* Deltoid
* Trapezius
* Subclavius
* Pectoralis major
* Sternocleidomastoid
* Sternohyoid
40
What is the structure of the lateral end of the clavicle?
It has a small concave facet for articulation with the acromion. Inferiorly there is a conoid tubercle which serves as attachment for the conoid ligament. Obliquely superolateral from the conoid tubercle is the trapezoid line where the trapezoid ligament attaches. The conoid and trapezoid ligaments are both part of the coracoclavicular ligament.
41
What type of joint is the glenohumeral joint?
A synovial ball and socket joint
42
How is shoulder stability compared to other joints?
The shoulder is the most mobile and least stable joint in the body.
43
How much does the fibrocartilaginous labrum deepen the glenohumeral joint?
By 50%
44
What is the function of the fibrocartilaginous labrum of the glenohumeral joint?
It deepens the socket and creates a negative pressure in the joint, helping to secure the humerus into the joint.
45
What movements can occur at the glenohumeral joint?
* Flexion
* Extension
* Abduction
* Adduction
* Internal rotation
* External rotation
* Scapular plane abduction
46
How does the humeral head move during glenohumeral flexion?
* Inferior roll
* Posterior glide
47
How does the humeral head during extension at the glenohumeral joint?
* Superior roll
* Anterior glide
48
How does the humeral head move during glenohumeral abduction?
* Superior roll
* Inferior glide
49
How does the humeral head move during internal rotation of the glenohumeral joint?
Medial roll
50
How does the humeral head move during external rotation of the glenohumeral joint?
Lateral roll
51
What are the attachments of the glenohumeral joint capsule?
Laterally it attaches to the anatomical neck of the femur. Medially it attaches to the glenoid and labrum.
52
Which portion of the glenohumeral joint capsule is taut at rest?
Superior aspect
53
Which ligaments reinforce the anterior portion of the glenohumeral joint capsule?
Superior, middle and inferior glenohumeral ligaments
54
What are the muscles of the rotator cuff?
* Supraspinatous
* Infraspinatous
* Teres minor
* Subscapularis
55
Which orientations of the glenohumeral joint capsule are reinforced by the rotator cuff?
The superior, anterior and posterior aspects
56
Which region of the glenohumeral joint capsule is weakest and why?
The inferior aspect asit has no ligamentous or muscular reinforcement and it also has an axillary fold which allows the capsule to stretch during full abduction but that is weak when not held under tension.
57
What are the attachments of the superior glenohumeral ligament?
Originates from the glenoid and inserts onto the anatomical neck of the humerus.
58
Which movements are limited by the superior glenohumeral ligament?
* External rotation
* Inferior translation
59
What are the attachments of the middle glenohumeral ligament?
Originates from the glenoid and inserts onto the anatomical neck of the humerus directly below the superior glenohumeral ligament.
60
Which movements are limited by the middle glenohumeral ligament?
* External rotation
* Anterior translation
61
What are the attachments of the inferior glenohumeral ligament?
It originates from the glenoid and inserts onto the humerus just pass the lesser tuberosity, covering the majority of the inferior of the joint.
62
Which movements are limited by the inferior glenohumeral ligament?
The anterior portion limits external rotation, superior and anterior translation of the humeral head.
The posterior portion limits internal rotation and anterior translation of the humeral head.
63
What are the attachments of the coracohumeral ligament?
It originates from the coracoid process, spreads to cover the superior glenohumeral ligament and blends with the superior joint capsule and supraspinatous tendon.
64
What separates the coracohumeral ligament into anterior and posterior bands?
The biceps tendon
65
Which movements are limited by the coracohumeral ligament?
The anterior band limits extension.
The posterior band limits flexion
Both limit inferior and posterior translation of the humeral head.
66
What is the transhumeral ligament?
This is a small ligament on the proximal humerus that sits over the intertubercular sulcus and keeps the biceps tendon in it.
67
What type of joint is the acromioclavicular joint?
Plane synovial
68
What is the role of the fibrocartilaginous disc within the acromioclavicular joint?
It cushions and protects the joint
69
What is the structure of the articular facets of the acromioclavicular joints?
There is no consistent structure and they vary widely between individuals.
70
Which movements can occur at the acromioclavicular joint?
* Internal and external rotation
* Anterior and posterior tilting
* Lateral tilting
71
What is the structure of the acromioclavicular joint capsule?
It is a thin, synovium-lined capsule with reinforcement from ligaments superiorly and inferiorly.
72
Which ligament superiorly reinforced the acromioclavicular joint?
The acromioclavicular ligament
73
What is the structure of the coracoclavicular ligament?
It is made of two distinct elements: a trapezoid ligament more laterally and a conoid ligament more medially.
74
Which movements are limited by the coracoclavicular ligament?
Superior dislocation of the acromioclavicular joint.
Scapula rotation is also limited.
75
What are the articulations of the sternoclavicular joint?
The manubrium of the sternum and an articulating facet on the first rib articulate with the medial aspect of the sternoclavicular joint.
76
What type of joint is the sternoclavicular joint?
A saddle synovial joint
77
What is the role of the articulating disc in the sternoclavicular joint?
It often improves congruency as joint surfaces are frequently incongruent.
78
What are the attachments of the disc of the sternoclavicular joint?
Attaches to posterosuperior margin of the clavicle and the costal cartilage of rib 1.
79
Which movements can occur at the sternoclavicular joint?
* Anterior and posterior rotation
* Elevation and depression
* Protraction and retraction
80
What are the attachments of the anterior stenoclavicular ligament?
It attaches to the medial clavicle and the anterosuperior aspect of the manubrium.
81
What are the functions of the anterior sternoclavicular ligament?
* Anterior reinforcement of the joint capsule
* Prevents anterior translation of the clavicle
82
Which is stronger: anterior or posterior sternoclavicular ligament?
Anterior
83
What are the attachments of the posterior sternoclavicular ligament?
It originates from the posterior aspect of the medial clavicle and the posterosuperior aspect of the manubrium.
83
What is the function of the posterior sternoclavicular ligament?
It reinforces the joint capsule posteriorly and prevents posterior translation of the clavicle.
83
What are the attachments of the costoclavicular ligament?
It attaches to the costal cartilage of the first rib and the inferior aspect of the clavicle.
84
What is the function of the costoclavicular ligament?
* Anchors the medial clavicle to the first rib and costal cartilage
* Provides the main restraint to the sternoclavicular joint
85
Which movement of the sternoclavicular joint is limited by the costoclavicular ligament?
Pectoral girdle elevation
86
What are the attachments of the interclavicular ligament?
It attaches to the supermedial aspects of both clavicles producing bilateral depression force.
87
What are the functions of the interclavicular ligament?
* Reinforces the SC joint capsule superiorly
* Resists downward glide of the clavicle
88
How does the clavicle move during elevation at the SC joint?
* Superior roll and inferior glide
89
Why is the scapulothoracic joint not an anatomical joint?
It is not united by fibrous, cartilaginous or synovial tissue.
90
The integrity of which true joints are responsible for maintaining articulation in the scapulothoracic joint?
* Sternoclavicular joint
* Acromioclavicular joint
91
What is the normal distance from the medial border of the scapula to the midline between T2 and T7-9?
2 inches
92
Which movements can occur at the scapulothoracic joint?
* Elevation and Depression
* Protraction and Retraction
* Upward and Downward Rotation
* Anterior and posterior tipping
93
What muscle activity controls uppwards rotation of the scapula?
1. Upper fibres of trapezius elevate the lateral clavicle
2. Lower fibres of trapezius pull on the medial aspect of the scapular spine
3. Serratus anterior pulls on the inferior border of the scapula
94
What are the origins of biceps brachii?
* Supraglenoid muscle and glenoid labrum (long head)
* Apex of the coracoid process (short head)
95
What are the insertions of biceps brachii?
* Radial tuberosity
* Antebrachial fascia
96
Which actions are mediated by biceps brachii?
* Elbow flexion
* Forearm supination
97
Which nerves innervate biceps brachii?
Musculocutaneous nerve (C5-C6 nerve roots)
98
Which blood vessels supply biceps brachii?
* Brachial artery
* Circumflex humeral artery
99
Which structures are posterior to biceps brachii?
Brachialis
100
Which structures are anterior to biceps brachii?
Pectoralis major
101
Which structures are medial to biceps brachii?
Coracobrachialis
102
How can you strengthen biceps brachii?
Bicep curls
103
How do you stretch biceps brachii?
* Interlock your fingers behind your back and stretch them backwards
* Place your forearm on a wall or door and turn away from your arm
104
How do you palpate biceps brachii?
1. Palpate the lateral portion of the clavicle and drop inferiorly and palpate deeply to feel the coracoid process
2. Ask the patient to perform resisted elbow flexion with supinated forearm and this will generate tension in the short head beneath the coracoid process
3. For the long head you can palpate the biceps tendon in the bicipital groove and follow the muscle belly down to its tendinous insertion at the radial tuberosity with the patient performing resisted elbow flexion
105
What type of muscle is biceps brachii?
Fusiform
106
What are the origins of coracobrachialis?
Coracoid process of the scapula
107
What are the insertions of coracobrachialis?
Middle third of the medial aspect of the humerus
108
Which actions are mediated by coracobrachialis?
* Shoulder adduction
* Shoulder flexion
109
Which nerves innervate coracobrachialis?
Musculocutaneous nerve (C5-C7 nerve roots)
110
Which blood vessels supply coracobrachialis?
* Brachial artery
* Circumflex humoral artery
111
Which structures are posterior to coracobrachialis?
* Subscapularis
* Teres major
* Latissimus dorsi
* Triceps brachii
112
Which structures are anterior to coracobrachialis?
Pectoralis major
113
Which structures are lateral to coracobrachialis?
* Brachialis
* Biceps brachii
114
How do you strengthen coracobrachialis?
* Eccentrically contract to prevent abduction
* Press a dumbell between your hands
115
How do you stretch coracobrachialis?
Sit with your hands on your knees and rotate your head and shoulders as far as you can and you will contralaterally stretch coracobrachialis
116
How do you palpate coracobrachialis?
1. Place the patient's arm in 90 degrees abduction and full external rotation (to soften biceps brachii)
2. Palpate for the insertion around the middle of the medial humeral shaft
3. Perform resisted adduction and the muscle belly will be clear below biceps brachii
It is almost impossible to follow coracobrachialis to its origin as it goes posterior to pectoralis major
117
What type of muscle is coracobrachialis?
Strap-like
118
What are the origins of deltoid?
* Lateral third of the clavicle
* Acromion
* Spine of the scapula
119
What are the insertions of deltoid?
Deltoid tuberosity of the humerus
120
Which actions are mediated by deltoid?
* Flexion
* Extension
* Abduction
* Medial rotation
* Lateral rotation
121
Which nerves innervate deloid?
Axillary nerve (C5-C6 nerve roots)
122
Which blood vessels supply deltoid?
* Thoracoacromial artery
* Deep brachial artery
* Circumflex humeral artery
123
Which structures are deep to deltoid?
* Glenohumeral joint
* Biceps brachii tendon
* Triceps brachii tendon
124
Which structures are medial to deltoid?
* Pectoralis major
* Trapezius
* Infraspinatus
125
How do you strengthen deltoid?
* Military press (arms from 90 degrees abduction and elbow flexion to straight above the head with weights)
* Dumbell lateral raise
126
How do you stretch deltoid?
* Raise one arm over your head, grab the elbow of it with the other arm and gently pull (anterior deltoids)
* Reach behind your back, grab your opposite elbow and pull it towards you (posterior deltoids)
* Arm across chest stretch
127
How do you palpte deltoid?
1. Palpate the lateral third of the clavicle, round the acromion and then on to the spine of the scapula, these are the insertions of deltoid
2. Palpate triangularly towards the deltoid tuberosity
3. Resisted flexion fires anterior fibres, resisted abduction fires middle fibres, resisted extension fires posterior fibres
128
What type of muscle is deltoid?
Triangular
129
What are the origins of pectoralis major?
* Anterior aspect of the medial half of the clavicle
* Manubrium
* Sternum
* True ribs and their costal cartilages
* Aponeurosis of external abdominal obliques
130
What are the insertions of pectoralis major?
Crest of the greater tubercle of the humerus
131
Which actions are mediated by pectoralis major?
* Shoulder adduction
* Shoulder medial rotation
* Pectoral girdle depression at the acromioclavicular and sternoclavicular joints
132
Which nerves innervate pectoralis major?
Medial and lateral pectoral nerves
133
Which blood vessels supply pectoralis major?
* Thoracoacromial artery
* Internal thoracic artery
* Superior thoracic artery
* Lateral thoracic artery
134
Which structures are deep to pectoralis major?
* Sternum
* First 6 ribs and their costal cartilages
* Serratus anterior
* Subclavius
* External intercostals
135
What structures are superficial to pectoralis major?
Breast tissue
136
How do you strengthen pectoralis major?
* Push ups
* Resisted adduction
137
How do you stretch pectoralis major?
* Place your forearm on a doorway and turn your head and shoulder away
* Walk through a doorway with your forearms on either side of the door
* Interlace your fingers behind your back and lift them upwards
138
How do you palpate pectoralis major?
1. Put the patient in supine with their arm in 90 degrees abduction
2. Palpate the medial clavicle
3. Ask the patient to lift their arm off the plinth and you will see pectoralis major fire
4. You can palpate down the manubrium, sternum and costal cartilages of the true ribs and then palpate laterally to feel the main muscle belly
139
What type of muscle is pectoralis major?
Convergent
140
What are the origins of pectoralis minor?
Anterior ends of 3rd-5th ribs
141
What are the insertions of pectoralis minor?
Coracoid process of the scapula
142
Which actions are mediated by pectoralis minor?
* Shoulder protraction
* Shoulder medial rotation
143
Which nerves innervate pectoralis minor?
Medial and lateral pectoral nerves
144
Which blood vessels supply pectoralis minor?
* Thoracoacromial artery
* Superior thoracic artery
* Lateral thoracic artery
145
Which structures are posterior to pectoralis minor?
* 3rd-5th ribs
* Serratus anterior
* External intercostals
146
Which structures are anterior to pectoralis minor?
Pectoralis major
147
Which structures are medial to pectoralis minor?
Costal cartilages of 3rd-5th ribs
148
How can you strengthen pectoralis minor?
* Weighted shrugs
* Push ups
* Fly
149
How do you stretch pectoralis minor?
Shoulder retraction
150
How do you palpate pectoralis minor?
1. Palpate the costal cartilages from ribs 1-3
2. Follow rib 3 laterally and palpate deeply, asking your patient to lift their shoulder off the plinth and to try bring it across their body, this will fire off pectoralis minor which you can follow to the coracoid process
151
What type of muscle is pectoralis minor?
Convergent triangular muscle
152
What are the origins of latissimus dorsi
* Spinous processes T7-T12
* 9th-12th ribs
* Iliac crest
* Thoracolumbar fascia
153
What are the insertions of latissimus dorsi?
Floor of the intertubercular sulcus of the humerus
154
Which actions are mediated by latissimus dorsi?
* Shoulder adduction
* Shoulder medial rotation
* Shoulder extension
155
Which nerves innervate latissimus dorsi?
Thoracodorsal nerve (C6-C8 nerve roots)
156
Which blood vessels supply latissimus dorsi?
* Thoracodorsal artery
* Intercostal arteries
* Subcostal arteries
* Lumbar arteries
157
Which structures are deep to latissimus dorsi?
* Inferior angle of the scapula
* 9th-12th ribs
* External intercostal muscles
* Serratus anterior
* Serratus posterior
* Internal abdominal obliques
* Erector spinae
158
Which structures are superficial to latissimus dorsi?
Lower fibres of trapezius
159
Which structures are superior to latissimus dorsi?
* Teres major
* Rhomboid major
* Supraspinatus
160
How can you strengthen latissimus dorsi?
* Deadlifts
* Lat pulldowns
* Dumbbell rows
161
How can you stretch latissimus dorsi?
* Kneel on the floor, sit on your heels and lead forward, stretching through your fingertips with one arm then switch
* Stand with hands on the back of a chair and hinge at the hips until your head is below your hands
* Eagle pose
162
How do you palpate latissimus dorsi?
1. Palpate the posterior iliac crest
2. Palpate superomedially to the spinous processes of L5 to T7
3. Palpate the inferior 4 ribs
4. Each of these are different origins
5. If you place your hand between these and the intertubercular sulcus of the humerus and perform resisted shoulder extension then you can feel latissimus dorsi and can follow it up into the axilla
163
What type of muscle is latissimus dorsi?
Convergent
164
What are the origins of levator scapulae?
Transverse processes of C1-C4
165
What are the insertions of levator scapulae?
* Superior angle of the scapula
* Medial border of the scapula superior to the spine of the scapula
166
Which actions are mediated by levator scapulae?
* Elevation of the shoulder girdle at the AC and SC joints
* Medial rotation of the shoulder girdle
* Neck extension
* Neck lateral flexion
167
Which nerves innervate levator scapulae?
* Anterior rami of 3rd and 4th cervical nrev
* Dorsal scapular nerve
168
Which blood vessels supply levator scapulae?
* Cervical artery
* Vertebral artery
169
Which structures are deep to levator scapulae?
Serratus posterior
170
Which structures are superficial to levator scapulae?
* Sternocleidomastoid
* Trapezius
171
Which structures are lateral to levator scapulae?
Supraspinatus
172
Which structures are medial to levator scapulae?
Rhomboid minor
173
How do you strengthen levator scapulae?
* Shrugs
* Barbell rows
174
How do you stretch levator scapulae?
Turn your head 45 degrees then look down, tucking your chin to your chest and gently apply overpressure with the opposite arm.
175
How do you palpate levator scapulae?
1. Palpate between the mastoid process and the angle of the mandible and sink into to find the C1 transverse process.
2. Move inferiorly over sternocleidomastoid to C3 transverse process.
3. Palpate inferiorly and slightly laterally from this region towards the medial border of the scapula and ask your patient to shrug and you will feel the muscle belly.
176
What are the origins of rhomboid major?
Spinous processes of T2-T5
177
What are the insertions of rhomboid major?
Medial border of the scapula, inferior to the spine of the scapula
178
Which actions are mediated by rhomboid major?
* Shoulder retraction
* Shoulder medial rotation
179
Which nerves innervate rhomboid major?
Dorsal scapular nerve (C4-C5 nerve roots)
180
Which blood vessels supply rhomboid major?
* Dorsal scapular artery
* Posterior intercostal arteries
181
Which structures are anterior to rhomboid major?
* Erector spinae
* Serratus posterior
182
Which structures are superficial to rhomboid major?
Trapezius
183
Which structures are lateral to rhomboid major?
* Scapula
* Infraspinatus
184
Which structures are superior to rhomboid major?
Rhomboid minor
185
How do you strengthen rhomboid major?
* Prone lateral raises
* Prone arm lifts with thumbs up and shoulders fully flexed
186
How do you stretch rhomboid major?
Interlock your hands and stretch out forwards, protracting the shoulder girdle.
187
How do you palpate rhomboid major?
1. Palpate C7 spinous process and work down to between T2 and T5 spinous processes.
2. Follow inferolaterally to the lower part of the medial border of the scapula
3. Ask your patients to retract their shoulder slightly off the table and you will be able to palpate rhomboid major without excessive activation of trapezius
188
What type of muscle is rhomboid major?
Quadrilateral
189
What are the origins of rhomboid minor?
* Spinous processes of C7-T1 vertebrae
* Nuchal ligament
190
What are the insertions of rhomboid minor?
Medial border of the scapula, adjacent to the spine of the scapula
191
Which actions are mediated by rhomboid minor?
* Retraction of the shoulder girdle
* Medial rotation of the scapula
192
Which nerves innervate rhomboid minor?
Dorsal scapular nerve
193
Which blood vessels supply rhomboid minor?
* Dorsal scapular artery
* Posterior intercostal arteries
194
Which structures are deep to rhomboid minor?
Serratus posterior
195
Which structures are superficial to rhomboid minor?
Trapezius
196
Which structures are lateral to rhomboid minor?
* Scapula
* Supraspinatus
* Levator scapula
197
Which structures are inferior to rhomboid minor?
Rhomboid major
198
How do you strengthen rhomboid minor?
* Prone lateral arm raises
* Prone arm lifts with thumbs up and shoulders fully flexed
199
How do you stretch rhomboid minor?
Grab one hand with the other and stretch forwards, protracting the shoulders
200
How do you palpate rhomboid minor?
1. Palpate C7 and palpate down to T1.
2. Palpate from here inferolaterally to the medial border of the scapula adjacent to the spine of the scapula
3. Ask the patient to slightly retract the shoulder blades and you will feel this band of muscle activating
201
What type of muscle is rhomboid minor?
Quadrilateral
202
What are the origins of serratus anterior?
External surface of 1st-9th ribs
203
What are the insertions of serratus anterior?
Medial border of the scapula (ventrally)
204
Which actions are mediated by serratus anterior?
* Shoulder protraction
* Scapular lateral rotation
205
Which nerves innervate serratus anterior?
Long thoracic nerve (C5-C7 nerve roots)
206
Which blood vessels supply serratus anterior?
* Superior thoracic artery
* Lateral thoracic artery
* Thoracodorsal artery
207
Which structures are deep to serratus anterior?
* 1st-8th ribs and their external intercostal muscles
208
Which structures are superficial to serratus anterior?
* Scapula
* Latissimus dorsi
* Trapezius
* Subscapularis
209
Which structures are anterior to serratus anterior?
•Pectoralis major
•Pectroalis minor
210
How do you strengthen serratus anterior?
•Plank with protracted shoulders
•Overhead shrugs
211
How do you stretch serratus anterior?
•Lie on one side propped up by one elbow and then allow your torso to drop towards the bed
•Sit on a chair and grab the right side of the chair with your left arm then turn your body back towards the front
212
How do you palpate serratus anterior?
1. With the patient in side lying ask them to bring their top arm on top of their other, exposing their ribs.
2. Palpate from ribs 12 to 9 in the mid-axillary line
3. Palpate dorsally and ask the patient to perform resisted protraction and you will feel the serrated belly of the muscle
4. Follow these bellies to the scapular border (and not below as this is very uncomfortable for the patient)
213
Which muscle does serratus anterior interdigitate with at the mid-axillary line?
External abdominal obliques
214
What type of muscle is serratus anterior?
Fan-shaped
215
What are the origins of teres major?
Posterior aspect of the inferior border of the scapula
216
What are the insertions of teres major?
Crest of the lesser tubercle of the humerus
217
Which actions are mediated by teres major?
•Shoulder adduction
•Shoulder medial rotation
218
Which nerves innervate teres major?
Lower subscapular nerve (C5-C7 nerve roots)
219
Which blood vessels supply teres major?
* Circumflex scapular artery
* Subscapular artery
* Circumflex humeral artery
220
Which structures are superficial to teres major?
Triceps brachii
221
Which structures are deep to teres major?
* Scapula
* Coracobrachialis
222
Which structures are inferior to teres major?
Latissimus dorsi
223
Which structures are superior to teres major?
* Teres minor
* Infraspinatus
224
How do you strengthen teres major?
Resisted adduction
225
How do you stretch teres major?
* Doorway stretch with hands below waist
* Cross body arm stretch
226
How do you palpate teres major?
1. With the patient in prone, ask the patient to put their arm behind their back and relax.
2. Palpate the inferior angle of the scapula
3. Palpate along the lateral border of the scapula to find the origin of teres major
4. Place the patient's arm off the table and perform resisted medial rotation and you will see a clear band of muscle between the lateral border of the scapula and the axilla
5. Beyond the axilla it becomes impossible to differentiate from latissimus dorsi
227
What type of muscle is teres major?
Fusiform
228
What are the origins of triceps brachii?
* Infraglenoid tubercle of the scapula (long head)
* Posterior surface of the humerus, superior to the radial groove (lateral head)
* Posterior surface of the humerus, inferior to the radial groove (medial head)
229
What are the insertions of triceps brachii?
* Olecranon of the ulna
* Adjacent antebrachial fascia
230
Which actions are mediated by triceps brachii?
Forearm extension
231
Which nerves innervate triceps brachii?
Radial nerve (C6-C7 nerve roots)
232
Which blood vessels supply triceps brachii?
* Deep brachial artery
* Superior ulnar collateral artery
* Circumflex humeral artery
233
Which structures are medial to triceps brachii?
* Teres major
* Teres minor
234
How do you stretch triceps brachii?
* Put your hand on the middle of your back with arm behind your head and use the opposite arm to apply pressure down on the elbow.
* Arm across body stretch
235
How do you palpate triceps brachii?
1. With the patient in prone and their arm off the table, palpate the superior aspect of the lateral border of te scapula (infraglenoid tubercle)
2. Perform resisted elbow extension and you will feel the tendon contract and you can follow the long head down to the olecranon.
3. For the lateral head, ask the patient to lift their arm off the plinth to find the inferior border of deltoids, below this there is the lateral head of triceps.
4. The medial head is palpated by moving the long head laterally and palpating beneath while performing resisted extension.
236
What type of muscle is triceps brachii?
Fusiform
237
What are the origins of supraspinatus?
Supraspinous fossa of the scapula
238
What are the origins of supraspinatus?
Greater tubercle of the humerus
