Shoulder

Question 1

List 4 taught points in the shoulder and describe their location

Answer 1

Shoulder points

1. LI15

With the arm abducted, identify the anterior tip of the acromion. To locate the point, slide down into the depression/dimple between the anterior and middle fibers of the deltoid. If patient is unable to abduct to 90 ° the point may be located with the arm by the side.

2. TE14

With the arm abducted, identify the posterior tip of the acromion. To locate the point, slide down into the depression/dimple between the posterior and middle fibers of the deltoid.

3. SI11

Midway on the line connecting the midpoint of the upper margin of the spine of the scapula (SI 12) and the inferior angle of the scapula. Alternatively, locate the point at the junction of the upper one third and lower two thirds on the line connecting the midpoint of the lower margin of the spine of the scapula and the inferior angle of the scapula.

4. SI12

In the supraspinous fossa, directly above the midpoint of the spine of the scapula

Question 2

LI15 location and needling technique

• Location
• Insertion
• Depth

Answer 2

LI15 location and needling technique

Location

With the arm abducted, identify the anterior tip of the acromion. To locate the point, slide down into the depression/dimple between the anterior and middle fibers of the deltoid. If patient is unable to abduct to 90 ° the point may be located with the arm by the side.

Insertion

intra-articular, toward the midpoint of the axilla (HT1)

Depth

1-1.5 cun

Question 3

Describe relevant LI15 anatomy

• Muscles (2)
• Nerves (1; deeper - 1)
• Vessels (2)

Answer 3

LI15 anatomy

Muscles

1. deltoid
2. rotator cuff when the arm is hanging down

Nerves

1. supraclavicular nerve (C3 and C4) in the skin
   * Deeper:*
2. anterior branch of the axillary nerve (C5, 6)

Vessels

1. & 2. Anterior circumflex humeral artery and vein

Question 4

List 5 neuroanatomical LI15 indications

Answer 4

LI15 indications

1. pain and inflammation anywhere in the shoulder joint, ligaments and tendons
2. subdeltoid bursitis
3. arthritis
4. capsulitis
5. tendonitis

Question 5

TE14 location and needling technique

• Location
• Insertion
• Depth

Answer 5

TE14 location and needling technique

Location

With the arm abducted, identify the posterior tip of the acromion. To locate the point, slide down into the depression/dimple between the posterior and middle fibers of the deltoid.

Insertion

Intra-articular, toward the midpoint of the axilla (HT 1)

Depth

1-1.5 cun

Question 6

Describe relevant TE14 anatomy

• Muscles (3)
• Nerves (3)
• Vessels (2)

Answer 6

TE14 anatomy

Muscles

1. deltoid
2. teres minor
3. rotator cuff (with arm in anatomical position)

Nerves

1. supraclavicular nerve
2. superior lateral brachial cutaneous nerve
3. posterior branch of the axillary nerve

Vessels

1. & 2. posterior circumflex humeral artery and vein

Question 7

List 5 neuroanatomical TE14 indications

Answer 7

TE14 indications

1. pain and inflammation of the shoulder joint, ligaments tendon and fascia
2. subdeltoid bursitis
3. arthritis
4. capsulitis
5. tendonitis

Question 8

SI11 location and needling technique

• Location
• Insertion
• Depth

Answer 8

SI11

Location

Midway on the line connecting the midpoint of the upper margin of the spine of the scapula (SI 12) and the inferior angle of the scapula. Alternatively, locate the point at the junction of the upper one third and lower two thirds on the line connecting the midpoint of the lower margin of the spine of the scapula and the inferior angle of the scapula.

Insertion

Oblique, medial to lateral and inferior to superior (towards the glenohumeral joint).

Nb. Deep needling on an osteoporotic scapula could produce pneumothorax.

Depth

0.5 - 1 cun

Question 9

Describe relevant SI11 anatomy

• muscles (1)
• nerves (1)
• vessels (4)

Answer 9

SI11 anatomy

Muscles

1. infraspinatus

Nerves

1. lower branch of the suprascapular nerve

Vessels

1. & 2. suprascapular artery and vein
2. & 4. circumflex scapular artery and vein

Question 10

List 3 neuroanatomical SI11 indications

Answer 10

SI11 indications

1. myofascial pain/inflammation of infraspinatus
2. impaired external rotation of the shoulder
3. trigger points in infraspinatus could limit internal rotation

Question 11

SI12 location and needling technique

• Location
• Insertion
• Depth

Answer 11

SI12 location and needling technique

Location

In the supraspinous fossa, directly above the midpoint of the spine of the scapula

Insertion

Aim towards the floor of the suprapinous fossa, down into the supraspinatus muscle.

Caution: Perpendicular insertion, posterior to anterior may cause Pneumothorax

Depth

0.5-1 cun

Question 12

Describe relevant SI12 anatomy

• Muscles (2)
• Nerves (1; deeper - 1)
• Vessels (2)

Answer 12

SI12 anatomy

Muscles

1. Trapezius
2. Supraspinatus

Nerves

1. supraclavicular nerve in the skin C3, 4
   * Deeper*
2. suprascapular nerve C5, 6

Vessels

1. & 2. supraclavicular artery and vein

Question 13

List 4 neuroanatomical SI12 indications

Answer 13

SI12 indications

1. Supraspinatus myofascial pain/strain
2. Supraspinatus tendonitis
3. Impaired shoulder abduction
4. Stiff neck, pain in the scapular region