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Joint Detail Last saved by ws-is 4/30/2017 2:12:37 AM Shoulder joint Specifically known as Glenohumeral Joint Name: Dominique Grady, Traves Yelder, LaJoy Paige, Date: 9/1/10 Lindsey Robinson 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 & Flexion 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 anterior fibers, 90-100 depressor can be held intertubercular groove of clavicle lateral lip of C7 Pectoralis major upper degrees between teeth for the humerus, during intertubercular fibers Plane: reference flexion and adduction groove of Recomm Patient is Sagittal from the anatomical humerus Stabilization Shoulder girdle is ended short sitting Axis: position stabilized to prevent Testing with arms at Frontal flexion of thoracic & Deltoid anterior From the clavicle toward Anterior lateral Deltoid tuberosity Axillary nerve Position sides, elbow lumbar spine fibers the anterior humerus third of clavicle on the lateral (C5, C6) slightly during resisted flexion or humerus Center Over the external flexed, and horizontal adduction auditory meatus forearm supinated Proximal Arm Perpendicular or parallel to ground Resistanc Examiner Distal Arm With base of nares or e Hand stands at parallel to longitudinal Placemen test side with one axis of tongue depressor t hand giving maximal resistance over distal humerus and other hand stabilizing shoulder. Patient Patient 1 Joint Detail Motion: Extension Range: 40-60 degrees Plane: Sagittal Axis: Frontal Motion: Abduction Range: 90-100 degrees Last saved by ws-is 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 major 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 Posteriorly 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 Pectoralis major From medial end of Medial half of upper fibers clavicle to the anterior surface intertubercular groove of of clavicle 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 Flat tendon 2 or 3 Lateral pectoral inches wide to nerve (C5, C6, lateral lip of C7 2:12:37 AM Instructio raises arm n off table keeping elbow straight. Special notes Recommended Prone, head facing Ext Motion Muscle specific, list Testing Position away from involved en or ↓ shoulder, G-H 00 sio abduction & rotation, n elbow slight flex, 00 of Muscle( Pectoralis major lower fibers, pronation-supination s) Latissimus dorsi, Teres major Stabilization Scapula to prevent Recommended Patient is prone with elevation, anterior tilting Testing Position arms at sides and Center Close to acromion shoulder internally process rotated. Proximal Arm Midaxillary line of Resistance Hand Examiner stands at thorax Placement test side and applies maximal resistance Distal Arm Lateral midline of over posterior arm humerus, lateral just above elbow. epicondyle Patient Instruction Patient raises arm off table keeping elbow straight. Special notes Recommended Supine, may be sitting Testing Position or prone, G-H 00 flexextension, full ext rotation, elbow extension Abd ucti on Mus cle(s Motion or Muscle specific, list ↓ Pectoralis major, upper fibers, Deltoid anterior fibers, Deltoid 2 Joint Detail Plane: Frontal Axis: Sagittal Motion: Adduction Range: 0 degrees Plane: Frontal Axis: Sagittal Last saved by ws-is 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 Supraspinatus 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 major 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 4/30/2017 intertubercular groove of humerus 2:12:37 AM Stabilization 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 Center Proximal Arm Distal Arm Scapula to prevent UR & elevation, Thorax to prevent lateral flex of trunk Close to anterior acromion process Parallel to midline of ant sternum Medial midline of humerus ) middle fibers, Deltoid posterior fibers, Supraspinatus Recommended Patient is short Testing Position sitting with arm at side and elbow slightly flexed. Resistance Hand Examiner is standing Placement behind patient giving resistance over arm just above elbow. Patient Instruction Patient abducts arm to 90 degrees against maximal downward pressure. Special notes Superiorly on Suprascapula greater tubercle nerve (C5) of humerus 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 Add Motion Muscle specific, list Testing Position or prone, G-H 00 flex- ucti or ↓ extension, full on extension rotation, Muscle( Pectoralis major lower fibers, elbow extension s) Lattissimus dorsi, Teres major Stabilization Scapula to prevent UR Recommended Stand behind the & elevation, Thorax to Testing Position patient while the prevent lateral flex of patient to patient is trunk sitting erect. Center Close to anterior Resistance Hand Place your stabilizing acromion process Placement hand upon the Proximal Arm Parallel to midline of acromion and your anterior sternum resisting hand proximal to the Distal Arm Medial midline of elbow joint. Since humerus the pectoralis major muscle is a primary adductor, move the 3 Joint Detail Last saved by ws-is Teres major Motion: Internal Rotation Range: 45 degrees Plane: Transverse Axis: Vertical Agonists 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 the inferior angle of the scapula during resisted external rotation Palpation 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 major 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 position and throughout most of its length during 4/30/2017 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 2:12:37 AM 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 Inter Motion Muscle specific, list Testing Position abduction, forearm nal or ↓ perpendicular to Rota supporting surface & 00 tion of pronation-supination,Muscle( Pectoralis major upper fibers, full length of humerus s) Pectoralis major lower fibers, on supporting surface Lattissimus dorsi, Teres major, Stabilization Humerus to maintain Subscapularis 900 abduction, scapula Recommended Patient is prone with to prevent elevation & Testing Position shoulder abducted to anterior tilting 90 degrees with Center Over olecranon process folded towel placed under distal arm and Proximal Arm Parallel to or forearm hanging perpendicular to floor vertically over edge Distal Arm Ulnar, using olecranon of table. & ulnar styloid Resistance Hand Examiner stands at Placement test side giving 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 ws-is Teres major Subscapularis 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 2:12:37 AM direction Medial lip Lower intertubercular subscapular groove of nerve (C5, C6) humerus, just posterior to the insertion of the latissimus dorsi Special notes 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 ws-is 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 middle greater tubercle (C5, C6) aspect of lateral of humerus border of scapula 2:12:37 AM Recommended Supine, arm in 900 of Exte Motion Muscle specific, list Testing Position abduction, forearm rnal or ↓ perpendicular to Rota supporting surface & 00 tion of pronation-supination,Muscle( Teres minor, Infraspinatus full length of humerus s) on supporting surface Recommended Patient is prone with Stabilization Humerus to maintain Testing Position shoulder abducted to 900 abduction, scapula 90 degrees and to prevent post tilting forearm hanging Center Over olecranon process vertically over edge of table. Proximal Arm Parallel to or perpendicular to floor Resistance Hand Examiner stands at Placement test side at level of Distal Arm Ulnar, using olecranon patient's waist. One & ulnar styloid hand gives resistance at wrist 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