Upper Extremity Flashcards
(44 cards)
Upper fibres of trapezius
Innervation:
– Motor supply CN11- accessory nerve
– sensor supply- ventral rami of cervical nerves (C2-C4)
Attachment:
– occiput, C1-C7 and lateral clavicle, acromion
– head straight, resist lateral flexion of head above the ear and resist shoulder elevation as well
Trapezius- middle
Attachment-
- C2 to T12, Nuchal Line, Superior Angle of the scapula, Distal Clavicle, Acromion
Supine-
- arm extended to the side 90 degrees
- place hand on the posterior forearm of pt
- resist downward movement
Prone-
- arm extended to side 90 degrees
- place hand on anterior forearm
- place other hand on posterior forearm
- resist upward movement gently
Trapezius- lower
Supine:
- humerus abducted to 135 degrees with elbow locked
- place band on posterior forearm superior to the wrist
- resist downward motion
Prone:
- humerus abducted 135 degrees with elbow locked
- place one hand on anterior forearm and other on posterior forearm
- resist upward motion, gently
Latissimus dorsi- straight arm
Innervation:
– thoracodorsal nerve (C6-C8), from the posterior cord of the brachial plexus
Attachment-
- T7-T12, Thoracolumbar Fascia, Iliac Crest, Last 3-4 ribs, bicipital groove
Supine or prone:
- humerus addicted and medically rotated against body, elbow locked
- place hand on posterior forearm
- resist adduction
Latissimus dorsi- bent elbow
Supine or prone:
- Abducted 90 to side, elbow bent 90 degrees
- shoulder externally rotated
- resist adduction to elbow
Levator Scapula
Innervation:
– cervical C3, C4 and dorsal scapula C4, C5
Attachment-
- C1-C4, superior angle of the scapula
Supine or prone:
- rotate pt head slightly to side
- resist side ending of neck above ear with 1 hand, and resist shoulder elevation with the other hand
Teres major
Innervation:
– lower sub scapular nerve (C5, C6), arises from the posterior cord of the brachial plexus
Movement:
– internal rotation of shoulder
– extension of shoulder
Attachment:
– inferior angle of scapula
– bicipital groove of humerus
Supine:
– chicken wing arm
– back of pts hand underneath their waistline
– resist downwards movement
Prone:
– same but the movement will be upwards
Rhomboids
Innervation:
– dorsal scapula (C4, C5)
Attachment-
- C7-T5, medial border of the scapula
Supine:
- humerus abducted 45 degrees, elbow bent 90 degrees
- palm facing in
- resist adduction at elbow
Prone:
- elbow bent and slightly abducted
- resist adduction at elbow
Teres Minor
Innervation:
– axillary nerve (C5, C6)
Attachment-
- Upper axillary border of the scapula, Greater tubercle of the humerus
Supine and prone:
- Elbow bent 90 degrees, humerus abducted 45 degrees
- Resist lateral rotation with hand superior to wrist stabilising medial elbow
Infraspinatus
Innervation:
– supra scapular nerve (C5, C6), from the upper trunk of the brachial plexus
Attachment-
- Infraspinatus fossa of scapula, Greater tubercle of humerus
Supine and Prone:
- Elbow bent 90 degrees, humerus abducted 90 degrees
- Resist lateral rotation, supporting medial elbow
Supraspinatus
Innervation:
– supra scapular nerve (C5, C6) from the upper trunk of the brachial plexus
Attachment-
- Supraspinatus fossa of scapula, Greater tubercle of humerus
Supine:
- Humerus abducted 10-15 degrees and lifted slightly off the table
- Resist abduction
Prone:
- Arm at side
- Resist first 15 degrees of abduction
Subscapularis
Innervation:
– Upper and lower subscapular nerves (C5-C7), from the posterior cord of the brachial plexus
Attachment-
- Subscapular fossa of scapula, Lesser tubercle of humerus
Supine and Prone:
- Humerus abducted between 45 and 90 degrees
- Elbow flexed 90 degrees
- Resist medial rotation of elbow, stabilising lateral elbow
Biceps- long head
Innervation:
– musculocutaneous nerve (C5, C6)
Attachment-
- Supraglenoid tubercle of the scapula, Radial Tuberosity
Supine:
- Humerus abducted 45 degrees
- Resist elbow flexion holding superior to wrist
Prone:
- Clients elbow bent 90 degrees
- Grasp forearm superior to elbow, and resist movement of hand to shoulder
Biceps short head
Innervation:
– musculocutaneous nerve (C5, C6)
Attachment:
– coracoid process
– radial tuberosity
Action:
– flexion of humerus, flexion of elbow
– supination of forearm
– adduction of humerus
Supine:
– humerus adducted, elbow bent 90 degrees
– resist elbow flexion superior to wrist
Brachialis
Innervation:
– musculocutaneous nerve (C5, C6)
Attachment:
– lower half of the anterior shaft of the humerus
– ulnar tuberosity and coronoid process of ulnar
Action:
– flexion of elbow
Supine:
– humerus abducted, elbow bent 90 degrees
– thumb facing pts head (hammer curl)
– resist flexion
Pronator Teres
Innervation:
– median nerve (C5, T1)
Attachment-
- Medial epicondyle of humerus, Middle of lateral shaft of radius
- Clients elbow bent
- Grasp thumb with one hand, and place back of other hand against back of pt hand
- Resist pronation
Supinator
Innervation:
– Radial nerve (C5-T1)
Attachment-
- Lateral epicondyle of humerus, Lateral surface of proximal third of radius
- Pt elbow bent
- One hand behind pt thumb and index finger, other hand on hypothenar eminence
- Resist supination
This also tests biceps supination action
Longus colli
Innervation:
– C2-6
Attachment:
– anterior C1 and C2
– anterior C3 and C4
– Support pts head an inch or 2 off the bed with hand under occiput
– get pt to chin tuck, while you gently try to tip the forehead back, as if to undo the nod.
Medial scalene
Innervation:
– C4-8
Action:
- neck flexion and SB raises first rib
Attachment:
- C3-C7 and anterior ribs 1-2
Deltoid anterior
Innervation:
– axillary (C5, 6)
Attachment:
– lateral third of the clavicle
– deltoid tuberosity
Supine:
– elbow bent:
—- humures abducted 90 degrees
—- resist horizontal adduction (across body)
—- with one hand on bicep and other grasping the pt’s hand
elbow straight:
– abduct the humerus slightly
– resist humeral flexion with hand on posterior forearm superior to the wrist
Prone:
– pts elbow bent and shoulder abducted 90 degrees so arm is hanging off the bed
– top hand place above elbow for stability and one underneath to resist the downward motion
Deltoid middle
Innervation:
– axillary C5, 6
Attachment:
– lateral acromion and deltoid tuberosity
Action:
– abduction of shoulder to 90 degrees
Supine:
– pts elbow bent 90 degrees
– pts shoulder abducted 90 degrees
– hold arm and hand on superior shoulder
– resist further abduction
Prone:
– same as supine
– arm hanging off the bed
Posterior deltoid
Innervation:
– Axillary (C5, C6)
Attachment:
– lateral acromion and deltoid tuberosity
Action:
– extension, horizontal abduction and lateral rotation of the humerus
Supine:
– shoulder abducted 90 degrees and elbow flexed 90 degrees
– resist backwards motion of the shoulder
Prone:
– same as supine but resist upward motion
Coracobrachialis
Innervation:
– musculocutaneous nerve (C5, C6, C7)
Attachment:
– coracoid process and middle third of medial surface of humeral shaft
Action:
– flexion of humerus
– adduction of humerus
Supine:
– humerus abducted slightly
— arms lifted up slightly
– elbow bent 90 degrees
– place hand on bicep while grasping pts hand
– resist flexion of the shoulder
Pectoralis major clavicular fibres
Innervation:
– upper fibres:
—- lateral pectoral nerve (C5, C6)
– lower fibres:
—- lateral and medial pectoral nerves (C6-C8, T1)
Attachment:
– medial half of the clavicle and bicipital groove
Supine:
– pt arm straight up with posterior arm facing their opposite shoulder and palm of hand facing you
– resist movement of shoulder across body
Prone:
– pt arm straight out with palm facing the floor
– resist downward movement towards the floor
