Shoulder Complex
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4 ArticulationsSternoclavicularAcromioclavicularGlenohumeralScapulothoracic
Osteology (sternum, scapula, humerus, clavicle, ribs)
CharacteristicsExtensive ROMRelative Instablity
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3 angles Inferior, superior, lateral
3 bordersMedial, superior, lateral
2 processesCoracoid, acromion
4 fossaSupraspinous, infraspinous, subscapular,
glenoid
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Spine of scapula Supraglenoid tubercle Infraglenoid tubercle
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Figure 14-3 Right scapula and right clavicle with surface markings.
14-2
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Head of humerusFaces medially and superiorly
Anatomic Neck 2 tubercles form bicipital groove Lesser tubercle
Subscapularis attachment Greater tubercle
Supraspinatus InfraspinatusTeres minor
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Figure 14-4 Right humerus with surface markings.
14-3
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Trapezius Levator scapulae Rhomboids major and minor Pectoralis minor Serratus Anterior Pectoralis major Latissimus dorsi Teres major Deltoid Rotator Cuff - SITS
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Overview Covers vast territory Wide variety of functions
Referral Area Neck, mastoid process, ear, temporal
region Angle of the mandible
Manual Therapy Petrissage Pincer compression
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Overview Common site for pain in the neck and
shoulders Raises scapula
Referral Area Locally, medial border of scapula Upper scapula to back of upper arm
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Overview Major source of upper back pain Associated with tight pectorals
Referral Area Medial border of scapula Superior angle of scapula
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Overview Anchors scapula to the chest Tightness can entrap the nerve causing
numbness in the arm Referral Area
Anterior shoulder, chest Arm and last three fingers
Caution! Major brachial nerves and blood vessels
pass through this area
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Overview Works with pectoral muscle Opposes the rhomboids
Referral Area Side of the chest, middle of ribcage Ulnar aspect of arm to last two fingers Inferior angle of the scapula
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Three Major Pectoralis Major Latissimus Dorsi (assisted by Teres MAJOR) Deltoids
360 degrees of movement Abduction / Adduction Flexion / Extension Horizontal Abduction / Horizontal Adduction Medial and Lateral Rotation Hyperextension Circumduction
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Overview Important for postural alignment Three sections
Referral Area Ipsilateral breast and chest Anterior shoulder Forearm, middle, and ring fingers
Manual Therapy Pincer compression Compression/Broadening
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Overview Large and powerful muscle Covers lower posterior torso
Referral Area Interior angle of the scapula, axilla, back
of the arm, last two fingers Manual Therapy
Pincer compression
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Overview Works with latissimus Assists in formation of the rear border of the
armpit Referral Area
Middle deltoid area Dorsal forearm
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Overview Three aspects cap the head of the
humerus Anterior and posterior are antagonists to
each other Referral Area
Locally over area of muscle
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“SITS”Superspinatus InfraspinatusTeres MinorSubscapularis
Frequent injury to athletes that throw balls
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Overview Stabilizer of the glenohumeral joint Initiates ABDUCTION of HumerusInitiates ABDUCTION of Humerus Subject to overuse problems
Referral Area Over the shoulder, middle deltoid Down the radial side of arm
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Overview Lateral rotator and stabilizer of the
glenohumeral joint Common trouble spot
Referral Area Medial border of the scapula, middle
and/or anterior deltoid Radial aspect of the arm in first two or
three fingers
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Overview SYNERGIST to infraspinatus
Referral Area Over the outer upper arm
Manual Therapy Stripping
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Overview Medial rotator of the shoulder Stabilizer of the glenohumeral joint “FROZEN SHOULDERFROZEN SHOULDER” usual
suspect Referral Area
Over the scapula, behind axilla Posterior arm into wrist
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Biceps brachii Brachialis Triceps brachii Anconeus Coracobrachialis
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Overview BI-two heads Crosses two joints Runs over humerus but has no
attachments to it
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Overview Prime flexor Prime flexor of the elbow DEEP to Biceps Brachii Biceps brachii must be moved massage
this muscle
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Overview Two of three heads cross only the
elbow joint Long head crosses both elbow Long head crosses both elbow
and shoulderand shoulder ANTAGONISTANTAGONIST to biceps brachii and
brachialis
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Overview Attaches to coracoid process of scapula DEEP to Biceps Brachii
Caution! In working in the axilla, take care to
maintain contact with the muscle and avoid the nerves and blood vessels that pass under the coracoid process into the arm
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Overview Powerful and efficient flexor of the elbow “Hammer”
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Overview Cover the POSTERIOR of the forearm “EL” and “FM” Stabilize the wrist during hand
movements Can be treated as a group
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Extensor Carpi Radialis Brevis Extensor Carpi Radialis Longus Extensor Carpi Ulnaris Extensor Digiti Minimi Extensor Digitorum Extensor Indicis Extensor Pollicis Brevis Extensor Pollicis Longus Abductor Pollicis Longus
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Overview Anterior forearm “EL” and “FM” Most tendons pass through the carpal tunnel Swollen tendons indicate carpal tunnel
syndrome Can be massaged as a group
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Flexor Retinaculum Palmaris Longus Flexor Carpi Radialis Flexor Carpi Ulnaris Flexor Digitorum Profundus Flexor Digitorum Superficialis Flexor Pollicis Longus
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Anterior**Anterior**
O- Transverse processes C3-C6
I – First Rib Middle
O – Transverse processes C2-C7I - First Rib
PosteriorO - Transverse processes C6-C7
I - Second Rib
AS A GROUPAS A GROUPO – Trans. Process. C2-C7I - Ribs 1 & 2A - (Bilateral) Neck Flexion / Rib Elevation
(Unilateral) Lateral Flexion Neck / Rotation Opposite Side
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