Rotator Cuff muscles

Rotator cuff

Supraspinatus

Action Abduction

Origin Supraspinous fossa of the

scapula

Insertion Greater tuberosity of the

humerus

Innervation Suprascapular nerve (C4-6)

Supraspinatus

Prone

Locate the spine of scapula

Slide fingers up into the supraspinous fossa

Palpate through the trapezius

Follow the belly laterally until it tucks under the acromion

Ask pt. alternately abducting slightly and relaxing the shoulder.

Rotator cuff tendons - supraspinatus Supine or seated with the

arm at the side of the body

Locate the acromion and slide inferiorly onto the surface of the greater tubercle

Sink your thumb tip through the deltoid fibeers

Rotator cuff tendons - supraspinatus Seated

Place pt’s arm behind her back

Passively extend the arm as far as is comfortable

This position brings the supraspinatus tendon out from under acromion, just anterior and inferior to the AC joint

Infraspinatus

Action External rotation

Origin Infraspinous fossa of the

scapula

Insertion Greater tuberosity of the

humerus

Innervation Suprascapular nerve (C4-6)

Infraspinatus

Prone with forearm off the side of the table

Locate the spine, med. border and lat. border of the scapula

Form a triangle around the infraspinatus

Palpate in the triangle

Follow laterally to the humerus

Ask pt. to raise his elbow toward ceiling and relax.

Teres minor

Action External rotaton, weak

adduction

Origin Lateral border of the scapula

Insertion Greater tuberosity of the

humerus

Innervation Axillary nerve (C5,C6)

Teres minor

Prone with the arm off the side of the table

Locate the lat. border of the scapula; specifically its superior half.

Slide laterally off the lat. border onto the surface of the teres minor

Reach your thumb up into the axilla and grasp the belly of the teres minor

Ask pt. to laterlly rotate his shouder.

Rotator cuff tendons : infraspinatus and teres minor

Prone with arm off the side of the table

Locate the bellies of these muscles

Follow their bellies laterally as they pass inferior the acromion

Palpating through the deltoid, slender tendinous attachments at the greater tubercle

SubscapularisAction

Internal rotation

Origin Subscapular fossa of the

scapula

Insertion Lesser tuberosity of the

humerus

Innervation Subscapular nerve (C5,

C6)

Subscapularis Sidelying

Flex the shoulder and pull the arm anteriorly as much as possible

Hold the arm with one hand while thumb of other locates the lat. Border

Slowly and gently curl your thumb onto the subscapular fossa

Ask pt. to gently rotate his shoulder medially.

Subscapularis

Supine

Cradle the arm in a flexed position

Locate the lateral border

Slowly sink your thumbpad onto the subscapular fossa

Rotator cuff tendons - subscapularis

Seated or supine

Place the arm next to the trunk in anatomical position

Locate the coracoid process

Slide one inch inferiorly and laterally from the coracoid → between the two tendons of the biceps brachii

Palpate through the deltoid fibers

Explore by moving medially off the lesser tubercle

Ligaments of shoulder and glenohumeral joint

Ligaments of shoulder and glenohumeral joint

Coracoclavicular ligament

Seated or supine

Abduct and medially rotate the shoulder

Locate the coracoid process and the shaft of clavicle

Palpate b/w these landmarks. Roll your thumbpad across its fibers

Coracoacromial ligament Supine or seated

Locate coracoid process. Then locate the ant. edge of the acromion

Palpating deep to the deltoid fibers, explore b/w these landmarks for the wide band of the coracoacromial ligament

To bring the ligament closer to the surface, try extending the arm

Subacromial bursa With pt seated, stand behind him and

locate the acromion

Drop your fingers off the ant. edge of

the acromion

Slowly extend the pt’s shoulder by

pulling the elbow posteriorly

You will palpate at the depth b/w the

deltoid and rotator cuff tendons Palpate gently. Bursae are delicate

structures and best accessed with a soft touch