MMT Trunk.pptx

Muscle Testing of the Trunk
Prof. Satyen Bhattacharyya
Associate Professor: BIMLS, Bardhaman
Chief Physio: Fit O Fine
Director: Well O Fit Healthcare PVT. LTD.
Muscle Testing of the Trunk
Trunk Flexion
Rectus abdominis
Muscles contribute to Trunk Flexion � Rectus abdominis
Origin:
Pubic crest and pubic symphysis
Insertion:
5, 6, 7 costal cartilages, medial inferiorcostal margin and posterior aspect of xiphoid
Action:
Trunk Flexion
Nerve supply:

Normal
Position:
Supine with hands behind neck.
Stabilization:
Stabilize legs firmly.
Desired Motion:
Patient flexes thorax on pelvis through ROM

Normal
Note:
If hip flexor muscles are weak, stabilize pelvis.
A curl up is emphasized, and flexion is possible until scapulae are raised from table.
Tests for neck flexion should precede those for trunk flexion

Good
Position:
Back lying with arms at sides.
Stabilization:
Stabilize legs firmly.
Desired Motion:
Patient flexes thorax on pelvis through range of motion.
If hip flexor muscles are weak, stabilize pelvis.
Flexion is possible until scapula are raised from table.

Fair
Position:
Supine with arms at sides.
Stabilization:
Stabilize legs firmly.
Desired Motion:
Patient flexes thorax on pelvis through partial range of motion.
Head, tips of shoulders and cranial borders of scapulae should clear table with inferior angle remaining in contact with table.
If hip flexor muscles are weak, stabilize pelvis

Poor
Position:
Supine with arms at sides
Desired Motion:
Patient flexes cervical spine.
Caudal portion of thorax is depressed, and pelvis is tilted until the lumbar area of spine is flat on table.
Palpation will help to determine smoothness of contraction

Trace & Zero
Position:
Supine
Observation:
A slight contraction may be determined by palpation over anterior abdominal wall as patient attempts to cough (also during rapid exhalation or as patient attempts to lift head).
Observe deviation of umbilicus.
Cranial movement indicates stronger contraction of upper section of muscle, and caudal movement, stronger contraction of lower section (not illustrated.)

Note
Factors Limiting Motion:
1- Tension of posterior longitudinal ligament, ligamenta flava, and interspinal and supraspinal ligaments
2- Tension of spinal extensor muscles
3-Apposition of caudal lips of vertebra bodies anteriorly with surfaces of subjacent vertebrae
4-Compression of ventral part of intervertebral fibrocartilages
5-Contact of last ribs with abdomen
Fixation:
1-Reverse action of hip flexor muscles
2-Weight of legs and pelvis

Trunk Extension
Muscles contribute to Trunk Extension � Erector spinae – Spinalis
Origin:
Spinous processes
Insertion:
Spinous processes six levels above
Action:
Trunk Extension
Nerve supply:
Dorsal rami of spinal nerves

Muscles contribute to Trunk Extension � Erector spinae – lliocostalis
Origin:
Iliac crest, sacrum, lumbar vertebrae
Insertion:
Ribs, cervical transverse processes
Action:
Trunk Extension
Nerve supply:
Dorsal ram

1. Prof. Satyen Bhattacharyya Associate Professor: BIMLS, Bardhaman Chief Physio: Fit O Fine Director: Well O Fit Healthcare PVT. LTD. Muscle Testing of the Trunk

2. Muscle Testing of the Trunk

3. Trunk Flexion Rectus abdominis

4. Muscles contribute to Trunk Flexion Rectus abdominis Origin: Pubic crest and pubic symphysis Insertion : 5, 6, 7 costal cartilages, medial inferiorcostal margin and posterior aspect of xiphoid Action: Trunk Flexion Nerve supply:

5. Normal Position : Supine with hands behind neck. Stabilization : Stabilize legs firmly. Desired Motion : Patient flexes thorax on pelvis through ROM

6. Normal Note: If hip flexor muscles are weak, stabilize pelvis. A curl up is emphasized, and flexion is possible until scapulae are raised from table. Tests for neck flexion should precede those for trunk flexion

7. Good Position : Back lying with arms at sides. Stabilization : Stabilize legs firmly. Desired Motion : Patient flexes thorax on pelvis through range of motion. If hip flexor muscles are weak, stabilize pelvis. Flexion is possible until scapula are raised from table.

8. Fair Position : Supine with arms at sides. Stabilization : Stabilize legs firmly. Desired Motion : Patient flexes thorax on pelvis through partial range of motion. Head, tips of shoulders and cranial borders of scapulae should clear table with inferior angle remaining in contact with table. If hip flexor muscles are weak, stabilize pelvis

9. Poor Position : Supine with arms at sides Desired Motion : Patient flexes cervical spine. Caudal portion of thorax is depressed, and pelvis is tilted until the lumbar area of spine is flat on table. Palpation will help to determine smoothness of contraction

10. Trace & Zero Position : Supine Observation: A slight contraction may be determined by palpation over anterior abdominal wall as patient attempts to cough (also during rapid exhalation or as patient attempts to lift head). Observe deviation of umbilicus. Cranial movement indicates stronger contraction of upper section of muscle, and caudal movement, stronger contraction of lower section (not illustrated.)

11. Note Factors Limiting Motion: 1- Tension of posterior longitudinal ligament, ligamenta flava, and interspinal and supraspinal ligaments 2- Tension of spinal extensor muscles 3-Apposition of caudal lips of vertebra bodies anteriorly with surfaces of subjacent vertebrae 4-Compression of ventral part of intervertebral fibrocartilages 5-Contact of last ribs with abdomen Fixation: 1-Reverse action of hip flexor muscles 2-Weight of legs and pelvis

12. Trunk Extension Erector spinae – Spinalis Erector spinae – lliocostalis Erector spinae – Longissimus

13. Muscles contribute to Trunk Extension Erector spinae – Spinalis Origin: Spinous processes Insertion : Spinous processes six levels above Action: Trunk Extension Nerve supply: Dorsal rami of spinal nerves

14. Muscles contribute to Trunk Extension Erector spinae – lliocostalis Origin: Iliac crest, sacrum, lumbar vertebrae Insertion : Ribs, cervical transverse processes Action: Trunk Extension Nerve supply: Dorsal rami of spinal nerves

15. Muscles contribute to Trunk Extension Erector spinae – Longissimus Origin: Transverse processes of lumber vertebrae Insertion : Tip of Transverse processes of all thoracic vertebrae Action: Trunk Extension Nerve supply: Dorsal rami of spinal nerves

16. Normal & Good Extension of lumbar spine Position : Prone. Stabilization : Stabilize pelvis. Desired Motion : Patient extends lumbar spine until caudal part of thorax is raised from table. Resistance : Is given on caudal portion of thoracic area.

17. Normal & Good Extension of thoracic spine Position : Prone lying Stabilization : Stabilize pelvis and lower part of thorax. Desired Motion : Patient extends thoracic spine to horizontal position. Resistance: Is given on cranial portion of thorax. A pad can he placed under caudal portion of thorax if a greater range of motion is needed.

18. Fair Extension of thoracic and lumbar spine Position : Prone lying Stabilization : Stabilize pelvis. Desired Motion : Patient extends thoracic and lumbar spine through range of motion.

19. Poor Extension of thoracic and lumbar spine Position : Prone lying. Stabilization : Stabilize pelvis. Desired Motion : Patients completes partial ROM

20. Trace & Zero Position : Prone lying. Observation: Examiner palpates spinal extensor muscles to determine presence and degree of contraction as patient attempts to raise trunk

21. Note Factors Limiting Motion: 1-Tension of anterior longitudinal ligament of spine 2-Tension of anterior abdominal muscles 3-Contact of spinous processes 4-Contact of caudal articular margins with laminae Fixation: 1-Contraction of Glutens maximums and 2-Hamstring muscles 3-Weight of pelvis and legs

22. Trunk Rotation Obliquus externus abdominis Obliquus internus abdominis

23. Muscles contribute to Trunk Rotation Obliquus externus abdominis Origin: Anterior angles of lower eight ribs Insertion : Outer anterior half of iliac crest, inguinal leg, public tubercle and crest, and aponeurosis of anterior rectus sheath Action: Trunk Rotation Nerve supply:

24. Muscles contribute to Trunk Rotation Obliquus internus abdominis Origin: Lumbar fascia, anterior two thirds of iliac crest and lateral two thirds of inguinal ligament Insertion : Costal margin, aponeurosis of rectus sheath (anterior and posterior ), conjoint tendon to pubic crest and pectineal line Action: Trunk Rotation Nerve supply:

25. Normal Position : Backlying with hands behind neck. Stabilization : Stabilize legs firmly. Desired Motion : Patient rotates and flexes thorax to one side. Repeat to opposite side. Note : Test for left Obliquus externus abdominis and right Obliquns interims abdominis is shown in illustration. Rotation to left is brought about by opposite muscles. If hip flexor muscles are weak, stabilize pelvis as in "Fair" test. Upper thorax should be lifted from table with rotation.)

26. Good Position : Backlying with arms at sides. Stabilization : Stabilize legs firmly. Desired Motion : Patient rotates and flexes thorax to one side. Repeat to opposite side. If hip flexor muscles are weak, stabilize pelvic as in "Fair" test.

27. Fair Position: Backlying with hands on opposite shoulders. Stabilization : Stabilize pelvis. Desired Motion : Patient rotates thorax until scapula on side of forward shoulder is raised from table. Repeat with rotation to opposite side.

28. Poor Position : Sitting with arms relaxed at sides. Stabilization : Pelvis stabilized. Desired Motion : Patient rotates thorax. Repeat with rotation to opposite side.

29. Trace & Zero Examiner palpates muscles as patient attempts to approximate thorax on left and pelvis on right. Repeat on opposite side. Note: Observe deviation of umbilicus, which will move toward strongest quadrant if there is a difference in strength of opposing oblique muscles.

30. Reference Daniels and Wortingham’s Muscle Testing Techniques of Manual Examination Physiopedia