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Picture

"Measurement of Pectoralis Minor Muscle Length: validation and clinical application"

10/3/2012

9 Comments

 
Picture
Throughout our early clinical rotations, a common impairment that we noticed was forward shoulder posture (look around your classroom and you will see it as well!). In our program, we were taught to measure muscle strength using Kendall's technique. In her book, Muscles: Testing and Function, in Posture and Pain, Kendall demonstrates measuring the length of the pec minor, along with several other muscles, in the supine position, from the posterolateral border of the acromion to the table top (>3-4 finger lengths being an adaptively shortened muscle). In this position, the biceps brachii, coracobrachialis, and pectoralis minor could all contribute to the protracted/anteriorly tilted shoulder, due to the common attachment to the coracoid process. We commonly found that the scapula lowered to normal position with shoulder flexion, which would indicate adaptively shortened coracobrachialis, even though the common assumption is the pec minor being the culprit.

This article demonstrates that the pectoralis minor is indeed found to be adaptively shortened in many individuals and provides a much more reliable technique to measure the length of the pectoralis minor, as long as proper palpation skills are used. The key is to use a tape measure or caliper to measure the distance between the coracoid process and the sternal edge of the 4th rib. While there may not be sufficient evidence to start using this in the clinic right away, this new technique is something to consider when examining patients.

Anatomy Review:

Pectoralis Minor Muscle: 
Origin: Anterior surface of the sternal ends of ribs 3-5
Insertion: Coracoid Process of the scapula
Action: Protracts and depresses the scapula. Helps elevate the ribs (if O and I are reversed)
Innervation: Medial Pectoral Nerve (C8-T1)
9 Comments
bakhtara mahmood
1/16/2013 01:40:01 am

how do i find and palpate the sternal edge or the costochondral junction of the 4th rib frm where the muscle originates,,,
??

Reply
Chris link
1/20/2013 07:42:06 am

"The investigator located the landmark by initially finding the inferior-medial aspect of the first rib at the sternum distal to the medial clavicle, and then counting down to the fourth rib."

An alternative method is to find the sternal angle. This is where the manubrium meets the body - you will feel a prominence. Go directly lateral to the sternal angle to find the 2nd rib. Stay close to where the cartilage of the rib meets the sternum. Follow the sternal edge down noting gaps and bony prominences. The gaps are the spaces between the ribs and the bony parts are the ribs (or the cartilage of the junction). Follow this down to the 4th rib. If you still are having trouble, let us know and we can do a video demonstration as well!

Reply
Ed Buresh
5/27/2013 11:23:28 am

What role does the serratus anterior play in this mix? You mention biceps brachii, coracobrachialis, and pectoralis minor as culprits in anteriorly protracting the shoulder. Isn't that what the serratus anterior does? Are you ruling it out due to the anterior tilt?

Reply
Jim Heafner
5/29/2013 12:29:15 pm

Hey Ed,
What we were saying was that the biceps brachii, coracobrachialis,and pectoralis minor all have the potential to anteriorly tilt the scapula based on their origin at the coracoid process. While people with an anteriorly tilted scapula often have other scapulo-thoracic dysfunction including a protracted scapula, the serratus anterior will not affect the anterior tilt. The serratus functions as a protractor, upward rotator, and actually causes a posterior tilt of the scapula as well. I hope this clarifies your confusion. Sorry for the misunderstanding.

Reply
kendrakennedy link
10/27/2013 09:46:09 am

I thoroughly enjoyed this blog and created a Weebly account too.

Reply
Jim Heafner
10/28/2013 01:52:54 pm

Glad you are enjoying it! Let us know if there is any specific content or information you would like to learn more about!

Reply
Tonger
6/19/2014 02:12:53 pm

May I ask about 3-4 finger length what does it mean in cm or mm

Reply
obgyn gilbert az link
10/12/2017 01:23:59 pm

When government reforms anything the results are greater costs and more complicated processes. These results will be horrifying to the healthcare system. There must be a better way.

Reply
YK11 link
2/28/2018 11:54:36 pm

YK11 is a dietary supplement that works primarily as a myostatin inhibitor. It is designed to help increase your muscle mass, produce more healthy chemicals, and create a healthy body growth that is sustainable for an extended period. There is some debate over whether or not it is a SARMSproduct.

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test