MSK SKILLS CHECK 1

dynamic reversals

active motion changing from one direction to opposite without pause of relaxation PT resists patient moving in one direction. At reversal of direction, patient resists movement in opposite direction

scapula D2 extension

scapula rotates, abducts, and depresses "anterior depression, posterior elevation" - ipsilateral pocket

Scapula D1 flexion

scapula rotates, abducts, and elevates "anterior elevation, posterior depression" - ipsil elevation towards shoudler

Scapula D1 extension

scapula rotates, adducts and depresses "anterior elevation, posterior depression" - back pocket

scapula D2 flexion

scapula rotates, adducts, and elevates "anterior depression, posteror elevation" - toward neck

Upper Quarter Scan

(postural assessment) AROM Myotomes Reflexes Dermatomes

AROM (UQS)

** if painful w/ AROM, no overpressure - cervical flexion - cervical extension (no OP) - cervical lateral flexion - cervical rotation

Reflexes (UQS)

- C5-6 Biceps- thumb over. tendon, tap over thumb - C6 Brachioradialis- distal end of radial wrist - C7 Triceps- hold distal humerus, tap tendon above olecranon process

rhythmic initiation

- INDIC: difficulty initiating motion, movement too slow or fast, uncoordinated - GOALS: increase ability to imitate movement, teach pattern, improve coordination and stability - STEPS: 1) PROM 2) AAROM 3) AROM 4) resisted AROM

combination of isotonics

1) PT resists concentric agonist contraction 2) at end range, do isometric contraction 3) PT resists eccentric control of agonist back to starting position

alternating isometrics

1) PT resists isometric of agonist 2) PT does manual contacts 3) PT resists isometric of antagonist **isometric resistance in any plane and at any point in ROM

rhythmic stabilization

1) isometric contraction of agonist 2) resisted motion of antagonist pattern

stabilizing reversals

1) resistance to patient in one direction 2) resistance in another direction ** same as dynamic reversals but in very small arc of motion at mid-end ROM

GHJ open pack position

55 Abduction 30 Horizontal adduction neutral forearm

Dermatomes (UQS)

C4: upper trap, shoulder ridge C5: lateral brachium to elbow C6: lateral forearm/elbow to lateral 1/2 of hand 1-2 digits C7: lateral arm - 3rd digit C8: medial 1/2 hand to medial elbow T1: medal elbow to brachium T2: medal side of upper arm to axilla region

Belly Press Test

Indication- assess quality of subs cap when can't tolerate lift off/ so much IR Patient position: standing or seated Movement: 1) patient places hand on belly and IRs into abdomen 2) PT can resist or feel IR pressure to assess Results (+) elbow dropping behind body into extension= subs cap tear

Milking Maneuver (posterior band)

Indication: Indication: test for MCL (ulnar) injury and Posterior band Patient Position: seated with arm in shoulder flexion, elbow flexion, adduction, ER, some supination Movement: 1) PT pulls downward on patients thumb Results (+) reproduction of pain

Yergason's Test

Indication: ability of transverse humeral ligament. to hold biceps in groove Position: standing or seated Movement: 1) PT palpates biceps groove 2) PT stabilizes elbow against their trunk and in 90 degrees elbow flexion and pronation 3) resists forearm supination Modification- resist ER and supination simultaneously Results (+) pain during muscle contraction in bicipital groove. If tendon displaces out of groove= transverse humeral ligament tear

Patte Test (hornblower's sign)

Indication: assess integrity of heres minor Patient position; seated or standing Movement: 1) patient elbow flexed to 90, supported in 90 abduction in scapular plane 3) patient ER against resistance Results (+) if cannot ER ** careful that arm is in scapular plane always

External Rotation Lag Sign and Dropping Sign

Indication: assess integrity of infraspinatus and supraspinatus tendons Patient position: seated Movement: 1) elbow flexed passively to 90 while shoulder is kept in 70-90 elevation in scapular plane and full ER 2) PT supports elbow and holds wrist to ER 3) PT supports elbow and drops wrist Results (+) inability to maintain arm near full ER= supraspinatus tear (+) inability to maintain position and arm drops to neutral rotation= infraspinatus tear

Internal Rotation Lag Sign

Indication: assess integrity of subscapularis tendon Patient position: seated with arm on back palm away Movement: 1) arm held by PT (at elbow and wrist) in max IR and 20 extension behind patient 2) PT lets go of wrist only and patient is asked to maintain position Results (+) cannot hold position = rupture of subscap tendon

Anterior Drawer Test

Indication: assessing increased or decreased translation of humeral head relative to the glenoid Structures: 0 ABD= superior glenohumeral ligament 45 ABD= middle glenohumeral ligament 90 ABD= anterior band of inferior glenohumeral ligament Patient Position: supine with affected arm's hand in PT's axilla. Movement: 1) PT holds affected shoulder in different degrees of abduction with slight forward flexion and neutral rotation 2) PT holds scapula with left hand and presses scap spine forward with fingers. 3) PT grasps relaxed upper arm and pulls it anterior medially Results (+) pain, clicking, or an increase or decrease in humeral head translation

ROOS Test

Indication: assessment of thoracic outlet syndrome Patient position: seated Movement: 1) shoulders into 90 abduction, 90 elbow flexion, ER 2) open and close hand for 1-3 minutes Results (+) reproduction of pain, numbness, heaviness, tingling, and fatigue <3 min = thoracic outlet syndrome

Costoclavicular Manuever

Indication: suspected thoracic outlet compressing subclavian artery Patient position: seated Movement: 1) patient's arm hyperextended 2) PT palpating radial pulse 3) patient tucks chin, adducts, and retracts scap while protruding chest for 1 minute Results (+) diminished pulse or paresthesia

Speed's Test

Indication: evaluate bicipital involvement (tendonitis/ tenopathy) in bicipital groove Patient Position: seated with PT seated on affected side Movements: 1) Patient brought to 70-80 flexion with elbow extended, ER, and forearm supination 2) PT isometrically resists shoulder flexion at distal forearm 3) palpate bicipital groove Variation: Dynamic Speeds AKA SLAP test 1) resists shoulder flexion and elbow flexion as patient actively moves into shoulder flexion Results (+) resisted fwd flexion of shoulder causes bicipital groove pain SLAP tear (Dynamic Speed's) Localized pain d/t inflammation of bicep tendon

AC Anterior/ Posterior Glide

Indication: evaluate quantity and quality of joint play and end feel, increase ROM, increase into shoulder elevation ROM Patient Position: seated with PT behind Mobilizing Hand: grip around clavicle with your fingers just proximal to joint space. thumb typically on posterior aspect of clavicle, fingers on anterior surface Stabilizing Hand: fixate patient's scap by gripping acromion or coracoid process from anterior side and the spine of the scap from the posterior side Anterior Movement: use thumbs to glide clavicle anteriorly Posterior Movement: use fingers to glide clavicle posteriorly ** make sure there is no scapular rotation

SC posterior glide

Indication: evaluate quantity and quality of joint play and end feel. To increase retraction Patient position: supine Mobilizing Hand: thumb on anterior surface on proximal end of clavicle. flex index finger and place the middle phalanx along caudal surface of clavicle supporting thumb Stabilizing hand: on superior/ lateral side of shoulder Movement: push clavicle with your thumb posteriorly

Full Can Test

Indication: examine integrity of supraspinatus. Less likely to result in muscle weakness following pain Patient position: standing Movement: 1) patient in 90 flexion in scaption and 45 degrees ER (thumb up) 2) PT applies downward resistance at wrist or elbow Results (+) increase shoulder pain, ms weakness, or increase both pain and weakness

Neer Impingement Test

Indication: impingement of rotator cuff on anterosuperior glenoid rim or coracoacromial ligament Patient Position: seated Movement: 1) UE is passively forced into elevation in scapula plane while scapula is stabilized 2) Overpressure in ER, neutral then IR Results (+) pain at the end range of available ROM, ask patient to point to the pain

HRJ Dorsal Glide

Indication: increase extension Patient Position: supine with elbow extended and full supination Mobilizing Hand: grasp radius with pincer grip Stabilizing Hand: Stabilize humerus from medial side of arm Movement: glide radius dorsally (downward) with palm of hand ** In photo, small arrow

HRJ Volar Glide

Indication: increase flexion Patient Position: supine with elbow extended and full supination Mobilizing Hand: grasp radius with pincer grip Stabilizing Hand: Stabilize humerus from medial side of arm Movement: glide radius vollarly (upwards) with palm of hand ** In photo, big arrow

HUJ Distal Glide (inferior)

Indication: increase flexion patient position: supine, elbow off table, wrist against PT's shoulder Mobilizing Hand: force against prox ulna at 45 degree angle to shaft Stabilizing Hand: use belt or PT hand to stabilize humerus Movement: 1) scooping motion: distraction then distal distraction ** can be done in sidelying

HRJ Distraction

Indication: increase mobility of radius and correct and pushed elbow (prox displacement of radius) Patient Position: supine or sitting with elbow resting in extension/ supination Mobilizing Hand: grasp distal 1/3 of radius with pincer grip Stabilizing Hand: at humerus Movement: 1) long axis traction with PT weight shift

DRUJ Volar Glide

Indication: increase pronation Patient position: seated with elbow and forearm on resting position on table. Mobilizing Hand: on head of distal radius with fingers on dorsal surface and thenar eminence on volar surface Stabilizing Hand: fixates ulna on wrist lumbrical grip Movement: force distal radius volarly by directing force with your palm

PRUJ Dorsal Glide

Indication: increase pronation Patient position: seated with elbow and forearm on resting position on table. hand in hand Mobilizing Hand: on head of prox radius with fingers on dorsal surface and palm on volar surface Stabilizing Hand: fixates ulna on medial aspect of forearm Movement: force radial head dorsally by directing force with your palm * small arrow in picture

DRUJ Dorsal Glide

Indication: increase supination Patient position: seated with elbow and forearm on resting position on table. Mobilizing Hand: on head of distal radius with fingers on dorsal surface and thenar eminence on volar surface Stabilizing Hand: fixates ulna on wrist lumbrical grip Movement: force distal radius dorsally by directing force with your palm

PRUJ Volar Glide

Indication: increase supination Patient position: seated with elbow and forearm on resting position on table. hand in hand Mobilizing Hand: on head of prox radius with fingers on dorsal surface and palm on volar surface Stabilizing Hand: fixates ulna on medial aspect of forearm Movement: force radial head volarly by directing force with your fingers * big arrow in picture

HRJ Compression

Indication: reduce pulled elbow subluxation Patient position: seated or supine elbow flexed to 90 Mobilizing Hand: locking thumbs with patient's hand Stabilizing Hand: fixate humerus and prox ulna against side of PT body Movement: 1) compressive force along long axis of radius by pressure on thenar eminence and providing supination * for an acute subluxation, grade 5 quick motion needed

Hawkins Kennedy

Indication: shoulder impingement, rotator cuff involvement, subacromial bursitis Patient position: seated Movement: 1) PT stabilizes scapula 2) PT moves arm into 90 shoulder flexion in scaption 3) then arm is forced into IR 4) add horizontal adduction if no pain in scaption Results (+) reproduction of anterior shoulder pain in subacromial space. the more medial the position of the humerus is, it means the RC tendons are impinging at the coracoacromial arch/ process

Feagin Test

Indication: suspected anteroinferior instability. AKA inferior drawer test. Tests inferior instability/ superior GH ligament Position: seated Movement: 1) pt shoulder abducted to 90, elbow in full extension and arm on PT's shoulder 2) PT places both hands on proximal humerus over deltoid and interlocks fingers. 3) PT applies inferior forces to humerus and palpates for inferior movement. Results: (+) inferior movement (greater than uninvolved side), apprehension or pain

Anterior Apprehension Test

Indication: suspicion of anterior instability (sublux or dislocation). Patient Position: supine with PT on ipsilateral side. Mobilizing Hand: On wrist to apply ER Stabilizing Hand: on elbow for support Movement: 1) arm passively abducted to 90 (elbow at 90) 2) slowly ER Results: (+) apprehension or signs of pain. may replicate signs of dislocation ** pain without dislocation could indicate posterior impingement or rotator cuff

Modified Jobe's Subluxation- Relocation Test

Indication: suspicion of anterior instability (sublux or dislocation). When there was pain with apprehension test Patient Position: supine with PT on ipsilateral side. Mobilizing Hand: On wrist to apply ER Stabilizing Hand: on anterior shoulder to provide posterior force Movement: 1) arm passively abducted to 90 (elbow at 90) 2) slowly ER 3) posterior force at anterior shoulder at onset of apprehension Results: (+) decreased pain and/or increase ER

Maudsley Test

Indication: test fo lateral epicondylalgia AKA tennis elbow Patient Position: seated Movement: 1) PT palpates lateral epicondyle with patient in full elbow extension and pronation 2) PT stabilizes arm 3) PT provides downward resistance of 3rd finger Results (+) provocation of pain Extensor digitorum

Cozen's Test

Indication: test fo lateral epicondylalgia AKA tennis elbow Patient Position: seated or supine Movement: 1) Patient with forearm pronated 2) PT stabilizing elbow with thumb on lateral epicondyle and grips distal wrist with other hand 3) Patient extends and radially deviates wrist against resistance Results: (+) pain provocation if above lateral epicondyle= ECRL If on actual lateral epicondyle = ECRB

Mill's Test

Indication: test fo lateral epicondylalgia AKA tennis elbow Patient Position: seated or supine with forearm pronated Movement: 1) palpates lateral epicondyle 2) passively extends elbow and fully flexing wrist ** put into full stretch Results (+) pain in lateral epicondyle of elbow

Valgus Test (anterior band)

Indication: test for MCL (ulnar) injury and anterior band Patient position: supine Movement: 1) Patient in 20-30 elbow flexion, supination, 2) PT has one hand on wrist and other at LCL 3) Valgus stress is applied Results (+) reproduction of pain and increased joint space in valgus compared to unaffected

Moving Valgus Stress Test

Indication: test for chronic MCL (ulnar) injury Patient position: seated with PT behind Movement: 1) Patient brought into 90 ABD, 120 elbow flexion 2) PT applies valgus force to elbow until full ER and extends elbow to 30 degrees quickly Results (+) reproduction of medial elbow pain from 120-70 flexion

Golfer's Elbow

Indication: test for medial epicondylitis/ algia. Tenderness and pain distal/ anterior to medial epicondyle that worsens with resisted wrist flexion or passive stretch of ext/ supination #1: Position: patient seated with elbow in slight flexion and full supination Movement: resists flexion of wrist and ask where pain is #2 Position: seated with arm full supination Movement: PT puts elbow in passive max extension, ask where pain is Results (+) pain in medial epicondyle No specific tendon due to common origin

Posterior Apprehension Test

Indication: test posterior GHJ laxity and/ or posterior labrum Position: supine Movement: 1) 90 shoulder flexion, neutral rotation, 100-105 horizontal adduction with elbow flexion 2) PT places hand under scapula for support 3) PT provides posterior force on forearm/ olecranon area. Results: (+) apprehension and increased muscle guarding to prevent posterior shoulder dislocation ** MODIFICATION- move into more horizontal adduction or IR

Adson's Test

Indication: test to R/O neurovasculature compressions as a result of abnormalities of scalene muscles or cervical ribs. Patient Position: seated Movement: 1) arm at 15 abduction 2) palpates radial pulse 3) Patient inhales deeply and extends and rotates head to test side (looks at PT behind) Results (+) if pulse diminished or if paresthesia

Elbow flexion test

Indication: tests for ulnar entrapment/ cubital tunnel syndrome. Sx of pain/ numbness of 4-5th digits/ medial forearm, difficulty separating fingers, decrease grip strength, atrophy, and contracture Patient Position: sit with arms in anatomical position Movement: 1) ask patient to depress both shoulders and flex elbows max with full supination 2) Hold for 3-5 minutes and describe symptoms Results (+) tingling, numbness or tingling along ulnar nerve distribution

Pressure Provocation Test/ Tinels

Indication: tests for ulnar entrapment/ cubital tunnel syndrome. Sx of pain/ numbness of 4-5th digits/ medial forearm, difficulty separating fingers, decrease grip strength, atrophy, and contracture Patient position: seated Movement: 1) PT hold pt's in 20 flexion and supination 2) PT palpates prox cubital tunnel 3) Hold for 60 seconds 4) Add tinnels/ tapping to tunnel Results (+) sx provocation along ulnar nerve

Lift off Test

Indication: to assess quality of subscapularis of RC. may induce pain secondary to subacromial impingement Patient Position: sitting or standing Movement: 1) arm IR with hand in small of their back 2) Patient actively lifts hand away from back 3) PT provides resistive force to hand to assess subs cap. ** make sure no extension or other substitutions. only IR Results (+) inability to lift hand off back

Empty Can Test

Indication: to determine integrity of supraspinatus tendon: partial or complete rupture Patient position: standing with arm in scaption Movement 1) patient is in 90 flexion in scaption and IR 2) Resistance applied on forearm inferiorly Results (+) partial rupture= painful and weak test complete rupture= painless and weak test

Active Compression Test (O'Brien's)

Indication: to identify (superior) labral tears and AC joint abnormalities Patient Position: standing, arm flexed to 90, elbow extended, adducted 10-15. PT slightly behind and adjacent to test arm Movement: 1) PT's hand stabilizes scapula and clavicle by holding shoulder. Other hand on forearm. 2) IR (thumb down) and PT applies inferior force 3) Progress to ER (thumb up) and PT applies inferior force Results (+) for superior labral tear if pain or clicking in IR but NOT ER labral pain is deep. If its on top of shoulder, AC joint probs impacted

Crossover Impingement Test (Horizontal Adduction, AC joint impingement test)

Indication: to identify AC joint dysfunction and possible impingement of RC under AC Joint Patient position: seated Movement: 1) PT stabilizes scapula 2) Pt moves into 90 flexion and horizontal adduction 3) overpressure applied to elbow into more horizontal adduction Results (+) pain reproduced in AC region

Biceps Load (90 and 120)

Indication: to identify SLAP lesion Position: supine with arm abducted to 90 or 120, forearm supinated Movement: 1) Do anterior apprehension test- move into ER until apprehension 2) at apprehensive point, pt flexes elbow and PT resists elbow flexion Results (+) apprehension is unchanged or becomes more painful. Deep pain within shoulder during contraction indicates SLAP lesion

Crank Test

Indication: to identify bucket handle tears (type 3 or 4 labral tears) Patient position: supine Movements: 1) Elevate pt's ar, 160 in scapular plane 2) apply compression through elbow while rotating into IR and ER (large and small movements) Results (+) apprehension, pain in shoulder with ER, clicking and grinding

Anterior Slide

Indication: to identify superior labrum tear vs SLAP Patient Position: standing with hands on hips, thumbs posteriorly Movements: 1) PT's hand is on scapula to stabilize 2) Other PT hand is behind elbow 3) provide anterior and superior force to elbow Results (+) 1) if pain is localized to anterosuperior part of shoulder 2) there is a pop or click in anterosuperior region 3) reproduction of symptoms

GHJ Inferior Glide

Indication: to increase abduction and subacromial space Patient position: supine with GHJ in resting position. PT stands "outside" arm Mobilizing Hand: webspace of your hand around superior aspect of GHJ and thumb distal to acromion process Stabilizing Hand: table stabilizes scapula. Hold medial side of forearm Movement: glide humerus inferiorly

ST superior glide

Indication: to increase elevation and lateral rotation Patient Position: sidelying facing PT. PT scooping top arm so its relaxed Mobilizing Hand: top hand is across acromion process to control direction of motion. Stabilizing Hand: inferior hand scoops under medial border and inferior angle of scapula. inferior hand on whole scalula to assist with superior glide Movement: superior hand moves scap superiorly

GHJ Anterior Glide

Indication: to increase extension and ER Patient Position: prone with GHJ in resting position over edge of table. stabilize acromion and support arm with thigh Mobilizing Hand: ulnar border of hand distal to posterior angle of acromion process, fingers pointing away from you Stabilizing Hand: support patient's arm against your thigh and with outside hand Movement: weight of pt's arm against your thigh distracts the humerus. Apply force in anterior direction. Bend knees ** do not lift arm at the elbow and angle humerus. this could cause anterior subluxation ** could be done in supine

GHJ posterior glide

Indication: to increase flexion and IR Patient Position: supine with GHJ in resting position. PT stands between pt's arm and body Mobilizing Hand: on shoulder with ulnar side of hand just distal to anterior margin of the joint with fingers pointing slightly superiorly Stabilizing Hand: table stabilizes scap. support the patient's arm against your trunk and grasp distal humerus with your hand Movement: distract humerus and then provide posterior-lateral force

GHJ distraction

Indication: to increase overall ROM of GHJ (Grade 3) and pain control (Grade 1-2) Patient position: supine with GHJ in resting position Mobilizing Hand: place webspace of hand around superior aspect of GHJ and thumb distal to acromion process (over anterior shoulder) Stabilizing Hand: slide pt forearm between your trunk and elbow and grasp scapular on lateral surface Movement: move humerus laterally away from joint surface

ST Lateral Glide

Indication: to increase protraction, elevation, and lateral rotation Patient Position: sidelying facing PT. PT scooping top arm so its relaxed Mobilizing Hand: superior hand is on acromion process to control direction of motion Other Hand: fingers of inferior hand scoop under medial border and inferior angle of scapula Movement: both hands glide scapular in a lateral direction

ST Medial Glide

Indication: to increase retraction, depression, and medial rotation Patient Position: sidelying facing PT. PT scooping top arm so its relaxed Mobilizing Hand: superior hand is on acromion process to control direction of motion Other Hand: on lateral border to help with medial glide Movement: Both hands glide scap medially

ST Inferior Glide

Indication: to increase scapular depression and medial rotation Patient Position: sidelying facing PT. PT scooping top arm so its relaxed Mobilizing Hand: top hand is across acromion process to control direction of motion. Stabilizing Hand: fingers of inferior hand scoop under medial border and inferior angle of scapula Movement: superior hand glides acromion in an inferior direction

Varus Test

Indication: to test for RCL injury Patient position: seated Movement: 1) Pt elbow in 5-30 of full extension 2) PT stabilizes humerus and adducts ulna with pincer grip 3) end feel is noted Results (+) ???

Drop Arm Test

Indication: to test integrity of supraspinatus muscle and complete tear of RC Patient Position: seated or standing Movement: 1) PT passively move patient into 90 abduction 2) patient is asked to slowly lower arms to side Results (+) unable to slowly lower all the way down= complete rotator cuff tear ** watch for shoulder shrug

Sulcus Test

Indications: suspicious of inferior instability. assess superior GH ligament and coracohumeral ligaments Position: seated with involved arm 20-50 ABD and relaxed on their lab. unaffected hand grasps wrist of involved arm Movement: 1) PT stabilizes at acromion 2) PT grasps elbow and applied inferior force. 3) Grade laxity 0= no laxity 3+= maximum laxity Results: (+) depression greater than a finger breath between lateral acromion and HOH when inferior traction applied

triceps

Muscle Length Test: 1) pt supine or sitting 2) shoulder completely flexed 3) PT passively flexes elbow and stabilizes the shoulder in flexion Results: (+) limitation in flexion- measure with goni

Load and Shift Test (posterior instability)

Indications: test traumatic instability problems of GHJ. Patient Position: seated no back support, hand on thigh. good posture to limit protraction at shoulder. PT stands behind/ laterally Mobilizing Hand: on head of humerus with the thumb over posterior humeral head and fingers of anterior humeral head. Stabilizing Hand: over clavicle and scapula Movement: 1) Load the humerus- HOH pushed into glenoid to seat it properly in fossa. 2) shift- push humeral head postero/laterally 3) note amount of translation and end feel Results: (+) not equal to uneffected side, reproduction of symptoms **laxity alone doesn't prove or indicate that the shoulder is unstable

Load and Shift Test (anterior instability)

Indications: test traumatic instability problems of GHJ. Assesses anterior capsule and superior glenohumeral ligament Patient Position: seated no back support, hand on thigh. good posture to limit protraction at shoulder. PT stands behind/ laterally Mobilizing Hand: on head of humerus with the thumb over posterior humeral head and fingers of anterior humeral head. Stabilizing Hand: over clavicle and scapula Movement: 1) Load the humerus- HOH pushed into glenoid to seat it properly in fossa. 2) shift- push humeral head anterior/ medial 3) note amount of translation and end feel Results: (+) not equal to uneffected side, reproduction of symptoms **w/ anterior instability present, anterior translation will be possible but posterior absent bc of tight posterior capsule accompanying anterior instability.

Pec Major Sternal

Muscle Length Test: 1) UE moved passively into full ABD and horizontal ABD level with table Results: Arm should maintain contact throughout range, palpate anterior shoulder for movement into hand, watch for compensations

Pec Minor

Muscle Length Test: 1) pt supine 2) measure from bottom of acromion to table Results: shortening if lateral border of spine of scap is more than 1 inch off table

Lat Dorsi

Muscle Length Test: 1) pt supine 2) perform B shoulder flexion 3) stabilize trunk Results: lumbar lordosis or unable to do full shoulder flexion

pec major (clavicular)

Muscle Length Test: 1) support pt arm and move it off edge of table at ABD 90 or less 2) palpate anterior shoulder 3) UE should move toward the floor as PT moves it not horizontal abduction Results: - slight barrier- normal - hard barrier- abnormal - feel for humeral head moving anterior into hand, rib cage elevation, or pt unable to get humerus level with table

biceps

Muscle Length Test: 1). pt upright in chair or supine w/ shoulder off edge of table 2) place pt in hyperextension, forearm pronated and allow elbow joint to extend with relaxed wrist Results: (+) elbow not completely extend- measure with Goni

tapotement

Soft Tissue Mobilization percussion

compression (trigger point)

Soft Tissue Mobilization rhythmic pumping action with tips of fingers, palms, heels or fisted hand. compresses against bone

Petrissage

Soft Tissue Mobilization skin squeezed, rolled and compressed with firm pressure in circular direction; grasp tissue with palms of hands

friction (cross friction)

Soft Tissue Mobilization small transverse, or circular motions penetrating into deep tissue by moving tissue under skin

direct pressure

Soft Tissue Mobilization static pressure hold over specific structure, slow gradual release essential. not supported by latest research

effleurage

Soft Tissue Mobilization superficial: light touch, centripetal or centrifugal deep: firm pressure, centripetal

vibration

Soft Tissue Mobilization fine tremulous, rapid shaking or trembling of hands

Wright's Test (hyperabduction test)

indication: determine if TOS is caused by pec minor tightness/ impingement Patient position: standing Movement: 1) PT passivley hyper hor- abducts and has them turn away from affected side 2) PT palpates radial pulse 3) hold for 1-2 minutes Results (+) diminished radial pulse or paresthesia

SC superior glide

indication: evaluate quantity and quality of joint play and end feel. to increase depression Patient position: supine Mobilizing Hand: use both hands, fingers are placed superiorly and thumb inferiorly around clavicle Stabilization: thorax stabilizes sternum Movement: your index finger forces in a superior direction

SC Inferior Glide

indication: evaluate quantity and quality of joint play including end feel. Increase elevation Patient position: supine Mobilizing Hand: use both hands, fingers are placed superiorly and thumb inferiorly around clavicle Stabilization: thorax stabilizes sternum Movement: glide prox clavicle in inferior direction

ST Distraction

indication: increase overall scapular ROM Patient position: sidelying, facing PT. your arm is scooping top arm so it is relaxed Mobilizing Hand: top hand is across acromion process to control direction of motion. inferior hand scoops medial border and inferior angle of scapula Movement: superior hand moves scap medial and caudally while inferior hand lifts scapula from ribs. OR both hands may grasp medial border and apply gentle distraction

HUJ Distraction

indication: pain control, increase flexion or extension Patient position: supine, elbow over edge of table, humerus in restraint. elbow flexed and wrist resting on PT shoulder Mobilizing Hand: PT holds proximal ulna on volar surface Stabilizing Hand: PT fixates humerus with belt or hand Movement: 1) 45 angle to the shaft and glide perpendicularly ** can be done in sidelying. use bottom arm

Myotomes (UQS)

isometric hold x 5 sec - C4: shoulder shrug - C5: shoulder abduction - C6: elbow flexion/ wrist extension - C8: finger flexion - T1: finger ABD, ADD

Cervcial Myotomes (UQS)

isometric resistance - cervical flexion (C1/2) - cervical extension (C1/2) - cervical lateral flexion (C3) - cervical rotation

UE D1 extension

shoulder extension abduction pronation UD finger extension "grab child's hand/ throw apple"

UE D2 extension

shoulder extension adduction IR pronation UD finger/ wrist flexion "grab the sword"

UE D2 flexion

shoulder flexion abduction ER supination RD finger/ wrist extension "sword in air"

UE D1 flexion

shoulder flexion adduction ER supination RD finger flexion "pick apple"