shoulder & arm 3
TRANSCRIPT
Rotator Cuff muscles
Rotator cuff
Supraspinatus
Action Abduction
Origin Supraspinous fossa of the
scapula
Insertion Greater tuberosity of the
humerus
Innervation Suprascapular nerve (C4-6)
Supraspinatus
Prone
Locate the spine of scapula
Slide fingers up into the supraspinous fossa
Palpate through the trapezius
Follow the belly laterally until it tucks under the acromion
Ask pt. alternately abducting slightly and relaxing the shoulder.
Rotator cuff tendons - supraspinatus Supine or seated with the
arm at the side of the body
Locate the acromion and slide inferiorly onto the surface of the greater tubercle
Sink your thumb tip through the deltoid fibeers
Rotator cuff tendons - supraspinatus Seated
Place pt’s arm behind her back
Passively extend the arm as far as is comfortable
This position brings the supraspinatus tendon out from under acromion, just anterior and inferior to the AC joint
Infraspinatus
Action External rotation
Origin Infraspinous fossa of the
scapula
Insertion Greater tuberosity of the
humerus
Innervation Suprascapular nerve (C4-6)
Infraspinatus
Prone with forearm off the side of the table
Locate the spine, med. border and lat. border of the scapula
Form a triangle around the infraspinatus
Palpate in the triangle
Follow laterally to the humerus
Ask pt. to raise his elbow toward ceiling and relax.
Teres minor
Action External rotaton, weak
adduction
Origin Lateral border of the scapula
Insertion Greater tuberosity of the
humerus
Innervation Axillary nerve (C5,C6)
Teres minor
Prone with the arm off the side of the table
Locate the lat. border of the scapula; specifically its superior half.
Slide laterally off the lat. border onto the surface of the teres minor
Reach your thumb up into the axilla and grasp the belly of the teres minor
Ask pt. to laterlly rotate his shouder.
Rotator cuff tendons : infraspinatus and teres minor
Prone with arm off the side of the table
Locate the bellies of these muscles
Follow their bellies laterally as they pass inferior the acromion
Palpating through the deltoid, slender tendinous attachments at the greater tubercle
SubscapularisAction
Internal rotation
Origin Subscapular fossa of the
scapula
Insertion Lesser tuberosity of the
humerus
Innervation Subscapular nerve (C5,
C6)
Subscapularis Sidelying
Flex the shoulder and pull the arm anteriorly as much as possible
Hold the arm with one hand while thumb of other locates the lat. Border
Slowly and gently curl your thumb onto the subscapular fossa
Ask pt. to gently rotate his shoulder medially.
Subscapularis
Supine
Cradle the arm in a flexed position
Locate the lateral border
Slowly sink your thumbpad onto the subscapular fossa
Rotator cuff tendons - subscapularis
Seated or supine
Place the arm next to the trunk in anatomical position
Locate the coracoid process
Slide one inch inferiorly and laterally from the coracoid → between the two tendons of the biceps brachii
Palpate through the deltoid fibers
Explore by moving medially off the lesser tubercle
Ligaments of shoulder and glenohumeral joint
Ligaments of shoulder and glenohumeral joint
Coracoclavicular ligament
Seated or supine
Abduct and medially rotate the shoulder
Locate the coracoid process and the shaft of clavicle
Palpate b/w these landmarks. Roll your thumbpad across its fibers
Coracoacromial ligament Supine or seated
Locate coracoid process. Then locate the ant. edge of the acromion
Palpating deep to the deltoid fibers, explore b/w these landmarks for the wide band of the coracoacromial ligament
To bring the ligament closer to the surface, try extending the arm
Subacromial bursa With pt seated, stand behind him and
locate the acromion
Drop your fingers off the ant. edge of
the acromion
Slowly extend the pt’s shoulder by
pulling the elbow posteriorly
You will palpate at the depth b/w the
deltoid and rotator cuff tendons Palpate gently. Bursae are delicate
structures and best accessed with a soft touch