Manual Muscle Testing of Scapular Muscles Lectures 2 & 3 PDF

MANUAL MUSCLE TESTING OF SCAPULAR MUSCLES By Dr. Doaa Said Sallam PT, PhD. Lecturer of Physical Therapy for Basic Science Department Horus University-Egypt. Objectives After completion of this lecture, you...

MANUAL MUSCLE TESTING OF SCAPULAR MUSCLES By Dr. Doaa Said Sallam PT, PhD. Lecturer of Physical Therapy for Basic Science Department Horus University-Egypt. Objectives After completion of this lecture, you Scapular Movement 1 will be able to describe & apply muscle testing of: Scapular abduction & upward rotation Surface Anatomy of 2 Scapular Muscles Scapular elevation Scapular adduction Scapular depression & adduction Manual muscle testing Scapular adduction & downward 3 of Scapular Muscles rotation Scapular Movement Elevation Depression Abduction (Protraction) Adduction (Retraction) Scapular Rotation Abd. & Upward Rotation Adduction & Downward Rotation Depression & Adduction Surface Anatomy of Scapular Muscles Rh. Minor Rh. Major  Manual muscle testing of Scapular Muscles Main & Accessory Ms. Grade Antigravity position 3, 4, 5 Starting position of patient Gravity minimized Grade Order position 2, 1, 0 Fixation Substitution Resistance Grade 4, 5 Palpation Grade 1 1 Abduction & Upward Rotation Serratus Anterior  Abduction & Upward Rotation Accessory Pectoralis Minor (abduction), upper & lower trapezius (upward rot.)  Abduction & Upward Rotation Test position: 130° shoulder flexion Palpates the edges of the scapula at the inferior angle and may apply resistance by proximal hand Raise your arm forward over your head. Keep your elbow straight; hold it! Don't let me push your arm down. Scapula maintains its abducted and rotated position (without winging) NB: GH muscles must be ≥ G 3 Grade 4 & 5  Abduction & Upward Rotation Test Position: 130 ° of flexion with the elbow extended. Instructions : "Raise your arm forward 130 above your head ". Scapula moves through full ROM without winging but can tolerate no resistance other than the weight of the arm. Grade 3  Alternate more accurate test Grades 5 & 4 Test Position: Arm forward flexed to about 130° and then protracted in that plane as far as it can move. 130 Instructions: Bring your arm up and reach for the target on the wall." *Stabilize trunk to prevent trunk rotation. Grade 3 Grade 4 & 5 Alternate more accurate test Grade 3  Abduction & Upward Rotation Test Position: Arm flexed above 90° & supported by examiner. Monitors scapular motion by using a light grasp > 90 on the scapula at the inferior angle. Instructions: "Hold your arm in this position (Hold…. Relax). Scapula abducts and rotates upward as the patient attempts to hold the arm Grade 2  Abduction & Upward Rotation Test Position: Short sitting with arm forward flexed to above 90° supported by therapist. Palpate The serratus with the tips of the fingers just in front of the inferior angle along the axillary border. Instructions: "Try to hold your arm in this position". Grade 1 & 0  Scapular Elevation Upper Trapezius & Levator Scapula 2 Shoulder Shrugging *Acc. Ms.: Rhomboids major & minor  Main Elevation Accessory Upper Trapezius & Levator Scapula Rhomboids Major & Minor  Elevation Position: Sitting hands relaxed in lap Instructions: Shrug your shoulders." OR "Raise your shoulders toward your ears. Hold it. Don' t let me push them down." Strong ms. Grade 3 Grade 4 & 5  Head in mid position, When the face is turned to either side, there is more trapezius activity and less levator activity on that side or turned to opposite side. Substitution: Scapula move to adduction and downward rotation by Rhomboids (Vs. assistance). Grade 2 & 1 & 0 Surface Anatomy of Upper Trapezius  3 Scapular Adduction (Retraction) Main Middle Trapezius Rhomboids Major Accessory Rhomboid minor Upper & lower trapezius Levator scapulae C7- T3  Scapular Adduction (Retraction) Grades 5 & 4 When the posterior deltoid is ≥ Grade 3 Test Position: Prone, Shoulder abducted 90°. Elbow flexed to a right angle. Stabilize contralateral scapular area to prevent trunk rotation. *Lift your elbow toward the ceiling. Hold scapula not humerus. Grade 4 & 5  Scapular Adduction (Retraction) Grades 5 & 4 When the posterior deltoid is ≤ Grade 2 Therapist places scapula in test position Resistance is given in a downward direction (toward floor) with the hand contoured over the shoulder joint. Less resistance Scapular Adduction (Retraction) Grade 3 Prone or sitting Palpate the middle fibers At the spine of the scapula from the acromion to the vertebral column. Substitutions: Rhomboids: Scapula will adduct and rotate downward. Posterior deltoid: Horizontal abduction but there is no scapular adduction. Grade 2 & 1 & 0 Scapular Adduction (Retraction) Alternate Test Grades 5, 4 and 3 Alternate Position: Elbow extended (by Kendall), with external rot, elbow fully extended. Surface Anatomy of Middle Trapezius  Scapular Adduction (Retraction) Helpful Hint: When the posterior deltoid muscle is weak, support the patient's shoulder with the palm of one hand, and allow the patient's elbow to flex. Passively move the scapula into adduction via horizontal abduction of the arm. Have the patient hold the scapula in adduction as the examiner slowly releases the shoulder support. Observe whether the scapula maintains its adducted position. If it does, it is Grade 3.  4 Scapular Depression & Adduction Lower Trapezius Other primary ms.: Middle trapezius. Acc. Ms.: Latissimus dorsi. Pectoralis major. Pectoralis minor.  Main Depression & Add. Accessory Lower Trapezius Latissimus Dorsi  Scapular Depression & Adduction Test position: 145° shoulder abduction Forearm mid position. Patient raises arm from the table to at least ear level. 145 Resistance May be applied over scapula (less resistance). Alternatively: Arm may be placed in test position & patient is asked to hold Grade 3 Grade 4 & 5  Scapular Depression & Adduction Position of Therapist: Stand at test side. Support patient's arm under the elbow. Test: Patient attempts to lift the arm 145 from the table. If the patient is unable, lift and support the weight of the arm. Substitutions: Middle trapezius. Rhomboid. Trunk rotation. Grade 2 & 1 & 0  Scapular Depression & Adduction Helpful Hints: If shoulder ROM is limited in flexion and abduction, the patient's arm should be positioned over the side of the table and supported by the examiner at its maximal range of elevation as the start position. Examiners are reminded of the test principle that the same lever arm must be used in sequential testing (over time) for valid comparison of results.  Adduction & Downward 5 Rhomboids Major & Minor Rotation Acc. Ms.: Levator scapulae.  Main Add. & Downward Rotation Accessory Rhomboids Major & Minor Levator Scapula Posittion: Prone. Shoulder is internally Adduction & Downward Rotation rotated; arm is adducted across the back and elbow flexed and hand resting on the back. Head turned to opposite side to exclude levator scapula ??? Resistance is placed on the humerus just above the elbow in a downward and outward direction. If shoulder extensors ≥ G 3 Stabilize contralateral thorax Grade 3 Grade 4 & 5  Adduction & Downward Rotation Support arm by grasping the wrist. Palpate the muscle under the vertebral border of the scapula. Substitutions: Middle trapezius. Trunk rotation. Pectoralis minor (scapular protraction). Shoulder extensors. Grade 2 & 1 & 0  Alternate Rhomboid Test by Kendall Provided that strong shoulder adductors Head turned to opposite side to exclude levator scapula ??? Resistant upward and abduction If weak shoulder muscles→ resistance on scapula Grading: scapular not humeral movement. Formative Test 24/10 Quiz 1 31/10