Scapular MMT 1 (3rd Lecture & 3rd Section) PDF

Scapular Motions Prof. Dr. Amir N Wadee  Scapular Motions Elevation. Depression. Adduction (Retraction). Abduction (Protraction). Upward rotation. Downward rotation.  Muscles contribute to Scapular Abduction & Upward Rotation Serratus Anterior...

Scapular Motions Prof. Dr. Amir N Wadee  Scapular Motions Elevation. Depression. Adduction (Retraction). Abduction (Protraction). Upward rotation. Downward rotation.  Muscles contribute to Scapular Abduction & Upward Rotation Serratus Anterior  Serratus Anterior Origin: lateral, anterior surface of the upper 8th- 9th ribs Insertion: Anterior aspect of the medial vertebral border of the scapula Action: strongest abductor of the scapula and Shoulder Abduction to 90º Nerve supply: Long thoracic nerve (C5 – C7) Palpation site: Along the midaxillary line adjacent to the inferior angle of the scapula.  Secondary Movers Pectoralis minor  Factors Limiting Motion: 1-Tension of trapezoid ligament (limits forward rotation of scapula upon clavicle). 2-Tension of trapezius and Rhomboid major and minor muscles Fixation: 1- In strong scapular abduction, pull of external Obliquus externus abdominus on same side. 2-Weight of thorax  Effect of weakness: 1- Winging of scapula (main weakness) 2- Difficult to flex or abduct the shoulder. 3- Difficulty to raise the arm overhead  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. Subject directive: “Punch up toward the ceiling and resist as I push down.” Scapular Abduction & Upward Rotation Alternate Alternate  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. Alternate  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 Alternate  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  Trace & Zero The serratus anterior is palpated along the mid axillary line adjacent to the inferior angle of the scapula as the subject attempts to abduct the scapula against light resistance. Muscles contribute to Scapular Elevation Upper Trapezius Levator scapulae  Upper Trapezius Origin: Base of the skull & posterior ligaments of the neck Insertion: Posterior aspect of the lateral 3rd of clavicle Nerve supply: Accessory nerve (C3 – C4) Palpation site : - Parallel to cervical spine C7 and near the insertion above the clavicle  Lavetor scapulae Origin: Transverse process of 1st four cervical Insertion: Medial border of the scapula Nerve supply: Dorsal Scapular Nerve (C5) - Palpation site: - Deep to the upper trapezius in the Angle formed by the upper trapezius and sternocleidomastoid muscles.  Secondary Movers Rhomboids major and minor  Factors Limiting Motion: 1-Tension of costoclavicular ligament 2- Tension of muscles depressing scapula and clavicle: Pectoralis minor, subclavius, and Trapezius (lower fibers). Fixation: 1-Flexor muscles of cervical spine (for tests done in sitting position). 2-Weight of head (foe tests done in prone position).  Substitution In patients with weak shoulder elevators, the Rhomboids may attempt to substitute. During unsuccessful attempts to shrug the shoulder the inferior angle of the scapula will move medially toward the cervical spine (scapular adduction), and downward motion (rotation) also may occur.  Effect of weakness Lateral winging of the scapula, which is most obvious when attempting to abduct the shoulder. Difficulty when trying to abduct or flex the upper extremity above shoulder height. Effect of weakness  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.  Fair Position: Sitting with arms at sides. Desired Motion: Patient elevates shoulders through ROM. Subject directive: “Raise your shoulders as high as possible toward the ceiling and hold while I try to push them down.”  Poor Position: Prone with shoulders supported by examiner and forehead resting on table. Desired Motion: Patient moves shoulders toward ears through ROM.  Trace & Zero Examiner palpates upper fibers of Trapezius parallel to cervical Vertebrae and near their insertion above clavicle. Note  Evidence- Based Practice for Therapeutic Exercise