Functional Anatomy

Full

Patient moves shoulders toward ears in an upward direction

• Therapist's right hand cups inferior angle of scapula and elevates scapula. Left hand assists in controlling the direction of movement
• End feel: Firm

• Start: Patient is sitting. Shoulders slightly abducted, and elbows are flexed to 90 degrees
• Movement: Patient elevates shoulder girdles to bring the acromion process closer to the ear
• Palpation: Upper fibers of Trapezius-on a point of a line midway between the inion and the acromion process. Levator Scapulae-too deep to palpate
• Substitution: Lowering ear to shoulder and contralateral trunk side flexion
• Resistance Location: Applied over top of shoulders
• Resistance Direction: Scapular depression

• Start: Patient prone. Arm is at side, and shoulder in neutral rotation. Therapist supports weight of UE to reduce resistance of friction
• End Position: Patient elevates scapula through full ROM
• Substitution: Contralateral trunk side flexion

Full

Patient moves shoulders towards waist in a downward direction

Therapist's left hand is placed on top of shoulders and depresses scapula. Right hand cups inferior angle of scapula to control direction of movement

• Start: Patient prone. Head is rotated to opposite side, and shoulder is abducted to about 130 degrees
• Movement: Patient raises arm to produce depression and adduction of scapula
• Palpation: Medial to inferior angle of scapula along a line between root of spine of scapula and T12 spinous process
• Substitution: Trunk extension, middle fibers of trapezius
• Resistance Location: Over scapula
• Resistance Direction: Scapular elevation and abduction

• Start: Patient prone with arms at sides. Therapist supports arm through range to reduce resistance of friction
• End: Patient depresses and adducts scapula through full ROM
• Substitution: Ipsilateral trunk side flexion and middle fibers of trapezius

Full

From start position, patient flexes arms to 90 degrees, and scapular abduction is observed as patient reaches forward. Vertebral borders of scapula move away from vertebral column

• Therapist uses thumb and index finger to grasp vertebral border and inferior angle of scapula and abducts scapula. Therapist's left hand is placed on top of shoulder to assist in abduction
• End feel: Firm

• Start: Patient supine. Shoulder flexed to 90 degrees with slight horizontal abduction, and elbow is extended
• Movement: Patient abducts scapula through full ROM
• Palpation: Midaxillary line over thorax
• Substitution: Pectoralis Major, Pectoralis Minor
• Resistance Location: Applied on distal end of humerus
• Resistance Direction: Scapular adduction

Full

Patient moves scapule horizontally toward vertebral column

Therapist uses thumb and index finger of right hand to grasp axillary border and inferior angle of scapula and adducts scapula. Therapist's left hand is placed on top of shoulder to assist adduction

• Start: Patient prone. Shoulder is flexed to 90 degrees and in neutral rotation. Arm is hanging vertically over edge of plinth
• Movement: Patient adducts scapula toward midline
• Palpation: Between medial (vertebral) border of scapula and vertebrae, above spine of scapula
• Substitution: Rhomboid major, rhomboid minor, and ipsilateral trunk rotation
• Resistance Location: Applied over scapula (not humerus)
• Resistance Direction: Scapular abduction

• Start: Patient sitting. Shoulder is ina few degrees of horizontal abductionand internal rotation. Arm is supported by therapist
• End: Patient adducts scapula through full ROM
• Substitution: Shoulder horizontal abduction, and ipsilateral trunk rotation