Shoulder & Arm

Topographical views

Topographical views

Topographical views

Surface anatomy - shoulder

A. Clavicle

B. S-C joint

C. SCM muscle

D. A-C joint

E. Acromion

F. Coracoid process

G. Pectoralis major

H. Delotid

I. Deltoid tuberosity

J. Biceps brachii

K. Supraclavicular fossa

Surface anatomy - shoulderA. Spine of scapular

B. Med border of scapula

C. Supraspinatus

D. Infraspinatus

E. Teres minor

F. Trapezius

G. Lat border of scapula

H. Rhomboid muscle

I. Levator scapula

J. Post. Deltoid

K. Latissimus dorsi

L. Triceps brachii

M. Soft spot

Surface anatomy – upper arm

A. Acromion

B. Deltoid

C. Deltoid

tubersity

D. Briceps brachii

E. Triceps brachii

Bones of the shoulder and arm

Bony Landmarks

Bony landmark trail

Trail 1. Along the Edge a. spine of the scapula b. medial border c. inferior border d. superior border e. lateral border f. infraglenoid tubercle

Bony landmark trail

Trail 2. In the Trenches a. infraspinous fossa b. supraspinous fossa c. subscapular fossa

Bony landmark trail

Trail 3. Springboard Ledge a. acromion b. clavicle c. acromioclavicular and

sternoclavicular joints d. coracoid process e. deltoid tuberosity

Bony landmark trail

Trail 4. Two Hills and a Valley a. greater tubercle b. intertubercular

groove c. lesser tubercle

Deltoid

1. Clavicular part

2. Acromial part

3. Spinal part

Deltoid

Action Clavicular part: Anteversion, internal

rotation, adduction Acromial part: Abduction Spinal part: retroversion

Origin Clavicular part: Lateral third of the clavicle Acromial part: Acromion Spinal part: scapular spine

Insertion Deltoid tuberosity on the humerus

Innervation Axillary nerve (C5,6)

Deltoid Seated

Locate the spine of the scapula, the acromion and the lat. one-third of the clavicle (Note the “V” shape these landmarks form)

Locate the deltoid tuberosity

Palpate between these landmarks to isolate the superficial, convergent fibers of the deltoid.

If pt. alternately abduct and releases, do you

feel the fibers contract and relax?

Deltoid

Be sure to explore the deltoid’s most anterior and posterior aspects.

Test for deltoid

Test for deltoid

• Patient:Patient: Sitting

• Fixation:Fixation: If the scapular fixation muscles are weak, the the examiner must stabilize the scapula

• Test:Test: Shoulder abduction without rotation. When placing the shoulder in test position, the elbow should be flexed to indicate the neutral position of rotation

• Pressure:Pressure: Against the dorsal surface of the distal end of the humerus.

Test for anterior deltoid

• Patient:Patient: Sitting

• Fixation:Fixation: If scapular fixation muscles are weak, the scapula must be stabilized by the examiner

• Test:Test: Shoulder abduction in slight flexion, with the humerus in slight lateral rotation.

• Pressure:Pressure: Against the anteromedial surface of the arm, in the direction of adduction and slight extension

Test for posterior deltoid

• Patient:Patient: Sitting

• Fixation:Fixation: If scapular fixation muscles are weak, the scapula must be stabilized by the examiner

• Test:Test: Shoulder abduction in slight extension, with the humerus in slight medial rotaion.

• Pressure:Pressure: Against the posterolateral surface of the arm, above the elbow, in the direction of addduction and slight flexion