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Minnesota State University, Mankato

Minnesota State University, Mankato
Athletic Training

Manual Muscle Testing

Page address: http://ahn.mnsu.edu/athletictraining/spata/shouldermodule/muscletesting.html

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