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DPT Semester 1 > CP1 MMT > Flashcards

CP1 MMT Flashcards

1
Q

what muscle is primarily tested in shoulder flexion?

A

anterior deltoid

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2
Q

what secondary muscles contribute to shoulder flexion?

A
  1. coracobrachialis
  2. supraspinatus
  3. biceps brachii
  4. trapezius (shoulder hiking)
  5. pectoralis major (if there is horizontal add)
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3
Q

for grades 3 and up, how should a pt be positioned when tested shoulder flexion?

A
  1. short sitting
  2. arm flexed to 900
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4
Q

for grades 0,1,2 how should a pt be positioned to test shoulder flexion?

A
  1. side lying
  2. palpate for anterior deltoid
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5
Q

where do you stabilize when testing shoulder flexion (MMT)?

A

stabilize at shoulder

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6
Q

where is resistance applied when performing shoulder flexion MMT?

A

distal humerus, downward direction

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7
Q

what are some common substitutions pts may utilize during a shoulder flexion MMT?

A
  1. ER of arm
  2. shoulder hiking
  3. leaning trunk backwards
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8
Q

what muscle(s) are primarily tested during shoulder extension MMT?

A
  1. posterior deltoid
  2. latissimus dosi
  3. teres major
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9
Q

what secondary muscles contribute to shoulder extension?

A

long head of triceps brachii

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10
Q

for grades 3 and up, how should a pt be positioned during shoulder extension MMT?

A
  1. prone
  2. face turned towards testing side
  3. palm facing up
  4. elbow remains extended and straight
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11
Q

for grades 0,1,2 how should a pt be positioned for shoulder extension MMT?

A
  1. side lying
  2. palpate for posterior deltoid or teres major
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12
Q

where do you stabilize when testing shoulder extension?

A

at the shoulder

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13
Q

where is resistance applied when performing shoulder extension MMT?

A

distal humerus

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14
Q

what muscle(s) are primarily tested during shoulder abduction MMT?

A
  1. middle deltoid
  2. supraspinatus
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15
Q

for grades 3 and up how should a pt be positioned when performing shoulder abduction MMT?

A
  1. short sitting
  2. shoulder abducted 900
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16
Q

for grades 0,1,2 how should a pt be positioned when performing shoulder abduction MMT?

A
  1. supine
  2. towel under arm to reduce friction on bed
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17
Q

where should the tester stabilize when performing shoulder abduction MMT?

A

at the shoulder

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18
Q

where is resistance applied when performing shoulder abduction MMT?

A

distal humerus

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19
Q

what are some common substitutions that may occur when performing shoulder abduction MMT?

A
  1. trunk lateral flexion
  2. scapular/shoulder elevation
  3. using biceps brachii (arm will ER)
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20
Q

what muscle(s) are primarily tested during shoulder horizontal abduction MMT?

A
  1. posterior deltoid
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21
Q

for grades 3 and up how should the pt be positioned when peforming shoulder horizontal abduction MMT?

A
  1. prone facing arm being tested
  2. thumb down
  3. elbow at 900 (only for grade 3)

“lift your elbow to the ceiling, don’t let me push you down”

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22
Q

for grades 0,1,2 how should the pt be positioned when performing horizontal shoulder abduction MMT?

A
  1. sitting
  2. arm supported on surface

“slide your arm backwards on the table”

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23
Q

where should the tester stabilize when performing shoulder horizontal abduction MMT?

A
  1. shoulder/scapule = for grades 3 and up
  2. scapular for grade 0,1,2
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24
Q

where is resitance applied when testing horizontal shoulder abduction?

A

above elbow/distal humerus

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25
Q

what is a common substituion that may be observed when testing shoulder horizontal abduction?

A

elbow may straigten out (long head of triceps will be used)

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26
Q

what muscle(s) are primarily tested during shoulder horizontal adduction MMT?

A

pectoralis major

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27
Q

for grades 3 and up, how should the pt be positioned during shoulder horizontal ADD MMT?

A
  1. supine
  2. arm pointed towards the ceiling
  3. sligh elbow flexion

“bring your arm towards the middle, don’t let me pull it back out”

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28
Q

how can you isolate the clavicular head of the pectoralis major during shoulder horizontal ADD MMT?

A

begin with the shoulder at 600 of ABD and tell the pt to move arm “up and in”

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29
Q

how can you isolate the sternal head of the pectoralis major during shoulder horizontal ADD MMT?

A

begin with the shoulder in 1200 of ABD and tell the pt to move arm “down and in”

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30
Q

where is resistance applied when performing a horizontal shoulder ADD MMT?

A

distal humerus/elbow

pull towards the therapist

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31
Q

what muscle(s) are primarily tested when performing shoulder ER MMT?

A
  1. Infraspinatus
  2. Teres Minor
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32
Q

for grades 3 and up how is the pt positioned during shoulder ER MMT?

A
  1. prone, head turned towards testing side
  2. hand hangin off side of table
  3. PT supports under the arm
  4. instruct pt to move forearm up and towards the ceiling and hold there
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33
Q

for grades 0,1,2 how is the pt positioned during shouder ER MMT?

A

Can do gravity minimized on table (towel under to reduce friction)

or

pt laying prone with arm off the table (instruct them to turn their palm out clockwise)

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34
Q

where do you stabilize when performing shoulder ER MMT?

A

distal humerus for support

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35
Q

where is resistance applied during shoulder ER MMT?

A

forearm in a downward direction

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36
Q

what muscle(s) are primarily tested during shoulder IR MMT?

A
  1. Subscapularis
  2. Teres Major
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37
Q

what secondary muscles contribute to shoulder internal rotation?

A
  1. pectoralis major
  2. latissimus dorsi
  3. anterior deltoid
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38
Q

for grades 3 and up, how is the pt positioned during shoulder IR MMT?

A
  1. prone
  2. head facing towards testing side
  3. start with hand hanging down and PT supporting arm
  4. instruct pt to move forearm backwards and hold there
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39
Q

for grades 0,1,2 how is the pt positioned during shoulder IR MMT?

A

Gravity minimized = seated w/towel under arm

OR

laying prone with arm handing entirely off the table, instruct pt to turn their arm counter-clockwise

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40
Q

where do you stabilize when performing shoulder IR MMT?

A

distal humerus

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41
Q

where is resistance applied during shoulder IR MMT?

A

forearm in a downward direction

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42
Q

which shoulder MMTs do you not apply resistance at the distal humerus?

A
  1. Shoulder IR
  2. Shoulder ER
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43
Q

what motions/directions do you test when performing shoulder MMT?

A
  1. Flexion
  2. Extension
  3. Abduction
  4. Horizontal Abduction
  5. Horizontal Adduction
  6. Internal Rotation
  7. External Rotation
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44
Q

what are the primary muscles for tested during elbow flexion MMT?

A
  1. biceps brachii
  2. brachioradialis
  3. brachialis
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45
Q

for grade 3 and up, how should the pt be positioned during elbow flexion MMT?

A
  1. sitting
  2. elbow flexed past 900
  3. for isolation:
    • biceps = palm up (supinated)
    • brachioradialis = thumb up (neutral)
    • brachialis = palm down (pronation)
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46
Q

for grade 0,1,2 how should the pt be positioned during elbow flexion MMT?

A

can be lying supine or PT can support arm while pt is sitting

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47
Q

where should the PT stabilize during elbow flexion MMT?

A

at the shoulder

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48
Q

where is resistance applied during elbow flexion MMT?

A

to the forearm, out and downward force

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49
Q

what are the primary muscle(s) tested during elbow extension?

A

triceps brachii

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50
Q

for grades 3 and up, how should the pt be positioned during elbow extension MMT?

A
  1. prone with arm off the table
  2. entire arm is off, the shoulder/armpit is at the edge of the table
  3. instrust pt to “straighten your arm, don’t let me push it down”
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51
Q

what muscle(s) assit during elbow flexion?

A
  1. pronator teres
  2. all wrist flexors
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52
Q

what muscle(s) assit in elbow extension?

A
  1. anconeus
  2. some wrist extensors
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53
Q

for grades 0,1,2 how should the pt be positioned during elbow extension MMT?

A
  1. sitting with shoulder abducted or flexted to 90
  2. elbow at 90, instruct pt to extend the arm
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54
Q

where should the PT stabilize when performing elbow extension MMT?

A

distal humerus

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55
Q

where is resistance applied when performing elbow extension MMT?

A

forearm

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56
Q

what are some common substitutions observed when testing elbow extension?

A

pt may ER their shoulder

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57
Q

what are the primary muscle(s) tested during forearm supination MMT?

A
  1. Biceps brachii
  2. Supinator
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58
Q

for grades 3 and up, how should the pt be positioned during forearm supination MMT?

A
  1. seated w/elbow at 90
  2. forearm fully pronated
  3. Instruct the pt to “turn palm up, don’t let me push you back”
  4. PT applies resistance to dorsum of forearm
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59
Q

for grades 0,1,2 how should the pt be positioned during forearm supination MMT?

A
  1. seated with shoulder and elbow at 90
    • elbow is supported by hand or table
  2. forearm is in neutral
  3. instruct the pt to “turn palm towards face”
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60
Q

where should the PT stabilize when performing forearm supination MMT?

A

at elbow

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61
Q

where is resistance applied when performing forearm supination MMT?

A

dorsal aspect of forearm

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62
Q

what are some common substitutions observed during forearm supination MMT?

A

shouler ER combined with horizontal ADD can indirectly cause the forearm to supinate

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63
Q

what muscle(s) are primarily tested during forearm pronation MMT?

A
  1. pronator teres
  2. pronator quadratus
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64
Q

for grades 3 and up, how should the pt be positioned during forearm pronation MMT?

A
  1. seated with elbow flexed to 90
  2. forearm fully supinated
  3. Instruct the pt to “turn palm down and don’t let me push it back”
  4. PT applies resistance to anterior forearm
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65
Q

for grades 0,1,2 how should the pt be positioned during forearm pronation MMT?

A
  1. seated with shoulder and elbow flexed to 90
    • elbow supported by PT hands or by table
  2. forearm in neutral rotation
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66
Q

where should the PT stabilize when performing forearm pronation MMT?

A

at elbow

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67
Q

where is resistance applied when performing forearm pronation MMT?

A

anterior forearm

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68
Q

what muscle(s) are primarily tested during wrist flexion MMT?

A
  1. Flexor carpi ulnaris
  2. Flexor carpi radialis
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69
Q

what muscle(s) are secondary/assit with wrist flexion?

A
  1. palmaris longus
  2. flexor digitorum profundus
  3. flexor digitorum superficialis
  4. flexor pollicis
  5. Abductor pollicis
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70
Q

for grades 3 and up, how should the pt be positioned during wrist flexion MMT?

A
  1. seated with forearm supinated on table
  2. wrist in neutral for group flexion testing
    • for FCU = flex + ulnar deviation (PT pulls into radial deviation)
    • for FCR = flex + radial deviation (PT pulls into ulnar deviation)
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71
Q

T/F: when trying to isolate the flexor carpi ulnaris, instruct the pt to flex their wrist as well as radially deviate?

A

FALSE

flex + ulnar deviation

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72
Q

for grades 0,1,2 how should the pt be positioned during wrist flexion MMT?

A
  1. seated with forearm in neutral pro/supination resting on table
    • can use towel under arm
  2. to target FCU or FCR, palpate accordingly
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73
Q

where should the PT stabilize when performing wrist flexion MMT?

A
  1. group testing = forearm and wrist
  2. FCU = hold under wrist so that your fingers wrap around to palpate the 5th metacarpal
  3. FCR = hold the wrist so that your finger wrap around to palpate the 2nd and 3rd metacarpals
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74
Q

where is resistance applied when performing wrist flexion MMT?

A
  1. group test = resistance applied to pt palm towards PT
  2. FCU = pull into radial side
  3. FCR = pull into ulnaris side

*use 4 fingers on the palm

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75
Q

what muscle(s) are primarily testing during wrist extension MMT?

A
  1. Extensor capri radialis longus
  2. Extensor carpi radialis brevis
  3. Extensor carpi ulnaris
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76
Q

for grades 3 and up, how should the pt be positioned during wrist extension MMT?

A
  1. short sitting
  2. forearm pronated and resting on table
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77
Q

for grades 0,1,2 how should the pt be positioned for wrist extension MMT?

A
  1. short sitting
  2. forearm in neutral rotation and resting on table
  3. palpate for contraction
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78
Q

where should the PT stabilize when performing wrist extension MMT?

A

pt forearm

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79
Q

where is resistance applied during wrist extenstion MMT?

A

downward force applied to back of hand

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80
Q

to isolate the ECRL where shoul the PT palpate?

A

dorsum of 2nd MC

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81
Q

to isolate the ECRB where should the PT palpate?

A

dorsum of 3rd MC

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82
Q

to isolate the ECU where should the PT palpate?

A

dorsum of 5th MC and styolid process

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83
Q

what muscle(s) are primarily tested during MCP flexion +IP extension MMT?

A
  1. palmar interossei (PADs and DABs)
  2. Lumbricals
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84
Q

for grades 3 and up, how should the pt be positioned for MCP flexion + IP extension?

A
  1. short sitting
  2. forearm supinated and resting on table
  3. Don’t let IPs curls, should remain extended
  4. Instruct the pt to “curl your hand towards your body while keeping your fingers as straight as you can”
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85
Q

for grades 0,1,2 how should the pt be positioned during MCP flexion + IP extension MMT?

A
  1. short sitting
  2. forearm in neutral rotation and resting on table
    • thumb pointing up
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86
Q

where should the PT stabilize when performing MCP flexion + IP extension MMT?

A

stabilize with one hand gripping the metacarpals

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87
Q

where is resistance applied during MCP flexion + IP extension MMT?

A

proximal phalanx, down and out force

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88
Q

what muscle(s) are primarily tested during finger PIP and DIP flexion MMT?

A
  1. PIP = flexor digitorum superficialis
  2. DIP = flexor digitorum profundus
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89
Q

for grades 3 and up, how should the pt be positioned when performing finger PIP and DIP flexion MMT?

A
  1. short sitting
  2. forearm supinated and resting on table
  3. isolate each finger to test IPs
    • PIP = “bend middle joint of your finger”
    • DIP = “bend tip of your finger”
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90
Q

for grades 0,1,2 how should the pt be positioned when performing finger PIP and DIP flexion MMT?

A
  1. short sitting
  2. fowarm in neutral and resting on table
  3. palpate targeted muscle
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91
Q

T/F: this image depicts PIP flexion MMT?

A

FALSE, it depicts DIP flexion MMT

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92
Q

where should the PT stabilize when performing finger PIP and DIP flexion MMT?

A
  1. PIP = stabilize other finger to keep them from flexion
  2. DIP = stabilize at middle phalanx to prevent PIP flexion
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93
Q

where is resitance applied during finger PIP and DIP flexion MMT?

A
  1. PIP = resistance is applied to middle phalanx
  2. DIP = resistance is applied to distal phalanx
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94
Q

what muscle(s) are primarily tested during MCP extension?

A
  1. Extensor digitorum
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95
Q

what muscle(s) assit in MCP extension?

A
  1. extensor indicis
  2. extensor digiti minimi
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96
Q

for grades 3 and up, how should the pt be positioned for MCP extension MMT?

A
  1. short sitting
  2. forearm pronated and resting on table
  3. PT supporting wrist to keep this position
  4. instruct the pt to “bend your knuckles as far back as you can”
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97
Q

for grades 0,1,2 how should the pt be positioned for MCP extension MMT?

A
  1. short sitting
  2. forearm in neutral
  3. PT supporting wrist
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98
Q

where should the PT stabilize when performing MCP extension MMT?

A

at the wrist

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99
Q

where is resistance applied during MCP extension MMT?

A

applied to the back of proximal phalanx

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100
Q

what muscle(s) are primarily tested during finger ABDuction MMT?

A

Dorsal interossei (DABs)

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101
Q

how should the pt be positioned for finger ABDuction MMT?

A
  1. short sitting
  2. forearm in pronation and resting on table
  3. fingers spread
  4. Instruct the pt to “not let me push your fingers together”
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102
Q

T/F: finger abduction MMT can also be done in isolation?

A

TRUE

  1. Abduction of ring finger toward little finger
  2. Abduction of middle finger toward ring finger
  3. Abduction of middle finger toward index finger
  4. Abduction of index finger toward thumb
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103
Q

T/F: There is no specific gravity minized test for finger ABD?

A

TRUE

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104
Q

where should the PT stabilize when preforming finger ABD MMT?

A

at the wrist to keep it neutral

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105
Q

where is resistance applied during finger ABD MMT?

A

fingers pushed toward one another

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106
Q

what muscle(s) are primarily tested during finger ADD MMT?

A

Palmar Interossei (PADs)

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107
Q

how should the pt be positioned for finger ADD MMT?

A
  1. short sitting
  2. forearm in pronation and resting on table
  3. finger together
  4. Instruct pt to “not let me pull your fingers apart”
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108
Q

T/F: finger ADD MMT can also be done in isolation?

A

TRUE

  1. Adduction of little finger toward ring finger,
  2. Adduction of ring finger toward long finger,
  3. Adduction of index finger toward long finger,
  4. Adduction of thumb toward index finger
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109
Q

T/F: There is not specific gravity minimized test for finger ADD MMT?

A

TRUE

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110
Q

where should the PT stabilize when performing finger ADD MMT?

A

both hands used to pull fingers apart

if done in isolation, can stabilize the wrist

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111
Q

where is resistance applied during finger ADD MMT?

A

fingers pulled away from one another

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112
Q

what muscle(s) are primarily tested in thumb MCP and IP flexion?

A

flexor pollicis brevis

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113
Q

how should the pt be positioned when assessing thumb MCP and IP flexion MMT?

A
  1. short sitting
  2. forearm in supination and resting on table
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114
Q

how should you instruct a pt to move when assessing thumb MCP flexion MMT?

A

“Bring your thumb across your hand, touching your hand the whole time, don’t let me push it back”

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115
Q

how should you instruct a pt to move their thumb when assess thumb IP flexion MMT?

A

“flex just your thumb joint, don’t let me push it back”

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116
Q

where should the PT stabilize when performing thumb MCP and IP flexion MMT?

A
  1. MCP = stabilize at the wrist
  2. IP = stabilize at the MCP (proximal phalanx)
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117
Q

where is resistance applied when assessing thumb MCP and IP flexion MMT?

A

apply resistance into extension

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118
Q

what muscle(s) are primarily tested when performing thumb MCP and IP extension MMT?

A

extensor pollicis brevis

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119
Q

how should the pt be positioned when assessing thumb MCP and IP extension?

A
  1. short sitting
  2. forearm and wrist in neutral position and resting on table
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120
Q

how should you instruct a pt to move their thumb when assessing thumb MCP extension?

A

“lift your thumb to the ceiling, don’t let me push it down”

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121
Q

how should you instruct a pt to move their thumb when assessing thumb IP extension?

A

“dont let me push the end of your thumb down”

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122
Q

where should the PT stabilize when performing thumb MCP and IP extension MMT?

A
  1. MCP = stabilize at the wrist
  2. IP = stabilize at the MCP (proximal phalanx)
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123
Q

where is resistance applied when assessing thumb MCP and IP extension?

A
  1. MCP = resistance applied to back of proximal phalanx
  2. IP = resistance applied to back of distal phalanx
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124
Q

what muscle(s) are primarily assessed during thumb abduction MMT?

A
  1. abductor pollicis longus
  2. abductor pollicis brevis
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125
Q

for grades 3 and up, how should the pt be positioned when assessing thumb abduction with MMT?

A
  1. short sitting
  2. forearm in supination and resting on the table
  3. wrist in neutral
  4. “move your thumb to the ceiling, don’t let me push it down”
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126
Q

for grades 0,1,2 how should the pt be positioned when assessing thumb abduction with MMT?

A
  1. short sitting
  2. forearm in neutral (thumb pointed up) and resting on the table
  3. instruct the pt to “move your thumb to the side”
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127
Q

where should the PT stabilize when performing thumb abduction MMT?

A

stabilize at the wrist

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128
Q

where is resistance applied when assessing thumb abduction with MMT?

A

downward force applied to lateral thumb

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129
Q

what muscle(s) is primarily assessed during thumb adduction MMT?

A

adductor pollicis

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130
Q

for grades 3 and up, how should the pt be positioned for thumb adduction MMT?

A
  1. short sitting
  2. forearm in pronation and resting on table
  3. wrist in neutral
  4. Instruct the pt to “move your thumb towards your other fingers, don’t let me push it back down”
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131
Q

for grades 0,1,2 how should the pt be positioned when assessing thumb adduction with MMT?

A
  1. short sitting
  2. forearm in neutral (thumb up) and resting on table
  3. Instruct the pt to “move your thumb back towards your fingers”
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132
Q

where should the PT stabilize when assessing thumb adduction with MMT?

A

stabilize at the wrist

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133
Q

where should resistance be applied when assessing thumb adduction with MMT?

A

downward force applied to medial thumb

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134
Q

what muscle(s) are primarily assessed when performing thumb opposition MMT?

A
  1. Opponens pollicis
  2. Opponens digiti minimi
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135
Q

how should the pt be positioned when assessing thumb opposition with MMT?

A
  1. short sitting
  2. forearm supinated and resting on table
  3. Instruct the pt to “make an O with your fingers by toughing th tips of your thumb and pinky”
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136
Q

where should the PT stabilize during thumb opposition MMT?

A

no stabilization because you are using both hands

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137
Q

where should resistance be applied when assessing thumb opposition with MMT?

A

resistance applied to the thenar portion of the hand in an effort to pull the thumb and 5th digit apart

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138
Q

which MMT tests for the UE do not have a gravitiy minized position?

A
  1. Thumb MCP flexion and extension
  2. Thumb IP flexion and extension
  3. Finger ADD
  4. Finger ABD
  5. Thumb opposition
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139
Q

how do differeniate between a 0,1,2 for tests that do not have a gravity minimized position?

A

check for full or partial ROM

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140
Q

what muscle(s) are primarily assessed with hip flexion MMT?

A
  1. Iliacus
  2. Psoas Major
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141
Q

what muscle(s) assist with hip flexion?

A
  1. rectus femoris
  2. sartorius
  3. TFL
  4. Pectineus
  5. Adductor group
  6. Gluteus Medius (anterior)
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142
Q

for grades 3 and up, how should the pt be positioned during hip flexion MMT?

A
  1. sitting with legs off table
  2. hands on table
  3. instruct the pt to “lift your leg off the table, don’t let me push you dont”
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143
Q

for grades 0,1,2 how should the pt be positioned during hip flexion MMT?

A
  1. side lying
  2. bottom leg bent, top leg straight
  3. PT stabilizes top leg
  4. Instruct the pt to “bring your knees toward your chest”
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144
Q

where does the PT stabilize during hip flexion MMT?

A
  1. nowhere specific for grades 3 and up
  2. at hop for 0,1,2
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145
Q

where should resistance be applied during hip flexion MMT?

A

distal femur

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146
Q

what muscle(s) are primarily assess with hip extension MMT?

A
  1. Gluteus Maximus
  2. Hamstrings
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147
Q

what muscle(s) assist with hip extension?

A
  1. Adductor Magnus
  2. Gluteus medius
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148
Q

for grades 3 and up, how should the pt be positioned during hip extension MMT?

A
  1. pt in prone
  2. therapist on the side of testing leg
  3. Instruct pt to “lift leg as high as you can”

*picture depicts wrong side for the therapist

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149
Q

for grades 0,1,2 how should the pt be positioned during hip extension MMT?

A
  1. side lying
  2. therapist supports lef with forearm and hand under knee
  3. Instruct the pt to “move your leg back towards me”
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150
Q

What is a valid reason for utilizing a modified hip extension MMT?

A

hip flexor tightness

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151
Q

how should a pt be positioned for hip extension MMT if they have tight hip flexors?

A
  1. pt leans chest onto table
  2. therapist on side of testing leg
  3. Instruct pt to “lift your foot off the floor as high as you can and hold it there”
  4. apply resistance to distal femur
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152
Q

where does the PT stabilize during hip extension MMT?

A

at the pelvis for postural alignment

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153
Q

where should resistance be applied during hip extension MMT?

A
  1. for normal exams = at the ankle
  2. for modified test = distal femur
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154
Q

what muscle(s) primarily perform hip abduction?

A
  1. Gluteus medius
  2. Gluteus minimus
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155
Q

what muscle(s) assist with hip abduction?

A
  1. Upper fibers of gluteus maximus
  2. TFL
  3. deep hip rotators
  4. sartorius
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156
Q

for grades 3 and up, how should the pt be positioned during hip abduction MMT?

A
  1. pt in side lying
  2. bottom leg is bent
  3. hips stacked
  4. Instruct pt to “bring your fot to the ceiling”
    • do not let hip roll as the leg lifts up
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157
Q

T/F: grades 4 and 5 have different lever arms?

A

TRUE

grade 5 = resistance applied at ankle

grade 4 = resistance applied to distal femur

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158
Q

for grades 0,1,2 how should a pt be positioned during hip abduction MMT?

A
  1. supine
  2. toes pointed to the ceiling
  3. place a towel under foot
  4. Instruct pt to “move your leg to the side”
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159
Q

where should the PT stabilize during hip abduction MMT?

A

at the pelvis, watch out for hip ER!

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160
Q

What would you expect a pt to be able to do if they recieve a 4 or 5 on hip abduction MMT?

A

they should be able to stand on one limb and keep their pelvis level?

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161
Q

what are common substitutions a pt may demonstrate during hip abduction MMT?

A
  1. hip flexion with ER to recruit TFL
  2. hip extension ro recruit gluteus maximus
  3. may hip hike using quadratus lumborum and other trunk muscles
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162
Q

what muscle(s) primarily perform hip adduction?

A
  1. adductor magnus
  2. adductor brevis
  3. adductor longus
  4. pectineus
  5. gracilis
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163
Q

what muscle(s) assist with hip adduction?

A
  1. obturator externus
  2. gluteus maximus
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164
Q

for grades 3 and up, how should the pt be positioned during hip adduction MMT?

A
  1. side lying
  2. PT is supporting upper leg
  3. bottom leg is the one being tested
  4. Instruct pt to “move the leg on the table up to your other leg and hold”
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165
Q

for grades 0,1,2 how should the pt be positioned during hip adduction MMT?

A
  1. supine
  2. toes pointed up to the ceiling
  3. legs extended
  4. start with tested leg abducted
  5. Instruct pt to “move your leg into the other”
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166
Q

where should the PT stabilize during hip adduction MMT?

A
  1. upper leg for grades 3 and up
  2. pelvis in grades 0,1,2
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167
Q

where is resistance applied during hip adduction MMT?

A
  1. distal portion of medial femur
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168
Q

what is a common substitution a pt may demonstrate during hip adduction MMT?

A

may attempt to recruit hip flexors = will appear as through trunk rotation is occuring from side lying

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169
Q

what MMT is done specifically to target the sartorius?

A

hip flexion, abduction, and ER with knee flexion

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170
Q

for grades 3 and up, how is the pt positioned when testing the sartorius with MMT?

A
  1. sitting with legs off table
  2. PT should place pt into the position
  3. Can also instruct pt to “slide your hel up your other leg’s shin, resist my push”
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171
Q

for grades 0,1,2 how should the pt be positioned when testing the sartorius with MMT?

A

same test as grades 3 and up only place the pt in supine

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172
Q

where should the PT stabiilze during sartorius MMT?

A

no stabilization, both hands used for resistance

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173
Q

where should resistance be applied when testing the sartorius with MMT?

A
  1. one hand at ankle to move pt’s foot laterally and straighten the knee
  2. other hand at knee to move the hip into extension and adduction
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174
Q

what muscle(s) are primarily assessed with hip external rotation MMT?

A
  1. Obturator Externus/Internus
  2. Quadratus femoris
  3. piriformis
  4. gemellus superior/inferior
  5. gluteus maximus
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175
Q

what muscle(s) assist with hip ER?

A
  1. sartorius
  2. biceps femoris long head
  3. gluteus medius
  4. psoas major
  5. adductor magnus
  6. adductor longus
  7. popliteus
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176
Q

for grades 3 and up, how should a pt be positioned during hip ER MMT?

A
  1. sitting
  2. knees off the table
  3. instruct pt to bring their foot inward
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177
Q

for grades 0,1,2 how should the pt be positioned during hip ER MMT?

A
  1. supine
  2. as pt to roll leg outward
  3. can’t truly palpate for a grade 1 or 2 since most primary movers are deep
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178
Q

how can you discern between a grade 1 and 2 and 0 for hip ER?

A
  1. grade 2 = pt able to roll hip past midline voluntarily
  2. grade 1 = no discernable movement, give a grade 1
  3. no grade 0
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179
Q

where should the PT stabilize during hip ER MMT?

A

stabilize at the knee

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180
Q

where should resistance be applied during hip ER MMT?

A

medial ankle towards PT

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181
Q

what are some common subsitutions that may be observed during hip ER MMT?

A
  1. hip hiking
  2. hip abduction
  3. recruting knee flexors
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182
Q

what muscles are primarily assessed with hip internal rotation MMT?

A
  1. gluteus minimus
  2. gluteus medius
  3. TFL
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183
Q

what muscles assist with hip IR?

A
  1. semitendinosus
  2. semimembranosus
  3. adductor magnus
  4. adductor longus
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184
Q

for grades 3 and up, how should a pt be positioned during hip IR MMT?

A
  1. sitting
  2. knees off the table
  3. leg positioned outward
  4. Instruct pt to “keep your leg where it is, don’t let me pull it in”
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185
Q

for grades 0,1,2 how should the pt be positioned during hip IR MMT?

A
  1. supine
  2. toes towards ceiling
  3. legs extended
  4. ask pt to roll leg inward
  5. palpate muscles
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186
Q

where should the PT stabilize during hip IR MMT?

A

knee

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187
Q

where should resistance be applied during hip IR MMT?

A

lateral ankle towards PT

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188
Q

what muscles are primarily assessed during knee flexion MMT?

A

Hamstrings

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189
Q

what muscles assist with knee flexion?

A
  1. Gracilis
  2. TFL
  3. Sartorius
  4. Popliteus
  5. Gastrocnemius
  6. Plantaris
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190
Q

for grades 3 and up, how should the pt be positioned during knee flexion MMT?

A
  1. prone
  2. knee flexed between 45-90
  3. Instruct pt to “keep your leg where it is, don’t let me push it down”
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191
Q

for grades 0,1,2 how should the pt be positioned during knee flexion MMT?

A
  1. side lying
  2. PT supports top leg and ask pt to flex the knee
192
Q

where should the PT stabilize during knee flexion MMT?

A

knee

193
Q

where should resistance be applied during knee flexion MMT?

A

calf

194
Q

How can a PT bias the medial hamstring?

A

internally rotating leg (toes pointed toward midline)

apply and downward and outward force

195
Q

how can a PT bias the lateral hamstring?

A

externally rotating the leg (toes pointed laterally)

apply a downward and inward force

196
Q

what are some common substitutions that may be observed during knee flexion MMT?

A
  1. pt may utilize hip flexion to initiate
  2. sartorius activation will cause hip and knee flexion and ER
  3. if adduction observed, pt is using gracilis
  4. may dorsiflex to use hamstring shortening to cause knee flexion
197
Q

what muscles primarily extend the knee?

A

quadriceps

198
Q

what muscles assist in knee extension?

A

TFL

199
Q

for grades 3 and up, how should a pt be positioned during knee extension MMT?

A
  1. sitting
  2. knee off the table
  3. good posture (not leaning back), keep hands on table
  4. pt should not be in full extension
200
Q

for grades 0,1,2 how should the pt be positioned during knee extension MMT?

A
  1. side lying
  2. PT supports top leg and starts off with it slightly flexed
  3. Instruct pt to “try and extend your knee back out”
201
Q

where should the PT stabilize during knee extension MMT?

A

under the knee

202
Q

where should resistance be applied during knee extension MMT?

A

at the ankle

203
Q

T/F: It is necessary to test hamstring length prior to this test?

A

TRUE

may impact ROM,

204
Q

what is an alternative way to test knee extension?

A

chair stand test

205
Q

how much strength is needed to rise up out a chair without arms??

A

strength equal to half the body weight

206
Q

approximately how much force is transmitted through the knee during stair descent?

A

nearly 3x body weight

207
Q

what muscles primarily plantarflex the ankle?

A
  1. gastrocnemius
  2. soleus
208
Q

what muscles assist in plantarflexion of the ankle?

A
  1. Tibialis posterior
  2. Plantaris
  3. Peroneus longus
  4. Peroneus brevis
  5. Flex digitorum longus
  6. Flex hallucis longus
209
Q

for grades 3 and up, how should a pt be positioned for plantarflexion MMT?

A
  1. pt standing beside table
  2. Instruct pt to perform as many heel raises as you can through full ROM
    • grade 5 = 25
    • grade 4 = 2-24
    • grade 3 = 1 heel raise
210
Q

for grades 0,1,2 how should the pt be positioned during ankle plantarflexion MMT?

A
  1. prone
  2. feet off table
  3. Instruct pt to “point toes down like a ballet dancer”
211
Q

where should the PT stabilize during ankle plantarflexion MMT?

A
  1. no stabilization for grades 3 and up
  2. support ankle for 0,1,2
212
Q

where should resistance be applied during ankle plantarflexion MMT?

A

no resistance applied

213
Q

T/F: the pt can place 1-2 fingers on the table for balance during ankle plantarflexion MMT?

A

TRUE

214
Q

what determines that the test has ended during ankle plantarflexion (grades 3 and up)?

A

pt slows down

pt starts to only obtain 50% ROM

215
Q

what muscle primarily dorsiflexes the ankle?

A

tibialis anterior

216
Q

what muscles assist with ankle dorsiflexion?

A
  1. peroenus teritius
  2. extensor digitorum longus
  3. extensor hallucis longus
217
Q

for grades 3 and up, how should the pt be positioned during ankle dorsiflexion and inversion MMT?

A
  1. seated
  2. knee in 90 off the table
  3. heel is resting on PT thigh
  4. Instruct pt to “bring your foor up and in”
218
Q

Alternative position for grades 3 and up in foot dorsiflexion and inversion MMT?

A
  1. Supine
  2. leg extended
  3. toes pointed up
  4. Instruct pt to “bring your foot up and in”
219
Q

T/F: in the alternative supine position for foot dorsiflexion and inversion MMT, you must apply some resistance for grade 3

A

TRUE

to compensate for lack of gravity

220
Q

for grades 0,1,2 how should the pt be positioned during foot dorsiflexion and inversion MMT?

A

no specific test

look for only partial ROM and use palpation

221
Q

where should the PT stabilize during foot dorsiflexion and inversion MMT?

A

cup one hand around the dorsomedial aspect of the foot/ankle

222
Q

where should resistance be applied during foot dorsiflexion and inversion MMT?

A

applied down and in toward PT

223
Q

what muscles primarily invert the foot?

A

tibialis posterior

224
Q

what muscles assist with foot inversion?

A
  1. tibialis anterior
  2. flexor digitorum longus
  3. flexor hallucis longus
  4. soleus
  5. extensor hallucis longus
225
Q

for grades 3 and up, how should the pt be positioned during foot inversion MMT?

A
  1. sitting
  2. knee of table
  3. ankle in slight plantarflexion
  4. Instruct pt to “turn your foot down and in”
226
Q

for grades 0,1,2 how should the pt be positioned during foot inversion MMT?

A

no specific test

check for full vs partial ROM
palpate for activation

227
Q

where should the PT stabilize during foot inversion MMT?

A

ankle, just above the malleoli

228
Q

where should resistance be applied during foot inversion MMT?

A

applied to medial side of the foot at the level of the metatarsals

229
Q

what is a common substitution that may be observed during foot inversion MMT?

A

toe flexion

230
Q

what muscles primarily plantarflex and evert the foot?

A
  1. Fibularis longus
  2. Fibularis brevis
231
Q

what muscles assist in foot eversion and plantarflexion?

A
  1. extensor digitorum longus
  2. fibularis tertius
  3. gastrocnemius (plantarflexion)
232
Q

for grades 3 and up, how should the pt be positioned during foot eversion and plantarflexion MMT?

A
  1. sitting
  2. pt everts and plantarflexes foot
  3. instruct pt to “point your foot outward and down”
233
Q

for grades 0,1,2 how should the pt be positioned during foot eversion and plantarflexion MMT?

A

no specific test (same position as before)

assess full vs partial ROM

use palpation

234
Q

where should the PT stabilize during foot eversion and plantarflexion MMT?

A

stabilize at ankle just above malleoli

235
Q

where should resistance applied during foot eversion and plantarflexion MMT?

A

applied to lateral foot trying to move to the foot toward midline and dorsiflexion

236
Q

how do you palpate the fibularis longus?

A

place fingers on lateral upper leg just below the head of the fibula

237
Q

what muscles primarily flex the hallux and toes MPs?

A
  1. lumbricals
  2. flexor hallucis brevis
238
Q

what muscles assist with hallux and toe MP flexion?

A
  1. PADs and DABs
  2. flex digiti minimi
  3. flex digitorium longus,
  4. flex digitorum brevis,
  5. flex hallucis longus,
  6. abductor hallucis,
  7. adductor hallucis
239
Q

how should the pt be positioned for hallux and toe MP flexion?

A
  1. sitting or supine
  2. ankle in neutral
  3. test foot rests on therapist’s lap
240
Q

how should the PT instruct the pt to move if they are testing the hallux MP flexion?

A

bend your big toe over my finger, don’t let me straighten it

241
Q

how should the PT instruct the pt to move if they are testing the toes MP flexion?

A

bend your toes over my finger, don’t let me straighten them out

242
Q

how should the pt be positioned for grades 0,1,2 during hallux and toe MP flexion MMT?

A

same as grades 3 and up

assess full vs partial ROM

palpation for contraction

243
Q

where should the PT stabilize during hallux and toe MP flexion MMT?

A

metatarsals

244
Q

where should resistance be applied during hallux and toe MP flexion MMT?

A

proximal phalanx

245
Q

list the primary muscles for the following:

hallux IP flexion

DIP flexion

PIP flexion

A
  1. hallux = flexor hallucis longus
  2. DIP = flexor digitorum longus
  3. PIP = flexor digitorum brevis
246
Q

what assists in toe DIP flexion?

A

quadratus plantae

247
Q

what assist in toe PIP flexion?

A

flexor digitorum longus

248
Q

how should the pt be positioned for hallux and toe DIP and PIP flexion MMT?

A
  1. sitting or supine
  2. foot on therapist’s lap
  3. ankle neutral
249
Q

how should the PT instruct the pt to move if they are testing the hallux IP flexion?

A

curl your big toe and hold it

250
Q

how should the PT instruct the pt to move if they are testing toe DIP and PIP flexion?

A

curl your toes, hold it

251
Q

how do you grade hallux and toe DIP and PIP flexion MMT?

A
  • Grade 5: Completes against resistance
  • Grade 4: mod resistance
  • Grade 3: no resistance but can complete ROM
  • Grade 2: completes partial range
  • Grade 1: palpable contractile activity
252
Q

where should the PT stabilize during hallux and toe DIP and PIP flexion MMT?

A
  1. stabilize at the MP joint for the PIP
  2. stabilize at the PIP for DIP
253
Q

where should resistance be applied during hallux and toe DIP and PIP flexion MMT?

A

plantar aspect of middle and distal phalanx

254
Q

what muscle primarily extends the hallux MP and IP joint?

A

extensor hallucis longus

255
Q

what muscle primarily extends the toes MP and IP joints?

A
  1. extensor digitorum longus
  2. extensor digitorum brevis
256
Q

how should the pt be positioned when testing the hallux and toe MP/IP extension with MMT?

A
  1. sitting or supine
  2. foot on therapist lap
  3. Instruct the pt to “straighten your toes and hold it”
257
Q

when you test the lateral toes MP and IP extension, where should you stabilize?

A

metatarsals

258
Q

when you test the hallux MP and IP extension where should you stabilize?

A

metatarsal area with one hand

other hand stabilizes the foot at the heel

259
Q

how do you grade hallux and toe MP/IP extension MMT?

A
  • Grade 5: Completes extension against resistance
  • Grade 4: mod/min resistance
  • Grade 3: no resistance but can complete ROM
  • Grade 2: completes partial range
  • Grade 1: palpable contractile activity
260
Q

T/F: most individuals cannot separate great toe extension from lateral toes?

A

TRUE

261
Q

what are some self-reported measures tests?

A
  1. Falls Efficay Scale (FES)
  2. Activities-Specific Balance Confidence Scale (ABC)
  3. Patient Specific Functional Scale (PSFS)
262
Q

what is the FES?

A

16 item questionnaire

measures fear or concern of falling

263
Q

what is the ABC?

A

similar to FES but expands to daily acitivities

measures an individual’s confidence in his/her ability to perform daily activities w/o falling

264
Q

what is the PSFS used for?

A

to quantify activity limitations and measure functional outcome for pts

265
Q

name some gait/balance assessment tests

A
  1. 6 minute walk test
  2. Timed Up and Go (TUG) test
  3. Berg Balance Scale
  4. Functional Reach Test
  5. Balance Evauation Systems Test (BESTest)
    • full version
    • MiniBest
    • BreifBest
  6. Tinetti Performance Oriented Mobility Assessment
266
Q

describe the 6 min walk test

A

measures the distance covered in 6 minutes while walking at a comfortable pace

267
Q

In what populations can the 6 min walk test be used?

A
  1. Arthritis
  2. MS
  3. Parkinson’s Disease
  4. acquired brain injury
  5. stroke
268
Q

there are normative values for _______ and ________ in the 6 minute walk test

A

gender and age

269
Q

describe the TUG Test

A

tests mobility, balance, walking ability, and fall risk

used mostly in the elderly

score decreases sig w/mobility impairments

270
Q

In what populations can the TUG test be used?

A
  1. Arthritis/Joint conditions
  2. CP
  3. MS
  4. Parkinson’s Disease
  5. Neurological and vestibular conditions/disorders
271
Q

what the Berg Balance scale?

A

objective measurement of static and dynamic balance abilities

14 functional tasks commonly performed in everyday life

272
Q

In what populations can the Berg Balance scale be used?

A
  1. Arthritis/Joint diseases
  2. MS
  3. Parkinson’s Disease
  4. Neurologic Conditions
  5. Brain injuries/stroke
273
Q

describe the functional reach test

A

quick screen of balance in elderly

max distance one can reach forward beyond arm’s length while maintaining a fixed BOS in the standing position

274
Q

scores >_____ on the functional reach test indicated limited functional balance

A

7 inches

275
Q

what is the BESTest?

A

balance test with 36 items grouped into 6 systems

276
Q

what are the 6 systems included in the BESTest?

A
  1. biomechanical constraints
  2. stability limits/verticality
  3. anticipatory postural adjustments
  4. postural responses
  5. sensory orientation
  6. stability in gait
277
Q

describe the MiniBest

A

shortened version of BESTest

has 4 scoring domains:

anticipatory

postural response

sensory orintation

gait balance

278
Q

what is the BriefBest

A

abbreviated version designed to assese 6 different aspects contributing to postural control in standing and walking

279
Q

describe the Tinetti Performance Oriented Mobility Assessment

A

used to measure gait and balance abilities

16 total items (9 balance and 7 gait)

280
Q

what categories are involved in a mental status screen?

A
  1. Appearance and behavior
  2. attention and orientation
  3. attention/memory
281
Q

what is the Mini Mental State Exam?

A

widely known test of cognition

score of >25 indicates cognitive impairment

celing effect w/mild impairments

282
Q

categories included in the Mini-Mental State Exam

A
  1. Orientation
  2. Registration
  3. Attention and Calculation
  4. Recall
  5. Language
283
Q

T/F: the Mini-Mental State Exam is free

A

False it costs money to use

284
Q

what is the Montreal Cognitive Assessment (MoCA)?

A

a rapid screen instrument for mild cognitive dysfunction

>26 is considered normal

takes ~10 min to administer

285
Q

what testing areas are included in the MoCA?

A
  1. Visuospatial/Executive
  2. Naming (animals)
  3. Memory
  4. Attention and Concentration
  5. Abstraction
  6. Delayed Recall
  7. Orientation
286
Q

what are ICD-10 codes used for?

A

medical and PT diagnoses of our patients

287
Q

describe the ICD-10 code structure

A
  1. category (first 3 characters)
  2. etiology, anatomic site, severity (4th-6th characters)
288
Q

how do you choose the correct ICD-10 code?

A

report specific diagnosis codes when they are supported by the available medical record doc and clinical knowledge of the patient’s health condition

289
Q

T/F: we want to choose a vague ICD-10 code?

A

TRUE, leaves us more wiggle room

signs, symptoms or unspecified codes are best

290
Q

you code at the __________

A

level you can confirm

291
Q

what codes are used for interventions?

A

CPT-4 codes

292
Q

what does CPT stand for?

A

Current Procedural Terminology

293
Q

T/F: CPT-4 codes are required to receive payment

A

TRUE

depends on insurance but mostly true

294
Q

most CPT codes that are available to PTs are located in the _______

A

97000 series called Physical Medicine and Rehab

295
Q

what is the 8 minute rule?

A

bill one unit for treatment greater than or equal to 8 minutes through and including 22 minutes

296
Q

Units breakdown for CPT codes

A
  • 8 -22 minutes = 1 unit
  • 23-37 minutes = 2 units
  • 38-52 minutes = 3 units
  • 53 -67 minutes = 4 units
  • 68-82 minutes = 5 units
297
Q

T/F: most PT practices under bill and use the wrong codes?

A

TRUE

298
Q

how does compensation work with CPT codes?

A

payment policy is determined by each individual payer and insurance

299
Q

CPT 97110 Therapeutic Exercise

A

develop strength and endurance, ROM and flexibility

300
Q

CPT 97530 Therapeutic Activities

A

direct (one-on-one) patient contact by the provider (use of dynamic activites to improve functional performance)

301
Q

T/F: antropometry is a key component of nutritional staus assessment in children and adults?

A

TRUE

302
Q

what are some methods for measuring antropometrics?

A
  1. Body weight/height (BMI)
  2. girth measurements (waist to hip ratio/limb girth)
  3. skinfold calipers
  4. hydrostatic weighing (gold standard)
  5. Bod pod
  6. electrical impedance
  7. limb length
  8. finger pressure (peripheral edema)
303
Q

what is considered a normal BMI?

A

18.5 - 24.9

304
Q

how is waist to hip ratio determined?

A

waist measurement taken at narrowest part of the torso (above the umbilicus and below the xiphoid process)

hip measurement taken at max circumference of the hip

305
Q

name a limb circumference technique we did earlier this year

A

Figure-8 ankle measurement

306
Q

describe the technique required for skinfold measurements

A
  1. grasp skin firmly by thumb and index finger
  2. place caliper 1 cm below hold
  3. maintain grip while releasing caliper
  4. wait 2 sec to read caliper to nearest 0.5 mm
  5. take 2 measurements at each site, alternating sites
307
Q

when should a 3rd skinfold measurement be taken?

A

if the 2 measurements differ by more than 1 mm

308
Q

written goals should be used to determine what?

A
  1. progress
  2. allow for adjustment of clinical impression
  3. prognosis, duration and frequency of the episode of care
  4. conclucsion of care and intervention plan
309
Q

Goal writing needs to be ________

A
  1. patient/client centered
  2. unbiased and objective
  3. quantifiable/measurable
  4. relates to a particular use or purpose and is therefore functional
  5. has a time frame
310
Q

what are 2 types of options of Daily notes?

A
  1. S.O.A.P
  2. S.I.R.P
311
Q

what does SIRP stand for?

A
  1. Status
  2. Intervention
  3. response
  4. Plan
312
Q

what are the elements of the Patient/Client Management Model?

A
  1. Examination
  2. Evauation
  3. Diagnosis
  4. Prognosis
  5. Intervention
  6. Outcomes
313
Q

what occurs during the examination in the Patient/Client Management Model?

A

examine the pt. and collect data through the history, systems review, and tests and measures

314
Q

what occurs during the evaluation in the patient/client management model?

A

evaluate the data and ID the problems

315
Q

what occurs during the diagnosis portion of the patient/client management model?

A

determination of the diagnosis and prognosis

316
Q

when is the POC implemented in the patient/client management model?

A

during Intervention

317
Q

What is the HOAC?

A

a clinical decision making model that generates hypotheses and facilitates the use of science and evidence in practice to confirm or refute hypothesis

318
Q

What does HOAC-II stand for?

A

Hypothesis-Oriented Algorithm for Clinicans II

319
Q

how does the HOAC-II differ from the Patient/Client Management Model?

A

HOAC-II involves the patient in decision making and provides payers with better justification

320
Q

In the HOAC-II model the problem is almost always a _______________

A

functional deficit

321
Q

how can patient problems be divided/subdivided in the HOAC?

A
  1. Exisiting
  2. Anticipated
  3. Patient ID
  4. non-patient identified
322
Q

What are the steps in the HOAC-II?

A
  1. Initial data collection
  2. Generate patient identified problems (PIP) list
  3. Exam strategy
  4. Conduct exam and analyze data
  5. Add Non-patient identified problems (NPIP) to problem list
  6. Justification for hypothesis
  7. Hypotheses about cuase
  8. Refine Problem List
  9. Goals
  10. Establish testing critera
  11. Establish predicitive criteria
  12. Reassessment Plan
  13. Plan and implement intervention
323
Q

What is included in the hypotheses formed at the end of the HOAC?

A

determination of probable cause as well as magnitude of deficits

followed by subsequent quantifable steps that must be achieved to eliminate the identified problem

324
Q

T/F: In PT, pathologies are often unchanged even though impairments or functional limitations are reduced or eliminated?

A

TRUE

325
Q

Goals are written/expressed almost exclusively as __________

A

functional activities

326
Q

All goals must represent ________

A

meaningul accomplishments

  • functional task analysis
  • short-term vs. long-term goals
327
Q

define testing criteria

A

level of improvement in impairment needed to eliminate the problem

328
Q

predictive criteria are related to ________

A

risk factors

329
Q

Define tactics as it pertains to the HOAC

A

specific elements of intervention (frequency, duration, intensity)

330
Q

What should goals be/include?

A
  1. patient/client centered
  2. unbiased and objectable
  3. quantifiable/measurable
  4. relates to a particular use or purpose and is therefore functional
  5. have a time frame
331
Q

what is the purpose of muscle length testing?

A

to determine the greatest extensibility of a muscle-tendon unit

332
Q

how would you determine muscle length at a one joint muscle?

A

via goni measurement of PROM of motion opposite to action of muscle of interest

333
Q

how would you measure muscle length in a two joint muscle?

A

lengthen the muscle across one joint and then asses ROM available at the second joint

334
Q

how do you know when elbow extension is limited by a short bicep?

A

elbow extension will be limited when:

shoulder is postioned in full extension and the forearm is in full pronation

335
Q

what else can limit elbow extension?

A
  1. joint surfaces
  2. shortening of the anterior capsule/collateral ligaments
  3. other muscles such as brachialis/brachioradialis
336
Q

what would indicate that something other than a short biceps is limiting elbow extension?

A

if elbow ext is limited regardless of shoulder position

337
Q

describe the muscle length test for the biceps brachii

A
  1. position pt. in supine at edge of table
  2. flex the elbow fully, then move the shoulder into full ext while holding the forearm in pronation
  3. test ends when resistance (should be firm end-feel) is felt
  4. hold and measure w/goni
338
Q

how do you know when elbow flexion is limited by the triceps brachii?

A

elbow flexion will be limited when the shoulder is positioned in full flexion

339
Q

what else (other than the long head of triceps) can limit elbow flexion and how do you know?

A

abnormalities of joint surfaces

shortening of the posterior capsule

muscles that cross only the elbow (anconeus, M/L tricep)

elbow flexion will be limited regardless of shoulder position

340
Q

describe the set up for muscle length testing of the triceps brachii

A
  1. supine at edge of table
  2. ext the elbow and move shoulder into full flexion w/00 of abduction
  3. supinate the forearm
  4. move the elbow into flexion until you feel resistance
341
Q

describe how to measure the pectoralis major length

A
  1. position pt in supine w/hands behind head
  2. stabilize contralateral trunk/shoulder
  3. measure the distance between the olecranon and the table
342
Q

describe how to measure the pectoralis minor length

A
  1. position the pt in supine with netural shoulder and elbow extended and palms facing up
  2. measure the distance between the posterior acromion and the table
343
Q

what is considered “tight” for the pectoralis minor length test?

A

a distance greater than 1 inch

differences compared to the contralateral side

344
Q

what does the Thomas Test measure?

A

hip flexors muscle length

**there are a lot of compensations

345
Q

describe how to perform the Thomas Test

A
  1. position the pt at the end edge of the table w/lower thighs, knees, and legs off the table
  2. assist the pt into supine position by supporting pt’s back and flex hips and knees
  3. flex hips and knees enough to flatten low back and pelvis onto table
  4. stabilize hip not being tested in flexion
  5. extend hip being tested toward table (involved hip and knee should be relaxed)
346
Q

Goni alignments for Thomas Test (for hip flexors)

A
  1. Fulcrum = greater trochanter
  2. Stationary = lateral midline of the pelvis
  3. Moving = lateral midline of the femur (lateral epicondyle as ref)
347
Q

what else can the Thomas Test be used to measure?

(other than hip flexors)

A
  1. rectus femoris
  2. abductor/adductors
  3. sartorius tightness

*use goni landmarks that test each of those ROMs

348
Q

what are some possible abnormal findings during the Thomas Test?

A
  1. unable to reach hip extension in testing position
  2. Hip moves into ABD + ER + Knee flex
  3. Hip moves into ABD + IR
  4. Knee extends and is not flexed at 900
  5. Hip moves into ADD
349
Q

if you are unable to reach adequate hip extension in the testing position during the Thomas Test what may be the cause?

A

hip flexors may be shortened

350
Q

What is most likely the cause of the hip moving into

ABD + ER + Knee flexion during the Thomas Test?

A

Sartorius may be shortened

351
Q

What is most likely the cause of the Hip moving into

ABD + IR during the Thomas Test?

A

TFL may be shortened

352
Q

What is most likely the cause of the knee extending out and not remaining at 900 during the Thomas Test?

A

Rectus femoris may be shortened

353
Q

What is most likely the cause of the hip moving into ADD during the Thomas Test?

A

The adductors may be tight

(pectineus, adductor longus, adductor brevis)

354
Q

Alternate name for the testing Hamstring muscle length?

A

SLR test

355
Q

describe how to perform the SLR test

A
  1. position the pt supine w/knee extended, hip in 00 flex, ext, ABD, ADD and rotation
  2. stabilize knee being tested at 00
  3. flex the hip by lifting the LE off the table while keeping the knee in 00 extension
356
Q

what is considered a normal length for the SLR Test?

A

70-800 of hip flex w/knee extended

357
Q

Describe how to test the distal hamstring length

A
  1. position the pt in supine w/involved hip flexed to 900 and 0 of ABD/ADD/Rotation
  2. uninvolved leg w/knee in 00 ext and hip in 00 everything
  3. stabilize femur to prevent Rotation/ABD/ADD
  4. Extend the knee to the end of RO
    • stop the motion when resistance is felt and hip begins to move into extensino
358
Q

what is the distal hamstring length test also called?

A

popliteal angle test

359
Q

what are the main differences between the proximal and distal hamstring length?

A
  1. goni placement
    • prox => fulcrum over greater troch
    • distal => fulcrum over lateral epicondyle of femur
  2. knee angle
    • prox => knee is full extended
    • distal => knee starts off flexed
  3. hip angle
    • prox => hip starts at 00 flex
    • distal => hip starts at 900 flex
360
Q

describe how to perform the muscle length test for the rectus femoris

A
  1. position the pt. prone w/feet off end of table
  2. knees extended, hips in 00 everything
  3. stabilize posterior hip to maintain neutral position
  4. flex the knee towards buttocks
  5. end ROM occurs when reistance is felt from ant thigh
361
Q

what is another name for the rectus femoris muscle length test?

A

Ely Test

362
Q

if knee flex is limited when the hip is in a flexed position and the pt is prone what is most likely the cause?

A

NOT from a short rectus

most likely from abnormalities of joint structure

or

short one joint knee extensor

363
Q

What does the Ober Test examine?

A

length of TFL and IT band that ABD the hip

364
Q

describe how to perform the Ober Test

A
  1. position pt in side-lying near back edge of table w/involved leg on top
  2. stabilize top iliac crest to stabilize the pelvis
    • bottom hip and flexed knee stabilize trunk
  3. support the involved leg by holding under med aspect of knee and lower leg
  4. flex the hip and knee to 900
  5. keep knee flexed and move the hip into ABD and Ext and then lower the hip into ADD and lower toward table
365
Q

what does the IT band limit?

A

hip ADD

hip Ext, ER (a little)

Knee flexion (a little)

366
Q

shortening of the IT band can contribute to what?

A
  1. LBP
  2. ITB friction syndrome
  3. patellofemoral pain
367
Q

goni alignment for the Ober Test

A
  1. Fulcrum = over ASIS
  2. Stationary = parallel to the opposite ASIS
  3. Movement arm = ant midline of femur (patella as ref)
368
Q

how is the modified Ober Test different from the standard Ober Test?

A

the knee is held in extension in the modified version

369
Q

what does the modified Ober Test do?

A

evaluate the length of the hip abductors

370
Q

How many ways are there to evaluate the muscle length of the Gastrocnemius?

A

2

371
Q

describe how to perform the muscle length test for the Gastroc in supine

A
  1. position pt in supine w/knee extended and foot in neutrl EV/IN
  2. hold knee in full extension
  3. dorsiflex the ankle to end ROM by pushing across plantar aspect of met heads
372
Q

Goni alignment for Gastroc muscle length testing in supine

A
  1. Fulcrum = over lateral aspect of lateral malleolus
  2. Stationary = lateral midline of fibular, fibular head as ref
  3. Moving = parallel to the lateral aspect of 5th met
373
Q

T/F: if the gastroc is short it will limit ankle DF when the knee if flexed

A

FALSE - when the knee is extended it will limit ankle DF

374
Q

If DF is limited regardless of what position the knee is in, what may be the cause?

A

abnormalities of ankle joint surfaces

shortening of the joint capsule

shortening of ligaments

shortening of the soleus

375
Q

describe how to perform the muscle length test for the Gastroc in standing

A
  1. maintain the knee in full ext
  2. ensure heel remains in contact w/floor
  3. pt DF ankle by leaning body foward
  4. test ends when the individual feels tension in the post calf and knee, or if further DF causes the knee to flex and heel to lift of the floor
376
Q

how much hip flexion is required for putting on socks?

A

120 of flexion

377
Q

In order to walk on level surfaces how much function hip flexion is required?

A

0-300

378
Q

in order to ascend stairs, how much hip flexion is required?

A

1-0-66

379
Q

in order to descend stairs, how much hip flexion is required?

A

1-0-45

380
Q

what are the primary muscles that perform capital extension?

A
  1. rectus capitis Posterior Major/Minor
  2. Longissimus Capitis
  3. Obliquus Capitis Superior/Inferior
  4. Semispinalis Capitis
  5. Trapezius
  6. Spinalis Capitis
381
Q

for grades 3 and up, how should the pt be positioned when assessing capital extension with MMT?

A
  1. Prone
  2. Head off table
  3. PT supports at chin with one hand
  4. Instruct pt to “look at where the wall meets the floor”
382
Q

for grades 0,1,2 how should the pt be positioned when assessing capital extension with MMT?

A
  1. supine
  2. head supported on table
  3. place hands under base of skull to palpate muscles
  4. Instruct pt to “look back at me without lifting your head from the table”
383
Q

where should the PT stabilize during capital extension MMT?

A

one hand under chin (grades 3 and up) just in case head drops

384
Q

where should resistance be applied during capital extension MMT?

A

towards the ground at the base of the head

385
Q

what muscles are primarily assessed during cervical extension?

A
  1. erector spinae cervical portion
  2. semispinalis cervicis
  3. splenius cervicis
  4. Upper traps
386
Q

what muscles are assisting in cervical extension?

A
  1. Interspinalis cervicis
  2. Intertransversarii cervicis
  3. rotatores cervicis
  4. Multifidi
  5. levator scapulae
387
Q

for grades 3 and up, how should the pt be positioned when assessing cervical extension with MMT?

A
  1. Prone
  2. head off the table (shoulders at the edge of table)
  3. Pt supports under the chin with one hand and places other hand on the back of head
  4. Instruct the pt to “push your head back into my hand without tilting your head”
    • movement is like a chin tuck
388
Q

what is the alterantive position for cervical extension grade 3?

A

in presence of trunk weakness, therapist holds upper trunk

389
Q

for grades 0,1,2 how should the pt be positioned for cervical extension MMT?

A
  1. supine
  2. PT has hands under occiput
  3. Instruct the pt to “push your head down into my hands”
    • similar to a chin tuck motion
390
Q

where should the PT stabilize during cervical extension MMT?

A

one hand under the chin for grades 4 and 5

at the upper trunk for grade 3

391
Q

where should force be applied during cervical extension MMT?

A

towards the ground at the back of head

make sure the pt doesn’t tilt the head back

392
Q

what are the primary muscles tested during combined extension (cervical and capital)?

A

same muscles that performed cervical and capital extenstion

393
Q

how should the pt be positioned for combined cervical and capital extension MMT?

A
  1. prone
  2. shoulders at the edge of table so head is off
  3. arms by the sides
  4. Instruct the pt to “lift your head and look at the wall/ceiling”
394
Q

what is the alternative pt positioning for combined cervical and capital extension MMT?

A

for grade 3

involves stabilization of upper back if pt has trunk or hip extensor weakness?

395
Q

how do you grade combined cervical and capital extension MMT?

A

No specific test/position for grades 0,1,2

check for full or partial ROM

Palpate

396
Q

where should the PT stabilize during combined cervical and capital extension MMT?

A

PT has one hand under chin in case of head drop

upper trunk for alternative test

397
Q

where should resistance be applied during combined cervical and capital extension MMT?

A

applied down and slightly out

398
Q

what muscles are primarily assessed during capital flexion MMT?

A
  1. rectus capitis anterior
  2. rectus capitis lateralis
  3. longus capitis
399
Q

what muscles assist in capital flexion?

A

suprahyoid muscles

400
Q

how should the pt be positioned during captial flexion MMT?

A
  1. supine
  2. head supported on table
  3. Instruct the pt to “tuck your chin, don’t lift your head from the table, don’t let me lift your chin”
  4. same position for all grades
401
Q

where should the PT stabilize and apply resistance during capital flexion MMT?

A

no stabilization

both hands are used to counter flexion at the chin

402
Q

what muscles are primarily assessed with cervical flexion MMT?

A
  1. SCM
  2. longus colli
  3. anterior scalene
403
Q

what muscles assist with cervical flexion?

A

suprahyoid muscles

middle and posterior scalene

404
Q

for grades 3 and up, how should the pt be positioned during cervical flexion MMT?

A
  1. supine
  2. head supported on table
  3. Instruct pt to “lift your head from the table keeping your shoulders down, don’t let me push your head down”
405
Q

for grades 0,1,2 how should the pt be positioned during cervical flexion MMT?

A
  1. supine
  2. head supported on table
  3. Instruct pt to “roll your head to the left and then right”
  4. palpate for contractility
406
Q

where should the PT stabilize during cervical flexion MMT?

A

stabilize thorax to prevent lifting of shoulders

407
Q

where should resistance be applied during cervical flexion MMT?

A

forehead with 2 fingers

408
Q

what muscles are primarily assessed during combined capital and cervial flexion?

A

all capital and cervical flexors

409
Q

how should the pt be positioned for combined capital and cervical flexion MMT?

A
  1. supine
  2. head supported on the table
  3. Instruct pt to “bring your head up until your chin is toward your chest, do not raise your shoulders off the table”
410
Q

how should combined capital and cervical flexion MMT be graded?

A
  • Grade 5: Pt completes ROM Against strong resistance.
  • Grade 4: Pt Completes ROM w/mod resistance
  • Grade 3: Pt completes ROM w/no resistance.
  • Grade 2: Partial ROM
  • Grade 1: Palpate muscle but no motion.
411
Q

where should the PT stabilize during combined capital and cervical flexion MMT?

A

stabilize thorax to prevent lifting of shoulders

412
Q

where should resistance be applied during combined cervical and capital flexion

A

applied to the forehead down and out

413
Q

how can you isolate the SCM with MMT?

A
  1. same position as cervical flexion
  2. instruct pt to “turn head to one side and then lift your head keeping it turned
  3. for gravity minimized simply have them turn their head and palpate SCM
414
Q

what muscles are primarily assessed with cervical rotation MMT?

A
  1. SCM
  2. semispinalis
  3. longissimus capitis and cervicis
  4. trapezius
  5. scalenes
  6. levator scapulae
  7. obliquus capitis
  8. rectus capitis
415
Q

for grades 3 and up, how should the pt be positioned for cervical rotation MMT?

A
  1. supine
  2. head supported on table
  3. start off facing L/R
  4. Instruct pt to “turn your head and face the ceiling, don’t let me push it back down
416
Q

for grades 0,1,2 how should the pt be positioned for cervical rotation MMT?

A
  1. sitting
  2. head posture neutral
  3. instruct pt to “turn your head as far R/L as you can”
417
Q

where should the PT stabilize and apply resistance for cervical rotation MMT?

A
  1. no specific stabilization
  2. resistance applied to side of head above ear
418
Q

T/F: for trunk extension, thoracic and lumbar extension can be separated for all grades?

A

FALSE

only for grades 5 and 4

419
Q

what muscles will be involved in trunk extension? (both thoracic and lumbar)

A
  1. Iliocostalis thoracis and lumborum
  2. Longissimus thoracis
  3. Spinalis thoracis
  4. Semispinalis thoracis
  5. Multifidus (multifidi)
  6. Thoracic and lumbar rotatores
  7. Intertransversarii Thoracis & Lumborum
  8. Quadratus lumborum
420
Q

for grades 4 and 5, how should the pt be positioned for lumbar extension MMT?

A
  1. prone
  2. hands behind head
  3. Instruct pt to “raise your head, shoulders, and chest as high as you can”
  4. observe for pt to clear umbilicus
421
Q

where should the PT stabilize during lumbar extension grades 4 and 5 MMT?

A

at the ankles

OR

pelvis if they have hip extnesion weakness

422
Q

where should the PT apply resistance for grades 5 and 4 lumbar extension MMT?

A

no resistance applied

pts own weight is used as resistance

423
Q

T/F: test for hip and neck extension prior to trunk

A

TRUE

424
Q

for grades 4 and 5, how should a pt be positioned for thoracic extension MMT?

A
  1. prone
  2. mid chest (nipple line) off table with hands behind head
  3. Instruct pt to “raise your head, shoulders, and chest to table level
425
Q

where should the PT apply resistance and stabilize during thoracic extension grades 4 and 5 MMT?

A

no resistance

stabilize at ankles

426
Q

T/F: for grades 3, 2, 1, 0 thoracic and lumbar extension are tested together?

A

TRUE

427
Q

for grades 3 and down, how should the pt be positioned for combined trunk extension MMT?

A
  1. Prone
  2. mid chest (nipple line) off table
  3. arms by side
  4. Instruct pt to “raise your head, and chest as high as you can”
    • full ROM is grade 3
428
Q

where should the PT stabilize and apply resistance during combined trunk extension MMT?

A

no resistance applied

stabilize at ankles

429
Q

where should the PT palpate for grades 0 during combined trunk extension?

A

thoracic or lumbar adjacent to specific segement of spine

430
Q

what are some common subsitutions that may be observed during combined trunk extension MMT?

A
  1. if spine extensors are weak and hip extensors are strong, pt will no be able to raise upper trunk from table. Instead pelvis will tilt posteriorly while L spine moves into flexion
  2. When back extensors are strong and hip extensors are weak, pt can hyperextend the low back and won’t be able to raise trunk without stabilization from PT
431
Q

what muscles are primarily tested during trunk flexion?

A
  1. Rectus abdominis
  2. obliquus externus
  3. obliquus internus
432
Q

what musles assist with trunk flexion?

A

Psoas major/minor

433
Q

how should the pt be positioned for grades 3 and up during trunk flexion MMT?

A
  1. supine
  2. hands behind head for grade 5
  3. hands across chest for grde 4
  4. hands out for grade 3
  5. Instruct pt to “keep your chin pointed at ceiling and lift your head, shoulder, and back off the table”
  6. check for scapular clearance
434
Q

how should a pt be positioned for grade 2 trunk flexion MMT?

A
  1. hook lying
  2. instruct pt to lift head from table
  3. if scapula does not lift its a grade 2
435
Q

how should pt be positioned for grade 1 trunk flexion MMT?

A
  1. hook lying
  2. ask pt to lift their head off table
  3. if they cannot lift head off table then cradles head and ask them to lean forward
  4. if rib depression is observed = grade 2
  5. no rib depression but muscle activation = grade 1
436
Q

if a pt coughs and you observe rib depression what grade should be given for trunk flexion?

A

grade 2

cough with no palpable contraction is a grade 1

437
Q

what muscle is primarily tested during trunk rotation?

A

internal and external obliques

438
Q

Instructions and positioning for trunk rotation grade 5

A
  1. supine
  2. hands behind head
  3. Instruct pt to “keep your chin pointed at the ceiling and lift your head, shoulders, and back off the table and to the side”
  4. look for scapular clearance
439
Q

Instructions and positioning for trunk rotation grade 4

A
  1. supine
  2. hands across chest
  3. instruct pt to “keep your chin pointed at the ceiling and lift your head, shoulders, and back off the table and to the side”
  4. check for scapular clearance
440
Q

Instructions and positioning for trunk rotation grade 3

A
  1. supine
  2. hands out
  3. Instruct pt to “keep your chin pointed to the ceiling and lift your head, shoulders, and back off the table and to the side”
  4. check for scapular clearance
441
Q

Instructions and positioning for grade 2 trunk rotation

A
  1. supine
  2. hands by side
  3. pt is unable to raise scapula off the table, but therapist can observe depression of rib cage
442
Q

Instructions and positioning for grade 1 trunk rotation

A
  1. hook lying
  2. PT supports pts with arm under upper trunk/shoulders
  3. palpate for internal oblique contraction
443
Q

T/F: bringing your left elbow to your right knee during trunk rotation testing is testing the left external and internal oblique?

A

FALSE

tests the left external and right internal oblique

444
Q

what is a common substitution that may be observed during trunk rotation testing?

A

if the pt has overactive pectoralis muscles, you will observe shoulder shrug/elevation with trunk flexion

445
Q

what are the scapular movements tested with MMT?

A
  1. elevation
  2. adduction
  3. abductino
  4. upward rotation
  5. depression and downward rotation
446
Q

what muscles primarily are assessed during scapular upward rotation and abduction?

A

serratus anterior

447
Q

why is upward rotation with abduction a significant motion for the scapula?

A

contributes to scapulo humeral rhythm

weakness in upward rotators may lead to dysfunction and downward rotation of scapula

increases risk for impingement

448
Q

T/F: the serratus anterior can never be graded higher than the grade assigned to shoulder flexion?

A

TRUE

weak deltoid = loss of lever for testing = cannot apply resistance in this test

449
Q

for grades 4 and 5, how should the pt be positioned for serratus anterior MMT?

A
  1. sitting
  2. shoulder flexed to 130 w/elbow extended
  3. apply resistance at distal humerus in a downward direction
  4. stabilize/palpate lateral edge of scapula to see if it maintains an abudcted and upwardly rotated position
450
Q

how should the pt be positioned for a grade 3 serratus anterior MMT?

A
  1. sitting
  2. shoulder flexed to at least 90 with elbow extended
  3. check position
    • is it uncoordinated? = weak serratus ant
  4. pt can get into position but cannot hold against resistance
451
Q

how should the pt be positioned for grades 0,1,2 serratus anterior MMT?

A
  1. sitting
  2. PT supported weight of arm and moves it into position of aprox 90 flex
  3. Instruct pt to “hold your arm in this position, let it relax. Now hold your arm up again. Let it relax”
  4. palpate serratus anterior
452
Q

alternative testing position for serratus anterior MMT?

A
  1. supine
  2. shoulder flexed to 90, neural rotation
  3. elbow extended
  4. instruct pt to make a fist and punch straight up into your hand
453
Q

T/F: it is alright to test scapular elevation bilaterally?

A

TRUE

454
Q

pt positioning for grades 3 and up scapular elevation MMT?

A

similar to how we performed it in systems review

455
Q

gravitiy minimized positioning for scapular elevation

A
  1. prone or supine
  2. neutral head (turning may influence activation of muscles)
456
Q

what muscles primarily perform scapular adduction (retraction)?

A
  1. middle trapezius
  2. rhomboid major
457
Q

what muscles assist with scapular adduction (retraction)?

A
  1. rhomboid minor
  2. upper and lower trapezius
  3. levator scapulae
458
Q

for grades 4 and 5 how should the pt be positioned for scapular adduction (retraction) MMT?

A
  1. prone
  2. arm abducted 90 and elbow flexted to 90
  3. head turned to either side
  4. stabilize contralateral scapula
  5. apply resistance at distal humerus (if posterior deltoid was a grade 3 at least)
459
Q

if a pt has a posterior deltoid that graded less than a 3, how should the pt be positioned during scapular adduction (retraction) MMT?

A
  1. set up is exactly the same as grades 3 and up
  2. main difference is lever arm changes from distal humerus to posterior shoulder
460
Q

for grades 0,1,2 how should the pt be positioned during scapular adduction (retraction) MMT?

A
  1. prone
  2. shoulder abducted 90, elbow flexed 90
  3. PT supports the weight of the arm
  4. other hand is placed along upper medial border of scapula being tested to palpate
  5. instruct pt to move arm through full ROM
461
Q

what are some common substitutions that may be observed during scapular adduction (retraction) MMT?

A
  1. rhomboid overtaking middle trap = scapula will adduct and rotate downwards
  2. no scapular adduction is observed but shoulder moves = posterior deltoid solely working
462
Q

what muscle primarily is tested during scapular downward rotation and depression?

A

lower trapezius

463
Q

what muscles assist in scapular depression and downward rotation?

A
  1. latissimus dorsi
  2. pectorals
464
Q

for grades 3 and up, how should the pt be positioned during scapular depression and downward rotation MMT?

A
  1. prone
  2. test arm overhead to 145 of abduction
  3. head turned to either side
  4. thumb up
  5. apply downward force at distal humerus
  6. other hand palpating along spine for lower trap
465
Q

for grades 0,1,2 how should the pt be positioned during scapular depression and adduction (downward rotation) MMT?

A
  1. prone
  2. support arm and position it to 145 abduction
  3. thumb pointed up
  4. palpate lower trap between base of spine of scapula and lower T vertebrae
466
Q

what is primarily tested during scapular downward rotation and adduction?

A

rhomboid major

467
Q

what muscles assist in scapular downward rotation and adduction?

A
  1. rhomboid minor
  2. levator scapulae
468
Q

T/F: the rhomboid are frequently underrated during MMT?

A

TRUE

evidence suggests they are difficult to accurately assess

469
Q

clinical weakness of the rhomboids is a strong diagnostic test for what?

A

subscapular nerve lesion or muscle tear

470
Q

for grades 3 and up, how should the pt be positioned during rhomboid MMT?

A
  1. prone
  2. arm behind back
  3. instruct pt to “lift hand from back”
  4. apply resistance in outward and downard direction at the distal humerus

*shoulder extensors must be graded as 3 or higher to do this

471
Q

for grades 0,1,2 how should the pt be positioned when testing the rhomboids?

A
  1. prone or sitting
  2. place pts arm behind back
  3. support under arm and shoulder (prone) under wrist (sitting)
  4. palpate medial border of scapula for rhomboids
472
Q

what are some common substitutions that may be observed during rhomboid MMT?

A
  1. Fibers of the middle trapezius can substitute for the adduction action of the rhomboids but not the downward rotation component
  2. When substitution occurs, the patient’s scapula will adduct with no downward rotation.

Palpation skills and visual observation will confirm this substitution

473
Q

what muscle primarily is tested during scapular depression and shoulder extension?

A

latissimus dorsi

474
Q

what can assit the lats in scapular depression and shoulder extension?

A
  1. teres major
  2. posterior deltoid
475
Q

when does the latissimus dorsi act as a scapular depressor?

A

when the origin is fixed

476
Q

how should the pt be positioned during MMT of the latissimus dorsi?

A
  1. prone
  2. arms by side
  3. head turned to either side
  4. pt depresses scapula down towards feet
  5. resistance is applied at the forearm directly upward towards pt’s head resisting motion
477
Q

alternative testing position for latissimus dorsi MMT?

A
  1. sitting
  2. hands placed on table
  3. instruct pt to lift their bottom off the table while palpating lats bilaterally
  4. apply resistance downwards resisting motion

can be done if PT is unable to cause pt to yield against max resistance in prone

DPT Semester 1 (12 decks)

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