Manualmusletesting

1. Testing the
Muscles of the
Upper Extremity

2. Shoulder Joint

3. Shoulder Flexion
Anterior Deltoid
Ccoracobrachialis

4. Muscles contribute to Shoulder Flexion
Anterior Deltoid
• Origin:
• Anterior lateral third of the clavicle
• Insertion:
• Deltoid tuberosity on the lateral humerus
• Action:
• Shoulder Flexion
• Nerve supply:

5. Muscles contributes to Shoulder Flexion
Ccoracobrachialis
• Origin:
• Coracoid process of the scapula
• Insertion:
• Middle 1/3 of the medial surface of the
humerus
• Action:
• Shoulder Flexion
• Nerve supply:

6. Normal and Good
• Position:
• Sitting with arm at side and elbow slightly
flexed
• Stabilization:
• Stabilize scapula.
• Palpation Point:
• Between lateral portion of clavicle and
coracoid process.
• Desired motion:
• Patient flexes arm to 90º (palm down to prevent
lateral rotation with substitution by the Biceps
brachii)
• Resistance:
• Is given above elbow.( Patient should not be
allowed to rotate or horizontally adduct or
abduct arm)

7. Fair
• The same as Normal and Good
techniques but without given
resistance

8. Poor
• Position:
• Patient sideling with arm at side
resting on smooth board (or
supported by examiner) and
elbow slightly flexed.
• Stabilization:
• Stabilize scapula.
• Palpation Point:
• Between lateral portion of
clavicle and coracoid process.
• Desired motion:
• Patient brings arm forward to
90º of flexion

9. Trace and Zero
• Position:
• Back lying.
• Palpation:
• Examiner palpates fibers
of anterior portion of
Deltoid on anterior aspect
of shoulder joint.

10. Caution!!!!

11. Notes
• Range Of motion: 0-90º
• Factors Limiting Motion: None, Rang of
motion is incomplete
• Fixation:
• Contraction Trapezius & Serratus anterior
muscles.
• Serratus anterior and upper fibers of Trapezius
assist in upward rotation of scapula as well as
in fixation

12. Shoulder Extension
Latissimus dorsi Teres Major Teres Minor

14. Muscles contribute to Shoulder Extension
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 Extension
• Nerve supply:

15. Muscles contribute to Shoulder Extension
Teres Major
• Origin:
• Lower 1/3 of the axillary border of the
scapula
• Insertion:
• Medial lip of intertubercular groove of
humerus
• Action:
Shoulder Extension
• Nerve supply:

16. Muscles contribute to Shoulder Extension
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:

17. Normal & Good
• Position:
• Prone with arm medially rotated
and Adducted (palm up to
prevent lateral rotation).
• Stabilization:
• Stabilize scapula.
• Desired Motion:
• Patient extends arm through
range of motion.
• Resistance:
• Is given proximal to elbow.

18. Fair
• Position:
• Prone with arm at side.
• Stabilization:
• Stabilize scapula.
• Desired Motion:
• Patient extends arm through
range of motion.

19. Poor
• Position:
• Sideling with arm flexed and
resting on smooth board (or
supported by examiner).
• Stabilization:
• Stabilize scapula.
• Desired Motion:
• Patient extends arm in position
of medial rotation through range.
of motion.

20. Trace & Zero
• Position:
• Prone.
• Examiner palpates fibers of Teres major on lower part
of axillary border of scapula (not shown) and fibers of
Latissimus dorsi slightly below.

21. Note
• Range Of motion: 0-50º
• Factors Limiting Motion:
• 1-Tension of shoulder flexor muscles.
• 2-Contact of greater tubercle of humerus with
acromion posteriorly.
• Fixation:
• Contraction of Rhomboideous major and minor and
Trapezius muscles.
• Weight of trunk

22. Shoulder Horizontal Abduction
Deltoid (posterior portion(

23. Muscles contribute to
Shoulder Horizontal Abduction
Deltoid (posterior portion)
• Origin:
• Inferior edge of the scapular spine
• Insertion:
• Deltoid tuberosity on the lateral humerusDeltoid tuberosity on the lateral humerus
• Action:
Shoulder Horizontal Abduction
• Nerve supply:

24. Normal & Good
• Position:
• Prone with shoulder abducted to 90º, upper arm
resting on table and lower arm hanging vertically
over edge.
• Stabilize:
• scapula in adduction.
• Palpation point:
• Below the spine of the scapula.
• Desired motion:
• Horizontal abduction of humerus to the level of
the table 90º.
• Resistance :
• Is given proximal to elbow.
• Motion takes place primarily at glenohumeral
joint and not between scapula and thorax

25. Fair
• Position:
• Prone with shoulder abducted
to 90 degrees, upper arm
resting on table and lower arm
hanging vertically over edge.
• Stabilization:
• Stabilize scapula.
• Desired motion:
• Patient abducts upper arm
through range of motion

26. Poor
• Position:
• Sitting with arm supported in
a position of 90º of flexion.
• Stabilization:
• Stabilize scapula.
• Desired Motion:
• Patient horizontally abducts
arm through range of
motion.

27. Trace & Zero
• Muscle fibers of posterior portion of Deltoid are
palpated on posterior aspect of shoulder joint.

28. Note
• Factors Limiting Motion:
1-Tension of anterior fibers of capsule of glenohumeral joint
2- Tension of Pectoralis major and Deltoid (anterior fibers)
• Fixation:
• Contraction of Rhomboid major and minor and Trapezius
(primarily) middle and lower fibers)
• Substitution:
• 1- Adduction of scapula with Trapezius.
• 2- Long head of the triceps.
• 3- Teres Major
• 4- Latissimus to some extend
Caution !!!!!

29. Shoulder Horizontal Adduction
Upper pectoralis major Lower pectoralis major

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