Manual Muscle Testing: Shoulder Horizontal Adduction

Muscles Involved:

Pectoralis Major

Patient Positioning

  • Supine with elbow flexed to 90 degrees & shoulder abducted to either 90, 60 or 120 degrees depending on desired target fibres to be tested.
  • For grades 0 to 2 patient is in sitting ('gravity minimal' position)


GENERAL FUNCTIONAL SCREENING TEST

  • shoulder abduction to 90 degrees

CLAVICULAR HEAD - C5 + C6 nerve root innervation, superior 1/3 of muscle fibres

  • shoulder abduction to 60°

STERNAL HEAD - C7, C8 + T1 nerve root innervation, inferior 2/3 of muscle fibres

  • shoulder abduction to 120°


Therapist Position

  • Therapist is standing at test side

To Test

  • Patient actively horizontally adducts the shoulder through full available range.
  • The difference between this test as a general screen or specifically for clavicular or sternal head will be direction of movement against resistance

GENERAL SCREENING starting at 90 degrees abduction, arm horizontally across chest

CLAVICULAR HEAD starting from 60 degrees abduction, arm will move up and across chest

STERNAL HEAD starting from 120 degrees abduction, arm will move down and across chest

  • For grades 4 to 5 apply resistance to forearm, just proximal to wrist in a direction opposite to horizontal adduction[1]
  • To satisfy grade 5 'normal muscle' performance criteria, the patient must have the ability to move through complete range of motion (active resistance testing) OR maintain an end point range (break testing) against maximum resistance.

References

  1. Hislop H, Avers D, Brown M. Daniels and Worthingham's muscle Testing-E-Book: Techniques of manual examination and performance testing. Elsevier Health Sciences; 2013 Sep 27.