Download Isolating UE muscles with Manual Muscle Testing

Isolating UE muscles with Manual Muscle Testing
Shoulder Flexion
Isolation of Anterior Deltoid
Start Position:
 Patient starts in sitting position

Arm placed in shoulder abduction
(~90o) with shoulder flexion (~90o)
and slight external rotation
Stabilize: With one hand, the therapist
stabilizes the scapula.
Instruction:

“Hold in this position”
Resistance: Therapist places hand at the anterior medial humerus, and gives
resistance toward adduction and extension.
Isolation of Coracobrachialis

Start Position:
o Starts in sitting position with arm
down by their side.
o Place shoulder in 45o of shoulder
flexion and 45o of shoulder
abduction.

Stabilize: Therapist places their hand
over the patient’s clavicle and scapula to
stabilize.

Instruction:
o “Flex your elbow as much as you
can and turn your palm up. “

Resistance: Therapist places the hand at the antero-medial distal humerus and
gives resistance towards extension and slight abduction.
Page 1 of 23
Isolating UE muscles with Manual Muscle Testing
Shoulder Abduction
Isolation of Middle Deltoid
Start Position:

Patient starts in sitting position with
arm down by their side and elbow
flexed. (~90o)
Stabilize: Therapist stands behind patient
with stabilizing hand on the ipsilateral clavicle
and scapula.
Instruction:

“Lift your arm out to your side to
shoulder level, and don’t let me push it
down.”
Resistance: Therapist places hand at the distal humerus and gives resistance
downward.”
Isolation of Supraspinatus
Start Position:

Patient starts in sitting position with
arm by side.

Patient should be abducted to 30o.
Stabilize: Therapist will place stabilizing
hand over the patient’s ipsilateral clavicle
and scapula.
Instruction:

“Slightly bend your elbow and lift
your arm out to the side.”
Resistance: Therapist will give resistance at the distal humerus towards shoulder
adduction.
Page 2 of 23
Isolating UE muscles with Manual Muscle Testing
Shoulder Horizontal Abduction
Isolation of Posterior Deltoid
Start Position:

Patient is lying in prone position.

Shoulder is abducted to 90o with
distal 1/2 of humerus hanging
over the edge of the mat.
Stabilize: Therapist stabilizes the
contralateral scapula.
Instruction:

“Raise your elbow toward the
ceiling. Don’t let me push it down.”
Resistance: Therapist places hand on the
posterior distal humerus and gives resistance downward.
Shoulder Horizontal Adduction
Isolation of Clavicular Head
Start Position:

Patient is lying in supine position
on the mat.

Have the patient abduct shoulder
to 60o with elbow flexed to 90o.
Stabilize: Therapist places hand on
posterior deltoid to provide stabilization.
Instruction:

“Move your arm up and in across
your chest, don’t let me push it away.”
Resistance: Therapist applies resistance above the wrist in a downward direction
(toward the floor) and outward.
Page 3 of 23
Isolating UE muscles with Manual Muscle Testing
Shoulder Horizontal Adduction (cont.)
Isolation of Sternocostal Head
Start Position:

Patient is lying in supine position on
the mat.

Abduct shoulder to 120o and flex
elbow to 90o and abduct
Stabilize: Therapist places hand on
posterior deltoid to provide stabilization.
Instruction:

“Move your arm down and in
toward your opposite hip, don’t let
me move it.”
Resistance: Therapist applies resistance above the wrist in an up and outward
direction.
Shoulder External Rotation
Isolation of Infraspinatus
Starting Position:

Patient is prone.
Stabilize: Proximal to elbow
Instruction:

“Lift the back of your hand toward
the ceiling.”
Resistance: Therapist applies resistance at
distal end of forearm pushing towards
internal rotation.
Page 4 of 23
Isolating UE muscles with Manual Muscle Testing
Shoulder External Rotation
Isolation of Teres Minor
Starting Position:

Patient is supine.

Shoulder abducted to 45 o

Elbow flexed to 90 o
Stabilize: Provide counter pressure on inner aspect of
distal end of humerus.
Instruction:

“Bend your elbow and move your shoulder out slightly and hold.”
Resistance: Therapist applies resistance at distal end of forearm pushing towards
internal rotation.
Shoulder Internal Rotation
Isolation of Subscapularis
Starting Position:

Patient is prone.

Shoulder abducted to 45 o

Elbow flexed to 90 o
Stabilize: Proximal to the elbow.
Instruction:

“Lift the palm of your hand toward the ceiling.”
Resistance: Therapist applies resistance at distal end of forearm pushing towards
external rotation.
Page 5 of 23
Isolating UE muscles with Manual Muscle Testing
Shoulder Internal Rotation
Isolation of Teres Major
Starting Position:

Patient is sitting or standing.

Extension and adduction of humerus in
internal rotation.
Stabilize: Opposite shoulder.
Instruction:

“Place your arm behind your back and lift your hand off.”
Resistance: Therapist applies resistance proximal to the elbow in an abduction and
flexion direction.
Shoulder Internal Rotation
Isolation of Latissimus Dorsi
Starting Position:

Patient is sitting or standing.

Extension and adduction of humerus in
internal rotation.
Stabilize: Opposite shoulder.
Instruction:

“Place your arm behind your back and lift your hand off.”
Resistance: Therapist applies resistance proximal to the elbow in an abduction and
flexion direction.
Page 6 of 23
Isolating UE muscles with Manual Muscle Testing
Scapular Elevation
Isolation of Upper Trapezius
Starting Position:

Patient is sitting with arms by their
side.
Stabilize: None
Instruction:

Turn you head toward your
opposite knee

Bring your ear and shoulder
together.
Resistance: Therapist will use both hands
to provide resistance at Upper Trapezius
and Occiput in opposing directions.
Scapular Elevation (cont.)
Isolation of Levator Scapulae
Start Position:

Patient is sitting with arms at their
side.
Stabilize: None
Instruction:

“Pull your shoulder blades together
and shrug your shoulders. Don’t let
me push your shoulder down.”
Resistance: Therapist gives resistance over
shoulder toward scapular depression.
Page 7 of 23
Isolating UE muscles with Manual Muscle Testing
Scapular Retraction
Isolation of Middle Trapezius
Start Position:

Patient is lying in prone position with
the shoulder at the edge of the mat.

Shoulder is abducted to 90o, elbow
flexed to 90o, and externally rotated.

Note: Patient’s head can be turned to
either side for comfort.
Stabilize: None
Instruction:

“Don’t let me move your shoulder blade.”
Resistance: Resistance is given at medial boarder of scapula in lateral direction.
Scapular Retraction (cont.)
Isolation of Rhomboids
Start Position:

Patient is lying in prone position
with shoulder internally rotated
behind the patient’s back, with the
dorsum of the hand resting on the
lower back.

Patient’s head can be turned to
either side for comfort.
Stabilize: Therapist places stabilizing hand on contralateral scapula.
Instruction:

“Try to lift your hand off your back toward the ceiling; don’t let me push it
down.”
Resistance: Resistance is applied downward at the distal humerus.
Page 8 of 23
Isolating UE muscles with Manual Muscle Testing
Scapular Protraction
Isolation of Serratus Anterior
Start Position:

Patient is lying supine with humerus flexed to
90o and elbow flexed to 150o.
Stabilize: Therapist places hand on trunk to stabilize
against the mat.
Instruction:

“Reach your elbow toward the ceiling. Don’t let
me push it down.”
Resistance: Resistance is applied downward by
cupping hand over the elbow.
Scapular Anterior Tilt
Isolation of Pectoralis Minor
Start Position:

Patient is lying supine with arm at side.
Stabilize: none.
Instruction:

“Lift your shoulder up toward the ceiling without
lifting your hand.”
Resistance: Resistance is applied downward on the shoulder.
Page 9 of 23
Isolating UE muscles with Manual Muscle Testing
Scapular Depression/Adduction
Isolation of Lower Trapezius
Start Position:

Patient is lying prone with abducted to
130 o
Stabilize: none.
Instruction:

“Lift your hand up towards the ceiling.”
Resistance: Resistance is applied downward on forearm.
Elbow Flexion
Isolation of Biceps Brachii
Start Position:

Patient is sitting with arms down at their
side.
Stabilize: Therapist stands in front of patient
and places stabilizing hand over ipsilateral
anterior shoulder.
Instruction:

“Bend your elbow with your palm facing
the ceiling. Don’t let me push your arm
down.”
Resistance: Resistance is applied at the forearm proximal to the wrist in direction
of extension.
Page 10 of 23
Isolating UE muscles with Manual Muscle Testing
Elbow Flexion
Isolation of Brachialis
Start Position:

Patient is sitting with their arm down at
their side.
Stabilize: Therapist stands in front of patient
and places stabilizing hand over ipsilateral
anterior shoulder.
Instruction:

“Bend your elbow with your palm facing
down. Don’t let me push it down.”
Resistance: Resistance is applied at the forearm proximal to the wrist in direction
of extension.
Elbow Flexion (cont.)
Isolation of Brachioradialis
Start Position:

Patient is sitting with their arm down at
their side with forearm in a neutral position.
Stabilize: Therapist stands in front of patient and
places stabilizing hand over ipsilateral anterior
shoulder.
Instruction:

“Bend your elbow with your thumb up. Hold
it and don’t let me push it down.”
Resistance: Resistance is applied at the forearm proximal to the wrist in direction
of extension.
Page 11 of 23
Isolating UE muscles with Manual Muscle Testing
Forearm Supination
Supinator
Start Position:
 Patient is sitting with their arm at
their side.
 Have patient extend their shoulder to
50o.
Stabilize: Therapist will place stabilizing
hand at the elbow.
Instruction:
 “Bring your arm back and rotate your
palm so that it faces the ground.
 Now, don’t let me turn it.”
Resistance: Resistance is given on the
forearm against supination.
Forearm Pronation
Isolation of Pronator Quadratus
Start Position:

Patient is sitting with humerus
adducted, elbow completely flexed,
and forearm pronated.
Stabilize: Therapist can use stabilizing hand
to cup and support elbow.
Instruction:

“Keep your elbow bent and your
palm facing out, don’t let me turn it.”
Resistance: Therapist applies resistance proximal to the wrist in the direction of
supination.
Page 12 of 23
Isolating UE muscles with Manual Muscle Testing
Forearm Pronation
Isolation of Pronator Teres
Start Position:

Patient is sitting with humerus adducted, elbow flexed to 90 o at side, and
forearm pronated.
Stabilize: Therapist can use stabilizing hand to cup and support elbow.
Instruction:

“Keep your elbow bent and your palm facing out, don’t let me turn it.”
Resistance: Therapist applies resistance proximal to the wrist in the direction of
supination.
Wrist Flexion/Deviation
Isolation of Flexor Carpi Radialis
Start Position:

Patient is sitting with elbow at 90 o and
forearm slightly less than full supination.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Flex your wrist toward your thumb side.”
Resistance: Therapist applies resistance proximal at
the thenar eminence towards extension and ulnar deviation.
Page 13 of 23
Isolating UE muscles with Manual Muscle Testing
Wrist Flexion/Deviation
Isolation of Flexor Carpi Ulnaris
Start Position:

Patient is sitting with elbow at 90 o and
forearm in full supination.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Flex your wrist toward your small finger
side.”
Resistance: Therapist applies resistance proximal at
the hypothenar eminence towards extension and
radial deviation.
Wrist Extension/Deviation
Isolation of Extensor Carpi Radialis Longus
Start Position:

Patient is sitting with elbow at 30o from full
extension and forearm in slightly less than
full pronation.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Extend your wrist toward your thumb
side.”
Resistance: Therapist applies resistance at dorsum of hand at 2nd and 3rd
metacarpals toward flexion and ulnar deviation.
Page 14 of 23
Isolating UE muscles with Manual Muscle Testing
Wrist Extension/Deviation
Isolation of Extensor Carpi Radialis Brevis
Start Position:

Patient is sitting with elbow fully flexed and
forearm in slightly less than full pronation.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Extend your wrist toward your thumb side.”
Resistance: Therapist applies resistance at dorsum
of hand at 2nd and 3rd metacarpals toward flexion
and ulnar deviation.
Wrist Extension/Deviation
Isolation of Extensor Carpi Ulnaris
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in pronation.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Extend your wrist toward your small finger
side.”
Resistance: Therapist applies resistance at dorsum of hand at 5th metacarpal
toward flexion and radial deviation.
Page 15 of 23
Isolating UE muscles with Manual Muscle Testing
Thumb Adduction
Isolation of Adductor Pollicis
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Move your thumb across your palm.”
Resistance: Therapist applies resistance toward abduction away from the palm.
Thumb Abduction
Isolation of Abductor Pollicis Brevis
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Move your thumb to form an ‘L’ with your thumb
and palm.”
Resistance: Therapist applies resistance towards adduction to the palm.
Page 16 of 23
Isolating UE muscles with Manual Muscle Testing
Thumb Abduction
Isolation of Abductor Pollicis Longus
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Extend your thumb.” Therapist places thumb between extension and palmar
abduction.
Resistance: Therapist applies resistance towards adduction to the palm.
Thumb Opposition
Isolation of Opponens Pollicis
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Touch your thumb to your small finger and then open slightly and hold.”
Resistance: Therapist applies resistance towards adduction and lateral rotation of
the thumb.
Page 17 of 23
Isolating UE muscles with Manual Muscle Testing
Thumb Opposition
Isolation of Opponens Digiti Minimi
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist can stabilize at the forearm.
Instruction:

“Touch your thumb to your small finger and then open slightly and hold.”
Resistance: Therapist applies resistance at 5th digit MCP towards medial rotation.
Thumb Extension
Isolation of Extensor Pollicis Longus
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist stabilizes the thumb MP.
Instruction:

“Extend your thumb like a hitchhikers’ thumb and hold.”
Resistance: Therapist applies resistance at thumb IP towards flexion.
Page 18 of 23
Isolating UE muscles with Manual Muscle Testing
Thumb Extension
Isolation of Extensor Pollicis Brevis
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist stabilizes the thumb CMC.
Instruction:

“Extend your thumb like a hitchhikers’ thumb and hold.”
Resistance: Therapist applies resistance at thumb MP towards flexion.
Thumb Flexion
Isolation of Flexor Pollicis Longus
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist stabilizes the thumb MP.
Instruction:

“Flex the end of your thumb and hold.”
Resistance: Therapist applies resistance at thumb IP towards extension.
Page 19 of 23
Isolating UE muscles with Manual Muscle Testing
Thumb Flexion
Isolation of Flexor Pollicis Brevis
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist stabilizes the thumb MP.
Instruction:

“Flex your thumb and hold.”
Resistance: Therapist applies resistance at thumb MP towards extension.
Finger Flexion
Isolation of Flexor Digitorum Profundus
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist stabilizes the hand and isolates each
finger one at a time.
Instruction:

“Flex the end of your finger and hold.”
Resistance: Therapist applies resistance at finger DIP towards extension.
Page 20 of 23
Isolating UE muscles with Manual Muscle Testing
Finger Flexion
Isolation of Flexor Digitorum Superficialis
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist stabilizes the hand and isolates each
finger one at a time.
Instruction:

“Flex the middle of your finger and hold.”
Resistance: Therapist applies resistance at finger PIP towards extension.
Finger IP Extension and MCP Flexion
Isolation of Lumbricals
Start Position:

Patient is sitting with elbow flexed at 90 o and forearm in
supination.
Stabilize: Therapist stabilizes the hand or forearm.
Instruction:

“Flex your fingers while keeping the middle of your fingers
straight and hold.”
Resistance: Therapist applies resistance at finger IPs towards
flexion and then distal to MCPs towards extension.
Page 21 of 23
Isolating UE muscles with Manual Muscle Testing
Finger MCP Extension
Isolation of Extensor Digitorum
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in pronation.
Stabilize: Therapist stabilizes the forearm.
Instruction:

“Flex your fingers like a hook and then extend your knuckles and hold.”
Resistance: Therapist applies resistance at finger MCPs towards flexion.
Finger MCP Extension
Isolation of Extensor Indicis and Digiti Minimi
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in pronation.
Stabilize: Therapist stabilizes the forearm.
Instruction:

“Extend your index and small fingers only and hold.”
Resistance: Therapist applies resistance at index and small fingers MCPs towards
flexion.
Page 22 of 23
Isolating UE muscles with Manual Muscle Testing
Finger Abduction
Isolation of Dorsal Interossei
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in pronation.
Stabilize: Therapist stabilizes the forearm.
Instruction:

“Spread your fingers apart as far as you can and hold.”
Resistance: Therapist isolates each finger and provides resistance at MCPs towards
adduction.
Finger Abduction
Isolation of Abductor Digiti Minimi
Start Position:

Patient is sitting with elbow flexed at 90 o and
forearm in supination.
Stabilize: Therapist stabilizes the forearm.
Instruction:

“Mover your small finger away from your ring finger as far as you can and
hold.”
Resistance: Therapist provides resistance at 5th digit MCP towards adduction.
5th Digit Flexion
Isolation of Flexor Digiti Minimi
Start Position:

Patient is sitting with elbow flexed at 90 o and forearm in
supination.
Stabilize: Therapist stabilizes the forearm.
Instruction:

“Flex your small finger toward your palm and hold.”
Resistance: Therapist provides resistance at 5th digit MCP towards extension.
Page 23 of 23