MEDIDAS PARA DAR RESPUESTA A LA DIVERSIDAD

Muscle strength testing in the shoulder will determine the ability of muscles to provide stability and movement. As shoulder muscle weakness can be caused by disuse as well as overuse, it is essential for the therapist to collate these results with those of alignment and movement analysis and muscle length testing.

The major shoulder muscles that

contribute to movement and stability which should be tested are outlined below.

51 Evaluation of the shoulder

Figure 7.7.Test for length of medial and lateral

Muscle(s)/movement:Anterior deltoid/flexion.

Starting position:Sitting with elbow flexed to 90°.

Test:Place palm down on acromion to stabilise scapula and palpate anterior deltoid. Client resists posterior palmar pressure applied on the anterior arm around lower bicep.

Weakness:Decreased ability to push arm forwards-upwards.

Shortness:Decreased range of motion in extension.

Muscle(s)/movement:Posterior deltoid/extension.

Starting position:Sitting with elbow flexed to 90°.

Test:Place palm down on acromion to stabilise scapula and palpate long head of triceps with thumb, and posterior deltoid with palm. Pressure is now applied with other hand on the distal humerus in an anterior direction.

Weakness:Decreased ability to push arm backwards-upwards.

Shortness:Decreased range of motion in flexion.

52 _{Corrective Exercise: A Practical Approach}

Muscle(s)/movement:Middle deltoid/abduction.

Starting position:Sitting with elbow flexed to 90°.

Test:Stabilise the acromion with palm on middle deltoid. Other palm applies pressure on lateral epicondyle of humerus, as client abducts arm.

Weakness:Decreased ability to lift arm in abduction; downward translation of humeral head.

Shortness:Decreased range of motion in adduction.

Muscle(s)/movement:Pectoralis major/adduction.

Starting position:Sitting with elbow flexed to 90°.

Test:Stabilise acromion with palm on middle deltoid. Other palm applies pressure on medial epicondyle of humerus, as client adducts arm. Palpate pectoralis major during movement.

Weakness:Decreased ability to adduct arm.

Shortness:Decreased range of movement in abduction.

53 Evaluation of the shoulder

Figure 7.10.Middle deltoid strength test Figure 7.11.Pectoralis major/latissimus dorsi strength

Muscle(s)/movement:Subscapularis, pectoralis major/internal rotation.

Starting position:Sitting with elbow flexed to 90°.

Test:Stabilise humerus by holding elbow joint by waist. Place other hand on wrist and instruct client to rotate arm inwards against resistance.

Weakness:Decreased ability medially to rotate humerus; humerus assumes position of lateral rotation.

Shortness:Range of motion limited in lateral rotation and overhead flexion.

Muscle(s)/movement:Infraspinatus, teres minor/external rotation.

Starting position:Sitting with elbow flexed to 90°.

Test:Stabilise humerus by holding elbow joint by waist. Place other hand on wrist and instruct client to rotate arm outwards.

Weakness:Decreased ability laterally to rotate humerus; humerus assumes position of medial rotation.

Shortness:Range of motion limited in medial rotation.

54 _{Corrective Exercise: A Practical Approach}

Muscle(s)/movement:Upper trapezius, levator scapulae/scapula elevation.

Starting position:Standing with arms at sides.

Test:Place each palm on acromion, using thumbs to palpate upper trapezius. Apply downward pressure as client shrugs shoulders.

Weakness:Decreased ability to elevate scapulae and extend cervical spine; the presence of scapula abduction as rhomboid stabilisation is lost; medial rotation.

Shortness:Scapula starts movement from a position of adduction and elevation; shortness accompanies serratus weakness (rhomboid dominance).

Muscle(s)/movement:Rhomboid/scapula retraction.

Starting position:Prone, lying with test arm held away from table in medial rotation and 90° abduction. The scapula should be slightly elevated.

Test:One hand is placed on the opposite scapula to fixate it. Pressure is applied

against the forearm in a downward direction, and client resists.

Weakness:Decreased ability to retract scapulae; abduction of scapula and forward shoulder position in static posture.

Shortness:Scapula starts movement from a position of adduction and elevation; weak serratus.

55 Evaluation of the shoulder

Figure 7.14.Upper trapezius/levator scapulae strength

test

Muscle(s)/movement:Serratus anterior/scapula protraction.

Starting position:Standing with arm flexed to 90° and elbow flexed to approximately 90°.

Test:Stand behind client and place palm on thoracic spine to stabilise trunk. Cup the other hand around the flexed elbow and apply resistance posteriorly. Client to resist motion by pushing the elbow forwards.

Weakness:Winging of scapula; difficulty in flexing arm.

Shortness:Abduction of scapula during static alignment, often accompanied by weak rhomboids; forward shoulder position.

Muscle(s)/movement:Teres major/extension, adduction.

Starting position:Prone, lying with arm in extension and adduction; elbow is flexed to allow hand to rest on lower back.

Test:Pressure is applied against arm, just above elbow, in the direction of abduction and flexion.

Weakness:Decreased ability to hold extension/abduction.

Shortness:Full range of motion limited in lateral rotation and abduction; scapula will begin to rotate simultaneously with

flexion/abduction. 56 _{Corrective Exercise: A Practical Approach}

Figure 7.16.Serratus anterior strength test

Muscle(s)/movement:Latissimus dorsi.

Starting position:Prone, lying with arm straight by the sides, in medial rotation.

Test:Pressure against forearm in direction of abduction and slight flexion. Client tries to adduct and extend arm.

Weakness:Inability to adduct arm towards body. Lateral trunk flexion is reduced.

Shortness:Limitation in flexion/abduction. Depression of shoulder girdle downwards. Seen in long-term crutch-walking patients. 57 Evaluation of the shoulder

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CORRECTIVE EXERCISE FOR