Manual Muscle Test()

: (resistance) (gravity) .

Manual Muscle Test 1) (1) ( ) (2) ) C6 : C7 : push-up T12 : stair climbing L1 : LLB L4 : SLB

2) (, , ) , ) ulnar nerve palsy claw deformity knuckle bender splint lumbrical dorsal interossei - finger abductor M.P jt flexor palmar interossei - finger adductor flexor digitorum profundus

3) , . :

4)
zero, trace : passive ROM Ex poor : active-assistive ROM Ex fair : active ROM Ex good : resistive ROM Ex

5) . (1) (2) , (3)

Manual Muscle Test

Normal(N). 5. 100% : complete range of motion against gravity with maximal(full) resistance at end of range Good(G). 4. 75% : complete range of motion against gravity with some resistance at end of range Fair(F). 3. 50% : complete range of motion against gravity without resistance

 Poor(P). 2. 25% : complete range of motion without gravity Trace(T). 1. 10% : no range of motion slight contraction Zero(Z). 0. 0% : no range of motion no contraction
Good, Poor NFTZ

(neck)

Neck Flexion(I V) : atlanto-occipital jt(motion)

Gr Posture supine shoulder relaxed
1) : 2) : ,
1)

Muscle & Nerve Sternocleido mastoid () : accessory N (Cr11) and ventral primary division (C2,3)

Technique cervical spine full ROM flexed. resistance : forehead antero-lateral neck flexion head Rt,Lt rotation cervical spine flexed(, ) resistance : above ear cervical spine full ROM flexion cervical spine partial ROM flexion cervical spine full ROM flexion (no gravity) neck flexion , sternocleidomastoid muscle
,

Stabilization lower thorax

N G

2)

lower thorax

F P T Z

lower thorax

sidelying with head supported by examiner

supine shoulder relaxed

Note()

1) shoulder flat on the table. 2) accessory muscle weakness turtle neck position

Neck Flexion(0~60) Goniometer Stationary arm

Along midaxillary line of trunk

Position of patient Sitting & standing

Moving arm
In line with the mastoid process

Neck Extension(V I)
Gr Posture Technique
1) cervical spine full ROM extended. resistance : occiput

Muscle & Nerve

1) Trapezius (upper fiber) : accessory N(Cr11) and ventral primary division (C3, 4) 2) Semispinalis capitis : dorsal primary divisions of the cervical nerves 3) Splenius capitis : dorsal primary divisions(C4~8) 4) Splenius cervicis : dorsal primary divisions(C4~8) 5) Sacrospinalis 6) Semispinalis cervicis : dorsal primary divisions of spinal nerves

Stabilization

N G

prone with neck flexed

2) extensor : head Rt. rot extended extensor : head Lt. rot extended cervical spine full ROM extended
cervical spine partial ROM extended

upper thorax area and scapulae

sidelying with neck flexed & head supported by examiner

cervical spine full ROM extended (no gravity)

T Z

prone with neck supported

neck extension posterior neck muscle ,

Note()

: upper trunk flat on the table (back extensor )

Neck Extension(0 ~ 40)

Position of patient Sitting & standing

Goniometer
Stationary arm Moving arm

Along midaxillary line of trunk

In line with the mastoid process

(Trunk)

Trunk Flexion
Gr Posture supine with hands behind neck supine with arms at side

Muscle & Nerve

Technique Trunk full ROM flexed.(scapulae inferior angle table )

Stabilization
Lower limb Hip flexor pelvis

Rectus abdominis () : intercostal N (7 ~ 12) O: crest of pubis, ventral surface of symphysis pubis I : costal cartilages5,6,7

G F
P T Z

Trunk partial ROM flexed. (head, shoulder tip, scapulae superior border table )
cervical spine flex lower trunk depress lumbar area table flat Pelvis tilt

anterior abdominal wall ,

Trunk Flexion(0 ~ 45) Goniometer Stationary arm

5 (perpendicular to the floor with axis of the goniometer just above the ilium)

Position of patient

Moving arm

Sitting & standing, sidelying

7 5 (parallel to contour of the back)

Trunk Rotation- Rt. side rotation(LR)

Lt. External abdominal oblique Rt. Internal abdominal oblique

Muscle & Nerve

Gr

Posture

Technique

Stabilization Lower limb

1) 2) 3)Hip flexor pelvis

External abdominal oblique () : intercostal N (T8 ~ 12) Internal abdominal oblique () : intercostal N (T8 ~ 12)

supine with hands behind neck

Trunk flex thorax rotate.(shoulder scapulae table )

supine with arms at side

Sitting with arms relaxed at side

( scapulae table )

Lower limb

F P T Z

( scapula table )

Thorax rotate Note : fair partial ROM poor (sitting )

Lt. Thorax Rt. Pelvis lower edge ,(pectoralis major trunk rot. shoulder table )

pelvis

supine neck support

Trunk Rotation(0 ~ 40)

Position of patient

Goniometer

Stationary arm
()

Moving arm

Sitting

Trunk Extension
Gr Posture Technique
<Lumbar spine> lower thorax table lumbar spine extend. resistance : lower thoracic area <thoracic spine> thoracic spine horizontal position extend resistance : upper thoracic area full ROM thoracic & lumbar spine extend partial ROM thoracic & lumbar spine extend

Muscle & Nerve

Stabilization

Erector spinae ()
: dorsal primary division adjacent spinal nerves iliocostal thoracis longissimus thoracis spinalis thoracis iliocostalis lumborum

pelvis
Pelvis & lower part of thorax

N G

prone

Quadratus lumborum ()
: ventral primary division(T12, L1)

P
T Z

Pelvis & lower limb

extension spinal extensor muscle ,

Note : table

Trunk Extension(0 ~ 30)

Goniometer Stationary arm
5 (perpendicular to the floor with axis of the goniometer just above the ilium)

Position of patient

Moving arm

Sitting & standing, sidelying

7 5 (parallel to contour of the back)

Elevation of pelvis
Gr Posture
Supine(prone)

Muscle & Nerve

Technique
Thorax table edge pelvis elevation. resistance : above ankle jt full ROM pelvis thorax full ROM elevation

Stabilization

Quadratus lumborum ()
: ventral primary division(T12, L1)

N G F

Thorax

Supine Standing()

iliocostalis lumborum ()
: dorsal primary division of adjacent spinal N

P T Z

Supine

full ROM elevation pelvis thorax elevation quadratus lumborum muscle , erector spinae lateral edge lumbar area

Supine

Hip Flexion
Gr Posture
Sitting with legs over edge of table

Muscle & Nerve

Technique
table edge Hip jt full ROM flexion. resistance : proximal to knee jt resistance : X 90 (proximal knee jt) full ROM Hip jt full ROM flexion ( ) Knee flexion(hamstring tension ) Hip jt inguinal ligament ,

Stabilization

Psoas major ()
: ventral primary division(L2, 3)

N G F

Pelvis
(posterior tilt )

iliacus()
: femoral N(L2, 3)

Supine Sidelying (upper limb supported) Supine (leg Supported)

P T Z

Note : sartorius hip jt ext. rot, abduction tensor fascia lata hip jt int. rot, abduction

Hip Flexion(0~90, 0~125(knee jt flexed) )

Position of patient Supine

Goniometer
Stationary arm Moving arm

Parallel to the long axis of the trunk

In line with the lateral midline of the femur

Axis : greater trochanter

Hip Flexion, abduction & lateral rotation(knee flexed)

Gr Posture
Sitting with legs over edge of table

Muscle & Nerve

Technique
Patient heel cord tibia shaft hip flexed. resistance : above knee( ) above ankle()

Stabilization

N G
Sartorius ()
: femoral N(L2, 3)

Pelvis
Normal full ROM (no gravity) Passive hip flexion, abduction, ext. rot ilium ASIS , (posterior tilt )

P
T Z

Supine

Supine

Note : iliopsoas rectus femoris

Hip Extension(0~10-20)
Gr Posture Technique full ROM hip extension. resistance : proximal knee jt
Gluteus maximus hamstring Knee flexion hip extension.

Muscle & Nerve

Stabilization

Gluteus maximus
() : inferior gluteal
(L5, L1,2)

N G
F

prone with knee straight

prone with knee flexion
Sidelying with upper leg supported, lower leg hip flex, knee flex

pelvis

Hamstring
Biceps femoris (long head) : sciatic N(S1,2,3) tibial portion Semitendinosus Semimembranosus : sciatic N(L5,S1,2) tibial portion

resistance : proximal knee jt

full ROM hip extension.

P
T Z

prone

hip extension gluteus maximus palpate ,

Note : hip flexor contracture, back muscle weakness , hip jt 90 flexed prone .( sidelying ) pelvis table

Hip Extension(0~15)
Position of patient
Prone

Goniometer Stationary arm Moving arm

Parallel to the long axis of the trunk

Axis : greater trochanter

In line with the lateral midline of the femur

Hip Abduction(0~45)
Gr Posture Technique
Lateral rotation full ROM abduction. resistance : proximal to knee jt Lateral rotation full ROM abduction.

Muscle & Nerve

Stabilization

Gluteus medius ()
: superior gluteal N (L4, 5, S1)

N G F

Sidelying

Pelvis
Pelvis & another limb

P
T Z

supine
supine

rotation full ROM abduction

Hip abduction gluteus medius , ( : femur greater trochanter)

Note : lateral trunk muscle pelvis hip flexion tensor fascia latae

Hip Abduction(0~45)
Position of patient
Goniometer Stationary arm Parallel with a transverse line between the ASIS Moving arm In line with the lateral midline of the femur

Supine

Axis : ASIS

Hip Abduction from flexed position(knee extended)

Gr Posture
Sidelying with lower leg knee flexed exam leg Hip jt 45 flexed

Muscle & Nerve

Technique
Hip jt 30 abduction resistance : above knee jt

Stabilization

N G
Tensor fascia Lata ()
: superior gluteal N (L4, 5, S1)

Pelvis

F P T Z

Hip jt 30 abduction

Sitting with knee extension (long-sitting position)

Trunk table 45 . Hip jt 30 abduction

Hip jt abduction tensor fascia lata knee jt ,

Pelvis & other leg

Hip Adduction(0~20-30)
Gr Posture
Sidelying with Upper leg 25 abducted supported Supine, Hip jt lower leg thigh upper limb hip jt adduction resistance : proximal knee jt lower leg thigh upper limb hip jt adduction

Muscle & Nerve

Technique

Stabilization

Adductor magnus Adductor longus Adductor brevis : obturator N(L3,4) Gracilis : obturator N(L3,4) Pectineus : femoral N(L2,3,4)

N G F P T Z

rotation full ROM

hip jt adduction
Hip jt adduction thigh pubic rami ,

25 abducted

Pelvis & other leg

Note : (fair grade) sidelying position

hip flexor hip med. rot pelvis hamstring hip lat. rot pelvis

Hip Adduction(0~20)

Position of patient

Goniometer

Stationary arm
Parallel with a transverse line between the ASIS

Moving arm In line with the lateral midline of the femur

Supine

Axis : ASIS

Hip Lateral rotation(0~40-50)

Muscle & Nerve Gr Posture
Sitting with legs over edge of table pad

Technique pelvis table edge hip jt lat. rot. resistance : above ankle jt

Stabilization

Six outward
Obturator externus : obturator N(L3,4) Obturator internus Quadratus femoris Piriformis Gemellus superior Gemellus inferior : Branches from Sacral plexus (L4,5,S1,2) Gluteus maximus : inferior gluteal N (L5, S1,2)

N G F

Above knee

full ROM lat. rot.

standing

(knee jt counter pressure )

knee flex, hip jt abducted

full ROM hip jt lat. rot. full ROM hip jt lat. rot.
( end range . proximal knee jt, ankle jt)

Pelvis
(ankle )

supine

T Z

hip jt lat. rot.

supine

lat. rotator M greater trochanter ischium ,

Note : resistance , sitting position N, G, F supine

Hip Lateral rotation(0~45)

Position of patient

Goniometer

Stationary arm
Parallel to a transverse line across the ASIS of the pelvis or the table top. ( 90 )

Moving arm In line with the crest of the tibia ()

Sitting & Supine

Axis : patella

Hip Medial rotation(0~35-45)

Gr Posture
Sitting with legs over edge of table pad

Muscle & Nerve

Technique
pelvis table edge hip jt full ROM med. rot.

Stabilization

Gluteus minimus ()
: superior gluteal N (L4, 5, S1)

N G F
P T Z

Above knee

resistance : above ankle jt

Supine or standing (hip jt lat. rot)

full ROM hip jt med. rot.

Tensor fascia Lata ()

: superior gluteal N (L4, 5, S1)

Pelvis

med. rot.

Supine

tensor fascia lata ASIS gluteus minimus gluteus medius tensor fascia lata ,

Note : (med. Rot) test test pelvis knee jt extension or hip jt extension & adduction

Hip Medial rotation(0~45)

Goniometer

Position of patient

Stationary arm
Parallel to a transverse line across the ASIS of the pelvis or the table top. ( 90 )

Moving arm In line with the crest of the tibia ()

Sitting & Supine

Axis : patella

Knee Flexion(0~135-145)
Gr Posture Technique Stabilization

Muscle & Nerve

< Biceps femoris >

lateral hamstring
Biceps femoris(long) : sciatic N(S1,2,3) tibial portion Biceps femoris(short) : sciatic N(L5,S1,2) peronial portion

N G

prone

lower leg slight lat. rot knee flexion( 90 knee flexed) resistance : above ankle jt

pelvis

< Semitendinosus & Semimembranosus >

lower leg slight med. rot knee flexion resistance : above ankle jt

medial hamstring
Semitendinosus Semimembranosus : sciatic N(L5,S1,2) tibial portion

F P T Z

Sidelying with Knee extended & upper leg supported Prone with one leg slight flexed & support

90 knee flexed(90 ) Gastrocnemius weak knee 10 flexion

femur

Knee jt full ROM flexion

knee jt flexion Hamstring muscle proximal knee jt palpate ,

Note : sartorius,

gracilis,

gastrocnemius muscle ankle plantar flex

hip flex & ext. rot, hip add,

Knee Flexion(0~135-145)
Goniometer

Position of patient

Stationary arm

Moving arm
Parallel to the fibula in line with the lateral malleolus.
( )

Parallel to the femur on a line from the lateral condyle Prone() to the greater trochanter. & Supine ( )

Knee Extension(135-145~0)
Gr Posture
Sitting with legs over edge of table pad Sidelying (upper leg supported) exam leg knee flexion

Muscle & Nerve

Technique Terminal locking full ROM Knee extension resistance : above ankle jt Hip jt lat. rot full ROM Knee extension

Stabilization

N G
Quadriceps
: femoral N (L2,3,4)
Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius

Thigh
(quadriceps femoris )

F P T Z

Above knee jt thigh

full ROM Knee extension
(quadriceps femoris )

Supine
knee flexion flex knee jt support

knee extension Patella tibial tuberosity quadriceps femoris tendon ,

Note : locked knee . hip jt hip jt

Knee Extension(135-145~0)
Goniometer

Position of patient

Stationary arm

Moving arm
Parallel to the fibula in line with the lateral malleolus.
( )

Parallel to the femur on a line from the lateral condyle Prone() to the greater trochanter. & Supine ( )

Ankle Plantar Flexion(0~45-55)

Gr Posture Knee straight standing

Muscle & Nerve

Technique

Stabilization

N
Gastrocnemius : tibial N(S1,2) Soleus : tibial N(S1,2) Triceps sural
(achilles tendon)

Weight-bearing test Leg floor 4~5 heel full ROM plantar flexed

G F
P T Z

2~3

Sidelying position knee extended & foot midposition

heel floor full ROM (plantar flexed)

full ROM plantar flexion
Calcaneus tendon leg posterior muscle fiber , full ROM plantar flexed

Lower leg

= Calf muscle

( ) P, T, Z

Supine, N foot in over end G of table

resistance : heel cord

resistance

Lower leg

Muscle & Nerve

Gr

Posture Knee slight flexed & standing position

Knee 90 flexion &

Technique floor 4~5 heel full ROM plantar flexed full ROM plantar flexed(maximal) resistance : heel cord

Stabilization

prone position

Lower leg

2~3

G
Soleus

full ROM plantar flexed(some) resistance : heel cord heel floor (plantar flexed) full ROM plantar flexion full ROM plantar flexion
Calcaneus tendon ,

Lower leg

Lower leg Lower leg

P T Z

Sidelying (knee slight flexed & foot mid position)

Ankle Plantar Flexion(0~50)

Goniometer Stationary arm Parallel to the fibula. () Moving arm

Position of patient
Sitting & Supine (knee extended)

In line with the lateral edge of the heel and the head of the fifth metatasal(5)

Foot dorsiflexion and Inversion(0~15-25)

Muscle & Nerve Gr Posture Technique relax of toes, foot dorsiflexion and inversion . resistance : medial dorsal aspect of the foot foot full ROM dorsiflexion and inversion foot partial ROM dorsiflexion and inversion foot full ROM dorsiflexion and inversion
Tendon ankle medial volar aspect muscle fiber antero-lateral portion ,

Stabilization

N G
Tibialis anterior : deep peroneal N(L4,5,S1)

Sitting with legs over edge of table

Ankle jt

F P

supine

T Z

Foot dorsiflexion (0~20)

Goniometer Stationary arm Parallel to the fibula. () Moving arm

Position of patient
Sitting & Supine (knee extended)

In line with the lateral edge of the heel and the head of the fifth metatasal(5)

Foot Inversion(0~30-40)
Muscle & Nerve Gr Posture Technique
full ROM foot inversion resistance : forefoot medial border
flexor digitorum longus & flexor hallucis longus toe flexor relax.

Stabilization

Tibialis posterior : tibial N(L5,S1)

N G
F

Sidelying
( plantarflexion)

Lower leg

Supine ()

full ROM foot inversion

P T Z

Tibialis posterior tendon medial malleolus & navicular bone , malleolus ,

Note : inversion supination, adduction, plantar flexion

Foot Eversion(0~15-25)
Muscle & Nerve
Gr Posture Technique full ROM foot eversion resistance peroneus brevis - foot lateral border peroneus longus-head of first metatarsal plantar surface derotating motion full ROM foot eversion Stabilization

Peroneus longus Peroneus brevis : superficial peroneal N (L4,5,S1)

N G F

Sidelying with ankle midposition

Lower leg

Supine (ankle midposition)

foot eversion

T Z

peroneus brevis

supine

tendon - bone of fifth metatasal proximal, muscle bulk - leg lat. Lower part

peroneus longus
tendon - fibula head distal leg lat. upper

Note : eversion pronation, abduction, dorsiflexion

Flexion of metatarsophalangeal jt of Toes(0~35-45)

Gr Posture Technique Stabilization

Muscle & Nerve

Lumbricals
1) first lumbrical : medial plantar (L4, 5) 2) 2,3,4 lumbrical : lateral plantar (S1, 2)

1. Flexion of MP jt of lateral 4 toes.

<Lumbricals> Patient extents the IP jt & flex the lateral 4 toes, MP jt Resi : proximal low of phalanges 2. Flexion of MP jt of hallux. <flexor hallucis brevis> Patient flex the hallux Resi : proximal phalanges

Metatarsal

N G

Supine (ankle midposition)

Flexor hallucis brevis

: medial plantar (L4, 5, S1)
Note :

First metatarsal

F P

full ROM . Partial ROM

1. MP jt flexor PIP - DIP jt extension . lumbricals 1 muscle power 2. N, G grade .

Flexion of interphalangeal jt of Toes(0~50-80)

Muscle & Nerve Gr Posture Technique <flexor digitorum brevis> Flexion of PIP jt of lateral 4 toes. toe flex Resi : middle row of phalanges
Supine (midposition)

Stabilization proximal row of phalanx

flexor digitorum longus

N flexor digitorum G
brevis
: medial plantar (L4, 5)

: tibial (L5, S1)

<flexor digitorum longus> Flexion of DIP jt of lateral 4 toes. toe flex Resi : distal row of phalanges

middle row of phalanx

flexor hallucis longus

: tibial (L5, S1)

<flexor hallucis longus> Flexion of IP jt of hallucis. Resi : beneath distal phalanx

proximal phalanx

F P

full ROM flexion

partial ROM flexion

Extension of metatarsophalangeal jt of Toes & interphalangeal jt of Hallux (0~75-85)

Muscle & Nerve Gr Posture Technique 1. extension of MP jt of lateral 4 toes. <extensor digitorum longus & brevis> toe extend Resi : proximal of phalanges Stabilization Metatarsal area

extenor digitorum longus : deep peroneal (L4,5, S1) extenor digitorum brevis : deep peroneal (L5, S1) extensor hallucis longus : deep peroneal (L4,5, S1)

N G

Supine (midposition)

2. extension of MP jt of hallux. <medial division of extensor digitorum brevis> 1st toe MP jt extend Resi : proximal of phalanges 3.extension of IP jt of hallux. <extensor hallucis longus> 1st toe IP jt extend Resi :dorsal surface

1st metatarsal

proximal phalanx

full ROM extension

partial ROM extension

Scapular Abduction and upward Rotation

Gr Posture Technique Stabilization

(U/E)

Muscle & Nerve

serratus anterior
: long thoracic N (C5,6,7)
serratus anterior winging scapular push-up

N G

Supine shoulder 90 arm flexed, elbow resistance : forearm & elbow jt extend downward & inward ( scapular winging
)

Supine Shoulder 90 flexed

arm . scapular winging (elbow extensor elbow forearm )

thorax

Sitting

@ winging scapular ( scapular medial border )

P T Z

Shoulder

arm

90 flexed

sitting supine partial ROM

serratus anterior , Arm winging or extenal oblique latissimus

Sitting

Scapular Elevation
Muscle & Nerve Gr Posture Technique
shoulder elevation. resi : (downward) full ROM shoulder elevation.

Stabilization

Trapezius
(superior fibers)
: accessory N (spinal portion Cr.11)

N G

Sitting
relaxed

F P

Prone
shoulders , forehead

full ROM shoulder elevation.

Prone P, T, Z supine (prone position ) shoulder elevation trapezius upper fiber clavicle ,

Levator scapulae
: dorsal scapular(C5) , C3, 4 (cervical N )

T Z

Prone

Scapular Adduction
Gr Posture Technique
arm abducted, scapular adduction . resi : scapular lateral angle( ) glenohumeral M . arm full ROM scapular adduction .
arm abducted, full ROM scapular adduction . sitting P, T, Z prone (poor partial ROM)

Muscle & Nerve

Stabilization

Prone Trapezius
(middle fibers)
: accessory N (spinal portion Cr.11)

N G

(shoulder 90 abd, ext. rot, elbow - 90 flexed) T - position

Thorax

F
P

Sitting

Rhomboid
major & minor
: dorsal scapular (C5)

shoulder 90 abd
elbow flexed

T Z

Sitting or Prone

trapezius middle fiber , (acromion) vertebral column

Scapular Depression & Adduction

Gr Posture Technique
arm trapezius lower fiber scapular . resi : scapular lateral angle deltoid . , full ROM arm .
partial ROM arm . deltoid trapezius lower fiber , arm (root) (triangular area) ,

Muscle & Nerve

Stabilization

Prone

N G
Trapezius
(inferior fibers)
: accessory N (spinal portion Cr.11)

( shoulder
130 abd, rotation)

Thorax

P
T Z

Scapular Adduction & Downward rotation

Gr Posture Technique
arm scapular adduction . resi : scapular vertebral border (outward & upward) scapular humerus head adducted.( .) trunk rotation arm full ROM scapular adduction . scapular adduction . flexion rotation trunk anterior, posterior pressure . scapular adduction trapezius lower fiber scapular vertebral border ,

Muscle & Nerve

Stabilization

Prone

N G
Rhomboid major & minor
: dorsal scapular (C5)

(shoulder int. rot, arm adduction Head rot.)

Thorax

Sitting

P
T Z

shoulder int. rot,

arm adduction

Sitting

Poor (sitting position) 2 position : scapular adduction, adduction and downward rotation

Shoulder Flexion(0~170-180)
Muscle & Nerve Gr Posture Technique
arm 90 flexed

Stabilization

Sitting
Deltoid

(anterior fiber) : axillary N (C5, 6) Coracobrachialis : musculocutaneous

(C6, 7)

N G F P

with arm side elbow slight flexion palm down

Scapula
( )

resistance : above proximal elbow jt

Shoulder jt ext. rot biceps

thorax

sidelying

90 arm flexed
partial ROM arm flexed upper arm powder board 90 full ROM flexed Deltoid(anterior fiber) 1/3 Coracobrachialis 1/3

Note : (palm down biceps brachii

T Z

supine

Shoulder Flexion(0~170-180)

Position of patient

Goniometer Stationary arm Moving arm

Sitting & standing

Axis : acromion

Shoulder Extension(0~50-60)
Muscle & Nerve Gr Posture Technique
full ROM shoulder extend.

Stabilization

Prone
Deltoid

Scapula
( )

(posterior fiber) : axillary N (C5, 6) Latissimus dorsi : thoracodorsal (C6, 7, 8)

Teres major : inferior subscapular (C5, 6)

N G F

shoulder int. rot, adduction. ( palm up)

resistance : proximal elbow jt

triceps brachii

Thorax
(normal)

Prone with
arms at side, shoulders int. rot

full ROM shoulder extend.

partial ROM shoulder extend.

Sidelying
( powder border .) full ROM shoulder extend.

T Z

Prone

Deltoid(posterior fiber) 1/3 Teres major scapular lower border Latissimus dorsi teres major

Shoulder Extension(0~60)
Goniometer Stationary arm Moving arm

Position of patient

Sitting & standing

Axis : acromion

Shoulder Abduction(0~170-180)
Muscle & Nerve Gr Posture Technique Stabilization

Sitting

Deltoid
(middle fibers) : axillary N (C5, 6) Supraspinatus : suprascapular
(C5)

N G

(with arm side, elbow slight flexion)

shoulder 90 abduction (palm down)

Thorax
Scapula
( )

resistance : proximal elbow jt

shoulder ext. rot & biceps brachii elbow slight flexed. shoulder 90 abduction(palm down) Note : lateral flexion ( ) rotation shoulder abduction

P Supine ()

T Z

supine

Deltoid(middle fiber) 1/3 Supraspinatus (supraspinous fossa)

Shoulder Abduction(0~180)
Goniometer Stationary arm Moving arm

Position of patient

Sitting & standing

Axis : acromion

Shoulder Horizontal Abduction

Gr Posture Technique
shoulder full ROM horizontal abduction . resi : proximal elbow jt

Muscle & Nerve

Stabilization

Deltoid
(posterior fiber)

N G

Prone
(shoulder-90abd,
forearm table edge

: thorax : scapula

: axillary N (C5, 6)

F P T Z

shoulder full ROM horizontal abduction .

Sitting
(arm 90 flexed
supported, elbow flexed)

Deltoid(posterior fiber) 1/3 (scapular spine)

Note : elbow extension (triceps )

Shoulder Horizontal Adduction

Gr Posture Technique
shoulder full ROM horizontal adduction ().

Muscle & Nerve

Stabilization

N G
Pectoralis major
: medial & lateral pectoralis N (C5~ 8)

Supine
(shoulder90 abd)

thorax
( )

resi : proximal elbow jt

sternal portion ; upward & outward clavicle portion : downward & outward
shoulder full ROM horizontal adduction ().

sternal portion ; 90 abduction clavicle portion : 90 abduction

shoulder full ROM horizontal adduction ()

Sitting

P T Z

arm 90- abd

elbow flexed

Pectoralis major palpation muscle trunk tendon arm insertion

Shoulder Lateral rotation(0~80-90)

Gr Posture Technique
forearm full ROM lateral rotation .

Muscle & Nerve

Stabilization

Prone
Infraspinatus : suprascapular
(C5, 6)

N G F
P T Z

shoulder-90 abd, , forearm table edge

( )

Thorax
Scapula
( )

resi : proximal wrist jt

( )
forearm full ROM lateral rotation .

Teres minor : axillary(C5)

Thorax

Prone (arm int.rot table edge

) full ROM lateral rotation .

lateral rotation
forearm supination
Teres minor scapular lateral border Infraspinatus scapular spine infraspinatus fossa

Shoulder Lateral rotation(0~ 90)

Goniometer Stationary arm Moving arm

Position of patient

Sitting & prone

Axis : olecranon

Shoulder Medial rotation(0~70-80)

Gr Posture Technique
forearm full ROM medial rotation . resi : proximal wrist jt

Muscle & Nerve

Stabilization

Subscapularis
: superior & inferior subscapular (C5, 6)

Prone

Pectoralis major
: medial & lateral pectoral N (C5, 6, 7, 8, T1)

N G
F P

shoulder-90 abd, , forearm table edge

( )

Thorax
Scapula
( )

( )
forearm full ROM medial rotation .

Thorax

Latissimus dorsi
: thoracodorsal N (C6, 7, 8) Prone (arm ext.rot table edge
)

full ROM medial rotation .

medial rotation
forearm pronation

Teres major : inferior

subscapular (C5, 6)

T Z

palpation axilla insertion

Shoulder Medial rotation(0~80)

Goniometer
Stationary arm Moving arm

Position of patient

Sitting & prone

Axis : olecranon

Elbow Flexion(0~145-155)
Muscle & Nerve Gr Posture Technique Stabilization

Sitting (with arm side)

Biceps brachii
: musculocutaneous (C5, 6)

N G F

biceps - supinated brachialis - pronated brachioradialis midposition

full ROM elbow flexed

Arm ()
(biceps & brachialis )

resi : proximal wrist jt

full ROM elbow flexed

Brachialis
: musculocutaneous (C5, 6)

Sitting with arm side

forearm -supinated

Supine(shoulder
90abd, ext. rot)

Brachioradialis : radial (C5, 6)

wrist muscle
relaxed,

full ROM elbow flexed

Sitting(shoulder90 abd,
forearm & arm elbow extended, full ROM elbow flexed

forearm - midposition biceps tendon elbow jt muscle fiber short head long head 1/3 brachialis fiber biceps brachioradialis elbow forearm anterolateral

sitting
supine position

T Z

supine

Elbow Flexion(0~145)
Position of patient Goniometer Stationary arm Humerus midline ( ) Moving arm Radius midline ( )

Sitting & supine standing

Axis : elbow jt

Elbow Extension(145-155~0)
Muscle & Nerve Gr Posture Technique
full ROM elbow jt extension

Stabilization

Triceps brachii
: Radial N(C7, 8)

N G F

Supine
(shoulder90 flexed & elbow jt flexed)

resi : proximal wrist jt

(locked extension) & arm

Arm ()

Supine(shoulder
90 abd & ext. rot, elbow jt flexed)

full ROM elbow extended

Sitting(shoulder
90 abd, forearm & arm elbow flexed, forearm - midposition full ROM elbow extended

T Z

supine

tendon olecranon process() proximal muscle fiber arm

Elbow Extension(0~5)
Goniometer Stationary arm Humerus midline ( ) Moving arm Radius midline ( )

Position of patient

Sitting & supine standing

Axis : elbow jt

Forearm Supination(0~80-90)
Muscle & Nerve Gr Posture Technique
forearm supination.(90) resi : ulnar radius full ROM forearm supination (90 ) forearm arm elbow thorax
partial ROM forearm supination

Stabilization

Biceps brachii
: musculocutaneous (C5, 6)

N G

Sitting(with arm side)

forearm pronated elbow 90 flexed, , relaxed

Arm ()

Supinator : radial (C6)

( )

elbow 90 flexed - rotation

Sitting
(shoulder90 flexed, vertical to forearm on the table) full ROM forearm supination

T Z

Sitting

Supinator forearm

Forearm Pronation(0~80-90)
Muscle & Nerve Gr Posture Technique
forearm pronation.(90) resi : ulnar dorsal surface radius palmar surface full ROM forearm pronation (90 ) forearm pronation int. rot or abd .
partial ROM forearm pronation

Stabilization

Pronator teres : Median(C6, 7)

N G F

Sitting(with arm side)

forearm supinated elbow 90 flexed, , relaxed

Arm ()

Pronator quadratus : Median(C8, T1)

( )

elbow 90 flexed - rotation

Sitting
(shoulder90 flexed, vertical to forearm on the table) full ROM forearm pronation

T Z

Sitting

pronator teres fiber humerus medial condyle radius lateral border forearm palmar surface 1/3

Wrist Flexion(0~80-90)
Muscle & Nerve Gr Posture Technique
full ROM wrist flexed

Stabilization

Sitting
Flexor carpi radialis : median N (C6, 7) Flexor carpi ulnaris : ulnar N (C8, T1)
Note
: (Curling)

N G

(forearm supinated, dorsal surface ) Thumb & finger M relaxed

Resistance
Flexor carpi radialis : base of 2nd metacarpal bone Flexor carpi ulnaris : base of fifth metacarpal bone

Forearm

F P
T Z

Sitting
forearm midposition hand .

ulnar deviation or radial deviation wrist flexed

full ROM wrist flexed wrist jt proximal

Sitting

Flexor carpi radialis tendon wrist lateral palmar aspect() Flexor carpi ulnaris tendon wrist medial palmar aspect()

Wrist Flexion(0~90)
Position of patient

Goniometer Stationary arm Radius midline ( ) Moving arm 2nd metacarpal bone (2)

Sitting & supine standing

Axis : wrist jt

Wrist Extension(0~75-85)
Muscle & Nerve

Gr

Posture

Technique
wrist extension

Stabilization

Sitting
Extensor carpi radialis longus & brevis : radial N (C6, 7)

Extensor carpi ulnaris : deep radial N(C6,7,8)

N G

(forearm pronated, palmar surface ) Thumb & finger M relaxed

Resistance
extensor carpi radialis longus & brevis : 2, 3 extensor carpi ulnaris : 5

Forearm

F
Note :

Sitting
forearm

ulnar deviation or radial deviation wrist extended

full ROM wrist extended wrist jt proximal

midposition hand .

T Z

Sitting

extensor carpi radialis longus & brevis tendon 2, 3 wrist lateral dorsal surface() extensor carpi ulnaris tendon 5 medial dorsal surface()

Wrist Extension(0~75-85)
Position of patient Goniometer Stationary arm Radius midline ( ) Moving arm 2nd metacarpal bone (2)

Sitting & supine standing

Axis : wrist jt

(NFTZ)

Position(gravity) :
1) (N) 2) (F) 3) (T) 4) (Z)

(Muscles of the Forehead & Nose)

Occipitofrontalis() : expression of surprise( ) Corrugator supercilli() : frowning( ) Procerus() : distate( ) Nasalis() : nostrils()

(Muscles of the Eye)

Orbicularis oculi() : Lavator palpebrae superioris( ) : .

(Muscles of the Mouth)

Orbicularis Oris() : Levator Labii Superior and Zygomaticus Minor( ) : . Levator Anguli Oris() : sneering( ) Zygomaticus Major() : smiling( ) Risorius() : grimacing( ), Buccinator() : blowing( )- . Depressor Labii Inferioris and Mentalis( ) : pouting( ), . Depressor Anguli Oris and Platysma( ) :

(Muscles of the Mastication)

Temporalis, Masseter and medial Pterygoid (, , ) : Digastric and Suprahyoid muscles(, ) : digastric M Cr 5, Cr 7 ( )