Thoracoacromial artery

Anterior and Posterior humeral circumflex arteries, which arise from the axillary artery

Glenohumeral

Acromioclavicular - planar joint

Sternoclavicular

Scapulothoracic

Suprehumeral AKA Subacromial

The Bicipital Groove

scapulothoracic

sternoclavicular

acromioclavicular

Scapula glides on a curved surface of loose connective tissue between the serratus anterior and subscapularis muscles

medial and lateral movements of the scapula (abduction and adduction)

elevation of the scapula

upward and downward rotation of the scapula (tilt)

multi-axial synovial ball and socket (spheroidal) joint

Flexion and extension

abduction and adduction

internal and external rotation

circumduction

Most dislocated joint in the body (usually dislocates anteriorly)

Elevation and depression of the shoulder in the frontal plane (horizontal axis)

Protraction (ventral) and retraction (dorsal) in the horizontal plane (vertical axis)

Rotates on its mechanical axis

synovial plane joint

permits gliding movement as the arm is raised and the scapula rotates

Injured frequently when person falls onto shoulder or outstretched arm

"piano-key sign"

Supraspinatous

Infraspinatous

Teres minor

Subscapularis

Range of Motion in Clavicle

Sternoclavicular joint

Elevation - 40 degrees

Depression - 10 degrees

Protraction (anterior) - 30 degrees

Retraction (posterior) - 25 degrees

Range of Motion for Shoulder Joint

Flexion and Extension

Flexion - 150-170 degrees

Extension - 40 degrees

ROM of Shoulder Joint 

Horizontal Movements 

(Arm raised at 90 degrees abduction)

forward - 130-160 degrees

backward - 40-50 degrees

ROM of shoulder joint

Abduction and Adduction

Abduction/Elevation - 160-180 degrees

Adduction - 20-40 degrees

ROM at Elbow joint

Arm hanging at side Internal and External rotation

Internal Rotation - 70 degrees

External rotation - 60 degrees

External rotation - 90 degrees

Internal rotation - 70 degrees

Cervicals

Thoracics

Ribs

Shoulder

Posterior Landmarks:

Spine of Scapula

Inferior Angle of Scapula

T3

T7

Anterior Deltoid, C5

Coracobrachialis, C5-6

Pectoralis Major, C5 - T1

Biceps, musculocutaneous (C5,C6)

Latissimus Dorsi,  Thoracodorsal nerve C6-8

Teres Major, Lower Subscapular nerve C5-6

Posterior Deltoid, Axillary nerve, C5-6

Teres Minor, Axillary Nerve, C5-C6

Long head of Triceps, Radial Nerve, C6, C6, C8

Middle Deltoid, Axillary nerve, C5-6

Supraspinatus, Suprascapular nerve, C4, C5-6

Anterior and Posterior Deltoid, Axillary Nerve, C5-C6

Serratus Anterior, Long Thoracic Nerve, C5-7

Pectoralis Major, Medial and Lateral Pectoral Nerves, C5-T1

Latissimus Dorsi, Thoracodorsal nerve, C6-8

Teres Major, Lower sub scapular nerve, C6-7

Anterior Deltoid, Axillary Nerve, C5-6

Infraspinatus, Suprascapular nerve, C4-6

Teres Minor, Axillary Nerve, C5-C6

Subscapularis, Upper and lower subscapular nerve, C5-6

Pectoralis Major, Medial and Lateral pectoral nerves, C5-T1

Latissmus Dorsi, Thoracodorsal nerve, C6-8

Teres Major, Lower sub scapularis nerve, C5-6

Trapezius, CN XI

Levator Scapulae C3-5

Romboid Major, Dorsal Scapular nerve, C4-C5

Romboid Minor, same as above

Extension

Flexion

Circumduction with Compression

Circumduction with Traction

Abduction

Internal Rotation

Traction Stretch

Can be used as diagnostic test, not treatment used as muscle energy or articulatory technique

Treat upper thoracic dysfunctions, ribs, and cervicals before the shoulder and arm

Tender points are found at origin, insertion, and/or muscle bellies

Infection

Crystals

Spondyloarthropathy

Spondyloarthropathy

Sarcoidosis

Lyme disease

Rheumatoid Arthritis

Systemic Lupus

Gout

Disseminated gonorrhea

Patient's arm is elevated to 90 degrees of abduction and released

Arm will drop if there is a tear in the rotator cuff muscles

If the tear is partial, the physician will cause the arm to drop by tapping on the arm

For a chronically dislocating shoulder

Shoulder is abducted, extended and externally rotated.

Patient will appear apprehensive at point where shoulder is about to dislocate

performed to assess the stability of the biceps tendon in the bicipital groove

Physician applies traction to the elbow and externally rotates the arm, the patient tried to internally rotate the arm against resistance

If the tendon is unstable in the groove it will pop out with a snap and the patient will experience discomfort

ROM of Hand/Wrist

Sagittal Plane

Flexion 85 degrees

Extension 45 degrees

ROM of Hand/Wrist

Coronal Plane

Ulnar deviation (abduction) 15 degrees

Radial Deviation (adduction) 45 degrees

Superficial Flexors

Deep Flexors

Superficial Extensors

Deep Extensors

Radialis Muscles

Thenar Eminems

Hypothenar Eminems

Lumbricles

Palmar interosseous Muscles

Dorsal interosseous muscles

Pronator Teres, Median Nerve, C6-C7

Flexor Digitorum Superficialis, Median nerve, C7, C8, T1

Flexor Carpi Radialis, Median nerve, C6, C7

Flexor Carpi Ulnaris, Ulnar nerve, C7-C8

Palmaris Longus, Median nerve, C7-C8

Flexor Digitorum Profundus, Median nerve - 1 and 2, ulnar nerve - 3 and 4

Flexor Pollicis Longus, median nerve, C8-T1

Pronator Quadratus, Median Nerve, C8-T1

Extensor Digitorum, Radial Nerve, C7-C8

Extensor Digiti Minimi, Radial nerve, C7-C8

Extensor Carpi Ulnaris, Radial Nerve, C7-C8

Supinator, Radial Nerve, C5-6

Abductor Pollicis Longus, Radial Nerve, C7-8

Extensor Pollicis Brevis, Radial nerve, C7-8

Extensor Pollicis Longus, Radial Nerve, C7 - 8

Extensor Indicis, Radial Nerve, C7-8

Brachioradialis

Extensor Carpi Radialis Longus

Extensor Carpi Radialis Brevis

Abductor Pollicis Brevis

Adductor Pollicis

Flexor Pollicis Brevis

Opponenes Pollicis

Recurrent branch of the Median Nerve

Abductor Digiti Minimi

Flexor Digiti Minimi

Opponens Digiti Minimi

Palmaris Brevis

Ulnar Nerve

Lumbricles

Palmar Interosseous Muscles

Abductor digit minimi

Doral Interosseous Muscles

Floor-Scaphoid

Radial Border - Abductor Pollicis Longus and Extensor Pollicis Brevis tendons

Ulnar Border - Extensor Pollicis Longus tendon

Radial artery runs deep in the snuffbox, any tenderness suggests a fracture

Defined by pisiform, tubecle of the scaphoid, hook of the hamate, and tubercle of the trapezium, flexor retinaculum (transverse carpal ligament)

Transports the finger flexors and the median nerve

Repetitive motion lead to synovial hypetrophy around flexor tendons and swelling - resulting in compression of median nerve

Changes in sensation of the 1-3 digits, atrophy of thenar eminens muscles

Predisposing motion - wrist flexion

patient flexes the wrists and presses the back of hands together (reverse prayer position)

Pain or paresthesisa positive for carpal tunnel syndrome

Retinaculum release

splinting with 20-30 degrees of dorsiflexion, NSAIDs, rest, steroid injection, exercises, surgical decompression

Stenosing tenosynovisitis of the thumb

Inflammation of tendons - extensor pollicis brevis and abductor pollicis longus 

Pain with circumduction of the thumb

Close fist around the thumb, then ulnar deviation

Positive test - pain at the anatomic snuffbox indicating DeQuervain's Tenosynovitis

caused by an avulsion injury to the extensor tendon at the distal phalanx cause by forced flexion

loss of ability to ectend the finger at DIP joint

Can occur in Rhematoid Arhtritis

PIP joint is hyper extended

MCP and DIP are flexed

Avulsion or stretching of the middle branch of the extensor mechanism

creates a stiff and immobile PIP articulation

Extended MCP and DIP

Flexed PIP

Nodules that can occur in the finger flexors

results in snapping during finger flexion and extension

Extensor Carpi radialis longus, Radial nerve, C6-7

Extensor carpi radialis brevis, radial nerve, C7-8

extensor carpi ulnaris, radial nerve, C7-8

Flexor carpi radialis, median nerve, C6 - C7

Flexor carpi ulnaris, Ulnar nerve, C7-C8

Extensor digitorum, Radial nerve, C7-C8

Extensor indicis, Radial Nerve, C7-C8

Extensor digit minimi, Radial nerve, C7-C8

DIP - Flexor Digitorum profundus, Median and Ulnar

PIP - Flexor digitorum superficialis, median, C7-T1

MCP- lumbricals, Median and Ulnar, C8-T1

Dorsal interossei, Ulnar, C8-T1

Abductor digiti minimi, Ulnar, C8-T1

MCP - Extensor pollicis brevis, Radial, C7, C8

IP- Extensor pollicis longus, Radial, C7-C8

MCP - flexor pollicis longus, median nerve C8-T1

flexor pollicis brevis, median, C8-T1

Flexion - 160 degrees

Extension - 0 degrees

160 degrees, Coronoid process of ulna moves into coronoid fossa of humerus

same mechanism for supination

0 Degrees, Olecranon of the ulna extens into olecranon fossa of the humerus

same mechanism for pronation

Brachialis, Musculocutaneous Nerve, C5-C6

Biceps, Musculocutaneous, C5-7

Brachioradialis, Radial Nerve, C5-C7

Supinator, Radial Nerve, C5-6

Biceps Brachii, Musculocutaneous, C5-6

Supinator, Radial nerve, C7-C8

Pronator Teres, median nerve, C6-C7

Pronator Quadratus, Median nerve, C8-T1

Ulnar

Median

Musculotaneous

Radial

adduction of the Proximal ulna, cubitus valgus, ulnar deviation (adduction) of the wrist and hand

Also abduction of the ulna (distal), and adduction of the wrist and hand

cubitus varus, Abduction of the proximal ulna, radial deviation (abduction) of the wrist and hand

Also, adduction of the distal ulna and abduction of the wrist and hand

Posterior radial head

Distal radius is more anterior and radial head is pushed posteriorly

Posterior Pronation of the Radial Head

Anterior Radial head and posterior distal head

Arm was still in supination (anatomic position) 

Anterior Supination of the Radial Head

Tenderness over the radial head, lateral epicondyle

(lateral epicondylitis)

Tennis Elbow 

strain of the flexor muscles of the forearm near the medial epicondyle

Medial epicondylitis

Evaluate above and below: shoulder, thoracics and carpals and treat accordingly

Somatic dysfunction of the ulnohumeral joint is usually primary

Somantic dysfunction of the radioulnar joint is usually secondary

Neurological

Vascular

Disputed

C8-T1 injury, lower trunk injury and ulnar distribution which would lead to pain/parethesias in the medial aspect of the arm, forearm, 4th and 5th digits

"Neurological symptoms"

Sensation of heaviness or cramping of the upper extremity

Cyanosis or discoloration 

Edema or engorgment

Raynaud's phenomemon - discoloration of the fingers

Nerve Root Alvusion

Cervical rib/fibroud bands

Anterior/Middle Scalene

Clavicle/first rib

Pectoralis Minor/coracoid Process

Pancoast Tumor

Nerve Cells Are sick, CRazy People Players

Pulses diminish or extinguish (vascular)

Production of paresthesias (neurogenic)

Reproduction of symptoms (either)

Positive if compression is between scalenes

Palpate radial pulse at neutral and have patient turn head to affected side. Then abduct, externally rotate, and extend the arm - this is stretching pec minor

Reverse with head turned to opposite side is stretching scalenes

Patient abducts and externally rotates shoulders, and flexes elbows

Clenches and unclenches hands for one minute 

Reproduction of heaviness or symptoms is positive 

Fracture

Dislocation

Arthritis

Scoliosis/postural studies

Roentgen discover in 1895

First use in 1896

See blood

acute cerebral blled or edema

skull fracture

best for calcified structures

renal stones

Soft Tissue masses

Renal, cystic structures

Shoulder -Rotator Cuff

Elbow - Soft Tissue Infection

Wrist - Cyst, Tendon, Ligament, CT Involvement

Hip - peds-congenital hip dysplasia

Knee - popliteal cyst

Renal/GU - cyst stones

Cardiac - valves

OB/GYN

Soft Tissues

Ligamentus, cartilaginous, muscular injuries

Brain structures (CNS)

Soft Tissues

Rapid bone turn over

Infection

Occult Fracture

Tumor

Inflammation

Dexa Scan

Screening for Osteoporosis