Scale manual muscle testing

The patient attempts to move the arm out to the side. The examiner states: " Try to move your arm out to the side ". Grade 2 is assigned if the patient moves with gravity eliminated. If weaker than Grade 2, the examiner states " Try to move your arm out to the side " and palpates the middle deltoid muscle, as demonstrated, for contraction, and scores as Grade 1 or 0 as previously defined.

Shoulder MMT can be performed with central venous catheters e. Figure 2. The remaining assessments will be completed similarly to above using specific test positions for the patient and examiner, and specific instructions for the patient's movement.

Test position - forearm supinated and flexed slightly more than 90 degrees. Verbal instructions: " Bend your elbow slightly more than 90 degrees ".

The hand giving resistance is contoured over the flexor surface of the forearm proximal to the wrist. The examiner's other hand applies counterforce by cupping the palm over the anterior superior aspect of the shoulder. The examiner then states: " Hold it. Don't let me push it down " and scores Grades 3, 4, or 5 as previously described.

If weaker than Grade 3, the shoulder is abducted to 90 degrees. The examiner supports the arm under the elbow and, if necessary, the wrist as well. The forearm is turned with the thumb facing the ceiling. With the elbow extended, the patient attempts to flex the elbow.

The examiner states: " Try to bend your elbow. If weaker than Grade 2, the forearm is supinated and positioned at the side in approximately 45 degrees of elbow flexion. The examiner states " Try to bend your elbow ", palpates the biceps tendon and scores as either Grade 1 or 0.

Test position - arm at the side, elbow flexed to 90 degrees with the forearm pronated and the wrist fully extended.

Verbal instructions: " Bend your wrist up as far as possible. The examiner's other hand supports the patient's forearm. Don't let me push it down " and scores Grades 3, 4 or 5. If weaker than Grade 3, the elbow is flexed to 90 degrees and forearm turned with thumb facing the ceiling. The forearm and wrist are supported by the examiner. The examiner states: " Bend your hand toward me ". Grade 2 is assigned if the patient can extend the wrist.

If weaker than Grade 2, the examiner states " Bend your wrist toward me " and palpates the two extensor tendons, one on each side of the wrist, as demonstrated, and scores as Grade 1 or 0. The examiner is careful not to palpate the tendons in the middle of the wrist. This test is not performed if there is an ipsilateral radial arterial catheter in place. Test position - sitting with the hip fully flexed and knee bent.

The patient may place their hands on the bed or table for stability. Verbal instructions: " Raise your knee up as high as it will go. The other hand provides stability at the side of the hip. If weaker than Grade 3, the patient lays down on the side not being tested.

For example, the patient lays on the right side to test the left hip. The examiner stands behind the patient with one arm cradling the leg being tested with the hand supporting under the knee. The opposite hand maintains alignment of the trunk at the hip. The examiner states:" Bring your knee toward your chest. If weaker than Grade 2, the patient is supine. The examiner asks, " May I touch your leg here?

With the patient's permission, the examiner states " Bend your hip " and palpates the iliopsoas tendon, as demonstrated, and scores as Grade 1 or 0. These protocols are necessary to get the most accurate results with manual muscle testing. Conversely, there are some things to avoid which can negatively impact results. Here are some of the other things that you should consider when performing manual muscle testing:.

In , Florence Kendall and two other authors published a guide to performing muscle testing: Muscles: Testing and Function. Detailed below, published by the National Institute of Health is an adaptation from the discussion of muscle testing procedures found in that book, which established a widely accepted grading chart that can be used by physicians to assess patients. Grade 5 Normal.

Grade 4 Good. Grade 1 Trace. Grade 5 Normal : This grade means the patient is able to complete the full range of motion movement against gravity while the practitioner applies maximum resistance. Grade 4 Good : This grade means the patient is able to complete the full range of motion movement against gravity while the practitioner applies moderate resistance.

Grade 3 Fair : The patient can complete the motion against gravity with no resistance applied by the practitioner. When conducting manual muscle testing this is the level in which the testing begins. In addition to standard isokinetic dynamometers used to measure key muscle groups, such as those of the elbow, hip, shoulder, or knee, there are handheld dynamometers that can measure grip strength and even pinch strength.

No matter how strong you may feel as you recover from an illness or injury, two types of tests can tell you how strong your muscles really are: manual muscle testing and dynamometric testing. The former, the more common of the two, calls for a PT to push on the body while the patient resists the pressure. The PT then grades the effort.

The second test measures the tension that a muscle exerts during an isometric contraction. The tests produce information that can guide a patient's rehab plan. If you're experiencing muscle weakness resulting in the loss of functional mobility, speak with your healthcare provider about exploring the possible causes.

You may be referred to an orthopedic surgeon if the cause is believed to be musculoskeletal or a neurologist if the muscle weakness is believed to be caused by a nerve disorder. Only a proper diagnosis can lead to an effective rehab plan. Muscle strength grading can be performed by healthcare providers, nurses, physical therapists, occupational therapists , chiropractors , and other healthcare providers who are properly trained.

Muscle strength grading is commonly used to measure muscle strength in people with a known or suspected neurological condition, such as a stroke. But it can be used in anyone who complains of muscle weakness to help differentiate true weakness from imbalance or endurance problems. Get exercise tips to make your workouts less work and more fun.

Human Kinetics. Muscular strength, power, and endurance training. Associations of maximal strength and muscular endurance test scores with cardiorespiratory fitness and body composition. J Strength Cond Res. Manual muscle testing: A method of measuring extremity muscle strength applied to critically ill patients.

J Vis Exp. Bohannon RW. Reliability of manual muscle testing: A systematic review. Isokinetic Exer Sci. Considerations and practical options for measuring muscle strength: A narrative review. Physical therapists use their own internal gauge to monitor and evaluate the forces being exerted.

Device-less manual muscle testing procedures are becoming less and less popular due to their reliance on subjective muscle strength measurement procedures that vary from examiner to examiner.

Dynamometry is a strength testing measurement technique using handheld dynamometers and other sophisticated strength measuring devices to produce accurate, repeatable, strength evaluations. The resistance applied at the end of the range being tested is referred to as the 'break test'. In other words, the break test tells the examiner when the muscle being tested is no longer capable of max force and the test is over.

Whichever testing method is used, the resistance should be applied and released gradually to give the patient sufficient time to offer resistance.