MLT, MMT & Gonie for UE Flashcards
1
Q
What do you do if a patient is below an MMT grade 3 for Cervical Extension?
A
For a grade 3 leave them prone and the patient tries to hold the position without resistance.
Grade 2 and below the patient is supine and the therapist put their fingers in the back of the patients head and ask to push into the hands. If they move through small range (grade 2). If they don’t move but you can feel the muscles contracting (grade 1) If they don’t move and you don’t feel muscle contracture (grade 0)
2
Q
What do you do if a patient is below an MMT grade 3 for Upper Trapezius?
A
Patient is placed in a prone position, one hand supports shoulder, the other palpates upper trap.
Grade 2: Patient completes full ROM in gravity minimized position
Grade 1: Upper trap fibers can be palpated at clavicle or neck
Grade 0: There is no contracture
3
Q
What do you do if a patient is below an MMT grade 3 for Middle Trapezius?
A
Patient REMAINS in the same position and the Therapist cradles arm while the other hand palpates muscle.
Grade 2: Completes ROM without the weight of the arm.
Grade 1: Muscle contracts with slight movement
Grade 0: No motion or contraction
4
Q
What do you do if a patient is below an MMT grade 3 for Lower Trapezius?
A
Patient REMAINS in the same position and the Therapist supports patients arm under the elbow
Grade 2: Completes full scap. ROM without weight of arm.
Grade 1: Can feel contraction
Grade 0: No contraction or motion
5
Q
What do you do if a patient is below an MMT grade 3 for Rhomboids (Scap. Adduction, retraction)?
A
Place patient in a sitting position with the arm behind the back (Like Gerber lift offs), one hand supports the wrist while the other palpates the muscle.
Grade 2: Completes range of scap. motion
Grade 1: Muscle contracts
Grade 0: No movement or contraction
6
Q
What do you do if a patient is below an MMT grade 3 for Serratus Anterior?
A
Supports the patient at the arm, while the other hand is palpating the serratus anterior.
Grade 2: The patient actively goes through the motion, if it is not smooth abduction and upward rotation its SA weakness.
Grade 1: Patient holds arm in elevated position. There is muscle contraction.
Grade 0: Patient holds arm in elevated position. There is no muscle contraction.
7
Q
What is the normative range for shoulder flexion?
A
0-180
8
Q
What is the normative range for shoulder extension?
A
0-60
9
Q
What is the normative range for shoulder abduction?
A
0-180
10
Q
What is the normative range for medial rotation?
A
0-70
11
Q
What is the normative range for lateral rotation?
A
0-90
12
Q
What is the normative range for cervical flexion?
A
40
13
Q
What is the normative range for cervical extension?
A
50
14
Q
What is the normative range for cervical lateral flexion?
A
22
15
Q
What is the normative range for cervical rotation?
A
70
16
Q
When the opposing muscle is stretched to a point where it can no longer lengthen and allow further movement, what type of insufficiency?
A
Passive insufficiency
17
Q
Occurs when the muscle produces simultaneous movement at all the joints it crosses and reaches such a shortened position that it no longer has the ability to develop effective tension, is what type of insufficiency?
A
Active insufficiency
18
Q
What do you do if a patient is below a MMT grade 3 for shoulder flexion?
A
Put the patient sidelying and cradle test arm with one hand and with the other palpate the anterior surfaces of the deltoid.
Grade 2: Completes full ROM in gravity minimized position.
Grade 1: Feel or see contraction, no motion
Grade 0: No contraction or movement
19
Q
What do you do if a patient is below an MMT grade 3 for shoulder extension?
A
Grade 2: Patient completes partial ROM
Patient stays in prone position, palpate posterior shoulder and deltoid.
Grade 1: Feel contraction, no movement
Grade 0: No contraction and no movement
20
Q
What do you do if a patient is below an MMT grade 3 for shoulder abduction?
A
Lay the patient supine and place hand on middle deltoid.
Grade 2: Completes ROM in this position.
If they cannot complete, slightly flex the elbow and continue to palpate posterior shoulder.
Grade 1: Contraction with no movement
Grade 0: No contraction or movement
21
Q
How do you grade a patient that can hold the test position against maximal resistance?
A
5
22
Q
How do you grade a patient that can hold a test position against moderate to strong pressure?
A
4+
23
Q
How do you grade a patient that can hold a test position against moderate pressure?
A
4
24
Q
How do you grade a patient that can hold a test position against slight moderate to moderate pressure?
A
4-
25
How do you grade a patient that holds against gravity with minimal pressure?
3+
26
How do you grade a patient that can hold a test position against gravity with no additional pressure applied?
3
27
How do you grade a patient that has gradual release from a test position and is unable to hold against gravity?
3-
28
How do you grade a patient that can move through full ROM in gravity minimized position and hold against resistance.
Or can move against partial ROM against gravity.
2+
29
How do you grade a patient that can move through full ROM in gravity eliminated position?
2
30
How do you grade a patient that can move through partial ROM in gravity eliminated position?
2-
31
How do you grade a patient when there is no motion, but the therapist feels or sees contractile activity of muscle?
1
32
How do you grade a patient that has no discernable palpable contractile activity?
0
33
What do you do if a patient is below an MMT grade 3 for shoulder horizontal adduction (Pec major-Upper Fibers)?
Upper fibers:
Place patient in supine position, while therapist supports arm at 90 degrees of abduction with elbows flexed at 90.
Grade 2: Patient adducts shoulder through available ROM with arm supported by therapist.
Grade 1: Palpable contractile activity
Grade 0: No discern palpable contractile activity
34
What do you do if a patient is below a MMT grade 3 for Horizontal shoulder abduction?
Patient is in (short) sitting position and therapist supports forearm and palpates over the posterior surface of shoulder. Patient "trys to move their arm back".
Grade 2: Moves through full ROM
Grade1: No motion but palpable contraction
Grade 0: No discernable palpable contractile activity
35
What do you do if a patient is below an MMT grade 3 for Latissimus dorsi?
For grade 0-5 patient stays in same position (Nothing to do if below grade 3)
Alternate test: patient is sitting and arms are on both sides of the table, the therapist is behind patient palpating latissimus dorsi.
--Patient pushes down on hands and lifts butt off the table.
Grade 3, 4 and 5:
If patient can lift buttocks clear off table.
36
What do you do if a patient is below an MMT grade 3 for elbow flexion?
(This one is a lot check book for visual and full description)
The patient is short-sitting with arm flexed at 90 and internally rotated and is supported by therapist.
or
Patient is side-lying with arm supported at the elbow in 90 degree flexion
Grade 2: Completes ROM in gravity minimized position (in each muscle group tested.
Grade 1 and 0: Side-lying for all three muscles
Grade 1: Therapist can palpate a contractile response in each of the three muscles.
Grade 0: No discernable palpable contractile activity
37
What do you do if a patient is below an MMT grade 3 for elbow extension?
Patient is short sitting, shoulder is abducted to 90 and neutral rotation with the elbow flexed to about 45 degrees to minimize gravity .
For grade 2 support the limb at the elbow.
For grade 1 and 0 support the limb under the forearm and palpate triceps.
Grade 2: Complete ROM with gravity minimized position
Grade 1: Therapist can feel tension in the tricep, contractile activity
Grade 0: No discernable palpable muscle activity.
38
What are the attachments and innervation of the Deltoid?
-Lateral one-third of clavicle, acromion, spine of scap.
-Deltoid Tuberosity
Axillary Nerve
39
What are the attachments and innervation of the Trapezius?
-External occipital protuberance, ligamentum nuchae, C7-T12
-Lateral one-third of clavicle, acromion, and spine of scap.
Spinal accessory nerve (CN XI)
40
What are the attachments and innervation of the Latissimus Dorsi?
-Thoracolumbar fascia, last 3-4 ribs, inferior angle of scap., iliac crest
-Floor of Intertubercular sulcus
Thoracodorsal Nerve
41
What are the attachments and innervation of the Teres Major?
-Inferior angle and lower one-third of lateral border of scap.
-Medial lip of intertubercular sulcus of humerus
Lower Subscapular Nerve
42
What are the attachments and innervation of the Suprasinatus?
-Supraspinous fossa
-Greater tubercle of humerus
Suprascapular Nerve
43
What are the attachments and innervation of the Infraspinatus?
-Infraspinous fossa
-Greater tubercle of humerus
Suprascapular Nerve
44
What are the attachments and innervation of the Teres Minor?
-Upper two-thirds (Middle part) of the lateral border
-Greater tubercle of humerus
Axillary Nerve
45
What are the attachments and innervation of the Subscapularis?
-Subscapular foss
-Lesser tubercle of humerus
Upper Subscapular and Lower Subscapular Nerve
46
What are the attachments and innervation of the Rhomboid Major?
-Spinous process of T2-T5
-Medial border of the scap, and inferior angle of scap
Dorsal Scapular Nerve
47
What are the attachments and innervations of the Rhomboid Minor?
-Spinous process of C7-T1
-Smooth triagngular area at medial end of scapular spine.
(Upper part of medial border of the scap.)
Dorsal Scapular Nerve
48
What is the Goni placement for Shoulder Flexion and position of patient?
Patient is Supine, knees bent
Axis: Lateral aspect of acromion
Moving Arm: Lateral midline of humerus toward lateral epicondyle
Stationary Arm: Lateral midline of thorax
49
What is the Goni placement for Shoulder Extension and position of patient?
Patient is prone
Axis: Lateral aspect of acromion
Moving Arm: Lateral midline of humerus toward lateral epicondyle
Stationary Arm: Lateral midline of thorax
50
What is the Goni placement for shoulder Abduction and position of patient?
Patient is supine, knees bent
Axis: Anterior aspect of acromion
Moving Arm: Anterior midline of humerus toward medial epicondyle
Stationary Arm: Parallel to sternum
51
What is the Goni placement for Shoulder Lateral Rotation and position of the patient?
Patient is supine, knees bent , elbow on towel.
Axis: Olecranon process
Moving Arm: Ulnar border of forearm toward ulnar styloid process
Stationary Arm: Perpendicular to floor
52
What is the Goni position for Shoulder Medial Rotation and position of the patient?
Patient is supine, knees bent, elbow on towel
Axis: Olecranon process
Moving Arm: Ulnar border of forearm toward ulnar styloid process
Stationary Arm: Perpendicular to floor
53
What is the Goni position for Cervical Flexion and position of the patient?
Patient is sitting
Axis: Earlobe
Moving Arm: Base of the nose
Stationary Arm: Perpendicular to ceiling
54
What is the Goni position for Cervical Extension and position of the patient?
Patient is sitting
Axis: Earlobe
Moving Arm: Base of the nose
Stationary Arm: Perpendicular to Ceiling
55
What is the Goni placement for Cervical Rotation and position of patient?
Patient is sittiing
Axis: Top of patients head
Moving Arm: Nose
Stationary Arm: Imaginary line connecting two acromion processes
56
What is the Goni placement for Cervical Side Flexion and position of patient?
Patient is sitting
Axis: C7 spinous process
Moving Arm: Midline of skull
Stationary Arm: Thoracic spinous processes (Perpendicular to floor)
57
58
What is the end feel and normative ROM for elbow flexion?
Soft end feel
150°
59
What is the end feel and normative ROM for elbow extension?
Hard end feel
0°
60
What is the end feel and normative ROM for elbow pronation?
Firm end feel
80°
61
What is the end feel and normative ROM for elbow supination?
Firm end feel
80°
62
What is the end feel and normative ROM for wrist flexion?
Firm end feel
80°
63
What is the end feel and normative ROM for wrist extension?
Firm end feel
70°
64
What is the end feel and normative ROM for Ulnar Deviation?
Firm end feel
30°
65
What is the end feel and normative ROM for Radial Deviation?
Hard end feel
20°
66
What is the end feel and normative ROM for Finger MCP flexion?
Firm end feel
90°
67
What is the end feel and normative ROM for Finger MCP extension?
Firm end feel
45°
68
What is the end feel and normative ROM for Finger MCP abduction?
Firm end feel
No normative value
(roughly 20-25°)
69
What is the end feel and normative ROM for Finger PIP flexion?
Can be Hard, Firm, Soft end feel
100°
70
What is the end feel and normative ROM for Finger PIP extension?
Firm end feel
0°
71
What is the end feel and normative ROM for Finger DIP flexion?
Firm end feel
90°
72
What is the end feel and normative ROM for Finger DIP extension?
Firm end feel
0°
73
What is the end feel and normative ROM for Thumb CMC flexion?
Soft end feel
15°
74
What is the end feel and normative ROM for Thumb CMC extension?
Firm end feel
20°
75
What is the end feel and normative ROM for Thumb CMC abduction?
Firm end feel
45-70°
76
What is the end feel and normative ROM for Thumb MCP flexion?
Can be Hard, Firm, Soft end feel
50°
77
What is the end feel and normative ROM for Thumb MCP extension?
Can be Hard, Firm, Soft end feel
0°
78
What is the end feel and normative ROM for Thumb IP flexion?
Can be Hard, Firm, Soft end feel
80°
79
What is the end feel and normative ROM for IP extension?
Can be Hard, Firm, Soft end feel
20°
80
When the opposing muscles is stretched to a point where it can no longer lengthen and allow further movement, what type of insufficiency is this?
Passive Insufficiency
81
When the muscle produces simultaneous movement at all the joints it crosses and reaches such a shortened position that it can no longer have the ability to develop effective tension, is what type of insufficiency?
Active Sufficiency
82
How do you grade a patient that can hold the test position against maximal resistance?
5
83
How do you grade a patient that can hold a test position against moderate to strong resistance?
4+
84
How do you grade a patient that can hold a test position against moderate resistance?
4
85
How do you grade a patient that can hold a test position against slight moderate to moderate resistance?
4-
86
How do you grade a patient that can hold against minimal resistance?
3+
87
How do you grade a patient that can hold a test position against gravity with no additional resistance applied?
3
88
How do you grade a patient that has gradual release from a test position and is unable to hold against gravity?
3-
89
How do you grade a patient that can move through full ROM in gravity minimized position and hold against resistance?
2+
90
How do you grade a patient that can move through full ROM in gravity minimized position?
2
91
How do you grade a patient that can move through partial ROM in gravity minimized position?
2-
92
How do you grade a patient when there is no motion, but the therapist feels or sees contractile activity of muscle?
1
93
How do you grade a patient that has no discernable palpable contractile activity?
0
94
What is the cervical plexus formed by?
It is formed by the anterior rami of C1-C4 with contributions of C5
95
What is the Brachial plexus formed by?
It is formed by the anterior rami of C5-T1
96
What is the definition of a Myotome?
-A muscle or group of muscles served by a single nerve root.
97
How are myotomes graded?
On a 0-5 scale (SAME AS MMT)
98
What is the movement of C1-C2 myotome?
Neck Flexion
99
What is the movement of C3 myotome?
Neck side flexion
100
What is the movement of C4 myotome?
Shoulder elevation or scapular elevation (Shrugging)
101
What is the movement of C5 myotome?
Shoulder ABD or ER
102
What is the movement of C6 myotome?
Elbow flexion or wrist extension
103
What is the movement of C7 myotome?
Elbow extension or wrist flexion
104
What is the movement of C8 myotome?
Thumb extension or Ulnar deviation
105
What is the movement of T1 myotome?
Hand intrinsics
106
What is the definition of Dermatome?
The area of skin supplied by a single nerve root
107
How are dermatomes graded?
0-Absent
1-Diminished
2-Normal
NT-Not Tested
108
Where is the sensation of C1 dermatome?
Anterior/Superior cranium
109
Where is the sensation of C2 dermatome?
Posterior cranium
110
Where is the sensation of C3 dermatome?
Lateral upper-mid cervical spine
111
Where is the sensation of C4 dermatome?
Superior and lateral shoulder
112
Where is the sensation of C5 dermatome?
Lateral arm
113
Where is the sensation of C6 dermatome?
Lateral thumb
114
Where is the sensation of C7 dermatome?
Dorsal midline of hand
115
Where is the sensation of C8 dermatome?
Ulnar forearm/hand
116
Where is the sensation of T1 dermatome?
Medial elbow
117
What is the definition of Sclerotome?
Area of bone or fascia supplied by a single nerve root
118
What is the definition of Deep Tendon Reflex (DTR)?
A brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap on the tendon at the insertion of the muscle
119
When testing for DTR, patients can be classified as what?
Hyporeflexia: An absent or diminished response to DTP
Hypereflexia: The hyperactivity or repeating (Clonic) response to DTP
120
How are DTRs graded?
Graded 0-4:
-Grade 0: No response; always abnormal
-Grade 1: A slight but definitely present response; may or may not be normal
-Grade 2: A brisk response; normal
-Grade 3: A very brisk response; may or may not be normal
-Grade 4: Hypertonic. A tap elicits a repeating reflex (Clonus); always abnormal
121
What do you do below a grade 3 for Forearm Supination?
Patient is short sitting, therapist supports forearm at distal elbow, fingers palpate the supinator.
- Grade 2: Completes partial ROM
- Grade 1: Slight contraction, no movement
- Grade 0: No discernable palpable contractile activity
122
What do you do below a grade 3 for Forearm Pronation?
Patient is short sitting, therapist supports forearm at distal elbow, fingers palpate pronator teres.
- Grade 2: Completes partial ROM
- Grade 1: Slight contraction, no movement
- Grade 0: No discernable palpable contractile activity
123
What do you do below a grade 3 for Wrist Flexion?
Patient with elbow supported on table, in mid-position with hand resting on ulnar side. Therapist supports forearm proximal to wrist.
- Grade 2: Completes available range in gravity minimized position
Patient with supinated forearm supported on table. Therapist supports the wrist in flexion and palpates FCR and FCU tendons
- Grade 1: One or both tendons may have visible or palpable contraction, but the part doesn't move.
- Grade 0: No discernable palpable contractile activity
124
What do you do below a grade 3 for Wrist Extension?
Patients forearm supported on table in neutral position, therapist supports wrist.
- Grade 2: Completes full range in gravity minimized position
Patients hand and forearm supported on table with forearm fully pronated. Therapist supports wrist in extension and palpates ECRL, ECRB, ECU separately.
- Grade 1: For any of the three muscles, there is visible or palpable contraction, no wrist motion occurs
Grade 0: No discernable palpable contractile activity
125
What do you do below a grade 3 for Finger PIP and DIP Flexion?
(PIP)
Test is the same, just palpate FDS.
Grade 2 - Complete ROM
Grade 1 - There is palpable and visible contraction
Grade 0 - No discernable palpable contractile activity
(DIP)
Test is the same, Palpate FDP.
Grading is the same as PIP
126
What do you do below grade 3 for Finger MCP Extension?
Test is the same except forearm is in mid-position.
Grade 2 - Complete range
Grade 1 - Visible tendon activity but no joint motion
Grade 0 - No discernable palpable contractile activity
127
What do you do below a grade 3 for Finger MCP Flexion?
Patients are is in mid-position.
Therapist stabilizes metacarpals
Grade 2 - Completes full ROM in gravity minimized position
Grade 1 - Minimal motion
Grade 0 - Absence of any discernable palpable contractile activity
128
What do you do below a grade 3 for Finger Abduction?
Test is the same.
Grade 2 - Patient can complete partial range of abduction
Grade 1 - Dorsal interosseous is palpable
Grade 0 - No discernable palpable contractile activity
129
What do you do below a grade 3 for Finger Adduction?
Test is the same
Grade 2 - Patient can complete partial range of adduction
-Palpation is rarely feasible, therapist's finger against finger tested, therapist may detect slight outward motion for muscle less than Grade 2
130
What do you do below a grade 3 for Thumb MCP and IP Flexion?
(MCP)
Test is the same.
Grade 2 - Complete partial ROM
Grade 1 - Palpate FPL, and FPB
Grade 0 - No Discernable palpable activity
(IP)
Test is the same
Grade 2 - Holds test position
Grade 1 - Palpate tendon of FPL, (palpable activity)
Grade 0 - No discernable palpable activity
131
What do you do below a grade 3 for Thumb MCP and IP Extension?
-Patients forearm in pronation with wrist in neutral (Palm of table),
Therapist stabilizes the wrist over its dorsal surface,
"Straighten the end of the thumb"
Grade 2 - Thumb complets ROM
Grade 1 - Palpate tendon of EPL
Grade 0 - No discernable palpable contractile activity
132
What do you do below a grade 3 for Thumb Abduction?
Test is the same: (Abductor Pollicis Longus)
Grade 2 - Completes partial ROM
Grade 1 - Palpate tendon of the APL
Grade 0 - No discernable palpable contractile activity
(Abductor Pollicis Brevis)
Patients forearm in mid-position, wrist in neutral, therapist stabilized wrist in neutral
Grade 2 - Completes partial ROM
Grade 1 - Palpate the belly of the ABP in the center of Thenar eminence
Grade 0 - No discernable palpable contractile activity
133
What do you do below a grade 3 for Thumb Adduction?
Patients arm is in mid-position and wrist in neutral resting on table, Therapist stabilizes wrist on the table, stabilizes metacarpals
Grade 2 - Completes full ROM
Grade 1 - Palpate adductor pollicis
Grade 0 - No discernable palpable contractile activity
134
What do you do below a grade 3 for Opposition?
Test is the same
Grade 2 - Moves through range of opposition
Grade 1 - Palpate the Opponens pollicis, and palpate opponens digiti minimi
Grade 0 - No discernable palpable contractile activity
135
What is the goni placement for Wrist Flexion (DORSAL alignment)?
Stationary arm: Dorsal midline of forearm towards lateral epicondyle
Moving arm: Dorsal midline of 3rd metacarpal
Axis: Lunate
136
What is the goni placement for Wrist Flexion (ULNAR alignment)?
Stationary arm: Lateral midline of ulna toward olecranon process
Moving arm: Lateral midline of 5th metacarpal
Axis: Triquetrum
137
What is the goni placement for Wrist Extension (VOLAR alignment)?
Stationary arm: Volar midline of forearm towards bicipital tendon at elbow
Moving arm: Volar midline of 3rd metacarpal
Axis: Lunate
138
What is the goni placement for Wrist Extension (ULAR alignment)?
Stationary arm: Lateral midline of ulna toward olecranon process
Moving arm: Lateral midline of 5th metacarpal
Axis: Triquetrum
139
What is the goni placement for Ulnar Deviation?
Stationary arm: Dorsal midline of the forearm toward lateral epicondyle.
Moving arm: Dorsal midline of 3rd metacarpal
Axis: Capitate
140
What is the goni placement for Radial Deviation?
Stationary arm: Dorsal midline of the forearm toward lateral epicondyle
Moving arm: Dorsal midline of 3rd metacarpal
Axis: Capitate
