Kinesiology Chapter 7

Kinesiology Chapter 7 - Key to Muscle Grading Function...

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Unformatted text preview: Key to Muscle Grading Function ol‘the Muscle Grade Symbols No contraction felt in the muscle Zero Tendon becomes prominent or feeble contraction felt in Trace the muscle. but no visible movement of the part MOVEMENT IN HORIZONTAL PLANE Moves through partial range of motion Poor 7 Moves through complete range of motion Poor - Moves to completion of range against resistance or i Moves to completion of range and holds against pressure r———-— Poor + ANTIGRAVITY POSITION | Moves through partial range of motion Gradual release from test position Fairi F7 4 ‘ Holds test position (no added pressure) Fair F 5 Holds test position against slight pressure - k u ' Holds best position against slight to moderate pressure 03* 7 Holds test position against moderate pressure Good G 8 Holds test position against moderate to strong pressure I Good + l G 1'- 9 Holds best position against strong pressure Normal N Comparison of grading symbols 0-10 0-5 has P. Kendall. Author grants permission to reproduce this chart. mats. II Inc nnmwtnrn fll‘fl pnrnlyzm. the “III wvightHr tho extremity Wlii run! on the tnhiv mul mulu- llcxion uml l‘.)(t('llNlllll dilliculL Il'tlm mlxluc tor muscles are strongr they will tend to misc tin- extremity so the full weight does not rest on the table, thereby reducing the friction, and the flex- ion and extension movements will be made easier. GRADING SYMBOLS Robert W. Lovett, M.D., introduced a method of testing and grading muscle strength, using gravity as resistance (35). A description of the Lovett system was published in 1932 and listed the following definitions: Gone—no contraction felt. Trace—muscle can be felt to tighten, but cannot produce movement. Poor—produces movement with gravity eliminated, but cannot function against gravity. Fair—can raise part against gravity. Good—can raise part against outside resistance as well as against gravity. Normal—can overcome a greater amount of resis- tance than a good muscle While symbols may vary, the movement and weight factors set forth by Lovett form the basis of most present-day muscle testing. The Kendalls —-—-——_~——_—.——__—__—___ Key To Grading Symbols _‘—————"——_-————b—__ 7, Normal N 10 5 Good + G + 9 4 + Good G 8 4 Good ~— G — 7 4 — Fair + F + 6 3 + Falr F 5 3 Fair 7 F- 7 4 3 ~ Poor + P + 3 2 + Poor P 2 2 Poor P 7 1 2 a Trace T T 1 Zero 0 0 0 188 tho haul. Inturlmt oi" thnnn who engage in mono null-win tt‘HiJllH than. no vll'url. In- mmh- In all: tillt'Iil‘M' us much llH possible thtl descriptions ui l tests um! tiu- Hymhols used. 'l'iwn- is incl-mm UHl' ol' uumcrnlu, and such new is Ill-t-clml I research that involves muscle Lost grades, The Key to Muscle Grading on thr- illthWll page is basically the same the Low-ti ::\-:.lu with added definitions for the minus and pl grades. The poor+ grade provides for mow-um in the horizontal plane and for partial arr :1 ][.IIII gravity. Both methods for grading poor l :m- common use. In this text the percent sign has been drum.“ normal— grade has been eliminated, and tln- :m changed to 0 to 10. Leaving zero as 0 aml Iran as T, the word and letter symbols trmmln directly as indicated by the Key to Grading: . bola below. As noted in the Key to Muscle Grmlm there is no movement involved with the 0 and grades, and the numerals 1 to 10 refer to 'I’.« Movement and Test Position grades. The scale oft] to 10 consists ofwhole numin-I‘ and does not involve the use of fractions or lil'l‘ mals. If computations were to be made using I] scale of 5, the minus and plus symbols maul translate as indicated below. J: E (5) (50) (41/2) (4.5) (4) (4-0) - l (3 2/3) (3.66) (31/3) (3.33) 3 (3.0] l (2 2/3) (2.66) (2 1/3) (2.33) (2) (2-0) (1 1/2) (1.5) (1) (1-0) (0) (0 0) Flexor Pollicis Longus Origin: Anterior surface of body of radius below Action: Flexes the interphalangeal joint of ” » tuberosity, interosseus membrane, medial border thumb, assists in flexion of the metacarpophai; of coronoid process of ulna, andfor medial epicon- geal and carpometacarpal joints, and may as; dyle 0f humerus. in flexion of the wrists Insertion: Base of distal phalanx of thumb, pal- Nerve: Median, 0(6), 7, 8, T1. mar surface. Patient: Sitting or supine. Pressure: Against the palmar surface of the d:- Fixatiom The hand may rest on the table for tal phalanx in the direction of extension. support (as illustrated) with the examiner stabi- Weakness: Decreases the ability to flex the CI: lizing the metacarpal bone and proximal phalanx tal phalanx, making it difficult to hold a per” 0f the thumb in extension; or the hand may rest for writing or to pick up minute objects betwe’ on its ulnar side with the wrist in slight extension the thumb and fingers, Marked weakness rr._; and the examiner stabilizing the proximal pha- result in a hyperextension deformity of the int»: lanx of the thumb in extension, phalangeal joint. Test: Flexion of the interphalangeal joint of the Contracture: Flexion deformity of interphala’ thumb. geal joint. 240 Adductor Pollicis Transverse head Oblique head ‘I‘ w , «mum of ()hlique Fibers: Capitate bone, and lmmm u! :u-vond and third metacarpal bones. Hrluiu ul‘ 'l‘ransverse Fibers: Palmar surface of llhlnl 1m~l:u'zirpa1 bone. Illnm‘imn: Transverse head into ulnar side of Ilium oi proximal phalanx of thumb, and oblique hum! Info d‘XLBnSOI' expansion. Action: Adducts the carpometacarpal joint, and adducts and assists in flexion of the metacarpo- phalangeal joint, so that the thumb moves toward the plane of the palm. Aids in opposition of the thumb toward the little finger. By virtue of the attachment of the oblique fibers into the extensor expansion, may assist in extending the interpha— langeal joint. Nerve: Ulnar, C8, T1. Flexor Digiiorum Profundus Palmar Vlew Origin: Anterior and medial su ‘ of proxir mal three fourths of ulna ~nterosseus membrane. and deep antebrachial fa. Insertion: By four tendons into bases of distal phalanges. anterior surface. Patient: Sitting o pine. Fixation: With the wrist in ‘light extension, the examiner stabilizes the proximal and middle pha— langes. Test: Flexion of the distal interphalangeal joint of the second, third, fourth, and fifth digits Each finger is tested as illustrated above for the index finger. Pressure: Against the palmar surf- ofthe dis» tal phalanx in the direction of extension. in flexinn of pro. ‘mal interphalangcal and meme carpophalangeal oints; may assist in flexion of the wrist. Nerve t0 Profundus I and II: Median. C7. 8. T1. Nerve to Profundus III and IV: Ulnar, C7. 8. T1. Weakness: Decreases the ability to flex the dis- tal joints of the fingers in direct proportion to the extent of weakness since this is the only muscle that flexes the distal interphalangealjoints. Flex- ion strength of the proximal interphalangeal. metacarpophalangeal, and wrist joints may be diminished. Contracture: Flexion defo ity of the distal phalanges of the fingers. Shortness: Flexion of the fingers if the wrist is extended. or flexion of the wrist if the fingers are extended. 257 Origin of the Humeral Head: Common flexor tendon from medial epicondyle of humerus. Origin of Ulnar HE E aponeuroSIS from the medial margin of ulec an 1, proximal twu thirds fpostcrmr border nl'ulna. and from the deep ante- brachial fascia. Patient: Sitting m‘ supinP. Fixation: The forearm s in full summation and res S on the table for support 0 15 ‘uppm‘ted by the examiner. Test: Flexinn of the wrist toward the ulnar side, ure: Against the hypothenar eminenc ‘n ,ctinn ofexl \ ion Inward the rsdual ride Flexor Curpi Ulnaris Insertion: P' 'form bone and, by ligaments. t0 hamatc and fifth metacarpal bon Acti n: Flexes and adducts the v» asust in flexion of the elbow Nerve: Ulnar C7. 8. T1. Weakness' Decreasew the strength of wrist flex- ion. and may result 111 a radial deviation (If Llw hand. Contracturc: Wrist fl side‘ 11 toward the ulnar N ote' Normally, fingers wille relaxed when the ' ‘ flexed. If the finge1 activ ' flex as wrist In L n 21th tln’a fin , (prufuudus and superficla are attemptmg to substitute for the Wrist flexun 259 Extensor Digitorum Extensor digltorum \V Extensor digit! mlnlml Origin: Common extensor tendon from lateral epicondyle of humerus, and deep antebrachial fas- cia. Insertion: By four tendons, each penetrating a membranous expansion on the dorsum of the sec- ond to fifth digits and dividing over the proximal phalanx into a medial and two lateral bands. The medial band inserts into the base of the middle phalanx while the lateral bands reunite over the middle phalanx and insert into the base of the distal phalanx. Action: Extends the metacarpophalangeal joints and, in conjunction with the Lumbricales and Interossei, extends the interphalangeal joints of the second through fifth digits. Assists in abduc- tion of the index, ring, and little fingers; and assists in extension and abduction of the wrist. Nerve: Radial, C6, 7 , 8. Patient: Sitting or supine. Fixation: The examiner stabilizes the twist, avoiding full extension: Test: Extension of the metacarpophalangeal joints of the second through fifth digits, with inter- phalangeal joints relaxed. Pressure: Against the dorsal surfaces of the proximal phalanges in the direction of flexion. Weakness: Decreases the ability to extend the metacarpophalangeal joints of the second through fifth digits, and may result in a position of flexion of these joints. Strength of wrist extension is diminished. Contracture: Hyperextension deformity of the metacarpophalangeal joints. Shortness: Hyperextension of the metacarpo- phalangeal joints if the wrist is flexed, or exten- sion of the wrist ifthe metacaipophalangealjoints are flexed. 255 Keeps Brachii and Brachialis Elbow Flexors Biceps Short head \\ Long luaaok Brachialis BICEPS BRACHII Patient: Supine or sitting Origin of Short Head: Apex of coracoid process Fixation: The 83min” Places one hand of scapula_ the elbow to cushion it from table pressures Origin of Long Head: Supraglenoid tubercle of TeSt: Elbow fleXi‘m Slightly less than or 3.- scapula angle, with forearm in supinationi Insertion: Tuherosity of radius, and aponeurosis ress’ureif AgamISt the lower forearm 171 of Biceps brachii (lacertus fibrosus). Memo“ 0 eXtenSIOH' Elbow fiexion with forearm supinatede Action: Flexes the shoulder joint, and the long weakn‘afss'. Decreases the‘ablhty to flex the head may assist with abduction if the humerus ls arm agamSt gTaVIty',Th‘?re IS markéd Interte‘ laterally rotated. With the origin fixed, flexes the Wlth .Such dad-Y actlvmes as feedmg (mtg elbow joint moving the forearm toward the hu- combing the ham merus, and supinates the forearm. With the inser» Contracture: Flexion deformity of the elb: mm flde’ flexes the glbow pint WOVng the hu’ Note: If the Biceps and Brachialis arc weil in a musculocutaneous lesion, the patient pronatc the forearm before flexing the elbow * Nerve: Musculocutaneous, CS, 6. Brachioradialis, Extensor carpi radialis lor. Pronator teres, and wrist flexors. BRACHIALIS The lower figure on the facing page illustr that, against resistance, the Biceps acts in He) ' Origin: Distal one half of anterior surface of even though the forearm is in pronatmn. 5- humerus, and medial and lateral interinuscular the Brachl‘ahsis inserted on the ulna, th septa 0f the forearm, whether in supination Insertion: Tuberosity and coronoid process of “(my does 110‘ age“ the amen 0f thls ulna_ elbow flexion, The Brachioradialis 3 than in the supinated position, although strongest action in flexion is with the forearm ' midposition. Nerve: Musculocutaneous, and small branch from radial, C5, 6‘ 268 ‘ ‘ d. Elbow flexion With forearm primate Triceps BrO'J'i and Anconeus Triceps Lats/a/ head An EC: men s TRICEPS BRACHII ANCONEUS Origin of Long Head: lnfraglenoid tuberrle of scapula. Origin of Lateral Head: Lateral and p ’ ‘ Insertion: Lateral side of oleoranon prOL . ' " of proximal one half of body ofhume upper one fourth of pi tterim surface of and lateral intermuscular septum. ulnar Origin of Media] Head: Distal two thirds of medial and posterior surfaces of humerus below the radial groove, and from medial intermuscular septum. Insertion: Posterior surface of Olecranon pror gs TRICEps BRACHH AND ANCONEUS of ulna and antebrachial fa‘ . Action: Extends the elbow oint. ln addition. the long head a: sts 1n adduction and extension of Fixation: The shoulderis at 903 abduction. '7 the shoulder int, tral with regard to rotation and With the su orted between th shoulder and the ele Nerve: Radlal’ (Jb‘ thgptable. The ex inc pla one hand u the arm near the elbow to cu on the arm i. table pressure, Patient: Prone Extension of the elbow joint [to Sll§ t han full extensiont Pressure: Against the forearm in the dir of flexion. esses of last six thoracic ver— Origin: Spinous proc four ribs. through the tho- tebrae, last three or racoluinbar fascia fr he lumbar and sacral ver— omt tebrae and posterior one third of external lip of iliac crest, a s angle of the scapula. lip from the inferior Rhomboid minor . Insertion: Intertubercular groove of humerus. in. fixed, medially rotates, .Rhomboid mayor Action: With the orig houlder joint. By con- adducts, and extends the s shoulder girdle, and , depre. es the n of the trunk. ("See p. 144.l fixed, a ts in tilting the pel- . rally. Acting bilaterally, : s in hyperextending the spine the pelvis, or in flexing the and anteriorly tilting ts relation to the axes of spine, depending upon '1 motion. This muscle is important in relation to move- ments such as climbing, walking with crutches, or hoisting the body up on parallel bars, in which the. muscles act to ard the fixed lift the body tow arms, The strength dorsi is a of the Latissimus factor in such forceful arm m ovements as swim— ming, rowing, and chopping. All adductors and t in these strong mo vements but medial rotators ac the Latissimus dorsi may be of major importance. The Latissimu muscle of respiration. Nerve: Thoracodorsal, C6, 7, S. of the arm - ‘ I ss the s ulder Medial Rotators The chief muscles acting in this shoulder medial rotation test are Latissimus dor Pectoralis major, Subscapularis, and Teres may Patient: Supine. Fixation: Countei‘pressure is applied by the examiner against the outer aspect of the distal end of the humerus in order to ensure a rotation motion. Test: Medial rotation of the humerus with arm at side and elbow held at right angle. Pressure: Using the forearm as a lever, pressure is applied in the direction of laterally rotating the humerus Note: For the purpose of objectively grading a Weak medial rotator group against gravity, the test in the prone position 1568 above right! is pre- ferred over the test in supine position, For a max- imum strength test, the test in supine position is preferred because less scapular fixation is re- quired. Subscapularls Patient: Prone. Fixation: The arm rests on the table. iner’s hand, near the elbow. cushions ag pressure and stabilizes the humerus tc rotation action by preventing any ad abduction. The Rhomboids give fixatn: scapula. Test: Medial rotation of the humerus T * elbow held at right angle. Pressure: Using the forearm as a leve is applied in the direction of laterally rota. humerus Weakness: Inasmuch as the medial r0 also strong adductors, the ability to per medial rotation and adduction is decre Shortness: Range of shoulder flexion 0'52.“ and lateral rotation are limited. SUBSCAPULARIS Origin: Subscapular fossa of scapula. Insertion: Lesser tubercle of humerus it.“ shoulder joint capsule, Action: Medially rotates the shoulderjoi stabi lzes the head of the humerus in the g cavity duringr movements of this joint. Nerve: Upper and lower subscapular, C5. 6 ' mm ‘Irfraepnau: Teres minor \ INFRASPINATUS Origin: Medial two thirds ot'jnfraspinous lbssa :: scapula. Insertion: Middle facet of greater tubercle of Jumei'us. and shoulder joint capsule, Action: Laterally rotates the shoulderjoint and stabilizes the head of the hum r1 in the glenoid .avity during movements Ofthl Joint. Nerve: Suprascapular. I, 5, 6: TERES MINOR >r two thirds, do .21 surface of lat— apula: Insertion: Lowest facet of greater tubercle at humeru and shoulder joint capsule. A tion: Laterally rotates the shuulderjoint. a d stabilizes the head of the humerus in the glenmd :aVity during movements of this joint, Shoulder Lateral Rotators \‘ ,\““‘\ ,“‘ Patient: Prone. 9 arm re hand uudt, th ' tab] 298 the humeru action prevent motion. The e ion CHE: ‘ the pula or the latei l rm break when p :rplied tion ofthc humerus with the humeru Patient: Fixation: applied by the examiner ag ‘ the inner aspect of the d tal end of the humerus in order to ensu ' i rotation motion. Tes Lateral rotation of the humerus with the elbow held at right angle. Pressur U sing the forearm a a lever. pre ure is applied in the direction of medially rotating the humerus. Weakness. The humerus ' medial rotation. Lateral . difficult or imp he pur} 1" ob lateral rotatur ,5 ‘1)L1p ' gal pa ion of the rota‘. upine p0, \x ' tance teimr Deltcm andx thout theme-ces- Slty of ma mal T1 pezms ii. a ion. the test in b pine. position 1.5. prete 281 S praspinuius andliddle Deltoid I ellmd anterior middle ' steriur DELTO|D Origin of Anterior Fibers' Ante or border. superior surface. lateral 0] hird 0t clavicle. Origin of Middle Fibers: Lateral margin and superh surface of acromion. Urigin of Poster or Fibers: Inferior lip of pos- .e110r border of spine of scapula. insertion: Deltnid tuberositu (if hunier , Action: Abduction of the brmed chiefly by the middle Iiber‘ with stabilie inhy the anteri r and poeterio fibers. In addi- the anterior fibers flex and, in the supine _ on. medially rotate the ' ' 'mnt’ the posterior fibers extend and, in the. prone pus ion. later My rotate. Nerve: Axillary. C5. 6. Patient: Sitting. Fixation: The position of the trunk in relation to the arm in this ‘ tha ' stable trunk will need no furth ' tion by t} examiner. If the scapular fixation mus. . are weak, the examiner must stabilize the 'ipula. Te : Shoulder abduction Without rotation. \ hen placing the shoulder in test position. the elbow should be flexed to in ate the neul n posi- tion of rotation. but mi extended after the shoulder position is estahl . lied i1 ,rder to use the e tended extremity for a longer lever. The exam- iner should be consistent in the technique to h- sequent t ‘ . . . of the di tal end of the hum ‘ ‘ ' s flexed, or a hr in_ the forearm if the elbow is Weakness: Results in the ii 'lity to lift the arm in abduction agamst g‘ra t» In the pre of para sis of the entire Deltoid * nd Supia natus, the humerus tends te downward if the arm remai (ion. The ca hu us from the glenoid unity. in c' larv nerve involvement in V nch the Deltoid is is not affected, the marked. but tends pula ' with the rhead. ‘v's'eakne; of Lower Trapcziu Allow' to ride upvt rd and tilt 1 ‘Ward ion of the eumcmd prone ll" the upper ' t ht, it hel to pull the pul an opponent to a weak law 9.1 ,"duction of the scapula and a for“ 3rd po>1t1un the shoulder. The middle and lower Trapeziu' acic spine e3 ens , the Trapezih ncr Mes the tendency toward a bi Weaknes of Upper Trapeziu Unilz erally. Lkneu let e; 1 t ‘ 1111011 and the eases the 1 iility tn eYtend the (tel , to rat 9 head from a prone p elevation of the shoulder girdle (coni- en in pri . f te 111d swunme In a posture \ th I‘VVJl‘d lie-1d and kvphosis. cervical spinc ' upper Jezius muscle ' Upper Trupezius Patient: Sitting. Fixation: None 11ece , Test: Elevation ot'the‘ 0111 al end (if 18 clavicle and scapul‘ p05 olate 1 Ex ens n of the neck bringing the , ipiit toward the elevated hmilrler with the face turned in the oppoi 'te (111 Ltion. The upper Trapezius can be dii rentiated from other elevators of the “ pula because 1 IS the 0111‘: one that ele the an m 1 end uf the c the elevation tha as in shi‘i he shouldera Pressure Ag st the shoulder in the dir ofdepreb on and again‘ the head in the dues- tion of flexmn anterolateral ' Contracture of Upper Trapezi Uni]. teml (Lure frequent ‘ rticolh mplot the 1 Oht upper T1 pe lu contracted £1101 Sternoclcidomz L wer Trupezius MODIFIED TRAPEZIUS TEST (no! illustrated) For use when posterior shoulder joint muscles are weak. Patient: Prone With . oulder at edge of table. arm hanging down (we de of table. Fixation: None. Test: Supporting the weight of the arm. the examiner places the scapula in a position ofadducr tion. with some lateral I'l ation of the inferior and without el llUll or the should ' Pressure: As support ofthe arm is released. the weight of the suspended i III will ' that ten to abduct the scapula. A Trapezius Will not hold the scapula adduuted against this force. It the Trapezius can hold the scapula in adduction against the weight of the suspended arm, then resist against the middle portion b pressure in the direction 0 hduction. and 21g n the lower portion by pr ' diagonal direction toward abdu n and elem tion. When recording the grade 0 ength. note that pressure was applied on the scapula because the arm could not be used as a lever. 286 A... LOWER TRAPEZIUS TEST Patient: Prone. Fixation: The intervening ‘houldcr ext ' particularly the posterior Delt' ’d mu. necessary ation of the humerus to the and, to a le to hold the 'ves fixation by p13 ' hand he ula on the opp ‘ \‘Jl aliottL Test: Adduction and depression of the “ with lateral rotation of the inferior angl T gonally overhead in line x it us all): is shoulder in order to brm the scapula into rotation. «See explanat on previous page Pressure: Against the forearm in a dovv " direction toward the table. Vote: Tests for lower ( ml i'nirldle Tra eziLE especiall important in e. minati which shoulder position i ulty, or in c upper back arm pain. Patient: Supine. Fixation: The shoulder firmly u n the table tains the elbow in extension, Pressure: Against the forearm in of horizontal the direction abduction. 011 116 to touch the Derrease " Pectora m Jar i medial rotation and adduc- esults in abduction of the scapula from the spine. Note: The rupture and part of the Pectoralis m wrestling The arm wal rotation and made to med authors hax . " in abduction when ' ially rotate ‘ nstead of the pelv' ‘iceps maintains W extended, and the , light medial rotation adduction of ' ' ly toward the oppo- site iliac cr Pressure: Against the for lateral and cranial dll‘eCtlt Weaknes earn] obliquely in 3 )IL of contin‘uilv of major to E on t m and Internal Oblique on result that (‘l’lOppl From a Serratus Anterior Anterolat. VIEW scapula. Actio ula, rot yes the inferior angle later ‘ glcnoid caVity cranially. and holds the med il bor- der of the , pula firnilv aaaint the rib cage. In addition. the. lo 'er fibe s ma depress the scapular and the upper fibers In elevate it slightly. Starting from 3 acts to displace the thorax p teri is made to push the bod ' example ofthi l, outed p With the scapul Rx Patient: Supine. Fixation: None nec elbow m es ; iner will upport the extremity in the pe ular p0 'tion as the tes is done. Test: Abduction of the scapula prQi upper extremity anterinrlv (upward f. tableli 11min nm and the I H‘ angle palpa plished b the action ofthe P ded bV the Le nd Rhoin ' ' k. in 'hich ingle mm s pot e1 orly and in the d of medial 1 tiun. The firm surface of t' supports the pula there will be no and the pi LssuI e ‘ gainst the hand may all appears to be normal strength Since th tting de ribed on the facing page accurate and is the preferred test, Pressure: Against the subject's fist. tr tinv the pressure downward through the ity to the scapula in the direction ofadduc t apula. Slight pressure may be applied the lat ral border ofthe scapula as well a the fist” Patient: Sitting, Fixation: None hould be necessary by the exam- ‘ 'the trunk . stable, but the shoulder flexo s be strong in order to use the arm as a lever in this test Allow the subject to hold on to the table with one hand, Test: The ability of the Serratus to stabilize the scapula in a position of abduction and lateral rota— t n with the arm in a position of approximately 120” to 130‘: flexion. This test empha s the upward rotation action of the Serratus in the abducted p . on as compared to the emphasis on the abdu ion action shown in the. supine and standing ' Pressure: Against the dorsal surfa fthe arm between shoulder and elb v downward in he direction nt'extension, and llghtpr ure inst the lateral border of the l apula in the l on ofrotating the inferior a ' Serratus Anterior more to tra the movement of the l to utter pres ur For pui‘po of photography. the examiner stood hehind the aubject and applied pre ’ the ting ‘ti 1 the scapula ill ' erable to andb ., pressure as illu ated by the 1 is not at ' able to use a long lever bv appr pre cure rm the forearm or at the Vim because intervenii dpula than in flexion. R marked W ' q, the soap- ula c nnot hold the po tion when pro: ’ ...
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This note was uploaded on 01/23/2012 for the course EX SCI 377:303 taught by Professor Chrisd’andrea during the Fall '11 term at Rutgers.

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Kinesiology Chapter 7 - Key to Muscle Grading Function...

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