Shoulder Arm Hand — Anatomy Lab for Acupuncturists

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Precise knowledge of clinical anatomy and kinesiology, and orthopedic/myofascial palpation and inspection, and movement analysis skills, are all essential foundations for diagnosis, and for determining where--and where not--to needle.

This unique class prepares students to get the most from the Shoulder Arm Hand module & Review/Practicum Lab.

Clinical anatomy and the jing-jin ("sinew meridians" or myofascial tracts)

• We will improve our abilities to accurately locate key bony landmarks, muscles, tendons, joints, neural and vascular tissues, through palpation on ourselves and each other, and through review of clinical anatomy.
• Through palpation, observation and movement exercises, we will explore functions of key muscles and their jing-jin associations, as well as functional vs. dysfunctional movement patterns.
• We will review safety considerations, including needling angle and depth, to avoid injuring the many critical structures in this body region.

Enhanced orthopedic palpation and inspection skills

• We will enhance our abilities to feel different tissue types and layers: skin, fascia, muscle, nerve, blood vessel, and bone, with both our hands and needle-tip sensation.
• We will practice inspection and palpation for tissue abnormalities including myofascial trigger points, tendinopathies and joint disorders.

Review of anatomical structure and kinesiologic function

Shoulder Girdle

• Bony landmarks: be able to locate by palpation; know which muscles attach to them, if applicable
  • Clavicle
  • Scapula
    • Medial and lateral borders
    • Scapular spine and supraspinous fossa
    • Acromion
    • Coracoid process
  • Head and neck of humerus
    • Greater tubercle
    • Lesser tubercle
    • Deltoid tubercle
    • Bicipital groove
    • Radial sulcus
• 3 true synovial joints: be able to find the joint lines and ligaments by palpation
  • Gleno-humeral (GH): the shoulder joint proper.
    • Joint line: anterior, superior, posterior
  • Sterno-clavicular (SC): the sole point of attachment of the arm to the axial skeleton.
    • Joint line: anterior, superior
  • Acromio-clavicular (SC): attaches the clavicle to the scapula, and allows for rotation of the clavicle during scapular motion.
    • Joint line: anterior, lateral, superior
    • Be able to distinguish AC joint line from the superior aspect of the GH jointline by palpation
    • Coraco-clavicular ligaments
  • (The “scapulo-thoracic joint:” the scapula moves on the thorax and functions like a joint, but is a structurally a myofascial tissue plane, not a true joint.)

• Myofascial structures that move and stabilize the scapula and humerus, extending from the thoraco-lumbar fascia, lower trapezius, and latissimus dorsi, to cervical spine and occiput, to sternum, clavi-pectoral fascia and upper ribs, to the elbow joint and proximal forearm. Be able to locate by palpation; know attachments and primary functions
  • Rotator cuff
    • Core: supraspinatus, infraspinatus, teres minor, subscapularis
    • Accessory: long heads of biceps and triceps
  • Scapular movers and stabilizers
    • Pectoralis minor
    • Serratus anterior
    • Rhomboids
    • Trapezius: all three divisions
  • Arm movers
    • Biceps brachii, including bicipital tendon and transverse humeral ligament
    • Triceps brachii
    • Coracobrachialis
    • Pectoralis major divisions
    • Latissimus dorsi
    • Teres major
    • Deltoids: anterior, medial, posterior

• Neurovascular tracts and critical structures. Be able to locate by palpation

• • Subclavian artery
  • Brachial artery
  • Brachial plexus
  • (Lungs, relative to above structures; obviously, we don’t palpate these!)

Upper Arm and Elbow

• Bony landmarks: be able to locate by palpation; know which muscles attach to them, if applicable
  • Medial epicondyle
  • Olecranon
  • Lateral epicondyle
  • Radial head

• Joints: be able to find the joint lines and ligaments by palpation
  • Radio-humeral and radio-capitellar joints
  • Ulnar-humeral joint

• Myofascial structures that move and stabilize the elbow. Be able to locate by palpation; know attachments and primary functions

• • • Elbow flexors and extensors
      • Biceps brachii and aponeurosis
      • Brachialis
      • Brachioradialis
      • Triceps heads

• Neurovascular tracts and critical structures. Know pathways and be able to locate by palpation where superficial

• • Brachial neurovascular bundle (medial upper arm)

Forearm, Wrist, Hand, and Fingers

• Bony landmarks: be able to locate by palpation; know which muscles attach to them, if applicable
  • Radial styloid
    • Ulnar styloid
• Joints: be able to find the joint lines and ligaments by palpation
  • Wrist
    • Radio-carpal joint
    • Ulnar-carpal joint
    • Distal radio-ulnar joint
    • 1st carpo-metacarpal joint

• • Fingers
    • Metacarpo-phalangeal joint
    • Proximal interphalangeal joints
    • Distal interphalangeal joints

• Myofascial structures that move and stabilize the forearm, wrist and fingers. Be able to locate by palpation; know attachments and primary functions; know which are mono- vs. poly-articular muscles
  • Forearm
    • Supinator
    • Pronators teres and quadratus

• • Wrist and finger extensors
    • Extensors carpi radialis longus and brevis
    • Extensor digitorum
    • Extensors carpi ulnaris

• • Wrist and finger flexors
    • Flexors carpi ulnaris, radialis
    • Flexor digitorum superficialis and profundus
    • Flexor pollicis longus
    • Palmaris longus

• • Thumb
    • Abductor, adductor and opponens pollicis

• Neurovascular tracts and critical structures. Know pathways and be able to locate by palpation where superficial
  • Median nerve
  • Ulnar nerve
  • Radial nerve
  • Radial artery