Shoulder Girdle Muscular Anatomy

Shoulder Girdle Retraction (Adduction)

Rhomboid Major Origin Insertion Action Nerve Supply Palpation Spinous processes of T2 to T5 Insertion Medial border of scapula Action Scapulae retraction, medial scapula rotation Nerve Supply Dorsal Scapular Nerve Palpation Side lying, with arm hanging over edge of bed to abduct scapulae. Palpate obliquely downwards and lateral from spinous process to medial scapula border

Rhomboid Minor Origin Insertion Action Nerve Supply Palpation Spinous process of C7 to T1 Insertion Upper medial border of scapula Action Scapulae retraction, medial scapula rotation Nerve Supply Dorsal Scapula Nerve Palpation Side lying, with arm hanging over edge of bed to abduct scapulae. Palpate obliquely downwards and lateral from spinous process to medial scapula border

Trapezius Origin Insertion Action Nerve Supply Palpation Medial superior nuchal line, external occipital protuberance, ligamentum nuchae and the spinous process of C7-T12 Insertion Posterior aspect of the lateral clavicle, medial acromion and the upper border of the spine of the scapula Action Upper fibres- elevation, neck extension, ipsilateral lateral flexion, lateral rotation of the scapula Middle fibres- shoulder retraction Nerve Supply Accessory nerve (11th Cranial Nerve) Palpation Model in prone. Place palpating hand over the upper trapezius. Have model actively abduct the arm at the shoulder joint and retract the scapula. Repeat above to palpate the middle and lower trapezius. To further bring out the upper trapezius, have model slightly extend the neck Trapezius

Shoulder Girdle Protraction (Abduction)

Serratus Anterior Origin Insertion Action Nerve Supply Palpation Outer surface of the upper 8-9 ribs and the intercostal fascia Insertion Costal surface of the medial border of the scapula Action Scapular protraction, scapular upward rotation, stabilises scapular to prevent medial border winging Nerve Supply Long thoracic nerve Palpation Side lying with arm resting on therapist shoulder. Therapist standing caudad facing cephalad. Palpate from axilla along chest wall

Pectoralis Minor Origin Insertion Action Nerve Supply Palpation Outer surface of the 3rd,4th and 5th ribs and the intercostal fascia Insertion Upper surface ad medial border of the coracoid process of the scapula Action Anterior tilt of scapula Nerve Supply Medial pectoral and Lateral pectoral nerves Palpation 1)Side lying with arm resting on therapist shoulder. Therapist pulls models arm forward to allow therapists hand to be placed posterior to pec major and directly onto caudal end of pec minor on the 5th rib. 2)In high sitting ask client to place hand behind back. Then ask them to further extend the shoulder whilst the therapist palpates 3rd, 4th and 5th ribs below the coracoids process. Pectoralis Minor

Shoulder Girdle Elevation

Transverse process of C1-4 Levator Scapulae Origin Transverse process of C1-4 Insertion Medial margin of the scapula between superior angle and spine of scapula Action Elevation, shoulder retraction, neck extension, ipsilateral lateral flexion, medial scapular rotation Nerve Supply Ventral rami of C3-4 Palpation Supine, ipsilateral cervical rotation, hand behind back. Palpate anterior to upper trapezius fibres and follow down onto superior angle of scapulae

Glenohumeral Abduction

Supraspinatus Origin Insertion Action Nerve Supply Palpation Medial two thirds of the supraspinous fossa Insertion Upper facet of the greater tubercle of the humerus Action First 20° of abduction, stabilise humeral head into glenoid Nerve Supply Suprascapular nerve Palpation Tendon- place model into glenohumeral maximal extension, medial rotation and adduction. Tendon can be palpated anterior to the acromion

Deltoid Origin Insertion Action Nerve Supply Palpation Anterior- anterior border of lateral third of clavicle. Middle- lateral margin of the acromion process. Posterior- lower lip of the crest of the spine of the scapula Insertion Deltoid tuberosity Action Abduction, flexion, extension, medial rotation, lateral rotation, horizontal abduction, horizontal adduction Nerve Supply Axillary Nerve Palpation Place palpating hand just proximal to the deltoid tuberosity. Model actively abduct s the arm. Anterior deltoid: Place hand on anterior shoulder. Have client actively horizontally flex the arm at the shoulder joint. Posterior deltoid: Place palpating hand just inferior to the spine of the scapula. Model actively horizontally extends the arm at the shoulder joint Deltoid

Glenohumeral Flexion

Pectoralis Major Origin Insertion Action Nerve Supply Palpation Clavicular head: Medial half of the anterior surface of clavicle. Sternal head: Anterior surface of the manubrium ad bod of sternum, anterior aspect of upper six costal cartilages and anterior past of the 6th rib and aponeurosis of external oblique . Insertion Lateral lip of intertubercular groove Action Adduction and medial rotation. Flexion to horizontal. Extension to neutral Nerve Supply Posterior primary rami of C1 Palpation From seated model raises arm to 90 degrees of abduction at the shoulder joint. Place palpating hand on the belly of the muscle. Ask the client to actively horizontally flex the arm at the shoulder joint against resistance and feel for the contraction of the pectoralis major. Pectoralis Major

Biceps Brachii Origin Insertion Action Nerve Supply Palpation Long head: Supraglenoid tubercle of the scapula and glenoid labrum. Short head: coracoid process of the scapula Insertion Posterior part of the radial tuberosity and bicipital aponeurosis Action Shoulder flexion, stabilise humeral head into glenoid. Elbow flexion and supination Nerve Supply Musculocutaneous nerve Palpation Long head tendon: 0° adduction, 20° medial rotation. Palpate the tendon in triangle bounded by medial deltoid, inferior clavicle and lateral pectoralis major.

Coracobrachialis Origin Insertion Action Nerve Supply Palpation Coracoid process of scapula Insertion Medial side of the shaft of the humerus Action Adduction and flexion Nerve Supply Musculocutaneous nerve Palpation Supine, 90° abduction and forearm supination. Therapist’s places fingers medial surface of the upper arm posterior to biceps brachii. Resist horizontal adduction to confirm palpation

Glenohumeral Extension

Latissimus Dorsi Origin Insertion Action Nerve Supply Palpation Spinous processes of lower six thoracic and all lumbar and sacral vertebrae, supraspinous and interspinous ligaments, outer lip of iliac crest, outer surfaces of lower 3 or 4 ribs and inferior angle of the scapula Insertion Intertubercular sulcus of humerus Action Extends, abducts and medially rotates shoulder Nerve Supply Thoracodorsal nerve and the posterior cord of the brachial plexus Palpation Model seated with hands at their sides. Place palpating hand on posterior axillary fold and ask the model to push down on the table with both hands, attempting to elevate the pelvis and trunk off the table. Feel for the contraction of the latissimusdorsi Latissimus Dorsi

Teres Major Origin Insertion Action Nerve Supply Palpation Dorsal surface of the scapular and inferior angle Insertion Medial lip of intertubercular groove of humerus Action Adduction, medial rotation and extension Nerve Supply Lower subscapular nerve Palpation Prone with arm off side of table. Grasp lat dorsi between your fingers and thumb. Move medially to scapula lateral border. Medial muscle fibres to lat dorsi is teres major

Triceps (Long Head) Origin Insertion Action Nerve Supply Palpation Infraglenoid tubercle of the scapula and the adjacent glenoid labrum Insertion Proximal surface of the olecranon of the ulna Action Shoulder adduction and extension. Elbow extension Nerve Supply Radial Nerve Palpation Have model extend the elbow. Palpate in the proximal medial 2/3 of the arm

Glenohumeral Lateral Rotation

Teres Minor Origin Insertion Action Nerve Supply Palpation Upper two thirds of lateral border of scapula Insertion Inferior facet of greater tubercle Action Lateral rotation Nerve Supply Axillary nerve Palpation Tendon: Patient prone on elbows, 90° shoulder flexion, 10° shoulder adduction and 20° lateral rotation. Palpate deep to deltoid and inferior to infraspinatus

Infraspinatus Origin Insertion Action Nerve Supply Palpation Medial two thirds of infraspinous fossa of scapula Insertion Middle facet of greater tubercle of humerus Action Lateral rotation Nerve Supply Suprascapular nerve Palpation Tendon: Patient prone on elbows, 90° shoulder flexion, 10° shoulder adduction and 20° lateral rotation. Palpate deep to deltoid

Glenohumeral Medial Rotation

Subscapularis Origin Insertion Action Nerve Supply Palpation Medial two third of subscapular fossa Insertion Lesser tubercle of humerus Action Medial rotation and adduction Nerve Supply Upper and Lower subscapular nerve Palpation Supine, passively flexion, abduction and protraction of the arm. Palpate the lateral border of the scapular anteriorly Tendon: 0° adduction, medial/lateral rotation. Palpate deep into the deltopectoral triangle

Muscular Anatomy Summary Shoulder Girdle

Retraction Protraction Rhomboid Major Rhomboid Minor Trapezius Serratus Anterior Pectoralis Minor

Trapezius (Upper Fibres) Elevation Trapezius (Upper Fibres) Levator Scapulae Upward Rotation Trapezius Serratus Anterior

Downward Rotation Rhomboid Major Rhomboid Minor Pectoralis Minor Levator Scapulae

Trapezius (Lower Fibres) Posterior Tilt Trapezius (Lower Fibres) Anterior Tilt Pectoralis Minor

Muscular Anatomy Summary Glenohumeral

Extension Adduction Latissimus Dorsi Teres Major Deltoid Triceps (Long Head Adduction Coracobrachialis Pectoralis Major

Medial Rotation Lateral Rotation Subscapularis Teres Major Latissimus Dorsi Pectoralis Major Deltoid Lateral Rotation Infraspinatus