Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
SHOULDER GIRDLE PTHY 6401 Kinesiology I Lab - 2015 I. Palpation Suprasternal Notch Sternoclavicular (SC) Joint Clavicle Coracoid process of scapula Spine of scapula Acromion process of scapula Acromioclavicular (AC) Joint Greater tubercle of humerus Lesser tubercle of humerus Bicipital groove of humerus Inferior angle of scapula Medial & Lateral scapular borders C7-T12 Spinous Processes Supraspinatus (humeral attachment only) Infraspinatus Teres Minor Teres Major Subacromial Space* including Subacromial Bursa* & Subdeltoid Bursa Axilla: Lymph nodes Brachial Artery Pulse Latissimus Dorsi & Teres Major again Pectoralis Major Serratus Anterior (ms belly) Sternocleidomastoid Biceps Brachii Anterior/Middle/Posterior Deltoid Upper/Middle/Lower Trapezius Rhomboids (major/minor) Levator scapulae (deep-general) Glenohumeral Joint (deep-general) Coracoacromial Arch (deep-general) * essentially not palpable; student to be able to explain and Q&A Plain Film Radiology of the Shoulder Girdle Region: Glenohumeral Joint: Two AP views (AP in ext rotation and AP in int rotation) AND Axillary view Acromioclavicular joint: AP bilateral views, 1 NWB and 1 WB (traction on the AC) are typical; Scapula: AP and Lateral “Scapular Y” views II. AROM Measurement GONIOMETRY Movement Reese & Bandy Position Axis Stationary Arm Moving Arm Avg 58 Flexion Supine Acromion Midline of thorax Lat epicondyle 0-165° 60 Extension Prone Acromion Midline of thorax Lat epicondyle 0-60° 62 Abduction Supine Anterior Acromion Parallel w/ sternum Med epicondyle 0-165° 64 Adduction Supine Anterior Acromion Parallel w/ sternum Med epicondyle ? 70 Lateral Rotation Supine Olecranon Vertical Ulnar styloid 0-90 ° 72 Medial Rotation Supine Olecranon Vertical Ulnar styloid 0-70° MUSCLE LENGTH TESTING Body Position Reese & Muscle Tested Bandy Movement Measurement 146 Pectoralis Major (general) Supine, L-spine flat, hands behind head PROM shoulder horizontal abduction (gravity) Meas distance: olecranon to surface 152 Pectoralis Minor Supine, L-spine flat, shoulder ER, forearm supinated PROM Scapular retraction (gravity) Meas distance: post acromial border to surface 144-150 Latissimus Dorsi, Pectoralis Major – sternal portion, Pectoralis Major – clavicular portion Supine (see book) Options III. Manual Muscle Testing see text for recommendations on stabilization and where to apply resistance Reese Movement Muscle(s) Tested Gravity Resisted Position Gravity Elim Position 20 Scapular Elevation Upper Trap, Levator S Seated; hands unsupported Prone, face down 23 Scapular Adduction Middle Trap, Rhomboids Prone, Shoulder Abd 90° & ER; elbow flex 90° Seated, Shoulder Abd 90° & ER, elbow extend (supported) 28 Scapular Adduction (Alternative Test) Middle Trap, Rhomboids 31 Scapular Adduction & Depression Lower Trap Prone, Shoulder abd 130°, elbow extended NONE (judge GR AROM) 35 Scapular Adduction & Downward Rotation Rhomboid Maj / Minor Prone, hand behind back on ipsilat. gluteal Seated, hand behind back on ipsilat. gluteal 40 Scapular Adduction & Downward Rotation (Alternative Test) Rhomboid Major & Minor Prone, arm at side; elbow flexed, forearm pronated NONE (judge GR AROM) 43 Scapular Abduction & Upward Rotation Serratus Anterior Seated, mvmt is shoulder flex ~125°; resist 2 places NONE (judge GR AROM) 47 Shoulder Flexion 0-90° Anterior Deltoid, Coracobrach. Seated, arm at side, elbow extended, forearm neutral Sidelying, arm at side, elbow extended, forearm neutral; test top arm (supported) 52 Shoulder Flexion 90° (Alternative Test) Anterior Deltoid 54 Shoulder Flexion & Adduct Coracobrachialis 57 Shoulder Extension Lats, Teres Major, Post. Deltoid Prone, arm at side, elbow extended, shoulder IR Sidelying, arm at side, elbow extended, shoulder IR; (supported) 61 Shoulder Abduction 0-90° Middle Deltoid, Supraspinatus Seated, UE joints in neutral position Supine, UE joints in neutral position; (supported) 69 Shoulder Horizontal Abduction Posterior Deltoid Prone, shoulder abd 90°, elbow flex 90° Seated, shoulder abd 90°, elbow flexed; (supported) 73 Shoulder Horizontal Adduction Pectoralis Major Supine, shoulder abd 90°, elbow flex 90° Seated, shoulder abd 90°, elbow flex 90°; (supported) 78 80 Shoulder Horizontal Adduction (Alternative Tests) Pectoralis Major – differentiate clavicular & sternal 83 Shoulder Medial Rotation Subscap, Pect Major, Latissimus, Teres Major 89 Shoulder Lateral Rotation Infraspinatus, Teres Minor Prone, shoulder abd 90°, elbow flex 90°, humerus horizontal Prone, shoulder abd 90°, elbow flex 90°, humerus horizontal Prone, shoulder flex 90° & ER, elbow extended (arm hanging vertically) Prone, shoulder flex 90° & IR, elbow extended (arm hanging vertically) HANDHELD DYNAMOMETRY Reese Movement Body Position Placement Stabilization 456 Scapular Elevation (GE) Prone (GE position) Superior Acromion Contralateral Shoulder 460 Shoulder Abduction Supine, see GE Sh Abd Lateral Distal Humerus Ipsilateral Shoulder Shoulder Flexion, Extension, Scapular Adduction, Shoulder Horizontal Abd/Adduction, Shoulder Medial and Lateral Rotation Shoulder Palpation Handout This narrative will talk you thru the palpation examination of several important shoulder girdle structures. Stand in front of your partner while he/she is sitting with their back supported. Begin palpation over the manubrium of the sternum and course cranially until your finger “falls off” an edge. This superior extent of the sternum is the suprasternal notch which is a concavity that is deepened by the proximal ends of the two clavicles. Draw in the notch on your partner. The sternoclavicular (SC) joint can be palpated on each side of the notch. Movement at the joint can be palpated during elevation/depression or protraction/retraction of the scapulae and clavicles. The clavicles are notably curved with the anterior surface convex medially and concave laterally (the opposite is true of the posterior surface). Trace these two surfaces as far as the lateral concavity. Place your index finger on the anterior-inferior surface pushing “up and in”. As you course lateral, your finger will be stopped by a boney structure. This downward projection of bone from the scapula is the coracoid process. Mark this medial border then continue to palpate its distal and lateral edges and mark them as well. You can confirm you drawing by placing your index finger on top of the coracoid and rolling off the prominence on both sides. Change your position to stand behind your partner. Palpate the ridge of bone on the posterior aspect of the scapula. The spine of the scapula courses in an inferiomedial to superiolateral direction. Draw in a single line along the inferior border. Laterally, the spine broadens and flattens into the acromion process of the scapula. Trace the lateral border of the acromion process, noting the anterior and posterior angles. Palpate the flat acromion that makes up part of the “roof” of the glenohumeral joint. Let your finger fall off the lateral edge and note the amount of joint space between the acromion and greater tubercle of the humerus. Move in front of your partner to complete the drawing by joining the clavicle and acromion. Start at the anterior angle of the acromion and palpate medially along the edge of the acromion until your finger falls into a small “v-notch”. Draw this in. This notch identifies the acromioclavicular (AC) joint. A larger “v-notch” exists on the posterior edge as well. These two “v’s” can be attached by a dotted line to designate the AC joint line. With the arm in the anatomical position, the lesser tubercle of the humerus is palpated as the deep boney structure just lateral to the coracoid process. The medial and inferior extents can be drawn in. The lateral border of the lesser tubercle is defined by the bicipital groove. To locate the groove, Stand behind your partner and place the ring finger of your contralateral hand on the coracoid while the middle finger rests on the lesser tubercle. Have your partner abduct to 80-90 and give moderate resistance with the ipsilateral hand to identify the septum between the anterior and middle deltoids. Place your index finger in this groove. While maintaining your fingers in position, lower the arm to 15 IR. Your index finger is located over the bicipital groove. This can be confirmed by passive IR/ER of the arm which causes the tendon to roll under your finger and the edges of the greater and lesser tubercles to come in contact with your finger.