Rhomboid Manual Muscle Test

What are rhomboid muscles?

The rhomboids are two muscles in the upper back (the rhomboid major and the rhomboid minor), specifically between the shoulder blades. Their primary role is to stabilize the scapula and help allow the smooth movement of the shoulder blades.

When the rhomboids contract, they aid the scapula in retracting and elevating. Whenever the scapula retracts and elevates, the shoulder blades can be moved close together and back. This allows people to perform upper-body movements like pulling, stretching, rowing, and more. They also help us maintain a good posture.

Just like any muscle, the rhomboids can get strained or injured. The rhomboid major and rhomboid minor can weaken or become inflamed if they get strained or injured. When these muscles weaken, it can lead to unwanted problems such as the following:

• Pain and discomfort in the upper back
• Lead us to have poor posture
• Cause shoulder instability, which makes us prone to injuries and dislocations
• Scapular Dyskinesis, which can lead to shoulder impingement and rotator cuff issues
• Lower our upper body strength, making it harder for us to perform certain activities

How to conduct the Rhomboid Manual Muscle Test:

When a patient presents themselves to a healthcare professional, specifically one that specializes in handling problems related to the musculoskeletal system, and they discuss pain and discomfort in their upper back, one of the tests that the professional can conduct is the Rhomboid Manual Muscle Test, sometimes referred to as the Rhomboid Weakness Test.

It’s a physical examination that involves passive movements through the manipulation of the arms by the professional. It involves two specific movements: adduction (moving the limb toward the body's midline or another part) and downward rotation. Here’s how it goes:

• First, the patient will lie down in a prone position (face down) on an examination table/bed
• The patient must put the back of their hand on the small of their back. The hand they must use will depend on which side the professional is at
• Once the hand is on the small of the back, the professional will instruct the patient to lift the hand off their back
• The professional will then apply force to the hand in a downward and outward direction at the distal humerus
• While doing this, the professional will instruct the patient to exert resistance against the force being applied to their hand
• The professional will exert maximum force at first (Grade 5) and then strong/moderate force (Grade 4)
• After that, the professional will palpate the muscles along the scapula’s medial border
• While palpating the muscles, the patient must try to reach their full range of motion by lifting their hand (Grade 3)
• Next, the patient will sit down while keeping their hand at the small of their back
• The professional will palpate the rhomboid muscles and scapula while instructing the patient to complete the test of motion by lifting the arm of their back in a backward, rising motion (Grade 2 to 0)

How to interpret the findings of the Rhomboid Manual Muscle Test

You’ve probably noticed the Grades 5 to 0 mentioned above. Those are what will determine the results of the Rhomboid Manual Muscle Test.

Here’s how to interpret the results:

• Grade 5 means they completed the range of motion and exhibited maximum resistance to maximum downward force. This means their rhomboid muscles are at normal strength. The professional's fingers will pop out when the rhomboids contract.
• Grade 4 means they completed the range of motion but only exhibited maximum resistance to strong/moderate downward force. This means their muscle strength is good. The professional’s fingers will usually pop out when the rhomboids contract
• Grade 3 means they can complete the range of motion but can’t tolerate the downward force exerted on their hand. This means their muscle strength is far
• Grade 2 means they can complete the scapula’s range of motion. This means their muscle strength is poor.
• Grade 1 means that contractile activity was detected despite having no movement. This means there is a trace of contraction.
• Grade 0 means there is no trace of contraction at all.

The weaker their muscles are, the higher the possibility of the patient having a subscapular muscle tear or lesion, especially if they can’t lift their hand from the small of their back. If the test indicates poor to no muscle strength, it would be best to further test the patient with other physical examinations and imaging tests to confirm the problem and address it accordingly.

When is it best to conduct the Rhomboid Manual Muscle Test?

When a patient discusses shoulder or upper back discomfort and pain

As mentioned earlier, the Rhomboid Manual Muscle Test is one possible test you can offer to conduct when a patient discusses shoulder or upper back pain and discomfort during an appointment with you. If they agree to go through this test, you can do so. It’s best to explain what it’s for and how it can help determine the problem causing the pain, discomfort, and perhaps weakness in the upper back and shoulders.

During rehabilitation or physical therapy sessions

Suppose a patient was confirmed to have weak rhomboid muscles during the initial testing and diagnosis, and they’re currently undergoing rehab to regain strength in their rhomboids. You can routinely conduct this test during rehabilitation or physical therapy sessions to see if their rhomboids are regaining strength.

When assessing athletes

Coaches and trainers can employ physical examination techniques to assess their players. They can conduct this test as part of an overall athlete assessment to see if the athlete being assessed is in tip-top shape and condition. If the test results show otherwise, they can adjust the training plan to ensure they reach peak conditioning to take on competition and more difficult types of training.

What are the benefits of conducting the Rhomboid Manual Muscle Test?

It is a reliable diagnostic test

The Rhomboid Manual Muscle Test can help diagnose weakness of the rhomboid muscles and subscapular muscle tears or lesions! While it can’t diagnose these on its own, it can at least confirm the possibility of these problems, which can set the stage for the next series of tests to confirm the cause of upper back and shoulder pains and discomfort.

It can help specialists determine what they can do for the patient

Speaking of setting the stage for the subsequent tests, the Rhomboid Manual Muscle Test can help specialists determine what should go into a patient’s treatment plan. Based on the Rhomboid Manual Muscle Test results, let’s stipulate that the patient has poor rhomboid muscle strength. 

Specialists can shape their treatment plans while considering poor muscle strength. They can add specific physical therapy and rehabilitation to the plan to help the patient regain strength in their rhomboid muscles.

It can help monitor patients

The Rhomboid Manual Muscle Test doesn’t have to be a one-time, big-time test. It can be conducted repeatedly during a patient’s recovery and rehabilitation phase. By monitoring patients, specialists can be updated on the conditioning of the patients' rhomboid muscles. They can determine if their treatment plan is working or not. If it’s working, they can maintain the plan they’ve been following. If not, they can adjust and see if the changes benefit the patient.