D&W Upper Extremity MMT

Question 1

Scapular Abduction & Upward Rotation

Answer 1

Muscle: Serratus Anterior
Pt Position: short sitting, pt raises arm 130 shoulder flexion
PT Position: stand on test side, resistance on arm proximal to elbow, palpate inferior angle of scapula
2,1,0: pt sits w/ arm 90 flexion, supported by PT, hand on inferior angle of scapula, pt tries to hold position

Question 2

Scapular Elevation

Answer 2

Muscle: Upper Trapezius
Pt Position: short sitting, pt elevates shoulders
PT Position: Behind pt, hands on both shoulders, pressure on both shoulders simultaneously
2,1,0: pt prone/supine, PT stands on test side, supporting shoulder & palpating upper trap near clavicle

Question 3

Scapular Adduction

Answer 3

Muscle: Middle Trapezius
Pt Position: prone w/ shoulder @ edge of table, ABD 90, elbow flexed 90
PT Position: stand on test side, stabilize opposite scapular side, apply pressure downward @ elbow
2,1,0: PT supports arm off table, palpate muscle fibers

Question 4

Scapular Depression & Adduction

Answer 4

Muscle: Lower Trapezius
Pt Position: prone w/ test arm over head ~145 degrees ABD, thumb pointing toward ceiling
PT Position: resistance applied just proximal to elbow downward
2,1,0: same position, PT supporting pt’s arm under elbow, palpate lower trap fibers

Question 5

Scapular Adduction & Downward Rotation

Answer 5

Muscle: Rhomboids
Pt Position: prone, shoulder internally rotated & arm adducted, elbow flexed, hand resting on back
PT Position: stand on test side, have pt lift hand off back, pressure proximal to elbow down & outward
2,1,0: pt short sitting, shoulder internally rotated, arm extended & ADD behind back, PT palpating medial scapular border & supporting pt’s wrist

Question 6

Scapular Depression

Answer 6

Muscle: Latissimus dorsi, teres major, posterior deltoid
Pt Position: prone, head toward test side, arms at side, shoulder internally rotated (palm up)
PT Position: stand test side, grasp forearm above pt’s wrist w/ both hands, tell pt to reach toward feet, pressure pushing arm upward

Question 7

Shoulder Flexion

Answer 7

Muscle: Anterior deltoid, coracobrachialis
Pt Position: short sitting, shoulder 90 flexion
PT Position: resistance on distal humerus, stabilize test shoulder
2,1,0: same test, PT palpate deltoid fibers

Question 8

Shoulder Extension & Scapular Depression

Answer 8

Muscle: Posterior Deltoid & Latissimus dorsi
Pt Position: prone, internally rotated (palm up), lift arm into extension
PT Position: stand test side, pressure applied proximal to elbow
2,1,0: same test, PT palpate posterior shoulder

** TO ISOLATE LAT - have pt push themselves up off the table OR depress shoulder & push arm upward

Question 9

Shoulder Abduction

Answer 9

Muscle: Middle deltoid, supraspinatus
*** Check full ROM first, make sure scapula is stabile & moving smoothly
Pt Position: short sitting, elbow flexed, arm ABD 90
PT Position: standing behind pt, resistance over elbow, stabilize test shoulder
2,1,0: same test, PT palpates deltoid
ALTERNATE: pt supine, palm down, tries to ABD arm

Question 10

Shoulder Horizontal Abduction

Answer 10

Muscle: Posterior Deltoid
Pt Position: prone, shoulder 90 ABD, forearm off edge of stable, try to lift elbow upward
PT Position: stand test side, resist on elbow
2,1,0: pt sitting over end of table, PT support forearm, pt attempts to horizontally ABD
ALTERNATE: sitting w/ arm supported on table

Question 11

Shoulder Horizontal Adduction

Answer 11

Muscle: Pectoralis major
*** CHECK ROM first
Pt Position:
WHOLE - supine, shoulder ABD & flex 90 (stabilize shoulder)
CLAV - shoulder 60 ABD w/ elbow flexed, upward (stabilize shoulder)
STERN - shoulder 120 ABD, elbow flexed, downward (stabilize hip)
PT Position: stand test side, pressure proximal to elbow
2,1,0: pt supine w/ arm supported OR sitting in chair, arm on table 90 ABD, pt attempt to horizontally adduct shoulder

Question 12

Shoulder External Rotation

Answer 12

Muscle: infraspinatus & teres minor
Pt Position: prone, head toward test side, arm 90 ABD w/ arm supported by table (or towel)
PT Position: resistance near wrist, one arm supports elbow
2,1,0: pt puts flexed arm over edge of table, PT palpates muscle fibers as pt attempts to turn arm

Question 13

Shoulder Internal Rotation

Answer 13

Muscle: subscapularis
Pt Position: prone w/ head toward test side, shoulder 90 ABD w/ towel under arm
PT Position: one hand on flexor surface forearm, support elbow
2,1,0: pt hangs arm off side of table, PT palpates muscle fibers, pt attempts to turn arm

Question 14

Elbow Flexion

Answer 14

Muscle: Biceps Brachii, brachialis, brachioradialis
Pt Position: sitting, one elbow bend 90+
Bicep - forearm in supination
Brachialis - forearm pronation
Brachioradialis - forearm midposition
PT Position: stand in front of pt toward test side, pressure against flexor surface forearm proximal to wrist, stabilize shoulder
2,1,0: 2 - pt sitting arm ABD 90, supported by PT; asked to bend elbow
1,0 - supine w/ elbow bend 45, PT palpating contractile tissue as pt attempts all 3 positions

Question 15

Elbow Extension

Answer 15

Muscle: triceps brachii
Pt Position: prone, arm 90 ABD, forearm flexed & hanging over side of table
PT Position: support right above elbow, downward resistance on dorsal forearm
2,1,0: short sitting, arm 90 ABD, shoulder neutral, elbow 45 flex, arm horizontal to floor, support elbow

Question 16

Forearm Supination

Answer 16

Muscle: supinator & biceps brachii
Pt Position: short sitting, elbow 90 flex, forearm supinated
PT Position: “sandwich” pt’s arm proximal to wrist, try to turn arm into pronation
2,1,0: palpate as pt attempts to supinate from pronation
(for 2, fully bend elbow to eliminate gravity)

Question 17

Forearm Pronation

Answer 17

Muscle: pronator teres & quadratus
Pt Position: short sitting, elbow 90 flex, forearm pronated
PT Position: “sandwich” pt’s arm proximal to wrist, try to turn arm into supination
2,1,0: palpate as pt attempts to pronate from supination (for 2, fully bend elbow to eliminate gravity)

Question 18

Wrist Flexion

Answer 18

Muscle: flexors
Pt Position: short sitting, forearm supinated on table, wrist neutral
Both wrist flexors - resistance across hand straight down
FCR - pt flexes wrist upward toward radial dev, resistance on 2nd MC
FCU - pt flexes wrist upward toward ulnar dev, resistance on 5th MC
PT Position: one hand under pt’s wrist
2,1,0: 2 - short sitting, wrist midposition, ulnar side resting on table, PT supports wrist, full ROM w/o gravity
1,0 - wrist supinated, pt placed in flexion, try to bend & relax, palpate FCR & FCU tendons

Question 19

Wrist Extension

Answer 19

Muscle: wrist extensors
Pt Position: short sitting, elbow flexed, forearm pronated, supported by table
PT Position: support forearm, resistance over dorsal MC
Three extensors - extend wrist, resistance over 2nd - 5th MC
ECR (L&B) - resistance over dorsal 2nd & 3rd MC toward flexion & ulnar deviation
ECU - resistance over 5th MC toward flexion & radial deviation
2,1,0: 2 - forearm neutral, support wrist, ask pt to extend wrist
1,0 - ECRL (tendon line w/ 2nd MC) ECRB (tendon line w/ 3rd MC) ECU (tendon line w/ 5th MC)

Question 20

Finger MP Flexion

Answer 20

Muscle: lumbricals, interossei
Pt Position: short sitting or supine, forearm supinated, wrist neutral, MP fully flexed, IP joints flexed, uncurl fingers, then flex knuckles
PT Position: stabilized MC proximal to MP joints, resistance on palmar surface proximal row of phalanges toward extension
2,1,0: forearm & wrist in midposition, MP joints extended, IP joints flexed, stabilized MC “try to uncurl fingers while bending knuckles”

Question 21

Finger MP Extension

Answer 21

Muscle: extensor digitorum, indicis, digiti minimi
Pt Position: forearm pronated, wrist neutral, MP & IP relaxed in flexion
Digitorum - pt extends MP all fingers IP in slight flexion
Indicis - pt extends MP index
Digiti minimi - pt extend MP joint 5th digit
PT Position: stabilize wrist in neutral, have pt bend finger, don’t let me straighten it
2,1,0: same except forearm in midposition (antigravity)

Question 22

Finger Abduction & Adduction

Answer 22

Muscle:
Pt Position:
PT Position:
2,1,0:

Question 23

Finger PIP & DIP Flexion

Answer 23

Muscle: Flexor digitorum superficialis & profundus
Pt Position: forearm supinated, wrist neutral, stabilize previous joint
PT Position: test all fingers separately, only let specific joint flex, pressure on phalanx (DIP stabilized on both sides)
2,1,0: forearm in neutral, palpate movement

Question 24

Thumb MP & IP Extension & Flexion

Answer 24

Muscle:
Pt Position:
PT Position:
2,1,0:

Question 25

Thumb Abduction

Answer 25

Muscle:
Pt Position:
PT Position:
2,1,0:

Question 26

Thumb Adduction & Opposition

Answer 26

Muscle:
Pt Position:
PT Position:
2,1,0: