Shoulder & Arm 3

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  • Shoulder & Arm 3

    1. 1. Rotator Cuff muscles
    2. 2. Rotator cuff
    3. 3. Supraspinatus <ul><li>Action </li></ul><ul><ul><li>Abduction </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Supraspinous fossa of the scapula </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Greater tuberosity of the humerus </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Suprascapular nerve (C4-6) </li></ul></ul>
    4. 4. Supraspinatus <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Locate the spine of scapula </li></ul></ul><ul><ul><li>Slide fingers up into the supraspinous fossa </li></ul></ul><ul><ul><li>Palpate through the trapezius </li></ul></ul><ul><ul><li>Follow the belly laterally until it tucks under the acromion </li></ul></ul><ul><ul><li>Ask pt. alternately abducting slightly and relaxing the shoulder. </li></ul></ul>
    5. 5. Rotator cuff tendons - supraspinatus <ul><ul><li>Supine or seated with the arm at the side of the body </li></ul></ul><ul><ul><li>Locate the acromion and slide inferiorly onto the surface of the greater tubercle </li></ul></ul><ul><ul><li>Sink your thumb tip through the deltoid fibeers </li></ul></ul>
    6. 6. Rotator cuff tendons - supraspinatus <ul><ul><li>Seated </li></ul></ul><ul><ul><li>Place pt’s arm behind her back </li></ul></ul><ul><ul><li>Passively extend the arm as far as is comfortable </li></ul></ul><ul><ul><li>This position brings the supraspinatus tendon out from under acromion, just anterior and inferior to the AC joint </li></ul></ul>
    7. 7. Infraspinatus <ul><li>Action </li></ul><ul><ul><li>External rotation </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Infraspinous fossa of the scapula </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Greater tuberosity of the humerus </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Suprascapular nerve (C4-6) </li></ul></ul>
    8. 8. Infraspinatus <ul><ul><li>Prone with forearm off the side of the table </li></ul></ul><ul><ul><li>Locate the spine, med. border and lat. border of the scapula </li></ul></ul><ul><ul><li>Form a triangle around the infraspinatus </li></ul></ul><ul><ul><li>Palpate in the triangle </li></ul></ul><ul><ul><li>Follow laterally to the humerus </li></ul></ul><ul><ul><li>Ask pt. to raise his elbow toward ceiling and relax. </li></ul></ul>
    9. 9. Teres minor <ul><li>Action </li></ul><ul><ul><li>External rotaton, weak adduction </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Lateral border of the scapula </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Greater tuberosity of the humerus </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Axillary nerve (C5,C6) </li></ul></ul>
    10. 10. Teres minor <ul><ul><li>Prone with the arm off the side of the table </li></ul></ul><ul><ul><li>Locate the lat. border of the scapula ; specifically its superior half . </li></ul></ul><ul><ul><li>Slide laterally off the lat. border onto the surface of the teres minor </li></ul></ul><ul><ul><li>Reach your thumb up into the axilla and grasp the belly of the teres minor </li></ul></ul><ul><ul><li>Ask pt. to laterlly rotate his shouder. </li></ul></ul>
    11. 11. Rotator cuff tendons : infraspinatus and teres minor <ul><ul><li>Prone with arm off the side of the table </li></ul></ul><ul><ul><li>Locate the bellies of these muscles </li></ul></ul><ul><ul><li>Follow their bellies laterally as they pass inferior the acromion </li></ul></ul><ul><ul><li>Palpating through the deltoid, slender tendinous attachments at the greater tubercle </li></ul></ul>
    12. 12. Subscapularis <ul><li>Action </li></ul><ul><ul><li>Internal rotation </li></ul></ul><ul><li>Origin </li></ul><ul><ul><li>Subscapular fossa of the scapula </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Lesser tuberosity of the humerus </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Subscapular nerve (C5, C6) </li></ul></ul>
    13. 13. Subscapularis <ul><ul><li>Sidelying </li></ul></ul><ul><ul><li>Flex the shoulder and pull the arm anteriorly as much as possible </li></ul></ul><ul><ul><li>Hold the arm with one hand while thumb of other locates the lat. Border </li></ul></ul><ul><ul><li>Slowly and gently curl your thumb onto the subscapular fossa </li></ul></ul><ul><ul><li>Ask pt. to gently rotate his shoulder medially. </li></ul></ul>
    14. 14. Subscapularis <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Cradle the arm in a flexed position </li></ul></ul><ul><ul><li>Locate the lateral border </li></ul></ul><ul><ul><li>Slowly sink your thumbpad onto the subscapular fossa </li></ul></ul>
    15. 15. Rotator cuff tendons - subscapularis <ul><ul><li>Seated or supine </li></ul></ul><ul><ul><li>Place the arm next to the trunk in anatomical position </li></ul></ul><ul><ul><li>Locate the coracoid process </li></ul></ul><ul><ul><li>Slide one inch inferiorly and laterally from the coracoid -> between the two tendons of the biceps brachii </li></ul></ul><ul><ul><li>Palpate through the deltoid fibers </li></ul></ul><ul><ul><li>Explore by moving medially off the lesser tubercle </li></ul></ul>
    16. 16. Ligaments of shoulder and glenohumeral joint
    17. 17. Ligaments of shoulder and glenohumeral joint
    18. 18. Coracoclavicular ligament <ul><ul><li>Seated or supine </li></ul></ul><ul><ul><li>Abduct and medially rotate the shoulder </li></ul></ul><ul><ul><li>Locate the coracoid process and the shaft of clavicle </li></ul></ul><ul><ul><li>Palpate b/w these landmarks. Roll your thumbpad across its fibers </li></ul></ul>
    19. 19. Coracoacromial ligament <ul><ul><li>Supine or seated </li></ul></ul><ul><ul><li>Locate coracoid process . Then locate the ant. edge of the acromion </li></ul></ul><ul><ul><li>Palpating deep to the deltoid fibers, explore b/w these landmarks for the wide band of the coracoacromial ligament </li></ul></ul><ul><ul><li>To bring the ligament closer to the surface, try extending the arm </li></ul></ul>
    20. 20. Subacromial bursa <ul><ul><li>With pt seated, stand behind him and locate the acromion </li></ul></ul><ul><ul><li>Drop your fingers off the ant. edge of the acromion </li></ul></ul><ul><ul><li>Slowly extend the pt’s shoulder by pulling the elbow posteriorly </li></ul></ul><ul><ul><li>You will palpate at the depth b/w the deltoid and rotator cuff tendons </li></ul></ul><ul><ul><ul><li>Palpate gently. Bursae are delicate structures and best accessed with a soft touch </li></ul></ul></ul>

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