Upper extremity I: Anatomy of the shoulder

Question 1

pec major/minor TP location and treatment

Answer 1

location: belly of muscle, 3-4cm and 1-2cm medial to coracoid
treatment:

1. supine
2. physician on opposite side
3. grab opposite arm, pronate and adduct across chest
4. traction along plane toward opposite ASIS
5. fine tune with traction / adduction

Question 2

long head of biceps brachii muscle TP location and treatment

Answer 2

location: bicipital groove of humerus over long head tendon
treatment:

1. supine
2. physician on same side
3. “patient looking at their watch”
4. traction on shoulder, then move cephalad
5. fine tune by external or internal rotation

Question 3

upper trapezius TP location and treatment

Answer 3

location: anywhere along upper part of trap
treatment:

1. supine
2. physician at head of table
3. drape patient’s arm over forearm (not wrist)
4. side bend and rotate patient’s head toward TP
5. fine tune by rotating head away

Question 4

omohyoid TP location and treatment

Answer 4

location:

1. on muscle at suprascapular notch
2. medial to notch on scapula
3. as it courses over first rib

treatment

1. patient supine
2. physician at head of table
3. patient’s wrist over forehead, forearm-on-forearm
4. passively move head toward scapula
5. push hyoid bone toward side of TP

alternative: passively shrug shoulders then do above steps

Question 5

levator scapulae TP location and treatment

Answer 5

location: upper medial portion of scapula
treatment:

1. patient supine
2. physician on same side
3. shoulder flexed to about 30 degrees
4. elbow is fully flexed and patient’s hand placed under chin
5. compress along axis of humerus

Question 6

supraspinatus TP location and treatment

Answer 6

location: supraspinous fossa just behind trap and above scapular spine
treatment:

1. patient supine
2. physician on same side
3. flex shoulder to 90 degrees
4. internally rotate shoulder
5. apply traction

Question 7

infraspinatous TP location and treatment

Answer 7

location: approx 5 cm beneatch spine of scapula, 2cm lateral to medial border
treatment:

1. patient supine
2. physician same side
3. grab arm below elbow
4. “patient looking at their watch”
5. slight traction of shoulder
6. forearm moved cephalad
7. fine tune by internal or external rotation

Question 8

rhomboid TP location and treatment

Answer 8

location: along medial border of scapula
treatment:

1. patient SEATED
2. abduct arm until
3. pull arm posteriorly

alternative: bring forearm behind back

Question 9

teres minor TP location and treatment

Answer 9

location: within belly of muscle in posterior axillary fold
treatment:

1. patient lateral recumbent
2. externally rotate, abduct, and slightly flex arm
3. fine tune

Question 10

latissimus dorsi TP location and treatment

Answer 10

location: within belly of muscle, from near insertion on humerus to iliac crest
treatment:

1. patient supine
2. extend arm to 30 degrees, internally rotate humerus, adduct slightly
3. fine tune with internal rotation, extension, and gentle traction

Question 11

FPR for shoulder capsule - evaluation

Answer 11

1. patient supine
2. fully flex shoulder (arms overhead)
3. shortened arm means tight lat or lower trap

Question 12

FPR for latissimus

Answer 12

1. patient supine, turns head toward SD
2. pronate hand, extend elbow
3. little or no abduction, apply inferior traction
4. other hand monitors tightness in muscle (no TP)
5. re-evaluate

Question 13

FPR for trap

Answer 13

1. patient supine, turns head toward SD
2. supinate hand, extend elbow, abduct arm to 15 degrees
3. inferior traction
4. other hand monitors tightness in muscle (no TP)
5. re-evaluate