Scapular MMT
Origin:
·
Ribs
1-8 and aponeurosis of intercostals
Insertion:
·
Superior
angle, verterbral border, and inferior angle of scapula
Nerve
Innervation:
·
Long
thoracic
Patient
Position:
·
Patient
should be supine with shoulder flexed to 90°. The shoulder should be raised off the table, hand in a fist.
Therapist
and Patient Instructions:
·
Therapist
stands over the patient, resistance is given over the hand in a downward
direction. The stabilizing hand is
placed around the wrist.
MMT for Grades 2, 1, 0
Patient
Position:
·
Patient
sitting with entire arm in same position as above except now the arm is resting
on the table and the scapula is not abducted.
Therapist
and Patient Instructions:
·
Palpate
the serratus anterior while you ask the patient to slide the arm forward on the
table.
Trapezius (upper fibers)
Origin: Insertion:
·
Clavicle
(lateral one-third of the acromion process)
Nerve
Innervation:
·
Spinal
portion of cranial nerve XI (accessory), ventral ramus C2, 3, 4
Patient
Position:
·
Patient
is sitting with back facing the therapist.
Therapist
and Patient Instructions:
·
Therapist
should be standing behind the patient with hands placed over the acromial ends
of the clavicle and scapula. The
resistance is then placed in a downward direction. You then ask the patient to, “shrug your shoulders and hold
it. Don’t let me push them
down.” The therapist then
attempts to push the patients’ shoulders down.
· Patient will be lying prone on the table with arms at sides.
Therapist
and Patient Instructions:
· Therapist should be standing on the side of the patient to be tested. The trapezius should be palpated while asking the patient to, “raise your shoulder to your ear.”
Scapular
Adduction
Trapezius
(middle fibers)
Origin:
· Ligamentum nuchae, Spinous processes of T1-T6
Insertion:
· Acromium and spine of the scapula
Nerve
Innervation:
·
Spinal
portion of cranial nerve XI (accessory), ventral ramus C2, 3, 4
Patient
Position:
· Patient should be lying prone with the shoulder at the edge of the table. The arm should be abducted to 90°; the elbow should be bent 90° as well. The forearm is perpendicular to the floor.
Therapist
and Patient Instructions:
·
Resistance
hand should be placed at the distal end of the humerus.
The stabilizing hand should be on the medial and superior border of the
scapula. The therapist should ask
the patient to, “lift your elbow toward the ceiling and hold it.
Don’t let me push down.” The
examiner should be pushing down on the elbow while the patient holds it up.
MMT
for Grades 2, 1, and 0:
Patient
Position:
·
Patient
should be in the same position as above for the normal test, except in this
position the therapist needs to hold the patient’s arm so that the weight of
the limb is supported.
Therapist
and Patient Instructions:
·
The
trapezius should be palpated while asking the patient to, “lift your elbow
toward the ceiling.”
Trapezius
(lower fibers)
Origin:
·
Spinous
processes of T7-T12
Insertion:
·
Spine of
the scapula
Nerve
Innervation:
·
Spinal
portion of cranial nerve XI (accessory), ventral ramus C2, 3, 4
Patient
Position:
·
Patient
should be lying prone with arm abducted at the shoulder about 145°. The
elbow should be extended.
Therapist
and Patient Instructions:
·
The
resistance is given downward toward the floor at a position just above the elbow
on the humerus. The therapist
should stabilize at the inferior angle and medial border of the scapula.
The patient should raise his arm to the level of his ear and hold it
there against the resistance. Ask
the patient to, “raise your arm off the table as high as you can.
Don’t let me push it back down.”
MMT
for Grades 2, 1, and 0:
Patient
Position:
·
The
positioning is the same as for the normal test. However, in this position rather than giving resistance just
above the elbow you will now support the limb just above the elbow.
Therapist
and Patient Instructions:
·
The
trapezius should be palpated while the patient tries to lift the arm off the
table.
Origin:
·
Rhomboid
major: spinous
processes of T2-T5
·
Rhomboid
minor:
spinous processes of C7-T1
Insertion:
·
Rhomboid
major and minor:
Spine of Scapula
Nerve
Innervation:
·
Dorsal
scapular C4, 5
Patient
Position:
·
Patient
should be lying prone, with the elbow flexed and the arm internally rotated so
that the hand is approximately on the center of the waistline, or lower spine of
the back.
Therapist
and Patient Instructions:
·
The
patient is asked to lift his/her arm and hand off the back and hold it there.
Resistance is on the humerus just above the elbow and the resistance is
applied down and away. Stabilizing
hand is on the medial border of the scapula.
The patient should be able to hold the arm off the back against the
resistance. Ask the patient to, “raise your arm off your back and hold
it there, don’t let me push it down.”
MMT
for Grades 2,1, and 0:
Patient
Position:
·
Patient
is sitting with arm positioning the same as for the normal test.
The therapist will support the limb at the wrist; palpate the muscle
under the spine of the scapula.
Therapist
and Patient Instructions:
·
The
rhomboids should be palpated while the patient tries to move his/her hand off
the back.