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Assessing shoulder flexion with manual muscle testing

This is an excerpt from Principles of Goniometry and Manual Muscle Testing With HKPropel Online Video by Abigail Shelley.

Patient position: Seated on a stable chair or bench with their back supported

• Shoulder: Flexed to 90° with the arm in front and the thumb pointing up
• Elbow: Slightly flexed
• Trunk: Straight and supported by the chair

Clinician position: Standing beside the patient next to the shoulder to be tested

• Testing hand: On the distal humerus (near the elbow) to apply resistance
• Stabilizing hand: On the shoulder joint to stabilize the shoulder and prevent movement during the test

Test motion: The patient flexes their shoulder to 90°.

Patient instructions: “Raise your arm to shoulder height, and do not let me push it down.”

Grading

• Grade 5 (Normal): The patient can achieve full shoulder flexion to 90° and maintain this position against maximal resistance.
• Grade 4 (Good): The patient can achieve full shoulder flexion to 90° and maintain this position against moderate resistance.
• Grade 3 (Fair): The patient can achieve full shoulder flexion to 90° through the complete range of motion against gravity but cannot resist additional pressure from the clinician.
• Grade 2 (Poor): The patient can only achieve partial range of motion against gravity.
• Grade 1 (Trace): No visible movement of the shoulder is observed, but a palpable contraction of the shoulder flexors can be felt.
• Grade 0 (Zero): No muscle contraction or movement is observed or felt.

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Clinical tip: Ramp up resistance slowly when testing the shoulder to avoid injury. The clinician can track progress by assessing pain during testing and retesting by asking the patient to rate their pain each time.

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