Shoulder ROM / MMT Flashcards
what are the joints that move at the shoulder?
glenohumeral
sternoclavicular
acromioclavicular
scapulothoracic
how many degrees of freedom does the GH joint have?
3
how many degrees of freedom does the sternoclavicular joint have?
3
how many degrees of freedom does the acromioclavicular joint have?
3
how many degrees of freedom does the scapulothoracic joint have?
trick question. it is a functional joint not an anatomical joint.
what is the ratio of glenohumeral motion to scapulothoracic motion during flex/abd?
2 to 1
when testing flexion and abduction in a sitting position, what may affect the measurement?
slouching
what is an ADL?
activity of daily living
how many ROM differ between normative values and ADL values?
one may be able to get by with less ROM to complete ADL than what is considered as a “normal” value
what is the normative value for flexion at the shoulder complex?
180 deg
tell me the positioning of a patient when testing flexion ROM?
supine with knees comfortably flexed
arm by side in 0° ab/add
elbow extended and forearm in neutral position
what is the normal end feel of flexion
firm
what are the landmarks for the axis, stationary arm and moving arm during flexion
axis - greater tubercle
SA - parallel to midline of trunk
MA - lateral midline of humerus, lateral epicondyle
how would one isolate the GH joint?
stabilizing the scapula to about 120 deg
what plane / axis does flexion and extension at the shoulder occur?
sagittal plane
medial lateral axis
what is the normative value for shoulder extension?
60°
what is the testing position of shoulder extension?
patient in prone position with head turned away from side testing
shoulder in neutral abd, add, and rotation
elbow slightly flexed
forearm in neutral
what is the normal end feel for shoulder extension
firm
what are the landmarks for the axis, stationary arm and moving arm during extension
axis - greater tubercle
SA - parallel to midline of trunk
MA - lateral midline of humerus and lateral epicondyle
how would one stabilize a patient during extension
application of stabilizing force near lumbar spine to prevent rotation
how does one separate glenohumeral motion during extension
stabilizing the acromion and coracoid process
or
stabilize the inferior angle
what is the normative ROM for abduction
180°
what is the testing position for abduction
patient supine with arm by side
palm in anatomical position
elbow in full extension
what is the normal end feel for abduction
firm
what plane/axis does abduction occur in
frontal plane
anterior-posterior axis
what are the landmarks for the axis, stationary arm and moving arm during abduction
axis - over anterior aspect of acromion
SA - parallel to midline of trunk / sternum
MA - anterior midline of humerus and medial epicondyle
what are the planes / axises of rotation for IR and ER at the shoulder? how does this differ in testing postion?
typically in the transverse plane & vertical axis
testing occurs in sagittal plane about a medial-lateral axis
what is the normative ROM for IR at the shoulder?
70°
what is the testing position for IR / ER?
patient supine with arm in 90° of abduction and elbow flexed to 90°
forearm perpendicular to table with hand facing feet
pillow placed under the humerus
what is the normal end feel of IR at the shoulder?
firm
what are the landmarks for the axis, stationary arm and moving arm during IR / ER
axis - olecranon process
SA - parallel to starting position of forearm / perpendicular to the ground
MA - ridge of ulna and ulnar styloid
what stabilization may be needed in IR and ER testing
shoulder stabilization to prevent flexion or rotation of spine
what specifically may be stabilized during IR
coracoid, acromion and clavicle to prevent anterior tilting and protraction of scapula
what is the normative ROM for ER?
90°
what stabilization might be needed during measuring ER
coracoid, acromion, and clavicle to prevent posterior tilting and retraction of scapula
what muscles are tested during flexion?
anterior deltoid
coracobrachialis
proper testing sequence for gravity resisted shoulder flexion
patient will be:
1. in seated position with arm by side in neutral rotation and elbow flexed
2. passively flexed up to 90 and returned
3. asked to raise arm to shoulder height
4. resistance applied perpendicularly at distal humerus
5. stabilization of superior aspect of shoulder to prevent elevation
what is the gravity eliminated position for shoulder flexion
patient will be:
1. positioned in side-lying with uppermost arm supported by a flat surface
2. motion will be normal to gravity resisted but in horizontal plane without resistance
how is deltoid isolated in flexion MMT?
everything is the same as normal flexion, but instead arm is in scaption plane
how is the coracobrachialis isolated during flexion MMT
normal process but instead patient is:
seated with shoulder in full adduction (close to midline of trunk) and full ER
elbow flexed to 90
forearm is supinated
what muscles are tested during shoulder extension?
lat
teres major
post deltoid
what is the sequence of gravity resisted shoulder extension
patient is:
1. prone with arm by their side and elbow extended with palms facing ceiling
2. passively extended with shoulder in IR and adducted
3. asked to lift arm as high as possible
4. resistance applied to distal humerus and stabilized at scapula and ipsilateral thorax
what is the gravity eliminated test for shoulder extension
same as shoulder flexion, but patient will move in opposite direction with arm in IR position
what are the muscles tested during shoulder abduction
middle deltoid
supraspinatus
what is the sequence of gravity resisted testing for abduction
patient is:
1. seated with UE in neutral
2. shoulder passively abducted to 90
3. asked to lift arm to shoulder height
4. resistance applied at distal humerus and stabilized at shoulder
what is the gravity eliminated testing position for shoulder abduction
patient is supine on flat surface
patient is to make a “snow angel”
what muscle is being tested during horizontal abduction
posterior deltoid
what is the sequence for gravity resisted test of horizontal abduction
patient is:
1. prone with shoulder in 90 abduction, 90 elbow flexion with forearm hanging off edge of table
2. head turned away from side of testing
3. passively horizontally abducted
4. asked to lift elbow toward ceiling
5. stabilized at ipsilateral scap with resitance applied at distal humerus in direction of horizontal adduction
what is the gravity eliminated position for horizontal abduction and adduction?
patient is
1. seated with should abducted to 90, and elbow flexed to 90 supported on flat, smooth surface
2. patient will move arm away from midline to test abduction and toward midline to test adduction
what is the gravity resisted testing sequence for horiztonal adduction
patient is:
1. supine with shoulder in 90 abduction and 90 flexion
2. passively moved across their chest
3. asked to move arm across their chest
4. resistance is applied to distal humerus in direction of abduction
what muscles are tested during horizontal adduction
pectoralis major
how can the pectoralis major’s clavicular head be isolated?
patient is:
1. supine with shoulder flexed to 90 and medially rotated with elbow extended
2. passively adducted in horizontal direction
3. resistance applied at distal humerus in direction of horizontal abduction
how the pectoralis major’s sternocostal head isolated
positioned in same way as clavicular head
arm is horizontally adducted and extended then returned to starting
patient is asked to reach their hand toward opposite hip
resistance is applied to wrist in direction of horizontal abduction and flexion
what muscles are tested in IR MMT?
subscapularis
latissimus dorsi
pectoralis major
teres major
what is the sequence of gravity resisted position testing for IR
patient is:
1. prone with shoulder in 90 and and 90 elbow flexion with towel under humerus
2. passively medially rotated
3. asked to move forearm up toward the ceiling and back
4. resistance applied proximally to wrist in direction of lateral rotation
5. stabilize ipsilateral thorax and scapula if needed
what is the gravity eliminated position for IR and ER
patient prone with shoulder in 90 flexion hanging off of table
for IR - have arm in full external rotation and have patient move into internal rotation
for ER - have arm in full internal rotation and have patient move into external rotation
stabilize thorax to ensure that motion is from GH joint, not supination and pronation.
what muscles are being tested during external rotation of the shoulder
infraspinatus and teres minor
what is the gravity resisted testing sequence for external rotation
same position as internal
1. passively externally rotated
2. patient asked to move arm to level of table
3. resistance applied proximally to wrist in direction of medial rotation
what muscles are being tested during scapular elevation
upper trap and levator scapulae
what is the gravity resisted sequence for scapular elevation
patient is:
1. seated with arms at side, not touching supporting surface
2. patients shoulders ar passively elevated
3. patient is asked to shrug shoulders
4. resistance is applied to superior aspect of shoulders in an inferior direction
what is the gravity eliminated position for scapular elevation
patient is
1. prone with arms by side and head in neutral position
2. shoulders are supported off of the surface of table to prevent resistance
3. patient is to shrug shoulders
what muscle is being tested with shoulder adduction
middle trap
what is the sequence of scapular adduction MMT
patient i:
1. prone with shoulder in 90 abd and 90 flex at elbow
2. scapula is adducted by elevating the elbow and returned
3. patient is asked to lift their elbow toward the ceiling
4. resistance is applied to vertebral edge of scapula in direction of scapular abduction
what is the gravity eliminated position for scapular adduction
patient is seated with shoulder abducted to 90 in full ER supported on firm surface
patient is instructed to retract shoulders
what muscle is being tested during scapular depression
lower trapezius
what is the gravity resisted sequence for scapular adduction
patient is:
1. prone with upper extremity in a “y” position (130-145 of abduction) with patient’s head contralaterally positioned
2. scapula is passively adducted and depressed
3. asked to lift arm from the table as high as possible
4. resistance applied on distal humerus
what muscles are being tested during scapular adduction and downward rotation
rhomboid major and minor
what is the gravity resisted sequence for scapular adduction and downward rotation
patient is:
1. prone with arm behind their back with shoulder IR and adducted with head turned contralaterally
2. therapist is to lift hand off of back and return to starting position
3. patient is to repeat motion
4. resistance is applied proximally to the wrist in downward motion
what is the gravity eliminated test for scapular adduction and downward rotation
seated with arm positioned behind back and internally rotated
patient is to move arm from the small of their back posteriorly
what muscle is tested during scapular abduction and upward rotation
serratus anterior
what is the sequence of gravity resisted testing for scapular abduction and upward rotation
patient is:
1. supine with shoulder flexed to 90 and elbow extended
2. hand is passively moved toward ceiling
3. patient is to push arm toward ceiling with straight arm
4. resistance is applied downwardly at the elbow with hands on wrist and elbow
what is the gravity eliminated test for scapular abduction and upward rotation
patient is seated with upper extemity in shoulder flexion at 90 with elbow extended and supported
therapist is to passively slide hand forward on table
patient is to repeat motion
stabilization of trunk to prevent rotation away from testing side
