now we are going to move on down and we're going to go to the upper extremity so moving on to the shoulder elbows and wrists I'm actually going to have the patient take off the Gown so that way we can see the range of motion better of the upper extremities and as we move to the lower extremities so first for the shoulders I'm going to have you take your arms forward like a zombie forward flexion very good going in backward extension take your arms behind you wonderful the shoulders can also do abduction and adduction so if you think about if someone gets abducted they get taken away and an adduction adding together so I want you to take your arms as if you're doing a jumping jack or a snow angel so take up and then add them back together very good so that is a b abduction is a way adduction is coming together so you add them together next we're going to do external and internal rotation of the shoulders so I want you to do external rotation first taking your hands behind your head without interlocking the fingers that's external rotation now inter rotation take them behind your back how I remember the difference is I think if you were going in The Slammer or getting arrested then you would need to put your hands in internal rotation for handcuffs to be put on so think internal rotation in The Slammer and then finally for the shoulders we have circumductions so circumduction is like throwing a softball or doing what you'd have to do for jump rope very good so for the shoulder the patient had full range of motion active range of motion so we'll add that strength against resistance hey did you see the new study guide that follows along with this video so cut your study time in half and increase your retention of the need to know key points and memory tricks that love to come up on nursing school exams plus get 900 more videos not here on YouTube neatly organized in the playlist try it for free visit simplenursing.com today so to test that that induction and adduction I'm going to have you just hold your arms into a t because remember the important thing is opposing muscle forces so keeping your arms here don't let me push you down very good now don't let me put you up very good so that would be full strength against resistance so let's talk about if the patient didn't have full strength against resistance a four out of five are sometimes charted just four plus would mean that they have some strength against resistance so let's say I could not do full pressure on the client's arms let's say if I did full pressure they collapsed so now I'm going to do it again but I'm going to go a little bit easy on them so take your arms up and I'm just going to use two fingers this time to go a little lighter okay still able to hold it so that would get a four out of five or a four plus next would be a three out of five or a three plus so this would mean that the client cannot handle any resistance but they can hold up against gravity so go ahead and place your arms out in a t again holding your arms up like this Against Gravity is no easy feat if you've ever tried to hold your arms like this for an extended period of time it gets more and more difficult if the client can do this but the moment I add any resistance they collapse so let's say if I add resistance any drops then he could still do his arms out which means he would get a three out of five or three plus if the client could not hold up against gravity if I had to remove gravity meaning I had to help the client through by removing that extra exertion that gravity pushes down that would be that passive range of motion so passive means I'm helping the patient and that would be a two plus one plus would be if I have to do passive range of motion but then also you only really get slight contraction of the muscles on their own that would get a score of one plus zero or zero out of five would mean that there is absent muscle contraction essentially that the patient's having paralysis and that they have those flaccid or immovable muscles next we will continue now that we've gone through what that grading looks like we'll continue with the rest of our strengths against resistance of the shoulders so if you can we already did abduction adduction so take your arm out in a zombie and just hold it there don't let me push you down don't let me push you up so that tests our forward flexion and backward extension using those opposing muscle forces now take your hands back behind your head again don't let me pull you apart and now go behind your back internal rotation like you're in The Slammer don't let me push you apart very good so that would be a five out of five or full range of motion and full strength against resistance we don't routinely check the range of motion with the addition of the strength against resistance for circumduction of the shoulder just because of the risk of tearing the rotator cuff the rotator cuff is a series of muscles surrounding that shoulder girdle and can be easily torn in bodybuilders or anyone who really lifts weights also easily torn and nurses especially if you're not using great body mechanics while lifting patients in bed so next now that we've completed the shoulder we're going to move on to the Elbow so once you extend your arms out like this so that is extension of the elbow now flexing in that is flexion of the elbow for the most part flexion is towards the body an extension is away from the body so now go back into extension I want you to hold your hands out like you're holding a cup of soup this is supination of the elbow now pour that cup of soup out and that is pronation of the elbow so supination and pronation you may be familiar with those terms of someone laying supine or prone so supine would be as if you were laying up on your back in that cup of soup might be in your belly or in your belly button prone would be if you pour that cup of soup out and you're laying belly button down so next we're going to do the strength of the biceps so and of that elbow joint and so typically we primarily check that flexion and extension so I'm going to have you turn to the side wonderful and go ahead extend your arms out very good now flexing bending at the elbow pull towards in pull pull pull harder pull I know you can do more very good now hold there and now push out extend your arms very good all right so we have full range of motion and full strength against resistance of the elbow now let's move on to the wrist so your wrist can do flexion extension so can you wave bye bye like a toddler you know they flap their arms very good and then your wrist can also do radial deviation and ulnar deviation so can you shake it off like Taylor Swift very good so that's full range of motion of the wrist we're going to add strength against resistance and we're primarily just going to check that flexion and extension so using your hand like a gas pedal go ahead and push down push push push push push very good now we're going to switch pulling up at the wrist pull back very good now we're going to do the hands so once you spread your hands out wide very good that is abduction now take it in adduction now I want you to bend just the fingers perfect that is going to be flexion and pull your fingers back curving as if you had a manicure and you're looking at your manicure wonderful so that's flexion extension so you can also do circumduction of the fingers I want you to go as if you're going to a party very good that is circumduction of the fingers then there is one thing that your thumb can do that your other finger joints cannot do and that's called opposition so don't you take your thumb and go back and forth to the other fingers back and forth back and forth faster faster faster this also tests our rapid alternating movements which is a function of the cerebellum so wonderful now I'm going to test the strength of the hands so just go ahead and squeeze my fingers very good so the patient had full range of motion in full strength of the hands and fingers five out of five