Dooley Noted: 6/7/16
Four common movement compensators have an attachment to the coracoid process of the scapula:
1. Pectoralis Minor (PMin)
2. Coracobrachialis (CB)
3. Short Head, Biceps Brachii (SHBB)
4. Occasionally, a tendinous slip from subclavius (Subc)
These muscles have a typical axis of dominance, even though they exhibit multiplanar capabilities on the joints they cross. Look for these clinically dysfunctions and their primary coracoid presentations:
1. PM: primarily dysfunctional (overpowering) in protraction
2. CB: primarily dysfunctional in shoulder flexion, especially when coupled with horizontal adduction
3. SHBB: primarily dysfunctional in elbow flexion
4. Subc: primarily dysfunctional in clavicular depression (lowered shoulder girdle)
For palpation of these structures, make note of these helpful tips:
1. PM: palpate medial to coracoid, connecting muscle belly to ribs 3-5. Go deep to pectoralis major by letting fingers sink deep and medial to coracoid.
2. CB: Palpate the flat upper tendon of SHBB, inferior and slightly lateral to coracoid. CB is found medial and deep to that tendon, starting at mid-humeral shaft.
3. SHBB: Palpate the biceps brachii joint belly and stay medial as you trace towards toward the coracoid. Remember that the long head stays lateral in the IT Sulcus, while SH goes medial and has a broad, flat tendon attaching to coracoid from its lateral side.
4. SubC: Going deep to pectoralis major, palpate directly underneath the clavicle along its length, feeling for a slight tendinous insertion and some people from the SubC onto the medial and superior aspect of the coracoid.
Each of these four muscles can pull the coracoid towards the opposite attachment.
Below is a list of muscles commonly seen in my practice to be down-regulated in motor recruitment by their respective facilitator (movement dominator):
1. PM: shoulder retractors (esp. rhomboid), latissimus, upper serratus anterior
2. CB: LH biceps, posterior deltoid, latissimus
3. SHBB: LH biceps, LH triceps
4. SubC: pectoralis major, lower fibers serratus anterior, lower trapezius
When analyzing which muscle to prioritize, look to their respective typical effects on the scapulothoracic joint.
Since the coracoid is wired to fall with gravity towards the midline, consider first the antagonists of the respected facilitator.
By down-regulating the recruitment of the facilitator, the opportunity can arise to coach the missing motor control component of scapulothoracic movement.
I hope you find this tips helpful!
As always, it’s your call.
– Dr. Kathy Dooley