Scapula MMT Flashcards
MMT grading scale
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
What are the planes of motion of the scapula
- elevation/depression
- adduction/abduction (retraction/protraction)
- down rot/up rot
What muscle is tested using upward rotation and abduction?
Serratus anterior
What testing position is not reccommended when testing the serratus anterior?
supine - due to common substitution pattern by clavicular portion of pec performing protraction
What position should serratus anterior be tested in?
shoulder flexion to minimize synergy with the trap
The arm cannot be used to apply resistance, when testing for serratus anterior, if what muscle is weak?
deltoid
Serratus anterior MMT testing position
Seated with arm raised to 130 degrees of flexion and elbow extended
How far can the arm elevate without the serratus anterior activating?
60 degrees
Serratus anterior: For grades 0-2, what must be observed and what is clinically significant about it?
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
What muscles perform scapular elevation?
Upper trap
levator scapula
What is the mean ROM for scapular elevation?
There are no reliable ROM norms available
Scapular elevation: What is crucial before testing?
postural assessment for resting elevation and 1st rib involvement
T/F: it is NOT okay to perform scapular elevation MMT bilaterally
False; one of the only tests it is ok for
Scapular elevation: grades 3-5 general instructions
- instruct patient to elevate their shoulders
- apply bilateral resistance
For scapular elevation testing: What position is gravity minimized?
prone OR supine
For scapular elevation: What should be considered in gravity minimized positions?
Prone:
- head turn may decrease ability to interpret accurate score (uneven recruitment)
Supine:
- palpation may be more difficult
What muscles perform scapular adduction (retraction)?
- Middle trap
- Rhomboid major
some assistance from upper/lower trap, levator, rhomboid minor
Scapular adduction: What is the positioning for grades 4 & 5?
- arm abducted to 90, elbow flexed
- head turned (either side)
- resistance placed at distal brachium (only if post. delt is grade 3 or higher)
Scapular adduction: how do you modify for a pt with a deltoid grades 0-2?
utilize alternate application of resistance (shorter lever arm)
what muscles perform scapular depression and downward rotation?
Lower trap
- some lat and pec maj/min assistance
Keeping the scapula depressed prevents what?
GH impingement
Scapular depression/downward rotation: how should the patient be positioned?
- 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
Scapular depression/adduction positioning
Similar to performing prone Y’s
What muscles perform downward rotation with scapular adduction?
Rhomboid major
- rhomboid minor and levator scapula assist
What should be taken into consideration when grading downward rotation with scapular adduction?
- rhomboids are difficult to accurately asses and they are frequently under-rated
What does clinical weakness of the rhomboids indicate diagnostically?
subscapular nerve lesion or muscle tear
