MAPUA MALAYAN COLLEGES MINDANAO

COLLEGE OF HEALTH SCIENCES

PHYSICAL THERAPY PROGRAM

Session #3
Task Training

Theme of the Practice Goniometric Measurement and Manual Muscle Test Measurement
Location Laboratory
Session Duration Total: 240 mins
Demonstration and Explanation: 10 mins
Practice under supervision: 30 mins per work table
Session closure: 10
Program Physical Therapy
Professor Ar-an J. Nanol II, DM, PTRP Course PT Evaluation
LEARNING OBJECTIVE
1. Gather the range of motion and muscle strength of the shoulder.
2. Demonstrate proper way of measuring the range of motion and muscle strength of the shoulder.

REQUIRED MATERIALS
ALL STATIONS:

1. Goniometer.
2. Checklist (Kindly click below)

ORGANIZATION OF THE ENVIRONMENT

The place will be distributed into 7 work tables, 3 on one side and 4 on another side:

 Chairs and beds are place for each stations

- one station: Goniometric measurement of shoulder flexion and extension
- one station: Goniometric measurement of shoulder abduction, horizontal abduction, adduction
- one station: Goniometric measurement of shoulder internal and external rotation
- one station: Manual muscle test of shoulder flexors and extensors
- one station: Manual muscle test of shoulder abductors, horizontal abductors, and adductors
- one station: Manual muscle test of shoulder internal and external rotators

STATION 1: GONIOMETRIC MEASUREMENT OF SHOULDER FLEXION AND EXTENSION

Station 1 Learning Learning Station 1 Instruction:
Objective
Reference Material: https://www.youtube.com/watch?v=cRitcfrN4_A
Demonstrate the
proper way measuring
the range of motion
of shoulder flexion
and extension
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM

Learning station 1 checklist:

Follow the sequence of goniometric measurement of shoulder flexion

FLEXION

Patient position

1. Supine with the knees flexed to flatten the lumbar spine.

2. Shoulder in 0 degrees abductin, adduction, and rotation.
3. Elbow in extension.
4. Forearm in 0 degrees supination and pronation.
5. Palm faces the body.

Stabilization

6. Stabilize the scapula to prevent posterior tilting, upward rotation, and

elevation of the scapula.
7. Thorax to prevent extension of the spine and movement of the ribs.
8. The weight of the trunk may assist stabilization.

Goniometric Alignment

9. Center fulcrum of the goniometer over the lateral aspect of the greater
tubercle.
10. Align proximal arm parallel to the midaxillary line of the thorax.
11. Align distal arm with the lateral midline of the humerus. Depending on
how much flexion and rotation occur, the lateral epicondyle of the humerus
or the olecranon process of the ulnar may be helpful references.

Testing Motion

12. Flex the shoulder by lifting the humerus off the examining table, bringing
the hand up over the individual’s head.
13. Maintain the extremity in neutral abduction and adduction during the
motion. Slight rotation is allowed to occur as needed to attain maximal
flexion.

Note:

Glenohumeral Flexion
The end of glenohumeral fl exion ROM occurs when resistance to further
motion is felt and attempts to overcome the resistance cause upward
rotation, posterior tilting, or elevation of the scapula.

Shoulder Complex Flexion

The end of shoulder complex fl exion ROM occurs when resistance to further
motion is felt and attempts to overcome the resistance cause extension of
the spine or motion of the ribs.
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
EXTENSION

Reference Material: https://www.youtube.com/watch?v=Ps-oHY_wM30

Learning station 1 checklist:

Follow the sequence of goniometric measurement of shoulder extension

Patient position

1. Prone, with the face turned away from the shoulder being tested.
2. A pillow is not used under the head.
3. Place the shoulder in 0 degrees of abduction, adduction, and rotation.
4. Position the elbow in slight flexion so that tension in the long head of the
biceps brachii muscle will not restrict the motion.
5. Place the forearm in 0 degrees of supination and pronation so that the
palm of the hand faces the body.

Stabilization

6. Stabilize the scapula at the inferior angle or at the acromion and coracoid
processes to prevent elevation and anterior tilting (inferior angle moves
posteriorly) of the scapula.

Goniometric Alignment

7. Center fulcrum of the goniometer over the lateral aspect of the greater
tubercle.
8. Align proximal arm parallel to the midaxillary line of the thorax.
9. Align distal arm with the lateral midline of the humerus, using the lateral
epicondyle of the humerus for reference.

Testing Motion

10. Extend the shoulder by lifting the humerus off the examining table.
11. Maintain the extremity in neutral abduction and adduction during the
motion.

Note:

Glenohumeral Extension
The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause anterior tilting or elevation of
the scapula.

Shoulder Complex Extension

The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause forward flexion or rotation of the
spine.
 MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
STATION 2: GONIOMETRIC MEASUREMENT OF SHOULDER ABDUCTION, HORIZONTAL ADDUCTION
AND HORIZONTAL ABDUCTION
Station 2 Learning Learning Station 2 Instruction:
Objective
ABDUCTION
Demonstrate the
proper way measuring Reference Material: https://www.youtube.com/watch?v=1rMRK-Qp-jQ
the range of motion
of shoulder
abduction, horizontal
abduction, and
horizontal adduction

Learning station 2 checklist:

Student should demonstrate the goniometric measurement of shoulder
abduction

Patient position

1. Patient supine, with the shoulder in lateral rotation and 0 degrees of fl

exion and extension so that the palm of the hand faces anteriorly.
2. Laterally rotate the humerus.
3. Elbow extended so that tension in the long head of the triceps does not
restrict the motion.

Stabilization

4. Stabilize the scapula to prevent upward rotation and elevation of the

scapula.

Goniometric Alignment

5. Center fulcrum of the goniometer close to the anterior aspect of the

acromial process.
6. Align proximal arm so that it is parallel to the midline of the anterior
aspect of the sternum.
7. Align distal arm with the anterior midline of the humerus. Depending on
the amount of abduction and lateral rotation that has occurred, the medial
epicondyle may be a helpful reference.

Testing Motion

8. Abduct the shoulder by moving the humerus laterally away from the
individual’s trunk.
9. Maintain the upper extremity in lateral rotation and neutral flexion and
extension during the motion.

Note:

Glenohumeral Abduction
The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause upward rotation or elevation of
the scapula.
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Shoulder Complex Abduction
The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause lateral flexion of the spine.

ADDUCTION

Motion occurs in the frontal plane around an anterior–posterior axis.

Adduction in the frontal plane is not usually measured and recorded because
it is the return to the zero starting position from full abduction. Further
adduction can occur if the arm is positioned anterior to the body so that
contact is avoided, but in that case adduction is combined with shoulder
flexion.

HORIZONTAL ADDUCTION

Reference Material: https://www.youtube.com/watch?v=8IOZId-vRTU

Learning station 2 checklist:

Follow the sequence of goniometric measurement of shoulder horizontal
adduction.

Patient position

1. Seated or standing position.

2. Shoulder abducted 90 degrees
3. Arm flexed in front of their body at 90 degrees.

Stabilization

4. Stabilize the trunk ensuring twisting or lateral bending does not occur.

Goniometric Alignment

5. Axis Placement: superior acromion process

6. Stationary Arm Placement: parallel to the floor and perpendicular to the
trunk
7. Moveable Arm Placement: parallel to the humerus

Testing Motion

8. Ask patient to move arm to the midline making sure the body does not
twist.

HORIZONTAL ABDUCTION

Reference Material: https://www.youtube.com/watch?v=_heg5uEE428

 MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM

Learning station 2 checklist:

Follow the sequence of goniometric measurement of shoulder horizontal
abduction.

Patient position

1. Seated or standing position.

2. Shoulder abducted 90 degrees
3. Arm flexed in front of their body at 90 degrees.

Stabilization

4. Stabilize the trunk ensuring twisting or lateral bending does not occur.

Goniometric Alignment

5. Axis Placement: superior acromion process

6. Stationary Arm Placement: parallel to the floor and perpendicular to the
trunk
7. Moveable Arm Placement: parallel to the humerus

Testing Motion

8. Ask patient to move arm towards the back in a linear motion making sure
the body does not twist at the end of motion.

STATION 3: GONIOMETRIC MEASUREMENT OF SHOULDER INTERNAL AND EXTERNAL ROTATION

Station 3 Learning Learning Station 3 Instruction:
Objective
INTERNAL ROTATION
Demonstrate the
proper way measuring Reference Material: https://www.youtube.com/watch?v=3UBgMwJu-Hc
the range of motion
of shoulder internal
and external rotation

Learning station 3 checklist:

Follow the sequence of goniometric measurement of shoulder internal
rotation.

Patient position

1. Supine or sitting, with the arm being tested in 90 degrees of shoulder

abduction.
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
2. Forearm perpendicular to the supporting surface and in 0 degrees of
supination and pronation so that the palm of the hand faces the feet.
3. Rest the full length of the humerus on the examining table. The elbow is
not supported by the examining table.
4. Place a pad under the humerus so that the humerus is level with the
acromion process.

Stabilization

1. Beginning of the ROM - stabilization is often needed at the distal end of

the humerus to keep the shoulder in 90 degrees of abduction.
2. End of the ROM, the clavicle and coracoid and acromion processes of the
scapula are stabilized to prevent anterior tilting and protraction of the
scapula.

Goniometric Alignment

1. Center fulcrum of the goniometer over the olecranon process.

2. Align proximal arm so that it is either perpendicular to or parallel with the
floor.
3. Align distal arm with the ulna, using the olecranon process and ulnar
styloid for reference.

Testing Motion

1. Medially rotate the shoulder by moving the forearm anteriorly, bringing

the palm of the hand toward the floor.
2. Maintain the shoulder in 90 degrees of abduction and the elbow in 90
degrees of fl exion during the motion.

Glenohumeral Medial Rotation

The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause an anterior tilt or protraction of
the scapula.

Shoulder Complex Medial Rotation

The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause flexion or rotation of the spine.

EXTERNAL ROTATION

Reference Material: https://www.youtube.com/watch?v=7jfcg93u33Q

Learning station 2 checklist:

Follow the sequence of goniometric measurement of shoulder external
rotation.

Patient position
 MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM

1. Supine or seated, with the arm being tested in 90 degrees of shoulder

abduction.
2. Forearm perpendicular to the supporting surface and in 0 degrees of
supination and pronation so that the palm of the hand faces the feet.
3. Rest the full length of the humerus on the examining table.
4. Elbow is not supported by the examining table. Place a pad under the
humerus so that the humerus is level with the acromion process.

Stabilization

1. Stabilization is often needed at the distal end of the humerus to keep the
shoulder in 90 degrees of abduction.
2. To prevent extension or rotation of the spine, the thorax may be stabilized
by the weight of the individual’s trunk or by the examiner’s hand.

Goniometric Alignment

1. Center fulcrum of the goniometer over the olecranon process.

2. Align proximal arm so that it is either parallel to or perpendicular to the
floor.
3. Align distal arm with the ulna, using the olecranon process and ulnar
styloid for reference.

Testing Motion

1. Rotate the shoulder laterally by moving the forearm posteriorly, bringing

the dorsal surface of the palm of the hand toward the floor.
2. Maintain the shoulder in 90 degrees of abduction and the elbow in 90
degrees of flexion during the motion.

Glenohumeral Lateral Rotation

The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause a posterior tilt or retraction of
the scapula.

Shoulder Complex Lateral Rotation

The end of ROM occurs when resistance to further motion is felt and
attempts to overcome the resistance cause extension or rotation of the
spine.

STATION 4: MANUAL TEST - SHOULDER FLEXORS AND EXTENSORS

Station 4 Learning Learning Station 4 Instruction:
Objective
Reference Material: https://www.youtube.com/watch?v=ODHyiqnOxFU
Demonstrate the
proper way measuring
the muscle strength
of shoulder flexors
and extensors

SHOULDER FLEXORS

Learning station 4 checklist:

MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Student should demonstrate how to measure the muscle strength of
shoulder flexors.

Position of Patient:

1. Short sitting with arms at sides, elbow slightly flexed, forearm pronated.

Position of Therapist:

1. Stand at test side.

2. Hand giving resistance is contoured over the distal humerus just above the
elbow.
3. The other hand may stabilize the shoulder.

Test:

1. Patient flexes shoulder to 90 ° without rotation or horizontal movement.

2. The scapula should be allowed to abduct and upwardly rotate.

Instructions to Patient:

"Raise your arm forward to shoulder height. Hold it. Don't let me push it
down."

Grading

Grade 5 (Normal): Holds end position (90°) against maximal resistance.

Grade 4 (Good): Holds end position against strong to moderate resistance.

Grade 3 (Fair)

Position of Patient: Short sitting, arm at side with elbow slightly flexed and
forearm pronated.

Position of Therapist: Stand at test side.

Test: Patient flexes shoulder to 90 °.

Instructions to Patient: "Raise your arm forward to shoulder height."

Grading

Grade 3 (Fair): Completes test range (90°) but tolerates no resistance.

Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero)

Position of Patient:

1. Short sitting with arm at side and elbow slightly flexed.

Position of Therapist:

1. Stand at test side. Fingers used for palpation are placed over the superior
and anterior surfaces of the deltoid over the shoulder joint.
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Test: Patient attempts to flex shoulder to 90°.

Instructions to Patient: "Try to raise your arm."

SHOULDER EXTENSORS

Reference Material: https://www.youtube.com/watch?v=guVJqvYMo0Y

Learning station 4 checklist:

Student should demonstrate how to measure the muscle strength of
shoulder extensor.

Grade 5 (Normal) and Grade 4 (Good)

There are three tests for Grades 5 and 4 that should be used routinely. The
first is the traditional way of testing shoulder extension in the prone
position. The other two tests are used to isolate the latissimus dorsi to the
extent possible and to simulate a more functional movement.

Test 1: Generic Shoulder Extension

Position of Patient: Prone with arms at sides and shoulder internally rotated
(palm up).

Position of Therapist: Stand at test side. Hand used for resistance is

contoured over the posterior arm just above the elbow.

Test: Patient raises arm off the table, keeping the elbow straight.

Instructions to Patient: "Lift your arm as high as you can. Hold it. Don't let
me push it down."

Grading

Grade 5 (Normal): Completes available range and holds against maximal

resistance.

Grade 4 (Good): Completes available range but yields against strong

resistance.

Grade 3 (Fair) and Grade 2 (Poor)

Position of Patient: Prone with head turned to one side. Arms at sides; test
arm is internally rotated (palm up).

Position of Therapist: Stand at test side.

Test:

Test 1 (generic extension): Patient raises arm off table.

MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Instructions to Patient:

Test 1 (generic extension): "Lift your arm as high as you can."

Grading

Grade 3 (Fair): Completes available range of motion with no manual

resistance.

Grade 2 (Poor): Completes partial range of motion.

Grade 1 (Trace) and Grade 0 (Zero)

Position of Patient: Prone with arms at sides and shoulder internally rotated
(palm up).

Position of Therapist: Stand at test side. Fingers for palpation (latissimus)

are placed on the side of the thoracic wall below and lateral to the
inferior angle of the scapula.

Palpate over the posterior shoulder just superior to the axilla for posterior
deltoid fibers.

Palpate the teres major on the lateral border of the scapula just below the
axilla. The teres major is the lower of the two muscles that enter the axilla at
this point; it forms the lower posterior rim of the axilla.

Test and Instructions to Patient: Patient attempts to lift arm from table on
request.

Grading

Grade 1 (Trace): Palpable contractile activity in any of the participating

muscles but no movement of the shoulder.

Grade 0 (Zero): No contractile response in participating muscles.

Test 2: To Isolate Latissimus Dorsi

Position of Patient:

1. Prone with head turned to test side; arms are at sides and shoulder is
internally rotated (palm up). Test shoulder is "hiked" to the level
of the chin.

Position of Therapist:

1. Stand at test side. Grasp forearm above patient's wrist with both hands.

Test: Patient depresses arm caudally and in so doing approximates the rib
cage to the pelvis.

Instructions to Patient: "Reach toward your feet. Hold it. Don't let me push
your arm upward toward your head."

Grading
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM

Grade 5 (Normal): Patient completes available range against maximal

resistance. If the therapist is unable to push the arm upward using both
hands for resistance, test the patient in the sitting position as described in
Test 3.

Grade 4 (Good): Patient completes available range of motion, but the

shoulder yields at end point against strong resistance.

Grade 3 (Fair) and Grade 2 (Poor)

Position of Patient: Prone with head turned to one side. Arms at sides; test
arm is internally rotated (palm up).

Position of Therapist: Stand at test side.

Test:

Test 2 (isolation of latissimus): Patient pushes arm toward feet (not shown).

Instructions to Patient:

Test 2 (latissimus): "Reach down toward your feet."

Grading

Grade 3 (Fair): Completes available range of motion with no manual

resistance.

Grade 2 (Poor): Completes partial range of motion.

Grade 1 (Trace) and Grade 0 (Zero)

Position of Patient: Prone with arms at sides and shoulder internally rotated
(palm up).

Position of Therapist: Stand at test side. Fingers for palpation (latissimus)

are placed on the side of the thoracic wall below and lateral to the
inferior angle of the scapula.

Palpate over the posterior shoulder just superior to the axilla for posterior
deltoid fibers.

Palpate the teres major on the lateral border of the scapula just below the
axilla. The teres major is the lower of the two muscles that enter the axilla at
this point; it forms the lower posterior rim of the axilla.

Test and Instructions to Patient: Patient attempts to lift arm from table on
request.

Grading

Grade 1 (Trace): Palpable contractile activity in any of the participating

muscles but no movement of the shoulder.

Grade 0 (Zero): No contractile response in participating muscles.

 MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
STATION STATION 5: MANUAL TEST - SHOULDER ABDUCTORS, HORIZONTAL ADDUCTORS, AND
HORIZONTAL ABDUCTORS
Station 5 Learning Learning Station 5 Instruction:
Objective
ABDUCTORS
Demonstrate the
proper way measuring Reference Material: https://www.youtube.com/watch?v=2iJYAk-jQ3s
the muscle strength
of shoulder
abductors, horizontal
adductors, and
horizontal abductors

Learning station 4 checklist:

Student should demonstrate how to measure the muscle strength of
shoulder abductors, horizontal adductors, and horizontal abductors.

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

Preliminary Evaluation: Examiner should check for full range of shoulder

motion in all planes and should observe scapula for stability and smoothness
of movement. (Refer to test for scapular abduction and upward rotation.)

Position of Patient: Short sitting with arm at side and elbow slightly flexed.

Position of Therapist: Stand behind patient. Hand giving resistance is

contoured over arm just above elbow.

Test: Patient abducts arm to 90°.

Instructions to Patient: "Lift your arm out to the side to shoulder level. Hold
it. Don' t let me push it down. "

Grading

Grade 5 (Normal): Hold s end test position against maximal downward

resistance.

Grade 4 (Good): Hold s end test position against strong to moderate

downward resistance.

Grade 3 (Fair): Completes range of motion to 90 ° with no manual

resistance.

Grade 2 (Poor)

Position of Patient: Short sitting with arm at side and slight elbow flexion.
Position of Therapist: Stand behind patient to palpate muscles on test side.
Palpate the deltoid lateral to the acromial process on the superior aspect of
the shoulder. The supraspinatus can be palpated by placing the fingers deep
under the trapezius in the supraspinous fossa of the scapula.

Test: Patient attempts to abduct arm.

MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Instructions to Patient: "Try to lift your arm out to the side."

Grade 1 (Trace) and Grade 0 (Zero)

Position of Patient: Short sitting.

Position of Therapist: Stand behind and to the side of patient. Therapist

cradles test arm with the shoulder in about 90 ° of abduction, providing limb
support at the elbow.

Test: Patient tries to maintain the arm in abduction.

Instructions to Patient: "Try to hold your arm in this position."

HORIZONTAL ABDUCTORS

Reference Material: www.youtube.com/watch?v=WN-0dRz22mU&t=17s

Learning station 4 checklist:

Student should demonstrate how to measure the muscle strength of
shoulder horizontal abductors.

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

Position of Patient:

1. Prone. Shoulder abducted to 90 ° and forearm off edge of table with

elbow flexed.

Position of Therapist:

1. Stand at test side. Hand giving resistance is contoured over posterior arm
just above the elbow.

Test:

1. Patient horizontally abducts shoulder against maximal resistance.

Instructions to Patient: "Lift your elbow up toward the ceiling. Hold it. Don't
let me push it down."

Grading

Grade 5 (Normal): Completes range and holds end position against maximal
resistance.

Grade 4 (Good): Completes range and holds end position against strong to
moderate resistance.
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Grade 3 (Fair): Completes range of motion with no manual resistance.

Grade 2 (Poor), Grade 1 (Trace), Grade 0 (Zero)

Position of Patient: Short sitting over end or side of table.

Position of Therapist: Stand at test side. Support forearm under distal

surface and palpate over the posterior surface of the shoulder just superior
to the axilla.

HORIZONTAL ADDUCTORS

Reference Material: https://www.youtube.com/watch?v=N6xIKrt9yig

Learning station 4 checklist:

Student should demonstrate how to measure the muscle strength of
shoulder horizontal adductors.

The examiner begins with the patient supine and checks the range of motion
and then tests both heads of the pectoralis major simultaneously.

The patient is asked to move the arm in horizontal adduction, keeping it

parallel to the floor without rotation.

If the arm moves across the body in a diagonal motion, test the sternal and
clavicular heads of the muscle separately. Testing both heads of the
pectoralis major separately should be routine in any patient with cervical
spinal cord injury because of their different nerve root innervation.

For Grade 5 (Normal) and Grade 4 (Good)

Position of Patient

Whole Muscle: Supine. Shoulder abducted to 90°; elbow flexed to 90 °.

Instructions to Patient

Both Heads: "Move your arm across your chest. Hold it. Don't let me pull it
back."

Clavicular Head: Patient begins test with shoulder in 60 ° of abduction with

elbow flexed. Patient then is asked to horizontally adduct the shoulder.

To test the clavicular head, the patient's motion begins at 60 ° of abduction

and moves up and in across the body. The examiner applies resistance above
the wrist in a downward direction (toward floor) and outward (i.e., opposite
to the direction of
the fibers of the clavicular head, which moves the arm diagonally up and
inward).
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM

Instructions to Patient

Clavicular Head: "Move your arm up and in."

Sternal Head: Patient begins test with shoulder in about 120 ° of abduction
with elbow flexed.

To test the sternal head, the motion begins at 120° of shoulder abduction
and moves diagonally down and in toward the patient's opposite hip.
Resistance is given above the wrist in an up and outward direction (i.e.,
opposite to the motion of the
sternal head, which is diagonally down and inward).

Instructions to Patient

Sternal Head: "Move your arm down and in."

Grading

Grade 5 (Normal): Completes range of motion and takes maximal resistance.

Grade 4 (Good): Completes range of motion and takes strong to moderate

resistance, but muscle exhibits some "give" at end of range.

For Grade 3 (Fair)

Position of Patient: Supine. Shoulder at 90 ° of abduction and elbow at 90 °

of flexion.

Position of Therapist: Same as for Grade 5.

Test

Both Heads: Patient horizontally adducts extremity across chest in a straight

pattern with no diagonal motion.

For Grade 3 (Fair)

Position of Patient: Supine. Shoulder at 90 ° of abduction and elbow at 90 °

of flexion.

Position of Therapist: Same as for Grade 5.

Test

Clavicular Head: Direction of motion by the patient is diagonally up and

inward.

For Grade 3 (Fair)

Position of Patient: Supine. Shoulder at 90 ° of abduction and elbow at 90 °

of flexion.

Position of Therapist: Same as for Grade 5.

 MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Sternal Head: Direction of motion is diagonally down and inward.

Instructions to Patient: Same as for the Grade 5 (Normal) test, but no

resistance is offered.

Grading

Grade 3 (Fair): Patient completes available range of motion in all three tests
with no resistance other than the weight of the extremity.

For Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero)

Position of Patient: Supine. Arm is supported in 90 ° of abduction with elbow

flexed to 90°.

Position of Therapist: Stand at side of shoulder to be tested or behind the

sitting patient. When the patient is supine, support the full length of the
forearm and hold the limb at the wrist.

For both tests, palpate the pectoralis major muscle on the anterior aspect of
the chest medial to the shoulder joint.

Test: Patient attempts to horizontally adduct the shoulder. The use of the
alternate test position, in which the arm moves across the table, precludes
individual testing for the two heads.

Instructions to Patient: "Try to move your arm across your chest." In seated
position: "Move your arm forward."

Grading

Grade 2 (Poor): Patient horizontally adducts shoulder through available

range of motion with the weight of the arm supported by the examiner or
the table.

Grade 1 (Trace): Palpable contractile activity.

Grade 0 (Zero): No contractile activity.

STATION 6: MANUAL TEST - SHOULDER EXTERNAL AND INTERNAL ROTATORS

Station 6 Learning Learning Station 6 Instruction:
Objective
EXTERNAL ROTATORS
Demonstrate the
proper way measuring Reference Material: https://www.youtube.com/watch?
the muscle strength v=32fGfSA5q24&t=1s
of shoulder external
and internal rotators

Learning station 6 checklist:

Student should demonstrate how to measure the muscle strength of
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
shoulder external rotators.

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

Position of Patient:

1. Prone with head turned toward test side. Shoulder abducted to 90 ° with
arm fully supported on table.
2. Forearm hanging vertically over edge of table.
3. Place a folded towel under the arm at the edge of the table if it has a
sharp edge.

Alternate Position:

1. Short sitting with elbow flexed to 90°.

2. The amount of resistance tolerated in this position may be much greater
for Grades 5 and 4.

Position of Therapist:

1. Stand at test side at level of patient's waist.

2. Two fingers of one hand are used to give resistance at the wrist for Grades
5 and 4.
3. The other hand supports the elbow to provide some counterpressure at
the end of the range.

Test: Patient moves forearm upward through the range of external rotation.

Instructions to Patient: "Raise your arm to the level of the table. Hold it.
Don't let me push it down."

Therapist may need to demonstrate the desired motion.

Grading

Grade 5 (Normal): Completes available range of motion and holds firmly

against two-finger resistance.

Grade 4 (Good): Completes available range, but the muscle at end range
yields or gives way.

Grade 3 (Fair): Completes available range of motion but is unable to take

any manual resistance.

Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero)

Position of Patient:

1. Prone with head turned to test side, trunk at edge of table.

2. The entire limb hangs down loosely from the shoulder in neutral rotation,
palm facing table.

Position of Therapist:

1. Stand or sit on a low stool at test side of patient at shoulder level.

2. Palpate the infraspinatus over the body of the scapula below the spine in
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
the infraspinous fossa.
3. Palpate the teres minor on the inferior margin of the axilla and along the
axillary border of the scapula

Test:

1. Patient attempts to externally rotate the shoulder. Alternatively, place the

patient's arm in external rotation and ask the patient to hold the end
position.

Instructions to Patient: "Turn your palm outward."

Grading

Grade 2 (Poor): Completes available range (i.e., palm faces forward) in this
gravity-eliminated position.

Grade 1 (Trace): Palpation of either or both muscles reveals contractile

activity but no motion.

Grade 0 (Zero): No palpable or visible activity.

INTERNAL ROTATORS

Reference Material: https://www.youtube.com/watch?v=9P5XGMW1b6Q

Learning station 6 checklist:

Student should demonstrate how to measure the muscle strength of
shoulder internal rotators.

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)

Position of Patient:

1. Prone with head turned toward test side.

2. Shoulder is abducted to 90 ° with folded towel placed under distal arm
and forearm hanging vertically over edge of table.
3. Short sitting is a common alternate position.

Position of Therapist:

1. Stand at test side.

2. Hand giving resistance is placed on the volar side of the forearm just
above the wrist.
3. The other hand provides counterforce at the elbow.
4. The resistance hand applies resistance in a downward and forward
direction; the counterforce is applied backward and slightly upward.
5. Stabilize the scapular region if muscles are weak.
 MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM
Test:

1. Patient moves arm through available range of internal rotation (backward

and upward).

Instructions to Patient: "Move your forearm up and back. Hold it. Don't let
me push it down."

Demonstrate the desired motion to the patient.

Grading

Grade 5 (Normal): Completes available range and holds firmly against strong
resistance.

Grade 4 (Good): Completes available range, but there is a "spongy" feeling

against strong resistance.

Grade 3 (Fair): Completes available range with no manual resistance.

Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero)

Position of Patient: Prone with head turned toward test side. Patient must
be near the edge of the table on test side so that entire arm can hang down
freely
over the edge. Arm is in neutral with palm facing the table.

Position of Therapist: Stand at test side or sit on low stool. Hand used for
palpation must find the tendon of the subscapularis deep in the central area
of the axilla. Therapist may have to stabilize test arm at the shoulder.

Test: Patient internally rotates arm with thumb leading so that the palm
faces out or away from the table.

Instructions to Patient: "Turn your arm so that the palm faces away from
the table" (not shown).

Grading

Grade 2 (Poor): Completes available range.

Grade 1 (Trace): Palpable contraction occurs.

Grade 0 (Zero): No palpable contraction.

LEARNING ASSESSMENT
Access the following link to answer some questions that will help you reinforce what you have
learned.

https://docs.google.com/forms/d/e/
1FAIpQLSfdA5QrPkfBhhRsaT9mwRf19mI83wfqToxGkv31W4UoZEd23A/viewform?
vc=0&c=0&w=1&flr=0
MAPUA MALAYAN COLLEGES MINDANAO
COLLEGE OF HEALTH SCIENCES
PHYSICAL THERAPY PROGRAM