MUSCLE TESTING

 MUSCLE TESTING

Manual muscle tests are used to determine the extent and degree of muscular weakness resulting from disease, injuring or disuse. The records obtained from the tests provide a basis for planning therapeutic procedures and for periodic retesting, which can be utilized in evaluating these procedures. Muscle testing is therefore an important tool for all members for the health team dealing with the physical residual of disability.

          The public and the health professions are demanding a total approach to patient treatment. The emphasis is changing from “Sick Care” to “Health Care” through the pursuit of comprehensive, continuous and coordinated care. Consequently physicians, physical therapists, occupational therapists, nurses and their supporting personnel have need for varying levels of knowledge and ability in muscle testing in their concern for preventing disability, habilitating those who have never known normal function, restoring those with disability to optional function and maintaining the functions obtained. Physical educators, although less concerned with the treatment of muscle impairment, are definitely concerned with the optional development of the body and the prevention of disability. They must, therefore, be familiar with the details of muscle functions, testing for fair, good and normal function is an excellent device for teaching kinesiology to this group.

VALIDITY AND RELIABILITY IN TESTING

          Careful observation, palpation and correct positioning are essential for validity in testing. The patient should the asked to attempt to move the part through the range of motion, if he is able to do so. The examiner should observe and note dissimilarities in the size and contour of the muscle or group of muscles being tested and the counterpart on the opposite side of the body. The contractile tissue and tendon (or tendons) should be palpated, as a lack of tension helps to indentify substitution by muscles other by the prime movers. Substitution usually can be eliminated by careful positioning; if this is impossible a notation should be made on the record. A classic example of complete substitution can occur in patients with muscular dystrophy when the prime mover may be nonfunctioning and secondary muscles perform the movement.

          In considering the interpretation of a test grade its is probably unnecessary to point out the existence of variation in length and bulk of the body parts, variations in shape of like parts in different persons, age and sex differences persons, age and sex differences in strength, and  the ever-present  psychological considerations of cooperation and willingness to put maximal  effort that operate particular in every small children. In view of these and other factors such as fatigue, it would be an error to assume that invariably muscles or muscle groups with the same grade have suffered an  equal degree of involvement.

          A factor that has been widely disregarded, not only in muscles testing but also therapeutic exercise in general, is the considerable variation in the force that a muscle can normally exert at various point through the range of motion of the moving segment. Consideration of such “strength curves” shows that the test point in manual resistance tests is often near the weakest portion of the range. As long as the test is always done in the same manner, this willnot affect its reliability, but it may have implication for functional interpretation of the grade.  

NECK FLEXION

          Normal and Good

v    Backlying , shoulders relaxed.

v    Stabilize lower thorax.

v    Patient flexes cervical spine through range of motion.

v    Patient is given on forehead

Note: The accessory muscles flex the head and stabilize the cervical spine as the sternocleidomastoideus muscles flex the neck. if the accessory muscles are weak, the contraction of strong sternoccieddomastoideus muscles will increase rather than decrease the convexity of the cervical spine , the head can be raised but will be rotated posteriorly, chin up.

 

 


  Neck Extension

     Normal and Good

Ø    Facelying with neck in flexion

Ø    Stabilize upper thoracic area and scapulae

Ø    Patient extends cervical spine through range of motion.

Ø    Resistance is given on occiput.

Note: If there is considerable weakness of neck extensors or discomfort in this position, all tests may be given with head resting on bed or table.

Extensors muscles on right may be tested by rotation of head to right with extension and vice versa.

 


Trunk Flexion

     Normal and Good

ü    Backlying with hands behind neck.

ü    Stabilize lower limbs.

ü    Patients flexes thorax through range of motion.

A “curl-up” is emphasized, and flexion is possible until scapulae are raised from bed or table.

Note: If abdominals are weak, the reverse action of the hip flexors may cause lumber lordosis. If so, the patient’s hips and knees should be flexed (feet flat on bed/ tables). This allows “slacks” in the hip flexors. However, if the extensor muscles of the lumbar spine are weak, contraction of the abdominal muscles can cause posterior rotation of the pelvis. If this occurs, tension in the hip flexors would be useful in stabilize the pelvis.

·                    If hip flexors are weak, stabilize the pelvis.

NOTE: In all tests, observe the umbilicus cranial movement indicates a stronger contraction of upper segments of muscle, and caudal movement indicates a stronger contraction of lower segments.

·                    Tests for neck flexion should precede those for trunk flexion.

Patient flexes thorax on pelvis through range of motion

 


 Trunk Rotation

     Normal and Good

§  Backlying with hands behind neck

§  Stabilize lower limbs

§  Patient rotates and flexes thorax to one side. Repeat to opposite side.

§  Tests for left obliges externus abdominis and right obliques internus abdominis. Rotation to left is brought about by opposite muscles.

Note: In all tests, observe any deviation of umbilicus, which will move towards strongest quadrant if there is a difference in strength of opposing oblique muscles.

§  Flaring of rib cage denotes weakness of external obligues.

§  If hip flexion muscles are weak, stabilize pelvis.

§  A good grade is given if scapula on forward shoulders is raised from bed/table and other partially raised.


 

 Trunk Extension

    Normal and Good

v Facelying

v Stabilize pelvis

v With arms and shoulders clears of table/bed to prevent their use in extending trucks, patients extends is raised from table/bed.

v Resistance is given on caudal portion of thoracic area.

Note: Tests for neck extensions should precede those for trunks extension.


Question:
Watch all these videos and identify all the muscles in the upper limbs and lower limbs.


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