Scapular Muscle Test Overview
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Questions and Answers

What is the correct grading for a muscle that exhibits contractile activity or slight movement?

  • Grade 2 (Poor)
  • Grade 0 (Zero)
  • Grade 3 (Fair)
  • Grade 1 (Trace) (correct)

Which muscle serves as the prime mover during scapula depression and adduction?

  • Trapezius (lower fibers) (correct)
  • Rhomboid major
  • Latissimus dorsi
  • Serratus anterior

What is the effect of weakness in the muscles responsible for scapula depression and adduction?

  • Limited shoulder flexion
  • Inability to raise the arm overhead (correct)
  • Increased arm rotation
  • Enhanced stability of the scapula

What is the primary nerve supply for the muscles involved in scapula depression and adduction?

<p>XI Accessory (C3-C4) nerve (D)</p> Signup and view all the answers

During the grading of muscle strength, what does Grade 2 (Poor) indicate?

<p>Full range of motion without the weight of the arm (A)</p> Signup and view all the answers

Which muscle is primarily responsible for scapula abduction and upward rotation?

<p>Serratus anterior (C)</p> Signup and view all the answers

What is the nerve supply for the serratus anterior muscle?

<p>Long thoracic nerve (A)</p> Signup and view all the answers

Which motion involves the scapula being drawn toward the spine?

<p>Scapular adduction (B)</p> Signup and view all the answers

What condition may result from weakness of the serratus anterior muscle?

<p>Winging of scapula (C)</p> Signup and view all the answers

Which of the following does NOT affect the range of motion during scapula abduction and upward rotation?

<p>Loss of elasticity in pectoralis major (D)</p> Signup and view all the answers

Which joint allows for scapular movement during shoulder flexion?

<p>Both A and B (B)</p> Signup and view all the answers

During a routine scapular assessment, what should be observed concerning the scapulae?

<p>Symmetry and resting position of the scapulae (A)</p> Signup and view all the answers

What is the primary position for assessing the scapula adduction motion?

<p>Sitting with arms at sides (B)</p> Signup and view all the answers

What is the function of the upper trapezius during muscle testing?

<p>Assisting in shoulder elevation (A)</p> Signup and view all the answers

In which position should the patient be to comfortably test for Grades 2, 1, and 0 if prone is not suitable?

<p>Supine with head in neutral (B)</p> Signup and view all the answers

Which nerves supply the muscles involved in scapula adduction?

<p>XI Accessory (C3-C4) (C)</p> Signup and view all the answers

What must a patient achieve to be graded as Grade 2 (Poor) during shoulder elevation testing?

<p>Full range of motion in gravity-eliminated position (B)</p> Signup and view all the answers

What anatomical structure is primarily palpated to assess upper trapezius function?

<p>Insertion above the clavicle (C)</p> Signup and view all the answers

What is the role of the rhomboid major and minor in relation to shoulder girdle motion?

<p>Assisting in scapula retraction (B)</p> Signup and view all the answers

What could affect the activity levels of the upper trapezius when performing a prone test?

<p>Turning the head to one side (B)</p> Signup and view all the answers

What is essential for effective palpation when testing upper trapezius strength in a supine position?

<p>Optimal head positioning (D)</p> Signup and view all the answers

What is the desired motion when testing for a Fair strength in the scapula elevation assessment?

<p>Patient forces the arm upward without any scapula support. (B)</p> Signup and view all the answers

Which muscle is the prime mover for scapula elevation?

<p>Trapezius (superior fibers) (D)</p> Signup and view all the answers

What is the effect of weakness in the muscles responsible for scapula elevation?

<p>Inability to raise the shoulder upwards. (A)</p> Signup and view all the answers

Which nerve is primarily responsible for innervating the Levator scapulae muscle?

<p>Accessory nerve (C3-C4) (B)</p> Signup and view all the answers

In a Trace assessment for scapula motion, what indication suggests the presence of a contraction?

<p>Presence of digitations of the Serratus anterior on ribs. (B)</p> Signup and view all the answers

What should be observed to ensure that the scapula does not 'wing' during the Fair strength test?

<p>Scapula remains flat against the rib cage. (D)</p> Signup and view all the answers

What position is appropriate when assessing for a Poor strength in scapula elevation?

<p>Sitting with arm flexed to 90º and resting on table. (C)</p> Signup and view all the answers

Which of the following muscles acts as a synergist during scapula elevation?

<p>Rhomboid minor (A)</p> Signup and view all the answers

What is a potential limiting factor for range of motion in scapula elevation?

<p>Tension of the pectoralis minor muscle. (B)</p> Signup and view all the answers

What is a consequence of weakness in the scapular abductors?

<p>Inability to adduct the scapula (C)</p> Signup and view all the answers

Which structure is NOT a factor limiting scapular motion?

<p>Increased mobility of the lumbar spine (A)</p> Signup and view all the answers

In the presence of weak scapular muscles, which muscle takes over for scapula adduction?

<p>Rhomboids (C)</p> Signup and view all the answers

What is the primary position for the patient during the scapular adduction test?

<p>Prone with shoulder at edge of table (C)</p> Signup and view all the answers

In the grading of scapular adduction strength, what distinguishes grade 4 from grade 5?

<p>Resistance capability (D)</p> Signup and view all the answers

Which action is performed by the patient during the scapular adduction test?

<p>Horizontally abducting the arm (C)</p> Signup and view all the answers

What is the purpose of palpating the middle fibers of the trapezius during the test?

<p>To confirm muscle activation (A)</p> Signup and view all the answers

What position should the therapist be in while providing resistance during the scapular adduction test?

<p>Standing at the patient's test side (A)</p> Signup and view all the answers

If the posterior deltoid is graded at 2 or less, how is resistance applied?

<p>Downward toward the floor with the hand over the shoulder joint (C)</p> Signup and view all the answers

Which clinical finding indicates a grade 3 assessment of scapular adduction?

<p>Completes motion with minimal resistance (A)</p> Signup and view all the answers

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Flashcards

Scapular Abduction and Upward Rotation

The movement during which the scapula moves away from the midline of the body and rotates upwards. This is crucial for reaching overhead.

Serratus Anterior

The primary muscle responsible for scapular abduction and upward rotation. It originates from the ribs and inserts on the scapula.

Pectoralis Minor

The muscle that assists the Scapula Abduction and Upward Rotation movement, originating from the ribs and inserting into the scapula.

Long Thoracic Nerve

The nerve that supplies the serratus anterior, responsible for scapular abduction and upward rotation.

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Winging of Scapula

A condition where the scapula protrudes outwards, often observed when lifting objects or reaching overhead, indicating weakness or paralysis of the serratus anterior muscle.

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Range of Motion in Scapular Abduction and Upward Rotation

The distance measured between the spine process and the medial border of the scapula, quantifying the range of motion during the movement.

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Fixation of the Scapula

The muscle(s) that help stabilize the scapula during strong abduction movements, preventing excessive rotation.

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Scapular Abduction (Good/Normal)

Patient moves arm upward by abducting the scapula. Resistance is applied downward and inward towards the table.

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Scapular Abduction (Fair)

Patient forces arm upward, scapula fully abducted without 'winging' (elbow may be flexed or supported if extensor muscles are weak).

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Scapular Abduction (Poor)

Patient moves arm forward by abducting scapula, stabilize the thorax.

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Serratus Anterior (Trace/Zero)

Examiner gently pushes arm backward to detect a contraction of the Serratus anterior. Look for scapula 'winging' and palpate muscle for contraction.

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Scapular Elevation: Prime Movers

Trapezius (upper fibers) and Levator Scapulae are the primary muscles responsible for elevating the scapula.

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Scapular Elevation: Synergists

Rhomboids major and minor aid in scapular elevation.

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Scapular Elevation: Nerve Supply

The Accessory nerve (XI) and Dorsal Scapular nerve supply the muscles involved in scapular elevation.

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Scapular Elevation: Range of Motion

Measure the distance between the top of the shoulder and the ear loop.

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Scapular Elevation: Weakness Effect

Weakness in scapular elevation muscles leads to difficulty raising the shoulder (bilateral or unilateral).

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Range of Motion for Scapular Adduction

The distance measured between the transverse process and the medial border of the scapula, indicating the range of motion during scapular adduction.

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Trapezius (Middle Fibers)

The primary muscle responsible for pulling the scapula towards the spine, enabling a strong rowing motion.

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Synergists in Scapular Adduction

Muscles that assist the primary mover during scapular adduction, including the Rhomboid major and minor, and the upper and lower trapezius fibers.

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Accessory Nerve (XI)

The nerve supplying the trapezius muscle, enabling scapular adduction and other shoulder movements.

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Fixation for Scapular Adduction

No specific fixation is needed, but the weight of the thorax provides natural stability.

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Upper Trapezius Muscle Test

A test used to assess upper trapezius muscle strength, measuring the patient's ability to raise their shoulder towards their ear.

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Levator Scapulae

The muscle responsible for elevating the shoulder, which is assessed during the upper trapezius muscle test.

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Upper Trapezius Muscle Strength Grading

A grading scale used to quantify the strength of the upper trapezius muscle, ranging from 0 (no movement) to 2 (full range of motion in gravity-eliminated position).

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Prone Position

A position where the patient is lying face down on a table, with their head turned to the side for comfort, used for evaluating upper trapezius muscle strength.

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Supine Position

A position where the patient is lying on their back, used for assessing upper trapezius muscle strength, although less optimal for palpation.

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What is the prime mover for scapula depression and adduction?

The lower fibers of the trapezius are the primary muscle responsible for pulling the shoulder blade down and towards the midline (adduction).

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What is the synergist to the trapezius for scapula depression?

The latissimus dorsi muscle helps the trapezius in pulling the shoulder blade down and towards the midline.

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What nerve supplies the lower trapezius muscle?

The eleventh cranial nerve (accessory nerve) provides the nerve supply for the lower trapezius muscle. It also receives input from the C3 and C4 spinal nerves contributing to its function.

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How is the range of motion for scapula depression measured?

You can assess the range of motion of scapula depression by measuring the distance between the spine process of the scapula and the inferior angle of the scapula.

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What is the effect of weakness in scapula depression?

If the lower trapezius is weak, you may have difficulty raising your arm overhead. This is because the scapula cannot properly depress and adduct as your arm moves upwards.

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Scapular Adduction

The movement of the scapula towards the midline of the body. It is essential for raising the arm overhead.

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Effect of Weakness on Scapular Adduction

The scapula's inability to move towards the midline, resulting in limited arm elevation.

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Conoid Ligament Tension

A structure that limits movement. Tightness in this structure restricts the scapula's ability to adduct.

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Pectoralis Muscles and Serratus Anterior Tension

Muscles that can limit the scapula's movement. The more tensed these muscles, the harder it is for the scapula to adduct.

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Scapular Contact with Spinal Muscles

The scapula may touch the spinal muscles and limit movement when the arm is raised.

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Rhomboids' Role in Scapular Adduction

Muscles that compensate when scapular adductors are weakened. They help to pull the scapula closer to the spine.

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Posterior Deltoid's Compensation

A muscle that can help with arm movement if the scapular muscles are weak. It helps with horizontal movement of the shoulder.

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Scapular Adduction Strength Test

A test to assess the strength of the scapular adductors. This test is performed in a prone position, with the arm raised to 90 degrees.

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Resistance Applied to Distal Humerus

The most common way to apply resistance in the scapular adduction strength test. The therapist's hand is placed over the end of the upper arm.

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Resistance Contoured over Shoulder Joint

A modified technique to apply resistance during the scapular adduction strength test. This method requires less strength from the patient.

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Study Notes

Scapular Muscle Test

  • Overview: Examination of scapular muscles, both at rest and during active/passive shoulder flexion, is critical for diagnosis.

  • Preparation: Examine patient in a short sitting position with hands in lap.

  • 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.

  • 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

  • Joints: The shoulder girdle includes the sternoclavicular joint, acromioclavicular joint, scapular thoracic joint, glenohumeral joint and many associated spaces.

  • G-H Joint: (Glenohumeral) joint

  • A-C Joint: (Acromioclavicular) joint

  • S-T Joint: (Scapulothoracic) articulation

  • S-C Joint: (Sternoclavicular) joint

  • 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

  • Fixation (Scapula Abduction & Upward Rotation): Occurs through the pull of obliques externus abdominis on the same side and weight of the thorax.

  • Weakness/Contracture/Shortening Effects: Winging of the scapula (due to serratus anterior paralysis) and inability to raise the arm overhead are possible result.

  • 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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Scapular Muscle Test PDF

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.

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