Distal half of anterior surface of humerus & medial & latera intermuscular septa
Insertion
Tuberosity & coranoid process of ulna
Action
With the origin fixed, flexes the elbow joint moving the forearm toward the humerus With the insertion fixed, flexes the elbow joint moving the humerus toward the forearm
Flexion of the glenohumeral joint & medially rotate when supine
Nerve
Axillary, C5–6
Patient
Supine
Fixation
If the scapula is not propertly stabilized by the serratus anterior & the trapezius then the examiner should stabilize the scapula
Test
Glenohumeral abduction in slight flexion & medial rotation; one hand of the examiner is placed under the patient's wrist to make sure that the elbow is not lifted by reverse action of the wrist extensors which may occur if the patient is allowed to press the hand down on the chest
Pressure
Against the anterior surface of the arm just above the elbow in the direction of adduction toward the side of the body
Anterior surface of sternal one half of the clavicle
Insertion
Crest of the greater trochanter of the humerus; these fibers are more anterior & caudal than the lower fibers
Action of Upper Fibers
Flex & medially rotate the glenohumeral joint & horizontally adduct the humerus toward the opposite shoulder
Action of Muscle as a Whole
With the origin fixed, it adducts & medially rotates the humerus
With the insertion fixed, it may assist in elevating the thorax as in forced inspiration
Nerve
Lateral pectoral, C5–7
Patient
Supine
Fixation
The examiner holds the opposite shoulder firmly on the table while the triceps maintains elbow extension
Test
Starting with the elbow extended, & the shoulder in 90° flexion and slight medial rotation, the humerus is horizontally adducted toward the sternal end of the clavicle
Pressure
Against the forearm in the direction of horizontal abduction
Anterion surface of sternum, cartilages of ribs 1–6/7 & aponeurosis of the external oblique
Insertion
Crest of the greater trochanter of the humerus; these fibers are more posterior & cranial than the upper fibers
Action of Lower Fibers
Depress the shoulder girdle by attachment on humerus, & obliquely aduct the humerus toward the opposite iliac crest
Action of Muscle as a Whole
With the origin fixed, it adducts & medially rotates the humerus
With the insertion fixed, it may assist in elevating the thorax as in forced inspiration
Nerve
Lateral & medial pectoral, C6–8, T1
Patient
Supine
Fixation
Examiner places one hand on opposite iliac crest to hold the pelvis firmly on the table, if abdominals are weak the thorax should be stabilized instead of the pelvis, while the triceps maintains extension
Test
In elbow extension & shoulder flexion & slight medial rotation, adduction of the humerus obliquely toward the opposite iliac crest
Pressure
Against the forearm obliquely in a lateral & cranial direction
Superior margins, outer surfaces of ribs 3–5 near the cartilages & from the fascia over coresponding intercostal muscles
Insertion
Medial border & superior surfaces of the coracoid process of the scapula
Action
Origin fixed, tilts the scapula anteriorally (rotates the scapula about a coronal/ frontal axis) so that the coracoid process moves anteriorly & caudally, while the inferior angle moves posteriorly & medially
Insertion fixed, assists in forced inspiration
Nerve
Mostly medial pectoral but also lateral pectoral, C6–8, T1
Patient
Supine
Fixation
At rib cage on same side if needed
Test
Forward thrust of the subjects shoulder with arm at side without pushing down with same hand
Pressure
Against the anterior aspect of the shoulder downward toward the table
Spinous processes of T6–12, ribs 9/10–12, through the thoracolumbar fascia from the lumbar & cervical vertebrae & posterior one third of the external lip of the iliac crest, a slip from the inferior angle of the scapula
Insertion
Intertubercular groove of the humeris
Action
Origin fixed, medially rotates, adducts & extends the glenohumeral joint; insertion fixed, assists in tilting the pelvis anteriorly and laterally, when acting bilaterally this muscle assists in hyperextension of the spine & anterior rotation of the pelvis
Nerve
Thoracodorsal, C6–8
Patient
Prone
Fixation
One hand of the examiner may apply counter–pressure laterally on the pelvis
Test
Adduction of the arm, with extension, with medial rotation of the pelvis
Pressure
Against the forearm in the direction of abduction & slight flexion of the arm
Lesser tubercle of the humerus & glenohumeral joint capsule
Action
Medially rotates the glenohumeral joint & stabilizes the head of the humerus in the glenoid fossa during motion of the joint
Nerve
Upper & lower subscapular, C5–7
Patient
Prone
Fixation
Arm rests on table with the examiners hand near the elbow stabilizing the humerus to ensure a rotation action by preventing adduction or abduction, the rhomboides should stabilize the scapula
Test
Medial rotation of the humerus with the elbow at a right angle
Pressure
Using the forearm as a lever, pressure is applied in the direction of lateral rotation of the humerus
Medial two thirds of the infraspinous fossa of the scapula
Insertion
Middle facet of greater tubercle of the humerus & the glenohumeral joint capsule
Action
Laterally rotates the glenohumeral joint & stabilizes the head of the humerus in the glenoid fossa during motion of the joint
Nerve
Suprascapular, C4–6
Patient
Prone
Fixation
Arm rests on the table with the examiners hand near the elbow stabilizing the humerus to ensure a rotation action by preventing adduction or abduction, the middle & lower trapezius should stabilize the scapula
Test
Lateral rotation of the humerus with the elbow held at a right angle
Pressure
Using the forearm as a lever , pressure is applied in the directin of medial rotation of the humerus
Medial margin of acromion & superior lip of spine of scapula
Action
Scapular adduction & stabilization
Nerve
Spinal portion of cranial nerve XI (accessory), ventral ramus, C2–4
Patient
Prone
Fixation
(Deltoid, teres minor, & infraspinatus must give necessary fixation for the arm to be used as a lever) examiner provides fixation at opposite scapular area to prevent trunk rotation
Test
Adduction of the scapula with upward rotation & without elevation of the shoulder girdle, met by 90° abduction of arm with lateral rotation
Pressure
Against the forearm in a downward direction toward the table
Scapular abduction, upward rotation while also holding medial border against ribcage
Nerve
Long thoracic, C5–8
Patient
Supine
Fixation
None, unless shoulder or elbow musculature is weak; in this case arm would be supported in the perpendicular position
Test
Abduction of the scapula projecting the upper extremity anteriorly
Presure
Against the subjects fist or elbow downward through the extremity in the direction of scapular adduction, slight pressure can ne added to the lateral border of the scapula
