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Questions and Answers
What is the primary action of the subscapularis muscle?
What is the primary action of the subscapularis muscle?
Which nerve is primarily responsible for innervating the pectoralis major?
Which nerve is primarily responsible for innervating the pectoralis major?
Which muscle is responsible for adducting, medially rotating, and extending the shoulder joint?
Which muscle is responsible for adducting, medially rotating, and extending the shoulder joint?
What is the origin point of the latissimus dorsi?
What is the origin point of the latissimus dorsi?
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Which muscle helps to depress the shoulder girdle?
Which muscle helps to depress the shoulder girdle?
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Which muscle acts as a major contributor to forceful arm movements in activities like swimming and rowing?
Which muscle acts as a major contributor to forceful arm movements in activities like swimming and rowing?
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What is the appropriate patient position for testing shoulder movements with the therapist's commands?
What is the appropriate patient position for testing shoulder movements with the therapist's commands?
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What is the command given by the therapist for the 'Good' patient grade during the test?
What is the command given by the therapist for the 'Good' patient grade during the test?
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During the testing of shoulder movements, what type of resistance is given to a Grade 4 patient?
During the testing of shoulder movements, what type of resistance is given to a Grade 4 patient?
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Which muscle fibers can be palpated near the insertion point in the axilla when assessing shoulder function?
Which muscle fibers can be palpated near the insertion point in the axilla when assessing shoulder function?
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Study Notes
Muscle Test of the Shoulder Joint Part II
- The presentation is on muscle testing of the shoulder joint.
- The slides detail different aspects of testing, including patient and therapist positions, grades of resistance, and commands.
- The presentation encompasses the testing of the shoulder's horizontal abduction, external and internal rotations.
Shoulder Horizontal Abduction
- The deltoid (posterior portion) controls horizontal abduction of the shoulder.
- The range of motion for horizontal abduction, starting from 90° forward flexion, is 0° to 90°.
- The range of motion, starting from full horizontal adduction, is -40° to 90°.
Factors Limiting Shoulder Motion
- Tension in the anterior fibers of the glenohumeral joint capsule limits motion.
- Tension in the anterior fibers of the pectoralis major and deltoid muscles limits motion.
- Fixation: Rhomboid major and minor and trapezius (primarily middle and lower fibers) contract, limiting the motion.
Muscles Contributing to Horizontal Abduction
- The deltoid (posterior portion) is the main muscle.
- Origin: inferior edge of the scapular spine.
- Insertion: deltoid tuberosity on the lateral humerus.
- Action: shoulder horizontal abduction
- Nerve supply: Axillary C5-C6
Patient and Therapist Positions (Normal & Good)
- The patient lies prone, with the shoulder abducted to 90°, the upper arm on the table and the forearm off the edge of the table with elbow flexed.
- The therapist stands beside the table with the proximal hand on the shoulder and the distal hand on the elbow joint to apply resistance.
- Resistance is applied proximal to the elbow.
- Motion takes place primarily at the glenohumeral joint.
Resistance Grades
- Grade 4: Moderate leading resistance is applied to oppose the arm's upward movement.
- Grade 5: Maximum resistance is applied throughout the range of motion with a "hold" at the end of the range.
Patient Commands (Normal & Good)
- To the patient: "Pull your upper arm up --- Relax"
Patient Positions (Fair Grade)
- The patient is prone, with the shoulder abducted to 90° and the upper arm resting on a table. The lower arm hangs vertically over the edge of the table.
Patient Positions (Poor Test)
- The patient is sitting on a stool with the arm resting on the table that is positioned at 90° of abduction.
Trace & Zero Grasping Techniques
- The therapist palpates the posterior fibers of the deltoid muscle located below and lateral to the scapula's spine and the posterior aspect of the proximal arm near the axilla.
- Command: "Try to move your arm backward --- Relax".
Effect of Weakness
- Weakness in the posterior deltoid fibers causes a lack of horizontal abduction against gravity.
- Substitution occurs through: adduction of the scapula using the trapezius, the long head of the triceps, the teres major, and the latissimus dorsi muscles.
Shoulder Horizontal Adduction
- Upper pectoralis major: Origin- medial half of anterior surface of clavicle; Insertion- intertubercle groove of humerus; Action- horizontal adduction; Nerve supply- lateral pectoral nerve (C5, C6, C7)
- Lower pectoralis major: Origin- anterior surface of costal cartilage; Insertion- intertubercle groove of humerus; Action- horizontal adduction; Nerve supply - Lateral and medial pectoral nerve (C6, C7, C8, T1)
Shoulder External Rotation
- Teres Minor: Origin- upper 2/3, dorsal surface of lateral border of scapula; Insertion- lower facet of greater tubercle of humerus and shoulder joint capsule; Action- externally rotates the shoulder; Nerve supply- Axillary Nerve: C5, C6
- Infraspinatus: Origin- medial 2/3 aspect of infraspinatus fossa of scapula; Insertion- medial facet of greater tubercle of humerus and shoulder joint capsule; Action- externally rotates the shoulder; Nerve supply- Suprascapular nerve C4,C5
Shoulder Internal Rotation
- Subscapularis: Origin- anterior surface of subscapular fossa; Insertion- lesser tubercle of the humerus; Action- internally rotates the shoulder; Nerve supply- upper and lower subscapular nerve (C5, C6)
- Pectoralis Major: nerve supply- upper fibers: lateral pectoral nerve (C5, C6, C7); lower fibers: lateral and medial pectoral nerve (C6, C7, C8, T1)
- Teres Major: Origin- dorsal surfaces of inferior angle and lower third of lateral border of scapula; Insertion- crest of lesser tubercle of humerus; Action: medially rotates, adducts and extends the shoulder; Nerve supply- lower subscapular nerve (C5, C6, C7)
- Latissimus Dorsi: Origin- spines of lower 6 thoracic vertebrae; Insertion: intertubercle groove of humerus; Action: medially rotates, adducts and extends the shoulder, Assists in lateral flexion of the trunk; Nerve supply- Thoracodorsal nerve (C6, C7, C8)
Additional Notes
- Muscle palpation is also described (trace & zero).
- Positioning and procedures for the testing of each type of motion are noted.
- Resistance grading, patient positioning, and commands that are specific to each category of shoulder motion are covered.
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Description
This quiz focuses on muscle testing for the shoulder joint, emphasizing horizontal abduction, internal and external rotations. It covers patient and therapist positions, grades of resistance, and factors limiting shoulder motion. Test your knowledge on the anatomy and biomechanics involved in shoulder muscle assessments.
