rhs 221 theory department of physical therapy king saud...
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RHS 221 Manual Muscle Testing
Theory – 1 hour practical – 2 hours
Dr. Ali Aldali, MS, PT Tel# 4693601
Department of Physical Therapy King Saud University
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The scapulae lie against the thorax approximately between the levels of the second and seventh ribs.
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Observation of the scapulae, both at rest and during active and passive shoulder flexion, is a routine part of the test. Examine the patient in short sitting position with hands in lap.
Palpate the vertebral borders of both scapulae with the thumbs; place the web of the thumb below the inferior angle; the fingers extend around the axillary borders.
Specific Elements:
1. Position and symmetry of scapula: determine the position of the scapulae at rest and whether the two sides are symmetrical.
2. Scapular range of motion: within the total arc of 180o of shoulder forward flexion, 120o is glenohumeral motion, and 60o is scapular motion.
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G-H joint
A-C joint
S-T articulation
S-C joint
Subacromial space
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Includes:
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1. Scapula Abduction and Upward Rotation
2. Scapula Elevation
3. Scapula Adduction
4. Scapula Depression and Adduction
5. Scapula Adduction and Downward Rotation
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1. Prime mover/agonist: origin insertion Serratus anterior ribs 1-8 intercostal fascia Scapula (ventral surface of vertebral border)
2. Synergist/ Accessory muscles: Pectoralis minor.
3. Nerve supply: Long thoracic n. C5-C7
4. Range of motion: measure the distance between spine process and
medial border of scapula.
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5. Fixation: a. in strong scapular abduction, by pull of obliqus externus abdominis on same side.
b. By weight of thorax.
6. Effect of weakness ancontracture:-Video? Effect of weakness result in:
- Winging of Scapula (due to paralysis of serratus anterior) - In ability to raise the arm overhead.
7. Factor limited range of motion: a. Tension of trapezoid ligament. b. Tension of trapezius and rhomboid major and rhomboid minor muscles.
8. Substitution: None.
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9. Procedures:
a- observation for scapula position: At Rest and with motion.
b- patient position (pt): c- Therapist Position:
inner hand:
Outer hand: Direction of Resistance : Instruction to patient:
c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus
hold 3 sec. e. Palpation site:
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1. Prime mover/agonist: origin insertion Trapezius Occiput C7 Vert.SP. Clavicle (post. border) (superior fibers) Ligamentum nuchae Levator scapulae C1-C4 vert tp. Scapula (vert. border superior angle and root of spine
2. Synergist/ Accessory muscles: Rhomboid major and minor.
3. Nerve supply: XI Accessory(C3-C4) and Dorsal Scapular n.(C5) for Levator scapulae, XI Accessory(C3-C4) n. for Trapizius (superior fibers)
4. Range of motion: measure the distance between top of the shoulder and loops of ear.
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5. Fixation:
a. By flexor muscles of cervical spine..
b. By weight of head. 6. Effect of weakness/contracture/shortening: Effect of weakness result in:
effect of weakness result in: In ability to raise shoulder upwards;
either bilateral or unilateral weakness. 7. Factor limited range of motion: a. Tension of costoclavicular ligament.
b. Tension of scapular depression muscle and clavicle: pectoralis
minor, subclavius, and trapezius (lower fibers) muscles. 8. Substitution: by Rhomboids (scapula adduction and downward rotation) inferior angle will move medially.
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9. Procedures:
a- observation for scapula position: At Rest and with motion.
b- patient position (pt): c- Therapist Position:
inner hand:
Outer hand: Direction of Resistance : Instruction to patient:
c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus
hold 3 sec. e. Palpation site:
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1. Prime mover/agonist: origin insertion Trapezius T1-T5 vert.sp Scapula (superior lip of spine) (middle fibers)
2. Synergist/ Accessory muscles: Rhomboid major and minor, and Trapezius (upper and lower fibers)
3. Nerve supply: XI Accessory(C3-C4) n.
4. Range of motion: measure the distance between transverse process and medial border of scapula
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5. Fixation: a. By weight of thorax.
6. Effect of weakness/contracture/shortening:
effect of weakness result in:
In ability to adduct the scapula.
7. Factor limited range of motion: a. Tension of conoid ligament.
b. Tension of pectoralis major and minor, and serratus anterior muscles.
c. Contact of vertebral border of scapula with spinal musculature. 8. Substitution: by Rhomboids (scapula adduction and downward rotation)
inferior angle will move medially.
By the post. Deltoid if the scapular muscles are absent (horizontal adduction of shoulder will occur).
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9. Procedures:
a- observation for scapula position: At Rest and with motion.
b- patient position (pt): c- Therapist Position:
inner hand:
Outer hand: Direction of Resistance : Instruction to patient:
c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus
hold 3 sec. e. Palpation site:
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1. Prime mover/agonist: origin insertion Trapezius T1-T5 vert.sp Scapula (spine) (lower fibers)
2. Synergist/ Accessory muscles: latissimus dorsi.
3. Nerve supply: XI Accessory(C3-C4) n.
4. Range of motion: measure the distance between spine process and
inferior angle of scapula
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5. Fixation: a. By contraction of spinal extensor muscles.
b. By weight of thorax. 6. Effect of weakness/contracture/shortening: Effect of weakness result in:
- In ability to raise the arm overhead.
7. Factor limited range of motion: a. Tension of inter clavicular ligament and articular disk of
sternoclavicular joint.
b. Tension of trapezius muscle.
8. Substitution: None.
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9. Procedures:
a- observation for scapula position: At Rest and with motion.
b- patient position (pt): c- Therapist Position:
inner hand:
Outer hand: Direction of Resistance : Instruction to patient:
c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus
hold 3 sec. e. Palpation site:
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1. Prime mover/agonist: origin insertion Rhomboid major T2-T5 vert. sp Scapula (vertebral border
between root of spine and inferior angle)
Rhomboid minor C7-T1 vert sp Scapula (vert border at root of spine )
2. Synergist/ Accessory muscles: Levator scapulae.
3. Nerve supply: dorsal scapular n. C5
4. Range of motion: measure the distance between the vertebral
border of scapula and vert sp.
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5. Fixation:
a. By weight of thorax. 6. Effect of weakness/contracture/shortening: effect of weakness result in:
- The scapula will abduct and the inferior angle rotate outward. - In ability to adduct & downward rotate the scapula.
7. Factor limited range of motion: a. Tension of conoid ligament.
b. Tension of pectoralis major and minor, serratus anterior muscles.
c. Contact of vertebral border of scapula with spinal musculature. 8. Substitution: by middle trapezius (only adduct the scapula without downward
rotation).
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9. Procedures:
a- observation for scapula position: At Rest and with motion.
b- patient position (pt): c- Therapist Position:
inner hand:
Outer hand: Direction of Resistance : Instruction to patient:
c- grading system: Normal(5), Good(4), Fair(3), Poor(2), Trace(1), Zero(0) make sure patient tolerates maximal resistance plus
hold 3 sec. e. Palpation site:
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Thank You
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