Shoulder and Arm

Question 1

Skin and Fascia

Answer 1

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

Question 2

Spine of the Scapula

Answer 2

Partner Prone. Palpate posterior shoulder with wide hand

Question 3

Medial Border

Answer 3

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

Question 4

Inferior angle

Answer 4

Partner Prone. Hand on small of back. Slide inferiorly from medial border to the tip.

Question 5

Superior Angle

Answer 5

Partner Prone. Locate Medial border and move superiorly. Must push skin out of the way.

Question 6

Lateral Border

Answer 6

Partner Prone. Slide superiorly from the inferior angle. Can also have them hang their arm off the table.

Question 7

Infraglenoid tubercle

Answer 7

Follow lateral border up towards arm pit. Difficult to feel.

Question 8

Infraspinous fossa

Answer 8

Palpate the spine of the scapula, medial and lateral border. Use fingers to outline fossa.

Question 9

Supraspinous Fossa

Answer 9

Palpate Spine of the scapula and slide superiorly into fossa.

Question 10

Subscapular Fossa

Answer 10

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

Question 11

Acromion

Answer 11

Partner seated. Palpate either the spine of the scapula or the clavicle and slide laterally to the edge where the acromion flattens out.

Question 12

Clavicle

Answer 12

Start either from the spine of the scapula or the acromion and move anteriorly along the clavicle.

Question 13

AC joint

Answer 13

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.

Question 14

SC joint

Answer 14

Palpate along the clavicle medially to a bump. Elevate and Depress shoulder to test.

Question 15

Coracoid Process

Answer 15

Find lateral shaft of clavicle

Slide inferiorly off clavicle no more than 1.5 inches

Question 16

Detoid tuberosity

Answer 16

Find Acromion slide down arm about half way down. Have partner abduct their arm against resistance and follow deltoid to the insertion.

Question 17

Greater tubercle

Answer 17

Shake partners hand and slide anteriorly off of the acromion. Externally rotate the arm and first bump is GT

Question 18

Lesser Tubercle

Answer 18

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

Question 19

Deltoid

Answer 19

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

Question 20

Trapezius Upper, middle and lower

Answer 20

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

Question 21

Latissimus Dorsi

Answer 21

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

Question 22

Teres Major

Answer 22

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

Question 23

Teres Minor

Answer 23

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

Question 24

Teres Minor and infraspinatus Tendon

Answer 24

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

Question 25

Supraspinatus

Answer 25

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

Question 26

Supraspinatus tendon

Answer 26

Slide off acromion on greater tubercle. Have partner place hand behind back and it will move anteriorly

Question 27

Infraspinatus

Answer 27

``` 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 ```

Question 28

Subscapularis

Answer 28

``` 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 ```

Question 29

Subscapularis Tendon

Answer 29

Arm in anatomical position Find coracoid process Slide one inch inferiorly and laterally

Question 30

Rhomboids

Answer 30

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

Question 31

Levator Scapula

Answer 31

``` 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 ```

Question 32

Serratus Anterior

Answer 32

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

Question 33

Pec Major

Answer 33

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

Question 34

Pec Minor

Answer 34

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

Question 35

Subclavius

Answer 35

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

Question 36

Biceps Brachii (and long head tendon)

Answer 36

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

Question 37

Triceps Brachii (and tendon of the long head)

Answer 37

``` 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 ```

Question 38

Coracobrachialis

Answer 38

``` 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 ```