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Shoulder & Arm 4
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Shoulder & Arm 4

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  • Transcript

    • 1. Levator scapulae & Rhonboid
      • Levator scapulae
      • Rhomboid minor
      • Rhomboid major
    • 2. Teres major
      • A : Internal rotation, adduction, retroversion
      • O : Lateral side of inferior angle and lower half of lateral border of the scapula
      • I : Crest of the lesser tubercle of the humerus
      • N : Thoracodorsal nerve (C4-6)
    • 3. Teres major
        • Prone with the arm off the side of the table
        • Locate and grasp the latissimus between your fingers and thumb
        • Move your fingers and thumb medially to where you feel the scapula’s lat. border . -> T. major
        • Ask pt. to rotate shoulder medially
        • distinguish TM from LD
    • 4. Test for teres major
      • Patient: Sitting or prone
      • Test: Extension and adduction of the humerus in the medially rotated position, with the hand resting on the posterior iliac crest
      • Pressure: Against the arm, above the elbow, in the direction of abduction and flexion
    • 5. Rhomboid
      • Action
        • Adduct, elevate and downwardly rotate the scapula
      • Origin
        • Major – SP of T2-T5 Minor – SP of C7-T`
      • Insertion
        • Major – Medial border of the scapula b/w spine of scapula and inferior angle
        • Minor – Upper portion of medial border of scapular
      • Innervation
        • Dorsal scapular nerve (C4-5)
    • 6. Rhomboids
        • Prone
        • Locate the scapula’s medial border and the spinous process of C7 through T5
        • Palpating through thin trapezius
    • 7. Test for rhomboid
      • Patient: Prone
      • Test: Adduction and elevation of scapula, with a downward rotation (medial rotation of the inferior angle). The position of the scapula is obtained by placing the shoulder in 90° abduction and in sufficient medial rotation to move the scapula into the test position. The palm of the hand faces in a caudal direction
      • Pressure: Against the forearm, in a downward direction toward the table.
    • 8. Levator scapulae
      • Action
        • Unilaterally – Elevate and downwardly rotate scapula, laterally flex the head and neck, rotate the head and neck to the same side
        • Bilaterally – Extend the head and neck
      • Origin
        • TP of 1 st through 4 th cervical vertebrae
      • Insertion
        • Upper region of medial border and superior angle of scapula
      • Innervation
        • Dorsal scapula and cervical nerves
    • 9. Levator scapula
        • Prone, supine or sidelying
        • Palpating through the trapezius, locate the sup. angle of the scapula and the upper region of the medial border
        • Place your finger just off the sup. angle firmly strum across the belly of levator
        • Follow superiorly
    • 10. Levator scapula
        • Prone, supine or sidelying
        • Locate the upper fibers of trapezius
        • Roll two fingers anterioirly off the trapezius
        • Gently strum fingers anteriorly and posteriorly
    • 11. Serratus anterior
      • Superior part
      • Intermediate part
      • Inferoir part
    • 12. Serratus anterior
      • Action
        • With the origin fixed: abduct and depress the scapula, hold the medial border of scapula
        • If scapula is fixed: may act in forced inhalation
      • Origin
        • Surfaces of upper eight or nine ribs
      • Insertion
        • Anterior surface of medial border of the scapula
      • Innervation
        • Long thoracic nerve (C5-7)
    • 13. Serratus anterior
        • Supine
        • Isolate the location of the serratus by abducting the arm slightly and locating the lower edge of pectoralis major
        • Locate the ant. border of latissimus
        • Place fingerpads along the side of the ribs between PM and LD
        • Strum across the ribs and palpate for serratus fibers.
    • 14. Test for serratus anterior (1)
    • 15. Test for serratus anterior (1)
      • Patient: Sitting
      • Test: The ability of the serratus to stabilize the scapula in a position of abduction and lateral rotation, with the arm in a position of approximately 120° to 130° of flexion.
      • Pressure: Against the dorsal surface of the arm, between the shoulder and elbow, downward in the direction of extension, and slight pressure against the lateral border of the scapula, in the direction of rotating the inferior angle medially.
    • 16. Test for serratus anterior (2)
    • 17. Test for serratus anterior (2)
      • Patient: Standing
      • Test movement: Facing a wall and with the elbows straight, the subject places both hands against the wall, either at shoulder level or slight above. To begin, the thorax is allowed to sag forward so that the scapulae are in a position of some adduction. The subject then pushes hard against the wall, displacing the thorax backward, until the scapulae are in a position of abduction.
      • Resistance: The thorax acts as resistance in this test