GAP - Topic 5 - Pectoral Girdle - Bones of Upper Limb PDF

Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle TOPIC #5 – BONES OF THE UPPER LIMB – THE PECTORAL GIRDLE Clinical Orientated Anatomy PECTORAL GIRDLE • • • Consists of the clavicle and scapula. The pectoral girdle is the set of bones that connect t...

Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle TOPIC #5 – BONES OF THE UPPER LIMB – THE PECTORAL GIRDLE Clinical Orientated Anatomy PECTORAL GIRDLE • • • Consists of the clavicle and scapula. The pectoral girdle is the set of bones that connect the upper limbs to the axial skeleton. Only the clavicle is directly attached to the axial skeleton. o This allows for the scapula to move freely. Sternoclavicular joint Acromioclavicular joint CLAVICLE ➢ ➢ ➢ ➢ ➢ Ossifies through intramembranous ossification It connects the axial skeleton and the upper limb Classified as a long bone The shaft of the clavicle is “S” shaped The lateral 1/3 is concave anteriorly (Acromial End) and articulates with the acromion of the scapula, known as the: o Acromioclavicular joint (ACJ) ➢ The medial 2/3 is convex anteriorly (Sternal End) and articulates with the manubrium of the sternum, known as the: o Sternoclavicular joint (SCJ) ▪ The Sternoclavicular joint is the only direct attachment the upper limb has to the trunk Page 1 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle BONEY LANDMARKS – CLAVICLE ➢ The inferior surface of the clavicle has from lateral to medial: o Trapezoid Line: Attachment for the trapezoid ligament (which is one of 2 ligaments that makes up the coracoclavicular ligament) o Conoid Tubercle: Attachment for the conoid ligament (which is 2nd ligament that make up the coracoclavicular ligament) o Subclavian Groove: Attachment for the subclavius muscle o Impression: For the costoclavicular ligament ➢ NOTE: The trapezoid ligament and the conoid ligament together form the CORACOCLAVICULAR LIGAMENT MEDIAL LATERAL CORACOCLAVICULAR LIGAMENTS Conoid Ligament Trapezoid Ligament Page 2 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle SCAPULA • • • Thin, triangular bone Lies at the level of ribs 2-7 Attachment sites for shoulder muscles BONEY LANDMARKS ➢ The Scapula has 3 borders: o Superior border - Extends laterally from the superior angle o Medial (vertebral) border – medial border of the scapula o Lateral (axillary) border – lateral border of the scapula ➢ The Scapula has 3 angles: o Superior angle - highest point in the scapula, buried under thick muscle o Inferior angle - lowest point of scapula, often sticks out o Lateral angle - Found superior to the lateral border and includes the Glenoid Fossa ➢ Posterior view landmarks: o Spine of the Scapula – It extends from the medial border and projects out laterally to a flattened end known as the acromion. o Acromion – The flattened lateral end of the scapula ▪ The acromial angle is the sharp change in direction between the spine of the scapula and the acromion. ➢ The spine of the scapula divides the posterior surface into 2 shallow depressions: o Supraspinous Fossa: Attachment for Supraspinatus muscle o Infraspinous Fossa: Attachment for Infraspinatus muscle ➢ Anterior view landmarks: o Subscapular Fossa – a large shallow depression, houses the subscapularis muscle origins o Coracoid Process - bony projection off of the anterior scapula (a tender palpation point in most people) ▪ Just medial to the coracoid process on the superior border of the scapula, there is a notch known as the Suprascapular Notch Page 3 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle ➢ Lateral view landmarks: o GLENOID FOSSA – found on the lateral border of the scapula (at the lateral angle) ▪ This is where the humerus articulates with the scapula (makes up the glenohumeral joint) ➢ The Glenoid Fossa has two tubercles: o Supraglenoid Tubercle: Found at the superior aspect of the glenoid fossa o Infraglenoid Tubercle: Located at the inferior aspect of the glenoid fossa Supraglenoid tubercle Superior angle Lateral angle Infraglenoid tubercle Inferior angle Subscapular Fossa Infraglenoid tubercle Page 4 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle PALPATIONS • The structures to be palpated in this lecture include: o Clavicle ▪ Sternal end ▪ Acromial end ▪ Inferior Surface ▪ Superior surface o Scapula ▪ Acromion ▪ Coracoid Process ▪ Spine of the Scapula ▪ Superior and Inferior Angles ▪ Lateral and Medial Borders ▪ Infraglenoid Tubercle ▪ Supraspinous Fossa, Infraspinous Fossa & Subscapular Fossa PALPATION OF CLAVICLE PATIENT POSITION NEUTRAL LANDMARK TRAIL STERNAL END OF THE CLAVICLE • Seated or Supine • Jugular notch • Moving from the jugular notch move laterally over the sternoclavicular joint. • Grasp the clavicle’s cylindrical body and explore its medial end. To access the inferior side, you may have to position the shoulder in 90 degrees of abduction and external rotation DESCRIPTION FUNCTION • Articulates with the manubrium to form the sternoclavicular joint • Costoclavicular ligament attachment • Sternoclavicular ligament attachment • Etc. Page 5 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle PATIENT POSITION NEUTRAL LANDMARK TRAIL ACROMIAL END OF THE CLAVICLE • Seated or Supine • Acromion • Move Medially from the acromion over the acromioclavicular joint. • Grasp the clavicle’s cylindrical body and explore its lateral end. • Notice that it curls posteriorly the acromial end DESCRIPTION FUNCTION • Upper fibers of Trapezuis attachment • Deltoid attachment • Acromioclavicular ligament • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated or Supine • Medial end of clavicle • From the medial end of the clavicle move superiorly and then laterally feeling the superior border of the clavicle. • Grasp the clavicle’s cylindrical body and explore its length from the medial to lateral • Notice that it curls posteriorly as you reach the acromial end SUPERIOR SURFACE OF THE CLAVICLE DESCRIPTION FUNCTION • Upper fibers of Trapezius attachment • Deltoid attachment • Etc. Page 6 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle PATIENT POSITION NEUTRAL LANDMARK TRAIL INFERIOR SURFACE OF THE CLAVICLE • Supine • Medial end of the clavicle • To access the inferior side, you may have to position the shoulder in 90 degrees of abduction and external rotation • From the medial end of the clavicle move laterally and inferiorly. • Grasp the clavicle’s cylindrical body and explore its length from manubrium to acromion. DESCRIPTION FUNCTION • Subclavius attachment • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated or Supine • Lateral End of the Clavicle • From the lateral end of the clavicle move laterally towards the AC joint • From here move laterally off clavicle over AC joint onto acromion • Explore flat surface of acromion, and sculpt around all of its sides PALPATION OF SCAPULA ACROMION DESCRIPTION FUNCTION • Upper fibers of Trapezius • Deltoid • Acromioclavicular ligament • Etc. Page 7 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle PATIENT POSITION NEUTRAL LANDMARK TRAIL CORACOID PROCESS • Seated • Lateral end of the clavicle • From the lateral end of the clavicle move inferiorly onto the coracoid process • Explore the coracoid process DESCRIPTION FUNCTION • Biceps brachii attachement • Coracoclavicular ligament attachment PATIENT POSITION NEUTRAL LANDMARK TRAIL • Prone • SP C7 • From the SP of C7 move inferiorly 2-3 vertebrae. • Move laterally to medial border of the scapula. • Explore medial border inferiorly (to the inferior angle) and superiorly (to the superior angle) MEDIAL BORDER OF THE SCAPULA DESCRIPTION FUNCTION • Rhomboid Major & Minor • Serratus Anterior • Etc. PATIENT POSITION NEUTRAL LANDMARK TRAIL • Seated or Prone • Acromion • From the acromion travel posteriorly then strum medially and locate the prominent ridge of bone travelling in an oblique-medial direction. • Palpate the spine’s width and edges as you explore along its entire length SPINE OF THE SCAPULA DESCRIPTION FUNCTION • Upper Fibres of Trapezius • Deltoid • Etc. Page 8 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle PATIENT POSITION NEUTRAL LANDMARK TRAIL INFERIOR ANGLE OF THE SCAPULA • Prone • Medial border of the scapula • From the medial border of the scapula strum inferiorly along the border. • At end of medial border, you will reach a change in angle. • This corner is known as the inferior angle. DESCRIPTION FUNCTION • Teres Major • Latissimus Dorsi PATIENT POSITION • Prone NEUTRAL LANDMARK • Medial border of the scapula TRAIL • From the medial border of the scapula strum superiorly along the border to its most superior part, curl fingers around the angle. • Push the scapula superiorly from the inferior angle/lateral border to feel the angle pop up into your hand. SUPERIOR ANGLE OF THE SCAPULA DESCRIPTION FUNCTION • Levator Scapulae PATIENT POSITION NEUTRAL LANDMARK TRAIL • Prone • Inferior Angle • From the inferior angle move laterally and superiorly along the border • Follow border towards the axilla. • If the musculature is too thick, curl underneath the tissue. LATERAL BORDER OF THE SCAPULA DESCRIPTION FUNCTION • Teres Minor Page 9 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle PATIENT POSITION NEUTRAL LANDMARK TRAIL INFRAGLENOID TUBERCLE • Prone • Lateral border of the Scapula • Follow the lateral border superiorly and laterally towards the axilla. • You've reached the tubercle once you feel a change in direction of the bone. DESCRIPTION FUNCTION • Triceps Brachii PATIENT POSITION NEUTRAL LANDMARK TRAIL • Prone or Seated • Spine of the Scapula • From the spine of the scapula, move medial and outline the medial border following it inferiorly to the angle then superiorly again along the lateral border • You have now outlined the infraspinous fossa • Take a moment to palpate the area you just outlined INFRASPINOUS FOSSA DESCRIPTION SUPRASPINOUS FOSSA FUNCTION • Infraspinatus PATIENT POSITION NEUTRAL LANDMARK TRAIL • Prone or Seated • Spine of the Scapula • From the spine of the scapula, move superiorly and curl fingers deep in the concave area of bone DESCRIPTION FUNCTION • Supraspinatus Page 10 of 11 Canadian College of Massage & Hydrotherapy GAP – Topic #5 Bones of the Upper Limb – Pectoral Girdle PATIENT POSITION NEUTRAL LANDMARK TRAIL SUBSCAPULAR FOSSA • Sidelying • SP C7 • Cradle patient arm in a “chicken wing” position, moving inferolateral to the medial border, curl fingers onto the anterior surface of the scapula. • Change hand contact to explore the lateral aspect of the fossa, have patients arm supported in abduction, place thumbs in the area of the axilla and sink in. Pad of your thumb should be facing posteriorly (away from ribs) draw arm anteriorly which brings the scapula into your contact DESCRIPTION FUNCTION • Subscapularis Page 11 of 11