MMT For Scapula PDF

# Scapular Movements ## 1-Scapular Abduction & Upward Rotation ### Grade 3 - Supine. - Stabilize weight of the trunk. - "Push your arm in front of you as you want to reach the ceiling." - Serratus anterior - Pectoralis minor + trapezius (upper & lower) ### Grade 4, 5 - Same position as grade 3....

# Scapular Movements ## 1-Scapular Abduction & Upward Rotation ### Grade 3 - Supine. - Stabilize weight of the trunk. - "Push your arm in front of you as you want to reach the ceiling." - Serratus anterior - Pectoralis minor + trapezius (upper & lower) ### Grade 4, 5 - Same position as grade 3. - Resistance to: - Distal end of humerus ### Grade 2, 1 and zero - Sitting - Stabilization = avoid trunk rotation - "Push your arm forward." - **Palpation:** Mid axillary adjacent to inferior angle of scapula - **Push up test for serratus anterior** - Weakness is shown by "winging of scapula" ## 2- Scapular(shoulder) elevation ### Grade 3 - Sitting. - "Pull your shoulders upward as much as you can." - Stabilization: weight of head - Trapezius - Levator scapula - Rhomboids (major &minor) ### Grade 4, 5 - Same position as grade 3. - Resistance to: - Over top of shoulder. ### Grade 2, 1 and zero - Prone - The therapist support the weight of the upper extremity to reduce the resistance of friction. - Stabilization = weight of the head. - "Pull your shoulders toward your ears." - **Palpation of trapezius only:** Middle point from inion to the acromion. - There is no palpation of levator scapula, it's deep to palpate ## 3- Scapular adduction (retraction) ### Grade 3 - Prone - Patient bring his arm up & adducts scapula toward the midline. - Stabilization: contralateral thorax. - "Raise your arm up in horizontal abduction and adduct the scapula." - Trapezius (middle) - Rhomboids major - Rhomboids minor ### Grade 4, 5 - Same position as grade 3. - Resistance to: - Distal forearm. ### Grade 2, 1 and zero - Sitting - Stabilization = avoid trunk rotation - "Pull your arm slightly backward and bring your scapula back and in." - **Palpation:** Medial border of the scapula and the vertebra above the spine of scapula (from T1-T5) ## 4- Scapular depression and adduction ### Grade 3 - Prone - Arm over head 145 degree of shoulder elevation and abduction. Forearm is in mid position (neutral rotation) with the thumb pointing toward the ceiling. - "Move your arm from the table as high as possible." - Trapezius (lower) - Trapezius (middle) + Lattisimus dorsi + Pectoralis minor and major ### Grade 4, 5 - Same position as grade 3. - Resistance to: - Distal forearm. - Resistance is done by telling the patient to hold his arm against the resistance without push it down. - "Hold your arm. Don't let me push it down." ### Grade 2, 1 and zero - Prone - Same position of grade 3. - Therapist lifts and supports weight of the arm. - "Lift your arm from the table past your ear." - **Palpation:** between the root of the spine and lower thoracic vertebrae. (T7-T12) (medial to the inferior angle of the scapula) ## 5- Scapular adduction and downward rotation ### Grade 3 - Prone - Dorsum of the hand is placed over the buttocks of the non-test site. - Stabilization = weight of the trunk. - "Pull your arm up and bring your scapula down." - Rhomboids (Major+Minor) - Levator scapula + middle trapezius ### Grade 4, 5 - Same position as grade 3. - Resistance to: - On the humerus just above the elbow. - (Resistance is cupped around flexed elbow) - "Pull your arm up. Don't let me push it down." ### Grade 2, 1 and zero - Sitting - Dorsum of the hand is placed over the buttocks of the non-test site. - "Bring your arm back and your scapula in" - **Palpation:** - C7: T5 + Rhomboids major can be palpated near inferior angle of scapula. - Grade 1: try to bring.