Scapular MMT Flashcards
what are the scapular movements tested with MMT?
- elevation
- adduction
- abductino
- upward rotation
- depression and downward rotation
what muscles primarily are assessed during scapular upward rotation and abduction?
serratus anterior
why is upward rotation with abduction a significant motion for the scapula?
contributes to scapulo humeral rhythm
weakness in upward rotators may lead to dysfunction and downward rotation of scapula
increases risk for impingement
T/F: the serratus anterior can never be graded higher than the grade assigned to shoulder flexion?
TRUE
weak deltoid = loss of lever for testing = cannot apply resistance in this test
for grades 4 and 5, how should the pt be positioned for serratus anterior MMT?
- sitting
- shoulder flexed to 130 w/elbow extended
- apply resistance at distal humerus in a downward direction
- stabilize/palpate lateral edge of scapula to see if it maintains an abudcted and upwardly rotated position
how should the pt be positioned for a grade 3 serratus anterior MMT?
- sitting
- shoulder flexed to at least 90 with elbow extended
- check position
- is it uncoordinated? = weak serratus ant
- pt can get into position but cannot hold against resistance
how should the pt be positioned for grades 0,1,2 serratus anterior MMT?
- sitting
- PT supported weight of arm and moves it into position of aprox 90 flex
- Instruct pt to “hold your arm in this position, let it relax. Now hold your arm up again. Let it relax”
- palpate serratus anterior
alternative testing position for serratus anterior MMT?
- supine
- shoulder flexed to 90, neural rotation
- elbow extended
- instruct pt to make a fist and punch straight up into your hand
T/F: it is alright to test scapular elevation bilaterally?
TRUE
pt positioning for grades 3 and up scapular elevation MMT?
similar to how we performed it in systems review
gravitiy minimized positioning for scapular elevation
- prone or supine
- neutral head (turning may influence activation of muscles)
what muscles primarily perform scapular adduction (retraction)?
- middle trapezius
- rhomboid major
what muscles assist with scapular adduction (retraction)?
- rhomboid minor
- upper and lower trapezius
- levator scapulae
for grades 4 and 5 how should the pt be positioned for scapular adduction (retraction) MMT?
- prone
- arm abducted 90 and elbow flexted to 90
- head turned to either side
- stabilize contralateral scapula
- apply resistance at distal humerus (if posterior deltoid was a grade 3 at least)
if a pt has a posterior deltoid that graded less than a 3, how should the pt be positioned during scapular adduction (retraction) MMT?
- set up is exactly the same as grades 3 and up
- main difference is lever arm changes from distal humerus to posterior shoulder
for grades 0,1,2 how should the pt be positioned during scapular adduction (retraction) MMT?
- prone
- shoulder abducted 90, elbow flexed 90
- PT supports the weight of the arm
- other hand is placed along upper medial border of scapula being tested to palpate
- instruct pt to move arm through full ROM
what are some common substitutions that may be observed during scapular adduction (retraction) MMT?
- rhomboid overtaking middle trap = scapula will adduct and rotate downwards
- no scapular adduction is observed but shoulder moves = posterior deltoid solely working
what muscle primarily is tested during scapular downward rotation and depression?
lower trapezius
what muscles assist in scapular depression and downward rotation?
- latissimus dorsi
- pectorals
for grades 3 and up, how should the pt be positioned during scapular depression and downward rotation MMT?
- prone
- test arm overhead to 145 of abduction
- head turned to either side
- thumb up
- apply downward force at distal humerus
- other hand palpating along spine for lower trap
for grades 0,1,2 how should the pt be positioned during scapular depression and adduction (downward rotation) MMT?
- prone
- support arm and position it to 145 abduction
- thumb pointed up
- palpate lower trap between base of spine of scapula and lower T vertebrae
what is primarily tested during scapular downward rotation and adduction?
rhomboid major
what muscles assist in scapular downward rotation and adduction?
- rhomboid minor
- levator scapulae
T/F: the rhomboid are frequently underrated during MMT?
TRUE
evidence suggests they are difficult to accurately assess
clinical weakness of the rhomboids is a strong diagnostic test for what?
subscapular nerve lesion or muscle tear
for grades 3 and up, how should the pt be positioned during rhomboid MMT?
- prone
- arm behind back
- instruct pt to “lift hand from back”
- apply resistance in outward and downard direction at the distal humerus
*shoulder extensors must be graded as 3 or higher to do this
for grades 0,1,2 how should the pt be positioned when testing the rhomboids?
- prone or sitting
- place pts arm behind back
- support under arm and shoulder (prone) under wrist (sitting)
- palpate medial border of scapula for rhomboids
what are some common substitutions that may be observed during rhomboid MMT?
- Fibers of the middle trapezius can substitute for the adduction action of the rhomboids but not the downward rotation component
- When substitution occurs, the patient’s scapula will adduct with no downward rotation.
Palpation skills and visual observation will confirm this substitution
what muscle primarily is tested during scapular depression and shoulder extension?
latissimus dorsi
what can assit the lats in scapular depression and shoulder extension?
- teres major
- posterior deltoid
when does the latissimus dorsi act as a scapular depressor?
when the origin is fixed
how should the pt be positioned during MMT of the latissimus dorsi?
- prone
- arms by side
- head turned to either side
- pt depresses scapula down towards feet
- resistance is applied at the forearm directly upward towards pt’s head resisting motion
alternative testing position for latissimus dorsi MMT?
- sitting
- hands placed on table
- instruct pt to lift their bottom off the table while palpating lats bilaterally
- apply resistance downwards resisting motion
can be done if PT is unable to cause pt to yield against max resistance in prone
