Scapular MMT

Question 1

what are the scapular movements tested with MMT?

Answer 1

1. elevation
2. adduction
3. abductino
4. upward rotation
5. depression and downward rotation

Question 2

what muscles primarily are assessed during scapular upward rotation and abduction?

Answer 2

serratus anterior

Question 3

why is upward rotation with abduction a significant motion for the scapula?

Answer 3

contributes to scapulo humeral rhythm

weakness in upward rotators may lead to dysfunction and downward rotation of scapula

increases risk for impingement

Question 4

T/F: the serratus anterior can never be graded higher than the grade assigned to shoulder flexion?

Answer 4

TRUE

weak deltoid = loss of lever for testing = cannot apply resistance in this test

Question 5

for grades 4 and 5, how should the pt be positioned for serratus anterior MMT?

Answer 5

1. sitting
2. shoulder flexed to 130 w/elbow extended
3. apply resistance at distal humerus in a downward direction
4. stabilize/palpate lateral edge of scapula to see if it maintains an abudcted and upwardly rotated position

Question 6

how should the pt be positioned for a grade 3 serratus anterior MMT?

Answer 6

1. sitting
2. shoulder flexed to at least 90 with elbow extended
3. check position
   
   • is it uncoordinated? = weak serratus ant
4. pt can get into position but cannot hold against resistance

Question 7

how should the pt be positioned for grades 0,1,2 serratus anterior MMT?

Answer 7

1. sitting
2. PT supported weight of arm and moves it into position of aprox 90 flex
3. Instruct pt to “hold your arm in this position, let it relax. Now hold your arm up again. Let it relax”
4. palpate serratus anterior

Question 8

alternative testing position for serratus anterior MMT?

Answer 8

1. supine
2. shoulder flexed to 90, neural rotation
3. elbow extended
4. instruct pt to make a fist and punch straight up into your hand

Question 9

T/F: it is alright to test scapular elevation bilaterally?

Answer 9

TRUE

Question 10

pt positioning for grades 3 and up scapular elevation MMT?

Answer 10

similar to how we performed it in systems review

Question 11

gravitiy minimized positioning for scapular elevation

Answer 11

1. prone or supine
2. neutral head (turning may influence activation of muscles)

Question 12

what muscles primarily perform scapular adduction (retraction)?

Answer 12

1. middle trapezius
2. rhomboid major

Question 13

what muscles assist with scapular adduction (retraction)?

Answer 13

1. rhomboid minor
2. upper and lower trapezius
3. levator scapulae

Question 14

for grades 4 and 5 how should the pt be positioned for scapular adduction (retraction) MMT?

Answer 14

1. prone
2. arm abducted 90 and elbow flexted to 90
3. head turned to either side
4. stabilize contralateral scapula
5. apply resistance at distal humerus (if posterior deltoid was a grade 3 at least)

Question 15

if a pt has a posterior deltoid that graded less than a 3, how should the pt be positioned during scapular adduction (retraction) MMT?

Answer 15

1. set up is exactly the same as grades 3 and up
2. main difference is lever arm changes from distal humerus to posterior shoulder

Question 16

for grades 0,1,2 how should the pt be positioned during scapular adduction (retraction) MMT?

Answer 16

1. prone
2. shoulder abducted 90, elbow flexed 90
3. PT supports the weight of the arm
4. other hand is placed along upper medial border of scapula being tested to palpate
5. instruct pt to move arm through full ROM

Question 17

what are some common substitutions that may be observed during scapular adduction (retraction) MMT?

Answer 17

1. rhomboid overtaking middle trap = scapula will adduct and rotate downwards
2. no scapular adduction is observed but shoulder moves = posterior deltoid solely working

Question 18

what muscle primarily is tested during scapular downward rotation and depression?

Answer 18

lower trapezius

Question 19

what muscles assist in scapular depression and downward rotation?

Answer 19

1. latissimus dorsi
2. pectorals

Question 20

for grades 3 and up, how should the pt be positioned during scapular depression and downward rotation MMT?

Answer 20

1. prone
2. test arm overhead to 145 of abduction
3. head turned to either side
4. thumb up
5. apply downward force at distal humerus
6. other hand palpating along spine for lower trap

Question 21

for grades 0,1,2 how should the pt be positioned during scapular depression and adduction (downward rotation) MMT?

Answer 21

1. prone
2. support arm and position it to 145 abduction
3. thumb pointed up
4. palpate lower trap between base of spine of scapula and lower T vertebrae

Question 22

what is primarily tested during scapular downward rotation and adduction?

Answer 22

rhomboid major

Question 23

what muscles assist in scapular downward rotation and adduction?

Answer 23

1. rhomboid minor
2. levator scapulae

Question 24

T/F: the rhomboid are frequently underrated during MMT?

Answer 24

TRUE

evidence suggests they are difficult to accurately assess

Question 25

clinical weakness of the rhomboids is a strong diagnostic test for what?

Answer 25

subscapular nerve lesion or muscle tear

Question 26

for grades 3 and up, how should the pt be positioned during rhomboid MMT?

Answer 26

1. prone 2. arm behind back 3. instruct pt to "lift hand from back" 4. apply resistance in outward and downard direction at the distal humerus \*shoulder extensors must be graded as 3 or higher to do this

Question 27

for grades 0,1,2 how should the pt be positioned when testing the rhomboids?

Answer 27

1. prone or sitting 2. place pts arm behind back 3. support under arm and shoulder (prone) under wrist (sitting) 4. palpate medial border of scapula for rhomboids

Question 28

what are some common substitutions that may be observed during rhomboid MMT?

Answer 28

1. Fibers of the middle trapezius can substitute for the adduction action of the rhomboids but not the downward rotation component 2. When substitution occurs, the patient's scapula will adduct with no downward rotation. Palpation skills and visual observation will confirm this substitution

Question 29

what muscle primarily is tested during scapular depression and shoulder extension?

Answer 29

latissimus dorsi

Question 30

what can assit the lats in scapular depression and shoulder extension?

Answer 30

1. teres major 2. posterior deltoid

Question 31

when does the latissimus dorsi act as a scapular depressor?

Answer 31

when the origin is fixed

Question 32

how should the pt be positioned during MMT of the latissimus dorsi?

Answer 32

1. prone 2. arms by side 3. head turned to either side 4. pt depresses scapula down towards feet 5. resistance is applied at the forearm directly upward towards pt's head resisting motion

Question 33

alternative testing position for latissimus dorsi MMT?

Answer 33

1. sitting 2. hands placed on table 3. instruct pt to lift their bottom off the table while palpating lats bilaterally 4. apply resistance downwards resisting motion can be done if PT is unable to cause pt to yield against max resistance in prone