4 ArticulationsSternoclavicularAcromioclavicularGlenohumeralScapulothoracic

Osteology (sternum, scapula, humerus, clavicle, ribs)

CharacteristicsExtensive ROMRelative Instablity

3 angles Inferior, superior, lateral

3 bordersMedial, superior, lateral

2 processesCoracoid, acromion

4 fossaSupraspinous, infraspinous, subscapular,

glenoid

Spine of scapula Supraglenoid tubercle Infraglenoid tubercle

Figure 14-3 Right scapula and right clavicle with surface markings.

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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.

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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

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

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

Overview Major source of upper back pain Associated with tight pectorals

Referral Area Medial border of scapula Superior angle of scapula

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

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

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

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

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

Overview Works with latissimus Assists in formation of the rear border of the

armpit Referral Area

Middle deltoid area Dorsal forearm

Overview Three aspects cap the head of the

humerus Anterior and posterior are antagonists to

each other Referral Area

Locally over area of muscle

“SITS”Superspinatus InfraspinatusTeres MinorSubscapularis

Frequent injury to athletes that throw balls

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

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

Overview SYNERGIST to infraspinatus

Referral Area Over the outer upper arm

Manual Therapy Stripping

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

Biceps brachii Brachialis Triceps brachii Anconeus Coracobrachialis

Overview BI-two heads Crosses two joints Runs over humerus but has no

attachments to it

Overview Prime flexor Prime flexor of the elbow DEEP to Biceps Brachii Biceps brachii must be moved massage

this muscle

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

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

Overview Powerful and efficient flexor of the elbow “Hammer”

Overview Cover the POSTERIOR of the forearm “EL” and “FM” Stabilize the wrist during hand

movements Can be treated as a group

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

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

Flexor Retinaculum Palmaris Longus Flexor Carpi Radialis Flexor Carpi Ulnaris Flexor Digitorum Profundus Flexor Digitorum Superficialis Flexor Pollicis Longus

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