The document describes various muscles and ligaments of the rotator cuff and shoulder joint. It provides details on the origin, insertion, innervation and palpation techniques for the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. Additionally, it discusses the coracoclavicular ligament, coracoacromial ligament, and subacromial bursa. Palpation tips are provided for identifying each structure through gentle movement and positioning of the shoulder and arm.

1. Rotator Cuff muscles

2. Rotator cuff

3. Supraspinatus Action Abduction Origin Supraspinous fossa of the scapula Insertion Greater tuberosity of the humerus Innervation Suprascapular nerve (C4-6)

4. Supraspinatus Prone Locate the spine of scapula Slide fingers up into the supraspinous fossa Palpate through the trapezius Follow the belly laterally until it tucks under the acromion Ask pt. alternately abducting slightly and relaxing the shoulder.

5. Rotator cuff tendons - supraspinatus Supine or seated with the arm at the side of the body Locate the acromion and slide inferiorly onto the surface of the greater tubercle Sink your thumb tip through the deltoid fibeers

6. Rotator cuff tendons - supraspinatus Seated Place pt’s arm behind her back Passively extend the arm as far as is comfortable This position brings the supraspinatus tendon out from under acromion, just anterior and inferior to the AC joint

7. Infraspinatus Action External rotation Origin Infraspinous fossa of the scapula Insertion Greater tuberosity of the humerus Innervation Suprascapular nerve (C4-6)

8. Infraspinatus Prone with forearm off the side of the table Locate the spine, med. border and lat. border of the scapula Form a triangle around the infraspinatus Palpate in the triangle Follow laterally to the humerus Ask pt. to raise his elbow toward ceiling and relax.

9. Teres minor Action External rotaton, weak adduction Origin Lateral border of the scapula Insertion Greater tuberosity of the humerus Innervation Axillary nerve (C5,C6)

10. Teres minor Prone with the arm off the side of the table Locate the lat. border of the scapula ; specifically its superior half . Slide laterally off the lat. border onto the surface of the teres minor Reach your thumb up into the axilla and grasp the belly of the teres minor Ask pt. to laterlly rotate his shouder.

11. Rotator cuff tendons : infraspinatus and teres minor Prone with arm off the side of the table Locate the bellies of these muscles Follow their bellies laterally as they pass inferior the acromion Palpating through the deltoid, slender tendinous attachments at the greater tubercle

12. Subscapularis Action Internal rotation Origin Subscapular fossa of the scapula Insertion Lesser tuberosity of the humerus Innervation Subscapular nerve (C5, C6)

13. Subscapularis Sidelying Flex the shoulder and pull the arm anteriorly as much as possible Hold the arm with one hand while thumb of other locates the lat. Border Slowly and gently curl your thumb onto the subscapular fossa Ask pt. to gently rotate his shoulder medially.

14. Subscapularis Supine Cradle the arm in a flexed position Locate the lateral border Slowly sink your thumbpad onto the subscapular fossa

15. Rotator cuff tendons - subscapularis Seated or supine Place the arm next to the trunk in anatomical position Locate the coracoid process Slide one inch inferiorly and laterally from the coracoid -> between the two tendons of the biceps brachii Palpate through the deltoid fibers Explore by moving medially off the lesser tubercle

16. Ligaments of shoulder and glenohumeral joint

17. Ligaments of shoulder and glenohumeral joint

18. Coracoclavicular ligament Seated or supine Abduct and medially rotate the shoulder Locate the coracoid process and the shaft of clavicle Palpate b/w these landmarks. Roll your thumbpad across its fibers

19. Coracoacromial ligament Supine or seated Locate coracoid process . Then locate the ant. edge of the acromion Palpating deep to the deltoid fibers, explore b/w these landmarks for the wide band of the coracoacromial ligament To bring the ligament closer to the surface, try extending the arm

20. Subacromial bursa With pt seated, stand behind him and locate the acromion Drop your fingers off the ant. edge of the acromion Slowly extend the pt’s shoulder by pulling the elbow posteriorly You will palpate at the depth b/w the deltoid and rotator cuff tendons Palpate gently. Bursae are delicate structures and best accessed with a soft touch