Palpable muscles and tendons

supraspinatus origin： supraspinous fossa of the scapula insertion： passing underneath the acromial process of the scapula and then attaching onto the upper facet of the greater tubercle of the humerus
actions： shoulder abduction against resistance innervation： suprascapular nerve (C5-C6) infraspinatus origin： infraspinous fossa of the scapula insertion： middle facet of the greater tubercle of the humerus actions： shoulder external rotation innervation： axillary nerve (C5-C6) teres minor (Latin： teretis = round and long) origin： lateral border of the scapula insertion： lower facet of the greater tubercle of the humerus actions： shoulder external rotation as the shoulder at 75º of abduction innervation： axillary nerve (C5-C6)
subscapularis origin： costal surface of the scapula insertion： lesser tubercle of the humerus actions： shoulder internal rotation； passive stabilizer to prevent anterior subluxation of the humerus innervation： suprascapular nerve (C5-C6) long head of the biceps brachii origin： supraglenoid tubercle of the scapula insertion： passing the intertubercular groove of the humerus and then attaching at the radial tuberosity of the radius actions： forearm supination, elbow flexion as the forearm supinated, and shoulder flexion as the elbow extended innervation

1. Have the subject sit on a high-back chair to support the subject's back. 
   • The muscle belly of the supraspinatus muscle can be identified above the spine of the scapula.  A momentary contraction can be induced by a quick short-arc motion of shoulder abduction.
     
     
   • The musculotendinous junction of the supraspinatus muscle is just right at the intersection of the clavicle and the spine of the scapula.
     
     
   • Place the subject's hand on the sacrum.  Identify the acromion process of the scapula.  The tendon of the supraspinatus can be found just distal to the anterior aspect of the acromion process of the scapula.  The tendon can be brought out by abduction of the humerus against resistance.
   
   
   
2. Have the subject sit on a high-back chair with the hand placing on the opposite shoulder.  Identify the acromion process of the scapula and the tendon of the infraspinatus can be found just inferolateral to the acromion process.  The tendon can be brought out by raising the hand off the opposite shoulder against resistance.
   
   
3. Have the subject sit on a high-back chair with the arm elevating to 70º of shoulder abduction and resting on a stable platform to relax the deltoid. Place your hand on the top of the deltoid muscle with the thumb just below the inferior border of the posterior deltoid muscle. press deeply into the soft tissue and the teres minor muscle can be found if it is spasm or painful.
   
   
4. Between the greater and lesser tubercles, you can find the intertuberculcar groove.

1. Have the subject sit with the arm abduction to 90º.  The anterior deltoid is in front of the head of the humerus, which can easily separated from the middle deltoid and from the pectoralis major.  Ask the subject to perform shoulder horizontal adduction to bring out the muscle.
   
   
2. Have the patient sit with the arm in the dependent position.  The middle deltoid is easily found when ask the patient abducts the humerus against resistance.
   
   
3. Have the subject sit with the arm abduction to 90º.  The posterior deltoid is brought out when the subject is asked to abduct his/her arm horizontally against resistance.

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Sternoclavicular Joint

Arthrology

	proximal component： sternum saddle-shaped manubrium sterni distal component： clavicle saddle-shaped medial end of the clavicle articular disc between 2 articular surfaces joint type： 3 degree-of-freedom saddle joint
	movements elevation： lateral end of the clavicle moving superiorly and medial end gliding inferiorly depression： lateral end of the clavicle moving inferiorly and medial end gliding superiorly protraction： lateral end of the clavicle moving forward and medial end gliding anteriorly retraction： lateral end of the clavicle moving backward and medial end gliding posteriorly axial rotation of the clavicle： clavicle rotating about its longitudinal axis

 Bony landmarks

sternum manubrium sterni (Latin： manubrium = handle) jugular notch (sternal notch) not palpable：  clavicular facets, costal facets clavicle sternal (medial) end curved-shape of the shaft： convex forward medially and concave forward laterally not palpable： interarticular disc, costal facet, costal tuberosity, acromial facet

1. Have the subject lie down on his/her back.  The upper portion of the sternum is the manubrium sterni.
   
   
2. The superior margin of the manubrium is the jugular notch.
   
   
3. By following the shaft of the clavicle medially, the sternal end of the clavicle is palpated.  Carefully identify the curve of the clavicle.
   

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Acromioclavicular Joint

Arthrology

proximal component： convex lateral end of the clavicle distal component： concave acromion process of the scapula joint type： nearly plane joint movements upward rotation： scapula swinging upwardly and outwardly and the glenoid cavity faces superiorly
downward rotation： scapula back to its anatomic position from upward rotation winging (horizontal plane adjustment)： vertebral border of the scapula moving off the rib cage tipping (sagittal plane adjustment)： inferior angle of the scapula moving off the rib cage DOF = 3

Bony landmarks

1. The spine of the scapula rests transversely across the upper portion of the scapula.
   
   
2. By following the spine of the scapula laterally, the acromion process is at the lateral end of the spine of the scapula.  Carefully find the tip of the shoulder.
   
   
3. By following the shaft of the clavicle laterally, the acromial end of the clavicle is palpated.
   

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Scapulothoracic Articulation

Arthrology

proximal component: convex rib cage distal component: concave anterior surface of the scapula Note： not a real anatomical joint movements at the scapulothoracic articulation are the results of movements occurring at the sternoclavicular and acromioclavicular joints elevation： scapula sliding superiorly on the rib cage (shoulder shrugging) depression：  scapula sliding inferiorly on the rib cage protraction： scapula sliding anterior-laterally on the rib cage and the medial border of the scapula moving away from the midline (abduction) retraction： scapula sliding posterior-medially on the rib cage and the medial border of the scapula moving toward the midline (adduction) upward rotation： inferior angle of the scapula rotating in a superior-lateral direction downward rotation： inferior angle of the scapula rotating in a inferior-medial direction

Bony landmarks

1. Have the subject sit in a high-back chair to relax scapular muscles.  Follow the outline of the scapula, you can find three borders (superior, lateral, and medial borders) and three angles (superior, lateral, and inferior angles).
   
   
2. The spine of the scapula rests transversely across the upper portion of the scapula.
   
   
3. By following the spine of the scapula medially, the root of the scapula is at the medial end of the spine of the scapula, which is a smooth triangular-shaped area.
   
   
4. Just below the lateral end of the clavicle, the coracoid process can be identified as a round process.

Muscles and tendons

1. lower portion： the origin is palpable as the arm is overhead
   
   
2. upper and middle portion： the muscle contracts when the arm is in halfway between 135º of shoulder flexion and abduction and reaches forward

1. Palpation： Have the subject lie on his/her abdomen.  The shoulder is abducted to 90º and retract the shoulder girdles bilaterally.
   
   
2. upper and middle portion： the muscle contracts when the arm is in halfway between 135º of shoulder flexion and abduction and reaches forward

1. Palpation： Have the subject sit with the hand placing behind the sacrum.  Palpate the rhomboid muscles medial to the medial border of the scapula.  The upper portion is the rhomboid minor while the lower one is the rhomboid major.
   
   
2. Contraction： downward rotation of scapula
   If the subject raises the hand off the back.  The rhomboid muscles contract vigorously.

1. Palpation： Have the subject sit with the hand placing behind the sacrum.  Palpate the tendon of the pectoralis minor at one finger below the coracoid process of the scapula.
   
   
2. Contraction：
   • anterior tilt of scapula： Ask the subject raises his/her hand off the back a little bit. 
   • depression of scapula： Ask the subject press down on the table with the hands but not elevate the trunk

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