Shoulder/Elbow/Forearm MMT Flashcards
(118 cards)
1
Q
(Serratus anterior) actions
A
Scapular abduction, upward rotation, depression
2
Q
(Serratus anterior) nerve
A
Long thoracic nerve C5-7
3
Q
(Serratus anterior) fair and above pos
A
Sitting; shoulder flexed 130 deg
4
Q
(Serratus anterior) resistance
A
Pt pushes upward into flexion
Therapist pushes downward on arm above elbow
5
Q
(Serratus anterior) below fair pos
A
Therapist takes weight of arm- ask pt to lift arm, scapula should maintain abduction and UR.
6
Q
(Serratus anterior) palpation
A
Hand should be along lower borders of scapula with web space at the inferior angle
7
Q
(Serratus anterior alt) fair and above pos
A
Sitting or supine; shoulder flexed to 100
8
Q
(Serratus anterior alt) resistance
A
Patient pushes forward and upward. Resistance is backwards and downwards
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
10
Q
(Serratus anterior alt) palpation
A
Hand should be along lower borders of scapula with web space at the inferior angle
11
Q
(Upper trap) (Levator scapula) actions
[one from MMT chart]
A
Scapular elevation
12
Q
(Upper trap) (Levator scapula) Innervation
A
Upper trap: CN XI, C3-4
Levator scap: C3-4, and dorsal scapula nerve, C5
13
Q
(Upper trap) (Levator scapula) fair and above pos
A
Sitting: arms at sides
14
Q
(Upper trap) (Levator scapula) Resistance
A
Pt shrugs shoulders. Resistance is applied downward toward surface over superior shoulder
15
Q
(Upper trap) (Levator scapula) Below fair pos
A
Supine or prone. Head should be midline
16
Q
(Upper trap) (Levator scapula) palpation
A
Near insertion near clavicle or near cervical spine
Upper traps insert to lateral clavicle
17
Q
(Upper trap) (Levator scapula) subs
A
Watch hands pushing down on legs or surface.
Rhomboids- see adduction and UR
18
Q
(Middle trap) action
A
Scapular adduction
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
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
21
Q
(Middle trap) below fair pos
A
Therapist takes weight of arm
22
Q
(Middle trap) palpation
A
At spine of scapula from acromion to vertebral column (T1-6)
23
Q
(Middle trap) subs
A
Rhomboids- see DR with adduction
24
Q
(Lower traps) action
A
Scapular depression and adduction
25
(Lower traps) fair and above pos
Prone: arm abducted 145 deg, forearm mid-position with thumb pointing to ceiling
26
(Lower traps) resistance
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)
27
(Lower traps) below fair pos
Therapist takes weight of arm
28
(Lower traps) palpation
Below spine of scapula and across thoracic vertebrae T7-12
29
(Rhomboids) action
Scapular adduction and downward rotation
30
(Rhomboids) nerve
Dorsal scapular nerve C5
31
(Rhomboids) fair and above pos
Prone: shoulder internally rotated, arm adducted with elbow flexed, hand on back (chicken wing)
32
(Rhomboids) resistance
Pt lifts hand off back.
Resistance proximal to elbow if shoulder is strong
Resistance is downward and outward
33
(Rhomboids) below fair pos
Therapist takes weight of arm
OR
Short sitting (gravity minimized)
34
(Rhomboids) palpation
Deep under vertebral border of scapula. With strong activity, fingers will pop out from palpation point
35
(Rhomboids) subs
Do not allow elbow to lead= humeral extension
| Middle trap- see scap add without rotation
36
(Anterior deltoid, supraspinatus, coracobrachialis) action
Shoulder flexion
37
(Anterior deltoid, supraspinatus, coracobrachialis) nerves
Deltoid: axillary nerve, C5-6
Coracobrachialis: MCN, C5-7
38
(Anterior deltoid, supraspinatus, coracobrachialis) fair and above pos
Sitting: shoulder flexed to 90, neutral rotation, elbow slightly flexed, forearm pronated
39
(Anterior deltoid, supraspinatus, coracobrachialis) resistance
Pt flexes shoulder.
| Downward resistance applied to proximal elbow
40
(Anterior deltoid, supraspinatus, coracobrachialis) below fair pos
Sidelying with therapist supporting weight of the arm
OR
Partial range in short sitting
41
(Anterior deltoid, supraspinatus, coracobrachialis) palpation
Deltoid: anterior and medial aspect of shoulder
Supraspinatus: placing fingers deep under trap in supraspinatus fossa of scapula
42
(Anterior deltoid, supraspinatus, coracobrachialis) subs
Trunk should remain upright
Biceps- see external rotation of shoulder
Upper trap- see shoulder elevation
Pec major- see horizontal adduction
43
(Lat dorsi, teres major, posterior deltoid) action
Shoulder extension
44
(Lat dorsi, teres major, posterior deltoid) nerves
Lat dorsi: thoracodorsal nerve C6-8
| Teres major: lower subscapular nerve C5-6
45
(Lat dorsi, teres major, posterior deltoid) fair and above position
Prone: arms at sides with shoulder internally rotated (palm facing upward)
46
(Lat dorsi, teres major, posterior deltoid) resistance
Patient extends shoulder
| Resistance to proximal elbow downward toward support surface
47
(Lat dorsi, teres major, posterior deltoid) below fair pos
Poor= partial range
48
(Lat dorsi, teres major, posterior deltoid) palpation
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
(Lat dorsi) action
Shoulder depression
50
(Lat dorsi) fair and above position
Prone: arms at sides with shoulder IR (palm facing upward), shoulder hiked to chin, head rotated to test side
51
(Lat dorsi) resistance
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
(Lat dorsi) below fair pos
Poor= partial range
53
(Lat dorsi) palpation
Lateral aspect of thoracic wall below and lateral to inferior angle of scapula
54
(Deltoid, supraspinatus) action
Shoulder scaption
55
(Deltoid, supraspinatus) nerves
Deltoid: axillary nerve, C5-6
Supraspinatus: suprascapular nerve, C5-6
56
(Deltoid, supraspinatus) fair and above pos
Sitting: shoulder midway between flexion and abduction, arm 90 deg to trunk (diagonal out)
57
(Deltoid, supraspinatus) resistance
Pt raises arm.
| Resistance applied proximal to elbow downwards toward floor
58
(Deltoid, supraspinatus) below fair pos
Poor= partial range
59
(Deltoid, supraspinatus) palpation
Deltoid: anterior and medial aspect of shoulder
Supraspinatus: placing fingers deep under traps in supraspinous fossa of scapula
60
(Middle deltoid, supraspinatus) action
Shoulder abduction
61
(Middle deltoid, supraspinatus) fair and above pos
Sitting: arm at side with elbow slightly flexed
62
(Middle deltoid, supraspinatus) resistance
Patient abducts shoulder.
| Resistance applied proximal to elbow in downward direction
63
(Middle deltoid, supraspinatus) below fair pos
Supine OR partial range in sitting
64
(Middle deltoid, supraspinatus) palpation
Superior aspect of shoulder, lateral to the acromion
65
(Middle deltoid, supraspinatus) subs
Trunk should remain erect.
Shoulder should not elevate
Biceps- see ER and elbow flexion
66
(Post deltoid) action
Shoulder horizontal abduction
67
(Post deltoid) fair and above pos
Prone: shoulder abducted to 90 deg and neutral rotation, elbow flexed (forearm over edge of table)
68
(Post deltoid) resistance
Patient lifts elbow toward ceiling
| Resistance is applied proximal to elbow in downward direction
69
(Post deltoid) below fair pos
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
(Post deltoid) palpation
Posterior aspect of shoulder just superior to axilla
71
(Post deltoid) subs
Triceps: see elbow extension
72
(Pec major) action
Shoulder horizontal adduction
73
(Pec major) nerves
Clavicular fibers: Lateral pectoral nerve C5-6
| Sternocostal fibers: Medial pectoral nerve C6-T1
74
(Pec major) fair and above pos
Supine: elbow flexed
Both heads: shoulder 90 deg abd
Clavicular: shoulder 60 deg abd
Sternal: shoulder 120 deg abd
75
(Pec major) resistance
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
(Pec major) below fair pos
Sitting: at side of plinth shoulder in 90 deg abduction, supported by the table. Patient slides arm forwards. (Can only test both heads)
77
(Pec major) palpation
Anterior chest
Clavicular: under medial half of clavicle
Sternal: lower anterior border of axilla
78
(Infraspinatus, teres minor) action
Shoulder Er
79
(Infraspinatus, teres minor) nerves
Infraspinatus: suprascapular nerve, C5-6
| Teres minor: axillary nerve, C5-6
80
(Infraspinatus, teres minor) fair and above pos
Prone: with head turned toward test side, shoulder abducted 90, elbow flexed, arm supported by table
81
(Infraspinatus, teres minor) resistance
Patient moves arm into ER. Resistance over wrist, counter-force at elbow.
Apply resistance slowly and gradually.
82
(Infraspinatus, teres minor) below fair pos
Prone: shoulder 90 flexion, elbow extended
Entire UE over edge of table.
May have to stabilize at shoulder.
83
(Infraspinatus, teres minor) palpation
Infraspinatus: over body of scapula below spine
| Teres minor: inferior margin of scapula and along axillary border of scapula
84
(Infraspinatus, teres minor) subs
Supination in poor grade test will look like ER
85
(Subscapularis) action
Shoulder IR
Assist from pec major, lat dorsi, teres major
86
(Subscapularis) nerves
Supscapular nerve, C5-6
87
(Subscapularis) fair and above pos
Prone: with head turned toward test side, shoulder abd 90, elbow flexed, arm supported by table
88
(Subscapularis) resistance
Patient moves arm into IR. Resistance above wrist, counter-force at elbow. Apply resistance slowly and gradually.
89
(Subscapularis) below fair pos
Prone: shoulder 90 def flexion, elbow extended.
Entire UE over edge of table.
May have to stabilize at shoulder.
90
(Subscapularis) subs
Pronation in poor grade test will look like IR
91
(Biceps, brachialis, brachioradialis) action
Elbow flexion
92
(Biceps, brachialis, brachioradialis) nerves
Biceps and brachialis: musculucutaneous nerve, C5-6
| Brachioradialis: Radial nerve, C5-6
93
(Biceps, brachialis, brachioradialis) fair and above pos
Sitting:
Biceps- forearm supinated
Brachialis- forearm pronated
Brachioradialis- forearm neutral, thumb up
94
(Biceps, brachialis, brachioradialis) resistance
Patient flexed elbow. Therapist resists above wrist
95
(Biceps, brachialis, brachioradialis) below fair pos
Sitting: shoulder abducted or supine. Elbow flexed to 45
96
(Biceps, brachialis, brachioradialis) palpation
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
(Biceps, brachialis, brachioradialis) subs
Wrist flexors should stay relaxed
98
(Triceps) action
Elbow extension
99
(Triceps) nerve
Radial nerve, C6-8
100
(Triceps) Fair and above pos
Prone: arm abducted 90 elbow flexed (arm hanging over edge of table)
OR
Sitting shoulder abduction and IR
101
(Triceps) resistance
Therapist supports above elbow; other hand applies resistance
Elbow should by slightly flexed to prevent locking
102
(Triceps) below fair pos
Sitting: shoulder abducted and neutral rotation. Therapist supports arm at elbow
103
(Triceps) palpation
Posterior surface of arm above olecranon process
104
(Triceps) subs
Don't allow elbow to lock ER- gravity assists extension. Horizontal add- rapid motion thrusts arm into extension.
105
(Supinator, biceps) action
Supination
106
(Supinator, biceps) nerve
Supinator- radial nerve, C6-7
| Biceps- MCN, C5-6
107
(Supinator, biceps) fair and above pos
Sitting: arm at side, elbow flexed to 90
108
(Supinator, biceps) resistance
Patient turns palm up. Therapist supports elbow, other hand grasps forearm above the wrist, resisting rotation.
109
(Supinator, biceps) below fair pos
Sitting: shoulder flexed 45-90 elbow flexed to that hand points toward ceiling
110
(Supinator, biceps) palpation
Supination: distal to head of radius on dorsal aspect of arm
111
(Supinator, biceps) subs
ER and adduction- gravity assists
| Wrist and fingers should remain relaxed
112
(Pronator teres, pronator quadratus) action
Pronation
113
(Pronator teres, pronator quadratus) nerve
Medial N.
Pronator teres: C6-7
Pronator quadratus: C7-8
114
(Pronator teres, pronator quadratus) fair and above pos
Sitting: arm at side, elbow flexed to 90
115
(Pronator teres, pronator quadratus) resistance
Patient turns palm down. Therapist supports elbow, other hand grasps forearm above the wrist, resisting rotation
116
(Pronator teres, pronator quadratus) below fair pos
Sitting: shoulder flexed 45-90 elbow flexed so that hand points toward ceiling
117
(Pronator teres, pronator quadratus) palpation
Pronator teres: upper third of volar surface of forearm (diagonal line from medial condyles to lateral border of radius)
118
(Pronator teres, pronator quadratus) subs
IR and abduction- gravity assists
| Wrist and finger should remain relaxed
