T1 Anatomy Lab 2024 Course Notes PDF

T1 ANATOMY LAB Note Package Testing Information All the information that is testable in this course can be found in the Trial Guide and this note package. Your marks will be based on quizzes, oral-practical exams (one midterm, one final) and a final written test. You can find all the muscles, their...

T1 ANATOMY LAB Note Package Testing Information All the information that is testable in this course can be found in the Trial Guide and this note package. Your marks will be based on quizzes, oral-practical exams (one midterm, one final) and a final written test. You can find all the muscles, their origin and insertions, palpation guide as well as the landmarks to be used in the Trail Guide. All the muscles can be palpated in a variety of ways, and in a variety of positions, following different paths. Any version will be accepted as long as they are anatomically correct, and accurate. For example, the teacher may show a variation from the trail guide. You can use whichever option you prefer and find it easiest. Quiz Dates: 1. _____________________ Midterm OP: 2. _____________________ 3. _____________________ Final Written Exam and OP Date: ___________________________ __________________________ ANATOMY LAB - LOWER AND UPPER LIMB MUSCLES O/P expectations: 1. 2. 3. 4. Consent - What you will be doing? Fibre direction. Describe the proximal and distal landmarks and palpate for the muscle. Demonstrate the action of the muscle on yourself and describe the joint it crosses, the axis and its relationship. 5. Name two neighbouring structures to the muscle (not attachments). 6. Palpate the entire length of the muscle where possible. 7. Confirm you are on the muscle by contracting the muscle with palpation and with reciprocal inhibition or active insufficiency (if applicable) to relax with palpation LOWER LIMB TIBIALIS ANTERIOR pg 379 Fibre Direction Vertical Proximal Attachment Proximal anterolateral 1/2 of tibia + interosseous membrane Distal Attachment Base of 1st MT + medial cuneiform Joint/Axis/Relationship/Action 1. Talocrural/M-L/anterior/dorsiflexion 2. Subtalar/A-P/medial/inversion Palpation Notes Sitting / Supine From the shaft of the tibia move laterally to find the muscle belly at the proximal portion. The tendon disappears next to the medial cuneiform just distal to the navicular tuberosity and wraps under to 1st MT. Neighbouring Structures eg. Fibula, Extensor digitorum longus, Fibularis longus (completes the ‘stirrup’ of foot with the same distal attachments) Confirmation Reciprocal inhibition: Gastrocnemius and Soleus, (plantar flexion) Additional action: inversion EXTENSOR DIGITORUM LONGUS pg 380 Fibre Direction Vertical Proximal Attachment Proximal anterior ¾ of fibula + interosseous membrane Distal Attachment Middle and distal phalanges; 2nd-5th toes Joint/Axis/Relationship/Action 1. MTPs, PIPs + DIPs/M-L/superior/extension of toes 2-5 2. Talocrural/M-L/anterior/dorsiflexion Palpation Notes Sitting / Supine To find EDL tendons, get Px to extend toes with or without dorsiflexion then follow down the tendon where it splits into 4 tendons to the toes (2-5). Neighbouring Structures eg. Tibialis anterior, Fibularis longus, Fibularis brevis Confirmation Reciprocal inhibition: Flexor digitorum longus (toe flexion) FIBULARIS LONGUS pg 376 Fibre Direction Vertical Proximal Attachment Proximal lateral ⅔ of fibula Distal Attachment Base of 1st MT + medial cuneiform Joint/Axis/Relationship/Action 1. Subtalar/A-P axis/lateral/eversion 2. Talocrural/M-L axis/posterior/plantar flexion Palpation Notes Sitting / Supine/ Side lying From the tibial tuberosity, move laterally to the fibular head and ask Px to evert the foot for muscle to pop up. Muscle belly is on the proximal lateral aspect of the Fibula. At around halfway point, there's an indentation in the leg where it becomes more tendinous and lays on top of Fibularis brevis. As you follow the tendon distally it moves behind lateral malleolus with the tendon of Fibularis brevis. Can’t feel the attachment point as it's deep to the sole of the foot but follow it to the base of 1st MT for demonstration. Neighbouring Structures eg. Tibia, lateral malleolus, Fibularis brevis, Tibialis anterior (completes the ‘stirrup’ of foot with the same distal attachments) Confirmation Reciprocal inhibition: Tibialis anterior (inversion) Additional action: plantar flexion FIBULARIS BREVIS pg 376 Fibre Direction Vertical Proximal Attachment Distal lateral ⅔ of fibula Distal Attachment Tuberosity of 5th MT Joint/Axis/Relationship/Action Palpation Notes 1. Subtalar/A-P/lateral/eversion 2. Talocrural/M-L/posterior/plantar flexion Sitting/ Supine/ Side lying Locate Fibularis longus first and have Px evert the foot to make muscle pop up. The Fibularis brevis belly is just inferior to the Fibularis longus muscle belly. There is a slight divot in between the two muscles. Feel the tendon go behind the lateral malleolus and attach to the tuberosity of the 5th MT. Neighbouring Structures eg. Tibia, Lateral malleolus, Fibularis longus Confirmation Reciprocal inhibition: Tibialis anterior (inversion) GASTROCNEMIUS pg 371 Fibre Direction Vertical Proximal Attachment Posterior surface of the medial and lateral femoral condyles Distal Attachment Calcaneus via achilles tendon Joint/Axis/Relationship/Action 1. Talocrural/M-L/posterior/plantar flexion 2. Tibiofemoral/M-L/posterior/knee flexion Palpation Notes Standing/ Prone Passively extend the knee or stand on toes and palpate for the tendons near femoral condyles. With knee extension, have the Px resist plantar flexion to confirm location on condyles. Try to outline both heads by Px plantar flexing and resisting against your hand to make them pop up more. Medial head is typically longer and drops inferior to the lateral head. Follow the achilles tendon to calcaneus. Neighbouring Structures eg. Soleus, Malleoli Confirmation Reciprocal inhibition: Tibialis anterior (dorsiflexion) Addition action: Knee flexion SOLEUS pg 371 Fibre Direction Vertical Proximal Attachment Soleal line of tibia, proximal posterior fibula (including head) Distal Attachment Calcaneus via achilles tendon Joint/Axis/Relationship/Action 1. Talocrural/M-L/posterior/plantar flexion Palpation Notes Prone/ Standing Have Px resist plantar flexion against your hand or stand on their toes. Bend knee (active insufficiency of gastrocs) to isolate Soleus. Feel the muscle belly deep and lateral to the Gastrocnemius heads running along the distal leg to the achilles tendon. Neighbouring Structures eg. Gastrocnemius, plantaris (shares distal attachment), malleoli Confirmation Reciprocal inhibition: Tibialis anterior (dorsiflexion) Active insufficiency: knee flexion (gastrocnemius actively insufficient) PSOAS pg 332 Fibre Direction Vertical Proximal Attachment Lateral bodies and TVP’s of the lumbar vertebrae Distal Attachment Lesser trochanter Joint/Axis/Relationship/Action 1. Coxofemoral/M-L/anterior/hip flexion Palpation Notes Supine/ Supine Locate ASIS and belly button and imagine a line between them. Palpate gently into this line and ask Px to flex hip gently to confirm that you are on Psoas major. Neighbouring Structures eg. Iliacus (works together as iliopsoas), Inguinal ligament, Pubic symphysis Confirmation Reciprocal inhibition: Gluteus maximus (hip extension) ILIACUS pg 332 Fibre Direction Vertical Proximal Attachment Iliac fossa Distal Attachment Lesser trochanter Joint/Axis/Relationship/Action 1. Coxofemoral/M-L/anterior/hip flexion Palpation Notes Supine/ Side lying Position with hip in partial flexion and locate iliac crest. Sink into the iliac fossa and anterior hip to locate. Neighbouring Structures eg. Psoas major, Rectus femoris, Sartorius Confirmation Reciprocal inhibition: Gluteus maximus (hip extension) VASTUS LATERALIS pg 306 Fibre Direction Vertical Proximal Attachment Lateral lip of linea aspera Distal Attachment Tibial tuberosity Joint/Axis/Relationship/Action 1. Tibiofemoral/M-L/anterior/knee extension Palpation Notes Supine Locate tibial tuberosity and follow the tendon to the patella and then superiorly and lateral to rectus femoris. Neighbouring Structures eg. IT band, Rectus femoris Biceps femoris Confirmation VASTUS MEDIALIS Reciprocal inhibition: Hamstrings (knee flexion) pg 306 Fibre Direction Vertical Proximal Attachment Medial lip of linea aspera Distal Attachment Tibial tuberosity Joint/Axis/Relationship/Action 1. Tibiofemoral/M-L/anterior/knee extension Palpation Notes Supine Locate tibial tuberosity and follow the tendon to the patella and then superiorly, the muscle belly is most palpable at the distal medial thigh. Neighbouring Structures eg. Adductor magnus, Rectus femoris Confirmation Reciprocal inhibition: Hamstrings (knee flexion) RECTUS FEMORIS pg 306 Fibre Direction Vertical Proximal Attachment AIIS Distal Attachment Tibial tuberosity Joint/Axis/Relationship/Action 1. Tibiofemoral/M-L/anterior/knee extension 2. Coxofemoral/M-L/anterior/hip flexion (rectus femoris) Palpation Notes Supine Locate tibial tuberosity and follow the tendon to the patella and then superiorly to palpate rectus femoris between VL and VM at the AIIS. Neighbouring Structures eg. Vastus lateralis/medialis, Sartorius Confirmation Reciprocal inhibition: Hamstrings (knee flexion) SEMIMEMBRANOSUS pg 312 Fibre Direction Vertical Proximal Attachment Ischial tuberosity Distal Attachment Posterior aspect of medial condyle of tibia Joint/Axis/Relationship/Action Palpation Notes 1. Tibiofemoral/M-L/posterior/knee flexion 2. Coxofemoral/M-L/posterior/hip extension Prone Locate distal tendon of Semitendinosus and slide posteromedially palpating superior to the ischial tuberosity (semimembranosus is deep to semitendinosus). Neighbouring Structures eg. Semitendinosus, Medial head of Gastrocnemius Confirmation Reciprocal inhibition: Quadriceps (knee extension) SEMITENDINOSUS pg 312 Fibre Direction Vertical Proximal Attachment Ischial tuberosity Distal Attachment Proximal, anteromedial shaft of tibia (pes anserine) Joint/Axis/Relationship/Action 1. Tibiofemoral/M-L/posterior/knee flexion 2. Coxofemoral/M-L/posterior/hip extension Palpation Notes Prone Locate pes anserine finding the most medial and posterior tendon and palpate superiorly the ischial tuberosity. Neighbouring Structures eg. Semimembranosus, Gracilis, Sartorius Confirmation Reciprocal inhibition: Quadriceps (knee extension) BICEPS FEMORIS pg 312 Fibre Direction Proximal Attachment Distal Attachment Joint/Axis/Relationship/Action Vertical 1. Ischial tuberosity (long head) 2. Lateral linea aspera (short head) Fibular head 1. Tibiofemoral/M-L/posterior/knee flexion 2. Coxofemoral/M-L/posterior/hip extension Palpation Notes Prone Locate fibular head and palpate from the tendon of biceps femoris superiorly to the ischial tuberosity. Neighbouring Structures eg. Semitendinosus, Semimembranosus, Soleus Confirmation Reciprocal inhibition: Quadriceps (knee extension) TFL (Tensor Fascia Lata) & ITB (ILIOTIBIAL BAND) pg 324 Fibre Direction Inferolateral Proximal Attachment Anterior iliac crest from the ASIS to the iliac tubercle Distal Attachment Iliotibial tract (distal 2/3 of lateral thigh) to Gerdy’s tubercle Joint/Axis/Relationship/Action 1. Coxofemoral/vertical/anterior/medial rotation 2. Coxofemoral/A-P/lateral/abduction 3. Coxofemoral/M-L/anterior/hip flexion Palpation Notes Side lying Locate ASIS to iliac tubercle and palpate inferolaterally towards the IT band. Have Px medially rotate and abduct the thigh. Neighbouring Structures eg. Gluteus medius, Gluteus maximus (shares distal attachment) Confirmation Reciprocal inhibition: Piriformis (lateral rotation) GLUTEUS MAXIMUS pg 315 Fibre Direction Inferolateral Proximal Attachment 1. Posterior lateral surface of coccyx and sacrum 2. Sacrotuberous ligament 3. Posterior iliac crest Distal Attachment 1. Iliotibial tract (distal 2/3 of lateral thigh) to Gerdy’s tubercle 2. Gluteal tuberosity Joint/Axis/Relationship/Action 1. Coxofemoral/M-L/posterior/hip extension 2. Coxofemoral/vertical/posterior/lateral rotation 3. Coxofemoral/A-P/lateral/abduction Palpation Notes Prone Find the posterior iliac crest, outline where the edge of sacrum is and move in an inferolateral direction towards the gluteal tuberosity. Have the Px extend their hip (knee flexion = active insufficiency of hamstrings). Neighbouring Structures eg. Gluteus medius, gluteus minimus, Piriformis Confirmation Reciprocal inhibition: Psoas major (hip flexion) Active insufficiency: knee flexion (by making hamstrings actively insufficient to differentiate between it and Gluteus maximus) GLUTEUS MEDIUS pg 315 Fibre Direction Fan-shaped Proximal Attachment Lateral iliac crest between ASIS and PSIS Distal Attachment Lateral aspect of greater trochanter Joint/Axis/Relationship/Action 1. Coxofemoral/A-P/lateral/abduction 2. Coxofemoral/vertical/posterior/lateral rotation (posterior fibres) 3. Coxofemoral/vertical/anterior/ medial rotation (anterior fibres) Palpation Notes Side lying Locate ASIS and PSIS and palpate iliac crest b/w two landmarks inferiorly towards greater trochanter and have the Px abduct leg. Neighbouring Structures eg. Gluteus maximus, gluteus minimus Confirmation Reciprocal inhibition: Adductor longus (hip adduction) PIRIFORMIS pg 328 Fibre Direction Inferolateral Proximal Attachment Anterior lateral surface of sacrum Distal Attachment Posteromedial aspect of greater trochanter Joint/Axis/Relationship/Action 1. Coxofemoral/vertical/posterior/lateral rotation Palpation Notes Prone Drawing an imaginary line from the contralateral PSIS to ipsilateral greater trochanter, palpate from the lateral sacral border inferolaterally to the greater trochanter. Test by doing external hip rotation with the knee flexed and resisting from the medial side of the ankle. Neighbouring Structures eg. Ilium, Gluteus maximus, Quadratus femoris Confirmation Reciprocal inhibition: TFL (medial rotation) QUADRATUS FEMORIS pg 328 Fibre Direction Horizontal Proximal Attachment Lateral border of ischial tuberosity Distal Attachment Intertrochanteric crest Joint/Axis/Relationship/Action 1. Coxofemoral/vertical/posterior/lateral rotation Palpation Notes Prone Locate greater trochanter & ischial tuberosity inferior to Piriformis. Test by doing external hip rotation with the knee flexed and resisting from the medial side of the ankle. Neighbouring Structures eg. Piriformis, Gluteus maximus, Hamstrings Confirmation Reciprocal inhibition: TFL (medial rotation) ADDUCTOR MAGNUS pg 320 Fibre Direction Vertical Proximal Attachment 1. Anterior pubic bone (anterior) 2. Ischial tuberosity (posterior) Distal Attachment 1. Medial lip of linea aspera (distal ⅓) (anterior) 2. Adductor tubercle (posterior) Joint/Axis/Relationship/Action 1. Coxofemoral/A-P/medial/hip adduction 2. Coxofemoral/M-L/anterior/hip flexion (anterior fibres) 3. Coxofemoral/M-L/posterior/hip extension (posterior fibres) Palpation Notes Side lying Have the Px flex knee of top leg and straighten bottom leg and locate adductor tubercle on medial side of the knee. Have the Px adduct lower (straightened) leg to confirm magnus and palpate superiorly to ischial tuberosity. Most prominent muscle on the medial thigh. Neighbouring Structures eg. Adductor longus, Biceps femoris, Vastus medialis Confirmation Reciprocal inhibition: Gluteus medius (hip abduction) ADDUCTOR LONGUS pg 320 Fibre Direction Vertical Proximal Attachment Anterior pubic bone Distal Attachment Medial lip of linea aspera (middle ⅓) Joint/Axis/Relationship/Action 1. Coxofemoral/A-P/medial/hip adduction Palpation Notes Supine Hip slightly abducted and externally rotated papating from the posterior middle thigh superiorly to the pubic bone. Neighbouring Structures eg. Adductor brevis, Adductor magnus Confirmation: Reciprocal inhibition: Gluteus medius (hip abduction) GRACILIS pg 321 Fibre Direction Vertical Proximal Attachment Anterior pubic bone Distal Attachment Proximal anteromedial shaft of tibia at pes anserine Joint/Axis/Relationship/Action 1. Coxofemoral/A-P/medial/hip adduction 2. Tibiofemoral/M-L/posterior/knee flexion Palpation Notes Supine Knee flexed with hip in slight lateral rotation. Have the Px adduct thigh and the tendons will be more prominent and superficial near the proximal attachment. Palpate the muscle belly distally to pes anserine with Gracilis & Semitendinosus. Only hip adductor that crosses the knee. Neighbouring Structures eg. Sartorius, Semitendinosus, Adductor longus/magnus/brevis Confirmation Reciprocal inhibition: Gluteus medius (hip abduction) NOTABLE BONY LANDMARKS & HOW TO PALPATE THEM PUBIC SYMPHYSIS Locate the midline of the body (using the belly button) with your fingers towards Px face. Place the heel of your hand down until you feel bony prominence. Replace with thumbs for specific palpation. PUBIC TUBERCLES/ CREST Move laterally off the pubic symphysis, it may be sensitive for some people. It is the attachment for the inguinal ligament and the external oblique muscles. RAMUS OF ISCHIUM Side lying Palpating bottom leg (top leg is bent) and locate ischial tuberosity. Move just below it and superiorly towards the Inferior ramus. LANDMARKS FOR SPINOUS PROCESSES/RIBS T2 or RIB 2 Superior angle of scapula T7 or RIB 7 Inferior angle of scapula T4 or RIB 4 Root of the spine of scapula L4~L5 Top of iliac crest UPPER LIMB LEVATOR SCAPULA pg 84 Fibre Direction Vertical Proximal/Superior Attachment TVPs of C1-C4 Distal/Inferior Attachment Superior angle of scapula Joint/Axis/Relationship/Action 1. 2. 3. 4. 5. Scapulothoracic joint/NO RELATIONSHIP/elevation (UT) Intervertebral/A-P/lateral/ neck lateral flexion (Unilateral) Intervertebral/vertical/ipsilateral rotation Intervertebral/M-L/posterior/bilateral neck extension (BL) Scapulothoracic joint/NO RELATIONSHIP/downward rotation (pectoralis minor, rhomboids) Palpation Notes High seated Locate the spine of the scapula and palpate medially to the superior angle.. Locate the mastoid processes and palpate inferiorly (one finger width) to find the TVPs of C1-C4. Palpate lateral neck distally to the superior angle of scapula. Neighbouring Structures eg. Upper fibre trapezius, Rhomboids (force couple) Confirmation Reciprocal inhibition: scapular depression. Alternate action: neck extension or ipsilateral rotation TRAPEZIUS UPPER FIBRES pg 69 Fibre Direction Inferolateral Proximal/Medial Attachment Middle superior nuchal line and external occipital protuberance (Inion) to SP of C7 via nuchal ligament Distal/Lateral Attachment Lateral clavicle, Acromion, Spine of scapula Joint/Axis/Relationship/Action 1. 2. 3. 4. Intervertebral/A-P/lateral/ neck lateral flexion (Unilateral) Intervertebral/vertical/posterior/contralateral rotation Intervertebral/M-L/posterior/bilateral neck extension (BL) Scapulothoracic/ NO RELATIONSHIP/elevation (Levator Scapula) 5. Scapulothoracic/NO RELATIONSHIP/upward rotation (Serratus anterior, LF trapezius) Palpation Notes Seated Locate the spine of the scapula and palpate laterally to the acromioclavicular joint and around to the lateral ⅓ of the clavicle. Palpate up from C7 to Inion and then laterally to the middle ⅓ of the superior nuchal line. Neighbouring Structures eg. Trapezius middle fibres, Levator scapula Confirmation Reciprocal inhibition: contralateral neck flexion Alternate action: neck extension or contralateral rotation TRAPEZIUS MIDDLE FIBRES pg 69 Fibre Direction Horizontal Proximal/Medial Attachment SPs of C7-T5 Distal/Lateral Attachment Spine of scapula Joint/Axis/Relationship/Action 1. Scapulothoracic/NO RELATIONSHIP/retraction Palpation Notes Prone Have Px abduct shoulder to 90 degrees and retract scapula with point thumbs up. External rotation of GH causes less tension on Teres Minor and Infraspinatus and neutral position of the scapula for recruitment of the middle fibres to retract. Neighbouring Structures eg. Trapezius upper fibres, Trapezius lower fibres, Rhomboids Confirmation Reciprocal inhibition: protraction TRAPEZIUS LOWER FIBRES pg 69 Fibre Direction Superolateral Proximal/Medial Attachment SPs of T6-T12 Distal/Lateral Attachment Root of spine of scapula Joint/Axis/Relationship/Action 1. Scapulothoracic/ NO RELATIONSHIP/upward rotation 2. Scapulothoracic/NO RELATIONSHIP/depression (Pectoralis Minor) Palpation Notes Prone To activate, get patient to do Superman pose and resist abduction Neighbouring Structures eg. Trapezius middle fibres, Latissimus dorsi Confirmation Reciprocal inhibition: downward rotation (resist adduction) RHOMBOIDS pg 82 Fibre Direction Inferolateral Medial Attachment SPs of C7-T5 Lateral Attachment Medial border of scapula from spine to inferior angle Joint/Axis/Relationship/Action 1. Scapulothoracic/ NO RELATIONSHIP/retraction 2. Scapulothoracic/NO RELATIONSHIP/downward rotation Palpation Notes Prone Have Px adduct shoulder to 90 degrees and retract scapula with thumbs pointing down. Internal rotation of GH causes greater tension on Teres Minor and infraspinatus and a protracted position of the scapula requiring greater recruitment of Rhomboids to retract. Neighbouring Structures eg. Middle fibre trapezoids (deep to), levator scapula (force couple) Confirmation Reciprocal inhibition: protraction (serratus anterior) SERRATUS ANTERIOR pg 86 Fibre Direction Fan-shaped Medial Attachment Anterior surface of the medial border of scapula Lateral Attachment Lateral surface of Ribs 1-8 Joint/Axis/Relationship/Action 1. Scapulothoracic/NO RELATIONSHIP/protraction 2. Scapulothoracic/NO RELATIONSHIP/upward rotation Palpation Notes Supine Landmark the border of the scapula and palpate laterally on to the ribs. Start on the 4th rib and palpate down to the 8th (inferior angle of scapula is rib 7) and have Px protract (punch) into the air pushing down to add resistance. Neighbouring Structures eg. Subscapularis, Teres major/minor Confirmation Reciprocal inhibition: retraction (pushing shoulder into the table) PECTORALIS MINOR pg 92 Fibre Direction Superolateral Superior Attachment Coracoid process Inferior Attachment Anterior surface of Ribs 3-5 Joint/Axis/Relationship/Action 1. Scapulothoracic/NO RELATIONSHIP/protraction 2. Scapulothoracic/NO RELATIONSHIP/ downward rotation 3. Scapulothoracic/NO RELATIONSHIP/ depression (LT) Palpation Notes Supine Resist protraction and depression by having Px push flexed elbow into hand at 45 degrees of GH flexion. Neighbouring Structures eg. Biceps brachii short head and coracobrachialis share common proximal attachment, Pectoralis major Confirmation Reciprocal inhibition: ST and shoulder elevation (Levator scapula and Trapezius upper) PECTORALIS MAJOR pg 89 Fibre Direction Fan-shaped Medial Attachment 1. Medial clavicle (clavicular head) 2. Sternum & costal cartilages of ribs 2-6 (sternocostal head) Lateral Attachment Lateral lip of bicipital groove Joint/Axis/Relationship/Action 1. Glenohumeral/vertical/horizontal adduction 2. Glenohumeral/vertical/medial rotation Palpation Notes Supine Have Px abduct shoulder to 90 and resist horizontal adduction. Neighbouring Structures eg. Deltoids, Pectoralis minor, Latissimus dorsi, Teres major Confirmation Reciprocal inhibition: shoulder horizontal abduction (Deltoids) LATISSIMUS DORSI pg 71 Fibre Direction Superolateral Medial Attachment Lumbar and sacral vertebrae via thoracolumbar fascia, posterior Iliac crest SP T6 - T12, Iliac crest, Ribs 9-12 Lateral Attachment Floor of the bicipital groove Joint/Axis/Relationship/Action Palpation Notes 1. Glenohumeral/A-P/medial/adduction 2. Glenohumeral/M-L/posterior/extension 3. Glenohumeral/vertical/ M. rotation Prone Locate thoracolumbar fascia (diamond-shape on sacrum). Palpate up towards the axilla and then under the shoulder to find the bicipital groove ask them to resist GH adduction. Neighbouring Structures eg. Teres major, Pectoralis major, Serratus anterior Confirmation Reciprocal inhibition: shoulder abduction (deltoids) TERES MAJOR pg 71 Fibre Direction Superolateral Medial Attachment Posterior surface of inferior angle Lateral Attachment Medial lip of the bicipital groove Joint/Axis/Relationship/Action 1. Glenohumeral/A-P/medial/adduction 2. Glenohumeral/vertical/ medial rotation 3. Glenohumeral/M-L/posterior/extension Palpation Notes Prone Have Px abduct shoulder to 90 degrees and flex elbow 90 degrees. Resist medial rotation and adduction of the forearm. Neighbouring Structures eg. Latissimus dorsi, Teres minor Confirmation Reciprocal inhibition: lateral rotation and abduction (Deltoids & Infraspinatus) SUPRASPINATUS pg 75 Fibre Direction Horizontal Proximal Attachment Supraspinous fossa Distal Attachment Superior facet of the greater tubercle Joint/Axis/Relationship/Action 1. Glenohumeral/A-P/lateral/shoulder abduction Palpation Notes Seated Find the spine of the scapula and move superiorly to follow muscle from the fossa to the greater tubercle and resist GH abduction with arm at their side. Neighbouring Structures eg. Infraspinatus, Teres minor, Deltoids Confirmation Reciprocal inhibition: shoulder adduction INFRASPINATUS pg 75 Fibre Direction Superolateral Medial Attachment Infraspinous fossa Lateral Attachment Middle facet of greater tubercle Joint/Axis/Relationship/Action 1. Glenohumeral/vertical/posterior/GH L. rotation Palpation Notes Prone Locate the spine of the scapula and move inferiorly to palpate entire infraspinous fossa and move lateral to the greater tubercle Neighbouring Structures eg. Teres minor, Supraspinatus Confirmation Reciprocal inhibition: shoulder medial rotation TERES MINOR pg 75 Fibre Direction Superolateral Medial Attachment Middle of lateral border of scapula Lateral Attachment Inferior facet of greater tubercle Joint/Axis/Relationship/Action 1. Glenohumeral/vertical/posterior/GH L. rotation 2. Glenohumeral/A-P/medial/adduction Palpation Notes Seated Have Px abduct GH to 90 degrees with elbow flexed and resist lateral rotation and adduction of the humerus. Neighbouring Structures eg. Teres major, Infraspinatus Confirmation Reciprocal inhibition: M. rotation SUBSCAPULARIS pg 75 Fibre Direction Superolateral Proximal Attachment Subscapular fossa Distal Attachment Lesser tubercle Joint/Axis/Relationship/Action 1. Glenohumeral/vertical/anterior/medial rotation Palpation Notes Side-lying Pull Px’s arm to create protraction and apply pressure into the axilla towards the subscapular fossa. Neighbouring Structures eg. Infraspinatus, Teres minor, Serratus anterior Confirmation Reciprocal inhibition: shoulder external rotation DELTOIDS pg 67 Fibre Direction Proximal Attachment Fan - shaped 1. Lateral clavicle (anterior head) 2. Acromion (middle head) 3. Lateral spine of scapula (posterior head) Distal Attachment Deltoid tuberosity Joint/Axis/Relationship/Action 1. Glenohumeral/A-P/superior/GH abduction (together) 2. Glenohumeral/vertical/medial rotation and horizontal adduction (anterior head) 3. Glenohumeral/vertical/lateral rotation and horizontal abduction (posterior head) Palpation Notes Seated Find lateral end of the clavicle and spine of scapula and the acromion and palpate distally to the deltoid tuberosity while resisting arm abduction. Neighbouring Structures eg. Biceps brachii, Supraspinatus Confirmation Reciprocal inhibition: shoulder adduction (Latissimus dorsi) BRACHIALIS pg 132 Fibre Direction Vertical Proximal Attachment Anterior distal ½ of humerus Distal Attachment Ulnar tuberosity, Coronoid process Joint/Axis/Relationship/Action 1. Humeroulnar/M-L/anterior/elbow flexion (esp. pronated) Palpation Notes Seated Find distal half of the anterior arm and palpate distally to the Ulnar tuberosity while resisting elbow flexion with the arm pronated. Neighbouring Structures eg. Biceps brachii, Brachioradialis Confirmation Reciprocal inhibition: elbow extension (Triceps) BICEPS BRACHII pg 95 Fibre Direction Proximal Attachment Distal Attachment Joint/Axis/Relationship/Action Vertical 1. Supraglenoid tubercle (long head) 2. Coracoid process (short head) Radial tuberosity 1. Humeroulnar/M-L/anterior/elbow flexion 2. Radioulnar/vertical/NO RELATIONSHIP/supination Palpation Notes Seated Find anterior GH and coracoid process and palpate distally to the Radial tuberosity while resisting elbow flexion with arm supinated. Neighbouring Structures eg. Brachialis, Brachioradialis Confirmation Reciprocal inhibition: elbow extension CORACOBRACHIALIS pg 99 Fibre Direction Inferolateral Proximal Attachment Coracoid process Distal Attachment Middle, medial humerus Joint/Axis/Relationship/Action 1. Glenohumeral/vertical/anterior/horizontal adduction Palpation Notes Seated Find the coracoid process and palpate to the medial middle arm. Resist horizontal adduction with GH 90 degrees flexion. Neighbouring Structures eg. Biceps brachii, Pectoralis minor/major Confirmation Reciprocal inhibition: horizontal abduction (Deltoids) TRICEPS BRACHII pg 97 Fibre Direction Vertical Proximal Attachment 1. Infraglenoid tubercle (long head) 2. Posterior proximal humerus (superior to radial groove) (lateral head) 3. Posterior distal humerus (inferior to radial groove) (medial head) Distal Attachment Olecranon process Joint/Axis/Relationship/Action 1. Humeroulnar/M-L/posterior/Elbow extension (all) 2. Glenohumeral/M-L/posterior/Shoulder extension (long head) Palpation Notes Seated Find posterior GH and palpate distally to the olecranon process while resisting elbow extension. Neighbouring Structures eg. Deltoids, GH lateral rotators Confirmation Reciprocal inhibition: elbow flexion Additional action: shoulder extension PRONATOR TERES pg 146 Fibre Direction Proximal Attachment Distal Attachment Joint/Axis/Relationship/Action Inferolateral 1. Medial epicondyle of humerus 2. Coronoid process of ulna Middle, lateral radius 1. Proximal Radioulnar/vertical/anterior/pronation 2. Humeroulnar/M-L/anterior/flexion Palpation Notes Seated Find medial epicondyle and move laterally and distal to middle radius while resisting pronation with elbow extended. Neighbouring Structures eg. Flexor carpi radialis, Palmaris, Flexor carpi ulnaris Confirmation Reciprocal inhibition: supination FLEXOR CARPI RADIALIS pg 141 Fibre Direction Vertical Proximal Attachment Medial epicondyle of humerus Distal Attachment Base of 2nd & 3rd MC Joint/Axis/Relationship/Action 1. Radiocarpal/M-L/anterior/flexion 2. Radiocarpal/A-P/lateral/abduction with ECRL/ECRB 3. Humeroulnar/M-L/anterior/flexion Palpation Notes Seated. Find medial epicondyle and move laterally and distally to 2&3 MC while resisting wrist flexion. Neighbouring Structures eg. Pronator teres, Flexor carpi ulnaris Confirmation Reciprocal inhibition: wrist extension Alternate action: radial deviation PALMARIS LONGUS pg 141 Fibre Direction Vertical Proximal Attachment Medial epicondyle of humerus Distal Attachment Palmar aponeurosis Joint/Axis/Relationship/Action 1. Radiocarpal/M-L/anterior/wrist flexion 2. Humeroulnar/M-L/anterior/flexion Palpation Notes Seated Find medial epicondyle and move distally to the palm of the hand while resisting wrist flexion. Neighbouring Structures eg. Flexor carpi radialis, Flexor carpi ulnaris Confirmation Reciprocal inhibition: wrist extension FLEXOR CARPI ULNARIS Fibre Direction pg 142 Vertical Proximal Attachment 1. Medial epicondyle of humerus 2. Olecranon and proximal posterior ulna Distal Attachment 1. Pisiform 2. Hook of hamate 3. Base of 5th MC Joint/Axis/Relationship/Action 1. Radiocarpal/M-L/anterior/flexion 2. Radiocarpal/A-P/medial/adduction with ECU 3. Humeroulnar/M-L/anterior/flexion Palpation Notes Seated. Find medial epicondyle and move distally to the base of 5th MC while resisting wrist flexion. Neighbouring Structures eg. Pronator teres, Flexor carpi radialis Confirmation Reciprocal inhibition: wrist extension Alternate action: ulnar deviation BRACHIORADIALIS pg 133 Fibre Direction Vertical Proximal Attachment Proximal lateral supracondylar ridge Distal Attachment Distal lateral surface of radius Joint/Axis/Relationship/Action 1. Humeroulnar/M-L/anterior/elbow flexion (esp. neutral) Palpation Notes Seated Find lateral posterior distal arm and move inferiorly to the distal radius while resisting elbow flexion with arm neutral. Neighbouring Structures eg. Biceps brachii, Brachialis Confirmation Reciprocal inhibition: elbow extension EXTENSOR CARPI RADIALIS LONGUS pg 136 Fibre Direction Vertical Proximal Attachment Distal lateral supracondylar ridge Distal Attachment Base of 2nd MC Joint/Axis/Relationship/Action 1. Radiocarpal/M-L/posterior/extension 2. Radiocarpal/A-P/lateral/abduction with FCR and ECRB 3. Humeroulnar/M-L/posterior/extension Palpation Notes Seated Find lateral posterior distal arm and move inferiorly to 2 MC while resisting wrist extension. Neighbouring Structures eg. Extensor carpi radialis brevis, Brachioradialis Confirmation Reciprocal inhibition: wrist flexion Alternate action: radial deviation EXTENSOR CARPI RADIALIS BREVIS pg 136 Fibre Direction Vertical Proximal Attachment Lateral epicondyle of humerus Distal Attachment Base of 3rd MC Joint/Axis/Relationship/Action 1. Radiocarpal/M-L/posterior/extension 2. Radiocarpal/A-P/medial/adduction with FCR and ECRL 3. Humeroulnar/M-L/posterior/extension Palpation Notes Seated Find lateral epicondyle and move inferiorly to 3rd MC while resisting wrist extension. Neighbouring Structures eg. Extensor carpi radialis longus, Extensor digitorum Confirmation Reciprocal inhibition: wrist flexion Alternate action: radial deviation EXTENSOR DIGITORUM pg 136 Fibre Direction Vertical Proximal Attachment Lateral epicondyle of humerus Distal Attachment Distal phalanges of fingers 2-5 Joint/Axis/Relationship/Action 1. 2. 3. 4. Interphalangeal/M-L/posterior/finger extension MCP/M-L/posterior/finger extension Radiocarpal/M-L/posterior/wrist extension Humeroulnar/M-L/posterior/extension Palpation Notes Seated Find lateral epicondyle and move inferiorly to 2nd-5th DIP’s while resisting finger extension. Neighbouring Structures eg. Extensor carpi ulnaris, Extensor carpi radialis brevis/longus Confirmation Reciprocal inhibition: finger flexion Additional action: wrist flexion EXTENSOR CARPI ULNARIS pg 136 Fibre Direction Vertical Proximal Attachment Lateral epicondyle of humerus Distal Attachment Base of 5th MC Joint/Axis/Relationship/Action 1. Radiocarpal/M-L/posterior/wrist extension 2. Radiocarpal/A-P/medial/adduction with FCU 3. Humeroulnar/M-L/posterior/extension Palpation Notes Seated Find lateral epicondyle and move inferiorly to 5th MC while resisting wrist extension. Neighbouring Structures eg. Extensor digitorum, Flexor carpi ulnaris Confirmation Reciprocal inhibition: wrist flexion Addition action: ulnar deviation S-T MOVEMENTS & FORCE COUPLES Upward Rotation UF Trapezius, LF Trapezius, Serratus Anterior Downward Rotation Levator Scapula, Rhomboids, Pectoralis minor Protraction Serratus Anterior, Pectoralis minor Retraction MF Trapezius, Rhomboids Elevation Levator Scapula, UF Trapezius Depression LF Trapezius, Pectoralis minor