Shoulder MMT page 2

Shoulder Horizontal Abduction

Posterior Deltoid

Origin:

·        Posterior deltoid: scapula

Insertion:

·        Posterior deltoid: deltoid tuberosity of humerus

Nerve Innervation:

·        Posterior deltoid: axillary

Patient Position:

·        Patient is prone, shoulder is abducted to 90° and elbow is flexed to 90° off the edge of the table.

Therapist and Patient Instructions:

·        Resistance is given at the humerus just above the elbow.  Stabilizing hand is on the shoulder.  Ask the patient to, “lift arm up off the table, don’t let me push it down.”

MMT for Grades 2, 1, and 0:

Patient Position:

·        Sitting with test arm in same position as above, arm is supported by the therapist.

Therapist and Patient Instructions:

·        Ask the patient to try and bring elbow back, demonstrate to make the explanation easier.  Palpate the posterior deltoid.

Shoulder Horizontal Adduction

Pectoralis major

Origin:

·        Pectoralis major: sternal half of the clavicle, anterior surface to rib 6 of sternum, cartilage of ribs 1-7

Insertion:

·        Pectoralis major: greater tubercle of humerus

Nerve Innervation:

·        Pectoralis major: anterior thoracic

Patient Position:

·        Patient is supine with about 60° of shoulder abduction and 90° of elbow flexion.

Therapist and Patient Instructions:

·        Resistance is given at the wrist the therapist pulls back towards the shoulder while the patient pulls in toward the hip.  The patient then pushes out toward the shoulder while the therapist pulls in towards the hip.  Stabilizing hand is on the shoulder over the deltoid.  To test the clavicular head ask the patient to, “move your arm up and in, don’t let me pull it back.”  For the sternal head, “move your arm down and in, don’t let me pull it back.”

MMT for Grades 2, 1, and 0:

Patient Position:

·        Same as above except the therapist should now support the limb at the wrist.

Therapist and Patient Instructions:

·        Patient attempts to horizontally adduct, the therapist should be palpating the pectoralis major muscle at the clavicle.

Shoulder External Rotation

Infraspinatus and Teres minor

Origin:

·        Infraspinatus: infraspinous fossa of scapula

·        Teres minor: axillary border of scapula

Insertion:

·        Infraspinatus: greater tubercle of humerus

·        Teres minor: greater tubercle of humerus

Nerve Innervation:

·        Infraspinatus: suprascapular C5, 6

·        Teres minor: axillary C5, 6

Patient Position:

·        Patient is supine with the shoulder abducted to 90° and elbow flexed to 90°, the palm of the hand should be facing the ceiling.  Arm should be supported on the table and towel can be placed under the elbow for comfort. 

Therapist and Patient Instructions:

·        Resistance is placed at the wrist and applied in an upward direction; support is given at the elbow.  Ask the patient to, “push your hand down toward the ground, don’t let me pull it up.”

MMT for Grades 2, 1, and 0:

Patient Position:

·        Patient is prone with entire arm hanging down from the table. 

Therapist and Patient Instructions:

·        The therapist should palpate the infraspinatus over the body of the scapula below the spine.  Ask the patient to, “turn hand counter clockwise or to turn the palm outward.”

Shoulder Internal Rotation

Subscapularis

Origin:

·        Subscapularis: subscapular margin of the scapula

Insertion:

·        Subscapularis: lesser tubercle of humerus

Nerve Innervation:

·        Subscapularis: subscapular C5, 6

Patient Position:

·        Patient is supine with the shoulder abducted to 90° and elbow flexed to 90°, palm of the hand should be facing the floor.  Arm should be supported on the table and towel can be placed under the elbow for comfort. 

Therapist and Patient Instructions:

·        Resistance is at the wrist in a downward direction, support at the elbow.  Ask the patient to, “bring arm up as if you are trying to raise your hand, don’t let me push it down.”  Demonstrate to make the explanation easier.

MMT for Grades 2, 1, and 0:

Patient Position:

·        Patient is prone with entire arm hanging down from the table. 

Therapist and Patient Instructions:

·        Therapist should palpate the subscapularis deep in the axilla.  Ask the patient to, “turn arm clockwise or turn palm away from the table.”  

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