Deltoid: Difference between revisions

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== Description  ==
== Description  ==
[[File:Muscles connecting the upper limb to the trunk anterior aspect Primal.png|thumb|'''Deltoid''' ]]
[[File:Muscles connecting the upper limb to the trunk anterior aspect Primal.png|'''Deltoid''' |alt=|right|frameless]]
The Deltoid muscle is a large triangular shaped muscle which lies over the [[Glenohumeral Joint|glenohumeral joint]] and which gives the [[shoulder]] its rounded contour. It&nbsp;is named after the Greek letter delta, which is shaped like an equilateral triangle. It comprises 3 distinct portions each of which produces a different movement of the glenohumeral joint, commonly named the anterior, mid (or lateral) and posterior heads.
The Deltoid muscle is a large triangular-shaped muscle that lies over the [[Glenohumeral Joint|glenohumeral joint]] and which gives the [[shoulder]] its rounded contour.


== Anatomy  ==
* It is comprised of three distinct portions (anterior or clavicular, middle or acromial, and posterior or spinal)
<div class="flex-row row">
* Acts mainly as an abductor of the shoulder and stabiliser of the humeral head. as well as assists in forward elevation<ref name=":1">Moser T, Lecours J, Michaud J, Bureau NJ, Guillin R, Cardinal É. [https://pubmed.ncbi.nlm.nih.gov/23784480/ The deltoid, a forgotten muscle of the shoulder.] Skeletal radiology. 2013 Oct;42(10):1361-75.Available:https://pubmed.ncbi.nlm.nih.gov/23784480/ (accessed 5.1.2022)</ref>.
<div class="col-xs-12 col-md-6 col-lg-6">[[Image:Deltoid muscle Wikipedia.png|250px]][[Image:Deltoid Muscle top9.png|250px]]<br>
* The deltoid is a very powerful muscle and is used in many [[Activities of Daily Living|ADLs]] (eg putting clothes online, carrying shopping bags, washing hair) and many athletic activities. (eg netball, [[Swimming: Freestyle|swimming]], water polo).<ref>Sports MD [https://www.sportsmd.com/sports-injuries/shoulder-injuries/deltoid-strain/ Deltoid strain] Available: https://www.sportsmd.com/sports-injuries/shoulder-injuries/deltoid-strain/<nowiki/>(accessed 5.1.2021)</ref>
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=== Origin ===
Image 1: Deltoid Muscle overlying shoulder complex.  


'''Anterior Fibres/Head'''


Lateral third, Anterior Surface of the Clavicle (close to the lateral fibres of pectoralis major).


'''Mid/Lateral Head'''
== Anatomy  ==
=== Origin  ===


Acromion Process, Superior Surface.  
# [[File:Deltoid_muscle_Wikipedia.png|alt=|right|250x250px]]'''Anterior Fibres/Head:''' Lateral third, Anterior Surface of the [[Clavicula|Clavicle]] (close to the lateral fibres of [[pectoralis major]]).
 
# '''Mid/Lateral Head:''' [[Acromioclavicular Joint|Acromion]] Process scapula, Superior Surface.
'''Posterior Head'''  
# '''Posterior Head:''' Spine of the [[Scapula]], Posterior Border.
 
Spine of the [[Scapula]], Posterior Border.  


=== Insertion  ===
=== Insertion  ===


Fibres from all heads converge to insert into the deltoid tuberosity on the humerus.  
* [[File:Deltoid_Muscle_top9.png|alt=|right|250x250px]]Fibres from all heads converge to insert into the deltoid tuberosity on the [[humerus]].
 
* The deltoid [[fascia]] is continuous with&nbsp; the brachial fascia and connects to the medial and lateral intermuscular septa<ref>Rispoli, Damian M.; Athwal, George S.; Sperling, John W.; Cofield, Robert H. (2009). "The anatomy of the deltoid insertion". J Shoulder Elbow Surg 18: 386–390</ref>.
The deltoid fascia is continuous with&nbsp;the brachial fascia and connects to the medial and lateral intermuscular septa<ref>Rispoli, Damian M.; Athwal, George S.; Sperling, John W.; Cofield, Robert H. (2009). "The anatomy of the deltoid insertion". J Shoulder Elbow Surg 18: 386–390</ref>.  


=== Nerve Supply  ===
=== Nerve Supply  ===


Axillary Nerve, C5 &amp; 6, posterior cord of the [[brachial plexus]].  
[[Axillary Nerve Injury|Axillary Nerve]], C5 &amp; 6, posterior cord of the [[Brachial Plexus|brachial plexus]].  


=== Blood Supply  ===
=== Blood Supply  ===


Deltoid receives its blood supply from the&nbsp;posterior circumflex humeral artery.  
Deltoid receives its [[blood]] supply from the&nbsp; posterior circumflex humeral artery.  


== Function  ==
== Function  ==
[[File:Water polo.jpeg|right|frameless]]
An important function of the deltoid is the stabilisation of the shoulder joint preventing subluxation or even dislocation of the head of the humerus, particularly when carrying a load.&nbsp; Deltoid is the prime mover of shoulder abduction.
[[File:Suitcase.jpeg|right|frameless]]
All heads of the deltoid work together to produce abduction of the Shoulder Joint.&nbsp; It helps lift the arm front, side, and backward. Deltoid pain can affect anyone who does repetitive overhead activities eg house painters, swimmers, Waterpolo players, and pitchers. It also is active with carrying objects eg suitcases or reaching up for objects, to prevent subluxation/dislocation.


An important function of deltoid is the prevention of subluxation or even dislocation of the head of the humerus particularly when carrying a load.&nbsp;Deltoid is the prime mover of shoulder abduction.
The deltoid compensates for the loss of strength in the rotator cuff.  
 
=== Actions&nbsp;  ===
 
All heads of deltoid work together to produce abduction of the Shoulder Joint.&nbsp;In addition, each individual head produces the following:
 
'''Anterior Fibres'''
 
*<span style="line-height: 1.5em;">Flexes, abducts, medially rotates, and horizontally flexes the arm at the shoulder joint</span>
 
'''Posterior Fibres'''
 
*Extends, abducts, laterally rotates, and horizontally extends the arm at the shoulder joint.
{{#ev:youtube|https://youtu.be/FSSGkYrYwqM|width}}<ref>Availble from: [https://www.kenhub.com/ Kenhub-Learn Human Anatomy]
https://youtu.be/FSSGkYrYwqM.Kenhub-Learn Human Anatomy.Deltoid Muscle:Origin,Insertion&Action-Human Anatomy|Kenhub{last accessed 29 April 2020}</ref>


Images 4 and 5: Deltoids in action in water polo; in carrying deltoid prevent subluxation of the shoulder joint.
== Clinical Relevance ==
== Clinical Relevance ==
In case of patients suffering from Subacromial bursitis, there occurs impingement of deltoid muscle below the acromion process when the arm is hanging by the side leading to pain. Moreover, there occurs no pain while performing abduction movement of the arm due to vanishing of bursa under the acromion process. Subacromial or Subdeltoid bursitis is commonly seen secondary to supraspinatus tendonitis.<ref name=":0">Chaurasia BD. [https://www.pdfdrive.com/bd-chaurasia-books.html Human Anatomy Regional and Applied Dissection and Clinical]. Vol 1. CBS Publishers and Distributors Pvt Ltd, 2010</ref>
[[File:Shoulder Pain.png|right|frameless]]
Deltoid pathologies can lead to functional disfunction of the shoulder complex


During dislocation of the shoulder or fracture of surgical neck of the humerus, there occurs damage to axillary nerve. Moreover, the damage to axillary nerve leads to  paralysis of deltoid muscle, where the examiner ask the patient to abduct the arm to 90 degrees and the resistance will be provided. There occurs no contraction of the muscle during abduction and there will be complete loss of strength up to 90 degrees of shoulder abduction. Apart from that, there will be loss of sensation over the lower halves of the deltoid in a badge like area known as regimental badge.<ref name=":0" />
* Tears are not infrequently associated with large or massive rotator cuff tears and may further jeopardize shoulder function.
 
* Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction.<ref>Dyrna F, Kumar NS, Obopilwe E, Scheiderer B, Comer B, Nowak M, Romeo AA, Mazzocca AD, Beitzel K. [https://pubmed.ncbi.nlm.nih.gov/29741391/ Relationship between the deltoid and rotator cuff muscles during dynamic shoulder abduction: a biomechanical study of rotator cuff tear progression.] The American journal of sports medicine. 2018 Jul;46(8):1919-26.Available: https://pubmed.ncbi.nlm.nih.gov/29741391/<nowiki/>(accessed 5.1.2022)</ref>
Intramuscular injections are often given to the deltoid muscle. It should be provided to the middle of the deltoid to avoid injury to the axillary nerve.<ref name=":0" /> 
* A variety of other pathologies may affect the deltoid muscle including enthesitis, calcific tendinitis, myositis, infection, tumors, and chronic avulsion injury.  
 
* The deltoid muscle and its innervating axillary nerve may be injured during shoulder surgery, which may have disastrous functional consequences.
== Trigger Point Referal Patterns  ==
* Axillary neuropathies lead to deltoid muscle dysfunction and cause denervation of the deltoid muscle.
 
* Abnormalities of the deltoid may originate from nearby pathologies of the subdeltoid bursa, acromion, and distal clavicle.<ref name=":1" />  
<div class="flex-row row">
* During dislocation of the shoulder or fracture of surgical neck of the humerus axillary nerve may be injured. The [[Axillary Nerve Injury|damage to axillary nerve]] leads to paralysis of the deltoid muscle.<ref name=":0">Chaurasia BD. [https://www.pdfdrive.com/bd-chaurasia-books.html Human Anatomy Regional and Applied Dissection and Clinical]. Vol 1. CBS Publishers and Distributors Pvt Ltd, 2010</ref><br>
<div class="col-xs-12 col-md-6 col-lg-6">[[Image:Deltoid 1.jpg|350px]]<br>
== Palpation ==
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<div class="col-xs-12 col-md-6 col-lg-6">[[Image:Deltoid 2.jpg|350px]]<br>
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== Techniques  ==
 
=== Palpation ===
 
Flex elbow to 90 degrees and have patient abduct the shoulder against resistance.<br>
 
'''Anterior Fibers'''
 
*Deltoid palpated with elbow extended, shoulder 90 degrees abduction and then resist horizontal adduction.
 
'''Posterior Fibers'''
 
*Position same as above and then resist horizontal abduction.


* Flex elbow to 90 degrees and have the patient abduct the shoulder against resistance.
* Anterior Fibers: Deltoid palpated with the elbow extended, shoulder 90 degrees abduction, and then resist horizontal adduction.
* Posterior Fibers: Position same as above and then resist horizontal abduction.
=== Length Tension Testing  ===
=== Length Tension Testing  ===


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==== Length Tension Testing for Anterior Deltoid- ====
==== Length Tension Testing ====
* The position of patient will be high sitting
Anterior Deltoid- The position of the patient will be high sitting
* Mark the origin and insertion of anterior deltoid on patient's shoulder by palpating from 1/3rd of clavicle to deltoid tuberosity  for better understanding
* The therapist will be standing behind the patient holding the testing shoulder
* The therapist will be standing behind the patient holding the testing shoulder  
* The primary function of the anterior deltoid is flexion, internal rotation, and horizontal adduction, to stretch this muscle, reverse the action by extension, external rotation, and horizontal abduction shoulder, without letting the torso rotate
* The primary function of anterior deltoid is flexion, internal rotation and horizontal adduction
* While performing extension and external rotation, place your one hand on the patient forearm and with the other hand push the shoulder anteriorly from posterior, thereby lengthening the muscle
* In order to stress this muscle and to check for length test, we are going reverse the action by extension, external rotation and horizontal abduction without letting the torso rotate
Posterior Deltoid- The position of the patient will be high sitting
* While performing extension and external rotation, place your one hand on the patient forearm and with the other hand push the shoulder anterior from posterior thereby lengthening the muscle
* The therapist will be standing in front of the patient initially and moving back to the patient later for a better length assessment
 
* The primary function of the posterior deltoid is extension, external rotation, and horizontal abduction, to stretch this muscle, reverse the action by flexion, internal rotation, and horizontal adduction shoulder joint.
==== Length Tension Testing for Posterior Deltoid ====
* While performing flexion, internal rotation, and horizontal adduction, place one hand on the patient's shoulder and the other hand on the patient's forearm
* The position of patient will be high sitting
* Alternatively, perform flexion, internal rotation, and horizontal adduction shoulder by bringing the patient's shoulder against the chest and the therapist moving to the back of the patient by holding the patient's shoulder and forearm, lengthening the muscle.
* Mark the origin and insertion of posterior deltoid on patient's shoulder by palpating the spine of scapula to deltoid tuberosity for better understanding
* The therapist will be standing in front of the patient initially and moving back to the patient later for better length assessment  
* The primary function of posterior deltoid is extension, external rotation and horizontal abduction
* In order to stress this muscle and to check for length test, we are going to reverse the action by flexion, internal rotation and horizontal adduction  
* While performing flexion, internal rotation and horizontal adduction, place your one hand on the patient's shoulder and the other hand on patient's forearm  
* Moreover, if we want to, perform flexion, internal rotation and horizontal adduction by bringing the patient's shoulder against the chest and therapist moving to the back of the patient by holding the patient's shoulder and forearm thereby lengthening the muscle.  
 
== Treatment  ==


Exercises:<ref>Shoulderdoc.co.uk. Available from:https://www.shoulderdoc.co.uk/article/1028 (accessed 10 Nov 2020). </ref>&nbsp;
== Exercises ==
[[File: Shoulder Diagonal PNF with band.png|right|frameless]]
The following deltoid strengthening exercises are designed to improve the strength of the deltoid muscles


'''Supine active assisted:'''
Isometric Deltoid Contraction


Lie down flat on your back, with a pillow supporting your head.<br>Bend your elbow as far as possible. Then raise your arm to 90 degrees vertical, using the stronger arm to assist if necessary. Once you have got to 90 degrees, you can straighten your elbow. Hold your arm in this upright position with its own strength. <br>  
* Standing next to a wall with back and elbow straight. Gently push the arm to the side against the wall as hard as possible and comfortably without pain. Hold for 5 seconds and repeat 10 times on each side provided it is pain-free.<ref>Shoulderdoc.co.uk. Available from:https://www.shoulderdoc.co.uk/article/1028 (accessed 10 Nov 2020). </ref>&nbsp;


'''Circles''': Slowly with your fingers, wrist and elbow straight move the arm in small circular movements clockwise and counterclockwise. Gradually increase the circle as comfortable (this may take a few weeks to increase to bigger and bigger circles).
Progress


'''Progress to light weight:'''
* Suitable dumbbell weight,  arm raises anterior, lateral, and posterior. Repeat 10 times on each side provided it is pain-free
* Resistance Band Forward Raises, lateral raises, and pullbacks. Repeat 10 times on each side provided it is pain free<ref>Physio advisor [https://www.physioadvisor.com.au/exercises/strengthening-muscles/deltoid-shoulders/ Deltoid Strengthening Exercises] Available: https://www.physioadvisor.com.au/exercises/strengthening-muscles/deltoid-shoulders/<nowiki/>(accessed 6.1.2022)</ref>


As you get more confidence in controlling your shoulder movement, a lightweight e.g. a tin of beans or small paperweight, should be held in the affected hand.
Further progress


'''Progress to sitting and standing:'''
* Lots of variations.  eg  Shoulder Diagonal PNF with a band; [[Compound Exercises|compound exercises]] eg forward arm raises with squats; high side [[Plank exercise|plank]] walking.


Having more confidence in controlling your shoulder movement gradually go from lying down to sitting and eventually standing. <br>At this stage you may recline the head of your bed or put some pillows underneath your back to recline your position.<br>Repeat the same exercise again, this time against some gravity.<br>Start again from holding your arm in the upright position with its own strength.<br>Start first without any weights and progress to use the same lightweight you used before in the lying down position.  
Image: Shoulder Diagonal PNF with a band.


'''Resisted exercise:'''
== Resources  ==


For re-education of concentric contracture of the deltoid muscle.<br>Make a fist with the hand of the affected side. The flat hand of the opposite side is providing resistance. Push your affected side hand against resistance from the other hand. Whilst doing this, you will notice that you can fully elevate your arm (above your head).<br>Repeat these exercises in order to ‘learn’ and re-educate your Deltoid muscle to perform this ‘concentric contracture’ even without pushing against your other arm.
This video covers the anatomy of the deltoid in great detail <ref > Deltoid muscle video -  © Kenhub https://www.kenhub.com/en/library/anatomy/the-deltoid-muscle</ref>
{{#ev:youtube|FSSGkYrYwqM}}


== References  ==
== References  ==

Latest revision as of 19:02, 8 March 2024

Original Editor - Wendy Walker

Lead Editors - Lucinda hampton, Wendy Walker, Naomi O'Reilly, Sai Kripa, Joao Costa, Chrysolite Jyothi Kommu, Andeela Hafeez, Kim Jackson, Vidya Acharya, WikiSysop, Aminat Abolade, Admin, Evan Thomas, George Prudden, Uchechukwu Chukwuemeka and Wanda van Niekerk  

Description[edit | edit source]

The Deltoid muscle is a large triangular-shaped muscle that lies over the glenohumeral joint and which gives the shoulder its rounded contour.

  • It is comprised of three distinct portions (anterior or clavicular, middle or acromial, and posterior or spinal)
  • Acts mainly as an abductor of the shoulder and stabiliser of the humeral head. as well as assists in forward elevation[1].
  • The deltoid is a very powerful muscle and is used in many ADLs (eg putting clothes online, carrying shopping bags, washing hair) and many athletic activities. (eg netball, swimming, water polo).[2]

Image 1: Deltoid Muscle overlying shoulder complex.


Anatomy[edit | edit source]

Origin[edit | edit source]

  1. Anterior Fibres/Head: Lateral third, Anterior Surface of the Clavicle (close to the lateral fibres of pectoralis major).
  2. Mid/Lateral Head: Acromion Process scapula, Superior Surface.
  3. Posterior Head: Spine of the Scapula, Posterior Border.

Insertion[edit | edit source]

  • Fibres from all heads converge to insert into the deltoid tuberosity on the humerus.
  • The deltoid fascia is continuous with  the brachial fascia and connects to the medial and lateral intermuscular septa[3].

Nerve Supply[edit | edit source]

Axillary Nerve, C5 & 6, posterior cord of the brachial plexus.

Blood Supply[edit | edit source]

Deltoid receives its blood supply from the  posterior circumflex humeral artery.

Function[edit | edit source]

Water polo.jpeg

An important function of the deltoid is the stabilisation of the shoulder joint preventing subluxation or even dislocation of the head of the humerus, particularly when carrying a load.  Deltoid is the prime mover of shoulder abduction.

Suitcase.jpeg

All heads of the deltoid work together to produce abduction of the Shoulder Joint.  It helps lift the arm front, side, and backward. Deltoid pain can affect anyone who does repetitive overhead activities eg house painters, swimmers, Waterpolo players, and pitchers. It also is active with carrying objects eg suitcases or reaching up for objects, to prevent subluxation/dislocation.

The deltoid compensates for the loss of strength in the rotator cuff.

Images 4 and 5: Deltoids in action in water polo; in carrying deltoid prevent subluxation of the shoulder joint.

Clinical Relevance[edit | edit source]

Shoulder Pain.png

Deltoid pathologies can lead to functional disfunction of the shoulder complex

  • Tears are not infrequently associated with large or massive rotator cuff tears and may further jeopardize shoulder function.
  • Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction.[4]
  • A variety of other pathologies may affect the deltoid muscle including enthesitis, calcific tendinitis, myositis, infection, tumors, and chronic avulsion injury.
  • The deltoid muscle and its innervating axillary nerve may be injured during shoulder surgery, which may have disastrous functional consequences.
  • Axillary neuropathies lead to deltoid muscle dysfunction and cause denervation of the deltoid muscle.
  • Abnormalities of the deltoid may originate from nearby pathologies of the subdeltoid bursa, acromion, and distal clavicle.[1]
  • During dislocation of the shoulder or fracture of surgical neck of the humerus axillary nerve may be injured. The damage to axillary nerve leads to paralysis of the deltoid muscle.[5]

Palpation[edit | edit source]

  • Flex elbow to 90 degrees and have the patient abduct the shoulder against resistance.
  • Anterior Fibers: Deltoid palpated with the elbow extended, shoulder 90 degrees abduction, and then resist horizontal adduction.
  • Posterior Fibers: Position same as above and then resist horizontal abduction.

Length Tension Testing[edit | edit source]

Length Tension Testing[edit | edit source]

Anterior Deltoid- The position of the patient will be high sitting

  • The therapist will be standing behind the patient holding the testing shoulder
  • The primary function of the anterior deltoid is flexion, internal rotation, and horizontal adduction, to stretch this muscle, reverse the action by extension, external rotation, and horizontal abduction shoulder, without letting the torso rotate
  • While performing extension and external rotation, place your one hand on the patient forearm and with the other hand push the shoulder anteriorly from posterior, thereby lengthening the muscle

Posterior Deltoid- The position of the patient will be high sitting

  • The therapist will be standing in front of the patient initially and moving back to the patient later for a better length assessment
  • The primary function of the posterior deltoid is extension, external rotation, and horizontal abduction, to stretch this muscle, reverse the action by flexion, internal rotation, and horizontal adduction shoulder joint.
  • While performing flexion, internal rotation, and horizontal adduction, place one hand on the patient's shoulder and the other hand on the patient's forearm
  • Alternatively, perform flexion, internal rotation, and horizontal adduction shoulder by bringing the patient's shoulder against the chest and the therapist moving to the back of the patient by holding the patient's shoulder and forearm, lengthening the muscle.

Exercises[edit | edit source]

Shoulder Diagonal PNF with band.png

The following deltoid strengthening exercises are designed to improve the strength of the deltoid muscles

Isometric Deltoid Contraction

  • Standing next to a wall with back and elbow straight. Gently push the arm to the side against the wall as hard as possible and comfortably without pain. Hold for 5 seconds and repeat 10 times on each side provided it is pain-free.[6] 

Progress

  • Suitable dumbbell weight, arm raises anterior, lateral, and posterior. Repeat 10 times on each side provided it is pain-free
  • Resistance Band Forward Raises, lateral raises, and pullbacks. Repeat 10 times on each side provided it is pain free[7]

Further progress

  • Lots of variations. eg Shoulder Diagonal PNF with a band; compound exercises eg forward arm raises with squats; high side plank walking.

Image: Shoulder Diagonal PNF with a band.

Resources[edit | edit source]

This video covers the anatomy of the deltoid in great detail [8]

References[edit | edit source]

  1. ↑ 1.0 1.1 Moser T, Lecours J, Michaud J, Bureau NJ, Guillin R, Cardinal É. The deltoid, a forgotten muscle of the shoulder. Skeletal radiology. 2013 Oct;42(10):1361-75.Available:https://pubmed.ncbi.nlm.nih.gov/23784480/ (accessed 5.1.2022)
  2. ↑ Sports MD Deltoid strain Available: https://www.sportsmd.com/sports-injuries/shoulder-injuries/deltoid-strain/(accessed 5.1.2021)
  3. ↑ Rispoli, Damian M.; Athwal, George S.; Sperling, John W.; Cofield, Robert H. (2009). "The anatomy of the deltoid insertion". J Shoulder Elbow Surg 18: 386–390
  4. ↑ Dyrna F, Kumar NS, Obopilwe E, Scheiderer B, Comer B, Nowak M, Romeo AA, Mazzocca AD, Beitzel K. Relationship between the deltoid and rotator cuff muscles during dynamic shoulder abduction: a biomechanical study of rotator cuff tear progression. The American journal of sports medicine. 2018 Jul;46(8):1919-26.Available: https://pubmed.ncbi.nlm.nih.gov/29741391/(accessed 5.1.2022)
  5. ↑ Chaurasia BD. Human Anatomy Regional and Applied Dissection and Clinical. Vol 1. CBS Publishers and Distributors Pvt Ltd, 2010
  6. ↑ Shoulderdoc.co.uk. Available from:https://www.shoulderdoc.co.uk/article/1028 (accessed 10 Nov 2020).
  7. ↑ Physio advisor Deltoid Strengthening Exercises Available: https://www.physioadvisor.com.au/exercises/strengthening-muscles/deltoid-shoulders/(accessed 6.1.2022)
  8. ↑ Deltoid muscle video - © Kenhub https://www.kenhub.com/en/library/anatomy/the-deltoid-muscle

  

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