Shoulder Palpation and Treatment Procedures Quiz

Palpation and Treatment Procedures for Anterior Shoulder Structures

• The trapezius muscle is composed of three groups: upper, middle, and lower fibers, and is frequently affected by lesions due to its role in shoulder and cervical spine movement.

• Palpation of the upper fibers of the trapezius involves strumming from the clavicle to the occiput, while maintaining pressure on any identified tender points during treatment.

• The subclavius muscle stabilizes the sternoclavicular joint and assists in respiration, and can be difficult to palpate due to its location under the pectoralis major muscle.

• Palpation of the subclavius involves curling fingers under the clavicle and strumming up and down its length to identify tender points for treatment.

• The acromioclavicular (AC) joint is the articulation between the acromion of the scapula and the acromial end of the clavicle, and can be a site of irritation in the presence of rotator cuff weakness.

• Palpation of the AC joint involves tracing the clavicle to its lateral tip and exploring the joint from anterior to posterior to identify tender points for treatment.

• The deltoid muscle is composed of three fiber groups: anterior, middle, and posterior, and is responsible for shoulder abduction and serving as a force couple to the rotator cuff muscles.

• Palpation of the deltoid involves demarcating the fiber groups with firm pressure and exploring their proximal insertions to their common distal insertion at the deltoid tuberosity.

• Treatment procedures for the upper fibers of the trapezius, subclavius, and anterior aspect of the AC joint involve positioning the patient and applying pressure and manipulation to the affected area to elicit a fasciculatory response and promote tissue relaxation.

• Treatment procedures for the deltoid involve manipulating the patient's arm into different positions and applying pressure and manipulation to the affected area to elicit a fasciculatory response and promote tissue relaxation.

• Patient self-treatment procedures for the upper fibers of the trapezius and deltoid involve lying supine in a comfortable position and supporting the affected arm while monitoring the tissue for fasciculatory response.

• Lesions of the long head tendon of the biceps brachii are often present in conjunction with other shoulder conditions and can be easily located at the anterior crease of the shoulder.Palpation and Treatment Procedures for Anterior Shoulder Structures

• The biceps brachii (long head) originates from the supraglenoid tubercle and inserts at the radial tuberosity and bicipital aponeurosis.

• The biceps brachii (short head) originates from the coracoid process and inserts at the radial tuberosity and bicipital aponeurosis.

• The biceps brachii, along with the brachioradialis and brachialis, facilitate elbow flexion and supination and stabilize the humeral head in the glenoid fossa with deltoid contraction.

• The pronator teres, located anteriorly, facilitates pronation and is innervated by the C5-C6 musculocutaneous nerve.

• The subscapularis is the largest rotator cuff muscle and medially rotates the arm, with an origin at the scapular fossa and insertion at the lesser tubercle of the humerus and glenohumeral joint capsule.

• The serratus anterior, located between the pectoralis major and latissimus dorsi, facilitates scapular protraction and upward rotation.

• The pectoralis minor lies underneath the pectoralis major and facilitates scapular protraction and rib elevation during forced inspiration.

• Lesions of the pectoralis minor can result in neurovascular compression and the development of thoracic outlet syndrome.

• Palpation of the biceps brachii (long head) involves locating the intertubercular groove of the humerus and resisting elbow flexion with supination.

• Palpation of the biceps brachii (short head) involves locating the coracoid process and strumming lightly over the tendon.

• Palpation of the subscapularis involves flexing the shoulder to 70-90° and exploring the inferior lateral margin of the scapula while the patient internally rotates the arm.

• Palpation of the serratus anterior involves placing fingers within the axillary region on the rib cage and strumming across the fibers while the patient punches the arm toward the ceiling against resistance.Palpation and Positional Release Therapy for the Shoulder

• Patients with a large amount of breast tissue can be positioned in a side-lying position to move the tissue and the pectoralis major off the anterior chest wall during palpation.

• Palpation of the pectoralis major should be done around the breast tissue, not directly through it.

• The supraspinatus and infraspinatus are two of the four rotator cuff muscles and can be palpated individually.

• The supraspinatus muscle traverses under the acromion as a tendon to insert on the greater tubercle of the humerus.

• The infraspinatus muscle does not traverse under the acromion and crosses over the lateral border of the scapular spine to attach to the humerus.

• The teres minor muscle is located along the upper lateral edge of the scapula.

• Palpation procedures for each muscle involve strumming or grasping the muscle fibers and noting any tender points or fasciculatory responses.

• In the supine position, patients can be positioned with the arm slightly flexed or abducted to facilitate palpation of the supraspinatus and infraspinatus.

• During palpation, patients can be instructed to abduct or externally rotate the humerus to accentuate the muscle.

• Positional Release Therapy (PRT) involves applying humeral distraction, internal rotation, or external rotation to the shoulder while maintaining pressure on the tender point.

• PRT can be used to treat the pectoralis major, subclavius, AC joint, pectoralis minor, sternalis, sternocostal joint, serratus anterior, and corollary tissues.

• For the infraspinatus, the PRT clinician procedure involves applying external rotation, humeral distraction or compression, and an inferior glide to the humerus.Palpation and Treatment Procedures for Posterior Shoulder Structures in Positional Release Therapy

• Positional Release Therapy (PRT) is a technique used to treat musculoskeletal pain and dysfunction.

• The teres minor and teres major muscles are two distinct muscles in the posterior shoulder region.

• During palpation of the teres minor and teres major, external rotation of the arm helps to differentiate between the two muscles.

• The teres major is not considered a rotator cuff muscle and functions as a synergist with the latissimus dorsi.

• The latissimus dorsi is one of the broadest muscles in the body and produces the wing-like appearance of the back during bodybuilding poses.

• The posterior acromioclavicular joint is often a site of irritation in the presence of rotator cuff tear and weakness.

• The lower fibers of the trapezius course upward laterally from the thoracic vertebrae to the spine of the scapula.

• The rhomboid minor is located just above its neighbor, the rhomboid major, and lesions of these tissues are present in most people with poor postural control.

• PRT clinician procedures for each muscle involve supporting the arm and applying marked rotation or distraction with the far hand.

• Corollary tissues treated during PRT include the infraspinatus, supraspinatus, subscapularis, posterior deltoid, latissimus dorsi, serratus posterior, thoracic erector spinae, and rhomboid major.

• Patient self-treatment for posterior shoulder structures involves lying prone with a pillow under the anterior aspect of the shoulder to encourage scapular retraction or adduction.

• PRT is a non-invasive, safe, and effective technique for treating musculoskeletal pain and dysfunction in the posterior shoulder region.

Test your knowledge on the palpation and treatment procedures for anterior and posterior shoulder structures with this informative quiz. Learn about the different muscles involved in shoulder movement and their functions, as well as techniques such as Positional Release Therapy (PRT) for treating musculoskeletal pain and dysfunction. This quiz will help you understand how to identify tender points and fasciculatory responses during palpation, and how to apply pressure and manipulation to affected areas for tissue relaxation. Improve your understanding of shoulder anatomy and enhance your