Pectoralis major

Clavicular part

Sternocostal part

Abdominal part

Pectoralis majorAction

All fiber: Adduct and medially rotate the scapula, assist in elevating the thorax

Upper fiber: Flex and horizontally adduct the shoulder Lower fiber: Extend the shoulder

Origin Medial half of clavicle, sternum and cartilage of 1st

through 6th rib

Insertion Crest of greater tubercle of humerus

Innervation Medial and lateral pectoral

Pectoralis major Supporting pt’s arm, flex

the shoulder and pull it anteriorly toward you. This position not only brings

the pectoralis major off the chest wall, but also allows the breast tissue to fall away from you are palpating

Grasp the pectoralis major and explore its mass from the ribs to the humerus

Pectoralis major

Supine with arm raised

As you create resistance, ask pt. to flex his shoulder Contraction of upper fiber

Ask him to extend against your resistance Contraction of lower fiber

Pectoralis major

Supine

With pt’s shoulder slightly abducted

Locate the med. shaft of the clavicle and move inferior onto the clavicular fiber

Explore the surface of muscle

Follow the fibers laterally

Grasp the belly of pectoralis and ask pt. to medially rotate his shoulder against your resistance

Test for pectoralis major (length of lower fibers)

Test for pectoralis major (length of lower fibers)

• Position:Position: Supine, with the knees bent and the low back flat on the table

• Test movement:Test movement: The examiner places the subject’s arm in a position of approximately 135° of abduction, with the elbow extended. The shoulder will be in lateral rotation.

• Normal length:Normal length: Arm drops to table level, with low back remaining flat on the table.

• Shortness:Shortness: The extended arm does not drop down to the table level.

Test for pectoralis major(Lowr fibers)

Test for pectoralis major(Lower fibers)

• Patient:Patient: Supine

• Fixation: The examiner places one hand on opposite iliac crest to hold the pelvis.

• Test:Test: Starting with the elbow extended and with the shoulder in fixation and slight medial rotation, adduction of the arm obliquely toward the opposite iliac crest.

• Pressure:Pressure: Against the forearm obliquely, in a lateral and cranial direction.

Test for pectoralis major(Length of upper fibers)

Test for pectoralis major(Length of upper fibers)

• Patient:Patient: Supine, with the knee bent and the low back flat on the table

• Test:Test: The examiner places the subject’s arm in horizontal abduction, with the elbow extended and the shoulder in lateral rotation (palm upward)

• Normal length:Normal length: Full horizontal abduction, with lateral rotation, the arm flat on the table, and without trunk rotation.

• Shortness:Shortness: The arm does not drop down to table level.

Test for pectoralis major(upper fibers)

Test for pectoralis major(upper fibers)

• Patient:Patient: Supine

• Fixation:Fixation: The examiner hold the opposite shoulder firmly on the table. The triceps maintains the elbow in extension

• Test:Test: Starting with the elbow extended and with the shoulder in 90° flexion and slight medial rotation, the humerus is horizontally adducted toward the sternal end of the clavicle.

• Pressure:Pressure: Against the forearm, in the direction of horizontal abduction

Pectoralis minor

Action Depress, abduct the scapula, tilt

the scapula anteriorly

Origin 3rd, 4th, and 5th rib

Insertion Coracoid process of the scapula

Innervation Medial and lateral pectoral nerve

(C6-T1)

Pectoralis minor

Abduct the arm and place your fingerpad at the lat. edge of pectoralis major

Slowly and gently slide under the pectoralis major, following along the surface of the ribs

Ask pt. to depress his scapula

Pectoralis minor

Sidelying with arm in flexed position and pull it anterilory

Slowly slide your thumb under the pectoralis major, following along the surface of the ribs

Ask pt. to gently depress his scapula while you feel for the minor’s contraction

Test for pectoralis minor

Test for pectoralis minor

• Patient:Patient: Supine

• Test:Test: Forward thrust of the shoulder, with the arm at

the side. The subject must exert no downward pressure

on the hand to force the shoulder forward.

• Pressure:Pressure: Against the anterior aspect of the shoulder,

downward toward the table.

Subclavius

Action Draw clavicle inferiorly and

anteriorly, elevate 1st rib, stabilize the SC joint

Origin 1st rib and cartilage

Insertion Inferior, lateral aspect of the

clavicle

Innervation Subclavian (C5,6)

Subclavius

Sidelying with arm flexed and pull

it anteriorly

Place your thumb and fingers at the

center of the clavicle

Slowly curl your thumb around the

clavicle’s underside

You may not access a muscle belly,

but may feel instead some slightly

dense tissue tucked under the

claivcle