Isolating UE muscles with Manual Muscle Testing
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1 Shoulder Flexion Isolation of Anterior Deltoid Patient starts in sitting position Arm placed in shoulder abduction (~90 o ) with shoulder flexion (~90 o ) and slight external rotation Stabilize: With one hand, the therapist stabilizes the scapula. Hold in this position Resistance: Therapist places hand at the anterior medial humerus, and gives resistance toward adduction and extension. Isolation of Coracobrachialis o Starts in sitting position with arm down by their side. o Place shoulder in 45 o of shoulder flexion and 45 o of shoulder abduction. Stabilize: Therapist places their hand over the patient s clavicle and scapula to stabilize. 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
2 Shoulder Abduction Isolation of Middle Deltoid Patient starts in sitting position with arm down by their side and elbow flexed. (~90 o ) Stabilize: Therapist stands behind patient with stabilizing hand on the ipsilateral clavicle and scapula. 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 Patient starts in sitting position with arm by side. Patient should be abducted to 30 o. Stabilize: Therapist will place stabilizing hand over the patient s ipsilateral clavicle and scapula. 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
3 Shoulder Horizontal Abduction Isolation of Posterior Deltoid Patient is lying in prone position. Shoulder is abducted to 90 o with distal 1/2 of humerus hanging over the edge of the mat. Stabilize: Therapist stabilizes the contralateral scapula. 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 Patient is lying in supine position on the mat. Have the patient abduct shoulder to 60 o with elbow flexed to 90 o. Stabilize: Therapist places hand on posterior deltoid to provide stabilization. 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
4 Shoulder Horizontal Adduction (cont.) Isolation of Sternocostal Head Patient is lying in supine position on the mat. Abduct shoulder to 120 o and flex elbow to 90 o and abduct Stabilize: Therapist places hand on posterior deltoid to provide stabilization. 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 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
5 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. 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. 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
6 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. 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. 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
7 Scapular Elevation Isolation of Upper Trapezius Starting Position: Patient is sitting with arms by their side. Stabilize: None 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 Patient is sitting with arms at their side. Stabilize: None 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
8 Scapular Retraction Isolation of Middle Trapezius Patient is lying in prone position with the shoulder at the edge of the mat. Shoulder is abducted to 90 o, elbow flexed to 90 o, and externally rotated. Note: Patient s head can be turned to either side for comfort. Stabilize: None 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 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. 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
9 Scapular Protraction Isolation of Serratus Anterior Patient is lying supine with humerus flexed to 90 o and elbow flexed to 150 o. Stabilize: Therapist places hand on trunk to stabilize against the mat. 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 Patient is lying supine with arm at side. Stabilize: none. Lift your shoulder up toward the ceiling without lifting your hand. Resistance: Resistance is applied downward on the shoulder. Page 9 of 23
10 Scapular Depression/Adduction Isolation of Lower Trapezius Patient is lying prone with abducted to 130 o Stabilize: none. Lift your hand up towards the ceiling. Resistance: Resistance is applied downward on forearm. Elbow Flexion Isolation of Biceps Brachii Patient is sitting with arms down at their side. Stabilize: Therapist stands in front of patient and places stabilizing hand over ipsilateral anterior shoulder. 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
11 Elbow Flexion Isolation of Brachialis 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. 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 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. 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
12 Forearm Supination Supinator Patient is sitting with their arm at their side. Have patient extend their shoulder to 50 o. Stabilize: Therapist will place stabilizing hand at the elbow. 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 Patient is sitting with humerus adducted, elbow completely flexed, and forearm pronated. Stabilize: Therapist can use stabilizing hand to cup and support elbow. 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
13 Forearm Pronation Isolation of Pronator Teres 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. 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 Patient is sitting with elbow at 90 o and forearm slightly less than full supination. Stabilize: Therapist can stabilize at the forearm. 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
14 Wrist Flexion/Deviation Isolation of Flexor Carpi Ulnaris Patient is sitting with elbow at 90 o and forearm in full supination. Stabilize: Therapist can stabilize at the forearm. 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 Patient is sitting with elbow at 30 o from full extension and forearm in slightly less than full pronation. Stabilize: Therapist can stabilize at the forearm. Extend your wrist toward your thumb side. Resistance: Therapist applies resistance at dorsum of hand at 2 nd and 3 rd metacarpals toward flexion and ulnar deviation. Page 14 of 23
15 Wrist Extension/Deviation Isolation of Extensor Carpi Radialis Brevis Patient is sitting with elbow fully flexed and forearm in slightly less than full pronation. Stabilize: Therapist can stabilize at the forearm. Extend your wrist toward your thumb side. Resistance: Therapist applies resistance at dorsum of hand at 2 nd and 3 rd metacarpals toward flexion and ulnar deviation. Wrist Extension/Deviation Isolation of Extensor Carpi Ulnaris forearm in pronation. Stabilize: Therapist can stabilize at the forearm. 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
16 Thumb Adduction Isolation of Adductor Pollicis Stabilize: Therapist can stabilize at the forearm. Move your thumb across your palm. Resistance: Therapist applies resistance toward abduction away from the palm. Thumb Abduction Isolation of Abductor Pollicis Brevis Stabilize: Therapist can stabilize at the forearm. 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
17 Thumb Abduction Isolation of Abductor Pollicis Longus Stabilize: Therapist can stabilize at the forearm. 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 Stabilize: Therapist can stabilize at the forearm. 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
18 Thumb Opposition Isolation of Opponens Digiti Minimi Stabilize: Therapist can stabilize at the forearm. Touch your thumb to your small finger and then open slightly and hold. Resistance: Therapist applies resistance at 5 th digit MCP towards medial rotation. Thumb Extension Isolation of Extensor Pollicis Longus Stabilize: Therapist stabilizes the thumb MP. Extend your thumb like a hitchhikers thumb and hold. Resistance: Therapist applies resistance at thumb IP towards flexion. Page 18 of 23
19 Thumb Extension Isolation of Extensor Pollicis Brevis Stabilize: Therapist stabilizes the thumb CMC. 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 Stabilize: Therapist stabilizes the thumb MP. Flex the end of your thumb and hold. Resistance: Therapist applies resistance at thumb IP towards extension. Page 19 of 23
20 Thumb Flexion Isolation of Flexor Pollicis Brevis Stabilize: Therapist stabilizes the thumb MP. Flex your thumb and hold. Resistance: Therapist applies resistance at thumb MP towards extension. Finger Flexion Isolation of Flexor Digitorum Profundus Stabilize: Therapist stabilizes the hand and isolates each finger one at a time. Flex the end of your finger and hold. Resistance: Therapist applies resistance at finger DIP towards extension. Page 20 of 23
21 Finger Flexion Isolation of Flexor Digitorum Superficialis Stabilize: Therapist stabilizes the hand and isolates each finger one at a time. 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 forearm in supination. Stabilize: Therapist stabilizes the hand or forearm. 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
22 Finger MCP Extension Isolation of Extensor Digitorum forearm in pronation. Stabilize: Therapist stabilizes the forearm. 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 forearm in pronation. Stabilize: Therapist stabilizes the forearm. 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
23 Finger Abduction Isolation of Dorsal Interossei forearm in pronation. Stabilize: Therapist stabilizes the forearm. 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 Stabilize: Therapist stabilizes the forearm. Mover your small finger away from your ring finger as far as you can and hold. Resistance: Therapist provides resistance at 5 th digit MCP towards adduction. 5 th Digit Flexion Isolation of Flexor Digiti Minimi forearm in supination. Stabilize: Therapist stabilizes the forearm. Flex your small finger toward your palm and hold. Resistance: Therapist provides resistance at 5 th digit MCP towards extension. Page 23 of 23
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