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.