Podcast
Questions and Answers
What is the correct grading for a muscle that exhibits contractile activity or slight movement?
What is the correct grading for a muscle that exhibits contractile activity or slight movement?
Which muscle serves as the prime mover during scapula depression and adduction?
Which muscle serves as the prime mover during scapula depression and adduction?
What is the effect of weakness in the muscles responsible for scapula depression and adduction?
What is the effect of weakness in the muscles responsible for scapula depression and adduction?
What is the primary nerve supply for the muscles involved in scapula depression and adduction?
What is the primary nerve supply for the muscles involved in scapula depression and adduction?
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During the grading of muscle strength, what does Grade 2 (Poor) indicate?
During the grading of muscle strength, what does Grade 2 (Poor) indicate?
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Which muscle is primarily responsible for scapula abduction and upward rotation?
Which muscle is primarily responsible for scapula abduction and upward rotation?
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What is the nerve supply for the serratus anterior muscle?
What is the nerve supply for the serratus anterior muscle?
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Which motion involves the scapula being drawn toward the spine?
Which motion involves the scapula being drawn toward the spine?
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What condition may result from weakness of the serratus anterior muscle?
What condition may result from weakness of the serratus anterior muscle?
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Which of the following does NOT affect the range of motion during scapula abduction and upward rotation?
Which of the following does NOT affect the range of motion during scapula abduction and upward rotation?
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Which joint allows for scapular movement during shoulder flexion?
Which joint allows for scapular movement during shoulder flexion?
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During a routine scapular assessment, what should be observed concerning the scapulae?
During a routine scapular assessment, what should be observed concerning the scapulae?
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What is the primary position for assessing the scapula adduction motion?
What is the primary position for assessing the scapula adduction motion?
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What is the function of the upper trapezius during muscle testing?
What is the function of the upper trapezius during muscle testing?
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In which position should the patient be to comfortably test for Grades 2, 1, and 0 if prone is not suitable?
In which position should the patient be to comfortably test for Grades 2, 1, and 0 if prone is not suitable?
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Which nerves supply the muscles involved in scapula adduction?
Which nerves supply the muscles involved in scapula adduction?
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What must a patient achieve to be graded as Grade 2 (Poor) during shoulder elevation testing?
What must a patient achieve to be graded as Grade 2 (Poor) during shoulder elevation testing?
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What anatomical structure is primarily palpated to assess upper trapezius function?
What anatomical structure is primarily palpated to assess upper trapezius function?
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What is the role of the rhomboid major and minor in relation to shoulder girdle motion?
What is the role of the rhomboid major and minor in relation to shoulder girdle motion?
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What could affect the activity levels of the upper trapezius when performing a prone test?
What could affect the activity levels of the upper trapezius when performing a prone test?
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What is essential for effective palpation when testing upper trapezius strength in a supine position?
What is essential for effective palpation when testing upper trapezius strength in a supine position?
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What is the desired motion when testing for a Fair strength in the scapula elevation assessment?
What is the desired motion when testing for a Fair strength in the scapula elevation assessment?
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Which muscle is the prime mover for scapula elevation?
Which muscle is the prime mover for scapula elevation?
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What is the effect of weakness in the muscles responsible for scapula elevation?
What is the effect of weakness in the muscles responsible for scapula elevation?
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Which nerve is primarily responsible for innervating the Levator scapulae muscle?
Which nerve is primarily responsible for innervating the Levator scapulae muscle?
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In a Trace assessment for scapula motion, what indication suggests the presence of a contraction?
In a Trace assessment for scapula motion, what indication suggests the presence of a contraction?
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What should be observed to ensure that the scapula does not 'wing' during the Fair strength test?
What should be observed to ensure that the scapula does not 'wing' during the Fair strength test?
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What position is appropriate when assessing for a Poor strength in scapula elevation?
What position is appropriate when assessing for a Poor strength in scapula elevation?
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Which of the following muscles acts as a synergist during scapula elevation?
Which of the following muscles acts as a synergist during scapula elevation?
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What is a potential limiting factor for range of motion in scapula elevation?
What is a potential limiting factor for range of motion in scapula elevation?
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What is a consequence of weakness in the scapular abductors?
What is a consequence of weakness in the scapular abductors?
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Which structure is NOT a factor limiting scapular motion?
Which structure is NOT a factor limiting scapular motion?
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In the presence of weak scapular muscles, which muscle takes over for scapula adduction?
In the presence of weak scapular muscles, which muscle takes over for scapula adduction?
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What is the primary position for the patient during the scapular adduction test?
What is the primary position for the patient during the scapular adduction test?
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In the grading of scapular adduction strength, what distinguishes grade 4 from grade 5?
In the grading of scapular adduction strength, what distinguishes grade 4 from grade 5?
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Which action is performed by the patient during the scapular adduction test?
Which action is performed by the patient during the scapular adduction test?
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What is the purpose of palpating the middle fibers of the trapezius during the test?
What is the purpose of palpating the middle fibers of the trapezius during the test?
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What position should the therapist be in while providing resistance during the scapular adduction test?
What position should the therapist be in while providing resistance during the scapular adduction test?
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If the posterior deltoid is graded at 2 or less, how is resistance applied?
If the posterior deltoid is graded at 2 or less, how is resistance applied?
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Which clinical finding indicates a grade 3 assessment of scapular adduction?
Which clinical finding indicates a grade 3 assessment of scapular adduction?
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Study Notes
Scapular Muscle Test
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Overview: Examination of scapular muscles, both at rest and during active/passive shoulder flexion, is critical for diagnosis.
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Preparation: Examine patient in a short sitting position with hands in lap.
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Palpation: Palpate vertebral borders of both scapulae by using thumbs, positioning the thumb web below inferior angle, and fingers around axillary borders. Key elements for this include checking position and symmetry of scapulae at rest, noting any asymmetry. Also, assess scapular range of motion, within a total arc of 180° of shoulder forward flexion, encompassing glenohumeral (120°) and scapular (60°) motion.
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Specific Motions to Test: Scapula abduction and upward rotation, scapula elevation, scapula adduction, scapula depression and adduction, and scapula adduction and downward rotation.
Shoulder Girdle Anatomy
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Joints: The shoulder girdle includes the sternoclavicular joint, acromioclavicular joint, scapular thoracic joint, glenohumeral joint and many associated spaces.
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G-H Joint: (Glenohumeral) joint
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A-C Joint: (Acromioclavicular) joint
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S-T Joint: (Scapulothoracic) articulation
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S-C Joint: (Sternoclavicular) joint
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Subacromial space: Important space for shoulder function & pathology.
Scapular Motions
- The main scapular motions to evaluate include upward rotation, depression, adduction, abduction, downward rotation and elevation.
Pre-Examination
- Observation: Observe the scapulae for any visible issues while at rest and during active/passive shoulder motions..
Scapula Abduction and Upward Rotation
- Prime Mover (Agonist): Serratus Anterior
- Synergists/Accessory Muscles: Pectoralis Minor
- Nerve Supply: Long Thoracic Nerve (C5-C7)
- Range of Motion Measurement: Distance between spine process and medial border of scapula.
Scapula Fixation and Weakness
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Fixation (Scapula Abduction & Upward Rotation): Occurs through the pull of obliques externus abdominis on the same side and weight of the thorax.
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Weakness/Contracture/Shortening Effects: Winging of the scapula (due to serratus anterior paralysis) and inability to raise the arm overhead are possible result.
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Factors Limiting Range of Motion: Tension of trapezoid ligament and tension of trapezius and rhomboid muscles.
Scapula Elevation
- Prime Mover (Agonist): Trapezius (superior fibers) & Levator Scapulae
- Synergists/Accessory Muscles: Rhomboid Major and Minor
- Nerve Supply: Accessory nerve (C3-C4) and Dorsal Scapular nerve (C5)
Scapular Abduction
- Prime Mover (Agonist): Trapezius (middle fibers),
- Synergists/Accessory Muscles: Rhomboid major & minor & trapezius upper/lower fibers.
- Nerve Supply: XI Accessory (C3-C4)
- Range: Measure the distance between transverse process and medial border of scapula
Scapula Depression and Adduction
- Prime Mover (Agonist): Trapezius (lower fibers)
- Synergists/Accessory Muscles: Latissimus dorsi
- Nerve Supply: XI Accessory (C3-C4)
- Range: Measure the distance between spine process and inferior angle of scapula.
Grading Scales (Normal, Good, Fair, Poor, Trace, Zero)
- Detailed instructions and grading rubrics for different grades of scapula motion are provided.
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Description
This quiz covers the examination of scapular muscles essential for diagnosing shoulder conditions. It includes key palpation techniques, joint motions to test, and the anatomy of the shoulder girdle. Understanding these concepts will enhance the evaluation of shoulder functionality and symmetry.
