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16 Cards in this Set
- Front
- Back
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ROM Test:
•Test 1: Shoulder Flexion with Full Abduction •Test 2: Shoulder Flexion with Internal Rotation •Test 3: Active Protraction Muscle Test: 1A •Patient supine, arm in neutral. •Flex humerus 45º, abduct 45. •Palm up. Tester: •FORCE: Flex and adduct arm through oblique plane. •Force is up and across directly oblique/diagonal. Function: •Abducts and upwardly rotates the scapula. •The Primary abductor of the scapula. •Pulls scapula forward around the thoracic cage (protract or abduction). Palpation: Ribs •Patient supine, palpate upper surfaces of highest 4 ribs coming in from under the armpit. (2-3 finger widths on the ribs) •Outer superior surface of upper 4 ribs •Come under pec, stay lateral, toward clavicle and not in armpit, tips of fingers under clavicle, getting to the ribs. (get in crease between deltoid and pec) •Palpation along rib cage into medial border of upper ½ of scapula. Scapula(Medial Border Upper ½) •Can position client on side to wing the scapula; curl fingers to anterior side of vertebral border. Upper medial border of the scapula. •Hooking on anterior surface of the medial border of scapula, getting underneath, have them move the humerus back to allow access to the anterior surface. |
Serratus Anterior:
Upper Fibers |
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ROM Test:
•Test 3: Active Protraction Muscle Test: 1B •Patient supine, flex humerus 180º with palm up •Arm fully abducted against ear •Full shoulder flexion, lock elbow & keep it by the ear. Tester: •FORCE: Extend arm through sagittal plane (Push directly up into extension) Palpation: •Find the nipple line which is at about the 5th rib; get the lateral/superior aspect of the ribs. •Have them protract to push the muscle out. Scapula (Anterior Surface of Inferior Angle) •Patient supine, protract scapula, palpate directly into anterior surface of inferior angle. •Push the shoulder back to get under the scapula. Ribs 5 - 9 •Find nipple line (about 5th rib) •Palpate along superior aspect of the ribs moving away from the inferior angle. •Get on the ribs, not between them. Xyphoid Process •Landmarks: xyphoid process level down to the 9th rib: 1 level above cage |
Serratus Anterior:
Lower Fibers |
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ROM Test:
•Test 9: Shoulder Depression •Test 12: Humeral Extension Muscle Test: 2 •Patient supine, abduct humerus 25º •No humeral rotation •Arm straight, thumb up Tester: •FORCE: Abduct away from the body. Palpation/Function: •Adducts & downwardly rotates the scapula. •Assists when humerus moves into extension •If weak adduction strength will weaken due to inability to downwardly rotate scapula. •T6/T7 is about even with the inferior angle of scapula. T2-T5 Spinous Processes •Have patient flex neck to find C7. C7 will move slightly & T1 will not move. •C7 is the biggest bump, then go T1, then T2 •Prone, feel protrusion of C7 and T1 spinous process, palpate down levels T2-T5 spinous processes. (T6 is about even w/inferior angle of scapula). •ENTIRE LATERAL aspect of the spinous processes, Spine of Scapula •Palpate spine of scapula and move downwards along medial border of the scapula down to the inferior angle. •Find spine, come over to root, and work down medial border all the way to the inferior angle. •Have patient put their hand behind their back to treat the scapula. |
Rhomboid Major
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ROM Test:
•Test 9: Shoulder Depression •Test 12: Humeral Extension Muscle Test: 3 •Patient supine, abduct humerus 25º •Arm straight •Full external rotation Tester: •FORCE: Abduct away from the body. •Test is the same as Rhomboid Major except full external rotation. Palpation: •Rhomboid Minor is Superior to Rhomboid Major C7 – T1 Spinous Processes •Prone, feel protrusion of C7 and T1 Spinous Process •Find most “pokiest” process at C7 (go into lateral aspect) Spine of Scapula •Follow spine of scapula to medial border near root and palpate 1-2 inch ridge. •Get 1-2 inch spot on the medial border of the spine of the scapula. |
Rhomboid Minor
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ROM Test:
•Test 10: Internal Rotation at 110º of Abduction Muscle Test: 4A-1 •Patient supine, 120º abduction •Full internal rotation of humerus Tester: •FORCE: Adduct toward midline (Push arm down to side) Palpation/Function: •Adducts & upwardly rotates the scapula. •Elevates the scapula: resists the depression force of the lower traps. •Extends head and rotates chin to opposite side. •Upper traps lose effectiveness without stability of scapula. Superior Nuchal Line of the Occiput •Supine, place opposite hand under head to stabilize. •Palpate across superior nuchal line of the occiput. •Palpate superficially on occiput. Nuchal Ligament (Medial Border) •Find C7 go lateral to spinous process, find nuchal ligament, and curl into it and pull laterally (not a bony palpation) •Curl fingers into medial border of nuchal ligament upwards from the spinous process of C7. Spine of Scapula & Acromion Process •Palpate along superior, lateral 1/3 of the spine of the scapula, into the acromion process. •Follow superior border of spine of scapula around on the acromion, get the whole superior aspect of the acromion. •Come into the spine of the scapula; get the whole superior aspect of the acromion process. |
Upper Trapezius:
Scapular Fibers |
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ROM Test:
•Test 10: Internal Rotation at 110º of Abduction Muscle Test: 4A-2 •Patient supine, 45º humeral flexion •45º abduction •Palm in Tester: •FORCE: Adduct toward midline (Push straight across) Palpation/Function: •Adducts & upwardly rotates the scapula. •Elevates the scapula: resists the depression force of the lower traps. •Extends head and rotates chin to opposite side. •Upper traps lose effectiveness without stability of scapula. •Same palpation but palpate posterior/superior border of the clavicle. Superior Nuchal Line of Occiput •Supine, place opposite hand under head to stabilize. •Palpate across superior nuchal line of the occiput. •Palpate superficially on occiput. Nuchal Ligament (Medial Border) •Curl fingers into medial border of nuchal ligament upwards from the spinous process of C7. •Find C7, find nuchal ligament, and into it and pull laterally (not a bony palpation) Clavicle (Lateral 1/3) & Acromion Process •Palpate along the lateral 1/3 of the Clavicle, into the superior aspect of the Acromion Process. •Have them shrug shoulders; see where trap goes right in to the clavicle, palpate on posterior superior border across until you get to the acromion process. |
Upper Trapezius:
Clavicular Fibers |
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ROM Test:
•None Muscle Test: 4B •The picture given is the 2nd Test, In the 1st test the arm is straight up. •Patient supine, flex humerus 90º •Externally rotate, palm in •2nd Test: horizontal abduction •Always perform both tests Tester: •FORCE: Horizontal Adduction Palpation/Function: •Adduction, retracts scapula. •Assists in flexion of the humerus near full range by helping rotate the scapula. •Stabilizes scapula to produce shoulder flexion. •Reinforces thoracic spine extension. •If WEAK: Loses stability in shoulder flexion (middle) & Increase in thoracic kyphosis. Spine of Scapula (Superior/Middle 1/3) •Prone, palpate superior middle 1/3 of the spine of the scapula •Find the acromial end and go right across to the superior aspect of the middle 1/3 of the spine of scapula. T1 – T5 Spinous Processes •Use Superior Angle of Scapula as landmark: This is about T2 Spinous Process. •Move across and palpate T1 – T5 Spinous Processes, palpate laterally the sides of the processes. |
Middle Trapezius
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ROM Test:
•Test 1: Shoulder Flexion with Full Abduction Muscle Test: 4C •Patient Supine, abduct humerus 135º (halfway between 90º&180º) •External Rotation: Thumb down Tester: •FORCE: Extend and Adduct arm through the oblique plane. Palpation/Function: •Adducts scapula, scapular depression, rotates glenoid fossa upward over 90º of abduction, reinforces thoracic spine extension. •If WEAK: Loses stability in shoulder flexion (middle) & Increase in thoracic kyphosis. Spine of Scapula (Superior/Medial) •Prone, palpate superior medial spine of the scapula to the border. •Find the spine of Scapula, work way across medially and find the root (tubercle) of scapula medially. T5 – T12 Spinous Processes •Inferior Angle of Scapula = About T7, then go up two levels and begin palpating the lateral aspects of spinous processes. •Using inferior angle as landmark move across to palpate T7 Spinous Process: Palpate the lateral aspects of T5-T12. |
Lower Trapezius
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ROM Test:
•Test 5: External Rotation with Humeral Adduction •Test 8: Horizontal Adduction with External Rotation •Test 9: Shoulder Depression Muscle Test: 5A •Patient supine, elbow flexed to 90º •Depress shoulder, adduct humerus •Full external rotation of humerus. •Keep elbow into the side, more shoulder depression than side bend. •Put hand on elbow, & slide arm out. Tester: •FORCE: Abduct arm through coronal plane. (or plane of table) Palpation/Function: •Adduct and downwardly rotate the scapula, rotates head to the same side, extension of the humerus with the rhomboids and triceps, usually the cause of a stiff neck. Superior Angle of Scapula & Spine of Scapula •Prone, have client reach behind back to elevate scapula. •Palpate top of the superior angle downward posteriorly to the spine of the scapula (root). •Find superior angle, move downwards and medially on border to the spine of the scapula, come from superior angle down to the root (on medial border). C1 – C4 Lateral Transverse Processes •Locate transverse process of atlas palpate lateral TP’s of Upper 4 Cervical. •Find mastoid process and drop inferior. •Going to palpate the most lateral aspects of the TP’s. (C1 has the biggest TP, & C2 will be a lot narrower than C1). So drop down and in for C2. •Be gentle when palpating the cervical spine. |
Levator Scapula
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ROM Test:
•Test 1: Shoulder Flexion with Full Abduction •Test 2: Shoulder Flexion with Internal Rotation •Test 7: Horizontal Adduction with Internal Rotation Muscle Test: 5B •TEST 1: Patient Supine, Internally rotate arm with elbow locked, fully abduct humerus (arm by ear if motion is present) •FORCE: Adduct arm through coronal plane (pull straight out) •TEST 2: Patient supine, internally rotate arm with elbow locked, full horizontal adduction •FORCE: Horizontal abduction (pull out) Palpation: Manubrium •Supine, palpate manubrium at distal end of clavicle •Get against manubrium & get under clavicle, follow it all the way to acromion. •Palpate medially, deep to the clavicle to superior 1st rib •Palpate inferior border of clavicle, and superior border of 1st rib. Clavicle (Inferior/Lateral to tip of AC Joint) •Palpate across inferior lateral aspect of clavicle to tip of the AC Joint. •Get underneath as much as possible and then get tip of AC joint on superior aspect. •Sometimes it helps to raise their arm in the air. •Into union of acromion and clavicle superiorly. |
Subclavius
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ROM Test:
•Test 3: Active Protraction •Test 8: Horizontal Adduction with External Rotation •Test 9: Shoulder Depression •Test 12: Humeral Extension •Test 13: Humeral Extension, Abduction and Internal Rotation Muscle Test: 6 •Patient supine, 90º humeral flexion •Externally rotate, elbow locked •Depress shoulder 20º and bring arm 45º across chest. Tester: •FORCE: Abduct and extend arm through oblique plane. (diagonal) Palpation/Function: •Tilts the scapula anteriorly by tilting the corocoid process anteriorly and caudally, causing inferior angle to rotate medially. •If tight: Interferes with upward rotation of scapula. Ribs 2 - 5 (Superior Aspect) •Similar to Serratus, but more anteriorly toward SC joint. (more up and under) •Supine, palpate under pec major, palpate on superior aspect of ribs 2-5. •Go more toward the sternoclavicular joint Corocoid Process •Follow short head of bicep into Corocoid process (you can access this via armpit). •Pick the pec up, slide underneath toward the corocoid process. Not going into the armpit, sliding underneath the pec and into the corocoid process. •The more flexion you put them in the easier it is to access the corocoid process. |
Pectoralis Minor
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ROM Test:
•Test 7: Horizontal Adduction with Internal Rotation Muscle Test: 7A •Patient supine, flex humerus 90º •Internally rotate the humerus •Slight adduction and extension through oblique plane Tester: •FORCE: Flexion and abduction through oblique plane. •Pull more out, and slightly up. •Point to the direction of fibers on each test. Palpation/Function: •Horizontally adducts and internally rotates the humerus, depresses shoulder girdle Sternum •Supine, palpate along sternum and slightly outward to border of cartilage. •Have them flex pec; come right down the sternum, along the costal junctions. Greater Tubercle of Humerus •With arm abducted, palpate under deltoid into the humerus, ask client to actively adduct and internally rotate arm to follow into the greater tubercle. •Find the deltoid, slide it up and out of the way, have them internally rotate to bring Bicipital groove towards you, have them adduct, it pops out at you, and palpate about 2 inches. |
Pectoralis Major:
Sternal Fibers |
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ROM Test:
•Test 2: Shoulder Flexion with Internal Rotation •Test 7: Horizontal Adduction with Internal Rotation Muscle Test: 7B •Patient supine, 90º humeral flexion •Extend, adduct 20º •Full internal rotation Tester: •FORCE: Extension and abduction in the oblique plane. •Pull more down, and slightly out •Point to direction of fibers on each test. Palpation/Function: •Horizontally adducts and internally rotates the humerus, assists in flexion and horizontal adduction Clavicle (Anterior/Inferior/Medial 1/3) •Supine, palpate anterior, inferior aspect of the medial 1/3 of the clavicle. •Find the clavicle, come on the inferior/anterior aspect, palpate until you feel the tissue of the deltoid. Greater Tubercle of Humerus •With arm abducted palpate under deltoid into the humerus, ask client to actively adduct and internally rotate arm to follow into the greater tubercle. •Find the deltoid, slide it up and out of the way, have them internally rotate to bring Bicipital groove towards you, have them adduct, it pops out at you, and palpate about 2 inches |
Pectoralis Major:
Clavicular Fibers |
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ROM Test:
•Test 7: Horizontal Adduction with Internal Rotation Muscle Test: •Patient supine, humeral flexion 90º •Full internal rotation •10º Abduction Tester: •FORCE: Pull up and out •Pull more up and slightly out. Palpation/Function: •Horizontally adducts and internally rotates the humerus, depresses the shoulder girdle. Ribs 6 – 7 (Medial Aspect of Cartilage) •Supine, palpate along the medial aspect of cartilage of 6th & 7th ribs. •Have them lift arm up, feel bottom of pec, come where we left off for the sternal fibers, Greater Tubercle of Humerus •With arm abducted palpate under deltoid into the humerus, ask client to actively adduct and internally rotate arm to follow into the greater tubercle. •Find the deltoid, slide it up and out of the way, have them internally rotate to bring Bicipital groove towards you, have them adduct, it pops out at you, and palpate about 2 inches |
Pectoralis Major:
Costal Fibers |
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ROM Test:
•Test 12: Humeral Extension •Test 13: Humeral Extension, Abduction and Internal Rotation Muscle Test: 9 •Patient supine, 90º of elbow flexion •Abduct, internally rotate humerus •Place hand on posterior aspect of pelvis & extend arm on shoulder 45º. Tester: •FORCE: Lift elbow upwards and slightly out. Palpation/Function: •Adducts, extends/ and internally rotates humerus. •Internally rotates and elevates: becomes highly active with loads overhead. •If tight: scapula will laterally rotate immediately with abduction. •Will limit humeral external rotation. Scapula (Lower/Lateral Border & Posterior/Lateral/Inferior) •Prone with arm hanging off side of table, palpate lower lateral border of scapula and posterior lateral inferior angle. •Get on posterior medial border of inferior scapula. Bicipital Groove •Come down under deltoid, follow in and palpate directly up into the Bicipital groove medially on humerus (have them internally rotate to make it easier). •Active adduction: follow in with latissimus dorsi attachment (exact same palpation on humerus). •Slightly inferior to Lat |
Teres Major
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ROM Test:
•Test 9: Shoulder Depression •Test 11: Adduction with Internal Rotation •Test 12: Humeral Extension Muscle Test: 8A & 8B •TEST 8A: Patient Supine, elbow extended •Adduction, full internal rotation, thumb down •FORCE: Flex arm through sagittal plane •TEST 8B: Patient supine, elbow extended •20º of extension •Full internal rotation, thumb down •FORCE: Abduct arm through coronal plane. Palpation/Function: •Adducts, internally rotates and extends the humerus. •Depresses the shoulder girdle by pulling the humerus down. •With insertion fixed tilts pelvis anterior and extends the spine. •Unilaterally can laterally flex the trunk •Lifts body toward fixed bar, as in pull-ups Iliac Crest (Posterior/High Point) •Prone, palpate posterior iliac crest at high point •Palpate highest point on the crest of the ilium T7 – L5 Spinous Processes •Find inferior angle of scapula for landmark and palpate the posterior aspect of the inferior angle, then go across and work way all the way down through ALL of the spinous processes. •Can hit posterior aspect of inferior angle of scapula. •Palpate spinous processes of all lumbar and lower 6 thoracic vertebrae. Bicipital Groove •Come down under deltoid, follow in and palpate directly up into the Bicipital groove medially on humerus (have them internally rotate to make it easier). |
Latissimus Dorsi:
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