Shoulder & Arm 2


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  • Shoulder & Arm 2

    1. 1. Trapezius <ul><li>Upper fiber </li></ul><ul><li>Middle fiber </li></ul><ul><li>Lower fiber </li></ul>
    2. 2. Trapezius <ul><li>Action </li></ul><ul><ul><li>Upper fibers </li></ul></ul><ul><ul><li>Draws the scapula obliquely upward and rotates the glenoid cavity inferiorly </li></ul></ul><ul><ul><li>Middle fibers </li></ul></ul><ul><ul><li>D raws the scapula medially </li></ul></ul><ul><ul><li>Lower fibers </li></ul></ul><ul><ul><li>Draws the scapula medially downward (supports the rotating action of the descending part) </li></ul></ul>
    3. 3. Trapezius <ul><li>Origin </li></ul><ul><ul><li>External occipital protuberance, medial portion of superior nuchal line of the occiput, ligamentum nuchae and SP of C7 through T12 </li></ul></ul><ul><li>Insertion </li></ul><ul><ul><li>Lateral 1/3 of clavicle (upper fiber), acromion (middle fiber), scapular spine (lower fiber) </li></ul></ul><ul><li>Innervation </li></ul><ul><ul><li>Cranial nerve XI (accessory nerve) and cervical plexus (C2-4) </li></ul></ul>
    4. 4. Trapezius-upper fibers <ul><ul><li>Prone </li></ul></ul><ul><ul><li>Easily accessible flap of muscle lying across the top of shoulder </li></ul></ul><ul><ul><li>Grasp the superficial tissue on the top of the shoulder and feel the upper trapezius fibers. </li></ul></ul><ul><ul><li>Follow superiorly toward the base of the head at the occiput . </li></ul></ul><ul><ul><li>Ask the pt. to extend his head -> feel the fibers contract </li></ul></ul>
    5. 5. Trapezius- middle fiber <ul><ul><li>Locate the spine of scapula </li></ul></ul><ul><ul><li>Slide medially from the spine of the scapula onto the trapezius </li></ul></ul><ul><ul><li>Ask pt. to adduct his scapula – feel contraction </li></ul></ul>
    6. 6. Trapezius – lower fiber <ul><ul><li>Locate the edge of the lower fibers by drawing a line from the spine of scapula to the spinous process of T12 </li></ul></ul><ul><ul><li>Palpate along this line </li></ul></ul><ul><ul><li>Ask pt. to hold his arms out in front of him (like Superman) </li></ul></ul>
    7. 7. Test for upper trapezius
    8. 8. Test for upper trapezius <ul><li>Patient: Sitting </li></ul><ul><li>Test: Elevation of the acromial end of the clavicle and scapula, and posterolateral extension of the neck, bringing the occiput toward the elevated shoulder with the face turned in the opposite direction </li></ul><ul><li>Pressure: Against the shoulder, in the direction of depression, and against the head, in the direction of flexion anterolaterally. </li></ul>
    9. 9. Test for middle trapezius <ul><li>Patient: Sitting </li></ul><ul><li>Test: Adduction of the scapula, with upward rotation and without elevation of the shoulder girdle. The test position is obtained by placing the shoulder in 90° abduction and in lateral rotation of the inferior angle. </li></ul><ul><li>Pressure: Against the forearm, in a downward direction toward the table </li></ul>
    10. 10. Test for lower trpezius
    11. 11. Test for lower trpezius <ul><li>Patient: prone </li></ul><ul><li>Test: Adduction and depression of the scapula, with lateral rotation of the inferior angle. The arm is placed diagonally overhead, in line with the lower fibers of the trapzius. </li></ul><ul><li>Pressure: Against the forearm, in a downward direction toward the table </li></ul>
    12. 12. Latissimus dorsi <ul><ul><li>Prone with the arm off side of the table </li></ul></ul><ul><ul><li>Locate the scapula’s lat. Border </li></ul></ul><ul><ul><li>Grasp the thick wad of muscle tissue lat. to the lat. Border </li></ul></ul><ul><ul><li>Ask pt. to medially rotate his shoulder against your resistance “ Swing your hand up toward your hip.” </li></ul></ul>
    13. 13. Latissimus dorsi <ul><ul><li>Supine </li></ul></ul><ul><ul><li>Cradle the arm in a flexed position </li></ul></ul><ul><ul><li>Grasp the tissue of the latissimus located beside the lat. Border </li></ul></ul><ul><ul><li>Ask pt. to extend his shoulder against your resistance. “Press your elbow toward your hip.” </li></ul></ul>
    14. 14. Latissimus dorsi <ul><li>A : Internal rotation, adduction, retroversion (move the arm backward), respiration (expiration, “cough muscle”) </li></ul><ul><li>O : SP of last 6 thoracic vertebrae, last 3 or 4 ribs, thoracolumbar aponeurosis and posterior iliac crest </li></ul><ul><li>I : Crest of the lesser tubercle of the humerus </li></ul><ul><li>N : Thoracodorsal (C4-6) </li></ul>
    15. 15. Test for latissimus dorsi
    16. 16. Test for latissimus dorsi <ul><li>Patient: Prone </li></ul><ul><li>Test: Adduction of the arm, with extension, in the medially rotated position </li></ul><ul><li>Pressure: Against the forearm, in the direction of abduction and slight flexion of the arm. </li></ul>