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Shoulder Girdle Muscular
Anatomy
Shoulder Girdle Retraction (Adduction)
Spinous processes of T2 to T5
Rhomboid Major
Origin
Medial border of scapula
Insertion
Scapulae retraction, medial scapula rotation
Action
Dorsal Scapular Nerve
Nerve Supply
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
Spinous process of C7 to T1
Rhomboid Minor
Origin
Upper medial border of scapula
Insertion
Scapulae retraction, medial scapula rotation
Action
Dorsal Scapula Nerve
Nerve Supply
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
Trapezius
Origin
Insertion
Action
Medial superior nuchal line, external
occipital protuberance, ligamentum
nuchae and the spinous process of C7-T12
Posterior aspect of the lateral clavicle,
medial acromion and the upper border of
the spine of the scapula
Upper fibres- elevation, neck extension,
ipsilateral lateral flexion, lateral rotation of
the scapula
Middle fibres- shoulder retraction
Accessory nerve (11th Cranial Nerve)
Nerve Supply
Palpation
Model in prone. Place palpating hand over
the upper trapezius. Have model actively
abduct the arm at the shoulder joint and
retract the scapula. Repeat above to palpate
the middle and lower trapezius. To further
bring out the upper trapezius, have model
slightly extend the neck
Shoulder Girdle Protraction (Abduction)
Serratus Anterior
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
Pectoralis Minor
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 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
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
Place palpating hand just proximal to the deltoid
tuberosity. Model actively abduct s the arm.
Anterior deltoid: Place hand on anterior shoulder.
Have client actively horizontally flex the arm at
the shoulder joint. Posterior deltoid: Place
palpating hand just inferior to the spine of the
scapula. Model actively horizontally extends the
arm at the shoulder joint
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 .
Lateral lip of intertubercular groove
Insertion
Action
Adduction and medial rotation. Flexion to
horizontal. Extension to neutral
Posterior primary rami of C1
Nerve Supply
Palpation
From seated model raises arm to 90 degrees
of abduction at the shoulder joint. Place
palpating hand on the belly of the muscle.
Ask the client to actively horizontally flex
the arm at the shoulder joint against
resistance and feel for the contraction of the
pectoralis major.
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.
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
Glenohumeral Extension
Latissimus Dorsi
Origin
Spinous processes of lower six thoracic and
all lumbar and sacral vertebrae,
supraspinous and interspinous ligaments,
outer lip of iliac crest, outer surfaces of
lower 3 or 4 ribs and inferior angle of the
scapula
Insertion
Intertubercular sulcus of humerus
Action
Extends, abducts and medially rotates
shoulder
Nerve Supply
Thoracodorsal nerve and the posterior cord
of the brachial plexus
Palpation
Model seated with hands at their sides.
Place palpating hand on posterior axillary
fold and ask the model to push down on the
table with both hands, attempting to
elevate the pelvis and trunk off the table.
Feel for the contraction of the
latissimusdorsi
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
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
Have model extend the elbow. Palpate in
the proximal medial 2/3 of the arm
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
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
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
Downward
Rotation
Rhomboid Minor
Pectoralis Minor
Levator Scapulae
Posterior Tilt
Trapezius (Lower Fibres)
Anterior Tilt
Pectoralis Minor
Muscular Anatomy Summary
Glenohumeral
Pectoralis Major
Deltoid
Flexion
Biceps Brachii
Coracobrachialis
Supraspinatus
Abduction
Deltoid
Latissimus Dorsi
Extension
Teres Major
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