Manual Muscle Testing

Biceps Brachii

Origin of Short Head

Apex of coracoid process of scapula

Origin of Long Head

Supraglenoid tubercle of scapula

Insertion

Tuberosity of radius & aponeurosis of biceps brachii

Action

Flexes the shoulder joint & the long head may assist with abduction if the humerus is laterally rotated

Nerve

Musculocutaneous, C5–6

Patient

Supine or sitting

Fixation

Examiner places one hand under elbow to cushion it from table pressure

Test

Elbow flexion slightly less than or at right angle, with forearm in supination

See Test

Brachialis

Origin

Distal half of anterior surface of humerus & medial & latera intermuscular septa

Insertion

Tuberosity & coranoid process of ulna

Action

With the origin fixed, flexes the elbow joint moving the forearm toward the humerus
With the insertion fixed, flexes the elbow joint moving the humerus toward the forearm

Nerve

Musculocutaneous & small branch from radial, C5–6

Patient

(see above)

Fixation

(see above)

Test

(see above)

See Test

Coracobrachialis

Origin

Apex of coracoid prcess of scapula

Insertion

Medial surface of middle shaft of humerus, opposite deltoid tuberosity

Action

Flexes & adducts the shoulder joint

Nerve

Musculocutaneous, C6–7

Test

Shoulder flexion in lateral rotation with the elbow completely flexed and forearm supinated

Pressure

Against anteromedial surface of the lower third of the humerus in the direction of extension and slight abduction

See Test

Triceps Brachii

Origin of Long Head

Infraglenoid tubercle of scapula

Origin of Lateral Head

Lateral & posterior surfaces of proximalone half of body of humerus & lateral intermuscular septum

Origin of Medial Head

Distal two thirds of media & posterior surfaces of humerus below the radial groove & from medial intermuscular septum

Insertion

Posterior surface of olecranon process of ulna and antebrachial fascia

Action

Extends the elbow joint, with the long head assisting in adduction and extension of the shoulder joint

Nerve

Radial, C6–8, T1

Patient

Supine or prone

Fixation

Shoulder abducted to 90°, nuetral with regard to rotation, & supported between the shoulder & elbow by the table

Test

Extension of the elbow joint (to just short of full extension)

Pressure

Against the forearm in the direction of flexion

See Test

Anconeus

Origin

Lateral epicondyle of humerus on the posterior surface

Insertion

Lateral side of olecranon process and upper one fourth of posterior surface of body of ulna

Action

Extends elbow joint & may stabilize the ulna during pronation & supination

Nerve

Radial, C7–8

Patient

(see above)

Fixation

(see above)

Test

(see above)

Pressure

(see above)

See Test

Supraspinatus

Origin

Middle two thirds of supraspinatus fossa of scapula

Insertion

Superior facet of greater tubercle of humerus & shoulder joint capsule

Action

Abducts the shoulder joint & stabilizes the head of the humerus in the glenoid cavity during movements of the glenohumeral joint

Nerve

Suprascapular, C4–6

Patient

Sitting or standing with arms at side with head & neck extended & laterally flexed to the same side & the face rotated toward the opposite side

Fixation

None necessary since maximum pressure is not required

Test

Initiation of abduction of humerus to approximately 15°

Pressure

Against the forearm in the direction of adduction

See Test

Middle Deltoid

Origin

Anterior border, superior surface & lateral one third of the clavicle

Insertion

Deltoid tuberosity of humerus

Action

Abduction of the glenohumeral joint

Nerve

Axillary, C5–6

Patient

Sitting

Fixation

Stabilize opposite shoulder

Test

Glenohumeral abduction without rotation

Pressure

Against the dorsal surface of the distal end of the humerus if the elbow is flexed, or against the forearm if the elbow is extended

See Test

Anterior Deltoid

Origin

Lateral margin & superior surface of acromion

Insertion

Deltoid tuberosity of humerus

Action

Flexion of the glenohumeral joint & medially rotate when supine

Nerve

Axillary, C5–6

Patient

Supine

Fixation

If the scapula is not propertly stabilized by the serratus anterior & the trapezius then the examiner should stabilize the scapula

Test

Glenohumeral abduction in slight flexion & medial rotation; one hand of the examiner is placed under the patient's wrist to make sure that the elbow is not lifted by reverse action of the wrist extensors which may occur if the patient is allowed to press the hand down on the chest

Pressure

Against the anterior surface of the arm just above the elbow in the direction of adduction toward the side of the body

See Test

Posterior Deltoid

Origin

Inferior lip of posterior border of the spine of the scapula

Insertion

Deltoid tuberosity of humerus

Action

Extend the glenohumeral joint & in a prone position cause lateral rotation

Nerve

Axillary, C5–6

Patient

Prone

Fixation

The scapulamust be held stable by scapular muscles or by the examiner

Test

Horizontal abduction of the shoulder with slight lateral rotation

Pressure

Against the posterolateral surface of the arm in a direction obliquily downward midway between adduction & horizontal adduction

See Test

Teres Major

Origin

Dorsal surfaces of the inferior angle & lower third of the lateral border of the scapula

Insertion

Crest of lesser tubercle of humerus

Action

Medially rotates, adducts & extends the glenohumera joint

Nerve

Lower subscapular C5–7

Patient

Prone

Fixation

Opposite shoulder

Test

Extension & adduction of the humerus in the medially rotated position, with the hand resting on the posterior iliac crest

Pressure

Against the arm above the elbow in the direction of abduction & flexion

See Test

Pectoralis Major (Upper/ Clavicular)

Origin

Anterior surface of sternal one half of the clavicle

Insertion

Crest of the greater trochanter of the humerus; these fibers are more anterior & caudal than the lower fibers

Action of Upper Fibers

Flex & medially rotate the glenohumeral joint & horizontally adduct the humerus toward the opposite shoulder

Action of Muscle as a Whole

With the origin fixed, it adducts & medially rotates the humerus
With the insertion fixed, it may assist in elevating the thorax as in forced inspiration

Nerve

Lateral pectoral, C5–7

Patient

Supine

Fixation

The examiner holds the opposite shoulder firmly on the table while the triceps maintains elbow extension

Test

Starting with the elbow extended, & the shoulder in 90° flexion and slight medial rotation, the humerus is horizontally adducted toward the sternal end of the clavicle

Pressure

Against the forearm in the direction of horizontal abduction

See Test

Pectoralis Major (Lower/ Sternal)

Origin

Anterion surface of sternum, cartilages of ribs 1–6/7 & aponeurosis of the external oblique

Insertion

Crest of the greater trochanter of the humerus; these fibers are more posterior & cranial than the upper fibers

Action of Lower Fibers

Depress the shoulder girdle by attachment on humerus, & obliquely aduct the humerus toward the opposite iliac crest

Action of Muscle as a Whole

With the origin fixed, it adducts & medially rotates the humerus
With the insertion fixed, it may assist in elevating the thorax as in forced inspiration

Nerve

Lateral & medial pectoral, C6–8, T1

Patient

Supine

Fixation

Examiner places one hand on opposite iliac crest to hold the pelvis firmly on the table, if abdominals are weak the thorax should be stabilized instead of the pelvis, while the triceps maintains extension

Test

In elbow extension & shoulder flexion & slight medial rotation, adduction of the humerus obliquely toward the opposite iliac crest

Pressure

Against the forearm obliquely in a lateral & cranial direction

See Test

Pectoralis Minor

Origin

Superior margins, outer surfaces of ribs 3–5 near the cartilages & from the fascia over coresponding intercostal muscles

Insertion

Medial border & superior surfaces of the coracoid process of the scapula

Action

Origin fixed, tilts the scapula anteriorally (rotates the scapula about a coronal/ frontal axis) so that the coracoid process moves anteriorly & caudally, while the inferior angle moves posteriorly & medially
Insertion fixed, assists in forced inspiration

Nerve

Mostly medial pectoral but also lateral pectoral, C6–8, T1

Patient

Supine

Fixation

At rib cage on same side if needed

Test

Forward thrust of the subjects shoulder with arm at side without pushing down with same hand

Pressure

Against the anterior aspect of the shoulder downward toward the table

See Test

Latissimus Dorsi

Origin

Spinous processes of T6–12, ribs 9/10–12, through the thoracolumbar fascia from the lumbar & cervical vertebrae & posterior one third of the external lip of the iliac crest, a slip from the inferior angle of the scapula

Insertion

Intertubercular groove of the humeris

Action

Origin fixed, medially rotates, adducts & extends the glenohumeral joint; insertion fixed, assists in tilting the pelvis anteriorly and laterally, when acting bilaterally this muscle assists in hyperextension of the spine & anterior rotation of the pelvis

Nerve

Thoracodorsal, C6–8

Patient

Prone

Fixation

One hand of the examiner may apply counter–pressure laterally on the pelvis

Test

Adduction of the arm, with extension, with medial rotation of the pelvis

Pressure

Against the forearm in the direction of abduction & slight flexion of the arm

See Test

Subscapularis

Origin

Subscapular fossa

Insertion

Lesser tubercle of the humerus & glenohumeral joint capsule

Action

Medially rotates the glenohumeral joint & stabilizes the head of the humerus in the glenoid fossa during motion of the joint

Nerve

Upper & lower subscapular, C5–7

Patient

Prone

Fixation

Arm rests on table with the examiners hand near the elbow stabilizing the humerus to ensure a rotation action by preventing adduction or abduction, the rhomboides should stabilize the scapula

Test

Medial rotation of the humerus with the elbow at a right angle

Pressure

Using the forearm as a lever, pressure is applied in the direction of lateral rotation of the humerus

See Test

Infraspinatus

Origin

Medial two thirds of the infraspinous fossa of the scapula

Insertion

Middle facet of greater tubercle of the humerus & the glenohumeral joint capsule

Action

Laterally rotates the glenohumeral joint & stabilizes the head of the humerus in the glenoid fossa during motion of the joint

Nerve

Suprascapular, C4–6

Patient

Prone

Fixation

Arm rests on the table with the examiners hand near the elbow stabilizing the humerus to ensure a rotation action by preventing adduction or abduction, the middle & lower trapezius should stabilize the scapula

Test

Lateral rotation of the humerus with the elbow held at a right angle

Pressure

Using the forearm as a lever , pressure is applied in the directin of medial rotation of the humerus

See Test

Teres Minor

Origin

Upper two thirds & dorsal surface of the lateral border of the scapula

Insertion

Lowest facet of greater tubercle of humerus & glenohumeral joint capsule

Action

Laterally rotates the glenohumeral joint & stabilizes the head of the humerus in the glenoid fossa during movements of the joint

Nerve

Axillary, C5–6

Patient

(see above)

Fixation

(see above)

Test

(see above)

Pressure

(see above)

See Test

Rhomboides Major/Minor

Origin of Major

Spinous processes of T2–5

Insertion of Major

Fibrous attachment to medial border of scapula between spine & inferior angle

Origin of Minor

Ligamentum nuchae, spinous processes of C7 & T1

Insertion of Minor

Medial border at root of spine of scapula

Action

Adduct & elevate the scapula & rotate it sp the glenoid cavity faces caudally

Nerve

Dorsal scapular, C4–5

Fixation

None necessary as long as adductors of the shoulder are strong enough to hold the arm as a lever

Test

Extension & adduction of the humerus in the medially rotated position, with the hand resting on the posterior iliac crest

Pressure

Against the hand in the direction of flexion

See Test

Rhomboides Major/Minor (Alternate)

Origin of Major

Spinous processes of T2–5

Insertion of Major

Fibrous attachment to medial border of scapula between spine & inferior angle

Origin of Minor

Ligamentum nuchae, spinous processes of C7 & T1

Insertion of Minor

Medial border at root of spine of scapula

Action

Adduct & elevate the scapula & rotate it sp the glenoid cavity faces caudally

Nerve

Dorsal scapular, C4–5

Patient

Prone

Fixation

90° of abduction & medial rotation of the glenohumeral joint

Test

Adduction & elevation of the scapula with downward rotation

Pressure

Against the forearm in the direction of horizontal adduction

See Test

Levator Scapulae

Origin

Transverse processes of C1–4

Insertion

Medial border of scapula between superior angle & root of spine of scapula

Action

Elevates the scapula & assists in rotation so the glenoid fossa faces caudally

Nerve

Dorsal scapular, C3–5

Patient

Sitting

Fixation

Opposite shoulder

Test

Shoulder elevation

Pressure

Against superior shoulder in an inferior direction

See Test

Trapezius (Upper)

Origin

External occipital protuberance, medial one third of superior nuchal line, ligamentum nuchae & spinous process of C7

Insertion

Lateral one third of the clavicle & acromion process of the scapula

Action

Lateral rotation & elevation of the scapula

Nerve

Spinal portion of cranial nerve XI (accessory), ventral ramus, C2–4

Patient

Sitting

Fixation

None

Test

Elevation of the acromial end of the clavicle and scapula

Pressure

Against the shoulder in the direction of depression & against the head in the direction of lateral flexion

See Test

Trapezius (Middle)

Origin

Spinous processes of T1–5

Insertion

Medial margin of acromion & superior lip of spine of scapula

Action

Scapular adduction & stabilization

Nerve

Spinal portion of cranial nerve XI (accessory), ventral ramus, C2–4

Patient

Prone

Fixation

(Deltoid, teres minor, & infraspinatus must give necessary fixation for the arm to be used as a lever) examiner provides fixation at opposite scapular area to prevent trunk rotation

Test

Adduction of the scapula with upward rotation & without elevation of the shoulder girdle, met by 90° abduction of arm with lateral rotation

Pressure

Against the forearm in a downward direction toward the table

See Test

Trapezius (Lower)

Origin

Spinous processes of T6–12

Insertion

Tubercle at apex of spine of scapula

Action

Rotation upward rotationof the scapula

Nerve

Spinal portion of cranial nerve XI (accessory), ventral ramus, C2–4

Patient

Prone with shoulder at edge of table

Fixation

One hand below the scapula on the opposite side

Test

Supporting the weight of the arm, the examiner places the scapula in a position of adductin with some lateral rotation

Pressure

When support is released if the scapula remains adducted place pressure in the direction of abduction

See Test

Serratus Anterior

Origin

Outer surfaces & superior borders of ribs 1–8/9

Insertion

Costal surface of medial border of scapula

Action

Scapular abduction, upward rotation while also holding medial border against ribcage

Nerve

Long thoracic, C5–8

Patient

Supine

Fixation

None, unless shoulder or elbow musculature is weak; in this case arm would be supported in the perpendicular position

Test

Abduction of the scapula projecting the upper extremity anteriorly

Presure

Against the subjects fist or elbow downward through the extremity in the direction of scapular adduction, slight pressure can ne added to the lateral border of the scapula

See Test