Scapular Muscle Test PDF

# Scapular Muscle Test ## **Dr. Ahmed Ali Mohammed Torad** - **Page 287** - **Page 288** ### Shoulder Girdle - Sternoclavicular joint - Scapulothoracic joint - Acromioclavicular joint - Glenohumeral joint - G-H joint - A-C joint - S-T articulation - S-C joint - Subacromial space - *...

# Scapular Muscle Test ## **Dr. Ahmed Ali Mohammed Torad** - **Page 287** - **Page 288** ### Shoulder Girdle - Sternoclavicular joint - Scapulothoracic joint - Acromioclavicular joint - Glenohumeral joint - G-H joint - A-C joint - S-T articulation - S-C joint - Subacromial space - **Page 289** ### Scapular motions - Scapular Abduction and Upward Rotation - Scapula Elevation - Scapula Adduction - Scapula Depression and Adduction - Scapula Adduction and Downward Rotation - **Page 290** ### Pre Examination - Observation of the scapulae, both at rest and during active and passive shoulder flexion, is a routine part of the test. Examine the patient in short sitting position with hands in lap. - Palpate the vertebral borders of both scapulae with the thumbs place the web of the thumb below the inferior angle the fingers extend around the axillary borders. #### Specific Elements - **Position and symmetry of scapula:** determine the position of the scapulae at rest and whether the two sides are symmetrical. - **Scapular range of motion:** within the total arc of 180° of shoulder forward flexion, 120° is glenohumeral motion, and 60° is scapular motion. - **Page 291** ### Motion that will be tested 1. Scapula Abduction and Upward Rotation 2. Scapula Elevation 3. Scapula Adduction 4. Scapula Depression and Adduction 5. Scapula Adduction and Downward Rotation - **Page 292** ### Scapula Abduction and Upward Rotation 1. **Prime mover/agonist:** - Serratus anterior: - Origin: Ribs 1-8 intercostal fascia - Insertion: Scapula (ventral surface of vertebral border) 2. **Synergist/ Accessory muscles:** - Pectoralis minor. 3. **Nerve supply:** - Long thoracic n. C5-C7 4. **Range of motion:** - Measure the distance between spine process and medial border of scapula - **Page 293** ### Scapula Abduction and Upward Rotation 5. **Fixation:** - In strong scapular abduction, by pull of obliqus externus abdominis on same side. - By weight of thorax. 6. **Effect of weakness/contracture/shortening:** - **Effect of weakness result in:** - Winging of Scapula (due to paralysis of serratus anterior) - In ability to raise the arm overhead. 7. **Factor limited range of motion:** - Tension of trapezoid ligament. - Tension of trapezius and rhomboid major and rhomboid minor muscles. 8. **Substitution:** - None. - **Page 294** ### Normal & Good - **Position:** Supine with arm flexed to 90º with slight abduction, and elbow in extension. - **Stabilization & Palpation Point:** None - **Desired Motion:** Patient moves arm upward by abducting the scapula. - **Resistance:** Is given by grasping around forearm and elbow. Pressure is downward and inward toward table. - **Page 295** ### Fair - **Position:** Supine with arm flexed to 90º and scapula resting on table. - **Stabilization and Palpation:** None - **Desired Motion:** Patient forces arm upward. Scapula should be completely abducted without "winging" (If extensor muscles of elbow are weak, elbow may be flexed or forearm may be supported. - **Page 296** ### Poor - **Position:** Sitting with arm flexed to 90º and arm resting on table. - **Stabilization:** Stabilize thorax - **Desired Motion:** Patient moves arm forward by abducting scapula - **Page 297** ### **Trace & Zero** - Examiner lightly forces arm backward to determine presence of a contraction of Serratus anterior. - Scapula should be observed for "winging." - Digitations of Serratus anterior may be palpated on outer surface of ribs for a contraction - **Page 298** ### Scapula Elevation 1. **Prime mover/agonist:** - Trapezius (superior fibers): - Origin: Occiput C7 Vert.SP. and Ligamentum nuchae - Insertion: Clavicle (post. border) - Levator scapulae: - Origin: C1-C4 vert tp. - Insertion: Scapula (vert. border superior angle and root of spine) 2. **Synergist/ Accessory muscles:** - Rhomboid major and minor. 3. **Nerve supply:** - XI Accessory(C3-C4) and Dorsal Scapular n. (C5) for Levator scapulae, - XI Accessory(C3-C4) n. for Trapizius (superior fibers) 4. **Range of motion:** - Measure the distance between top of the shoulder and loops of ear. - **Page 299** ### Scapula Elevation 5. **Fixation:** - By flexor muscles of cervical spine.. - By weight of head. 6. **Effect of weakness/contracture/shortening:** - effect of weakness result in: In ability to raise shoulder upwards; either bilateral or unilateral weakness. 7. **Factor limited range of motion:** - Tension of costoclavicular ligament. - Tension of scapular depression muscle and clavicle: pectoralis minor, subclavius, and trapezius (lower fibers) muscles. 8. **Substitution:** - By Rhomboids (scapula adduction and downward rotation) inferior angle will move medially. - **Page 300** ### Normal & Good - **Position:** Sitting with arms at sides. - **Stabilization:** No fixation necessary. - **Palpation point:** Between lateral neck and acromion. - **Desired Motion:** Patient raises shoulders as high as possible - **Resistance:** Is given downward on top of shoulders. - **Page 301** ### Fair - **Position:** Sitting with arms at sides. - **Desired Motion:** Patient elevates shoulders through ROM. - **Page 302** ### Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero) - **Position of Patient:** Prone or supine, fully supported on table. If prone, head is turned to one side for patient comfort. If supine, head is in neutral position. - **Position of Therapist:** Standing at test side of patient. Support test shoulder in palm of one hand. The other hand palpates the upper trapezius near its insertion above the clavicle. A second site for palpation is the upper trapezius just adjacent to the cervical vertebrae. - **Test:** With the therapist supporting the shoulder, the patient elevates the shoulder (usually done unilaterally) toward the ear. - **Instructions to Patient:** "Raise your shoulder toward your ear." #### Grading - **Grade 2 (Poor):** Patient completes full range of motion in gravity-eliminated position. - **Grade 1 (Trace):** Upper trapezius fibers can be palpated at clavicle or neck. The levator muscle lies deep and is more difficult to palpate in the neck (between the sternocleidomastoid and the trapezius). It can be felt at its insertion on the vertebral border of the scapula superior to the scapular spine. - **Page 303** ### Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero) - **If the prone position is not comfortable, the tests for Grades 2, 1, and 0 may be performed with the patient supine, but palpation in such cases will be less than optimal.** - **In the prone position, the turned head offers a disadvantage. When the face is turned to either side, there is more trapezius activity and less levator activity on that side.** - **Page 304** ### Scapula Adduction (Retraction) 1. **Prime mover/agonist:** - Trapezius (middle fibers) - Origin: T1-T5 vert.SP - Insertion: Scapula (superior lip of spine) 2. **Synergist/ Accessory muscles:** - Rhomboid major and minor, and Trapezius (upper and lower fibers) 3. **Nerve supply:** - XI Accessory(C3-C4) n. 4. **Range of motion:** - Measure the distance between transverse process and medial border of scapula - **Page 305** ### Scapula Adduction (Retraction) 5. **Fixation:** - By weight of thorax. 6. **Effect of weakness:** - In ability to adduct the scapula. 7. **Factor limited range of motion:** - Tension of conoid ligament. - Tension of pectoralis major and minor, and serratus anterior muscles. - Contact of vertebral border of scapula with spinal musculature. 8. **Substitution:** - By Rhomboids (scapula adduction and downward rotation) inferior angle will move medially. - By the post. Deltoid if the scapular muscles are absent (horizontal adduction of shoulder will occur). - **Page 306** ### Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair) - **Position of Patient:** Prone with shoulder at edge of table. Shoulder is abducted to 90°. Elbow is flexed to a right angle. Head may be turned to either side for comfort. - **Position of Therapist:** Standing at test side close to patient's arm. Stabilize the contralateral scapular area to prevent trunk rotation. There are two ways to give resistance one does not require as much stregth as the other. 1. **When the posterior deltoid is Grade 3 or better:** The hand for resistance is placed over the distal end of the humerus, and resistance is directed downward toward the floor. The wrist also may be used for a longer lever, but the lever selected should be maintained consistently throughout the test. 2. **When the posterior deltoid is Grade 2 or less:** Resistance is given in a downward direction (toward floor) with the hand contoured over the shoulder joint. This placement of resistance requires less adductor muscle strength by the patient than is needed in the test described in the preceding paragraph. - **Page 307** ### Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair) - **The fingers of the other hand can palpate the middle fibers of the trapezius at the spine of the scapula from the acromion to the vertebral column if necessary.** - **Test:** Patient horizontally abducts arm and adducts scapula. - **Instructions to Patient:** “Lift your elbow toward the ceiling. Hold it. Don't let me push it down." #### Grading - **Grade 5 (Normal):** Completes available scapular adduction range and holds end position against maximal resistance. - **Grade 4 (Good):** Tolerates strong to moderate resistance. - **Grade 3 (Fair):** Completes available range but without manual resistance - **Page 308** ### Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero) - **Position of Patient and Therapist:** Same as for normal test except that the therapist uses one hand to cradle the patient's shoulder and arm, thus supporting the arm's weight, and the other hand for palpation. - **Test:** Same as that for Grades 5 to 3. - **Instruction to Patient:** “Try to lift your elbow toward the ceiling." #### Grading - **Grade 2 (Poor):** Completes full range of motion without the weight of the arm. - **Grade 1 (Trace) and Grade 0 (Zero):** A Grade 1 (Trace) muscle exhibits contractile activity or slight movement. There will be neither motion nor contractile activity in the Grade 0 (Zero) muscle. - **Page 309** ### Scapula Depression and Adduction 1. **Prime mover/agonist:** - Trapezius (lower fibers) - Origin: T1-T5 vert.sp - Insertion: Scapula (spine) 2. **Synergist/ Accessory muscles:** - latissimus dorsi. 3. **Nerve supply:** - XI Accessory (C3-C4) n. 4. **Range of motion:** - Measure the distance between spine process and inferior angle of scapula - **Page 310** ### Scapula Depression and Adduction 5. **Fixation:** - By contraction of spinal extensor muscles. - By weight of thorax. 6. **Effect of weakness:** - Inability to raise the arm overhead. 7. **Factor limited range of motion:** - Tension of inter clavicular ligament and articular disk of sternoclavicular joint. - Tension of trapezius muscle. 8. **Substitution:** - None. - **Page 311** ### Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair) - **Position of Patient:** Prone with test arm over head to about 145° of abduction (in line with the fibers of the lower trapezius). Forearm is in midposition with the thumb pointing toward the ceiling. Head may be turned to either side for comfort. - **Position of Therapist:** Standing at test side. Hand giving resistance is contoured over the distal humerus just proximal to the elbow. Resistance will be given straight downward (toward the floor). For a less rigorous test, resistance may be given over the axillary border of the scapula. Fingertips of the opposite hand palpate (for Grade 3) below the spine of the scapula and across to the thoracic vertebrae, following the muscle as it curves down to the lower thoracic vertebrae. - **Page 312** ### Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair) - **Test:** Patient raises arm from the table to at least ear level and holds it strongly against resistance. Alternatively, preposition the arm in elevation diagonally over the head and ask the patient to hold it strongly against resistance. - **Instructions to Patient:** "Raise your arm from the table as high as possible. Hold it. Don't let me push it down." #### Grading - **Grade 5 (Normal):** Completes available range and holds it against maximal resistance. This is a strong muscle. - **Grade 4 (Good):** Takes strong to moderate resistance - **Grade 3 (Fair):** Same procedure is used but patient tolerates no manual resistance. - **Page 313** ### Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero) - **Position of Patient:** Same as for Grade 5. - **Position of Therapist:** Standing at test side. Support patient's arm under the elbow. - **Test:** Patient attempts to lift the arm from the table. If the patient is unable to lift the arm because of a weak posterior and middle deltoid, the examiner should lift and support the weight of the arm. - **Instructions to Patient:** "Try to lift your arm from the table past your ear." #### Grading - **Grade 2 (Poor):** Completes full scapular range of motion without the weight of the arm. - **Grade 1 (Trace):** Contractile activity can be palpated in the triangular area between the root of the spine of the scapula and the lower thoracic vertebra (T7-T12), that is, the course of the fibers of the lower trapezius. - **Grade 0 (Zero):** No palpable contractile activity.