Origin:Shoulder MMT page 1
Origin:
·
Anterior
Deltoid:
front of clavicle and acromion process
·
Coracobrachialis:
coracoid
process of scapula
·
Supraspinatus:
supraspinous
fossa of scapula
Insertion:
·
Anterior
Deltoid: deltoid
tuberosity of humerus
·
Coracobrachialis:
midshaft
of humerus
·
Supraspinatus:
greater tubercle of humerus
Nerve
Innervation:
·
Anterior
Deltoid: axillary
·
Coracobrachialis:
musculocutaneous
·
Supraspinatus:
suprascapular C5, 6
Patient
Position:
·
Patient
should be sitting, shoulder flexed to 90°,
hand pronated.
Therapist
and Patient Instructions:
·
Resistance
should be given at the humerus just above the elbow in a downward direction.
The other hand may be placed on the shoulder to stabilize.
Ask the patient to, “raise your arm to the height of your shoulder,
make sure your palm faces the ground, hold it there and don’t let me push it
down.”
·
Note: If insufficient resistance is applied at the elbow the
therapist can use the forearm just above the wrist.
However, you must first rule out the possibility of any elbow injuries so
as not to cause further damage. Also,
make sure you are consistent bilaterally.
MMT
for Grades 2, 1, and 0:
Patient
Position:
·
Sitting
with arm at side and the elbow just slightly flexed.
Therapist
and Patient Instructions:
·
The
therapist should palpate the deltoid by placing the thumb and forefinger around
the anterior surface of the deltoid, then palpate the coracobrachialis and
supraspinatus as well. Ask the
patient to try and raise his/her arm.
Origin:
·
Latissimus
dorsi:
vertebrae: T6-T12, L1-L5, and sacral. Ribs 9-12, inferior angle of the scapula,
and the iliac crest
·
Teres
major: inferior angle of the scapula
·
Posterior
deltoid: spine
of scapula
Insertion:
·
Latissimus
dorsi: intertubercular
groove of humerus
·
Teres
major: intertubercular sulcus of humerus
·
Posterior
deltoid: deltoid
tuberosity of humerus
Nerve
Innervation:
·
Latissimus
dorsi: thoracodorsal
·
Teres
major:
subscapular C5, 6
·
Posterior
deltoid:
axillary
Patient
Position:
·
Patient
is lying prone with arms at sides palm facing up.
Therapist
and Patient Instructions:
·
Patient
should lift arm off the table as high as they can. Resistance is placed in a downward direction at the humerus
just above the elbow. The
stabilizing hand is placed on the medial border and inferior angle of the
scapula. Ask the patient to,
“lift arm up as high as you can, don’t let me push it back down.”
To
isolate latissimus dorsi:
Patient
Position:
·
Patient
positioning is the same as for the above test except the shoulder is
“shrugged” to the level of the chin.
Therapist
and Patient Instructions:
·
The
therapist holds the wrist with both hands and will push the arm toward the head
while the patient pushes down toward the feet.
Ask the patient to, “push down toward your feet, don’t let me push
your arm up.”
latissimus
dorsi·
Have
the patient sit on the table with arms at sides, hands flat on the table.
Therapist should stand behind the patient and palpate the latissimus
dorsi. Then the patient will lift
his/her buttocks off the table, bearing their body weight on their hands.
If the patient can perform this action it is a grade 5.
If patient is unable to lift off the table then an alternate test should
be used to establish lower ratings.
MMT
for Grades 2, 1, and 0:
Patient
Position:
·
Patient
is lying prone with arms at sides palm facing up.
Therapist
and Patient Instructions:
·
Ask
the patient to lift their arm off the table as high as they can.
The therapist should palpate the latissimus dorsi at the thoracic wall,
and the posterior deltoid just above the axilla.
Origin:
·
Anterior
Deltoid:
front of clavicle and acromion process
·
Middle
Deltoid:
acromion of scapula
·
Posterior
deltoid: spine
of scapula
·
Supraspinatus:
supraspinous
fossa of scapula
Insertion:
·
Anterior,
middle, and posterior deltoid: deltoid tuberosity of humerus
·
Supraspinatus:
greater tubercle of
humerus
Nerve
Innervation:
·
Anterior,
middle, and posterior deltoid: axillary
·
Supraspinatus:
suprascapular C5, 6
Patient
Instructions:
·
Patient
is sitting with shoulder flexed to 90°;
the shoulder is then moved halfway between flexion and abduction.
Therapist
and Patient Instructions:
·
In
shoulder scaption, resistance is placed at the humerus above the elbow and
applied in a downward direction. The
stabilizing hand is placed on the shoulder.
In order to describe this motion to the patient it might be easier to
demonstrate as well. Ask the
patient to, “raise arm to shoulder height and halfway between straight ahead
and out to the side, don’t let me push it down.”
MMT for Grades 2, 1, and 0
·
Patient
will be standing, trunk flexed to about 90°,
the shoulder and arm in the same position as above.
The trunk flexion allows for the movement to be performed in a
gravity-eliminated position.
·
Ask
the patient to try and raise his arm in this position.
Palpate the deltoid and supraspinatus.
Middle
deltoid and SupraspinatusOrigin:
·
Middle
deltoid: acromion
process of scapula
·
Supraspinatus:
supraspinous fossa of
scapula
Insertion:
·
Middle
Deltoid: deltoid
tubercle of humerus
·
Supraspinatus:
greater tubercle of
humerus
Nerve
Innervation:
·
Middle
Deltoid: axillary
·
Supraspinatus:
suprascapular C5, 6
Patient
Position:
·
Patient
should be sitting with shoulder abducted to 90°,
hand pronated.
Therapist
and Patient Instructions:
·
Resistance
is placed at the humerus just above the elbow and is applied in a downward
direction. The stabilizing hand is
on the shoulder. Ask the patient
to, “lift your arm out to your side to shoulder height, don’t let me push it
down.”
MMT for Grades 2, 1, and 0:
Patient
Position:
·
Sitting
with arm in 90°
abduction supported at the elbow by the therapist.
Therapist is standing just behind the arm cradling it for support.
Therapist
and Patient Instructions:
·
Therapist
palpates the deltoid and supraspinatus while the patient tries to hold his/her
arm in abduction.