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Evaluation and Treatment of the Shoulder Complex: Summary
Anterior Muscular Anatomy of the Shoulder Complex
Proximal Attachment Middle clavicle, sternum and
Distal Attachment Function
Muscle
Dysfunction
Pectoralis major (superficial muscle)
Humerus
Adduction and internal
Limited shoulder extension, external rotation (ER) and abduction, and ABD
rotation; sternal head extension; clavicular head flexion Anterior tilt of scapula; protraction of scapula Shoulder flexion and internal rotation (IR); elbow flexion and supination Shoulder flexion; shoulder IR
six costal cartilage, external oblique Ribs 3–5
Pectoralis minor (deep muscle)
Coracoid process of scapula
Anterior tilt of scapula and restricted range of motion in all planes at shoulder
Biceps brachii (superficial muscle)
Short head– coracoid process; long head– supraglenoid tubercle
Radial tuberosity
Anterior tilt of the scapula; humeral IR as a result of shortening of the short head limited shoulder extension and ER
Coracobrachialis
Coracoid process
Midshaft of humeral
Anterior tilt of scapula; protraction of scapula
The anterior fascia, also known as the pectoral fascia, of the shoulder creates the anterior arm line. The anterior fascia encapsulates a vast range of the anterior portion of the chest and proximal neck. It connects to the sternum, clavicle, anterior aspect of the scapula, anterior aspect of humerus, and anterior fibers of the deltoids. Additional attachments include the pectoralis minor, ribs, biceps brachii short head, wrist flexors, and median nerve . The pectoralis major is also associated with the anterior functional line (image A). This has fascia attachments from the pectoralis major to the external and internal obliques through the fascia of the rectus abdominus the fascia of the hip abductors. This creates an “X” of fascia across the body. Dysfunctions associated with the anterior fascia include headaches from cervical forward head postures; deviations of scapula that can lead to subacromial impingement; increased humeral
IR leading to subacromial impingement; and median nerve entrapment at the pronator teres, elbow, biceps and tricps brachii, and underneath the pectoralis minor . Image A: Anterior Functional Line
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