Download PTHY 6401 Kinesiology I Lab

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.