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E&M -JD > Shoulder/Elbow/Forearm MMT > Flashcards

Shoulder/Elbow/Forearm MMT Flashcards

1
Q

(Serratus anterior) actions

A

Scapular abduction, upward rotation, depression

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2
Q

(Serratus anterior) nerve

A

Long thoracic nerve C5-7

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3
Q

(Serratus anterior) fair and above pos

A

Sitting; shoulder flexed 130 deg

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4
Q

(Serratus anterior) resistance

A

Pt pushes upward into flexion

Therapist pushes downward on arm above elbow

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5
Q

(Serratus anterior) below fair pos

A

Therapist takes weight of arm- ask pt to lift arm, scapula should maintain abduction and UR.

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6
Q

(Serratus anterior) palpation

A

Hand should be along lower borders of scapula with web space at the inferior angle

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7
Q

(Serratus anterior alt) fair and above pos

A

Sitting or supine; shoulder flexed to 100

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8
Q

(Serratus anterior alt) resistance

A

Patient pushes forward and upward. Resistance is backwards and downwards

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9
Q

(Serratus anterior alt) below fair pos

A

Therapist takes weight of arm- ask pt to lift arm, scapula should maintain abduction and UR

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10
Q

(Serratus anterior alt) palpation

A

Hand should be along lower borders of scapula with web space at the inferior angle

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11
Q

(Upper trap) (Levator scapula) actions

[one from MMT chart]

A

Scapular elevation

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12
Q

(Upper trap) (Levator scapula) Innervation

A

Upper trap: CN XI, C3-4

Levator scap: C3-4, and dorsal scapula nerve, C5

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13
Q

(Upper trap) (Levator scapula) fair and above pos

A

Sitting: arms at sides

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14
Q

(Upper trap) (Levator scapula) Resistance

A

Pt shrugs shoulders. Resistance is applied downward toward surface over superior shoulder

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15
Q

(Upper trap) (Levator scapula) Below fair pos

A

Supine or prone. Head should be midline

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16
Q

(Upper trap) (Levator scapula) palpation

A

Near insertion near clavicle or near cervical spine

Upper traps insert to lateral clavicle

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17
Q

(Upper trap) (Levator scapula) subs

A

Watch hands pushing down on legs or surface.

Rhomboids- see adduction and UR

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18
Q

(Middle trap) action

A

Scapular adduction

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19
Q

(Middle trap) Fair and above pos

A

Prone: shoulder at 90 abduction and elbow at 90 (arm hangs over edge of table) or

Shoulder 90 deg abd and ER

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20
Q

(Middle trap) Resistance

A

Pt lifts elbow toward ceiling.
Resistance downwards toward floor proximal to elbow if deltoid is strong

If deltoid is weak- resist over scapula

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21
Q

(Middle trap) below fair pos

A

Therapist takes weight of arm

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22
Q

(Middle trap) palpation

A

At spine of scapula from acromion to vertebral column (T1-6)

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23
Q

(Middle trap) subs

A

Rhomboids- see DR with adduction

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24
Q

(Lower traps) action

A

Scapular depression and adduction

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25
Q

(Lower traps) fair and above pos

A

Prone: arm abducted 145 deg, forearm mid-position with thumb pointing to ceiling

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26
Q

(Lower traps) resistance

A

Pt lifts arm toward ceiling
Resistance downwards toward floor proximal to elbow if shoulder is strong

Over scapula if shoulder is weak (push upwards and outwards)

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27
Q

(Lower traps) below fair pos

A

Therapist takes weight of arm

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28
Q

(Lower traps) palpation

A

Below spine of scapula and across thoracic vertebrae T7-12

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29
Q

(Rhomboids) action

A

Scapular adduction and downward rotation

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30
Q

(Rhomboids) nerve

A

Dorsal scapular nerve C5

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31
Q

(Rhomboids) fair and above pos

A

Prone: shoulder internally rotated, arm adducted with elbow flexed, hand on back (chicken wing)

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32
Q

(Rhomboids) resistance

A

Pt lifts hand off back.
Resistance proximal to elbow if shoulder is strong
Resistance is downward and outward

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33
Q

(Rhomboids) below fair pos

A

Therapist takes weight of arm
OR
Short sitting (gravity minimized)

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34
Q

(Rhomboids) palpation

A

Deep under vertebral border of scapula. With strong activity, fingers will pop out from palpation point

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35
Q

(Rhomboids) subs

A

Do not allow elbow to lead= humeral extension

Middle trap- see scap add without rotation

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36
Q

(Anterior deltoid, supraspinatus, coracobrachialis) action

A

Shoulder flexion

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37
Q

(Anterior deltoid, supraspinatus, coracobrachialis) nerves

A

Deltoid: axillary nerve, C5-6
Coracobrachialis: MCN, C5-7

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38
Q

(Anterior deltoid, supraspinatus, coracobrachialis) fair and above pos

A

Sitting: shoulder flexed to 90, neutral rotation, elbow slightly flexed, forearm pronated

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39
Q

(Anterior deltoid, supraspinatus, coracobrachialis) resistance

A

Pt flexes shoulder.

Downward resistance applied to proximal elbow

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40
Q

(Anterior deltoid, supraspinatus, coracobrachialis) below fair pos

A

Sidelying with therapist supporting weight of the arm
OR
Partial range in short sitting

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41
Q

(Anterior deltoid, supraspinatus, coracobrachialis) palpation

A

Deltoid: anterior and medial aspect of shoulder
Supraspinatus: placing fingers deep under trap in supraspinatus fossa of scapula

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42
Q

(Anterior deltoid, supraspinatus, coracobrachialis) subs

A

Trunk should remain upright
Biceps- see external rotation of shoulder
Upper trap- see shoulder elevation
Pec major- see horizontal adduction

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43
Q

(Lat dorsi, teres major, posterior deltoid) action

A

Shoulder extension

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44
Q

(Lat dorsi, teres major, posterior deltoid) nerves

A

Lat dorsi: thoracodorsal nerve C6-8

Teres major: lower subscapular nerve C5-6

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45
Q

(Lat dorsi, teres major, posterior deltoid) fair and above position

A

Prone: arms at sides with shoulder internally rotated (palm facing upward)

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46
Q

(Lat dorsi, teres major, posterior deltoid) resistance

A

Patient extends shoulder

Resistance to proximal elbow downward toward support surface

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47
Q

(Lat dorsi, teres major, posterior deltoid) below fair pos

A

Poor= partial range

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48
Q

(Lat dorsi, teres major, posterior deltoid) palpation

A

Lat dorsi: lateral aspect of thoracic wall below and lateral to inferior angle of scapula
Post deltoid: posterior shoulder
Teres major: lateral border of scapula just below axilla

49
Q

(Lat dorsi) action

A

Shoulder depression

50
Q

(Lat dorsi) fair and above position

A

Prone: arms at sides with shoulder IR (palm facing upward), shoulder hiked to chin, head rotated to test side

51
Q

(Lat dorsi) resistance

A

Pt depresses shoulder (pushes hand toward feet). Resistance applied at forearm upwards toward patient’s head

Grade 5: max resistance as above OR sitting push up

52
Q

(Lat dorsi) below fair pos

A

Poor= partial range

53
Q

(Lat dorsi) palpation

A

Lateral aspect of thoracic wall below and lateral to inferior angle of scapula

54
Q

(Deltoid, supraspinatus) action

A

Shoulder scaption

55
Q

(Deltoid, supraspinatus) nerves

A

Deltoid: axillary nerve, C5-6
Supraspinatus: suprascapular nerve, C5-6

56
Q

(Deltoid, supraspinatus) fair and above pos

A

Sitting: shoulder midway between flexion and abduction, arm 90 deg to trunk (diagonal out)

57
Q

(Deltoid, supraspinatus) resistance

A

Pt raises arm.

Resistance applied proximal to elbow downwards toward floor

58
Q

(Deltoid, supraspinatus) below fair pos

A

Poor= partial range

59
Q

(Deltoid, supraspinatus) palpation

A

Deltoid: anterior and medial aspect of shoulder
Supraspinatus: placing fingers deep under traps in supraspinous fossa of scapula

60
Q

(Middle deltoid, supraspinatus) action

A

Shoulder abduction

61
Q

(Middle deltoid, supraspinatus) fair and above pos

A

Sitting: arm at side with elbow slightly flexed

62
Q

(Middle deltoid, supraspinatus) resistance

A

Patient abducts shoulder.

Resistance applied proximal to elbow in downward direction

63
Q

(Middle deltoid, supraspinatus) below fair pos

A

Supine OR partial range in sitting

64
Q

(Middle deltoid, supraspinatus) palpation

A

Superior aspect of shoulder, lateral to the acromion

65
Q

(Middle deltoid, supraspinatus) subs

A

Trunk should remain erect.
Shoulder should not elevate
Biceps- see ER and elbow flexion

66
Q

(Post deltoid) action

A

Shoulder horizontal abduction

67
Q

(Post deltoid) fair and above pos

A

Prone: shoulder abducted to 90 deg and neutral rotation, elbow flexed (forearm over edge of table)

68
Q

(Post deltoid) resistance

A

Patient lifts elbow toward ceiling

Resistance is applied proximal to elbow in downward direction

69
Q

(Post deltoid) below fair pos

A

Sitting at side of plinth- shoulder in 90 abduction, support by the table. Patient slides arm backwards. Stabilize scapula if scapular muscles are weak

70
Q

(Post deltoid) palpation

A

Posterior aspect of shoulder just superior to axilla

71
Q

(Post deltoid) subs

A

Triceps: see elbow extension

72
Q

(Pec major) action

A

Shoulder horizontal adduction

73
Q

(Pec major) nerves

A

Clavicular fibers: Lateral pectoral nerve C5-6

Sternocostal fibers: Medial pectoral nerve C6-T1

74
Q

(Pec major) fair and above pos

A

Supine: elbow flexed
Both heads: shoulder 90 deg abd
Clavicular: shoulder 60 deg abd
Sternal: shoulder 120 deg abd

75
Q

(Pec major) resistance

A

Both: patient moves arm across chest
Clavicular: patient moves up and in
Sternal: patient moves down and in
Resistance around forearm direction opposite to patient motion (if elbow is weak apply resistance above elbow)

76
Q

(Pec major) below fair pos

A

Sitting: at side of plinth shoulder in 90 deg abduction, supported by the table. Patient slides arm forwards. (Can only test both heads)

77
Q

(Pec major) palpation

A

Anterior chest
Clavicular: under medial half of clavicle
Sternal: lower anterior border of axilla

78
Q

(Infraspinatus, teres minor) action

A

Shoulder Er

79
Q

(Infraspinatus, teres minor) nerves

A

Infraspinatus: suprascapular nerve, C5-6

Teres minor: axillary nerve, C5-6

80
Q

(Infraspinatus, teres minor) fair and above pos

A

Prone: with head turned toward test side, shoulder abducted 90, elbow flexed, arm supported by table

81
Q

(Infraspinatus, teres minor) resistance

A

Patient moves arm into ER. Resistance over wrist, counter-force at elbow.
Apply resistance slowly and gradually.

82
Q

(Infraspinatus, teres minor) below fair pos

A

Prone: shoulder 90 flexion, elbow extended
Entire UE over edge of table.
May have to stabilize at shoulder.

83
Q

(Infraspinatus, teres minor) palpation

A

Infraspinatus: over body of scapula below spine

Teres minor: inferior margin of scapula and along axillary border of scapula

84
Q

(Infraspinatus, teres minor) subs

A

Supination in poor grade test will look like ER

85
Q

(Subscapularis) action

A

Shoulder IR

Assist from pec major, lat dorsi, teres major

86
Q

(Subscapularis) nerves

A

Supscapular nerve, C5-6

87
Q

(Subscapularis) fair and above pos

A

Prone: with head turned toward test side, shoulder abd 90, elbow flexed, arm supported by table

88
Q

(Subscapularis) resistance

A

Patient moves arm into IR. Resistance above wrist, counter-force at elbow. Apply resistance slowly and gradually.

89
Q

(Subscapularis) below fair pos

A

Prone: shoulder 90 def flexion, elbow extended.
Entire UE over edge of table.
May have to stabilize at shoulder.

90
Q

(Subscapularis) subs

A

Pronation in poor grade test will look like IR

91
Q

(Biceps, brachialis, brachioradialis) action

A

Elbow flexion

92
Q

(Biceps, brachialis, brachioradialis) nerves

A

Biceps and brachialis: musculucutaneous nerve, C5-6

Brachioradialis: Radial nerve, C5-6

93
Q

(Biceps, brachialis, brachioradialis) fair and above pos

A

Sitting:
Biceps- forearm supinated
Brachialis- forearm pronated
Brachioradialis- forearm neutral, thumb up

94
Q

(Biceps, brachialis, brachioradialis) resistance

A

Patient flexed elbow. Therapist resists above wrist

95
Q

(Biceps, brachialis, brachioradialis) below fair pos

A

Sitting: shoulder abducted or supine. Elbow flexed to 45

96
Q

(Biceps, brachialis, brachioradialis) palpation

A

Biceps: tendon in antecubital space/anterior middle 2/3 or arm
Brachialis: medial to biceps tendon
Brachioradialis: proximal volar surface of forearm, where it forms lateral border of cubital fossa

97
Q

(Biceps, brachialis, brachioradialis) subs

A

Wrist flexors should stay relaxed

98
Q

(Triceps) action

A

Elbow extension

99
Q

(Triceps) nerve

A

Radial nerve, C6-8

100
Q

(Triceps) Fair and above pos

A

Prone: arm abducted 90 elbow flexed (arm hanging over edge of table)
OR
Sitting shoulder abduction and IR

101
Q

(Triceps) resistance

A

Therapist supports above elbow; other hand applies resistance
Elbow should by slightly flexed to prevent locking

102
Q

(Triceps) below fair pos

A

Sitting: shoulder abducted and neutral rotation. Therapist supports arm at elbow

103
Q

(Triceps) palpation

A

Posterior surface of arm above olecranon process

104
Q

(Triceps) subs

A

Don’t allow elbow to lock ER- gravity assists extension. Horizontal add- rapid motion thrusts arm into extension.

105
Q

(Supinator, biceps) action

A

Supination

106
Q

(Supinator, biceps) nerve

A

Supinator- radial nerve, C6-7

Biceps- MCN, C5-6

107
Q

(Supinator, biceps) fair and above pos

A

Sitting: arm at side, elbow flexed to 90

108
Q

(Supinator, biceps) resistance

A

Patient turns palm up. Therapist supports elbow, other hand grasps forearm above the wrist, resisting rotation.

109
Q

(Supinator, biceps) below fair pos

A

Sitting: shoulder flexed 45-90 elbow flexed to that hand points toward ceiling

110
Q

(Supinator, biceps) palpation

A

Supination: distal to head of radius on dorsal aspect of arm

111
Q

(Supinator, biceps) subs

A

ER and adduction- gravity assists

Wrist and fingers should remain relaxed

112
Q

(Pronator teres, pronator quadratus) action

A

Pronation

113
Q

(Pronator teres, pronator quadratus) nerve

A

Medial N.
Pronator teres: C6-7
Pronator quadratus: C7-8

114
Q

(Pronator teres, pronator quadratus) fair and above pos

A

Sitting: arm at side, elbow flexed to 90

115
Q

(Pronator teres, pronator quadratus) resistance

A

Patient turns palm down. Therapist supports elbow, other hand grasps forearm above the wrist, resisting rotation

116
Q

(Pronator teres, pronator quadratus) below fair pos

A

Sitting: shoulder flexed 45-90 elbow flexed so that hand points toward ceiling

117
Q

(Pronator teres, pronator quadratus) palpation

A

Pronator teres: upper third of volar surface of forearm (diagonal line from medial condyles to lateral border of radius)

118
Q

(Pronator teres, pronator quadratus) subs

A

IR and abduction- gravity assists

Wrist and finger should remain relaxed

E&M -JD (11 decks)

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