MMT Shoulder Flashcards
when is MMT not used
when a pt has an upper neuron disorder
what MMT do we used
the break test
@ the end of available ROM or at a point in the ROM where the muscle is most challenged
the pt is asked to hold the part at that point and not allow the examiner to “break” the hold with manual resistance
MMT
the application of manual resistance against an actively contracting muscle (against the direction of the movement as if to prevent that movement)
what do the scores represent in the break test
the performance of all muscles that perform that motion
grade range
0-5
zero-normal
criteria for assigning a muscle grade
there is both subjective and objective info
subjective
plays a larger role
examiners impression of how much resistance to apply
the actual amount of resistance a pt can tolerate
objective
ability to complete full ROM
hold the position once there
ability to move against gravity or inability to move the part at all
grade 5
normal
complete a full ROM against gravity and maintain end range against maximum resistance provided by the examiner
implied normal function
grade 4
good
able to complete full ROM against gravity and can tolerate moderate resistance w/o breaking the test position
muscle will “give” or yield” to some extent at the end range with maximum resistance
grade 3
fair
muscle or muscle group can complete full ROM against only the resistance of gravity
no resistance
yields/gives right away w/ resistance
grade 2
poor
a muscle that can complete the full ROM in a position that minimizes the force of gravity
gravity minimized position
put into if the pt cannot complete full ROM against gravity
in this position the PT will support the weight of the arm
slight resistance will be applied in some circumstances
grade 1
trace
examiner can detect visually or by palpation some contractile activity in one or more of the muscles that participate in the movement being tested
there is no movement of the part as a result of this minimal contractile activity
grade 0
zero
the muscle is completely inactive on palpation or visual inspection
4+
muscle can complete full ROM against gravity and the pt can hold the position against more than moderate resistance
3+
muscle can complete full ROM and pt can hold the position against slight resistance
2+
can complete full ROM in gravity minimized position and holds against slight resistance
OR
muscle can complete less than half of full ROM against gravity
2-
muscle can complete partial ROM in the gravity minimized position
where do you apply resistance for 1 joint muscles
applied at end ROM
where do you apply resistance for 2 joint muscles
applied at approximate mid range
where is point of resistance on an extremity
applied near the distal end of the segment which the muscle attaches
2 exceptions
hip abductors
scapular muscles
hip abductors
give resistance down at the ankle
scapular muscles
give resistance on the humerus but pay attention to what the scapula does
how should resistance be applied
slowly and gradually
allowing it to build to the maximum tolerable intensity
how do you start MMT
passive ROM followed by pt doing AROM
shoulder flexion muscles
anterior deltoid
coracobrachialis
pec major
gravity minimized position for shoulder flexion
side lying
support weight of arm
if can support slight resistance –> 2+
cant –> 2
substitutions shoulder flexion
lateral flexion
shoulder shrug
moving out of the plane
extension of the spine
shoulder extension muscles
latissimus dorsi
posterior deltoid
teres major
gravity minimized position shoulder extension
there isn’t one
any ROM against gravity is a 2 (dont have to support their arm)
shoulder extension substitutions
going out of plane
trunk rotation
ABD
pt position shoulder flexion
short sitting
pt position shoulder extension
prone with arms at sides
palm up
no pillow
head to same side
shoulder ABD muscles
middle deltoid
supraspinatus
long head of biceps if in ER
gravity minimized position shoulder ABD
supine
arm supported by PT
have them do 90 degrees of ABD
apply slight resistance
tolerable –> 2+
can’t –> 2
substitutions of shoulder ABD
moving trunk out of plane
trunk flexion
shoulder rotation
shoulder elevation
pt position shoulder ABD
short side with arm at side
elbow slightly flexed
shoulder horizontal ABD muscles
posterior deltoid
middle deltoid
gravity minimized position for horizontal ABD
sitting on edge of table supporting the weight of the arm
start in ADD and ask them to move their arm backward
apply resistance at end of ROM
tolerated –> 2+
can’t –> 2
substitutions of shoulder horizontal ABD
trunk rotation
dropping down into ADD
elbow extension
coming out of plane of motion
pt position of shoulder horizontal ABD
prone
shoulder ABD to 90
elbow at 90
