Levator scapulae & Rhonboid

1. Levator scapulae

2. Rhomboid minor

3. Rhomboid major

Teres major

A : Internal rotation, adduction,

retroversion

O : Lateral side of inferior angle

and lower half of lateral border

of the scapula

I : Crest of the lesser tubercle of

the humerus

N : Thoracodorsal nerve (C4-6)

Teres major Prone with the arm off the side

of the table

Locate and grasp the latissimus between your fingers and thumb

Move your fingers and thumb medially to where you feel the scapula’s lat. border. → T. major

Ask pt. to rotate shoulder medially

distinguish TM from LD

Test for teres major

• Patient:Patient: Sitting or prone

• Test:Test: Extension and adduction

of the humerus in the medially

rotated position, with the hand

resting on the posterior iliac

crest

• Pressure:Pressure: Against the arm,

above the elbow, in the

direction of abduction and

flexion

Rhomboid

ActionAdduct, elevate and downwardly rotate the scapula

Origin Major – SP of T2-T5 Minor – SP of C7-T`

InsertionMajor – Medial border of the scapula b/w spine of scapula

and inferior angleMinor – Upper portion of medial border of scapular

InnervationDorsal scapular nerve (C4-5)

Rhomboids

Prone

Locate the scapula’s medial border and the spinous process of C7 through T5

Palpating through thin trapezius

Test for rhomboid• Patient:Patient: Prone

• Test:Test: Adduction and elevation of scapula, with a downward rotation (medial rotation of the inferior angle). The position of the scapula is obtained by placing the shoulder in 90° abduction and in sufficient medial rotation to move the scapula into the test position. The palm of the hand faces in a caudal direction

• Pressure:Pressure: Against the forearm, in a downward direction toward the table.

Levator scapulae

Action Unilaterally – Elevate and downwardly rotate scapula,

laterally flex the head and neck, rotate the head and neck to the same side

Bilaterally – Extend the head and neck

Origin TP of 1st through 4th cervical vertebrae

Insertion Upper region of medial border and superior angle of

scapula

Innervation Dorsal scapula and cervical nerves

Levator scapula Prone, supine or sidelying

Palpating through the trapezius, locate the sup. angle of the scapula and the upper region of the medial border

Place your finger just off the sup. angle firmly strum across the belly of levator

Follow superiorly

Levator scapula

Prone, supine or sidelying

Locate the upper fibers of trapezius

Roll two fingers anterioirly off the trapezius

Gently strum fingers anteriorly and posteriorly

Serratus anterior

1. Superior part

2. Intermediate part

3. Inferoir part

Serratus anterior

Action With the origin fixed: abduct and depress

the scapula, hold the medial border of scapula

If scapula is fixed: may act in forced inhalation

Origin Surfaces of upper eight or nine ribs

Insertion Anterior surface of medial border of the

scapula

Innervation Long thoracic nerve (C5-7)

Serratus anterior Supine

Isolate the location of the serratus by abducting the arm slightly and locating the lower edge of pectoralis major

Locate the ant. border of latissimus

Place fingerpads along the side of the ribs between PM and LD

Strum across the ribs and palpate for serratus fibers.

Test for serratus anterior (1)

Test for serratus anterior (1)

• Patient:Patient: Sitting

• Test:Test: The ability of the serratus to stabilize the scapula in a position of abduction and lateral rotation, with the arm in a position of approximately 120° to 130° of flexion.

• Pressure:Pressure: Against the dorsal surface of the arm, between the shoulder and elbow, downward in the direction of extension, and slight pressure against the lateral border of the scapula, in the direction of rotating the inferior angle medially.

Test for serratus anterior (2)

Test for serratus anterior (2)

• Patient:Patient: Standing

• Test movement:Test movement: Facing a wall and with the elbows straight, the subject places both hands against the wall, either at shoulder level or slight above. To begin, the thorax is allowed to sag forward so that the scapulae are in a position of some adduction. The subject then pushes hard against the wall, displacing the thorax backward, until the scapulae are in a position of abduction.

• Resistance:Resistance: The thorax acts as resistance in this test