Muscle chart
Comparing Myotomes- SCI vs Brachial Plexus Injury
SCI
With a SCI, the loss of motor and/or sensory function is due to damage to neural elements within the
spinal canal.
The ASIA Myotome Levels:
The muscles were chosen because of their consistency for being innervated by the segments
indicated and their ease of testing in the clinical situation, where testing in any position other than
the supine position may be contraindicated.
When using the ASIA, the motor examination is completed through the testing of key muscle
functions corresponding to 10 paired myotomes (C5-T1 and L2-S1). It is recommended that each
key muscle function should be
examined in a rostral-caudal
sequence, utilizing standard supine
positioning and stabilization of the
individual muscles being tested.
Improper positioning and stabilization
can lead to substitution by other
muscles and will not accurately reflect
the muscle function being graded.
MYOTOMES
• C5 – Elbow flexion
• C6 – Wrist extension
• C7 – Elbow extension
• C8 – Finger flexion
• T1 – Finger abduction
• L2 – Hip flexion
• L3 – Knee extension
• L4 – Ankle dorsiflexion
• L5 – Great toe extension
• S1 – Ankle plantarflexion
Brachial Plexus Injury
With a brachial plexus lesion/injury it is the peripheral nerves outside the spinal cord that are being affected.
The cervical and thoracic myotomes (C1-T12) are tested with the patient in a seated position. When testing for a
brachial plexus lesion, you want to test movement(s) which have the strongest association with each myotome.
Example: The primary muscles involved in the action of arm abduction include the supraspinatus, deltoid, trapezius, and
serratus anterior.
• Serratus Anterior, Deltoid- innervated by C5.
• Cranial nerve XI innervates the motor function of the trapezius.
• The supraspinatus muscle is supplied by the suprascapular nerve (C5 and C6)
Technique for assessing C5 myotome with BPL
C5- Shoulder abduction.
Ask the patient to raise both their arms to the side of them simultaneously as strongly as then can
while the examiner provides resistance to this movement. Compare the strength of each arm.
MYOTOMES
C5 – Shoulder abduction
C6 – Elbow
flexion Wrist
extension
C7 – Elbow
extension
C8 – Finger
flexion
T1 – Finger
abduction
L2 – Hip
flexion
L3 – Knee
extension
L4 – Ankle
dorsiflexion
L5 – Great toe
extension
S1 – Ankle
plantarflexion
Contractures
A contracture is a limitation in active or passive range of motion that is caused by structural changes in the muscles, ligaments and/or
tendons surrounding the involved joint. The primary cause of a contracture is loss of active motion due to another condition. Here is a
partial list of conditions that can cause loss of active motion in all or portions of the upper extremities, leading to the possibility of
contracture development:
-CVA with hemiparesis
-Traumatic brain injury
The development of contractures leads to permanent loss of
-Other chronic or progressive neurological conditions, such as multiple
function, problems with hygiene and skin integrity, pain, and
sclerosis, muscular dystrophy, amyotrophic lateral sclerosis, etc.
difficulty with ADLs. Splinting is often used to help reduce
-Alzheimer’s disease
contractures. Please see the worksheet on splinting for these
-Seizure disorder
techniques. The treatment techniques listed below also help to
-Cerebral palsy
prevent contracture development and progression. Once an
-Nerve lacerations
effective contracture management program is developed for a
-Brachial plexus injuries
patient, the occupational therapist should educate caregivers on
-Crush injuries
the techniques required to continue the program daily.
-Tendon and ligament injuries that do not receive timely or proper management
-Dupuytren’s contracture
-Burns
Types of ROM
Passive Range of Motion (PROM) – the amount of movement measured while the therapist moves the joint with no help from the patient.
Active Range of Motion (AROM) – the amount of movement measured while the patient actively moves the joint.
Active Assistive Range of Motion (AAROM) – the amount of movement measured while the patient actively moves the joint with gravity eliminated
or with assistance from the therapist.
Within Normal Limits (WNL) – range of motion is within the normal range of measurement for that specific joint. The therapist must measure the joint
and compare it to the normative data.
Within Functional Limits (WFL) – range of motion is functional for the particular tasks that the patient needs to complete. This can be different
depending on the patient and what he or she needs to do. To determine that range is WFL, the therapist must observe functional movement and
functional tasks, such as observing a patient getting dressed.
Range of motion refers to the directions and limits of movement in each joint of the body. During
evaluation, range of motion is measured using a full circle, half circle, or finger goniometer. To measure range
of motion of a joint, the stationary arm of the goniometer is placed parallel to the longitudinal axis proximal to
the joint, and the movable arm is placed parallel to the longitudinal axis distal to the joint. The goniometer
must be placed in correct alignment with the joint for the measurement to be accurate. Measurements are
always recorded in degrees of movement.
Treatment Techniques to Increase Range of Motion
Technique
Description
Example
Photo/Video
Passive
The therapist moves the joint with no assistance from the patient.
An occupational therapist
A physical therapy
The joint is moved until slight resistance is palpated and then the
provides passive range
position is held for several seconds before returning the joint to
student
of motion stretches to a
demonstrates
stretching
the starting position. The patient may experience some mild
discomfort at the end range during passive stretching if the joint
is tight, but should not experience significant pain.
patient who has left
upper extremity
hemiparesis resulting
passive range of
motion exercises.
from a CVA.
Active
Range of
Motion
The patient actively moves the joint without assistance
from the therapist. The patient may move the joint
independently, or may move the joint during functional
activities.
Exercises/Ac
tivities
A patient reaches
Demonstration of
for cones placed
activities that incorporate
on a shelf to
improve active
-Tendon Gliding – specific AROM exercises that ensure
adequate movement of the various tendons of the hand
shoulder flexion.
occupational therapy
upper extremity active
range of motion.
A hand therapist
demonstrates tendon
within the structures of the hand.
gliding exercises for
patients to do at home.
Active Assistive
The patient actively participates in range of motion exercises with
A patient pushes a towel
A woman demonstrates
Range of
partial assistance from the therapist or with adaptations to the
forward and back on a
active assistive range of
exercise set-up to eliminate gravity during the exercises. Active
table top with both hands
motion exercises, using
Motion
Exercises
assistive range of motion exercises are completed when the
patient has too much upper extremity weakness to allow for full
active range of motion.
to improve shoulder
flexion.
her stronger hand to help
her weaker hand.
Joint
The therapist manually manipulates a joint to loosen the
An occupational therapist
Demonstration of
mobilization
ligaments holding the joint together to improve range of motion.
applies joint mobilization
The joint is stabilized on both sides. The joint is distracted by
techniques to a patient’s
joint mobilization to
pulling the distal side away from the proximal side, then a small,
index MP joint to improve
the MP and IP
gentle force is applied repeatedly in the direction of the desired
index finger flexion. She
joints.
range. Joint mobilization is followed by passive stretching or
follows joint mobilization with
active range of motion exercises.
active finger range of motion
exercises.
Scapula and Shoulder Movements
The Shoulder Girdle
The shoulder girdle, also called the pectoral girdle, is formed by:
• the scapulae, posteriorly,
• the clavicles anteriorly
• manubrium of the sternum, anteriorly
The girdle functions as the anchor that attaches the upper
extremities to the axial skeleton. The glenohumeral
joints/shoulder joints and the shoulder girdle work together in
carrying out upper extremity activities.
The shoulder girdle muscles
– Stabilize the scapula so the shoulder joint will have a stable base from which to move the humerus
– Contract to maintain the scapula in a relatively static position during shoulder joint actions
– Contract to move the shoulder girdle and to enhance movement of upper extremity when the
shoulder goes through extreme ranges of motion.
Movements of the scapula
The pectoral girdle or more specifically, the scapula movements includes:
1. Elevation: movement that allows the shoulder girdle to move upwards as in shrugging the shoulders.
2. Depression: the reverse of the elevation movement. The pectoral girdle and entire shoulder move
downwards.
3. Scapular Abduction – also called scapular flexion or protraction. A movement where the scapula
moves laterally away from the spinal column.
4. Scapular Adduction – also called scapular extension or retraction. This movement pulls the scapula
back towards the rib cage. Pinching the shoulder blades together illustrates adduction of the shoulder girdle.
5. Downward rotation: rotating the lower scapula towards the rib cage as in moving the arm behind the
back.
Movements of the Shoulder
1. Forward Flexion – The anterior movement of the humerus or upper arm at the glenohumeral joint.
2. Extension – A posterior movement of the humerus at the glenohumeral joint.
3. Abduction– A movement of the arm away from the midsagittal plane of the trunk. This movement involves both
glenohumeral joint motion and movement of the shoulder girdle.
4. Adduction – A movement of the arm toward the midsagittal plane of the trunk.
5. External Rotation – also called lateral or outward rotation. A movement around the long axis of the humerus at the
glenohumeral joint . When the elbow joint is flexed to 90’ external rotation would cause the hand to move laterally or
away from the midsagittal plane of the body.
6. Internal Rotation – also called medial or inward rotation. A movement around the long axis of the humerus
causing the hand, with the elbow flexed to 90’ to move toward the midsagittal plane of the body.
The Glenohumeral Joint
The glenohumeral joint/shoulder joint allows a wide range of movements including flexion, extension, abduction,
adduction, rotation (medial and lateral rotation), and circumduction.
Instrumental Activities of Daily Living, or IADLs, are tasks that a person must
complete to live independently in the community.
Common IADL tasks include:
• Meal preparation – includes tasks involved in preparing both cold and hot foods.
• Household cleaning – includes sweeping, vacuuming, dusting, washing dishes, cleaning bathrooms, etc.
• Yard work – includes mowing grass, raking leaves, pruning shrubs, and other tasks.
• Clothing care/Laundry – includes washing, drying, folding and putting away clothing.
• Time management – includes telling time, reading a calendar, following a schedule and making appointments.
• Using communication devices – includes using a landline phone, cellphone, computer, intercom, and medical alert
device.
• Money management – includes counting and using money, managing bank accounts, and following a budget.
• Community mobility – includes arranging for transportation, using public transportation, and locating various places in
the community.
• Shopping – includes identifying which stores sell specific goods, making shopping lists, and planning routes for
shopping trips.
• Managing medications – includes taking medications as prescribed, learning which medications treat which conditions,
learning about possible side effects, and discussing medications with health care providers.