for hypertonicity or trigger points, particularly where they meet at the zygomatic arch. Cross-fiber friction, myofascial release, and trigger point therapy for masseter and Orbicularis oculi strength test This tests for Bell’s palsy, a dysfunction of cranial nerve VII due to trauma or injury. The client should be in a supine or seated position with their eyes closed. The therapist will attempt to open the affected eye with a clean or preferably gloved hand while the client resists. Bell’s palsy may be indicated if the client is unable to keep their eye closed against the therapist’s resistance, particularly if accompanied by the pathology’s other symptoms such as facial paralysis or numbing, headaches, decrease in the ability to taste, or changes in saliva production. If Bell’s palsy is suspected, refer the client to a physician. Note: Bell’s palsy is not an indication of a stroke. It may be caused by recent infections,
temporalis may restore normal mobility of the TMJ (Cleland et al., 2020).
so the therapist should screen for contraindications of an infectious nature (Cleland et al., 2020). Self-Assessment Quiz Question #1 Which orthopedic test for the neck would most likely be performed when a nerve impingement is suspected? a. Posterior neck extensors endurance test. b. Cervical compression test. c. Three knuckle test. d. Swallowing test.
SECTION II: ORTHOPEDIC TESTS FOR THE SHOULDER GIRDLE
Upper trapezius strength test This tests for a weakness of the upper trapezius muscle. The client will be lying supine with their arm abducted to 90 degrees on the side being tested. The massage therapist rotates the client’s head away from the side being tested, then applies light anteriorly directed pressure so that the Scapular adduction strength test This tests for weakness of the adductors/retractors of the scapula, rhomboids, and middle trapezius. The client should be in the prone position on a therapy table. Their arms will be abducted to 90 degrees and their elbows flexed to 90 degrees so that they are draped off the table. The client is asked to move their elbows toward the ceiling while trying to squeeze their scapulae together while the therapist resists the movement. (Squeezing the scapulas together is an important part of this test as failure to do so will recruit strength from the posterior aspect of the deltoid. See the Posterior deltoid strength test This tests for weakness of the posterior deltoid. The client should be in the prone position, their arm on the side being tested abducted to 90 degrees and elbow flexed to 90 degrees so that it is draped off the table. The client will hold their arm in this position while resisting the therapist’s push at the elbow toward the floor. A weakness of the posterior portion of the deltoid muscle is indicated by the client’s Shoulder extensors test This tests for hypomobility of the muscles that extend the shoulder, particularly the latissimus dorsi. The client will be laying supine with their knees bent to 45 degrees so that the latissimus dorsi is not stretched due to spinal lordosis. The client then fully flexes their arms over their head until their arms are resting on the therapy table or otherwise aligned with the client’s body. Hypomobility, normally due Pectoralis major length test This tests for hypertonicity of the pectoralis major. The client should be in the supine position on the therapy table with the edge of their torso parallel to the edge of the table. The client’s arm is then abducted to 90 degrees and released. Hypertonicity of the muscle’s sternal and costal fibers is indicated by the arm not dropping below table-top level. To Pectoralis minor length test This tests for hypertonicity of the pectoralis minor. The client will be supine on the table. The therapist sits at the head of the table and observes the position of the shoulders.
chin appears to be approaching the shoulder joint while the client resists the motion. A weak or dysfunctional upper trapezius muscle is indicated if the client is unable to resist the therapist’s strength. In this case, a client may want to consult a physical therapist or trainer (Cleland et al., 2020). following Posterior Deltoid Strength Test.) Weak rhomboids or middle trapezius muscles are indicated by the client being unable to maintain strength against the therapist’s resistance. Note that hypertonic abductors of the shoulder girdle—particularly the serratus anterior and pectoralis minor—may play a role in weak scapular adduction, in which case directional massage, PNF stretches, and trigger point therapy of these muscles may improve the strength of rhomboids and middle trapezius (Cleland et al., 2020). inability to resist the therapist’s directed pressure. If a client has pain occur near the spine of the scapula, it is the muscle tendon at the attachment that may be injured. The massage therapist should check for signs of inflammation, and if none is present, can proceed with cross-fiber friction along the distal aspect of the spine of the scapula to initiate healing (Cleland et al., 2020). to the hypertonicity of the latissimus dorsi and possibly teres major and posterior deltoid muscles, is indicated if the client cannot rest their arms on the table. Myofascial release, PNF stretches, and trigger point therapy (for the bellies of latissimus dorsi and teres major) are all indicated (Cleland et al., 2020). test the clavicular fibers of the pectoralis major, the client’s arm should be abducted to 135 degrees. Hypertonicity of the clavicular fibers is indicated by the arm not dropping below table level. Cross-fiber friction along the medial clavicle, lateral sternum, and inferior ribs may help relieve the hypertonicity (Cleland et al., 2020).
Hypertonicity of the pectoralis minor is indicated by an abduction of the shoulder over 20 degrees. The therapist should then press down on the affected side (bilaterally
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Book Code: MPA0825
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