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Related Concept Videos

Muscles of the Shoulder01:23

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The muscles surrounding the shoulder girdle, including the clavicle and scapula, primarily stabilize the scapula. This stable base allows other muscles to move the humerus effectively. Scapular movements often mirror those of the humerus and extend its range of motion. For instance, raising the arm above the head would not be feasible without simultaneous upward rotation of the scapula.
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Nine muscles are involved in arm movements. Two of these, the pectoralis major and latissimus dorsi, originate from the axial skeleton and are called axial muscles. The other seven originate from the scapula and are called the scapular muscles.
The pectoralis major has two origins. Its clavicular head originates on the medial half of the clavicle. In contrast, the sternocostal head originates on the costal cartilages of ribs 1-6, the sternum, and the aponeurosis of the external oblique of the...
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Related Experiment Video

Updated: Apr 16, 2026

Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients
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Shoulder Rotation Test: A New Test for Discriminating Between Functional and Structural Weakness.

Takamichi Kanbayashi1, Masahiro Sonoo1,2

  • 1Department of Neurology, School of Medicine, Teikyo University, Tokyo, Japan.

Brain and Behavior
|April 15, 2026
PubMed
Summary
This summary is machine-generated.

The new shoulder rotation test effectively distinguishes functional weakness from structural weakness in upper limb patients. Weak internal rotation is a key indicator of functional weakness.

Keywords:
external rotationfunctional neurological disorderfunctional weaknessinternal rotationpositive sign

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Area of Science:

  • Neurology
  • Orthopedics
  • Physical Medicine and Rehabilitation

Background:

  • Diagnosing functional weakness (FW) requires improved accuracy beyond existing signs.
  • Distinguishing FW from structural weakness (SW) is clinically important for appropriate treatment.

Purpose of the Study:

  • To introduce and validate the "shoulder rotation test" as a novel diagnostic tool.
  • To enhance the differentiation between FW and SW in patients with upper limb weakness.

Main Methods:

  • Retrospective analysis of patients diagnosed with FW or SW and upper limb weakness.
  • Utilized Medical Research Council (MRC) scores for shoulder internal rotation (IR) and external rotation (ER).
  • Defined the "shoulder rotation test" based on combinations of IR and ER MRC scores (≤4).

Main Results:

  • Weak IR demonstrated 100% sensitivity and 86% specificity for FW.
  • Normal IR with weak ER showed 86% sensitivity and 100% specificity for SW.
  • Weak IR with normal ER had 66% sensitivity and 100% specificity for FW.

Conclusions:

  • Preferential weakening of IR in FW suggests impairment of "active" movements.
  • The shoulder rotation test shows promise for accurately discriminating between FW and SW.
  • This test aids in differentiating functional vs. structural upper limb weakness.