Upper Extremity MMT Flashcards
Shoulder Flexion
MUSCLE: Anterior Deltoid
POSITION: Sitting
STABILIZE: Superior aspect of ipsilateral shoulder
PALPATION: Anterior aspect of shoulder joint distal to lateral 1/3 of clavicle
RESISTANCE: Proximal to elbow in direction of extension
GRAVITY ELIMINATED: Side lying (slide across documentation table)
Shoulder Flexion & ADduction
MUSCLE: Coracobrachialis
POSITION: Sitting
STABILIZE: Superior aspect of ipsilateral shoulder
PALPATION: Proximal 1/3 of anteromedial arm, anterior to brachial pulse
RESISTANCE: Anteromedial aspect of distal humerus in the direction of shoulder extension (and abduction)
GRAVITY ELIMINATED: None
Shoulder Extension
MUSCLE: Latissimus Dorsi, Teres Major, Posterior Deltoid
POSITION: Prone
STABILIZE: Thorax or Scapula
PALPATION: Lateral to inferior angle of scapula
RESISTANCE: Proximal to elbow on posteromeial aspect of arm in the direction of shoulder flexion (wrist sup or pro not important
GRAVITY ELIMINATED: Side Lying
Shoulder ABduction
MUSCLE: Middle Deltoid, Supraspinatus
POSITION: Sitting
STABILIZE: Superior aspect of ipsilateral shoulder
PALPATION: Inferior to tip of acromion process
RESISTANCE: Proximal to elbow on lateral aspect of arm in the direction of shoulder ADduction (patient palm face floor - thumb forward)
GRAVITY ELIMINATED: Supine
Shoulder Horizontal ABduction
MUSCLE: Posterior Deltoid
POSITION: Prone
STABILIZE: Ipsilateral scapula
PALPATION: Inferior to lateral aspect of spine of scapula
RESISTANCE: Distal end of the humerus in the direction of horizontal ADduction
GRAVITY ELIMINATED: Sitting
Shoulder Horizontal ADduction
MUSCLE: Upper & Lower Pectoralis Major
POSITION: Supine
STABILIZE: Ipsilateral shoulder/ upper thorax
PALPATION: Sternal head - anterior border of axilla, Clavicular head - inferior to middle of anterior border
RESISTANCE:Proximal to elbow in the direction of horizontal
GRAVITY ELIMINATED: Sitting or supine
Shoulder External Rotation
MUSCLE: Infraspinatus & Teres Minor
POSITION: Prone (w/towel)
STABILIZE: Ipsilateral thorax or scapula if scapular stabilizers are weak
PALPATION: Inferior to spine of scapula (infraspinatus) & axillary border of scapula (teres major)
RESISTANCE: Proximal to wrist in direction of internal rotation
GRAVITY ELIMINATED: Prone (arm straight down)
Shoulder Internal Rotation
MUSCLE: Subscapularis, Pectoralis major, latissimus dorsi, teres major
POSITION: Prone (w/towel)
STABILIZE: Ipsilateral thorax or scapula if scapular stabilizers are weak
PALPATION: Deep in the axilla along anterior surface of scapula with patient in prone
RESISTANCE: Proximal to wrist in the direction of external rotation
GRAVITY ELIMINATED: Prone (arm straight down)
Scapular Elevation
MUSCLE: Upper trapezius, levator scapulae
POSITION: Sitting
STABILIZE: None, bilateral test
PALPATION: Lateral to cervical spinous processes
RESISTANCE: Superior aspect of shoulders, towards depression (test bilaterally at same time)
GRAVITY ELIMINATED: Prone
Scapula ABduction & Upward (Lateral) Rotation
MUSCLE: Serratus anterior
POSITION: Supine or sitting
STABILIZE: Ipsilateral thorax
PALPATION: Lateral aspect of upper ribs 8-9 ribs just anterior to lateral border of scapula
RESISTANCE: Grasp above & below elbow, push downward toward scapular adduction (can stand for more leverage)
GRAVITY ELIMINATED: sitting (arm retracts over table)
Scapula ADduction
MUSCLE: Middle trapezius
POSITION: Prone
STABILIZE:Opposite thorax
PALPATION: Between the vertebral border of the scapula and the spinous process of lower cervical and upper thoracic vertebrae of side being tested
RESISTANCE: Lateral aspect of scapula in the direction of scapular abduction (middle of scapula - push with heel of hand)
GRAVITY ELIMINATED: Sitting
Scapular ADduction & Depression
MUSCLE: Lower trapezius
POSITION: Prone
STABILIZE: Posterior aspect of opposite thorax
PALPATION: Between the root of scapular spine and the spinous process of lower thoracic vertebrae
RESISTANCE: Lateral aspect of scapula in the direction of scapular abduction and elevation (push against medial border)
GRAVITY ELIMINATED: None
Scapula ADduction & Downward (Medial) Rotation
MUSCLE: Rhomboids (Major & Minor)
POSITION: Prone
STABILIZE:Contralateral thorax
PALPATION: Between vertebral border of scapula & spinous process of C7 to T5
RESISTANCE: Vertebral border of scapula in the direction of scapular abduction
GRAVITY ELIMINATED: Sitting
Elbow Flexion (Bicep Brachii - Long & Short head)
MUSCLE: Biceps Brachii (Long & Short head)
POSITION: Sitting
STABILIZE: Ipsilateral Humerus
PALPATION: Bicepital tendon on anterior aspect of humerus
RESISTANCE: Proximal to wrist in the direction of elbow extension
GRAVITY ELIMINATED: Sitting
Elbow Flexion (Brachialis)
MUSCLE: Brachialis
POSITION: Sitting
STABILIZE: Ipsilateral humerus
PALPATION: Medial to distal attachment of biceps brachii
RESISTANCE: Proximal to wrist in the directin of elbow extension
GRAVITY ELIMINATED: Sitting
Elbow Flexion (Brachioradialis)
MUSCLE: Brachioradialis
POSITION: Sitting
STABILIZE: Ipsilateral humerus
PALPATION: ANterolateral aspect of forearm, just distal to lateral epicondyle
RESISTANCE: Proximal to wrist in the direction of elbow extension
GRAVITY ELIMINATED: Sitting
Elbow Extension
MUSCLE:Triceps Brachii, Anconeus POSITION: Supine STABILIZE: Ipsilateral Shoulder PALPATION: Proximal to olecranon RESISTANCE: Proximal to wrist in the direction of elbow flexion
GRAVITY ELIMINATED: Sitting
Forearm Supination
MUSCLE: Supinator, biceps brachii
POSITION: Sitting (forearm pronated)
STABILIZE: Inferolateral aspect of humerus
PALPATION: (Supinator) posterior-superior aspect of radius, just distal to radial head, (Biceps brachii) bicepital tendon on anterior aspect of humerus
RESISTANCE: Volar surface of the ulna and the dorsal surface of the radius in the direction of pronation
GRAVITY ELIMINATED: sitting (elbow propped on table, fingers pointing up, sup/pro like waving
Forearm Pronation
MUSCLE: pronator quadratus, pronator teres
POSITION: sitting (forearm supinated)
STABILIZE: Inferolateral aspect of humerus
PALPATION: (pronator quadratus) too deep to palpate, (pronator teres) anterior surface of proximal 1/3 of forearm
RESISTANCE: volar surface of the radius and the dorsal surface of the ulna in the direction of supination
GRAVITY ELIMINATED: sitting
Wrist Flexion (Ulnar Deviation)
MUSCLE: flexor carpi ulnaris
POSITION: sitting (forearm supinated)
STABILIZE: posterior aspect of distal forearm
PALPATION: anteromedial aspect of wrist proximal to pisiform
RESISTANCE: volar aspect of 5th MC bone in the direction of wrist extension and radial deviation
GRAVITY ELIMINATED: sitting
Wrist Flexion (Radial Deviation)
MUSCLE: flexor carpi radialis
POSITION: sitting (forearm supinated)
STABILIZE: posterior aspect of distal forearm
PALPATION: base of the second MC lateral to midline of the forearm
RESISTANCE: volar aspect of MC 1 & 2 in the direction of wrist extension and ulnar deviation
GRAVITY ELIMINATED: sitting
Wrist Extension (Ulnar Deviation)
MUSCLE: Extensor carpi ulnaris
POSITION: sitting (forearm pronated)
STABILIZE: anterior aspect of distal forearm
PALPATION: ulnar side of wrist just distal to ulnar styloid process
RESISTANCE: dorsal aspect of 5th MC in the direction of wrist flexion and radial deviation
GRAVITY ELIMINATED: sitting
Wrist Extension (Radial Deviation)
MUSCLE: Extensor carpi radialis longus & brevis
POSITION: sitting (forearm pronated)
STABILIZE: Anterior aspect of distal forearm
PALPATION: (longus) dorsal aspect of wrist at base of 2nd metacarpal (brevis) base of 3rd metacarpal
RESISTANCE: dorsal aspect of 1st & 2nd metacarpals in the direction of wrist flexion and ulnar deviation
GRAVITY ELIMINATED: sitting
MCP Flexion & IP Extension
MUSCLE: Lumbricals, palmares, and dorsal interossei
POSITION: sitting (forearm supinated)
STABILIZE: distal dorsal surface of MC 2-5
PALPATION: NONE (too deep)
RESISTANCE: volar surface of proximal phalanx of digits 2-5 in direction of MCP extension
GRAVITY ELIMINATED: sitting
MCP Extension
MUSCLE: Extensor digitorum, extensor indicis, extensor digiti minimi
POSITION: sitting (forearm pronated)
STABILIZE:palmar surface of metacarpals 2-5
PALPATION: (digitorum) dorsal surface corresponding MC, (indicis) ulnar side of ext. digitorum for 2nd digit, (digiti) ulnar side of ext. digitorum for 5th digit
RESISTANCE: dorsal aspect of proximal phalanx 2-5
GRAVITY ELIMINATED: sitting
PIP Flexion
MUSCLE: Flexor digitorum superficialis
POSITION: sitting (forearm supinated)
STABILIZE: palmar surface of proximal phalanx of digits 2-5
PALPATION: volar surface of wrist between palmaris longus & flexor carpi ulnaris tendons or on proximal phalanx of digits 2-5
RESISTANCE: palmar surface of middle phalanges 2-5
GRAVITY ELIMINATED: None
DIP Flexion
MUSCLE: flexor digitorum profundus
POSITION: sitting (forearm supinated)
STABILIZE: palmar surface middle phalanges 2-5
PALPATION: palmar surface of middle phalanx digits 2-5
RESISTANCE: palmar surface of distal phalanges 2-5
GRAVITY ELIMINATED: None
Thumb MCP Flexion
MUSCLE: Flexor pollicis brevis
POSITION: sitting (forearm supinated)
STABILIZE: sides of MC 1
PALPATION: Proximal to MCP joint on middle of thenar eminence, medial to abductor pollicis brevis
RESISTANCE: volar aspect of proximal phalanx of thumb in direction of MCP extension
GRAVITY ELIMINATED: None
Thumb MCP Extension
MUSCLE: Extensor pollicis brevis
POSITION: sitting
STABILIZE: MC 1
PALPATION: dorsoradial aspect of wrist at base of shaft of thumb MC (radial border of anatomical snuff box, medial to tendon of abd pollicis longus
RESISTANCE: dorsal aspect of proximal phalanx of thumb in direction of MCP flexion
GRAVITY ELIMINATED: None
Thumb IP Flexion
MUSCLE: flexor pollicis longus
POSITION: sitting (forearm supinated
STABILIZE: sides of prox phalanx of thumb
PALPATION: volar aspect of proximal phalanx of the thumb
RESISTANCE: volar aspect of distal phalanx of thumb in direction of IP extension
GRAVITY ELIMINATED: None
Thumb IP Extension
MUSCLE: extensor pollicis longus
POSITION: sitting
STABILIZE: sides of prox phalanx of thumb
PALPATION: dorsoradial aspect of MC 1 and the prox phalanx of thumb, just to ulnar side of ext pollicis brevis
RESISTANCE: dorsal aspect of distal phalanx of thumb in direction of IP flexion
GRAVITY ELIMINATED:
Opposition
MUSCLE: oppones pollicis & opponens digiti minimi
POSITION: sitting (forearm supinated)
STABILIZE: none
PALPATION: (pollicis) radial border of MC 1 & (minimi) ulnar border of MC 5
RESISTANCE: volar shaft of MC 1 & 5 bone - pull apart
GRAVITY ELIMINATED: None
Thumb ADduction
MUSCLE: adductor pollicis
POSITION: sitting (forearm pronated)
STABILIZE: dorsum of wrist & MC 2-5
PALPATION: Palmar surface of hand between MC 1 & 2
RESISTANCE: Medial aspect of proximal phalanx of the thumb in the direction of CMC abduction
GRAVITY ELIMINATED: none
Thumb ABduction
MUSCLE: abductor pollicis longus
POSITION: sitting (forearm supinated)
STABILIZE: volar surface of wrist & MC 2-5
PALPATION: Base of thumb MC & on radial side of extensor pollicis brevis
RESISTANCE: lateral aspect of thumb MC in direction of CMC adduction
GRAVITY ELIMINATED: None
Finger ABduction
MUSCLE: dorsal interossei, abductor digiti minimi
POSITION: sitting (forearm pronated)
STABILIZE: dorsal surface of MC 2-5
PALPATION: (1st dorsal interossei) radial side of MC 2, (ADM) ulnar aspect of MC 5
RESISTANCE: proximal phalanx in direction of adduction
- radial side of MC 2&3
- ulnar side of MC 3,4&5
middle finger does ulnar and radial abduction
GRAVITY ELIMINATED: None
Finger ADduction
MUSCLE: Palmar interossei POSITION: Sitting (forearm pronated) STABILIZE:dorsal surface of MC 2-5 PALPATION: NONE (too deep) RESISTANCE: Proximal phalanx in direction of abduction - ulnar side of MC 2 - radial side of MC 4&5 **middle finger does not adduct**
GRAVITY ELIMINATED: None
