Exam 2 Flashcards
what is manual muscle testing?
a means of objectively grading the max contraction of a muscle/muscle group
what is the purpose of mmt?
1)determine extent of muscle power available
2)id muscle weakness which interferes w/client funct
3)prevent deformities from occurring by locating poss prob areas due to muscle imbalance
4)aid therapist in:
a) setting baseline for treatment
b)assessing need for and practicality of adaptive devices c)determining level of acts the client is capableof performing
d)eval the effectiveness of treatment techniques
indications for muscle testing
1) lower motor neuron disease (diseases which cause flaccid paralysis: polio, guillain-barre synd)
2)spinal cord injuries (quadriplegics and paraplegics will demo lower mot neu clinical pic above lvl of lesion)
3)neurological diseases that cause primary muscle weakness (multiple sclerosis, amyotrophic lat sclerosis, myasthenia gravis, muscular dystrophy)
contraindications for muscle testing
-for clients who primarily demonstrate an upper mot neu lesion (diseases that result in spasticity, hyperactive deep reflexes, pathological reflexes) such as:
-cerebral palsy
-cerebral vascular accident(if they still move in synergistic patterns of motion)
-spinal cord injuries
-parkinson’s disease
types of disabilities that may be tested with limitations considered
-arthritis: pain may inhibit client from moving part or accepting mac resistance
-parkinson’s: during early stages, prior to or in the absence of rigidity
-cerebral vascular accident: as synergy patterns break up, client may demo isolated muscle control in various joints if spasticity isn’t an inhibiting factor
-cerebral palsy: if hypertonicity or hypotonicity arent severe and incoordination not a prob, a form of muscle testing may be done w/adaptations
limitations of muscle testing
1)doesn’t show endurance and ability to do work
2)doesn’t show ability to combine muscles into smooth harmonious mvt
3)doesn’t show pic of gross/partial muscle control
4)doesn’t show ability to use muscle power: for funct, motivation, muscle sense (motor control and coord)
5)doesn’t show how much joint range the kind muscle is working through
skills needed by tester
1)know how to position part being tested
2)know to stabilize to rule out substitution and give a firm base
3) must know poss substitution patterns and how to look out for them
4) know how to palpate to feel contraction
5) know how and where to apply resistance
6)know how to set “normal” in muscle power
7) knowledge of origins, insertions, direction of fibers and pos of muscle layers
procedure for mmt
1)introduce self
2)position
3)stabilize
4)observe
**5) palpate
6) resist
7) grade
0/zero
no contraction of muscle, no mvt of the part
t(1) trace
slight cont can be palpated; no mvt of part
p-(2-) poor minus
prt moves through incomp ROM w/g min
p(2) poor
prt moves through com ROM w/g min
p+ (+2) poor plus
prt moves through com ROM w/g min, slight res
f-(3-) fair minus
moves through incom ROM vs g
f (3) fair
moves through com ROM vs g
f+ (3+) fair plus
moves through com ROM vs g, slight res
g(4) good
moves through com ROM vs g, mod res
n(5) normal
moves through com ROM vs g, normal res
funct capacity of a muscle indicates
ability of muscle to contract in a controlled setting. muscle grade will also give the therapist some info on how the client might be expected to perf funct acts
funct cap: good to normal
should perform all funct acts involving those muscles w/out undue fatigue providing endurance lvl is also good to normal
funct cap: fair plus
-should be able to perf most funct acts inde
-lower endurance lvl and easily tired
-work short periods, then rest needed
-may be protected by therapist, especially if muscle strength is expected to improve
-said to represent a definite funct threshold
funct cap: fair
-will be able to performmin task vs g, but no real work
-low endurance, client tires when attempting funct acts
-could prob do light work but w/frequent rest
-in lower extremities: not enough strength for walking
funct cap: poor
-below funct range
-should be able to maintain own ROM vs g min w/ no inhibiting factors
-could help stabilize joint, in terms of funct
funct cap: zero to trace
-completely dependent
-not able to perform funct acts w/out external power source(therapist, electric hand splint, electric wheelchair)
glenohumeral joint
true anatomical joint- diarthrosis- ball and socket
scapulothoracic joint
-not a true anatomical joint
-physiological joint mechanically linked to acromioclavicular and sternoclavicular joints
acromioclavicular joint
true anatomical joint
-plane synovial
-allows for additional range of rotation on the thorax in latter stages of elevation
-maintains relationship b/t clavicle and scapula in early stages of elevation
sternoclavicular joint
true anatomical joint
-plane synovial
-attaches clavicle to sternum
-serves as only bony connection of the upper extremity to trunk
subdeltoid joint
not anatomical joint, but a physiological joint
-2 surfaces moving w/respect to each other (humerus vs coracoacromial arch)
-mechanically lined to glenohumeral joint (mvt in one joint influences mvt in the other)
what bones makes up shoulder girdle
the clavicle and scapula
why are mvts of the shoulder girdle also called mvts of the spacula or scapulathoracic joint?
since position of clavicle doesnt permit its moving independently
translatory mvts
scapula moves as a whole
scapula: elevation
upward mvt of the scapula w/vertebral border remaining parallel to spinal column
scapula: depression
return from the position of elevation
scapula: protraction (abduction)
lat mvt of scap AWAY from spinal column w/the vertebral border remaining approx parallel to it, usually w/slight lat tilt
scapula: retraction (adduction)
medial mvt of scap toward the spinal column w/the vertebral border remaining parallel to it, usually w/reduction of lat tilt
scapula: rotary mvts
scap rots around a fixed axis
scapula: upward rotation
rot of scap in frontal plane so that the glenoid fossa faces somewhat upward (flexing arms up)
scapula: downward rotation
return from position of upward rot
-may be slight downward rot beyond the normal resting pos so that glenoid fossa faces slightly downward
scapula: accessory mvts
mvts that accompany translatory and rotary mvts of scap. these mvts occur to keep scap in contact with and accommodating to the curving of the thorax
scapula: upward tilt
as the scap is pulled up and forward on the thorax, the inferior angle of the scap will tip outward in an attempt to keep the superior aspect of the scap in contact w/rib cage
-this mvt occurs a frontal/coronal axis
scapula: winging
as the scap moves in protraction the vertebral border will move posteriorly the glenoid fossa anteriorly resulting in the vertebral border seeming to protrude as the scapula moves around a vertical axis
scapula: downward tilt
as the scap moves down on the thorax, the superior border angle of the scapula will tip outward, forcing the inferior angle to tip inward and maintain contact w/rib cage
-this mvt occurs around a frontal/coronal axis
what forms the sternoclavicular joint?
the sternal end of the clavicle attaching to the superior lat portion of the manubrium of the sternum and the cartilage of the first rib
what is the only bony connection of the upper extremity to the trunk?
the attachment of the clavicle to the sternum
what separates the sternoclavicular joint into two separate cavities?
a joint disk/meniscus interposed b/t the articulating surfaces
-so mvt takes place b/t clavicle and disk & disc and sternum
-it absorbs shock forces transmitted along tal end of clavicle
-helps check tendency of clavicle to medially dislocate on the manubrium
anterior/posterior sternoclavicular
checks anterior/posterior mvts of the head of the clavicle
costoclavicular
checks elevation and limits protraction and retraction
interclavicular
checks excessive downward mvt of clavicle which can cause dislocation or injury to vital structures running b/t the clavicle and first rib
what does the sternoclavicular joint primarily influence
the translatory mvts of the mechanical scapulothoracic joint
-contributes the most mvt at the glenohumeral joint during the 1st 90degrees of mvt
where does referred pain from this joint get attributed to
glenohumeral joint
primary function of acromioclavicular joint
to maintain the relationship b/t the clavicle and scap in the early stages of elevation of the upper limbs
-to allow the scap additional range of rot in the latter stages of elevation of the limb
mvts of sternoclavicular joint
Sag axis: elevation (45deg) dep(15deg)
vertical axis: protraction (15deg) retraction (15)
frontal axis: upward tilt
primary function of the acromioclavicular joint is?
to maintain the relationship b/t the clavicle and the scapula in the early stages of elevation of upper limbs
-to allow the scapula additional range of rotation in the latter stages of elevation of the limb
acromioclavicular joint: sag axis
upward and downward rot
acromioclavicular joint: vert axis
winging of vertebral border - permits scapula to hug thorax as it slides around the rib cage
acromioclavicular joint: frontal axis
upward and downward tilt needed during arm elevation
acromioclavicular ligament
prevents posterior dislocation of clavicle
-if torn, slight displacement of AC joint (grade 1)
-if fully ruptured the scapula and clavicle become partially separated (grade 2)
coracoclavicular ligament
provs joint stab, firmly unites clavicle and scap, checks backward motion of scapula
-most injured lig in shoulder
-comp rupture is “complete” shoulder separation (grade 3)
coracoacromial ligament
forms coracoacromial arch, which is there to prevent direct trauma to the humeral head and sensitive muscles, tendons and bursae overlying the humeral head
the acromioclavicular joint contributes the most mvt at the
glenohumeral joint during the second 90deg of mvt
acromioclavicular joint referred pain and injuries
from the AC joint during shoulder activity in the higher ranges of flexion and AB-duction (90-180degs)
-very common especially in active people
-6 grades of severity in separations. 1-3 are most common. 4-6 are uncommon and usually the result of significant trauma
*4-6 treated surgically bc severe disruption of ligamentous support for arm and shoulder
the gleno-humeral joint is formed by
the articulation of head of humerus w/ the glenoid cavity of scap
the glenohumeral joint sacrifices
stability for mobility
as demonstrated by:
1)lack of osseous support: large humerus head doesn’t fit in small glenoid fossa
2)lack of ligamentous support: only 2 main ligaments act on it (ant and sup)
3) lack of surrounding mscl support: muscles are ant, sup, and post to joint
4)structure of joint capsule: sup capsule is taut, inf capsule is loose
glenohumeral joint’s lack of structural support result in
tremendous variations in the mvts
intrinsic weakness makes the glenohumeral joint
susceptible to degenerative changes and to derangement
glenoid labrum
surrounds and is attached to periphery of glenoid fossa, enhancing its curvature
-thought to be synovium-lined fibrocartilage
-
bursae
-most imp are the subacromial and subdeltoid
-they sep the supraspinatus tendon and head of humerus below from acromion, coracoacromial lig and deltoids above
-may be continuous or separate
-MAIN FUNCT is to allow smooth gliding of lower structures on upper structures w/out friction. failure is common cause of pain and limitation of glenohumeral motion
capsule
surrounds entire glenohumeral joint when in resting pos
-taut superiorly and slack inferiorly
-2x the size of humeral head and allows slightly more than 1 inch distraction from glenoid fossa
-lax needed for large excursion of joint surfaces but gives little stability without ligs and mscls
-reinforcement is weakest inferiorly
coracoacromial arch
-overlies the subacromial bursa
-formed by acromion process, coracoacromial lig and coracoid process
-protects humeral head from direct trauma
-protects muscs, tendons, and bursae overlying the head
-prevents head of humerus from dislocating superiorly
-prevents humerus from impacting acromion process
glenohumeral (casular) lig
-could be mere capsular thickening
- 3 bands form a Z on anterior capsule
-each band becomes taut in and gives a check to certain humeral motion
-ALL bands tighten on ext rot
-MIDDLE and INFERIOR bands tighten during AB-duction
coracohumeral lig
-checks lateral rotation but more importantly it passively supports the upper limb against gravity
-anterior band taut during humeral extension
-posterior band taut during humeral flexion
dependent positon of glenohumeral joint
arms hanging loosely down at side
palm toward body, thumb anterior
structures that support the glenohumeral joint
hold in the head of humerus up in glenoid fossa (superior to joint):
supraspinatus muscle
coracohumeral lig
superior joint capsule
subluxation
pulled out of alignment
partial dislocation
often follows stroke/CVA
-stretching of supraspinatus, coracohumeral lig and sup joint capsule
-measured in finger widths
mvts of glenohumeral joint: flexion
forward mvt of arm in sagg plane
-full motion: arm a side and end up overhead
mvts of glenohumeral joint: extension-hyperextension
bacward mvt of arm that takes the hand posterior to body
mvts of glenohumeral joint: ADduction
-arm at side is ADducted
-frontal plane
-ADduction ends when arm touches side of trunk
mvts of glenohumeral joint: ABduction
-arm moved up and away from side of body
-frontal plane
-hand can be out at shoulder level and cont until it is overhead
-complete ABduction occurs more freely if humerus is externally rotated
mvts of glenohumeral joint: int rot
-humerus turning medially/anteriorly so that palm faces forward, toward body, posteriorly, and away from body
-occurs independent of mvts of elbow and forearm
-usually accompanies other mvts in glenohumeral joint (flexion)
-along humerus’ longitudinal/vertical axis
mvts of glenohumeral joint: ext rot
-mvt of humerus around longitudinal/vertical axis
-humerus turns laterally/posteriorly so that pal faces body, forward, and then away from body
-usually find of mvts of elbow and forearm
-usually accompanies other mvts in glenohumeral joint (horz ABduction)
mvts of glenohumeral joint: horz ADduction
arm raised to shoulder level, moved toward midline of body
-requires humeral head to move in and around combo of planes and axes
mvts of glenohumeral joint: horz ABduction
arm raised to shoulder level, moved backward toward vertebral column
-requires humeral head to move in and around combo of planes and axes
mvts of glenohumeral joint: Diagonal ADduction
from full flexion/ABduction the arm is brought down and diagonally across body until right hand touches left hip
-also diagonal extension
-requires humeral head to move in and around combo of planes and axes
mvts of glenohumeral joint: diagonal ABduction
from diagonal ADduction, hand is brought up and diagonally across the body until it reaches full flexion
-requires humeral head to move in and around combo of planes and axes
