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Joint Detail Last saved by yatesh 4/30/2017 6:32:39 PM Shoulder joint Specifically known as Glenohumeral Joint Name: Codie Hilton, Tamara Stacey, Megan Pate, James Date: 09/01/10 Mecalf Joint type Enarthrodial Joint Stability Static (ligaments) Dynamic (muscles) Close packed position Extension Anterior Coracohumeral, superior Pectoralis major, pectoralis minor, internal Loose packed position Flexion Glenohumeral, inferior intercostals, coracobrachialis, subscapularis, Degrees of freedom 170-180 degrees flexion and abduction Glenohumeral, middle deltoid trapezius, stemocleidomastiod glenohumeral Bones & specific bony Humerus Greater tuberosity, lesser tuberosity landmarks Posterior Levator scapulae, supraspinatus, deltoid, Scapula Spine of scapula, acromion, coracoid process infraspinatus, teres minor, teres, major, Sternum Manubrium of sternum rhomboideus major, latissimus dorsi, Specific articulating bony Greater tuberosity, lesser tuberosity, bicipital groove, Spine of scapula, trapezius, deltoid surfaces acromion, coracoid process, clavicle, Manubrium of sternum Medial Lateral Inferior Glenohumeral, middle Glenohumeral, superior Glenohumeral, coracohumeral, Movement Muscles Goniometry Manual Muscle Testing Agonists Palpation Proximal Distal Attachment Innervation Recommended Sitting, with thoracic & Motion or Muscle Motion: Attachment Testing Position lumbar spine well specific, Flexion supported by the back of list ↓ Pectoralis major From medial end of Medial half of Flat tendon 2 or 3 Lateral pectoral Range: the chair. Tongue upper fibers clavicle to the anterior surface of inches wide to nerve (C5, C6, Muscle(s) Deltoid 90-100 depressor can be held intertubercular groove of clavicle lateral lip of C7 anterior degrees between teeth for the humerus, during intertubercular fibers, Plane: reference flexion and adduction groove of Pectoralis Sagittal from the anatomical humerus Stabilization Shoulder girdle is major upper Axis: position stabilized to prevent fibers Frontal flexion of thoracic & Recommend Patient is Deltoid anterior From the clavicle toward Anterior lateral Deltoid tuberosity Axillary nerve lumbar spine fibers the anterior humerus third of clavicle on the lateral (C5, C6) ed Testing short sitting during resisted flexion or humerus Center Over the external Position with arms at horizontal adduction auditory meatus sides, elbow slightly Proximal Arm Perpendicular or parallel flexed, and to ground forearm Distal Arm With base of nares or supinated parallel to longitudinal axis of tongue depressorResistance Examiner Hand stands at Placement test side with one hand giving maximal resistance over distal humerus and other hand 1 Joint Detail Motion: Extension Range: 40-60 degrees Plane: Sagittal Axis: Frontal Motion: Abduction Last saved by yatesh Agonists Palpation Pectoralis major From the lower ribs and lower fibers sternum to the intertubercular groove of the humerus, during resisted extension from a flexed position Latissimus dorsi The tendon may be palpated as in passes under the teres mahor at the posterior axillary wall, particularly during resisted extension and internal rotation. The muscle can be palpated in the upper lumbar/lower thoracic area during extension from a flexed position and throughout most of its length during resisted adduction from a slightly abducted position Teres major Just above the latissimus dorsi and below the teres minor on the posterior scapula surface, moving diagonally upward and laterally from the inferior angle of the scapula during resisted internal rotation Agonists Palpation 4/30/2017 Proximal Attachment Anterior surface of costal cartilages of first six ribs, and adjoining portion of sternum Posterior crest of ilium, back of sacrum and spinous processes of lumbar and lower six thoracic vertebrae, slips from lower three ribs Distal Attachment Posterirly on inferior third of lateral border of scapula and just superior to inferior Medial lip Lower intertubercular subscapular groove of nerve (C5, C6) humerus, just posterior to the insertion of the latissimus dorsi Proximal Attachment Innervation Flat tendon 2 or 3 Medial pectoral inches wide to nerve (C8, T1) lateral lip of intertubercular groove of humerus Medial side of Thoracodorsal intertubercular (C6, C7, C8) groove of humerus, just anterior to the insertion of the teres major Distal Attachment Innervation 6:32:39 PM stabilizing shoulder. Patient Patient Instruction raises arm off table keeping elbow straight. Special notes Recommended Prone, head facing Motion Muscle specific, list Testing Position away from involved or ↓ shoulder, G-H 00 Muscle( Pectoralis major lower fibers, abduction & rotation, s) Latissimus dorsi, Teres major elbow slight flex, 00 of Recommended Patient is prone with pronation-supination Testing Position arms at sides and Stabilization Scapula to prevent shoulder internally elevation, anterior tilting rotated. Center Close to acromion Resistance Hand Examiner stands at process Placement test side and applies Proximal Arm Midaxillary line of maximal resistance thorax over posterior arm just above elbow. Distal Arm Lateral midline of humerus, lateral Patient Instruction Patient raises arm epicondyle off table keeping elbow straight. Special notes Recommended Supine, may be sitting Testing Position or prone, G-H 00 flex- Motion or Muscle specific, list ↓ 2 Joint Detail Range: 90-100 degrees Plane: Frontal Axis: Sagittal Motion: Adduction Range: 0 degrees Plane: Frontal Axis: Sagittal Last saved by yatesh Pectoralis major From medial end of Medial half of upper fibers clavicle to the anterior surface intertubercular groove of of clavicle the humerus, during flexion and adduction from the anatomical position Deltoid anterior From the clavicle toward Anterior lateral fibers the anterior humerus third of clavicle during resisted flexion or horizontal adduction Deltoid middle From the lateral border of Lateral aspect of fibers the acromion down acromion toward the deltoid tuberosity during resisted abduction Deltoid posterior From the lower lip of the Lateral aspect of fibers spine of the scapula acromion toward the posterior humerus during resisted extension or horizontal abduction Supra spinatus Above the spine of the Medial 2/3 of scapula in supraspinatus supraspinatus fossa during initial fossa abduction in the scapula plane, tendon may be palpated just off acromion on greater tubercle Agonists Palpation Proximal Attachment Pectoralis major From the lower ribs and Anterior surface lower fibers sternum to the of costal intertubercular groove of cartilages of first the humerus, during six ribs, and resisted extension from a adjoining portion flexed position of sternum Lattissimus The tendon may be Posterior crest of dorsi palpated as in passes ilium, back of under the teres mahor at sacrum and the posterior axillary wall, spinous particularly during processes of resisted extension and lumbar and lower internal rotation. The six thoracic 4/30/2017 Flat tendon 2 or 3 Lateral pectoral inches wide to nerve (C5, C6, lateral lip of C7 intertubercular groove of humerus Deltoid tuberosity Axillary nerve on the lateral (C5, C6) humerus Deltoid tuberosity Axillary nerve on lateral (C5, C6) humerus Deltoid tuberosity Axillary nerve on lateral (C5, C6) humerus 6:32:39 PM Stabilization Center Proximal Arm Distal Arm extension, full ext Muscle( Pectoralis major, upper fibers, rotation, elbow s) Deltoid anterior fibers, Deltoid extension middle fibers, Deltoid posterior fibers, Supra spinatus Scapula to prevent UR & elevation, Thorax to Recommended Patient is short prevent lateral flex of Testing Position sitting with arm at trunk side and elbow slightly flexed. Close to anterior acromion process Resistance Hand Examiner is standing Placement behind patient giving Parallel to midline of resistance over arm ant sternum just above elbow. Medial midline of Patient Instruction Patient abducts arm humerus to 90 degrees against maximal downward pressure. Special notes Superiorly on Suprascapula greater tubercle nerve (C5) of humerous Distal Attachment Innervation Flat tendon 2 or 3 Medial pectoral inches wide to nerve (C8, T1) lateral lip of intertubercular groove of humerus Medial side of Thoracodorsal intertubercular (C6, C7, C8) groove of humerus, just anterior to the insertion of the teres major Recommended Supine, may be sitting Testing Position or prone, G-H 00 flexextension, full extension rotation, elbow extension Stabilization Scapula to prevent UR & elevation, Thorax to prevent lateral flex of trunk Center Close to anterior acromion process Proximal Arm Parallel to midline of anterior sternum Distal Arm Medial midline of humerus Motion Muscle specific, list or ↓ Muscle( Pectoralis major lower fibers, s) Lattissimus dorsi, Teres major Recommended Stand behind the Testing Position patient while the patient to patient is sitting erect. Resistance Hand Place your stabilizing Placement hand upon the acromion and your resisting hand proximal to the elbow joint. Since the pectoralis major 3 Joint Detail Last saved by yatesh Teres major Motion: Internal Rotation Range: 45 degrees Plane: Transverse Axis: Vertical Agonists muscle can be palpated in the upper lumbar/lower thoracic area during extension from a flexed position and throughout most of its length during resisted adduction from a slightly abducted position Just above latissimus dorsi and below the teres minor on the posterior scapula surface, moving diagonally upward and laterally from theinferior angle of the scapula during resisted external rotation Palpation 4/30/2017 vertebrae, slips from lower three ribs Posteriorly ion inferior third of lateral border of scapula and just superior to inferior angle Proximal Attachment Pectoralis major From medial end of Medial half of upper fibers clavicle to the anterior surface intertubercular groove of of clavicle the humerus, during flexion and adduction from the anatomical position Pectoralis major From the lower ribs and Anterior surface lower fibers sternum to the of costal intertubercular groove of cartilages of first the humerus, during six ribs, and resisted extension from a adjoining portion flexed position of sternum Lattissimus dorsi The tendon may be Posterior crest of palpated as in passes ilium, back of under the teres mahor at sacrum and the posterior axillary wall, spinous particularly during processes of resisted extension and lumbar and lower internal rotation. The six thoracic muscle can be palpated vertebrae, slips in the upper lumbar/lower from lower three thoracic area during ribs extension from a flexed Medial lip of Axillary nerve intertubercular (C5, C6) groove of humerus, just posterior to the insertion of the latissimus dorsi Distal Attachment Innervation Flat tendon 2 or 3 Lateral pectoral inches wide to nerve (C5, C6, lateral lip of C7 intertubercular groove of humerus Flat tendon 2 or 3 Medial pectoral inches wide to nerve (C8, T1) lateral lip of intertubercular groove of humerus Medial side of Thoracodorsal intertubercular (C6, C7, C8) groove of humerus, just anterior to the insertion of the teres major 6:32:39 PM muscle is a primary adductor, move the stabilizing hand anteriorly and inferiorly on the acromion so that you can palpate the pectoralis major. Patient Instruction Instruct the patient to place his arm n a few degrees of abduction and shift your resisting hand so that your thumb rests against the medial aspect of his humerus. Special notes Recommended Supine, arm in 900 of Motion Muscle specific, list Testing Position abduction, forearm or ↓ perpendicular to Muscle( Pectoralis major upper fibers, supporting surface & 00 s) Pectoralis major lower fibers, of pronation-supination, Lattissimus dorsi, Teres major, full length of humerus Subscapularis on supporting surface Recommended Patient is prone with Stabilization Humerus to maintain Testing Position shoulder abducted to 900 abduction, scapula 90 degrees with to prevent elevation & folded towel placed anterior tilting under distal arm and Center Over olecranon process forearm hanging vertically over edge Proximal Arm Parallel to or of table. perpendicular to floor Distal Arm Ulnar, using olecranon Resistance Hand Examiner stands at Placement test side giving & ulnar styloid resistance over volar side of forearm just above the wrist in a downward and forward direction. Patient Instruction The other hand provides counterforce at the elbow in a backward and slightly upward 4 Joint Detail Last saved by yatesh Teres major Subscapularis position and throughout most of its length during resisted adduction from a slightly abducted position Just above the latissimus Posteriorly on dorsi and below the teres inferior third of minor on the posterior lateral border of scapula surface, moving scapula and just diagonally upward and superior to laterally from the inferior inferior angle of the scapula during resisted internal rotation Mostly inaccessible, Entire anterior lateral portion may be surface of palpated on supine subscapularis subject (arm in slight fossa flexion and adduction with elbow lying across abdomen); pull medial border laterally with one hand while palpating between the scapula and rib cage with other hand (subject actively internally rotates) 4/30/2017 6:32:39 PM direction Special notes Medial lip Lower intertubercular subscapular groove of nerve (C5, C6) humerus, just posterior to the insertion of the latissimus dorsi Lesser tubercle Upper and lower of humerus subscapular nerve (C5, C6) 5 Joint Detail Motion: External Rotation Range: 45 degrees Plane: Transverse Axis: Vertical Last saved by yatesh Agonists Infraspinatus Teres minor Palpation Just below the spine of the scapula passing upward and laterally to the humerus during resisted external rotation Just above the teres major on the posterior scapula surface, moving diagonally upward and laterally from the inferior angle of the scapula during resisted external rotation Proximal Attachment Medial aspect of infraspinatus fossa just below spine of scapula 4/30/2017 Distal Attachment Innervation Posteriorly on Suprascapula greater tubercle nerve (C, C6) of humerus Posteriorly on Posteriorly on Axillary nerve upper and midlle greater tubercle (C5, C6) aspect of lateral of humerus border of scapula 6:32:39 PM Recommended Supine, arm in 900 of Motion Muscle specific, list Testing Position abd, forearm or ↓ perpendicular to Muscle( Teres minor, Infraspinatus supporting surface & 00 s) of pronation-supination, Recommended Patient is prone with full length of humerus Testing Position shoulder abducted to on supporting surface 90 degrees and Stabilization Humerus to maintain forearm hanging 900 abduction, scapula vertically over edge to prevent post tilting of table. Center Over olecranon processResistance Hand Examiner stands at Proximal Arm Parallel to or Placement test side at level of perpendicular to floor patient's waist. One hand gives Distal Arm Ulnar, using olecranon resistance at wrist & ulnar styloid while other hand supports and provides counter pressure at the elbow. Patient Instruction Patient moves forearm upward through range of external rotation. Special notes 6