shoulder & arm 2
TRANSCRIPT
Trapezius
1. Upper fiber
2. Middle fiber
3. Lower fiber
Trapezius
Action Upper fibers
Draws the scapula obliquely upward and rotates the glenoid cavity inferiorly
Middle fibers
Draws the scapula medially
Lower fibers
Draws the scapula medially downward (supports the rotating action of the descending part)
Trapezius
Origin External occipital protuberance, medial portion of
superior nuchal line of the occiput, ligamentum nuchae and SP of C7 through T12
Insertion Lateral 1/3 of clavicle (upper fiber), acromion (middle
fiber), scapular spine (lower fiber)
Innervation Cranial nerve XI (accessory nerve) and cervical plexus
(C2-4)
Trapezius-upper fibers Prone
Easily accessible flap of muscle lying across the top of shoulder
Grasp the superficial tissue on the top of the shoulder and feel the upper trapezius fibers.
Follow superiorly toward the base of the head at the occiput.
Ask the pt. to extend his head → feel the fibers contract
Trapezius- middle fiber
Locate the spine of scapula
Slide medially from the spine of the scapula onto the trapezius
Ask pt. to adduct his scapula – feel contraction
Trapezius – lower fiber Locate the edge of the
lower fibers by drawing a line from the spine of scapula to the spinous process of T12
Palpate along this line
Ask pt. to hold his arms out in front of him (like Superman)
Test for upper trapezius
Test for upper trapezius
• Patient:Patient: Sitting
• Test:Test: Elevation of the acromial end of the clavicle and scapula, and posterolateral extension of the neck, bringing the occiput toward the elevated shoulder with the face turned in the opposite direction
• Pressure:Pressure: Against the shoulder, in the direction of depression, and against the head, in the direction of flexion anterolaterally.
Test for middle trapezius
• Patient:Patient: Sitting
• Test:Test: Adduction of the scapula, with upward rotation and without elevation of the shoulder girdle. The test position is obtained by placing the shoulder in 90° abduction and in lateral rotation of the inferior angle.
• Pressure:Pressure: Against the forearm, in a downward direction toward the table
Test for lower trpezius
Test for lower trpezius
• Patient:Patient: prone
• Test:Test: Adduction and depression of the scapula, with
lateral rotation of the inferior angle. The arm is placed
diagonally overhead, in line with the lower fibers of
the trapzius.
• Pressure:Pressure: Against the forearm, in a downward
direction toward the table
Latissimus dorsi Prone with the arm off side
of the table
Locate the scapula’s lat. Border
Grasp the thick wad of muscle tissue lat. to the lat. Border
Ask pt. to medially rotate his shoulder against your resistance “ Swing your hand up toward your hip.”
Latissimus dorsi
Supine
Cradle the arm in a flexed position
Grasp the tissue of the latissimus located beside the lat. Border
Ask pt. to extend his shoulder against your resistance. “Press your elbow toward your hip.”
Latissimus dorsi
A : Internal rotation, adduction, retroversion (move the arm backward), respiration (expiration, “cough muscle”)
O : SP of last 6 thoracic vertebrae, last 3 or 4 ribs, thoracolumbar aponeurosis and posterior iliac crest
I : Crest of the lesser tubercle of the humerus
N : Thoracodorsal (C4-6)
Test for latissimus dorsi
Test for latissimus dorsi
• Patient:Patient: Prone
• Test:Test: Adduction of the arm, with extension, in the
medially rotated position
• Pressure:Pressure: Against the forearm, in the direction of
abduction and slight flexion of the arm.