Manualmusletesting

1. Muscles contribute to
Shoulder Horizontal Adduction
Lower pectoralis major
• Origin:
• Anterior surface of costal cartilage of first six
ribs, adjacent portion of sternum
• Insertion:
• Intertubercle groove of humerus
• Action:
• Shoulder Horizontal Adduction
• Nerve supply:

2. Normal & Good
• Position:
• Supine with arm abducted to 90
degrees.
• Stabilization:
• Stabilize scapula to prevent abduction
of the scapula.
• Palpation:
• Below and near the origin at sternal
end of the clavicle.
• Desired Motion:
• Patient adducts arm through range of
motion.
• Resistance:
• Is given proximal to elbow joint.
Palpation

3. Fair
• Position:
• Supine with arm abducted to
90º.
• Stabilization:
• Stabilize scapula to prevent
abduction of the scapula.
• Palpation:
• Below and near the origin at
sternal end of the clavicle.
• Desired motion:
• Patient adducts arm to
vertical position.

4. Poor
• Position:
• Sitting with arm resting on
table in 90º of abduction.
• Stabilization:
• Stabilize trunk.
• Palpation:
• Below and near the origin at
sternal end of the clavicle.
• Desired motion:
• Patient brings arm forward
through ROM.

5. Trace & Zero
• Examiner palpates tendon of Pectoralis major near insertion
on anterior aspect of upper arm.
• Muscle fibers of both sternal and clavicular portions may be
observed and palpated on upper anterior aspect of thoracic.

6. Note
• Factor limiting Motion:
• Tension of shoulder extensor muscles
• Contact of arm with trunk.
• Fixation:
• In forceful horizontal adduction, contraction of
Obliquus externus abdominus muscle on same side.
• Substitution:
• 1-Anterior portion of deltoid
• 2-Coracobrachialis
• 3- Short Head of biceps.

7. Shoulder External Rotation
Teres Minor Infraspinatus

8. Muscles contribute to
Shoulder External Rotation
Teres Minor
• Origin:
• Posteriorly on upper & middle aspect
of lateral border of scapula
• Insertion:
• Posterior surface of greater tubercle of
the humerus
• Action:
Shoulder Extension
• Nerve supply:

9. Muscles contribute to
Shoulder External Rotation
Infraspinatus
• Origin:
• Posteriorly on upper & middle aspect of
lateral border of scapula
• Insertion:
• Posterior surface of greater tubercle of
the humerus
• Action:
Shoulder Extension
• Nerve supply:

10. Normal & Good
• Position:
• Prone with shoulder abducted to 90º,
upper arm supported on table and lower
arm hanging vertically over edge.
• Stabilization:
• Stabilize scapula with hand and
forearm, but allow freedom for rotation.
• Palpation point:
• None
• Desired motion:
• Patient swings lower arm forward and
up-ward and 'laterally rotates shoulder
through range of motion.
• Resistance:
• Is given above wrist on forearm.

11. Fair
• Position:
• Prone with shoulder abducted to 90º,
upper arm supported on table and lower
arm hanging vertically over edge.
• Stabilization:
• Stabilize scapula and place hand against
anterior surface of arm to prevent
abduction (without interfering with
motion).
• Palpation:
• None
• Desired motion:
• Patient swings lower arm forward and
up-ward and laterally rotates shoulder
through ROM.

12. Poor
• Position:
• Prone with entire arm over edge table
in medially rotated positron.
• Stabilization:
• Stabilize scapula.
• Palpation:
• None
• Desired Motion:
• Patient laterally rotates arm through
range of motion. (supination of the
forearm should not be allowed to
substitute for full range in lateral
rotation.)

13. Trace & Zero
• The Teres minor may be palpated on axillary
border of scapula, and Infraspinatus over body of
scapula below the spine.

14. Note
• Factors Limiting Motion:
• a- Tension of superior portion of scapular ligament.
• b- Tension of lateral rotator muscles of shoulder.
• Fixation:
• a- Weight of trunk.
• b- Contraction of Trapezius and Rhomboid major
and minor muscles to fix scapula
• Substitutions:
1. Wrist extensors
2. Roll the shoulder backwards.

15. Shoulder Internal Rotation
Subscapularis U. Pectoralis Major Latissimus DorsiL. Pectoralis Major

16. Muscles contribute to
Shoulder Internal Rotation
Subscapularis
• Origin:
• Anterior surface of subscapular
fossa
• Insertion:
• Lesser tubercle of the humerus
• Action:
• Shoulder Internal Rotation
• Nerve supply:

17. Muscles contribute to
Shoulder Internal Rotation
Upper pectoralis major
• Origin:
• Medial half of anterior surface of clavicle
• Insertion:
• Intertubercle groove of humerus
• Action:
• Shoulder Internal Rotation
• Nerve supply:

18. Muscles contribute to
Shoulder Internal Rotation
Lower pectoralis major
• Origin:
• Anterior surface of costal cartilage of first six
ribs, adjacent portion of sternum
• Insertion:
• Intertubercle groove of humerus
• Action:
• Shoulder Internal Rotation
• Nerve supply:

19. Muscles contribute to
Shoulder Internal Rotation
Latissimus dorsi
• Origin:
• a- Spines of lower 6 thoracic and lumbar vertebrae
• b- Posterior surface of sacrum& Posterior aspect of
crest of ileum
• c- Lower 3-4 ribs
• d- Inferior angle of scapula
• Insertion:
• Intertubercle groove of humerus
• Action:
• Shoulder Internal Rotation
• Nerve supply:

20. Normal & Good
• Position:
• Prone with shoulder abducted to 90 degrees,
upper arm supported on table and lower arm
hanging vertically over edge.
• Stabilization:
• Stabilize scapula with hand and forearm, but
allow freedom for rotation.
• Palpation:
• None
• Desired Motion:
• Patient swings lower arm backward and up-
ward and medially rotates shoulder through
range of motion.
• Resistance:
• Is proximal to wrist on forearm.

21. Fair
• Position:
• Prone with shoulder abducted to 90 degrees, upper arm
supported on table and lower arm hanging vertically over
edge.
• Stabilization:
• Stabilize scapula.
• Palpation:
• None
• Desired Motion:
• Patient swings lower arm backward and up-ward and
medially rotates shoulder through range of motion.

22. Poor
• Position:
• Prone with arm over edge of table in lateral rotation.
• Stabilization:
• Stabilize scapula.
• Palpation:
• None
• Desired Motion:
• Patient medially rotates arm through range of motion.
(Pronation of the forearm should not be
allowed to substitute for full range in medial
rotation.)

23. Trace & Zero
• Fibers of Subscapularis may be palpated deep in axilla
near insertion.

24. Shoulder Abduction to 90º
Middle Deltoid Supraspinatus

25. Muscles contribute to
Shoulder Abduction to 90º
Middle Deltoid
• Origin:
• Acromion process
• Insertion:
• Deltoid tuberosity on the lateral humerus
• Action:
• Shoulder Abduction to 90º
• Nerve supply:

26. Muscles contribute to
Shoulder Abduction to 90º
Supraspinatus
• Origin:
• Supraspinatus fossa
• Insertion:
• Greater tubercle of the humerus
• Action:
• Shoulder Abduction to 90º
• Nerve supply:

27. Note
• Factors Limiting Motion:
• None: range of motion incomplete.
• Fixation:
• Contraction of Trapezius and Serratus anterior
muscles.
• Serratus anterior and upper fibers of trapezius
assist in upward rotation of scapula as well as
in fixation.

28. Normal & Good
• Position:
• Sitting with arm at side in mid-position
between medial and lateral rotation.
• Elbow flexed a few decrees.
• Stabilization:
• Stabilize scapula.
• Palpation:
• Just below the acromion process of the
scapula.
• Desired Motion:
• Patient abducts the humerus to 90º(palm
down).
• Resistance :
• Is given proximal to elbow

29. Fair
• Position:
• Sitting with arm at side in midposition
between medial and lateral rotation.
• Elbow flexed a few degrees.
• Stabilization:
• Stabilize scapula.
• Palpation:
• Just below the acromion process.
• Desired Motion:
• Patient abducts arm to 90º (palm down).

30. Poor
• Position:
• Supine with arm at side in
midposition between medial and
lateral rotation.
• Elbow slightly flexed.
• Stabilization:
• Stabilize scapula over acromion.
• Desired Motion:
• Patient abducts arm to 90º
without Lateral rotation at
shoulder joint
Alternate