53.Muscles: Testing and Functions

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53.Muscles: Testing and Functions

 

 

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Syllabus

1 Fundamental Concepts 1
Introduction 3
Manual Muscle Testing 4, 5
Objectivity in Muscle Testing 6-8
Musculoskeletal System 9
Joints: Definitions & Classification, Chart 10
Gross Structure of Muscle 11
Range of Motion and Muscle Length 12
Classification for Strength Tests 13
Strength Testing Procedures 14-17
Suggested Order of Muscle Tests 18
Grading Strength 19-24
Key to Muscle Grading 23
Nerve Plexus 25
Spinal Nerve and Muscle Charts 26-29
Treatment Fundamentals 30, 31
Neuromuscular Problems 32, 33
Musculoskeletal Problems 34, 35
Treatment Procedures 36
Treatment Modalities 37
Polio: Factors Influencing Treatment 38

Polio and Postpolio Muscle Tests 39-43
Complications of Polio 44
Post-Polio Suggested Readings 45
References 46,47

Posture 49
Introduction 51
Section I: Fundamentals of Posture
Posture and Pain 52
Body Segments 53
Anatomical and Zero Positions, and Axes 54
Basic Planes and Center of Gravity 55
Movements in the Coronal Plane 56
Movements in the Sagittal Plane 57
Movements in the Transverse Plane 58
The Standard Posture 59-63
Section II: Postural Alignment
Types of Postural Alignment 64
Segmental Alignment: Side View 65-69
Abdominal Muscles in Relation to Posture 70-71
Sway-Back Posture 72
Ideal Alignment: Posterior View 73
Faulty Alignment: Posterior View 74, 75
Handedness: Effect on Posture 76
Faulty Posture: Side and Back Views 77
Shoulders and Scapulae 78, 79
Posture of Feet, Knees and Legs 80-83
Radiograph of Legs 84
Sitting Posture 85
Section III: Postural Examinations
Procedure for Postural Examination 86-88
Postural Examination Chart 89
Good and Faulty Posture: Summary Chart 90, 91
Faulty Posture: Analysis and Treatment,
Charts 92,93

Faulty Leg, Knee, and Foot Positions, Chart 94
Acquired Postural Weakness 95
Section IV: Posture of Children
Factors Influencing Children’s Posture 96, 97
Good and Faulty Posture of Children 98-100
Normal Flexibility According to Age Level 101
Flexibility Tests: Charts 102, 103
Problems with “Physical Fitness Tests” 104, 105
Section V: Scoliosis
Introduction 107
Scoliosis from Neuromuscular Disease 108
Postural Examination, and Chart 109-111
Functional Scoliosis 112
Exercises and Supports 113, 114
Early Intervention 115
Corrective Exercises 116
References 117

Head and Face 119
Introduction 121
Section I: Innervation
Cranial Nerves and Deep Facial Muscles 122
Cervical Nerves and Superficial Facial
and Neck Muscles 123
Temporomandibular Joint Movement 124
Cranial Nerve and Muscle Chart 124, 125
Section II: Facial and Eye Muscles
Facial and Eye Muscles, Charts 126, 127
Facial and Eye Muscles Tests 128-133
Section III: Facial Paralysis
Case #1 134, 135
Case #2 136, 137
Muscles of Deglutition 138, 139
References 140

Neck HI
Introduction 143
Section I: Innervation and Movements 144
Spinal Cord and Nerve Roots 144
Spinal Nerve and Muscle Chart 144
Cervical Plexus 145
Joint Movements of the Cervical Spine 146
Neck Range of Motion 147
Section II: Neck Muscles 148
Anterior and Lateral Neck Muscles, Charts 148, 149
Suprahyoid and Infrahyoid Muscles 150, 151
Cervical Spine Extension and Flexion 152
Faulty Head and Neck Positions 153
Section III: Neck Muscle Tests 154
Anterior Neck Flexors 154
Error in Testing Neck Flexors 155
Anterolateral Neck Flexors 156
Posterolateral Neck Flexors 157
Upper Trapezius 158
Section IV: Painful Conditions 159
Tight Posterior Neck Muscles 159
Upper Trapezius Strain 160
Cervical Nerve Root Pressure 160
Computer Ergonomics 161
Section V: Treatment 162
Massage of Neck Muscles 162
Exercises to Stretch Neck Muscles 163
References 164
Trunk and Respiratory Muscles 165
Introduction 167
Section I: Trunk 168
Innvervation, cliart 168
Joints of Vertebral Column 168

Trunk Range of Motion 169
Movements of Vertebral Column 169
Movements of Spine and Pelvis 172
Tests for Length of Posterior Muscles 174
Variation in Length of Posterior Muscles 175
Trunk Muscles 176
Neck and Back Extensors, Illustration 177
Neck and Back Extensors, Charts 178-179
Back and Hip Extensors 180
Back Extensors: Testing and Grading 181
Strong Back Extensors, Misdiagnosed 182
Quadratus Lumborum 183
Lateral Trunk Flexors and Hip Abductors 184
Lateral Trunk Flexors: Testing and Grading 185
Oblique Trunk Flexors: Testing and Grading 186
Section II: Abdominal Muscles 187
Analysis of Curled-Trunk Sit-Ups 187
Movements during Curled-Trunk Sit-Ups 188-189
Muscles during Curled-Trunk Sit-Ups 190-192
Trunk Movement 193
Rectus Abdominis, Illustration 194
External Oblique, Illustration 195
Internal Oblique, Illustration 196
Tranversus Abdominis, Illustration 197
Obliques: Weakness and Shortness 198
Divisions of Abdominal Muscles, Chart 199
Differentiating Upper and Lower
Abdominals 200-201
Upper Abdominal Muscles: Testing
and Grading 202-203
Abdominal Muscle Weakness: Trunk Raising 204
Abdominal and Hip Flexor Imbalance 205
Sit-Up Exercises 206-208
Therapeutic Exercises: Trunk Curl 209
Abdominal Muscles During Leg Lowering 210-211
Lower Abdominals: Testing & Grading 212-213
Abdominal Muscle Weakness: Leg Lowering 214
Therapeutic Exercises: Posterior Pelvic Tilt 215

Therapeutic Exercise: Trunk Rotation 216
Marked Abdominal Muscle Weakness 217-218
Section III: Painful Conditions of Low Back 219
Low Back Enigma 219
Low Back Pain 219-222
Anterior Pelvic Tilt 223-225
Back Supports 226
Hip Extensor Weakness 227
Posterior Pelvic Tilt 228
Lateral Pelvic Tilt 229
Lifting 230-231
Treatment for Back Weakness 232
Section IV: Muscles of Respiration 233
Introduction 233
Therapeutic Objectives 234
Primary Muscles of Respiration 235-237
Accessory Muscles of Respiration 237-238
Respiratory Muscle Chart 239
Muscles of Respiration 240-241
Corrective Exercises 242-243
References 244

6 Upper Extremity and Shoulder Girdle 245
Introduction 247
Section I: Innervation
Brachial Plexus 248, 249
Cutaneous Distribution Nerves 250
Spinal Nerve and Motor Point Chart 251
Nerves to Muscles: Motor and Sensory
and Motor Only and Chart 252, 253
Scapular Muscle Chart 253
Chart of Upper Extremity Muscles 254-255
Cutaneous Nerves—Upper Limb 256, 257
Section II: Hand, Wrist, Forearm and Elbow
Movements—Thumb and Finger Joints 258

Movements—Wrist, Radioulnar and Elbow 259
Chart for Analysis of Muscle Imbalance 260
Strength Tests
Thumb Muscles 261-268
Digiti Minimi 269-271
Dorsal and Palmar Interossei 272, 273
Lumbricales and Interossei 274—276
Palmaris Longus and Brevis 277
Extensor Indicis and Digiti Minimi 278
Extensor Digitorum 279
Flexor Digitorum Superficialis
and Profundus 280,281
Flexor Carpi Radialis and Ulnaris 282, 283
Extensor Carpi Radialis and Ulnaris 284, 285
Pronator Teres and Quadratus 286, 287
Supinator and Biceps 288, 289
Biceps Brachii and Brachialis 290, 291
Triceps Brachii and Anconeus 292, 293
Brachioradialis 294
Range of Motion Chart 295
Strength Testing of Thumb and Fingers 295
Joint Measurement Chart 296
Section III: Shoulder
Joints and Articulations 297-299
Charts: Shoulder Girdle Articulations 300, 301
Combined Shoulder & Scapular Muscles 302
Movements of Shoulder Girdle & Scapula 303
Movements of Shoulder Joint 304, 305
Length of Humeral and Scapular Muscles 306
Test for Length of Pectoralis Minor 307
Test for Tightness of Muscles that Depress
the Coracoid Process Anteriorly 307
Tests for Length of Pectoralis Major 308
Tests for Length of Teres Major,
Latissimus Dorsi and Rhomboids 309
Tests for Length of Shoulder Rotators 310, 311
Upper Extremity Muscle Chart 312

Strength Tests—Shoulder
Coracobrachialis 313
Supraspinatus 314
Deltoid 315-317
Pectoralis Major, Upper and Lower 318,319
Pectoralis Minor 320
Shoulder Lateral Rotators 321
Shoulder Medial Rotators 322
Teres Major & Subscapularis 323
Latissimus Dorsi 324, 325
Rhomboids, Levator Scapulae and
Trapezius 326-331
Serratus Anterior 332-337
Section IV: Painful Conditions of Upper Back
Weakness of Upper Back 338
Short Rhomboids 338
Middle & Lower Trapezius Strain 339
Back Pain from Osteoporosis 340
Painful Conditions of the Arm
Thoracic Outlet Syndrome 341
Coracoid Pressure Syndrome 342, 343
Teres Syndrome (Quadrilateral
Space Syndrome) 344
Pain from Shoulder Subluxation 345
Tight Shoulder External Rotators 345
Cervical Rib 345
Section V: Case Studies
Case 1: Radial Nerve Lesion 347
Case 2: Radial, Median, & Ulnar Nerve 348, 349
Case 3: Probable C5 Lesion 350
Case 4: Lateral and Medial Cord 351
Case 5: Partial Brachial Plexus Lesion 352-354
Case 6: Stretch Weakness Superimposed
on a Peripheral Nerve Injury 355
Overuse Injuries 356
Corrective Exercises 357
References 358

Lower Extremity 359
Introduction 361
Section I: Innervation
Lumbar Plexus, Sacral Plexus 362, 363
Spinal Nerve and Muscle Chart 364
Spinal Nerve and Motor Point Chart 365
Chart of Lower Extremity Muscles 366, 367
Nerves to Muscles: Motor & Sensory 368
Cutaneous Nerves of the Lower Limb 369
Section II: Joint Movements
Movements of Toes, Foot, Ankle and Knee 370, 371
Movements of Hip Joint 372, 373
Joint Measurement Chart 374
Treatment of Muscle Length Problems 375
Test for Length of Ankle Plantar Flexors 375
Test for Length of Hip Flexor Muscles 376, 380
Hip Flexor Stretching 381
Problems with Hamstring Length Testing 382
Tests for Length of Hamstring Muscles 383, 384
Short Hamstrings 385, 386
Effect of Hip Flexor Shortness 387
Errors in Testing Hamstring Length 388, 389
Hamstring Stretching 390
Ober and Modified Ober Test 391-394
Hip Flexor Length Testing 395-397
Tensor Fasciae Latae Stretching 398
Section III: Muscle Strength Tests
Chart for Analysis of Muscle Imbalance 399
Toe Muscles 400-409
Tibialis Anterior 410
Tibialis Posterior 411
Peroneus Longus and Brevis 412
Ankle Plantar Flexors 413-415
Popliteus 416
Hamstrings and Gracilis 417-419
Quadriceps Femoris 420,421

NTENTS

Hip Flexors 422,423
Sartorius 424
Tensor Fasciae Latae 425
Hip Adductors 426-428
Medial Rotators of Hip Joint 429
Lateral Rotators of Hip Joint 430, 431
Gluteus Minimus 432
Gluteus Medius 433
Gluteus Medius Weakness 434
Trendelenberg Sign & Hip Abductor Weakness 435
Gluteus Maximus 436,437
Leg Length Measurement 438
Apparent Leg Length Discrepancy 439
Section IV: Painful Conditions
Foot Problems 440-443
Shoes and Shoe Corrections 444-446
Knee Problems 447,448
Leg Pain 449
Tight Tensor Fasciae Latae and ITB 449, 450
Stretched Tensor and ITB 450, 451
Protruded Intervertebral Disk 452
Piriformis Muscle and Sciatic Pain 453, 454
Neuromuscular Problems 454
Case 1: Peroneal Nerve Injury 455
Case 2: Lumbosacral Nerves 456, 457
Case 3: L5 Lesion 458
Case 4: Guillain-Barre 459
Case 5: Guillain-Barre’ 460
Case 6: Polio 461
Corrective Exercises 462,463
References 464
Appendix A: Spinal Segment Distribution to
Nerves and Muscles 465-467
Charts 468-472
Appendix B: Isolated Paralysis of the Serratus
Anterior Muscle 473-480
Glossary G—1
Suggested Readings SR-1

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