Palpation of Bony Landmarks on Scapula
0:00
這是一個視頻演示，展示如何觸診肩胛骨的骨性標誌。演示是在右側進行的。
This is a video demo showing how to palpate the bony landmarks on the scapula. The demo is on right side.
0:07
肩胛骨有三個邊緣、三個角和三個凹槽。我們先觸診邊緣。
There are three borders, three angles and three fossa on the scapula. Let's palpate the borders first.
0:14
當你把病人的前臂放在下背部時，更容易找到內側邊緣。
It is easier to locate the medial border when you put your patient's forearm on low back.
0:20
肩胛骨的內側邊緣現在突起了。沿著整個內側邊緣向下觸診。
The medial border of scapula is sticking out now. Palpate along the whole medial border inferiorly.
0:27
哪些肌肉附著在上面？正確。是菱形肌和前鋸肌。
Which muscles are attached on it? Correct. It's rhomboids and serratus anterior.
0:33
從肩胛骨最底部尖的部分，沿著肩胛骨的外側邊緣向上觸診，朝向腋窩。
From the most inferior pointy part of scapula, palpate along the lateral border of the scapula superiorly and toward the axilla.
0:42
在觸診腋窩之前，別忘了獲得額外的同意。
Don't forget to get an extra consent before you palpate into the axilla.
0:46
有兩塊肌肉附著在外側邊緣。那些肌肉是什麼？
There are two muscles attached onto the lateral border. What are those muscles?
0:52
是的，大圓肌和小圓肌。隨著
Yes, teres major and minor. With
0:55
特定的同意，繼續沿著外側邊緣觸診，並在上層肌肉下方捲曲，找到它的最上方。
a specific consent, keep palpating along the lateral border and curl underneath the overlying muscles and locate the most superior aspect of it.
1:05
那是下盂結節。由於周圍組織和它的小尺寸，不容易清楚區分。
That is the infraglenoid tubercle. It is not easy to distinguish clearly due to the surrounding tissue and its small size.
1:13
下盂結節是肌肉的附著點。這是什麼？正確。
The infraglenoid tubercle is an attachment site for a muscle. What is it? Correct.
1:19
它是肱三頭肌長頭的附著點。回到內側邊緣。
It is for the long head of triceps muscle. Go back to the medial border.
1:25
沿著上方觸診到尖的部分，越過峰頂，沿著外側邊緣觸診。
Palpate along superiorly now to the pointy part and pass the peak and palpate along the superior border laterally.
1:32
這有點挑戰，因為它位於厚肌肉，斜方肌的深處。
It is a bit challenging because it is deep to the thick muscle, trapezius.
1:37
如果你能找到所有邊緣，那麼感覺角度就容易了。
If you are able to locate all borders, then it is easy to feel for the angles.
1:43
再次找到內側邊緣，並向下觸診。
Locate the medial border again, and palpate along inferiorly.
1:47
在移動到外側邊緣之前，最底部的部分是下角。
The most inferior part of it before moving onto the lateral border is the inferior angle.
1:53
內側邊緣與上邊緣相交的地方是上角。
Where the medial border meets the superior border is the superior angle.
1:58
試著透過斜方肌觸診尖尖的上部。內側角在內側邊緣上。
Try to palpate the pointy top part through the trapezius. The medial angle is on the medial border.
2:05
你可能會注意到內側邊緣不是一條直線結構。
You may notice that the medial border is not a straight line structure.
2:10
在肩胛骨脊的內側端有一個三角形部分，這是肩胛骨的內側角。
It has a triangular part at the medial end of the spine of scapula, which is the medial angle of scapula.
2:16
沿著肩胛骨脊向內側觸診。它與內側邊緣相交的地方是內側角，也
Palpate along the spine of scapula medially. Where it meets the medial border is the medial angle, also
2:23
被稱為肩胛骨脊根部的兩個凹槽
known as the root of spine of scapula two fossa
2:27
位於肩胛骨的後側，一個
are on the posterior aspect of scapula one
2:30
位於肩胛骨脊的上方，因此稱為
is superior to the spine of scapula so it is called
2:33
肩胛骨的上棘窩，肩胛棘上肌位於此，另一個窩位於肩胛骨脊的下方，稱為肩胛棘下窩，您可以觸診到肩胛棘下肌。
supraspinous fossa where the supraspinatus muscle sits the other fossa is inferior to the spine of scapula it is called the infraspinous fossa and you can palpate the infraspinatus.
2:46
沿著肩胛骨脊從根部向外觸診。您可以找到肩胛骨脊的結節。
Palpate along the spine of scapula from its root laterally. You can locate the tubercle of spine of scapula.
2:53
它位於根部的外側，更靠近肩胛骨脊的下方，三角肌開始附著於肩胛骨脊上。
It is lateral to the root and on more on the inferior part of spine where the deltoid muscle begins to be attached onto the spine.
3:01
繼續沿著肩胛骨脊觸診，您將到達肩峰，這是突出於肱骨頭上的部分。
Keep palpating along the spine and you end up being on the acromion, which is the part projecting over the head of the humerus.
3:10
另一個窩位於肩胛骨的前表面，稱為肩胛下窩，這是肩胛下肌的部位。
The other fossa is on the anterior surface of scapula which is called subscapular fossa and it is for subscapularis muscle.
3:18
由於肋骨和肩胛骨之間的空間狹窄，觸診此窩有點挑戰。
The fossa is a bit challenging to palpate due to the narrow space between the ribcage and the scapula.
3:24
讓您的病人仰臥或側臥。握住手臂，讓病人放鬆並外展手臂，這樣您可以隨著動作拉出肩胛骨。
Have your patient in supine or side lying. Hold onto the arm and have your patient relaxed and abduct the arm so that you can pull out the scapula along with the motion.
3:35
您應該獲得特定的同意來觸診此窩，因為您即將觸診到腋下，這可能會造成一些不適和癢感。
You should get a specific consent to palpate the fossa because you are about to palpate into the armpit and also it may create some discomfort and tickles.
3:43
在獲得同意後，嘗試用平坦、寬大的手觸診此窩。
After getting a consent, try to palpate the fossa with flat, broad hand.
3:49
用手的尺側邊緣推入可能比用手指尖更容易。
It may be easier to push into with your ulnar border of hand than with tip of fingers.
3:54
在肩胛骨的前表面，有喙突。
On the anterior aspect of scapula, there is the coracoid process.
3:59
觸診肩峰，然後向內移動到鎖骨的內側端。並向下觸診約一英寸。
Palpate the acromion and move medially onto the medial end of clavicle. And palpate inferiorly about an inch.
4:07
為了確認您在喙突上，而不是在小結節上，您可以將手臂向外和向內旋轉。
To confirm that you are on the coracoid process, not on the lesser tubercle, you can rotate the arm laterally and medially.
4:15
如果您的手指在骨性結構上保持靜止，您就在喙突上。
If your finger stays still in the bony structure, you are on the coracoid process.
4:21
如果您的手指隨著動作移動，您很可能在小結節上。
If your finger move along with the motion, you are most likely on the lesser tubercle.
4:26
但是，要小心只將手臂移動到內旋和外旋。
But, be careful to move the arm into only medial and lateral rotation.
4:30
如果您在旋轉的同時將手臂移動到外展，即使您在喙突上，您可能會感覺到骨性標誌的旋轉運動。
If you move the arm into abduction with the rotation, even though you are on the coracoid process, you may feel the rotatory movement of the bony landmark.
4:41
這是肩胛骨上骨性標誌的觸診。謝謝您的觀看。
This was the palpation of the bony landmarks on the scapula. Thank you for watching.