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Shoulder External Rotator Manual Muscle Testing (MMT) for an Active Population

Learn how to accurately assess shoulder external rotator manual muscle testing (MMT) for an active population with this video. Gain quality insights on MMT testing, see practical demonstrations, and get an in-depth understanding of the anatomy and biomechanics.

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00:05 - 00:06This is Brent of the Brookbush Institute,
00:06 - 00:07and in this video we're going to do
00:07 - 00:10shoulder external rotator manual muscle
00:10 - 00:12testing for an active population. So,
00:12 - 00:14since we're going to go ahead and test a
00:14 - 00:15more active population, we're going to
00:15 - 00:17get rid of that Kendall scale of the one
00:17 - 00:19through five of the pluses and minuses and
00:19 - 00:21replace it with a simpler scale of
00:21 - 00:25strong, weak, with compensation, or with
00:25 - 00:26pain. But, we're going to pay a little
00:26 - 00:30closer attention to the details, because
00:30 - 00:31we know in that more active population, who
00:31 - 00:33is putting a little bit more stress on
00:33 - 00:35their musculoskeletal system, it often
00:35 - 00:38doesn't take a very large change in
00:38 - 00:41muscle activity, length, or we'll say joint
00:41 - 00:44alignment to start showing signs of pain
00:44 - 00:45and dysfunction. I'm going to have my
00:45 - 00:47friend, Melissa, come out. She's going to
00:47 - 00:49help me demonstrate these tests. Now, the
00:49 - 00:51first test we're going to use for the
00:51 - 00:53infraspinatus and teres minor, which we
00:53 - 00:55know have a propensity to get long and
00:55 - 00:58underactive, is the very traditional
00:58 - 01:03Kendall style test. It is prone, facing
01:03 - 01:07away, with their humorous supported by a table, and you
01:07 - 01:09guys can use a little towel under their
01:09 - 01:12humorous so that they they keep in good
01:12 - 01:14alignment throughout their shoulder.
01:14 - 01:17Since their chest tissue
01:17 - 01:18will lift them up a little bit, we want
01:18 - 01:21them in neutral position. Now, in this
01:21 - 01:23position, I have a lot of control over her
01:23 - 01:25shoulder girdle, so I can help stabilize
01:25 - 01:28it. Or, I can put it back into good
01:28 - 01:30position and just have her hold that. I
01:30 - 01:33can also palpate her infraspinatus, just
01:33 - 01:36under the spine of her scapula, or I can
01:36 - 01:39use my thumb to palpate her teres
01:39 - 01:42minor. Now, the first thing I'm going to
01:42 - 01:43do with this test is I'm actually going
01:43 - 01:45to check her range of
01:45 - 01:49motion. We can see Melissa actually
01:49 - 01:52has pretty close to optimal range at 90 or
01:52 - 01:5595 degrees of external rotation. If I
01:55 - 01:57have her do the same thing actively- now
01:57 - 01:59go ahead and do that for me- you guys will
01:59 - 02:01start to notice that she actually doesn't
02:01 - 02:03have the same range of motion actively.
02:03 - 02:04That's something I want to take note of.
02:04 - 02:07She has good passive range of motion, but
02:07 - 02:09her active range of motion is lacking.
02:09 - 02:12Now, if I have her go ahead and do that
02:12 - 02:15again and then I add some external
02:15 - 02:17resistance,
02:17 - 02:19what we notice with Melissa is she
02:19 - 02:22has a weak spot through here.
02:22 - 02:24and then she catches about here, at about
02:24 - 02:2775 to 80 degrees of external
02:27 - 02:31rotation. Now, if you're asking me, I'm
02:31 - 02:33actually going to make a note of that.
02:33 - 02:37That's a week test to me. Although, she
02:37 - 02:41may test a five in this position, if she
02:41 - 02:44doesn't have optimal strength all the
02:44 - 02:47way to 90 degrees, the question I start
02:47 - 02:50asking myself are will she keep that 90
02:50 - 02:52degrees of external rotation. If she's
02:52 - 02:54not stable and strong in a range of
02:54 - 02:56motion, there is a chance that she could
02:56 - 03:00lose that range of motion. So note: weak
03:00 - 03:04maybe week last 15 degrees and whatever you
03:04 - 03:05guys want to add as far as detail, but
03:05 - 03:07this would be a weak test to me. I'm
03:07 - 03:09going to go ahead and have Melissa sit
03:09 - 03:13up. Now, the test I use more commonly is
03:13 - 03:16not the traditional Kendall test, but
03:16 - 03:18it's the one I see a lot of people use
03:18 - 03:20in clinic, because it's
03:20 - 03:23convenient and has some advantages. It's
03:23 - 03:26not quite as strict as that test, but if
03:26 - 03:29I have Melissa just sit up here, put both
03:29 - 03:31her arms out, and I'm going to go ahead and make
03:31 - 03:33sure she's in a slightly flexed position,
03:33 - 03:36so maybe elbows lined up with the
03:36 - 03:40anterior side of a rib cage here. Once
03:40 - 03:42she's lined up this way, I have posterior
03:42 - 03:47delt a little bit inhibited, I'm making
03:47 - 03:48sure I get as much infraspinatus and
03:48 - 03:51teres minor as I can, and I can go ahead
03:51 - 03:55and push both arms at once. The
03:55 - 03:58advantage to pushing both arms at once
03:58 - 04:03is I can compare her two sides. With all
04:03 - 04:04manual muscle testing, there's a little
04:04 - 04:07bit of practice that you guys need to do.
04:07 - 04:08You have to start comparing
04:08 - 04:10individuals. It takes a little bit of
04:10 - 04:12time to kind of determine what is strong
04:12 - 04:15versus what is weak. I can't just tell
04:15 - 04:17you guys on camera that a strong result
04:17 - 04:20would give you X percentage, or X pounds,
04:20 - 04:22or she should be able to hold, because I
04:22 - 04:23can tell you right now that Melissa's
04:23 - 04:27infraspinatus and teres minor are not as
04:27 - 04:29strong as my pecs. Right? Those are much
04:29 - 04:32smaller muscles. But, I don't have to
04:32 - 04:35necessarily be able to rate her
04:35 - 04:37infraspinatus and teres minor versus my
04:37 - 04:40pecs if I can compare sides, especially
04:40 - 04:42she's coming to see somebody like me to
04:42 - 04:44correct some shoulder pain on
04:44 - 04:47her right side. I can do that test and
04:47 - 04:50immediately compare her left side to the
04:50 - 04:54right side, and now I have presumably a good
04:54 - 04:57side and a symptomatic side to compare
04:57 - 04:59to. The other thing that this position is
04:59 - 05:02really nice for is I can easily address
05:02 - 05:05or see compensation. Remember, that's that
05:05 - 05:07test result with compensation that we
05:07 - 05:09talk about a lot when it comes to
05:09 - 05:11using these tests for helping us
05:11 - 05:12determine postural dysfunction and
05:12 - 05:16intervention. If I come behind her, which
05:16 - 05:17isn't how I would do this test,
05:17 - 05:19but just so you guys can see on camera,
05:19 - 05:23if I push her into internal rotation,
05:23 - 05:27you can see her start to abduct at the
05:27 - 05:29shoulder and her elbows are actually
05:29 - 05:34starting to flare out a little bit.
05:34 - 05:35Her infraspinatus and teres minor
05:35 - 05:38definitely don't do abduction, so she's
05:38 - 05:40starting to try to use her overactive
05:40 - 05:42synergists, which in the case
05:42 - 05:44of the external rotators is posterior
05:44 - 05:47delt and supraspinatus, to try to
05:47 - 05:50abduct her shoulders to resist me rather
05:50 - 05:53than do pure external rotation. That's
05:53 - 05:56with compensation. If I know her
05:56 - 05:58compensation's abduction, maybe I'm
05:58 - 06:00thinking in the back of my head already that
06:00 - 06:03maybe one of the interventions I
06:03 - 06:05want to give her is supraspinatus
06:05 - 06:08release, or posterior deltoid release
06:08 - 06:10along with her external rotator
06:10 - 06:12activation. Now, I do want to show you
06:12 - 06:16guys one more view from the side. I would
06:16 - 06:18make sure Melissa's sitting up nice and
06:18 - 06:20tall so that I don't have her starting
06:20 - 06:23in a compensated position. I'm once again
06:23 - 06:25going to line her arms up so that her
06:25 - 06:28elbows are at her anterior rib cage, just
06:28 - 06:31to try to inhibit her posterior delt a
06:31 - 06:32little bit. We don't
06:32 - 06:33want that taking over from the get-go.
06:33 - 06:36And then, all I'm going to do is use my
06:36 - 06:42pecs to go ahead and push in and see if
06:42 - 06:48she can maintain that perfect posture.
06:48 - 06:49Melissa, as we could tell from the other test, does have, in my
06:49 - 06:53opinion, fairly weak external rotators.
06:53 - 06:55From this view, they're even and
06:55 - 06:58unless I'm cueing her to do so, she
06:58 - 07:01actually doesn't compensate. So, maybe in
07:01 - 07:03Melissa's case, since she doesn't
07:03 - 07:05compensate, I could get away with not
07:05 - 07:08doing supraspinatus release, not doing
07:08 - 07:10posterior delt release, which is two less
07:10 - 07:13releases I have to do. Maybe I don't
07:13 - 07:14have to do any posterior capsule
07:14 - 07:16stretching, which is one less stretch I
07:16 - 07:18have to do. But, I am going to go ahead
07:18 - 07:22and do some external rotator isolated
07:22 - 07:25activation and integration to try to get
07:25 - 07:28her shoulders a little stronger. I hope
07:28 - 07:30you guys enjoyed this video. I hope you
07:30 - 07:33guys enjoyed seeing my take on the
07:33 - 07:35external rotators, or infraspinatus and
07:35 - 07:38teres minor manual muscle test for an
07:38 - 07:41active population.
07:47 - 07:49you

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