Tests For Length Of Shoulder Rotators

Placing the hands behind the back, as illustrated, requires normal range of shoulder joint rotation without abnormal shoulder-girdle movement.

Slightly excessive shoulder joint lateral rotation. The hands can easily be placed on the upper back.

Limited shoulder joint medial rotation, more in the right than in the left. The shoulder girdle is held down to prevent substitution of shoulder-girdle motion for shoulder joint motion.

Substitution by shoulder-girdle motion permits the subject to place the hands behind the back. However, encouraging or permitting such substitution has adverse effects by contributing to overdevelopment of the pectoralis minor. (See pectoralis minor, p. 307.)

312

UPPER EXTREMITY CHART

PATIENTS NAME

CLINIC No.

LEFT

RCHT I

Examiner Date

Trapezius, upper

Trapezius, middle

Trapezius, lower

Serratus anterior

1

Rhomboids

Pectoralis minor

Pectoralis major

Latissimus dorsi

Shoulder medial rotators

Shoulder lateral rotators

Deltoid, anterior

Deltoid, middle

f

Deltoid, posterior

Biceps

Triceps

1

Brachioradialis

Supinators

Pronators

Flexor carpi radialis

Flexor carpi ulnaris

Extensor carpi radialis

]

Extensor carpi ulnaris

i

Flexor digitorum profundus

i

2

Flexor digitorum profundus

2

a

Flexor digitorum profundus

a

4

Flexor digitorum profundus

4

i

Flexor digit, superficialis

i

2

Flexor digit superficialis

2

a

Flexor digit, superficialis

a

4

Flexor digit, superficialis

4

i

Extensor diqitorum

i

2

Extensor digitorum

2

a

Extensor digitorum

a

I

4

Extensor digitorum

4

i

Lumbricalis

i

2

Lumbricalis

2

a

Lumbricalis

a

4

Lumbricalis

4

i

Dorsal interosseus

i

2

Dorsal interosseus

2

a

Dorsal interosseus

a

1

4

Dorsal interosseus

4

i

Palmar interosseus

i

2

Palmar interosseus

2

a

Palmar interosseus

a

4

Palmar interosseus

4

Flexor pollicis longus

Flexor pollicis brevis

i i i

Extensor pollicis longus

Extensor pollicis brevis

Abductor pollicis longus

Abductor pollicis brevis

Adductor pollicis

1 "

Opponens pollicis

Flexor digiti minimi

Abductor digiti minimi

Opponens digiti minimi

NOTES

__ - ________

_ ■

CORACOBRACHIAL*

Origin: Apex of the coracoid process of the scapula. Insertion: Medial surface of the middle of the shaft of the humerus, opposite the deltoid tuberosity. Action: Flexes and adducts the shoulder joint. Nerve: Musculocutaneous, C6, 7. Patient: Sitting or supine.

Weakness: Decreases the strength of shoulder flexion, particularly in movements that involve complete elbow flexion and supination, such as combing the hair.

Shortness: The coracoid process is depressed anteriorly when the arm is down at the side.

Fixation: If trunk is stable, no fixation by the examiner should be necessary.

Test: Shoulder flexion in lateral rotation, with the elbow completely flexed and the forearm supinated. Assistance from the biceps in shoulder flexion is decreased in this test position because the complete elbow flexion and forearm supination place the muscle in too short a position to be effective in shoulder flexion.

Pressure: Against the anteromedial surface of the lower V3 of the humerus, in the direction of extension and slight abduction (Figure B).

Origin: Medial % of the supraspinous fossa of the scapula.

SUPRASPINATUS

Origin: Medial 2/3 of the supraspinatus fossa of the scapula.

Action: Abducts and laterally rotates the shoulder joint, and stabilizes the head of the humerus in the glenoid cavity during these movements.

Nerve: Suprascapular C4, 5, 6

Patient: Sitting, with neck extended and laterally flexed toward the tested side, with the face turned toward the opposite side.

Note: This position allows for relaxation of the trapezius muscle. Because the supraspinatus is completely covered by the upper and middle fibers of the trapezius, the trapezius should be as relaxed as possible in order to palpate the supraspinatus.

Fixation: The sitting position provides greater stabilization of the trunk than a standing position.

lest: With the elbow bent at a right angle, the arm is placed in abduction to shoulder level. The arm is a few degrees forward from the mid-coronal plane, and is held in a few degrees of external rotation to put it in line with the major part of the supraspinatus. Have the subject hold this position of slight anterior abduction and slight external rotation against pressure.

Note: The supraspinatus needs to be tested in its most shortened position because it is a one-joint muscle and tests strongest in its most shortened position (see page J13).

The "empty can" test does not meet the requirements for testing the strength of this muscle. Rowlands et al concluded "our study found that the empty can test does not allow selective activation of the Supraspinatus muscle." *

Weakness: The tendon of the supraspinatus is firmly attached to the superior surface of the capsule of the shoulder joint. Weakness of the muscle or rupture of the tendon decreases shoulder joint stability, allowing the humerus to alter its relationship with the glenoid cavity.

* Rowlands LK, Wertsch J.J, Primack S J, Spreiter AM, Robots MM. "Kinesiology of the empty can test. " Am J Phys. Med. Rehabil. 1995 Jul- Aug: 74(4):302-4

Middle

Middle

DELTOID

Origin of Anterior Fibers: Anterior border, superior surface, and lateral % of the clavicle.

Origin of Middle Fibers: Lateral margin and superior surface of the acromion.

Origin of Posterior Fibers: Inferior lip of the posterior border of the spine of the scapula.

Insertion: Deltoid tuberosity of the humerus.

Action: Abduction of the shoulder joint, performed chiefly by the middle fibers, with stabilization by the anterior and posterior fibers. In addition, the anterior fibers flex and, in the supine position, medially rotate the shoulder joint. The posterior fibers extend and, in the prone position, laterally rotate the shoulder joint.

Nerve: Axillary, C5, 6. Patient: Sitting.

Fixation: The position of the trunk in relation to the arm in this test is such that a stable trunk will need no further stabilization by the examiner. If the scapular fixa

tion muscles are weak, then the examiner must stabilize the scapula.

Test: Shoulder abduction without rotation. When placing the shoulder in test position, the elbow should be flexed to indicate the neutral position of rotation. The shoulder may be extended, however, after the shoulder position is established so that the extended extremity can be used for a longer lever. The examiner should be consistent in the technique during subsequent tests.

Pressure: Against the dorsal surface of the distal end of the humerus if the elbow is flexed, or against the forearm if the elbow is extended.

Weakness: Results in inability to lift the arm in abduction against gravity. With paralysis of the entire deltoid and supraspinatus, the humerus tends to subluxate downward if the arm remains unsupported in a hanging position. The capsule of the shoulder joint permits almost an inch of separation between the head of the humerus and the glenoid cavity. In cases of axillary nerve involvement in which the deltoid is weak but the Supraspinatus is not affected, relaxation of the joint is not as marked, but it tends to progress if the deltoid strength does not return.

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