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Questions and Answers
Which of the following muscles is primarily responsible for scapular protraction?
Which of the following muscles is primarily responsible for scapular protraction?
What is a common cause of long thoracic nerve injury?
What is a common cause of long thoracic nerve injury?
What is the origin of the serratus anterior muscle?
What is the origin of the serratus anterior muscle?
What visual sign indicates scapular winging during a physical examination?
What visual sign indicates scapular winging during a physical examination?
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Which nerve is responsible for innervating the serratus anterior muscle?
Which nerve is responsible for innervating the serratus anterior muscle?
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During the Grade 3 strength test, what is the patient’s arm position?
During the Grade 3 strength test, what is the patient’s arm position?
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Which motion is NOT associated with the serratus anterior muscle?
Which motion is NOT associated with the serratus anterior muscle?
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What is the main consequence of weakness in the serratus anterior muscle?
What is the main consequence of weakness in the serratus anterior muscle?
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What type of resistance is applied for a Grade 4 strength test?
What type of resistance is applied for a Grade 4 strength test?
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What is the range of motion for scapular abduction, measured in fingers?
What is the range of motion for scapular abduction, measured in fingers?
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What is the main command for the Grade 5 strength test?
What is the main command for the Grade 5 strength test?
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What position does the therapist assume for the Grade 2 strength test?
What position does the therapist assume for the Grade 2 strength test?
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Which muscles limit the upward rotation of the scapula?
Which muscles limit the upward rotation of the scapula?
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Which part of the serratus anterior muscle corresponds to the 1st and 2nd ribs?
Which part of the serratus anterior muscle corresponds to the 1st and 2nd ribs?
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In the context of strength testing, what does a Grade 1 indicate?
In the context of strength testing, what does a Grade 1 indicate?
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What is the primary action the patient performs in the Grade 2 strength test?
What is the primary action the patient performs in the Grade 2 strength test?
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What is the primary action of the upper fibers of the trapezius?
What is the primary action of the upper fibers of the trapezius?
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Which of the following nerves supplies the upper fibers of the trapezius?
Which of the following nerves supplies the upper fibers of the trapezius?
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What position should the patient be in to test for 'Fair Strength' (Grade 3) in scapular elevation?
What position should the patient be in to test for 'Fair Strength' (Grade 3) in scapular elevation?
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Which muscle assists in the downward rotation of the scapula?
Which muscle assists in the downward rotation of the scapula?
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What is the origin of the levator scapulae?
What is the origin of the levator scapulae?
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What may limit the range of motion during scapular elevation?
What may limit the range of motion during scapular elevation?
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When resistance is applied during the Grade 4 strength test for scapular elevation, how is it given?
When resistance is applied during the Grade 4 strength test for scapular elevation, how is it given?
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Which of the following actions does the upper fibers of the trapezius perform when acting unilaterally?
Which of the following actions does the upper fibers of the trapezius perform when acting unilaterally?
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What additional step is included in Grade 5 compared to Grade 4 during shoulder elevation?
What additional step is included in Grade 5 compared to Grade 4 during shoulder elevation?
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What is the starting position for the test related to Grade 3 strength?
What is the starting position for the test related to Grade 3 strength?
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Which of the following muscles assists in scapular adduction?
Which of the following muscles assists in scapular adduction?
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What is the primary action of the trapezius middle fibers?
What is the primary action of the trapezius middle fibers?
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Which nerve supply is associated with the trapezius muscle?
Which nerve supply is associated with the trapezius muscle?
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What limits the range of motion during scapular adduction?
What limits the range of motion during scapular adduction?
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Which command is used for Grades 4 and 5 strength testing?
Which command is used for Grades 4 and 5 strength testing?
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What support does the therapist provide during the Grade 3 strength test?
What support does the therapist provide during the Grade 3 strength test?
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What is the purpose of the proximal hand during scapular testing?
What is the purpose of the proximal hand during scapular testing?
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Which grade of strength testing involves maximum resistance throughout the range of motion?
Which grade of strength testing involves maximum resistance throughout the range of motion?
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In the patient position for Grade 2 testing, how should the affected arm be positioned?
In the patient position for Grade 2 testing, how should the affected arm be positioned?
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How does the therapist stabilize the thorax during the evaluation?
How does the therapist stabilize the thorax during the evaluation?
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Which type of scapular winging is associated with injury to the long thoracic nerve?
Which type of scapular winging is associated with injury to the long thoracic nerve?
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What kind of strength is classified as Grade 2 in scapular strength testing?
What kind of strength is classified as Grade 2 in scapular strength testing?
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Which muscle palsy is associated with lateral winging due to spinal accessory nerve injury?
Which muscle palsy is associated with lateral winging due to spinal accessory nerve injury?
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What command should be given to a patient during scapular strength testing?
What command should be given to a patient during scapular strength testing?
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Study Notes
Scapular Movements
- Protraction (Abduction): Scapula moves away from the spine
- Retraction (Adduction): Scapula moves towards the spine
- Abduction & Upward Rotation: Scapula moves upwards and away from the spine
- Adduction & Downward Rotation: Scapula moves downwards and towards the spine
- Elevation: Scapula moves upwards
- Depression: Scapula moves downwards
Serratus Anterior
- Origin: Surfaces of the upper eight or nine ribs
- Insertion: Front of the medial border of the scapula
- Nerve Supply: Long thoracic nerve (C5, C6, C7)
- Action: Protraction and upward rotation of the scapula, important for overhead arm movement
- Weakness: Scapular winging, difficulty raising the arm overhead
Scapular Elevation
- Muscles: Upper trapezius, levator scapulae, rhomboids major and minor (accessory)
- Range of Motion: Shoulder lifts 3 fingers below the ear
Scapular Adduction
- Muscles: Trapezius (middle fibers), upper and lower trapezius fibers (accessory), rhomboid major and minor (accessory)
- Range of Motion: Scapula moves 3 to 4 fingers from an abducted to an adducted position
Manual Muscle Testing (MMT) Serratus Anterior
- Grade 3 "Fair Strength": Patient supine, arm flexed at 90 degrees, therapist stabilizes thorax, patient pushes arm forward.
- Grades 4 and 5 "Good and Normal Strength": Same as Grade 3, but therapist applies moderate (Grade 4) or maximal (Grade 5) resistance at the elbow/wrist. Patient pushes arm forward, hold at end of range for Grade 5.
- Grade 2 "Poor Strength": Patient sitting, arm flexed at 90 degrees, therapist stabilizes thorax, patient pushes arm forward on a table.
- Grades 1 and 0 "Trace and Zero Strength": Same as Grade 2, therapist palpates for muscle contraction.
Manual Muscle Testing (MMT) Upper Trapezius
- Grade 3 "Fair Strength": Patient sitting, arm at side, therapist behind patient, patient shrugs shoulders upwards
- Grades 4 and 5 "Good and Normal Strength": Same as Grade 3, therapist applies moderate (Grade 4) or maximal (Grade 5) resistance at the shoulders, patient shrugs shoulders. Hold at end of range for Grade 5.
- Grade 2 "Poor Strength": Patient prone, therapist supports shoulders, patient shrugs shoulders.
- Grades 1 and 0 "Trace and Zero Strength": Same as Grade 2, therapist palpates muscle contraction.
Manual Muscle Testing (MMT) Trapezius (Middle Fibers)
- Grade 3 "Fair Strength": Patient prone, arm abducted at 90 degrees, elbow flexed, therapist stabilizes thorax, patient raises arm and adducts scapula.
- Grades 4 and 5 "Good and Normal Strength": Same as Grade 3, therapist applies resistance at scapula, patient raises arm and adducts scapula. Hold at end of range for Grade 5.
- Grade 2 "Poor Strength": Patient sitting, arm partially abducted, therapist stabilizes opposite shoulder, patient pulls arm backward.
- Grades 1 and 0 "Trace and Zero Strength": Same as Grade 2, therapist palpates muscle contraction.
Winging of the Scapula
- Types: Medial winging, Lateral winging
- Medial Winging: Caused by Serratus Anterior weakness due to Long Thoracic nerve injury. Scapula displaced medially.
- Lateral Winging: Caused by Trapezius weakness due to Spinal Accessory or Rhomboids weakness due to Dorsal Scapular nerve injury. Scapula displaced laterally either superiorly or inferiorly.
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Description
Explore the various movements of the scapula, including protraction, retraction, elevation, and depression. Learn about the anatomy and function of the serratus anterior muscle, its origin, insertion, nerve supply, and its role in shoulder movement. This quiz is essential for students of anatomy and physical therapy or anyone interested in human movement.
