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40 Cards in this Set
- Front
- Back
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biceps brachii/brachialis
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(1) brachioradialis: make sure the forearm stays in supination
(2) Wrist extensors: make sure the forearm stays in supination (3) Wrist flexors: keep wrist relaxed (4) Pronator teres: keep forearm in supination |
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brachioradialis
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(1) Biceps/brachialis: keep the forearm in neutral pronation/supination
(2) Wrist extensors (3) Pronator teres: keep the forearm in neutral pronation/supination |
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Triceps/anconeus
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Only mechanical substitutions, no true muscular extensor substitutions
(1) Scapular protraction or shoulder horizontal abduction can give some momentum for elbow motions and places the long head in better position to work |
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Supinator
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(1) Wrist extensors: keep the wrist in neutral flexion/extension
(2) Lateral rotation and or adduction of the shoulder-keep the humerus stabilized against the trunk (3) Biceps brachii: may mask weakness of supinator when strength tested with elbow at 90º |
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Pronators
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(1) Wrist flexors: can pull forearm over into pronation
(2) Shoulder medial rotation: make sure the humerus is stabilized against the trunk (3) Shoulder abduction |
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Extensor carpi radialis longus and brevis
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(1) Extensor pollicis longus: palpate and make sure the thumb stays relaxed
(2) Finger extensors: Keep the fingers relaxed and palpate (3) Flexor carpi radialis: make sure to get extension WITH radial deviation |
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Extensor carpi ulnaris
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(1) Extensor digiti minimi
(2) Extensor digitorum communis (3) Extensor carpi radialis: keep the wrist out of radial deviation (4) Finger extensors: extend and then ulnarly deviate (5) Flexor carpi ulnaris: make sure the wrist stays in extension |
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Flexor carpi radialis
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(1) Finger flexors: keep the fingers relaxed, palpate
(2) Palmaris longus: palpate (3) Flexor carpi ulnaris: avoid ulnar deviation and palpate (4) Abductor Pollicis Longus: Palpate, keep thumb relaxed (5) Extensor carpi radialis longus and brevis: make sure the wrist stays in flexion |
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Flexor carpi ulnaris
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(1) Finger flexors
(2) Palmaris longus (3) Flexor carpi radialis: keep out of radial deviation (4) Extensor carpi ulnaris: make sure the wrist stays flexed (5) Abductor digiti minimi: do not let patient abduct little finger |
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Palmaris longus
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(1) Flexor carpi radialis
(2) Flexor carpi ulnaris (do not allow the wrist to ulnarly deviate) (3) Flexor digitorum profundus (4) Flexor digitorum superficialis |
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Extensor Digitorum Communis
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(1) Wrist flexors: stabilize the wrist in a neutral position and palpate for finger extensors
(2) Interossei: Will see IP joint extension instead of MP joint extension (3) Make sure the patient keeps fingers held apart slightly so one finger does not assist the weaker finger |
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Flexor Digitorum Profundus
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(1) If subject hyperextends the finger and then relaxes, it may give the appearance of profundus motion
(2) Wrist extensors: keep wrist in neutral and palpate for finger flexors |
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Flexor Digitorum Superficialis
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(1) Flexor digitorum profundus: keep the DIP of the tested finger extended and keep all other fingers extended
(2) Wrist extensors: if finger flexors are tight, wrist extension will cause passive finger flexion; keep wrist in neutral and palpate for finger flexors |
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Extensor Pollicis Longus
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(1) Flexor pollicis longus: if patient flexes IP hard and then relaxes, will give the appearance of extension
(2) If MP joint is allowed to flex, can achieve IP extension by pull of thenar muscles on the extensor hood (Abductor Pollicis brevis, flexor pollicis brevis, adductor pollicis) |
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Abductor Pollicis Longus
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(1) Abductor Pollicis Brevis: ask for extension of thumb with only slight palmar abduction and palpate
(2) Extensor pollicis brevis and longus: distinguish the desired motions and try to palpate the difference; may see extension with adduction, or IP extension |
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Extensor Pollicis Brevis
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(1) Extensor Pollicis longus: palpate, keep the IP joint relaxed in flexion and note CMC adduction; CMC will tend to adduct if EDL is subbing
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Flexor Pollicis Longus
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(1) Extensor Pollicis longus: do not allow patient to hyperextend thumb and then relax
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Abductor Pollicis Brevis
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(1) Opponens: palpate and distinguish between opposition and abduction
(2) Abductor pollicis longus: ask for straight palmar abduction 90º from palm (3) Superficial head of flexor pollicis brevis: do not allow thumb flexion |
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Opponens Pollicis
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(1) Abductor pollicis longus and brevis
(2) Flexor pollicis longus and brevis (3) Have patient squeeze your hand. If there is no OP the first metacarpal will rotate away from the examiner's palm |
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Flexor pollicis brevis
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(1) Flexor pollicis longus
(2) Oblique head of adductor pollicis |
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Adductor pollicis
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(1) Flexor pollicis brevis: palpate
(2) First dorsal interosseus: palpate |
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Abductor digiti minimi (quinti)
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(1) Extensor digiti minimi: keep MP joint in neutral position of flexion/extension or slight flexion
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Opponens digiti minimi
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(1) Abductor digiti minimi: palpate, check for rotation
(2) Flexor digiti minimi: palpate |
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Flexor digiti minimi
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(1) Lumbricales: palpate
(2) Opponens digiti minimi (3) flexor digitorum superficialis: check PIP flexion (4) flexor digitorum profundus: check DIP flexion (5) Interossei: palpate |
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Lumbricales
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(1) Finger flexors: desired motion is finger extension of IP with MCP flexion; do not allow IP flexion
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Dorsal interossei
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(1) Finger extensors: assure that all joints of fingers remain in neutral flexion/extension
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Palmar interossei
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(1) Finger flexors: keep fingers in neutral flexion/extension
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Upper trapezius
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(1) Serratus anterior: do not allow the scapula to abduct
(2) Levator scapulae: make sure face is not turned toward tested side, palpate (3) Pectoralis minor: cups shoulder forward giving appearance of beginning elevation (4) Elbow extension: patient elevates shoulder by pushing on hands placed on plinth (5) Rhomboids: scapula downwardly rotates, do not allow |
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Middle trapezius
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(1) Rhomboids: do not allow downward rotation of the scapula; keep humerus in lateral rotation and in 90º abduction
(2) Levator scapulae (3) Upper trapezius: will see elevation of scapula (4) Lower trapezius or latissimus: will see depression of scapula (5) posterior deltoid: will see horizontal abduction instead of scapular abduction, arm lifts (6) Observe anterior/inferior glide of humeral head during active contraction phase |
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Lower trapezius
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(1) Rhomboids: do not allow downward rotation of scapula; keep humerus in lateral rotation and do not allow it to adduct
(2) Middle trapezius: be sure to get combined adduction and depression, not just adduction (3) Upper trapezius: will see scapular elevation (4) Latissimus: will see scapular depression only (5) Posterior deltoid: Will see horizontal abduction instead of scapular abduction (6) Observe anterior/inferior glide of humeral head during active contraction phase |
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Rhomboids/levator scapulae
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(1) Pectoralis Minor: if it cups shoulder, may appear that rhomboids are acting on scapula, stabilize and palpate
(2) Trapezius: must palpate the direction of fibers, make sure patient is doing desired motion; would see upward rotation (3) Latissimus or posterior deltoid: watch to assure scapular, not just humeral motion |
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Serratus anterior
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(1) Lower trapezius: keeps scapula adducted: make sure scapula abducts as well as upwardly rotates
(2) Upper Trapezius: be sure the scapula abducts (3) Pectoralis major: watch what the scapula does, not what the humerus does alone (4) Pectoralis minor along with levator and rhomboids (5) Deltoids: arm may come down but scapula stays the same |
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Latissimus dorsi
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(1) Lateral abdominals: laterally flexes the trunk
(2) Posterior deltoid: may show glenohumeral abduction with extension (3) Teres Major: assists with latissimus but will not see depression of shoulder girdle (4) Quadratus Lumborum: laterally flexes trunk; stabilize (5) Elbow flexion using biceps if resistance given distally (6) Scapular anterior tilt to substitute for shoulder extension |
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Anterior deltoid
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(1) Pec Major: Palpate
(2) Biceps: Keep elbow flexed (3) Coracobrachialis (4) Elevation of shoulder girdle to give appearance of shoulder flexion (5) Middle deltoid: humerus moves more toward horizontal abduction (6) Upper traps: don't allow scapula to elevate (7) Don't allow side-bending |
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Middle deltoid and supraspinatus
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(1) Long head of biceps: may help abduct
(2) Anterior and posterior deltoid: combine motions and achieves by vector force (3) Elevation of shoulder girdle may appear to be humeral abduction (4) Trunk flexion to opposite side |
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Posterior deltoid
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(1) Long head of triceps: assists extension
(2) Rotators: palpate (3) Upper trunk rotation/side bending: reduce trunk movement with back support (4) Latissimus: keep arm abducted to 90º and in some lateral rotation (5) Scapular adductors in GL test (6) Middle deltoid: humerus moves into more horizontal adduction |
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Pectoralis major: sternal fibers
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(1) Clavicular portion of pectoralis major
(2) pectoralis minor (3) Latissimus: allows adduction of shoulder toward side and humeral extension |
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Pectoralis major: clavicular fibers
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(1) Sternal fibers of pec major
(2) Coracobrachialis: palpate (3) Anterior deltoid: palpate (both assist in flexion) (4) Biceps long head: palpate, assists in flexion (5) Stabilize for trunk movement |
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Lateral rotators
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(1) Posterior deltoid: may see humeral horizontal abduction
(2) Wrist extensors may appear to be getting more lateral rotation: palpate |
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Medial rotators
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(1) Triceps: elbow extension vs. glenohumeral medial rotation
(2) Wrist flexors: wrist flexion vs. medial rotation of glenohumeral joint (3) Posterior deltoid in prone: horizontal abduction vs. glenohumeral medial rotation |
