Shoulder and Arm Flashcards
Skin and Fascia
Pull up on the skin and twist in different areas to see how thick they are and how mobile. OR sink fingers into upper chest and shift tissue side to side. Compare to axilla or clavicle area
Spine of the Scapula
Partner Prone. Palpate posterior shoulder with wide hand
Medial Border
Partner Prone. Slide medially from the spine of the scapula and down. Can have partner put their hand in the small of their back to make it lift up more
Inferior angle
Partner Prone. Hand on small of back. Slide inferiorly from medial border to the tip.
Superior Angle
Partner Prone. Locate Medial border and move superiorly. Must push skin out of the way.
Lateral Border
Partner Prone. Slide superiorly from the inferior angle. Can also have them hang their arm off the table.
Infraglenoid tubercle
Follow lateral border up towards arm pit. Difficult to feel.
Infraspinous fossa
Palpate the spine of the scapula, medial and lateral border. Use fingers to outline fossa.
Supraspinous Fossa
Palpate Spine of the scapula and slide superiorly into fossa.
Subscapular Fossa
Drape arm off table, protract the shoulder
Scoop underneath the scapula beneath the axilla
To test: partner internally/externally rotates arm, can feel Subscapularis contracting/relaxing
OR
Side lying, protract the arm
Scoop underneath medial border
Retract the arm
Acromion
Partner seated. Palpate either the spine of the scapula or the clavicle and slide laterally to the edge where the acromion flattens out.
Clavicle
Start either from the spine of the scapula or the acromion and move anteriorly along the clavicle.
AC joint
Slide from the clavicle laterally to a bump. have partner abduct arm to be sure you’re on it. Can also protract the scapula to test.
SC joint
Palpate along the clavicle medially to a bump. Elevate and Depress shoulder to test.
Coracoid Process
Find lateral shaft of clavicle
Slide inferiorly off clavicle no more than 1.5 inches
Detoid tuberosity
Find Acromion slide down arm about half way down. Have partner abduct their arm against resistance and follow deltoid to the insertion.
Greater tubercle
Shake partners hand and slide anteriorly off of the acromion. Externally rotate the arm and first bump is GT
Lesser Tubercle
Shake partners hand and slide anteriorly off of the acromion. Externally rotate the arm and after the first bump and the groove there is the lesser tubercle
Deltoid
Have partner abduct their arm against your resistance and feel the muscle contract.
O: PF spine of the scapula, MF Acromion, AF- lateral border of scapula
I: Deltoid Tuberosity
N: Axillary (C5, C6)
A: Abducts, flexes and extends
Trapezius Upper, middle and lower
Upper: palpate above the spine of the scapula to the occipital protuberance. Have partner elevate shoulder
Middle: slide medially off spine of scap. Have them lift their shoulders off table to test.
Lower: Have partner in super man. Make line from inferior angle to T12 and roll across fibers. Have them lift arms off table.
O: middle third of superior nuchal line, occipital protuberance, ligamentum nuchae and C7-T12
I: Lateral third of clavicle, Acromion, spine of scap.
A:Extends head, shoulder elevation and depression, rotates scap superiorly, retracts scap.
I: Accessory N 11, sensory- C3-C4
Latissimus Dorsi
Have partner lay with arm off table. Slide off lateral border and have them internally rotate.
O: T-7 to sacrum, iliac crest and last 3-4 ribs, inf angle of scap
I: below the intertubercular groove
A: Internal rotation, extension, adduction
I: Thoracodorsal N C7-C8
Teres Major
Have partner lay with arm off table. Slide off lateral border and have them internally rotate. should be just above lat coming off lateral border.
O: Inferior angle
I: Crest of lesser tubercle
A: Internal rotation, adduction and extension
N: Lower subscapular C5 C6
Teres Minor
Palpate the lateral border and have partner externally rotate arm. O: Lateral border I: lower facet of Greater tubercle A: External rotation N: Axillary C5 C6
Teres Minor and infraspinatus Tendon
Drape arm off side of table
Find bellies of the muscles, follow laterally until you “fall of the shelf” of the scapula
OR
Seated, shoulder flexed to 90 degrees, horizontally adducted, laterally rotated
Infraspinatus tendon will move below the acromion
Supraspinatus
Slide superiorly off spine of the scap, have partner abduct against resistance.
O: Supraspinatus fossa
I: superior facet of greater tubercle
A: helps start delt to abduct arm, stabilization
N: Suprascapular N C4 C6
Supraspinatus tendon
Slide off acromion on greater tubercle. Have partner place hand behind back and it will move anteriorly
Infraspinatus
Palpate inside inraspinatus fossa, have partner lift elbows towards ceiling. O: Infraspinatus fossa I: Middle facet of greater tubercle A: external rotation and abduction N: Suprascapular N C4 C6
Subscapularis
Have partner lay with arm off the table. Palpate under the lateral border and have them rotate their arm O: Subscapular fossa I: Lesser Tubercle A: Internal rotation N: Subscapular N C5 C6
Subscapularis Tendon
Arm in anatomical position
Find coracoid process
Slide one inch inferiorly and laterally
Rhomboids
Palpate off the medial border towards the vertebrae. Have partner squeeze shoulders together.
O: Minor C7 T1, Major T2-T5
I: Medial border
Action: Elevates and retracts the scapula, downward rotation of glenoid fossa
N: Dorsal Scapular N C5
Levator Scapula
Slide posteriorly off of the mastoid process and have partner laterally flex head against resistant O: Transverse processes C1-C4 I: Superior Angle of scap A: Elevate Scapula, lateral flexion M: Dorsal Scapular C5 and some C3 C4
Serratus Anterior
Partner lying supine with arm flexed to 90 degrees. Slide off lateral border and have them punch towards the ceiling.
O:Ribs 1-9
I: Medial border of scap
A: Protracts and rotates the scapula superiorly
N: Long Thoracic N C5-C7
Pec Major
Supine, arm slightly abducted
Find medial shaft of clavicle, palpate inferiorly
Partner medially rotates towards belly, PT resists, feel contraction
OR
Side lying, pull partner’s flexed arm toward PT
Can grasp muscle
Passively flex and extend shoulder to feel changing tension
O: Clavicle, Sternum, Ribs 2-6
I: Intertubercular groove
A: Flexion, adduction, extension, internal rotation
N: Medial and lateral pec n C5-T1
Pec Minor
On back push underneath pec major to feel the minor insert onto the coracoid. Have partner inhale deep breath
O: Coracoid
I: Ribs 2-5
A: Elevates ribs during breathing, protracts scapula
N: Medial Pectoral N C8 T1
Subclavius
Side lying, flexed arm, pull towards PT
Roll fingers off the clavicle to get under it
PT pushes shoulder up and partner resists by pulling shoulder down to feel contraction
O: 1st rib
I: inferior border of clavicle
A: Depress and pull scapula forward
N: Subclavian N from upper trunk of brachial plexus
Biceps Brachii (and long head tendon)
Seated shake hands with partner and have them flex their elbow. Feel tendon of long head through bicipital groove
O: Long head: Supraglenoid tubercle, short head: Coracoid
I: Tuberosity of radius and bicipital aponeurosis
A: Supinates and flexes arm, shoulder flexion
N: Musculocutaneous C6-C7
Triceps Brachii (and tendon of the long head)
Have partner extend elbow O: Medial head: medial border of humerus, long head: infraglenoid tubercle, Lateral head: lateral border of humerus I: Olecranon process of ulna A: Extends elbow and shoulder N: Radial N C7 C8
Coracobrachialis
Find proximal humerus Partner has elbow flexed and shoulder at 45 degrees, PT applies downward pressure to feel contraction O: Coracoid I: medial surface of middle humerus A: Flex and adduct the arm N: Musculocutaneous C6-7
