Supraspinatus: Abduction – best job (most active) is about the first 15 degrees or so..it is a kick start to abduction
before the big muscles kick in to carry it the rest of the way.
Put your hand in the small of your back. When I do that I bring her scapula up off of her chest wall. Then you find the
spine which is the bony landmark that I am looking for because this muscle sits just directly above it. Put my fingers right
in here like this (curl them down into that). The floor of that is the supraspinatus muscle belly. I am going to take my
hand and put it right here, hold don’t let me push you. I push towards her and she is pushing out to go into abduction. It
doesn’t take much force to do that because it activates most during the 1st 15 degrees.
Resist here.
Deltoids
Anterior portion comes off the lateral side of the clavicle, middle fibers come off the acromion,
and posterior fibers come off the spine of the scapula. all coming down and attaching to the
deltoid tuberosity of the humerus.
Anterior fibers give us: flexion of the glenohumeral joint, horizontal adduction, helps with
abduction, internal rotation
Middle fibers: mostly abduction, little bit of flexion
Posterior fibers: extension, horizontal abduction,
Bring her into abduction which should get all of them working, put her into a little bit of horizontal adduction, she is
already internally rotated, going toward a flexion plane. I can actually see the anterior deltoid. I want to put my hand
here and resist having her pull more into adduction. This little groove is called the deltopectoral interval- above that
interval is the deltoid, and below it is pectoralis major. It is actually a surgical entrance site because it is a natural interval
between muscles.
Deltoid tuberosity
Flexion/horizontal adduction,
slight internal rotation
Resist. Hold don’t let me
pull you.
Can see anterior deltoid.
deltopectoral interval
Sterna fibers of pec major
Clavicular fibers of pec major
Now we bring her out here like this into a pure abduction and I want to resist her on top.
The attachments of the deltoids are like a horseshoe. Bottom part of the horse shoe. Hard to distinguish them from the
rest of the fibers, but this is them.
Bottom of the horse shoe
(of deltoid attachments)
They go from the bottom of the
horse shoe to here.
Posterior- rotate her arm this way, into a little horizontal abduction. Hold, don’t let me pull. It comes off the spine of the
scapula.
Pectoralis Minor – scapular mover- depression, inward/downward rotation, protraction. We will activate it using its
depression job.
1st find the coracoids process. Then we come off the coracoids into the soft tissue below (inferior and a little bit towards
the middle) and then ask her to depress her scapula. Put her hands down to her side like this. Slide your hand down
towards your foot.
SERRATUS ANTERIOR - External rotation, outward rotator, powerful protractorPut your arm up like this. This is a cross palpation. Make a fist because it’s just more fun. Go up right into the armpit.
Right against her chest wall, so I feel ribs with the pads of my fingers. Move the lateral muscles out of the way.. you will
feel them on the back of your fingers (but I am not interested in that). Push your fist up toward the ceiling. I feel just a
little activity on my fingers… like an “ant fart”
Pectoralis MajorGlenohumeral movement.
Clavicular fibers- horizontal adduction, adduction, internal rotation, flexion
Sternal fibers- internal rotation, horizontal adduction, adduction, extension from a flexed position
1st I am going to activate the whole muscle. I am going to have her arm come out like this and have her come into a
horizontal adduction. She is going to bring her arm up like this. A little bit of resistance, I will try and push her back down
to the table. Hold, don’t let me push you.
Activating sterna head – push up
Clavicular head. Pushing down
resisting her going into horizontal
adduction.
If I want to make that more pronounced and activate one and not the other. I am going to have her straighten her
elbow. Put my hand here and say, hold don’t let me push you. I am going to push down, so she will be trying to flex to
activate the clavicular fibers.
Sternal- hold don’t let me push you. She will try and push down (from extended position).
Clavicular head
Sternal portion
If I find the spine of the scapula. Then, there is infraspinatus,
teres
minor, teres major, lattissimus dorsi in that order in the fan.
I know all of those muscles come off the scapula and come out to the arm. I
know that infraspinatus and teres minor attach (posterior) here:
And teres major and latissimus go around and attach anterior
That means that infraspinatus and teres minor (harder to feel the difference between)
are going to be EXTERNAL ROTATORS.
Teres Major and Latissiumus (can feel the difference between) will be INTERNAL
ROTATORS.
ACTIVATE MUSCLES: Bring her arm out to the side like this because it unfolds the fan
(spreads everything out).
Find the spine of the scapula and go immediately inferior to that and walk my way out towards the arm.
Find the spine of the scapula
Go inferior & walk my way
towards the arm
Back of the hand up
towards the ceiling
Infraspinatus & teres
minor
Now EXTERNAL ROTATION (infraspinatus & teres minor) I am going to ask her to take the back of her hand up towards
the ceiling. I may have to resist her a little bit (hold, don’t let me push you). See that bulge, which are infraspinatus and
teres minor. Now relax.
INTERNAL ROTATION (teres major and latissiums): I keep my fingers there and ask her to bring her palm to the ceiling.
Hold, don’t let me push.
Teres Major and Latissimus
Bring Palm of the hand to
the ceiling
Latissimus
Teres Major
TRAPS – elevate the scapula, retraction, outward rotation,
UpperMiddle- retraction or adduction of shoulder blade (C7 – 75 - acromion)
Lower – outward rotation, depression, little retraction (T6 – T12 – root of spine of scapula)
We can see all of them when we retract the shoulder blades.
Arms up like this.
Retract the shoulder
blades
Upper
Middle
lower
They like to elevate. So I will have her shrug her shoulders. Now you resist, hold. You can see the fibers right here.
Middles fibers- squeeze your shoulder blades together. Also shows this as she is lying on her stomach. Bring her arm out
to the side??
Can find Middle traps
sitting with shoulder
blades together
On stomach with arm out to
the side
Lower – on stomach. Arm is brought up above her head. Lateral border of the lower fiber.
Arm up and find lower traps
Lateral border of the lower
traps
Explaining what the lats do when
raising your arm.. why we can see
them this way.
Rhomboids: Palpated together. Covered by trapezius so need to relax trap by placing hand in small of back. Have pt. lift
hand off back (with resistance if needed) and the rhomboids push fingers out.