Shoulder & Arm 1

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  • Shoulder & Arm 1

    1. 1. Shoulder & Arm
    2. 2. Topographical views
    3. 3. Topographical views
    4. 4. Topographical views
    5. 5. Surface anatomy - shoulder <ul><li>Clavicle </li></ul><ul><li>S-C joint </li></ul><ul><li>SCM muscle </li></ul><ul><li>A-C joint </li></ul><ul><li>Acromion </li></ul><ul><li>Coracoid process </li></ul><ul><li>Pectoralis major </li></ul><ul><li>Delotid </li></ul><ul><li>Deltoid tuberosity </li></ul><ul><li>Biceps brachii </li></ul><ul><li>Supraclavicular fossa </li></ul>
    6. 6. Surface anatomy - shoulder <ul><li>Spine of scapular </li></ul><ul><li>Med border of scapula </li></ul><ul><li>Supraspinatus </li></ul><ul><li>Infraspinatus </li></ul><ul><li>Teres minor </li></ul><ul><li>Trapezius </li></ul><ul><li>Lat border of scapula </li></ul><ul><li>Rhomboid muscle </li></ul><ul><li>Levator scapula </li></ul><ul><li>Post. Deltoid </li></ul><ul><li>Latissimus dorsi </li></ul><ul><li>Triceps brachii </li></ul><ul><li>Soft spot </li></ul>
    7. 7. Surface anatomy – upper arm <ul><li>Acromion </li></ul><ul><li>Deltoid </li></ul><ul><li>Deltoid tubersity </li></ul><ul><li>Briceps brachii </li></ul><ul><li>Triceps brachii </li></ul>
    8. 8. Bones of the shoulder and arm
    9. 9. Bony Landmarks
    10. 10. Bony landmark trail <ul><li>Trail 1. Along the Edge </li></ul><ul><ul><li>a. spine of the scapula </li></ul></ul><ul><ul><li>b. medial border </li></ul></ul><ul><ul><li>c. inferior border </li></ul></ul><ul><ul><li>d. superior border </li></ul></ul><ul><ul><li>e. lateral border </li></ul></ul><ul><ul><li>f. infraglenoid tubercle </li></ul></ul>
    11. 11. Bony landmark trail <ul><li>Trail 2. In the Trenches </li></ul><ul><ul><li>a. infraspinous fossa </li></ul></ul><ul><ul><li>b. supraspinous fossa </li></ul></ul><ul><ul><li>c. subscapular fossa </li></ul></ul>
    12. 12. Bony landmark trail <ul><li>Trail 3. Springboard Ledge </li></ul><ul><ul><li>a. acromion </li></ul></ul><ul><ul><li>b. clavicle </li></ul></ul><ul><ul><li>c. acromioclavicular and sternoclavicular joints </li></ul></ul><ul><ul><li>d. coracoid process </li></ul></ul><ul><ul><li>e. deltoid tuberosity </li></ul></ul>
    13. 13. Bony landmark trail <ul><li>Trail 4. Two Hills and a Valley </li></ul><ul><ul><li>a. greater tubercle </li></ul></ul><ul><ul><li>b. intertubercular </li></ul></ul><ul><ul><li>groove </li></ul></ul><ul><ul><li>c. lesser tubercle </li></ul></ul>
    14. 14. Deltoid <ul><li>Clavicular part </li></ul><ul><li>Acromial part </li></ul><ul><li>Spinal part </li></ul>
    15. 15. Deltoid <ul><li>Action </li></ul><ul><ul><li>Clavicular part: Anteversion, internal rotation, adduction </li></ul></ul><ul><ul><li>Acromial part: Abduction </li></ul></ul><ul><ul><li>Spinal part: retroversion </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Clavicular part: Lateral third of the clavicle </li></ul></ul><ul><ul><li>Acromial part: Acromion </li></ul></ul><ul><ul><li>Spinal part: scapular spine </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Deltoid tuberosity on the humerus </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Axillary nerve (C5,6) </li></ul></ul>
    16. 16. Deltoid <ul><ul><li>Seated </li></ul></ul><ul><ul><li>Locate the spine of the scapula , the acromion and the lat. one-third of the clavicle (Note the “V” shape these landmarks form) </li></ul></ul><ul><ul><li>Locate the deltoid tuberosity </li></ul></ul><ul><ul><li>Palpate between these landmarks to isolate the superficial, convergent fibers of the deltoid. </li></ul></ul>If pt. alternately abduct and releases, do you feel the fibers contract and relax?
    17. 17. Deltoid <ul><ul><li>Be sure to explore the deltoid’s most anterior and posterior aspects. </li></ul></ul>
    18. 18. Test for deltoid
    19. 19. Test for deltoid <ul><li>Patient: Sitting </li></ul><ul><li>Fixation: If the scapular fixation muscles are weak, the the examiner must stabilize the scapula </li></ul><ul><li>Test: Shoulder abduction without rotation. When placing the shoulder in test position, the elbow should be flexed to indicate the neutral position of rotation </li></ul><ul><li>Pressure: Against the dorsal surface of the distal end of the humerus. </li></ul>
    20. 20. Test for anterior deltoid <ul><li>Patient: Sitting </li></ul><ul><li>Fixation: If scapular fixation muscles are weak, the scapula must be stabilized by the examiner </li></ul><ul><li>Test: Shoulder abduction in slight flexion, with the humerus in slight lateral rotation. </li></ul><ul><li>Pressure: Against the anteromedial surface of the arm, in the direction of adduction and slight extension </li></ul>
    21. 21. Test for posterior deltoid <ul><li>Patient: Sitting </li></ul><ul><li>Fixation: If scapular fixation muscles are weak, the scapula must be stabilized by the examiner </li></ul><ul><li>Test: Shoulder abduction in slight extension, with the humerus in slight medial rotaion. </li></ul><ul><li>Pressure: Against the posterolateral surface of the arm, above the elbow, in the direction of addduction and slight flexion </li></ul>

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