1. Shoulder Evaluations Supplemental Material for Chapter 10 – Shoulder Injuries

2. MM Acting on Scapula • Latissimus dorsi

3. Action: Depression of shoulder girdle Origin: Spinous processes of T6 – T12 and lumbar vertebrae via lumbodorsal fascia Insertion: Bicipital groove of the humerus Latissimus dorsi

4. MM Acting on Scapula • Latissimus dorsi • Rhomboid major

5. Action: Scapular retraction Scapular elevation Downward rotation of the scapula Origin: Spinous processes of T2, T3, T4 and T5 Insertion: Vertebral border of scapula (lower two thirds) Rhomboid major

6. MM Acting on Scapula • Latissimus dorsi • Rhomboid major • Rhomboid minor

7. Action: Scapular retraction Scapular elevation Origin: Inferior portion of the ligamentum nuchae Spinous processes C7 and T1 Insertion: Vertebral border of scapula (near the medial border of the scapular spine) Rhomboid minor

8. MM Acting on Scapula • Latissimus dorsi • Rhomboid major • Rhomboid minor • Serratus anterior

9. Action: Upward rotation Protraction Depression (lower fibers) Elevation (upper fibers) Fixation of the scapula to the thorax Origin: Anterior portion of 1st through 8th or 9th ribs Aponeuroses of the intercostal MM Insertion: Costal surfaces of the: Superior angle of scapula Vertebral border of scapula Inferior angle of scapula Serratus anterior

10. Action: Upward rotation Protraction Depression (lower fibers) Elevation (upper fibers) Fixation of the scapula to the thorax Origin: Anterior portion of 1st through 8th or 9th ribs Aponeuroses of the intercostal MM Insertion: Costal surfaces of the: Superior angle of scapula Vertebral border of scapula Inferior angle of scapula Serratus anterior

11. Action: Upward rotation Protraction Depression (lower fibers) Elevation (upper fibers) Fixation of the scapula to the thorax Origin: Anterior portion of 1st through 8th or 9th ribs Aponeuroses of the intercostal MM Insertion: Costal surfaces of the: Superior angle of scapula Vertebral border of scapula Inferior angle of scapula Serratus anterior

12. MM Acting on Scapula • Latissimus dorsi • Rhomboid major • Rhomboid minor • Serratus anterior • Trapezius

13. Action: Elevation of scapula Upward rotation of scapula Rotation of C-spine to the opposite side Extension of C-spine Origin: Occipital protuberance Superior nuchal line of the occipital bone Upper portion of the ligamentum nuchae Spinous process of C7 Insertion: Distal/lateral one third of clavicle Acromion process Scapular spine Trapezius: upper part

14. Action: Retraction of scapula Fixation of thoracic spine Origin: Lower potion of the ligamentum nuchae Spinous processes of 7th cervical vertebra and T1 through T5 Insertion: Acromion process Spine of the scapula (superior, lateral border) Trapezius: middle part

15. Action: Depression of scapula Retraction of scapula Fixation of thoracic spine Origin: Spinous processes and supraspinal ligaments of T8 T12 Insertion: Spine of the scapula (medial portion) Trapezius: lower part

16. MM Acting on Scapula • Latissimus dorsi • Rhomboid major • Rhomboid minor • Serratus anterior • Trapezius • Pectoralis major

17. Action: Depression of the shoulder girdle Origin: Medial one-half of clavicle Insertion: Greater tuberosity of the humerus – lateral lip of the bicipital groove Pectoralis major: clavicular head

18. Action: ADD of the arm at the shoulder IR of the arm at the shoulder Ext of the arm at the shoulder Origin: Anterolateral portion of the sternum Insertion: Greater tuberosity of the humerus – lateral lip of the bicipital groove Pectoralis major: sternal head

19. MM Acting on scapula • Latissimus dorsi • Rhomboid major • Rhomboid minor • Serratus anterior • Trapezius • Pectoralis major • Pectoralis minor

20. Action: Forward (anterior) lifting Origin: Costal cartilages of ribs 6 through 7 Anterior potion of 3rd through 5th ribs Insertion: Coracoid process of scapula Pectoralis minor

21. MM acting on the Humerus • Biceps Brachii

22. Action: Flex ABD Origin: Long head: Supraglenoid tuberosity of scapula Short head: Coracoid process of scapula Insertion: Radial tuberosity and aponeurosis Biceps brachii

23. Action: Flex ABD Origin: Long head: Supraglenoid tuberosity of scapula Short head: Coracoid process of scapula Insertion: Radial tuberosity and aponeurosis Biceps brachii

24. MM acting on the Humerus • Biceps Brachii • Corocobrachialis

25. Action: Flex ADD Origin: Coracoid process Insertion: Medial shaft of the humerus, adjacent to the deltoid tuberosity coracobrachialis

26. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid

27. Action: Flex ABD Horz ADD IR Origin: Lateral one third of the clavicle Insertion: Deltoid tuberosity Deltoid: anterior part

28. Action: ABD Flex Origin: Acromion process Insertion: Deltoid tuberosity Deltoid: Middle part

29. Action: Ext Horz ABD ABD ER Origin: Spine of scapula Insertion: Deltoid tuberosity Deltoid: posterior part

30. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus

31. Action: ER Horz ABD Humeral head stabilization Origin: Infraspinous fossa of the scapula Insertion: Lateral portion of the greater tuberosity of the humerus GH joint capsule Infraspinatus

32. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus • Latissimusdorsi

33. Action: EXT IR ADD Origin: Spinous processes of T6 through T12 and the lumbar vertebrae via the lumbodorsal fascia Posterior iliac crest Insertion: Floor of the bicipital groove of the humerus. Latissimus dorsi

34. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus • Latissimusdorsi • Pectoralis major

35. Action: ADD Horz ADD Flex(clavicular segment) IR Origin: Medial one-half of the clavicle Anterolateral portion of the sternum Costal cartilages of ribs 6 through7 Insertion: Greater tuberosity of the humerus Pectoralis major

36. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus • Latissimusdorsi • Pectoralis major • Subscapularis

37. Action: IR Humeral head stabilization Origin: Anterior surface (subscapular fossa) and axillary border of the scapula Insertion: Lesser tuberosity of the humerus Ventral portion of the GH capsule Subscapularis

38. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus • Latissimusdorsi • Pectoralis major • Subscapularis • Supraspinatus

39. Action: IR Humeral head stabilization Origin: Supraspinousfossa (medial two thirs) of the scapula Insertion: Medial aspect of the greater tuberosity GH joint capsule Supraspinatus

40. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus • Latissimusdorsi • Pectoralis major • Subscapularis • Supraspinatus • Teres major

41. Action: Ext IT ADD Origin: Inferior angle of scapula Lower one third of the axillary border of the scapula Insertion: Medial lip of the bicipital groove Teres major

42. Action: Ext IT ADD Origin: Inferior angle of scapula Lower one third of the axillary border of the scapula Insertion: Medial lip of the bicipital groove Teres Major

43. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus • Latissimusdorsi • Pectoralis major • Subscapularis • Supraspinatus • Teres major • Teres minor

44. Action: ER Horz ABD Origin: Lateral upper two thirds of axillary border of the scapula Insertion: Lateral aspect of the greater tuberosity Teres Minor

45. MM acting on the Humerus • Biceps Brachii • Corocobrachialis • Deltoid • Infraspinatus • Latissimus dorsi • Pectoralis major • Subscapularis • Supraspinatus • Teres major • Teres minor • Triceps brachii

46. Action: EXT ADD Origin: Infraglenoid tuberosity of scapula Insertion: Olecranon process of ulna Triceps brachii: long head

47. Action: ADD Origin: Lateral and posterior surface of the proximal ½ of the humerus Insertion Olecranon process of ulna Triceps brachii: Lateral Head

48. Action: ADD Origin: Lateral and posterior surface of the proximal ½ of the humerus Insertion Olecranon process of ulna Triceps brachii: Lateral Head

49. Action: ADD Origin: Distal 2/3 of medial and posterior humerus Insertion: Olecranon process of ulna Triceps brachii: Medial Head

50. Evaluating the shoulder • (See Evaluation Map) • Hx – • Determine the mechanism of injury and onset of the symptoms, and question the patient about any associated sounds or sensations at the time of the injury. • Ascertain any relevant history of prior injury to the involved and uninvolved sides. • The history continues throughout the evaluation based on the subsequent findings. • What are possible questions that we might ask? • Where is location of pain? • When was the onset of pain? • What activity causes the pain? • What was the MOI? • What are the symptoms of the injury? • Does patient have prior injury to this shoulder?