Rotator Cuff Shoulder Girdle Tests
2
ROUND EARTH PUBLISHING http://www.round-earth.com/RotatorCuffTests.html[10/1/2008 3:17:20 PM] Mouth Wraparound Test Infraspinatus DBAL Middle Deltoid SBAL Subscapularis DBAL Posterior Deltoid SBAL Supraspinatus Teres Major SFAL Latissimus Dorsi SFAL/BFL Levator Scapula DBAL Splenius Cervicis SL Teres Minor DBAL Coracobrachialis This is the single most important test for shoulder girdle dysfunction. Combine with Backrub Test , below. 1. Position patient’s head at 45 o to shoulders. 2. Patient reaches arm around back of head to mouth. Substitution: Increasing head angle to reach hand. Maintain proper posture. A. No restriction: Short upper arms should reach corner of mouth; Normal arms: center of mouth; Hypermobile arms: opposite side of mouth. B. Restriction: Primarily middle deltoid/infraspinatus with other possible involvement.If patient is: Unable to reach back of neck: subscapularis. Able to reach to ear only: infraspinatus. Able to reach over head but not behind it: posterior deltoid, coracobrachialis. Unable to hold arm in abduction: supraspinatus. Unable to rotate head to 45 o for this test. See Cervical Rotation Test . Backrub Test Coracobrachialis Anterior Deltoid SBAL 1. Patient reaches across lower back to opposite side. 2. Note distance achieved and difference between one side and the other. 3. Press at elbow, pushing arm downward and slightly to the rear (away from the body). A. No restriction: Knuckles of palm extend beyond spine. B. Restriction: Knuckles reach only to midline. Restriction rare in persons of normal weight. Failure, or pain or weakness on resistance: severe restriction in coracobrachialis, or a severely injured anterior deltoid; see Arm Abduction Test. Unable to reach behind back: supinator; see Supinator Test. Hand to Shoulder Blade Test Infraspinatus DBAL Anterior Deltoid SBAL Supraspinatus Subscapularis DBAL Supinator Pectoralis Major FF, SFAL Latissimus Dorsi SFAL, BFL Teres Minor DBAL 1. Patient reaches open hand behind back, wrist straight. 2. Observe hand level relative to spine of scapula. 3. Measure any side-to-side variation. Substitution: Bending wrist to reach higher up back. A. No restriction: Fingertips reach spine of scapula. B. Restriction: Fingertips cannot reach spine of scapula. If patient: Can barely reach hip pocket: infraspinatus (primary) and anterior deltoid (secondary). See Arm Abduction Test. Supraspinatus usually involved with infraspinatus (see Mouth Wraparound Test) or upper trapezius (see Cervical Lateral Flexion Test ).
Transcript of Rotator Cuff Shoulder Girdle Tests
ROUND EARTH PUBLISHING
http://www.round-earth.com/RotatorCuffTests.html[10/1/2008 3:17:20 PM]
Mouth Wraparound Test
Infraspinatus DBALMiddle Deltoid SBALSubscapularis DBALPosterior Deltoid SBALSupraspinatusTeres Major SFALLatissimus Dorsi SFAL/BFLLevator Scapula DBALSplenius Cervicis SLTeres Minor DBALCoracobrachialis
This is the single most important test for shoulder girdledysfunction. Combine with Backrub Test , below.
1. Position patient’s head at 45o to shoulders.2. Patient reaches arm around back of head to mouth.
Substitution: Increasing head angle to reach hand. Maintainproper posture.
A. No restriction: Short upper arms should reach corner of mouth;Normal arms: center of mouth; Hypermobile arms: opposite sideof mouth.
B. Restriction: Primarily middle deltoid/infraspinatus with otherpossible involvement.If patient is:
Unable to reach back of neck: subscapularis.Able to reach to ear only: infraspinatus.Able to reach over head but not behind it: posterior deltoid,coracobrachialis.Unable to hold arm in abduction: supraspinatus.Unable to rotate head to 45o for this test. See CervicalRotation Test.
Backrub Test
CoracobrachialisAnterior Deltoid SBAL
1. Patient reaches across lower back to opposite side.2. Note distance achieved and difference between one side
and the other.3. Press at elbow, pushing arm downward and slightly to the
rear (away from the body).
A. No restriction: Knuckles of palm extend beyond spine.
B. Restriction: Knuckles reach only to midline. Restriction rare inpersons of normal weight.
Failure, or pain or weakness on resistance: severerestriction in coracobrachialis, or a severely injured anteriordeltoid; see Arm Abduction Test.Unable to reach behind back: supinator; see SupinatorTest.
Hand to ShoulderBlade Test
Infraspinatus DBALAnterior Deltoid SBALSupraspinatus Subscapularis DBALSupinator Pectoralis Major FF, SFALLatissimus Dorsi SFAL, BFLTeres Minor DBAL
1. Patient reaches open hand behind back, wrist straight.2. Observe hand level relative to spine of scapula.3. Measure any side-to-side variation.
Substitution: Bending wrist to reach higher up back. A. Norestriction: Fingertips reach spine of scapula. B. Restriction:Fingertips cannot reach spine of scapula. If patient:
Can barely reach hip pocket: infraspinatus (primary) andanterior deltoid (secondary). See Arm Abduction Test.Supraspinatus usually involved with infraspinatus (seeMouth Wraparound Test) or upper trapezius (see CervicalLateral Flexion Test).
ROUND EARTH PUBLISHING
http://www.round-earth.com/RotatorCuffTests.html[10/1/2008 3:17:20 PM]
Is slightly restricted after treating infraspinatus: teres minor.Can overcome shortening and weakness through passivemotion (such as walking fingers or wrist up back:subscapularis.Has restriction with pain in supinator reference area ofthumb; difficulty bending elbow to reach behind back. SeeSupination Test.Still has restriction after working the above: pectoralismajor (see Shoulder Drop Test), latissimus dorsi (seeOverhead Reach Test).
Overhead Reach Test
Triceps DBAL Teres Major SFAL Latissimus Dorsi SFAL, BFL
1. Patient brings arms together over top of head as if clappinghands.
2. Determine whether patient can bring arms in to touch ears,palms together, fingers level.
Substitution: Tilting arms away from short side to equalize reach.
A. No restriction: Can touch ears with insides of arms, arms reachsame height, fingertips aligned.
B. Restriction:
With severely shortened triceps or teres major, one arm or(or both) will be bent, and it may be difficult or painful topress arms to ears.If not possible to move arm behind ears, teres major (seeMouthwrap Test), coracobrachialis (see BackrubTest), and latissimus dorsi may also be involved.
Over Shoulder Reach
Triceps DBAL
1. Raise arm to shoulder level, arm out, palm up.2. Flex elbow to place palm on same-side shoulder, palm
down.3. Slide palm down back, pointing elbow to ceiling.
Substitution: Dropping head forward to bring ear forward of arm.Shifting arm out to side to relieve tightness in triceps. Keep and
elbow perpendicular to body.
A. No restriction: Elbow vertical or beyond ear.
B. Restriction: Cannot point elbow to ceiling.
Note: The photo from which this sketch was made was not astaged shot. It was actual Before & After range of motion.Compare active triceps trigger points in B with improved range ofmotion immediately after treatment (A).
