UE Flashcards
shoulder flexion muscles
anterior and middle delt, supraspinatus, pec major, coracobrachialis, and biceps brachii
shoulder flexion normal ROM
180
GH-120
AC, SC, ST - 60 degrees
testing position of shoulder flexion ROM
supine
shoulder flexion ROM lines
Stationary: midline of the trunk
Moving: greater tubercle of the humerus toward the lateral epicondyle
Shoulder flexion normal end feel
firm
due to tension from the posterior joint capsule
Shoulder extension muscles
lats, posterior delt, teres major, tricep brachii (long head)
Normal ROM of shoulder extension
60
GH- 25
testing position for shoulder extension ROM
prone
Shoulder extension ROM lines
stationary: midline of the trunk
moving: greater tubercle and the lateral epicondyle
Normal end feel for shoulder extension
firm
due to anterior joint capsule
shoulder abduction muscles
middle delt, supraspinatus, and biceps brachii (long head)
shoulder abduction normal ROM
180
GH: 125
AC,SC,ST: 55
testing position for shoulder abduction ROM
supine
testing lines for shoulder abduction ROM
stationary: parallel to the sternum
moving: anterior midline toward the medial epicondyle
normal end feel for shoulder abduction
firm
due to tension of glenohumeral ligaments, inferior capsule, teres major and pec major
shoulder adduction muscles
lats, pec major, teres major and minor
normal shoulder adduction ROM
usually not measured as it is full return to 0 from abduction; in order to get the arm across the body the shoulder needs to flex and internally rotate
shoulder External Rotation Muscles
Infraspinatus, teres minor, posterior delt
normal shoulder external rotation ROM
90
testing position for shoulder external rotation ROM
supine; shoulder abducted to 90 degrees
shoulder external rotation ROM testing lines
stationary: perpendicular to the floor
moving: ulnar styloid process along the ulnar border
normal end feel for shoulder external rotation
firm
tension anterior joint capsule
shoulder internal rotation muscles
subscap, teres major, lats and pec major
normal shoulder internal rotation ROM
70
shoulder internal rotation ROM test position
supine
shoulder internal rotation ROM testing lines
stationary: perpendicular to the floor
moving: ulnar styloid process along the ulnar border
shoulder internal rotation normal end feel
firm
tension from posterior joint capsule and infraspinatus and teres minor
muscles that do scapular abduction and upward rotation
serratus anterior and pec minor
serratus anterior 0/1/2 MMT testing position
short sitting with arm flexed above 90 and supported by therapist
serratus anterior MMT 3/4/5 position
Short sitting with arm forward flexed to about 130° and then protracted in that plane as far as it can move
PT handling in serratus anterior MMT
use one hand to give resistance in the backward direction and another had to stabilize the trunk below the scapula
where to palpate the serratus anterior
under the armpit
muscles of scapular elevation
traps (upper fibers) and levator scap
scapular elevation MMT 0/1/2 position
prone pt head turned way from the test side to reduce contribution from the levator scap
scapular elevation MMT 3/4/5 position
short sitting with good posture. hands relaxed on legs
Scapular elevation PT handeling
stand behind patient. hands over the upper traps giving resistance in downward direction
where to palpate the upper traps?
at the clavicle
scapular adduction (retraction) muscles
middle traps, Rhomboid major/minor
scapular adduction (retraction) MMT 0/1/2 position
prone with shoulder handing off the table; pt used hand to cradle patients shoulder and arm
scapular adduction (retraction) 3/4/5 position
prone with shoulder hanging off the table (90 degrees of GH abduction and 90 of elbow flexion)
scapular adduction (retraction) PT handeling
stand at side of the pt. stabilize contralateral scapular area to prevent trunk rotation. apply resistance in a downward direction
where to palpate the middle traps for scapular adduction (retraction)
between the spine of the scapula from the acromion to the vertebral column
what do you do for the scapular adduction test if the posterior delt is weak?
Have the patient hold the scapula in adduction as the therapist slowly releases the shoulder support. Observe whether the scapula maintains its adducted position. If it does, it is Grade 3. Would then also need to apply resistance closer to the shoulder.
scapula depression and adduction muscles
lower traps and lats
scapula depression and adduction (lower traps) 0/1/2 MMT position
prone; PT supporting the weight of the arm
scapula depression and adduction 3/4/5 MMT position
prone with test arm over head at 140 degrees of shoulder elevation and abduction. thumb pointed toward the ceiling (y-fly)
scapula depression and adduction MMT PT handeling
resistance given at the wrist straight down (be very gentle these muscles are usually weak)
where to palpate the lower traps and lats?
the inferior angle of the scapula
special note for scapula depression and abduction MMT
if patient does not have at least 120 degrees of shoulder flexion then they cannot do this test.
scapula retraction and downward rotation muscles
Rhomboid major
scapula retraction and downward rotation(rhomboids major) 0/1/2 MMT position
seated ; hand behind the back. Palm of the hand to the wall
scapula retraction and downward rotation(rhomboid major) 3/4/5 position
Prone with hand behind the back. Allow the shoulder to drop and have patient raise hand to the sky.resistance in an out and downward direction
where to palpate the Rhomboid major
under the inferior angle
scapula retraction and downward rotation MMT PT handling
PT should apply resistance down and out above the elbow
how could the patient “cheat” in scapula retraction and downward rotation?
by allowing the elbow extensors (triceps) to lift up
scapular depression and retraction muscle
lats
scapular depression and retraction(lower traps) MMT 0/1/2 position
prone ; patient lifts to (partial) extension and adduction for a 2
scapular depression and retraction MMT 3/4/5 position
prone; patient lifts to full extension and adduction
scapular depression and adduction/retraction (lower traps) MMT PT handling
Resistance with hand over medial forearm above the patients wrist in the downward direction
where to palpate the lats
the belly of the lats (lower back)
alternative MMT test for lats
the lift off test
shoulder flexion MMT 0/1/2 position
sidelying; stand behind the patient and cradle the test arm at the elbow
shoulder flexion MMT 3/4/5 postion
short sitting with elbow slightly flexed and forearm pronated
shoulder flexion MMT PT handling
resistance going down just above the elbow, other arm supports the scapula
shoulder flexion palpation
superior and anterior surfaces of the deltoid
how could patients “cheat” in shoulder flexion
use their biceps
shoulder extension MMT 0/1/2 positon
prone
shoulder extension MMT 3/4/5 position
prone with palms facing the ceiling
shoulder extension MMT PT handling
add downward resistance above the elbow downward
shoulder extension palpation
posterior delt
shoulder abduction MMT 0/1/2 position
supine; arm supported on the table
shoulder abduction MMT 3/4/5 position
short sitting with elbow slightly flexed
shoulder abduction MMT PT handling
stand behind the patient and give resistance in a downward direction
where to palpate for shoulder abduction
middle delt
how could the patient “cheat” in shoulder abduction
by using their bicep; shoulder will externally rotate and elbow will flex
shoulder horizontal Abduction muscles
posterior delt
shoulder horizontal abduction 0/1/2 MMT position
short sitting; PT should support forearm under the palm side
shoulder horizontal abduction 3/4/5 MMT position
prone; shoulder abducted to 90 and foerarm off the edge of the table with elbow straight
shoulder horizontal abduction MMT PT handling
Stand at the side. Ask patient to lift elbow up toward the ceiling. Apply resistance over posterior arm just above the elbow and push down
where to palpate for shoulder horizontal abduction
posterior delt
horizontal adduction muscles
pec major
horizontal adduction MMT 0/1/2 position
supine: arm supported at 90 abduction and elbow flexed to 90
shoulder horizontal adduction MMT 3/4/5 position
supine
whole muscle: shoulder abducted to 90 elbow flexed to 90
Clavicular head; shoulder abducted 60 with elbow flexed
sternal head: shoulder abducted 120 and elbow flexed .
Patient moves arm down and in for all
shoulder horizontal adduction PT handling
Clavicular Head: resistance applied above the elbow in a downward direction (toward the floor) and outward.
Sternal Head: resistance is applied above the elbow in an up and outward direction
shoulder horizontal adduction palpation
belly of the pac major
shoulder external rotation muscles
infraspinatus and teres minor
shoulder external rotation MMT 0/1/2 position
short sitting with elbow flexed to 90 and supported on the table
shoulder external rotation MMT 3/4/5 position
short sitting with elbow flexed to 90
shoulder external rotation MMT PT handling
stand in front of patient, one hand stabilizes medial elbow the other provides resistance to the dorsal surface of the forearm
shoulder external rotation palpation
infraspinatus fossa and teres minor on the inferior margin of the axilla
shoulder internal rotation muscle
subscap
shoulder internal rotation 0/1/2 MMT postion
short sitting with elbow flexed
shoulder internal rotation MMT 3/4/5 position
short sitting with elbow flexed
shoulder internal rotation MMT PT handling
stand in front of the patient; one hand supporting the outside of the elbow the other hand providing resistance to the palmer surface of the forearm
Elbow flexion normal ROM
140-150
elbow flexion ROM testing position
supine; in supination, place towel under the distal humerus to allow for full extension
elbow flexion ROM arms
stationary: lateral midline of the humerus
fulcrum: lateral epicondyle of the humerus
moving arm: lateral midline of the radius, radial head and radial styloid process
elbow flexion normal end feel
soft tissue approximation
elbow extension normal ROM
0
elbow extension ROM postion
supine, supination with towel under the distal humerus
elbow extension ROM testing lines
stationary: lateral midline of the humerus
fulcrum: lateral epicondyle of the humerus
moving arm: lateral midline of the radius, radial head and radial styloid process
elbow extension normal end feel
Hard due to contact of the olecranon process and the olecranon fossa
forearm pronation normal ROM
75-80
forearm pronation ROM testing postion
sitting elbow flexed to 90 and thumb pointed to the ceiling
forearm pronation ROM lines
stationary: parallel to the anterior midline of the humerus
fulcrum: lateral to the ulnar styloid process
moving: the dorsal surface of the forearm proximal to styloid process of ulna and radius
forearm pronation normal end feel
Hard due to contact between the ulna and radius.
forearm supination normal ROM
80
forearm supination ROM position
sitting; elbow flexed to 90 and thumb pointed to the ceiling
forearm supination ROM lines
stationary: parallel to the anterior midline of the humerus
fulcrum: lateral to the ulnar styloid process
moving: the palmer surface of the forearm proximal to styloid process of ulna and radius
forearm supination normal end feel
firm due to the tension of the palmer radioulnar ligament and interosseous membrane
elbow extension muscles
triceps brachii
elbow extension MMT 0/1/2 postition
short sitting; shoulder abducted to 90 and elbow flexed to 45. limb should; PT should support the upper limb
elbow extensionMMT 3/4/5 position
prone, forearm hanging over the side of the table.
elbow extension MMT PT handling
PT stands to the side of the patient; one arm applies downward resistance at the proximal wrist and the other arm supports under the shoulder
where to palpate for triceps extension?
triceps tendon or belly
elbow extension substitutions
external rotation and horizontal abduction
elbow flexion muscles
biceps, brachialis and brachioradialis
elbow flexion MMT 0/1/2 position
Grade 2: Short sitting with arm flexed and internally rotated.
Grade 1: sideline
elbow flexion MMT 3/4/5 position
Short sitting
Biceps Brachii: forearm in supination
brachialis : forearm in pronation
Brachioradialis: thumb leads
elbow flexion MMT PT handling
short sitting; stand in front of the patient. one hand on the palm surface of the forearm proximal to wrist adding resistance and the other over the anterior surface of the shoulder
forearm supination muscles
supinator
forearm supination MMT 0/1/2 position
short sitting; support the forearm distal to the elbow
forearm supination MMT 3/4/5 position
short sitting; stand at the side of patient; one hand supports the elbow and the other provides resistance to the dorsal surface on the forearm
forearm supination substitution
patient might try to externally rotate and adduct the arm
forearm supination palpation
The supinator distal to the head of the radius on the dorsal aspect of the arm
forearm pronation muscles
Pronator teres and pronator quadratus
forearm pronation MMT 0/1/2 position
Short sitting. Support the arm distal to the elbow.
forearm pronation MMT 3/4/5 position
Short sitting with elbow flexed to 90 and forearm in supination
forearm pronation PT handling
Stand at side of patient. One had supports the elbow and the other applies resistance on the palmer surface away from the patient body
forearm pronation palpation
Pronator teres over the upper third of the flexor surface and the quadratus by the wrist.
forearm pronation substitution
internally rotate the shoulder or abduction
wrist flexion normal ROM
60-80
wrist flexion ROM testing position
Sitting; shoulder abducted to 90 degrees and flexed to 90 degrees. Fingers relaxed
wrist flexion ROM lines
stationary: lateral midline of the ulna
fulcrum: lateral aspect of the wrist, triquetrum
moving arm: lateral midline of the 5th metacarpal
wrist flexion normal end feel
firm
wrist extension normal ROM
60-70
wrist extension ROM testing position
sitting ; shoulder and elbow flexed to 90 degrees. Have the patients bring their knuckles to the ceiling
wrist extension ROM lines
stationary: lateral midline of the ulna
fulcrum: lateral aspect of the wrist, triquetrum
moving arm: lateral midline of the 5th metacarpal
wrist extension normal end feel
firm
radial deviation normal ROM
20
radial deviation ROM testing position
Sitting; shoulder abducted to 90 and elbow flexed to 90. Palm facing down
radial deviation ROM lines
stationary: dorsal midline of the forearm
fulcrum: dorsal aspect of the wrist over the capitate
moving arm: dorsal midline of the 3rd metacarpal
radial deviation normal end feel
hard ; due to the contact between the radius and scaphoid
ulnar deviation normal ROM
30
ulnar deviation ROM testing position
sitting ; shoulder abduction to 90 and elbow flexed to 90. Palm facing down
ulnar deviation ROM lines
stationary: dorsal midline of the forearm
fulcrum: dorsal aspect of the wrist over the capitate
moving arm: dorsal midline of the 3rd metacarpal
ulnar deviation normal end feel
Firm due to tension of the ligaments
wrist flexion muscles
flexor carpi radialis and flexor carpi ulnaris
wrist flexion MMT 0/1/2 position
seated with the thumb up
wrist flexion MMT 3/4/5 position
Short sitting; forearm is supinated
Flexor carpi radialis: wrist in radial deviation resistance is applied to the radial side of the hand in the direction of extension and ulnar deviation.
Flexor carpi ulnaris: place wrist in ulnar deviation , resistance is applied over the pinky side in the direction of radial deviation and extension.
wrist flexion MMT PT handeling
Sit or stand in front of the patient. One hand supports the forearm under the wrist, the other hand supplies downward resistance over the palmer surface of the hand
wrist flexion palpation
flexor carpi radialis - lateral wrist
flexor carpi ulnaris - medial wrist
wrist extension muscles
extensor carpi radialis longus and bravis and extensor carpi ulnaris
wrist extension MMT 0/1/2 position
short sitting with thumb up
wrist extension MMT 3/4/5 position
Short sitting
Extensor carpi radialis: hand in extension and radial deviation. Resistance given in the direction of flexion and ulnar deviation
Extensor carpi ulnaris: extension and ulnar deviation resistance is given on the dorsal surface ulnar side of the hand.
Wrist extension MMT PT handling
PT should be at a diagonal in front of the patient. Place resistance over the dorsal surface of the metacarpals
wrist extension palpation
Extensor carpi radialis longus: palpate the tendon on the dorsum of the wrist in line with the second metacarpal
Extensor carpi radialis brevis: tendon on the dorsal surface of the wrist in line with the third metacarpal
Extensor Carpi Ulnaris: tendon on the dorsal wrist proximal to the fifth metacarpal just distal to the ulnar styloid process
