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 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. 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 Acromioclavicular (AC) joint shear test This tests for the integrity of the AC joint ligaments. The client should be in a seated position with the therapist standing behind the client. The therapist will interlace their fingers with the palm of one hand on the lateral aspect of the clavicle and the other palm on the client’s lateral spine of the scapula. The therapist then squeezes their hands Adhesive capsulitis abduction test This tests for frozen shoulder at the glenohumeral joint. The client can be seated or standing. The therapist stands behind the client and holds the client’s affected arm above the elbow and at the wrist and attempts to slowly abduct the client’s arm out to 90 degrees. Frozen shoulder is indicated by pain accompanied by a limited ROM (under 90 degrees). The therapist can apply most manual therapy
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). aligned with the client’s body. Hypomobility, normally due 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. 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). if both sides appear affected) and ask if the client feels a stretch in the pectoralis minor area to confirm their observations. Cross-fiber friction at the coracoid process, as well as PNF stretches, directional massage, and myofascial release may be of use in relieving the hypertonicity (Cleland et al., 2020). together. Dysfunctional AC joint ligaments are indicated by pain or excessive movement of the joint. The therapist should use cold therapy to reduce pain before attempting cross-fiber friction on the AC joint to initiate tissue repair. Avoid moving the shoulder joint and perhaps stabilize it with a sports wrap or tape (Cleland et al., 2020). technique for the hypertonic muscles around the affected joint but should let the client know that such techniques are not a long-term solution for this condition since its cause is, in most cases, idiopathic (unknown) and affect the joint capsule itself rather than the musculature (Cleland et al., 2020).
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Book Code: MLA1225
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