Side view
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MMT to know for practical What to wear: look professional-ish, wear sports bra and shorts underneath. Ideal alignment and plumb line-ANT, POST, and SIDE views Muscle attachments Bony attachments (joints) Only measure goniometry on affected side UPPER EXTREMITY Shoulder Muscle Action AG position Pressure Anterior Deltoid As: Shoulder flexor Middle deltoid As: Shoulder abductor Posterior As: Sitting: Maintain some abduction (as this is the action of the ant. Delt) Sitting: Elbow 90° and arm abducted to 90° (palm face down) Sitting: Stabilize humerus downward GE position Substitutions Sidelying Elbow 90°, arm moves into flexion Hike shoulderupper trap. Sometimes middle trap too Dorsal humerus downward Humerus Upper trap Shoulder Sidelying: Upper trap deltoid Shoulder extensor and horizontal abductor Slight medial rotation, extension, some abduction (less than 90°) ***note: test AROM standing so chair is not in the way toward flexion and horizontal adduction slight adduction, elbow 90° Pectoralis majorclavicular Pectoralis majorsternal Latissimus dorsi and teres major Horizontal adductor As: Shoulder extensor Prone: Arm medially rotated and extended at elbow Downward on Scapula distal (same side) humerus(towards table) as a group Prone Elbow 90°, Towards lateral rotation, Sidelying: Maintain internal rotation. Stabilize on shoulder, or palpate for muscle contraction Prone entire arm Medial rotators Horizontal adductor Distal forearm? Pec minor (protraction) humerus on table, towel under humerus Lateral rotators as a group Prone Elbow 90°, humerus on table towel under humerus perpendicular to forearm Distal forearm? off edge of tablewatch cubital fossa to determine arc of motion Prone Posterior deltoid entire arm off edge of tablewatch cubital fossa to determine arc of motion Scapular Stabilizers *anything less than a 3 is a 2, no GE posn 2sink out of position for PROM, line up with fibers and 1 hand on proximal anterior humerus and the other on the scapula”up and in” motion Muscle Action AG position Pressure Stabilize Substitutions Serratus anterior Protraction and Sitting Down and back Inferior angle of Anterior deltoid upwardly rotates 120° shoulder retraction (back) scapula scapula. Holds flexion, scapular and downward scapula close to upward rotation, rotation(down) thoracic wall protraction can also give PROM: scap arm in full pressure directly on protract and scapula (i.e. if you elbow retract while had pain with extension supporting arm glenohumeral joint) Middle trapezius Scapular Prone Humerus, straight Thorax (cross Rhomboids (arm AROM: prone, retraction Arm extended, down. Also may arms) drops to chicken squeeze scapula elbow at 90° and apply pressure wing) together laterally rotated directly on scapula Post delt (more (thumbs up!) on the inf. Angle arm) upwardly into protraction (use if there is pain holding arm up) Lower trapezius Retraction in Prone Against forearm, Below scapula, Posterior deltoid upwardly rotated Arm adducted to downwardly opposite side (horizontal position “Y” shape towards table abduction) middle /superman trap (arm will sink position down to 90° adb) rhomboids Adduct, elevate, and downwardly rotate scapula Prone “chicken wing” posn, maintain adduction. This will allow pressure into downward rotation Distal humerusScapular protraction and upward rotation. (push inf angle laterally) Also may apply pressure directly on scapula on the inf. Angle upwardly into protraction (use if there is pain holding arm up) Thorax (when transitioning from PROM, hand that was under shoulder) Elbow Muscle Biceps brachioradialis triceps Action Elbow flexion in supination AG position Sitting Pressure Distal forearm Stabilize shoulder Elbow flexion in zero position Sitting Against lower forearm in direction of extension Against forearm in direction of flexion Under elbow Supine Arm overhead, shoulder in approximately 90° flexion Forearm and Wrist ***No GE, anything less than 3 is 2 Muscle Action AG position Supinator “turn palm Supine arm *establish 3 towards your overhead (to shoulder” eliminate *establish 3 biceps contribution) Pronator Bring palm Supine teres away from Elbow 90° shoulder Wrist Pressure Lumbrical grip on distal RADIUS towards pronation Lumbrical grip on distal RADIUS towards supination Stabilize Elbow Distal humerus Distal humerus, over biceps Substitutions Biceps brachi in sitting GE position supine (arm out to side) (or supine) Supine sidelying Substitutions Upper trap LOWER EXTREMITY Hip Muscle Psoas and rectus (hip flexors) together AG position Sitting or supine pressure Towards extension perpendicular to femur Gluteus medius (hip abductors) as a group **Test PROM in SUPINE pull pelvis down to prevent “hip hike” Gluteus maximus (hip extensors) Side-lying Leg (tibia/fibula) Bottom leg slightly (unless knee joint bent issue present) Adductors as a group Side-lying Fist on table for support thigh of bottom leg Medial rotators as a group Sitting Lateral leg Lateral rotators as a group sitting Medial leg Stabilize pelvis GE position Side-lying Substitutions Pelvis supine Flexion/medial rotation (rectus femoris/psoas; TFL, Gmed, Gmin) prone Hold top leg up, shift hand from hip (AROM) to proximal thigh Counter pressure at medial distal thigh Counter pressure at lateral side of lower thigh Side-lying Knees slightly bent Supine None? None? Hip hike Knee Muscle Quadriceps (knee extension) Hamstrings (as a group) Ankle Muscle Anterior tibialis Posterior tibialis AG position Sitting Pt. can lean back on hands If you see weakness, move to: Supine To get 1st arc, need to be in supine Prone Pressure Down Place my forearm under pt’s thigh and hand on their opposite thigh Stabilize thigh GE position Side lying Full knee flxn to extension Movement Full knee flxn to extension Stabilize with your hip Substitutions Hip flexors (psoas Distal legtowards extension Pelvis? Side lying See above gastrocnemius AG position Seated Foot dorsi flexed and inverted Seated Foot plantar flexed and Pressure Towards plantar flexion and eversion Stabilize Distal leg Towards dorsiflexion and inversion Distal leg GE position Substitutions Peroneals Eversion Inversion Gastrocnemius/soleus *remember to distract calcaneus while applying pressure) inverted Side-lying Or sitting if applying resistance (resistance trumps gravity) for pt comfort. Side lying (see above) To test together: 20 reps lifting heel while standing OR Prone, knee extension, feet off table To test soleus: keep knee flexed to eliminate gastroc Into inversion ***in side lying, include inversion due to gravity in arcs. Medial footinto eversion Plantar surface of foot Distal leg Thigh sitting Hip medial rotation Sitting Hip lateral rot? Side-lying? IDEAL PLUMB LINE Side view: Slightly posterior to apex of coronal suture Thru external auditory meatus Through odontoid process of axis Midway through shoulder Through bodies of lumbar vertebrae Through sacral promontory Slightly posterior to center of hip joint Slightly anterior to axis of knee joint Slightly anterior to lateral malleolus Through calcaneocuboid joint
