Shoulder & Arm 6

Biceps Brachi

Action Flex the elbow, supinate the forearm,

flex the shoulder

Origin Short head – Coracoid process of

scapula Long head – Supraglenoid tubercle of

scapula

Insertion Tuberosity of the radius andaponeurosis

of the biceps brachii

Innervation Musculocutaneous (C5-6)

Biceps brachii

Supine or seated

Bend the elbow and shake hands with pt

Ask pt to flex his elbow against your resistance

Palpate the ant. surface of the arm and locate the hard, round belly of the biceps

Follow the belly distally to the inner elbow and then follow proximally to where it tucks beneath the ant. fiber of deltoid

Biceps brachii – distal tendon

With elbow flexed, shake hands with pt.

As you locate the biceps’s distal tendon, ask pt to flex his elbow against your resistance

Slide over to the tendon’s medial aspect and explore for the aponeurosis

Biceps brachii- tendon of long head

Locate the intertubercular groove

Laterally rotating the arm may make it easier to pinpoint the tendon

Ask pt. to gently flex his elbow against your resistance

Brachialis

Action Flexion at the elbow joint

Origin Distal half of the anterior surface

of the humerus, also the medial and lateral intermuscular septa

Insertion Ulnar tuberosity

Innervation Musculocutaneous (C5-6) and

radial nerve (C7)

Brachialis Shake hands with pt. and

flex the elbow to 90°

Ask pt to flex his elbow against your resistance

With arm relaxed, slide laterally half an inch off the distal biceps. The edge of the brachialis can be detected

Brachialis

Locate the distal biceps

tenden

Palpate along either side of

the tendon for portions of

the deeper brachialis

Test for biceps brachii and brachialis

• Patient:Patient: Supine or sitting

• Fixation:Fixation: The examiner places one hand under the elbow to cushion it form table pressure

• Test:Test: Elbow flexion slightly less than or at a right angle, with the forearm in supination

• Pressure:Pressure: Against the lower forearm, in the direction of extension

Triceps brachi

Long head

Medial head

Lateral head

Triceps brachiAction

All head: Extend the elbow Long head: Extend and adduct the shoulder

Origin Long head: Infraglenoid tubercle of the scapular Lateral head: Posterior surface of proximal half of the

humerus Medial head: Posterior surface of distal half of the

humerusInsertion

Olecranon process of the ulnaInnervation

Radial (C6-8)

Triceps brachii

Prone

Bring the arm off the side of the table

Locate the olecranon process to outline the distal tendon of the triceps

Ask pt. to extend his elbow as you apply resistance

Slide proximally and onto the broad triceps tendon

Triceps brachii – tendon of long head

Prone

Place one hand on the proximal elbow and ask pt. to extend against your resistance

Locate its belly and follow the muscle proximally

Note how it disappears underneath the post. deltoid toward the infraglenoid tubercle

With the arm relaxed, press through the post. deltoid and strum across its tendon to the infraglenoid tubercle

Test for triceps and anconeus

• Patient:Patient: Prone

• Fixation:Fixation: The shoulder is at 90° abduction, neutral with regard to rotation, and with the arm supported between the shoulder and the elbow by the table.

• Test:Test: Extension of the elbow joint (to slightly less than full extension)

• Pressure:Pressure: Against the forearm, in the direction of flexion.

Corachobrachialis

Action Flex and adduct the shoulder

Origin Coracoid process of the scapula

Insertion Medial surface of mid-humeral

shaft

Innervation Musculocutaneous

Coracobrachialis Supine and laterally rotate and

abduct the shoulder to 45°

Locate the fibers of the pectoralis major

Lay one hand along the medial side of the arm and move your fingerpads into the armpit

Ask pt horizontally adduct gently against your resistance

Isolate the solid edge of the pectoralis major then slide off the fibers posteriorly (into the axilla) and explore the belly of coracobrachialis

Test for coracobrachialis

Test for coracobrachialis

• Patient:Patient: Sitting or supine

• Test:Test: Shoulder flexion in lateral rotation, with the

elbow completely flexed and the forearm supinated.

• Pressure:Pressure: Against the anteromedial surface of the

lower 1/3 of the humerus, in the direction of extension

and slight abduction