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Shoulder Girdle Muscular Anatomy Shoulder Girdle Retraction (Adduction) Rhomboid Major Origin Spinous processes of T2 to T5 Insertion Medial border of scapula Action Scapulae retraction, medial scapula rotation Nerve Supply Dorsal Scapular Nerve Palpation Side lying, with arm hanging over edge of bed to abduct scapulae. Palpate obliquely downwards and lateral from spinous process to medial scapula border Origin Spinous process of C7 to T1 Insertion Upper medial border of scapula Action Scapulae retraction, medial scapula rotation Nerve Supply Dorsal Scapula Nerve Palpation Side lying, with arm hanging over edge of bed to abduct scapulae. Palpate obliquely downwards and lateral from spinous process to medial scapula border Rhomboid Minor Shoulder Girdle Muscular Anatomy Shoulder Girdle Retraction (Adduction) Trapezius Origin Medial superior nuchal line, external occipital protuberance, ligamentum nuchae and the spinous process of C7-T12 Insertion Posterior aspect of the lateral clavicle, medial acromion and the upper border of the spine of the scapula Action Upper fibres- elevation, neck extension, ipsilateral lateral flexion, lateral rotation of the scapula Middle fibres- shoulder retraction Lower fibres- depression, lateral rotation of the scapula Nerve Supply Accessory nerve (11 Cranial Nerve) Palpation th Shoulder Girdle Muscular Anatomy Shoulder Girdle Protraction (Abduction) Serratus Anterior Pectoralis Minor Origin Outer surface of the upper 8-9 ribs and the intercostal fascia Insertion Costal surface of the medial border of the scapula Action Scapular protraction, scapular upward rotation, stabilises scapular to prevent medial border winging Nerve Supply Long thoracic nerve Palpation Side lying with arm resting on therapist shoulder. Therapist standing caudad facing cephalad. Palpate from axilla along chest wall Origin Outer surface of the 3rd,4th and 5th ribs and the intercostal fascia Insertion Upper surface ad medial border of the coracoid process of the scapula Action Anterior tilt of scapula Nerve Supply Medial pectoral and Lateral pectoral nerves Palpation 1)Side lying with arm resting on therapist shoulder. Therapist pulls models arm forward to allow therapists hand to be placed posterior to pec major and directly onto caudal end of pec minor on the 5th rib 2)In high sitting ask client to place hand behind back. Then ask them to further extend the shoulder whilst the therapist palpates 3rd, 4th and 5th ribs below the coracoids process. Shoulder Girdle Muscular Anatomy Shoulder Girdle Elevation Levator Scapulae Origin Transverse process of C1-4 Insertion Medial margin of the scapula between superior angle and spine of scapula Action Elevation, shoulder retraction, neck extension, ipsilateral lateral flexion, medial scapular rotation Nerve Supply Ventral rami of C3-4 Palpation Supine, ipsilateral cervical rotation, hand behind back. Palpate anterior to upper trapezius fibres and follow down onto superior angle of scapulae Shoulder Muscular Anatomy Glenohumeral Abduction Supraspinatus Origin Medial two thirds of the supraspinous fossa Insertion Upper facet of the greater tubercle of the humerus Action First 20° of abduction, stabilise humeral head into glenoid Nerve Supply Suprascapular nerve Palpation Tendon- place model into glenohumeral maximal extension, medial rotation and adduction. Tendon can be palpated anterior to the acromion Deltoid Origin Anterior- anterior border of lateral third of clavicle Middle- lateral margin of the acromion process Posterior- lower lip of the crest of the spine of the scapula Insertion Deltoid tuberosity Action Abduction, flexion, extension, medial rotation, lateral rotation, horizontal abduction, horizontal adduction Nerve Supply Axillary Nerve Palpation Shoulder Muscular Anatomy Glenohumeral Flexion Pectoralis Major Origin Clavicular head: Medial half of the anterior surface of clavicle. Sternal head: Anterior surface of the manubrium ad bod of sternum, anterior aspect of upper six costal cartilages and anterior past of the 6th rib and aponeurosis of external oblique Insertion Lateral lip of intertubercular groove Action Adduction and medial rotation. Flexion to horizontal. Extension to neutral Nerve Supply Posterior primary rami of C1 Palpation Biceps Brachii Origin Long head: Supraglenoid tubercle of the scapula and glenoid labrum Short head: coracoid process of the scapula Insertion Posterior part of the radial tuberosity and bicipital aponeurosis Action Shoulder flexion, stabilise humeral head into glenoid. Elbow flexion and supination Nerve Supply Musculocutaneous nerve Palpation Long head tendon: 0° adduction, 20° medial rotation. Palpate the tendon in triangle bounded by medial deltoid, inferior clavicle and lateral pectoralis major Shoulder Muscular Anatomy Glenohumeral Flexion Coracobrachialis Origin Coracoid process of scapula Insertion Medial side of the shaft of the humerus Action Adduction and flexion Nerve Supply Musculocutaneous nerve Palpation Supine, 90° abduction and forearm supination. Therapist’s places fingers medial surface of the upper arm posterior to biceps brachii. Resist horizontal adduction to confirm palpation Shoulder Muscular Anatomy Glenohumeral Extension Latissimus Dorsi Origin Thoracolumbar fascia, spinous process of T6-S5. Outer lip of iliac crest, outer surface of lower 3-4 ribs and inferior angle of scapula Insertion Floor of the intertubercular groove Action Extension, medial rotation and adduction. Scapular retraction Nerve Supply Thoracodorsal nerve Palpation Teres Major Origin Dorsal surface of the scapular and inferior angle Insertion Medial lip of intertubercular groove of humerus Action Adduction, medial rotation and extension Nerve Supply Lower subscapular nerve Palpation Prone with arm off side of table. Grasp lat dorsi between your fingers and thumb. Move medially to scapula lateral border. Medial muscle fibres to lat dorsi is teres major Shoulder Muscular Anatomy Glenohumeral Extension Triceps (Long Head) Origin Infraglenoid tubercle of the scapula and the adjacent glenoid labrum Insertion Proximal surface of the olecranon of the ulna Action Shoulder adduction and extension. Elbow extension Nerve Supply Radial Nerve Palpation Shoulder Muscular Anatomy Glenohumeral Lateral Rotation Teres Minor Origin Upper two thirds of lateral border of scapula Insertion Inferior facet of greater tubercle Action Lateral rotation Nerve Supply Axillary nerve Palpation Tendon: Patient prone on elbows, 90° shoulder flexion, 10° shoulder adduction and 20° lateral rotation. Palpate deep to deltoid and inferior to infraspinatus Origin Medial two thirds of infraspinous fossa of scapula Insertion Middle facet of greater tubercle of humerus Action Lateral rotation Nerve Supply Suprascapular nerve Palpation Tendon: Patient prone on elbows, 90° shoulder flexion, 10° shoulder adduction and 20° lateral rotation. Palpate deep to deltoid Infraspinatus Shoulder Muscular Anatomy Glenohumeral Medial Rotation Subscapularis Origin Medial two third of subscapular fossa Insertion Lesser tubercle of humerus Action Medial rotation and adduction Nerve Supply Upper and Lower subscapular nerve Palpation Supine, passively flexion, abduction and protraction of the arm. Palpate the lateral border of the scapular anteriorly Tendon: 0° adduction, medial/lateral rotation. Palpate deep into the deltopectoral triangle Muscular Anatomy Summary Shoulder Girdle Rhomboid Major Retraction Rhomboid Minor Trapezius Serratus Anterior Protraction Pectoralis Minor Trapezius (Upper Fibres) Elevation Levator Scapulae Trapezius Upward Rotation Serratus Anterior Rhomboid Major Rhomboid Minor Downward Rotation Pectoralis Minor Levator Scapulae Posterior Tilt Trapezius (Lower Fibres) Anterior Tilt Pectoralis Minor Glenohumeral Pectoralis Major Deltoid Flexion Biceps Brachii Coracobrachialis Supraspinatus Abduction Deltoid Latissimus Dorsi Teres Major Extension Deltoid Triceps (Long Head Coracobrachialis Adduction Pectoralis Major Latissimus Dorsi Teres Major Subscapularis Teres Major Medial Rotation Latissimus Dorsi Pectoralis Major Deltoid Teres Major Lateral Rotation Infraspinatus Deltoid