Manual Muscle Testing: Shoulder Flexion: Difference between revisions
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== Introduction == | == Introduction == | ||
The purpose of manual muscle testing is to detect weaknesses and imbalances to being the process of restoring normal strength, stability, and function via therapeutic exercise (strengthening). | |||
== Shoulder Flexion to 90 | == Shoulder Flexion Osteokinematic and Arthrokinematic Movements: == | ||
From 0-60 degrees, the scapula and clavicle elevate, the humeral head begins to glide inferiorly and rotates posteriorly. | |||
From 60-90 degrees, the humeral head is seated in the glenoid fossa and rotates posteriorly, the clavicle and scapula continue to elevate but the scapula beings to upwardly rotate. | |||
From 90-180 degrees, the scapula upwardly rotates, the clavicle rotates posteriorly, and the humeral head rotates posteriorly while still seated in the glenoid fossa. | |||
== Muscles Involved in Shoulder Flexion: == | |||
* [[Deltoid]] (anterior) | * [[Deltoid]] (anterior) | ||
* [[Coracobrachialis Muscle|Coracobrachialis]] | * [[Coracobrachialis Muscle|Coracobrachialis]] | ||
* Biceps | |||
* Pectoralis Major | |||
== Grading MMT: == | |||
=== Break Test: === | |||
PT gradually applies pressure until the muscle being tested cannot maintain testing position or until the patient shows signs of not being able to resist the pressure applied. | |||
==== Grading: ==== | |||
* Based on a system in the ability to move through full ROM, against gravity or hold the tested part in a given position against gravity establishes the grade 3 (FAIR). | |||
'''Normal (5)''': Holds test position against strong pressure or does not “BREAK” from test position; > 95% effort | |||
'''Good + (4+)''': Holds against moderate to strong pressure; 75-95% effort | |||
'''Good (4)''': Holds test position against moderate pressure; 50-74% effort | |||
'''Good - (4-)''': patient can hold against gravity plus slight to moderate pressure; 25-49% effort force | |||
'''Fair + (3+)''': patient can hold against gravity and additional minimal pressure (<25%); 1-24% | |||
'''Fair (3)''': can hold against gravity; no additional force applied | |||
'''Fair – (3-)''': Gradual release from test position, once the limb is placed vs gravity | |||
'''Poor + (2+)''': Ability to move through full ROM with gravity eliminated against resistance or to hold against resistance at end-range; Anti-gravity muscle can move through partial range | |||
'''Poor (2'''): Muscle or muscle group that can move through complete ROM with gravity eliminated with no external resistance | |||
'''Poor – (2-)''': Ability to move through partial range with GE | |||
'''Trace (1)''': Tendon becomes prominent or feeble contraction palpated in the muscle; no visible movement of the limb or joint; gravity eliminated | |||
'''Zero (0)''': No evidence of contraction, either visual or during palpation | |||
===== What is Gravity Eliminated (GE)? ===== | |||
* When testing weak muscles, patient must be positioned such that muscles are in a working position with gravity eliminate | |||
* Occurs in the Transverse plane | |||
== To Test Coracobrachialis: == | |||
=== Patient Position: === | |||
* Sitting or Supine | |||
=== Therapist Position === | |||
* Therapist to stand on ipsilateral side | |||
* Palpation shoulder flexors | |||
* No stabilization is necessary | |||
=== To Test: === | |||
* PT places patient supine on table with shoulder flexion in lateral rotation, with the elbow completely flexed and forearm supinated. | |||
* Therapist preforms PROM to show the patient the motion and to make sure they can achieve full range. The patient is then asked to actively perform the motion. | |||
* The physical therapist applies pressure against the anteromedial surface of the distal humerus, in the direction of extension and slight abduction and asks the patient to resist the movement. | |||
ADD VIDEO | |||
== To Test Anterior Deltoid: == | |||
=== Patient Position: === | |||
* Sitting | |||
* | |||
== Therapist Position == | === Therapist Position: === | ||
* Therapist stands behind the patient | |||
* | * Stabilizes the scapula | ||
* | |||
=== To Test: === | |||
* Shoulder is placed in abduction and slight flexion, with the humerus in slight lateral rotation. | |||
* Therapist preforms PROM to show the patient the motion and to make sure they can achieve full range. The patient is then asked to actively perform the motion. | |||
* The physical therapist applies pressure against the anteromedial surface of the arm, in the direction of adduction and slight extension. | |||
* The patient is asked to resist the movement. | |||
ADD VIDEO | |||
== References == | == References == |
Revision as of 18:38, 12 March 2024
Original Editor - Claire Knott
Top Contributors - Hollie Webb, Madison Gore, Claire Knott, Kaley Golden, Wanda van Niekerk, Tony Varela, Kim Jackson, Joao Costa and Nikhil Benhur Abburi
Welcome to Arkansas Colleges of Health Education School of Physical Therapy Musculoskeletal 1 Project. This space was created by and for the students at Arkansas Colleges of Health Education School in the United States. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
Introduction[edit | edit source]
The purpose of manual muscle testing is to detect weaknesses and imbalances to being the process of restoring normal strength, stability, and function via therapeutic exercise (strengthening).
Shoulder Flexion Osteokinematic and Arthrokinematic Movements:[edit | edit source]
From 0-60 degrees, the scapula and clavicle elevate, the humeral head begins to glide inferiorly and rotates posteriorly.
From 60-90 degrees, the humeral head is seated in the glenoid fossa and rotates posteriorly, the clavicle and scapula continue to elevate but the scapula beings to upwardly rotate.
From 90-180 degrees, the scapula upwardly rotates, the clavicle rotates posteriorly, and the humeral head rotates posteriorly while still seated in the glenoid fossa.
Muscles Involved in Shoulder Flexion:[edit | edit source]
- Deltoid (anterior)
- Coracobrachialis
- Biceps
- Pectoralis Major
Grading MMT:[edit | edit source]
Break Test:[edit | edit source]
PT gradually applies pressure until the muscle being tested cannot maintain testing position or until the patient shows signs of not being able to resist the pressure applied.
Grading:[edit | edit source]
- Based on a system in the ability to move through full ROM, against gravity or hold the tested part in a given position against gravity establishes the grade 3 (FAIR).
Normal (5): Holds test position against strong pressure or does not “BREAK” from test position; > 95% effort
Good + (4+): Holds against moderate to strong pressure; 75-95% effort
Good (4): Holds test position against moderate pressure; 50-74% effort
Good - (4-): patient can hold against gravity plus slight to moderate pressure; 25-49% effort force
Fair + (3+): patient can hold against gravity and additional minimal pressure (<25%); 1-24%
Fair (3): can hold against gravity; no additional force applied
Fair – (3-): Gradual release from test position, once the limb is placed vs gravity
Poor + (2+): Ability to move through full ROM with gravity eliminated against resistance or to hold against resistance at end-range; Anti-gravity muscle can move through partial range
Poor (2): Muscle or muscle group that can move through complete ROM with gravity eliminated with no external resistance
Poor – (2-): Ability to move through partial range with GE
Trace (1): Tendon becomes prominent or feeble contraction palpated in the muscle; no visible movement of the limb or joint; gravity eliminated
Zero (0): No evidence of contraction, either visual or during palpation
What is Gravity Eliminated (GE)?[edit | edit source]
- When testing weak muscles, patient must be positioned such that muscles are in a working position with gravity eliminate
- Occurs in the Transverse plane
To Test Coracobrachialis:[edit | edit source]
Patient Position:[edit | edit source]
- Sitting or Supine
Therapist Position[edit | edit source]
- Therapist to stand on ipsilateral side
- Palpation shoulder flexors
- No stabilization is necessary
To Test:[edit | edit source]
- PT places patient supine on table with shoulder flexion in lateral rotation, with the elbow completely flexed and forearm supinated.
- Therapist preforms PROM to show the patient the motion and to make sure they can achieve full range. The patient is then asked to actively perform the motion.
- The physical therapist applies pressure against the anteromedial surface of the distal humerus, in the direction of extension and slight abduction and asks the patient to resist the movement.
ADD VIDEO
To Test Anterior Deltoid:[edit | edit source]
Patient Position:[edit | edit source]
- Sitting
Therapist Position:[edit | edit source]
- Therapist stands behind the patient
- Stabilizes the scapula
To Test:[edit | edit source]
- Shoulder is placed in abduction and slight flexion, with the humerus in slight lateral rotation.
- Therapist preforms PROM to show the patient the motion and to make sure they can achieve full range. The patient is then asked to actively perform the motion.
- The physical therapist applies pressure against the anteromedial surface of the arm, in the direction of adduction and slight extension.
- The patient is asked to resist the movement.
ADD VIDEO