lab 4 - shoulder

What muscle length test position is used for latissimus dorsi?

Arms overhead with hips and knees flexed

Why is pectoralis major muscle length important?

It must be full length to allow shoulder external rotation

What is the setup for pectoralis major muscle length testing?

Hands behind head

How can short pectoralis minor affect motion?

Causes anterior scapular tilt and limits shoulder flexion by reducing scapular rotation

What is the setup for pectoralis minor length testing?

Palms up; observe posterior acromial border from head of bed

What quick shoulder mobility screen is used in lab?

Apley’s shoulder rotation screen

What should always be performed before shoulder MMT?

PROM

Scapular abduction and upward rotation muscles

Serratus anterior

Scapular abduction/upward rotation MMT position

Short sitting with hands in lap

Scapular abduction/upward rotation stabilization

Web space cradles inferior angle of scapula

Scapular abduction/upward rotation resistance

Proximal to elbow

What shoulder angle is used for serratus anterior testing?

~130° shoulder flexion

How is Fair serratus anterior graded?

Patient raises arm and therapist checks ~2 finger widths from spine

What finding suggests poor serratus anterior function?

Scapular winging, wavering, or inability to hold position

How is Trace serratus anterior tested?

Therapist supports arm and palpates contraction

Scapular elevation muscles

Upper trapezius and levator scapulae

Scapular elevation position

Sitting with hands in lap

Scapular elevation stabilization

Both shoulders

Scapular elevation resistance

Downward pressure on shoulders

Scapular elevation therapist position

Stand behind patient

Scapular adduction muscles

Middle trapezius and rhomboids

Scapular adduction position

Prone, shoulder abducted 90°, elbow flexed, thumb down

Scapular adduction stabilization

Opposite scapula/thorax

Scapular adduction resistance

Mid-upper arm closer to scapula

Clinical cue during scapular adduction testing

Use posterior deltoid to move patient into test position

Scapular depression and adduction muscles

Middle and lower trapezius

Scapular depression/adduction position

Prone, shoulder abducted 130–145°, thumb up leading movement

Scapular depression/adduction stabilization

Opposite scapula/thorax

Scapular depression/adduction resistance

Mid forearm

What must occur for lower trap activation?

Arm must raise to at least ~120°

If patient cannot assume lower trap test position, document what?

Unable to assume test position

Shoulder flexion muscles

Anterior deltoid, supraspinatus, coracobrachialis

Shoulder flexion MMT position

Sitting

Shoulder flexion stabilization

Same side shoulder avoiding anterior deltoid

Shoulder flexion resistance

Proximal to elbow

Why is shoulder flexion tested palm down?

Prevent long head of biceps substitution

What ROM is needed for Fair shoulder flexion?

Flexion to 90°

Shoulder extension muscles

Posterior deltoid assisted by latissimus dorsi and teres major

Shoulder extension position

Prone, arms at side, palms up

Shoulder extension stabilization

Opposite thorax unless scapular weakness

Shoulder extension resistance

Proximal to elbow

How can you bias latissimus dorsi during shoulder extension testing?

Move resistance distally and add abduction force

Shoulder abduction muscles

Middle deltoid and supraspinatus

Shoulder abduction position

Sitting with slight elbow flexion (“ballet arm”)

Shoulder abduction stabilization

Same or opposite shoulder avoiding middle deltoid

Shoulder abduction resistance

Proximal to elbow

What ROM is required for Fair shoulder abduction?

Abduction to 90°

What forearm position should be used during shoulder abduction testing?

Relaxed—not supinated

Shoulder horizontal abduction muscle

Posterior deltoid

Shoulder horizontal abduction position

Prone, shoulder abducted 90°, elbow flexed 90°

Shoulder horizontal abduction resistance

Proximal to elbow

Why should elbow remain flexed during horizontal abduction testing?

Prevent long head of triceps substitution

Shoulder horizontal adduction muscle

Pectoralis major

Shoulder horizontal adduction position

Supine, shoulder abducted 90°, elbow flexed 90°

Shoulder horizontal adduction stabilization

Opposite shoulder

Shoulder horizontal adduction resistance

Proximal humerus over biceps

Clinical safety modification for horizontal adduction resistance

Resist at bent arm—not wrist

Shoulder external rotation muscles

Infraspinatus and teres minor

Shoulder external rotation position

Sitting, arm at side, elbow 90°

Shoulder external rotation stabilization

Outside of elbow without gripping

Shoulder external rotation resistance

Dorsal forearm proximal to wrist

Why can maximal resistance be used for shoulder ER?

Not an anti-gravity position unless painful

Shoulder internal rotation muscle

Subscapularis

Shoulder internal rotation position

Sitting, arm at side, elbow 90°

Shoulder internal rotation stabilization

Outside of elbow without gripping

Shoulder internal rotation resistance

Volar forearm proximal to wrist

Why can maximal resistance be used during shoulder IR testing?

Not an anti-gravity position unless painful