Archive for March, 2007
Neck pain| external (outward) rotation of the arm and shoulder
March 21, 2007 10:49 amWednesday, March 21, 2007
Neck pain| external (outward) rotation of the arm and shoulder
Patients with neck pain often have difficulty performing this action. A brief functional test is to ask the patient to raise the tested arm overhead with the thumb placed uppermost as the arm is raised up. For those patients who cannot raise the shoulder overhead, the testing can be done with the arm at the side of the body and moving the forearm away from the body with the palm turned up.
Muscles that externally rotate the arm and shoulder are:
- infraspinatus supplied by the suprascapular nerve (C5, C6) from the upper trunk of the brachial plexus. This is the muscle most responsible for external rotation.
- teres minor supplied by the axillary nerve (C5, C6) from the posterior cord of the brachial plexus.
- posterior deltoid supplied by the axillary nerve (C5, C6) from the posterior cord of the brachial plexus.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| external (outward) rotation of the arm and shoulder
Infraspinatus, posterior deltoid and teres minor perform external rotation of the shoulder (below)
Neck pain| internal (inward) rotation of the arm and shoulder
March 20, 2007 10:16 amTuesday, March 20, 2007
Neck pain| internal (inward) rotation of the arm and shoulder
Patients with neck pain often have difficulty performing this action.
A brief functional test is to ask the patient to use the tested arm to reach to the opposite shoulder blade from behind the back as is in the motion for scratching the back or in reaching to the back hip pocket.
Pain, spasm and tightness in the following muscles will limit the patient's ability to perform the inward rotation of the arm.
Muscles performing internal rotation of the shoulder are:
- subscapularis: supplied by the upper and lower subscapular nerves (C5, C6) from the posterior cord of the brachial plexus.
- teres major: supplied by the lower subscapular nerve (C5, C6) from the posterior cord of the brachial plexus.
- anterior part of the deltoid (C5, C6) from the axillary nerve from the posterior cord of the brachial plexus.
- latissimus dorsi (C6, C7, C8) from the thoracodorsal nerve from the posterior cord of the brachial plexus.
- pectoralis major (C5, C6, C7) from the lateral pectoral nerve from the lateral cord of the brachial plexus and the C8, T1 nerve fibers via the medial pectoral nerve from the medial cord of the brachial plexus.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| internal (inward) rotation of the arm and shoulder
Photograph showing muscles that perform internal rotation of the shoulder (below)
Neck pain| pushing| serratus anterior| winging
March 19, 2007 8:02 amMonday, March 19, 2007
Neck pain| pushing| serratus anterior| winging
Patients with neck pain will have difficulty pushing especially with weakness of the serratus anterior muscle.
Serratus anterior is responsible for keeping the scapula (shoulder blade bone) opposed to the chest wall.
With weakness of the serratus anterior muscle, the shoulder blade bone is unable to be opposed to the chest wall and the inner margin of the affected shoulder blade will protrude backwards producing a condition known as winging.
The winging associated with weakness of the serratus anterior muscle will be noted as the patient pushes forward. The shoulder blade will lift up and the upper part of the scapula will move away from the midline while the lower tip of the scapula deviates and protrudes very noticeably toward the midline.
Weakness of the trapezius muscle (particularly of the middle and lower trapezius) will also cause winging. However weakness of the trapezius produces winging noticed only on lifting the arm away from the body (abduction) and not with pushing type activities.
It is important to observe also the bulk of the muscles. Atrophy (wasting) of the affected muscles will be obvious.
Serratus anterior muscle is supplied by the long thoracic nerve of Bell which comes off directly from the C5, C6 and C7 spinal nerve roots before these roots enter into the formation of the brachial plexus.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| pushing| serratus anterior| winging
Pushing motions involve the action of the serratus anterior muscle (below)
Neck pain| shoulder bracing
March 18, 2007 8:20 amSunday, March 18, 2007
Neck pain| shoulder bracing
Patients with neck pain often complain of pain between the shoulder blades.
Muscles responsible for shoulder bracing include:
- trapezius especially the middle and lower trapezius supplied by be C3, C4 nerve roots.
- rhomboid major and minor supplied by the dorsal scapular nerve (C5).
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| shoulder bracing
Examine the middle trapezius, lower trapezius and rhomboid major in the side lying position since the shoulder blade braces well in this position (below)
Neck pain| shoulder shrugging
March 17, 2007 7:35 pmSaturday, March 17, 2007
Neck pain| shoulder shrugging
People with neck pain will aggravate the pain by performing the shoulder shrug. Muscles responsible for shoulder shrugging involve:
- levator scapulae supplied by the dorsal scapular nerve (C3, C4, C5)
- upper trapezius (supplied by the accessory nerve which is cranial nerve # 11). The middle and lower trapezius muscles are supplied by the C3 and C4 nerve roots.
When the strong muscles involved in lifting are in pain or spasm, the upper trapezius is often called into play to perform lifting activities as a result of which not only neck pain is aggravated but patients will have headaches also since the trapezius attaches to the back of the skull.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| shoulder shrugging
Upper trapezius in shoulder shrugging (below)
Neck pain| shoulder| overhead arm elevation
March 16, 2007 9:07 amFriday, March 16, 2007
Neck pain| shoulder| overhead arm elevation
If any of the muscles listed below are in pain or discomfort, there will be an impairment of shoulder movements especially with overhead arm elevation.
Overhead arm elevation is a series of movements bringing the shoulder from the side of the body, to 60° away from the body, to 90° and then to a full overhead elevation.These movements have to be smooth and without hesitations showing that movements of the shoulder joint and movements between the shoulder blade and the chest wall is normal.
Normally, for every 2° movement at the shoulder joint , there is 1° of movement the shoulder blade on the chest wall.
Therefore, for overhead elevation of 180°, 120° of movement will occur at the shoulder joint and 60° of the movement is contributed by movements of the shoulder blade on the chest wall. The shoulder blade should not move with shoulder joint movements under 60°.
The arm can be elevated overhead by:
- lifting the arm forward (flexion)
- lifting it sideways (abduction).
Muscles that raise the arm overhead through lifting the arm forward (flexion):
- pectoralis major supplied by the lateral pectoral nerve from the lateral cord and medial pectoral nerve from the medial cord of the brachial plexus.
- infraspinatus and teres minor contract to bring the arm to 90° away from the shoulder and the activity become stronger as the arm is elevated above 90°.
- lower four slips of the serratus anterior muscle. The serratus anterior muscle is supplied by the C5, C6 and C7 nerve roots through the long thoracic nerve of Bell. The long thoracic nerve is given off from the C5-C7 nerve roots of before the formation of the brachial plexus. The serratus anterior is also helped by the rhomboid major and minor muscles and the levator scapulae which help to fix the shoulder blade to the chest wall. The serratus anterior helps to pull the shoulder blade out and up. The rhomboid muscles are important in bringing the arm down from the overhead position.
Muscles that raise the arm overhead through lifting the arm away from the side of the body:
- serratus anterior
- trapezius
- infraspinatus and teres minor
To raise the arm overhead, the shoulder must be externally rotated. If the shoulder is in internal rotation, the head of the humerus is caught under the acromion and full overhead arm elevation is not possible.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| shoulder| overhead arm elevation
If the shoulder is in internal rotation, the head of the humerus (shoulder bone) is caught under the acromion of the shoulder blade and full overhead arm elevation is not possible (below).
Raising the arm in external rotation can bring about full overhead elevation (below) 
Neck pain| shoulder| abduction to 90°
March 15, 2007 10:10 amThursday, March 15, 2007
Neck pain| shoulder| abduction to 90°
When you want to move your arm to 90° away from the side of the body, this movement is primarily performed by the deltoid muscle assisted by the supraspinatus.
Abduction of the arm to 90° have to be accompanied by external rotation of the shoulder. This is performed by the infraspinatus and teres minor.
Infraspinatus and teres minor muscles are also assisted by the subscapularis muscle whose action is to depress the humerus.
The infraspinatus muscle is supplied by the C5 and C6 nerve roots through the suprascapular nerve of the upper trunk of the brachial plexus.
Teres minor is supplied by the C5 and C6 nerve roots through the axillary nerve (same nerve supplying the deltoid muscle) from the posterior cord of the brachial plexus.
Subscapularis muscle is supplied by the C5-C8 nerve roots through the upper and lower subscapular nerves from the posterior cord of the brachial plexus.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| lower back pain
Neck pain| shoulder| abduction to 60°
March 14, 2007 1:49 pmWednesday, March 14, 2007
Neck pain| shoulder| abduction to 60°
When you want to move your arm to 60° away from the side of the body, the motion is primarily done by the deltoid muscle supplied by C5 and C6 nerve roots through the axillary nerve.
Abduction of the shoulder to 60° away from the side of the body is also aided by supraspinatus supplied by the C5 and C6 nerve roots through the suprascapular nerve and the trapezius muscle supplied by the C3 and C4 nerve roots.
© 2007 copyright all rights reserved www.stopmusclepain.com neck pain| lower back pain
Abduction of the shoulder to 60° (below)
Neck pain| shoulder| abduction from side of body
March 13, 2007 10:57 am Tuesday, March 13, 2007
Neck pain| shoulder| abduction from side of body
Abduction of the shoulder joint occurs when the arm moves away from the body.
When you want to move your arm away from its resting position at the side of the body, the muscles that come into play are the trapezius and the supraspinatus muscles.
This motion can occur due to fixation of the shoulder blade by the middle and lower parts of the trapezius muscle supplied by the C3 and C4 nerve roots.
The supraspinatus muscle is supplied by the C5 and C6 nerve roots through the suprascapular nerve.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| shoulder| abduction from side of body
Low back pain| nerve levels| S3-5
March 12, 2007 9:04 amMonday, March 12, 2007
Low back pain| nerve levels| S3-5
Lower back pain can be accompanied by pain in the perineum and perianal area as well as the genital organs.
Sensation:
S3: The skin of the buttock toward the midline where we sit upon.
S4: Small area between S3 and S5
S5: Perianal area
Coccygeal nerve: The skin immediately adjacent to the anus
Motor: Muscles supplied by the pudendal nerve (S3-S5) include:
- levator ani
- coccygeus
- transversus perinei (superficial and deep parts)
- bulbocavernosus
- ischiocavernosus
- sphincter urethrae (sphincter around urinary orifice)
- sphincter ani externus (sphincter around the anus)
Reflex: Bulbocavernosus (anal sphincter muscle contraction on squeezing the glans penis. The reflex goes through the S2, S3 and S4 nerve roots.
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| nerve levels| S3-5
Dissection anatomy of perineum and pudental nerve
