Anatomy
Action of the Teres Major
extension, ADD, & IR of the arm
O: dorsal surface scap near inf. angle
I: medial lip intertubercular groove
A: Ext, ADD, IR ("the little lat")
N: Lower Subscapular N.
Innervation of the deltoid.
Axillary N.
distal 1/3 at the contour change in bone
MOI & Key SS for biceps tendonitis
often chronic due to weak RC or GH joint instability; key SS = pain in late cocking and deceleration phases of throwing
What injury presents with holding the arm like a sling and chin pointed to affected side?
clavicle Fx (chin pointed to affected side decreases tension of SCM on clavicle)
ALL Fibers - ADD & IR
UPPER Fibers - flex & horiz. ADD
LOWER Fibers - EXT
Origin of the SCM
Clavicular Head - medial 1/3 clavicle
Define a 3rd° AC Joint Sprain
complete tear of the AC & CC ligaments
What does a (+) O'Brien's Test indicate?
SLAP tear
What motions will a patient with an SC joint sprain have pain with?
protraction (forward rolling of shoulders) and horizontal ADD - both cause compression of joint
Name all the muscles that attach to the coracoid process.
Coracobrachialis, Pec Minor, Biceps Brachii Short Head
Origins of Rhomboid Major & Minor
Rhomboid Major - spinous processes T2-T5
detachment of glenoid labrum and capsule from anterior glenoid rim (tear of anterior superior labrum)
Describe a Type IV SLAP lesion.
bucket-handle tear of superior labrum that extends into biceps
occurs secondary to GH joint instability and pt will have a painful arc 60°-120° of ABD and flexion
Action of the coracobrachialis.
Flex & ADD Shoulder
deltoid (origin) and traps (insertion)
What is a Hill Sachs lesion?
compression Fx of the posterior aspect of articular surface of humeral head (commonly occurs secondary to anterior GH Dx)
flattened deltoid appearance, arm slightly ABD & supported
Causes of primary impingement syndrome include...
weak RC (esp. weak supraspinatus = decreased ability to depress humeral head during ABD), inflamed RC or subacromial bursitis
Name all the muscles that attach to the scapula.
supraspinatus, infraspinatus, teres minor, subscapularis, teres major, rhomboid major, rhomboid minor, pec major, pec minor, short head of biceps, triceps, latissimus dorsi, traps, deltoid, levator scapulae, serratus anterior, SCM, coracobrachialis
Origin of the triceps.
Long Head - infraglenoid tubercle of the scap
Lat. Head - post. surface proximal 1/2 humerus
Med. Head - post. surface distal 1/2 humerus
Name all of the injuries associated with the throwing shoulder.
GIRD, Sx/Dx, impingement syndrome, RC injury, SLAP tears, biceps tendonitis
Name all of the adaptive changes in a throwing shoulder.
anterior capsule stretch & posterior capsule tightness, bony architecture changes, muscle hypertrophy, throwing shoulder sits lower, changes in posterior arc, multidirectional instability
Injuries related to the biceps tendon include...
weak RC, GH joint instability, impingement syndrome, SLAP lesion