NPTE - UQ Anatomy

Deltoid Origins

Lat 1/3 of clavicle, acromion process, spine of scapula

Deltoid insertion

Deltoid tuberosity

Deltoid innervation

Axillary nerve

Deltoid action

Abduction, flexion, extension, stabilization

Supraspinatus origin

Supraspinous fossa of the scapula

Supraspinatus insertion

Superior facet of the greater tubercle of the humerus

Supraspinatus innervation

Suprascapular nerve

Supraspinatus action

Abduction (first 30 degrees), stabilization

Infraspinatus origin

medial 2/3 of the infraspinous fossa of the scapula, internal surface of the infraspinous fascia

Infraspinatus insertion

Middle facet of the greater tubercle of the humerus, posterior aspect of the shoulder joint capsule

Infraspinatus innervation

Suprascapular nerve

Infraspinatus action

Shoulder ER

Teres Minor origin

post surface of the scapula, near the lat border, inf to the infraspinatus

Teres Minor Insertion

Inf facet of the greater tubercle of the humerus, med to infraspinatus tendon

Teres Minor innervation

Axillary nerve

Teres Minor Action

ER, adduction, ext, stabilization

Subscapularis origin

Subscapular fossa

Subscapularis insertion

Lesser tubercle of the humerus

Subscapularis Innervation

Upper and Lower Subscapular nerves

Subscapularis action

Shoulder IR

Neer Test

Pt sitting/standing

IR the arm

Stabilize the scapula to prevent rotation/elevation

Elevate the arm in the scapular plane and apply overpressure if needed

(+): reproduction of p!

Assesses subacromial impingement

Hawkins-Kennedy Test

Pt sitting

Flex the elbow and abduct the shoulder to 90 degrees

Forcibly IR the shoulder

(+): reproduction of p!, limited ROM

Indicative of subacromial impingement

Coracoid impingement variation: add 10-20 degrees of horizontal adduction before applying the forced IR

Empty Can Test

Pt sitting/standing

Shoulder placed at 90 degrees of elevation in scapular plane

Elbow fully extended and shoulder in full IR

Provide resistance at the distal forearm straight down

(+): pain/weakness/dropping of arm with resistance

Assesses supraspinatus integrity

“Full can” version as well

Apprehension Test

Ant Dislocation: abduct the arm to 90 degrees and slowly add shoulder ER

Post Dislocation: flex the arm to 90 degrees and apply post traction force through the elbow while performing shoulder IR

(+): pt looks/feels apprehensive/alarmed and resists further motion

Subluxation-Relocation Test

First, abduct the arm to 90 degrees and full ER. Grasp the forearm with 1 hand to maintain this position

Ant Instability: apply ant force at the humerus, followed by a post force

Post Instability: apply a post force at the humerus, followed by an ant force

(+): p! &/or apprehension with initial force reduces with opposite force

GHJ Arthrokinematics

Concave glenoid, Convex humeral head

GHJ Capsular Pattern

ER>Abd>IR

GHJ Loose-Packed Position

55 degrees abduction, 30 degrees horizontal adduction

GHJ Close-Packed Position

Abduction and ER

ACJ Arthrokinematics

None - plane joint!

ACJ Loose Packed Position

Arm resting by side in normal physiological position

ACJ Close Packed Position

90 degrees abduction

ACJ Capsular Pattern

P! at extremes of ROM

SCJ Arthrokinematics

convex on concave for elevation/depression

concave on convex for protraction/retraction

SCJ Loose Packed Position

arm resting by side in normal physiological position

SCJ Close Packed Position

Max shoulder elevation

SCJ Capsular Pattern

P! at extremes of ROM

Humeroulnar Joint Arthrokinematics

Convex trochlea, concave trochlear notch

Humeroulnar Loose Packed Position

70 degrees flexion, 10 degrees supination

Humeroulnar Close Packed Position

Full ext

Humeroulnar Capsular Pattern

Flexion > ext

Humeroradial Arthrokinematics

Convex capitulum, concave radial head

Humeroradial Loose Packed Position

Full ext, full supination

Humeroradial Close Packed Position

90 degrees flexion, 5 degrees supination

Humeroradial Capsular Pattern

Flexion>ext>sup>pronation

Proximal Radioulnar Joint Arthrokinematics

Spin

Proximal Radioulnar Joint Loose Packed Position

70 degrees flexion, 35 degrees supination

Proximal Radioulnar Joint Close Packed Position

5 degrees supination

Proximal Radioulnar Joint Capsular Pattern

sup>pronation

Biceps Brachii Origin

Long head: supraglenoid tubercle of scapula

Short head: coracoid process of scapula

Biceps Brachii Insertion

Radial tuberosity of radius

Biceps Brachii Innervation

Musculocutaneous nerve

Biceps Brachii Action

Elbow flexion and forearm supination

Shoulder flexion and abduction

Brachialis Origin

Ant surface of the distal ½ of the humerus

med and lat intermuscular septa

Brachialis Insertion

Coronoid process of the ulna and tuberosity of the ulna

Brachialis Innervation

Musculocutaneous nerve and radial nerve

Brachialis Action

Elbow flexion

Triceps Brachii Origin

Long head: infraglenoid tubercle of the scapula

Lateral head: post surface of the humerus, sup to the radial groove

Medial head: post surface of the humerus, inf to the radial groove

Triceps Brachii Insertion

Olecranon process of the ulna

Triceps Brachii Innervation

Radial nerve

Triceps Brachii Action

Elbow ext

Pronator Teres origin

Med epicondyle of humerus, coronoid process of ulna

Pronator Teres Insertion

Middle of lat surface of radius

Pronator Teres Innervation

Median nerve (AIN)

Pronator Teres Action

Forearm Pronation

Cozen’s

Pt sitting

Stabilize the pt’s elbow with 1 hand

With the forearm pronated, ask the pt to extend and RD the wrist

Apply resistance against this motion into wrist flexion and UD direction

(+): reproduction of p! at lat epicondyle

Assesses lat epicondylitis

Valgus Stress Test

Pt supine

Stabilize the distal humerus in full ER with 1 hand

Flex the elbow to 20 degrees with neutral forearm

With other hand, apply a valgus force to the elbow

Ensure that the epicondyles are II to the table

(+): reproduction of p!/excessive gapping at med elbow

Assesses UCL

Varus Stress Test

Pt supine

Stabilize the distal humerus in full IR with 1 hand

Flex the elbow to 20 degrees with neutral forearm

With other hand, apply a varus force to the elbow

(+): reproduction of p!/excessive gapping at lat elbow

Assesses RCL

Radiocarpal Joint Arthrokinematics

Concave radius/ulna, convex proximal carpal row

Radiocarpal Joint Loose-packed position

neutral with slight UD

Radiocarpal Joint Close Packed Position

Extension with radial deviation

Radiocarpal Joint Capsular Pattern

Flexion and extension equally limited

MCP/IPJoint Arthrokinematics

Distal bone concave, proximal bone convex

MCP/IP Joint Loose Packed Position

Slight Flexion

MCP/IP Joint Close Packed Position

Full extension

MCP/IP Capsular Pattern

Flexion>ext

FCR Origin

Med epicondyle

FCR Insertion

base of the 2nd and 3rd metacarpals

FCR Innervation

Median nerve

FCR Action

Wrist flexion and RD

FCU Origin

Medial epicondyle, olecranon process of ulna and post border of upper 2/3 of ulna

FCU Insertion

pisiform, hook of the hamate, and base of the 5th metacarpal

FCU Innervation

Ulnar nerve

FCU action

Wrist flexion and UD

ECRL Origin

Lat supracondylar ridge of the humerus, lat intermuscular septum

ECRL Insertion

Dorsal surface of the base of the 2nd metacarpal

ECRL Innervation

Radial nerve

ECRL Action

Wrist extension and RD

ECRB origin

Lat epicondyle of the humerus via the common extensor tendon

ECRB insertion

Dorsal aspect of the base of the 3rd metacarpal

ECRB innervation

Deep branch of radial nerve

ECRB action

Wrist extension and RD

ECU Origin

Lat epicondyle of humerus, post border of ulna

ECU Insertion

base of the 5th metacarpal

ECU Innervation

PIN (deep radial nerve)

ECU Action

Wrist extension and UD

What muscles comprise the thenar eminence?

Abductor pollicis brevis, FPL, opponens pollicis

What nerve innervates the thenar muscles?

Median nerve

What muscles comprise the hypothenar eminence?

Abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi, and palmaris brevis

What nerve innervates the hypothenar muscles?

Ulnar nerve