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FUNCTIONAL ANATOMY John Christiansen, PT, OCS, ATC Advanced Rehabilitation Clinics 1. Clavicle: articulates with sternoclavicular joint medially and acromioclavicular joint laterally muscle attachments: pectoralis major, deltoid, trapezius and subclavius 2. 1st Rib: articulates with T1 and manubrium muscle attachments: middle scalene and subclavius 3. Coracoid Process: coracoclavicular and coracoacromial ligaments muscle attachment: pectoralis minor 4. Acromion Process: articulates with clavicle muscle attachments: deltoid 5. Greater Tuberosity: muscle attachments: supraspinatus, infraspinatus, teres minor, pect major (lateral lip of intertubercular groove) 6. Lesser Tuberosity: ligamentus attachments: superior glenohumeral, middle glenohumeral, transverse humeral muscle attachment: subscapularis 7. Ligaments: a. Coracoclavicular- connects coracoid process and lateral clavicle b. Coracoacromial- connects coracoid process and acromion to form coracoacromial arch-key player in impingement c. Transverse humeral- unites lesser and greater tuberosities, holds long head of biceps d. Superior Glenohumeral- runs from glenoid to superior lesser tuberosity, contributes to posterior and inferior stabilization and resists inferior translation of humerus in unloaded, abducted shoulder e. Middle Glenohumeral- runs from glenoid to medial lesser tuberosity, limits ER in lower abducted ranges and provides anterior stability in 45° abduction f. Inferior Glenohumeral- composed of 3 parts- anterior and posterior bands and an axillary pouch, tightens as abduction in increased, at 90° abduction primary restraint to anterior and posterior dislocation, axillary pouch acts a hammock resisting inferior translation 8. Muscles: a. Subscapularis- O: medial 2/3 costal surface of scapula I: lesser tuberosity I: subscapular nerves (C5,6,7) A: shoulder adduction, interior rotation b. Supraspinatus-O: supraspinous fossa I: upper facet of greater tuberosity I: suprascapular nerve (C4,5,6) A: initiates abduction c. Infraspinatus- O: infraspinous fossa I: middle facet of greater tuberosity I: suprascapular nerve (C4,5,6) A: external rotation of humerus d. Teres Minor- O: upper 2/3 lateral border of scapula I: inferior facet of greater tuberosity I: axillary nerve (C4,5,6) A: adduction and external rotation of humerus e. Teres Major- O: inferior angle and lateral border of scapula I: medial lip of intertubercular groove I: lower subscapular nerve (C6,7) A: extend shoulder, adduct and medially rotate humerus f. SubclaviusO: junction of 1st rib ad costal cartilage I: inferior surface of middle 1/3 of clavicle I: nerve to subclavius (C5,6) A: stabilizes clavicle with shoulder motions g. Pect. Minor- O: ribs 3,4,5 I: coracoid process I: medial pectoral nerve (C6,7,8) A: scapular protraction and downward rotation h. Pect Major- O: clavicle, manubrium, sternum and 1-6 costal cartilage I: lateral lip of intertubercular groove I: medial and lateral pectoral nerves ( C5,6,7,8, T1) A: adduction and interior rotation of humerus i: Serratus Anterior-O: ribs 1-8 I: medial aspect of costal surface of scapula I: long thoracic nerve (C5,6,7) A: protract and upwardly rotate scapula j. Levator Scapulae- O: T.P. pf C1-4 I: medial superior ankle of scapula I: dorsal scapular nerve (C4,5) A: retract and elevate scapula k. Rhomboids- l. Trapezius- m. Deltoid- O: S.P. of C7, T1-5 I: medial border of scapula I: dorsal scapular nerve (C4,5) A: retract and elevate scapula O: nuchal line, ligamentum nuchae, S.P. of C7-T12 I: lateral 1/3 clavicle, acromion, spine of scapula I: spinal root of accessory nerve (CNXI) A: upper- elevates scapula middle- retract scapula lower- depress scapula O: lateral 1/3 clavicle, acromion, spine of scapula I: deltoid tuberosity I: axillary nerve (C5,6) A: anterior- flex and internally rotate humerus middle- abduct humerus posterior- extend and externally rotate humerus