Manual Muscle Testing of Shoulder Muscles PDF

MANUAL MUSCLE TESTING OF SHOULDER MUSCLES By Dr. Doaa Said Sallam PT, PhD. Lecturer of Physical Therapy for Basic Science Department Horus University-Egypt. ...

MANUAL MUSCLE TESTING OF SHOULDER MUSCLES By Dr. Doaa Said Sallam PT, PhD. Lecturer of Physical Therapy for Basic Science Department Horus University-Egypt.  2 LECTURE OBJECTIVES: After completion of this lecture, you will be able to describe & apply muscle testing of: Shoulder flexion Shoulder extension Shoulder abduction Shoulder horizontal abduction Shoulder horizontal adduction Shoulder external rotation Shoulder internal rotation Surface Anatomy of Deltoid  Shoulder Flexion (180°) Primary Muscles: ▪ Anterior deltoid. ▪ Coracobrachialis. Accessory Muscles: ▪ Clavicular portion of pectoralis major. ▪ Middle deltoid. ▪ Supraspinatus. ▪ Serratus anterior. ROM: 120° is glenohumeral motion, and 60° is scapular motion.  Shoulder Flexion 5 Grades 5 & 4 Position of Patient: ▪ Sitting, arms at sides, elbow slightly flexed, forearm pronated. Test Position: ▪ Patient flexes shoulder to 90° without rotation or horizontal movement. Resistance: ▪ Over the distal humerus. The other hand may stabilize the shoulder. Be careful: ▪ Scapula should be free.  Shoulder Flexion 6 Grade 3 Position of Patient: ▪ Sitting, arms at sides, elbow slightly flexed, forearm pronated.  Shoulder Flexion Grade 2, 1 & 0 7 ▪ G 2: Partial ROM Palpation: ▪ Over the superior & anterior surfaces of the deltoid over the shoulder joint. N.B: Coracobrachialis is difficult to palpate  Shoulder Flexion 8 Grade 2, 1 & 0 Alternate test Patient Position: Side lying G 2: Full ROM.  Shoulder Flexion 9 Substitution: By Biceps brachii Other substitutions: ▪ Upper trapezius. ▪ Pectoralis major. ▪ Leaning backward.  10 HHD for Shoulder Flexion Shoulder Flexion 11  12 Shoulder Extension (45- 60°) Primary Muscles ▪ Posterior deltoid (The only hyper extensor) Other prime movers: ▪ Latissimus dorsi. ▪ Teres major. Accessory Muscles: ▪ Long head of triceps. ▪ Sternal head of pectoralis major.  13 Shoulder Extension 3) Another Test to 1) Generic 2) To Isolate Isolate Latissimus Shoulder Extension Latissimus Dorsi Dorsi (Grade 5) only  Shoulder Extension (Generic Test) 14 Grades 5 & 4 Test Position: ▪ Prone with arms at sides and shoulder internally rotated (palm up). ▪ Keeping the elbow straight. Resistance: ▪ Just above the elbow.  Shoulder Extension Generic Shoulder Extension: Grades 3 & 2 ▪ G3: Full ROM. ▪ G2: Partial ROM. Alternative position for grade 2: from side lying (Full ROM).  Shoulder Extension 16 Grades 1 & 0 Latissimus: on the side of the thoracic wall below and lateral to the inferior angle of the scapula. Posterior Deltoid: over the posterior shoulder just superior to the axilla for posterior deltoid fibers. Teres major: on the lateral border of the scapula just below the axilla, the lower of the two muscles that enter the axilla at this point; it forms the lower posterior rim of the axilla. Substitution Long head of triceps (extension with lateral rotation).  Shoulder Extension Test to isolate latissimus dorsi: Grades 5, 4, 3, 2, 1 & 0 17 Position of Patient: ▪ Prone with head turned to test side; arms are at sides and shoulder is internally rotated (palm up). Test shoulder is "hiked" to the level of the chin. Same position ▪ Grasp forearm above patient's wrist with both hands. ▪ Reach toward your feet. Hold it. ▪ All grades of this test are tested from the same position. ▪ G3: Full ROM. ▪ G2: Partial ROM.  Shoulder Extension Another test to isolate latissimus dorsi: Grade 5 ONLY ▪ Closed Kinetic Chain. ▪ Resistance by Body weight. ▪ latissimus dorsi ( Vertebro-humeral Muscle). Latissimus Dorsi and Teres Major 19 20  21 HHD for Shoulder Extension  Shoulder Abduction (180°). 22 Primary muscles: ▪ Middle Deltoid and ▪ Supraspinatus. Accessory muscles: ▪ Anterior fiber of deltoid. ▪ Posterior fiber of deltoid.  Shoulder Abduction 23 Grades 5 & 4 Test Position: ▪ Short sitting with arm at side and elbow slightly flexed. ▪ Patient abducts arm to 90°. Resistance: ▪ Over arm just above elbow.  Shoulder Abduction 24 Grades 3 & 2 Grade 2 Grade 3 Partial ROM Full ROM  25 Shoulder Abduction Alternate Test for Grade 2 G 2: Full ROM Palpate the deltoid lateral to the acromial process on the superior aspect of the shoulder.  Shoulder Abduction 26 Grade 1 & 0 Test Position: ▪ Short sitting. with the shoulder in about 90° of abduction, providing limb support at the elbow. ▪ Middle Deltoid: lateral to the acromial process on the superior aspect of the shoulder. Shoulder Abduction Alternate Test for Grades 1 & 0 Substitutions: ▪ Long head of biceps. ▪ Shoulder elevation. ▪ Lateral trunk flexion to opposite side. Surface Anatomy of Supraspinatus 27 HHD for Shoulder Abduction  Shoulder Horizontal Abduction (130°) 30 Primary Muscles: ▪ Posterior deltoid. Accessory Muscles: ▪ Infraspinatus. ▪ Teres minor. ▪ Middle deltoid. ▪ Middle trapezius. ▪ Rhomboids Major.  Shoulder Horizontal Abduction 31 Grades 5 & 4 Test Position: ▪ Prone, Shoulder abducted to 90° and forearm off edge of table with elbow flexed. Resistance: ▪ Over posterior arm just above the elbow. Test: ▪ Patient horizontally abducts shoulder against maximal resistance. Stabilize scapula if weak scapular muscles. Shoulder Horizontal Abduction Grade 3 32  Shoulder Horizontal Abduction 33 Grade 2, 1 & 0 Test Position : ▪ Short sitting over end or side of table. With Support forearm under distal surface and palpate over the posterior surface of the shoulder just superior to the axilla.  Shoulder Horizontal Abduction 34 Alternate test for Grade 2, 1 & 0 Stabilization: ▪ Over the superior aspect of the shoulder and the other over the scapula. Palpate below and lateral to the spine of the scapula. Elbow semi flexed Substitutions: ▪ Long head of triceps. ▪ Rhomboids. ▪ Trunk rotation. 35  Shoulder Horizontal Adduction (130°) 36 Primary Muscles: ▪ Pectoralis Major. Accessory Muscles: ▪ Anterior Deltoid. Isolation of 2 heads: detect level of C SCI. 37  38 Shoulder Horizontal Adduction Grades 5 & 4 (whole muscle) → from 90° Abduction Test Position: ▪ Supine. Shoulder abducted to 90°; elbow flexed to 90°. Resistance: ▪ Outward. Instructions: ▪ Both Heads: "Move your arm across your chest.  Shoulder Horizontal Adduction 39 Grades 5 & 4 (Clavicular Head) → from 60° Abduction Test Position: ▪ 60° of abduction and moves up and in across the body. Resistance: ▪ Downward direction (toward floor) and outward.  Shoulder Horizontal Adduction Grades 5 & 4 (Sternal Head) → from 120° Abduction Test Position: ▪ 120° of shoulder abduction and moves diagonally down and in toward the patient's opposite hip. Resistance: ▪ Up and outward direction. Shoulder Horizontal Adduction Grade 3 (whole muscle)  Shoulder Horizontal Adduction 42 Grade 2 (whole muscle) Test Position: ▪ Horizontally adducts shoulder with the weight of the arm supported by the examiner or the table. Palpation: ▪ On the anterior aspect of the chest medial to the shoulder joint. Alternate test from supine. Substitution: Trunk rotation. 43 THANK YOU