Superficial Back and Scapular Region Flashcards
Trapezius
Origin:
1. Superior nuchal line
2. external occipital protuberance
3. SP C7-T12
4. ligamentum nuchae
Insertion:
1. lateral clavicle
2. acromion
3. tubercle fo scapular spine
Action:
1. upper fibers: elevate the scapula and upwardly/laterally rotate the scapula
2. medial fibers: retract (adduct) the scapula
3. lower fibers: depress the scapula and upwardly/laterally rotate the scapula
Innervation:
1. accessory nerve C3, C4
Latissimus Dorsi
Origin:
1. T7-sacrum (SP)
2. posterior iliac crest
3. posterior layer of the thoracolumbar fascia
4. lower 4 ribs (8-12)
insertion:
1. floor of the intertubercular floor of the humerus
Action:
1. IR (medially rotates arm)
2. extends the arm
3. adducts the arm
innervation: thoracodorsal nerve C6-C8
Rhomboid Major and Minor
Origin:
1. SP T2-T5 (major)
2. SP C7-T1 (minor)
Insertion:
1. medial border of scapula
Action:
1. retracts the scapula
2. downwardly rotates the scapula
3. elevates the scapula
Innervation:
1. Dorsal scapular nerve C4, C5
Levator Scapulae
Origin:
1. TP C1-C4
Insertion:
1. upper portion of medial scapula
Action:
1. elevate scapula
2. downwardly rotates the scapula
Innervation:
1. dorsal scapular nerve C4, C5
What nerves and arteries are in the superficial back
- Dorsal scapular nerve
C5 NR - dorsal scapular artery
- supra scapular nerve
- suprascapular artery
Lumbar triangle
- inferior: external oblique, iliac crest and Latissimus dorsi border
- Superior: 12th rib, internal oblique, and quadratus lumborum
can be sites of hernias
Triangle of auscultation
- Trapezius
- inferior angle of scapula
- latissimus dorsi
Dorsal scapular nerve what does it supply and review the course
- rhomboids
- levator scapulae
- penetrates through middle/anterior scalene
- travels deep to rhomboids
Dorsal scapular nerve entrapment
- can get entrapped between anterior and middle scalene
- pain
- muscles spasms/tightness (Levator or rhomboids)
- scapular dyskinesia
- Chronic - scapular winging secondary to atrophic changes and muscle denervation
- often overlooked because no sensory only Motor contribution
Posterior arm and shoulder muscles
- deltoid
teres major
teres minor
infraspinatus
supraspinatus
triceps
Posterior arm and shoulder nerves and arteries
- axillary nerve
- supra scapular nerve
- supra scapular artery
- radial nerve
- profunda brachii artery
Deltoid
Origin:
1. Acromion
2. Lateral clavicle
3. Spine of scapula
Insertion:
1. deltoid tuberosity
Action:
1. Anterior fibers flex
2. (all)middle fibers abduct
3. Posterior fibers extend
Innervation:
1. axillary nerve C5, C6
Teres major
Origin:
1. Inferior angle of the scapula
Insertion:
1. medial lip of inter tubercle groove
Action:
1. extends arm
2. adducts arm
3. IR arm
Innervation:
1. Inferior Subscapular nerve C6. C7
Supraspinatus
Origin:
1. Supraspinatus fossa
Insertion:
1. superior facet of the greater tubercle
Action:
1. initiates abduciton
Innervation:
1. Suprascapular nerve C5, C6
Infraspinatus
Origin:
1. infraspinatus fossa
Insertion:
1. middle facet of the greater tubercle
Action:
1. ER (lateral rotation) of the arm
Innervation:
1. suprascapular nerve C5,C6
Teres Minor
Origin:
1. lateral border of the scapula (upper 2/3)
Insertion:
1. inferior facet of the greater tubercle
Action:
1. ER (lateral rotation) of the arm
Innveration:
1. axillary nerve C5,C6
Triceps Brachii
Origin:
1. long head: infraglenoid tubercle of scapula
2. lateral head: poster humerus superior to radial glove
3. medial head: posterior humerus inferior to radial groove
Insertion:
1. olecranon process of ulna
Action:
1. Elbow extension (all three heads)
2. arm extension (long head)
3. arm adduction (long head)
Innervation:
1.radial nerve C6-C8
Quadrangular space borders and contents
Borders:
- superior = teres minor
- inferior= teres major
- medial = long head of triceps
- lateral = humerus
Contents:
- axillary nerve
- posterior circumflex humeral artery and vein
Triangular interval
Borders:
- superior: teres major
- medial = long head of triceps
- lateral = lateral head of triceps
Contents:
- radial nerve
- profunda brachii artery
axillary nerve what does it supply and review course
- Detloid
- teres minor
- passes through quadrangular space
- innervates the skin on the lateral shoulder and back of arm
What are common causes of axillary nerve entrapment
- quadrangular space (rare)
- injured when overstretched between neck and shoulder often with anterior dislocation
Suprascapular nerve - supplies what and review its course
- supraspinatus
- infraspinatus
- runs laterrally beneath the traps and omohydioeus muscles and descends through the suprascapular notch and then spinoglenoid notche
What are common causes of entrapment
suprascapular n.
- excessive protraction
Common MSK causes of shoulder pain
- subacromial impingement
- RC tendiopathy
- Degenerative disorders (OA/RA)
- LH biceps pathology
- GH instability
- AC joint pathology/instability (sprain/tear)
- Labral tear
- muscle strain
- scapular dyskinesia - serratus anterior
Organ referral patterns at the shoulder
- heart
- lung
- liver
- gallbladder
- pancreas
- diaphragm
- esophagus
RC tendiopathies
symptoms,causes, factors
- Shoulder pain
- most common cause is impingement and RC tendopathy
- Acute: direct blow, fall overhead activity
- chronic: tendinitis, repetitive overuse/overhead activity
- extrinsic factors: mechanical impingement by acromion/SA arch
- intrinsic - degeneration of RC, mid substance diminishing blood supply
Imaging guidelines for the shoulder
- X-Ray is initial choice
- MRI: glenoid labral tears, RTC tears/impingment, tendonopathies, bursitis
- CT: complex fx, or pre-surgery
- MSKUS: long head of biceps, RTC, impingement
PT diagnostic tools at the shoulder
impingement
- empty can test: evaluates SIS and supraspinatus tendon
- Scapular relocation test: with empty can
- Supine impingement test
- hawkins-kennedy test
- neer
- painful arc
Interventions for impingement/RC tendiopathy
- pain relief: pendulums/modalities
- submax isometrics
- AROM avoiding impingement zone
- progression to RC and scapular strengthening
- education on posture
