Scapula MMT

Question 1

MMT grading scale

Answer 1

5 (normal) - can’t break @ end point against max resistance
4 (good) - can withstand considerable but less than normal resistance
3 (fair) - full ROM against gravity but any additional resistance will break the position
2 (poor) - full ROM in gravity minimized position
1 (trace) - visually detect or palpate contractile activity

Question 2

What are the planes of motion of the scapula

Answer 2

• elevation/depression
• adduction/abduction (retraction/protraction)
• down rot/up rot

Question 3

What muscle is tested using upward rotation and abduction?

Answer 3

Serratus anterior

Question 4

What testing position is not reccommended when testing the serratus anterior?

Answer 4

supine - due to common substitution pattern by clavicular portion of pec performing protraction

Question 5

What position should serratus anterior be tested in?

Answer 5

shoulder flexion to minimize synergy with the trap

Question 6

The arm cannot be used to apply resistance, when testing for serratus anterior, if what muscle is weak?

Answer 6

deltoid

Question 7

Serratus anterior MMT testing position

Answer 7

Seated with arm raised to 130 degrees of flexion and elbow extended

Question 8

How far can the arm elevate without the serratus anterior activating?

Answer 8

60 degrees

Question 9

Serratus anterior: For grades 0-2, what must be observed and what is clinically significant about it?

Answer 9

initial postural observation
- if deviation is observed, the patient will not be able to effectively raise arm into shoulder flexion for grades 3-5 assessment

Question 10

What muscles perform scapular elevation?

Answer 10

Upper trap

levator scapula

Question 11

What is the mean ROM for scapular elevation?

Answer 11

There are no reliable ROM norms available

Question 12

Scapular elevation: What is crucial before testing?

Answer 12

postural assessment for resting elevation and 1st rib involvement

Question 13

T/F: it is NOT okay to perform scapular elevation MMT bilaterally

Answer 13

False; one of the only tests it is ok for

Question 14

Scapular elevation: grades 3-5 general instructions

Answer 14

• instruct patient to elevate their shoulders

- apply bilateral resistance

Question 15

For scapular elevation testing: What position is gravity minimized?

Answer 15

prone OR supine

Question 16

For scapular elevation: What should be considered in gravity minimized positions?

Answer 16

Prone:
- head turn may decrease ability to interpret accurate score (uneven recruitment)
Supine:
- palpation may be more difficult

Question 17

What muscles perform scapular adduction (retraction)?

Answer 17

• Middle trap
• Rhomboid major

some assistance from upper/lower trap, levator, rhomboid minor

Question 18

Scapular adduction: What is the positioning for grades 4 & 5?

Answer 18

• arm abducted to 90, elbow flexed
• head turned (either side)
• resistance placed at distal brachium (only if post. delt is grade 3 or higher)

Question 19

Scapular adduction: how do you modify for a pt with a deltoid grades 0-2?

Answer 19

utilize alternate application of resistance (shorter lever arm)

Question 20

what muscles perform scapular depression and downward rotation?

Answer 20

Lower trap

- some lat and pec maj/min assistance

Question 21

Keeping the scapula depressed prevents what?

Answer 21

GH impingement

Question 22

Scapular depression/downward rotation: how should the patient be positioned?

Answer 22

• test arm overhead to about 145deg of abduction
• head turned to either side, thumb pointed up
• pts extremity and PTs line of resistance should be aligned with the direction of pull of the lower trap

Question 23

Scapular depression/adduction positioning

Answer 23

Similar to performing prone Y’s

Question 24

What muscles perform downward rotation with scapular adduction?

Answer 24

Rhomboid major

- rhomboid minor and levator scapula assist

Question 25

What should be taken into consideration when grading downward rotation with scapular adduction?

Answer 25

• rhomboids are difficult to accurately asses and they are frequently under-rated

Question 26

What does clinical weakness of the rhomboids indicate diagnostically?

Answer 26

subscapular nerve lesion or muscle tear