MMT of shoulder and elbow Flashcards
Innervation of serratus anterior
long thoracic C5 - 7
recommended position for testing serratus anterior
sitting with shoulder flexed to 130
resistance applied to test serratus anterior
patient pushes upward into flexion, therapist pushes downward on arm above elbow
below fair grade for serratus anterior
PT takes weight of arm and asks patient to lift arm and scapula
shoulder should maintain abduction and upward rotation
Palpation of serratus anterior
hand should be along lower borders of scapula with web space at inferior angle
Alternate position for serratus anterior
sitting or supine with shoulder flexed to 100
Innervation of traps (upper, middle and lower)
Cranial nerve XI, C3 - 4
Action of serratus anterior
scapular abduction and upward rotation
innervation of levator scap
L3 - 4 and dorsal scapular nerve C5
recommended position for testing upper trap and levato scap
sitting with arms at sides
resistance for upper trap and levator scap
patient shrugs shoulders
resistance applied downward toward surface over superior shoulder
below fair position for upper trap and levator scap
supine or prone with head in midline
palpation for upper trap and levator scap
near insertion near clavicle or near cervical spine
substitution of upper trap and levator scap
watch hands pushing down on legs or surfaces
rhomboids substitute with adduction and upward rotation
action of upper trap and levator scap
scapular elevation
recommended position to test middle trap
Prone, shoulder at 90 degrees abduction and elbow at 90 (arm hands over edge of mat)
OR
shoulder 90 abduction and ER
resistance for middle trap
patient lifts elbow toward ceiling
resistance downwards towards floor, proximal to elbow if deltoid is strong, over scapular is deltoid is weak
below fair position for middle trap
therapist takes weight of arm
palpation point for middle trap
spine of scapular from acromion to vertebral column (T1 - T6)
substitutions of middle trap
rhomboids – downward rotation with adduction
action of middle trap
scapular adduction
recommended position to test lower trap
prone: arm abducted 145 forearm mid-position with thumb pointing to ceiling
resistance for lower trap
patient lifts arm towards ceiling
resistance applied downwards towards floor proximal to elbow if shoulder is strong, over scapula is shoulder is weak (push up and out)
below fair position for lower trap
therapist takes weight of arm
palpation of lower trap
below spine of scapula and across to thoracic vertebrae (T7 - 12)
Action of lower trap
scapular depression and adduction
innervation of rhomboids
dorsal scapular C5
recommended position of rhomboids
prone, shoulder internally rotated, arm adducted with elbow flexed, hand on back
resistance of rhomboids
patient lifts hand off back
resistance proximal to elbow if shoulder is strong
resistance downward and out if shoulder is weak
below fair position of rhomboids
therapist takes weight of arm
OR
short sitting (Gravity minimized)
palpation of rhomboids
deep under vertebral border of scapula
strong activity - fingers will pop out from palpation point
substitution of rhomboids
do not allow elbow to lead = humeral extension
middle trap = see add without rotation
action of rhomboids
scapular adduction and downward rotation
