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Questions and Answers
What happens to muscle tension when a muscle is fully contracted?
What happens to muscle tension when a muscle is fully contracted?
Which factor does NOT affect muscle strength according to the provided information?
Which factor does NOT affect muscle strength according to the provided information?
Why should muscle testing be avoided in the presence of pain?
Why should muscle testing be avoided in the presence of pain?
What is a contraindication for muscle testing?
What is a contraindication for muscle testing?
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Which population requires precautions during muscle testing due to potential cardiovascular issues?
Which population requires precautions during muscle testing due to potential cardiovascular issues?
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What defines the inner range of a muscle's contraction?
What defines the inner range of a muscle's contraction?
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What occurs during active insufficiency of a muscle that crosses multiple joints?
What occurs during active insufficiency of a muscle that crosses multiple joints?
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Which term describes when a muscle lengthens while developing tension?
Which term describes when a muscle lengthens while developing tension?
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What is the role of antagonistic muscles?
What is the role of antagonistic muscles?
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Which type of muscle contraction occurs when there is no change in muscle length?
Which type of muscle contraction occurs when there is no change in muscle length?
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What is a neutralizing synergist's primary role?
What is a neutralizing synergist's primary role?
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In which situation would a muscle experience passive insufficiency?
In which situation would a muscle experience passive insufficiency?
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What is the primary function of a prime mover or agonist muscle?
What is the primary function of a prime mover or agonist muscle?
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What is the primary objective of manual muscle testing?
What is the primary objective of manual muscle testing?
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Which of the following factors is NOT considered when assessing normal muscle strength?
Which of the following factors is NOT considered when assessing normal muscle strength?
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Which term refers to the ability of a muscle group to sustain repeated contractions against resistance?
Which term refers to the ability of a muscle group to sustain repeated contractions against resistance?
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What does the outer range in muscle work refer to?
What does the outer range in muscle work refer to?
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What is one of the key roles of gravity in muscle testing?
What is one of the key roles of gravity in muscle testing?
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Which type of muscle contraction occurs when a muscle shortens while generating force?
Which type of muscle contraction occurs when a muscle shortens while generating force?
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What is meant by 'manual resistance' in the context of muscle testing?
What is meant by 'manual resistance' in the context of muscle testing?
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Which of the following describes the term 'synergists' in muscle classification?
Which of the following describes the term 'synergists' in muscle classification?
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What is the primary purpose of a screen test in muscle strength assessment?
What is the primary purpose of a screen test in muscle strength assessment?
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Which grade indicates that there is a palpable muscle contraction with no joint motion?
Which grade indicates that there is a palpable muscle contraction with no joint motion?
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In muscle strength grading, what does a grade of 3 signify?
In muscle strength grading, what does a grade of 3 signify?
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What role does external pressure play in muscle strength assessments?
What role does external pressure play in muscle strength assessments?
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What factor primarily evaluates 'evidence of contraction' in manual muscle testing?
What factor primarily evaluates 'evidence of contraction' in manual muscle testing?
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What adjustment can be made to muscle strength grades to refine the assessment?
What adjustment can be made to muscle strength grades to refine the assessment?
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Which method is NOT part of the conventional assessment of muscle strength?
Which method is NOT part of the conventional assessment of muscle strength?
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Why might a therapist start assessing muscle strength at a grade of 3?
Why might a therapist start assessing muscle strength at a grade of 3?
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What role do stabilizing or fixating synergists play during movement?
What role do stabilizing or fixating synergists play during movement?
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What happens when the extensor carpi radialis longus contracts alone?
What happens when the extensor carpi radialis longus contracts alone?
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In muscle testing, why is it important to assess the strength of the uninvolved limb?
In muscle testing, why is it important to assess the strength of the uninvolved limb?
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When performing wrist flexion, how can the flexor carpi ulnaris be tested specifically?
When performing wrist flexion, how can the flexor carpi ulnaris be tested specifically?
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What happens to the deviation actions when all the wrist extensors contract together?
What happens to the deviation actions when all the wrist extensors contract together?
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Why is patient position important during muscle testing?
Why is patient position important during muscle testing?
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Which of the following is NOT a step in the muscle testing assessment procedure?
Which of the following is NOT a step in the muscle testing assessment procedure?
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What is the effect of the scapular muscles contracting when elbow flexors are engaged?
What is the effect of the scapular muscles contracting when elbow flexors are engaged?
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Study Notes
Muscle Range of Motion
- Muscles are categorized by their range of motion, which affects their ability to contract and generate force.
- Inner range: The muscle contracts from a position halfway through its full range to a position where it's fully shortened.
- Middle range: The portion of the full range between the midpoint of the outer range and the midpoint of the inner range.
- Outer range: The muscle stretches from a position where it's fully stretched to a position halfway through the full range of motion.
Active Insufficiency
- Active insufficiency occurs when a multi-joint muscle is fully shortened, causing it to lose tension and its ability to generate effective force.
- This occurs when the muscle is placed in a shortened position, known as "putting the muscle on slack."
Passive insufficiency
- Passive insufficiency occurs when a multi-joint muscle is fully lengthened, causing pain after a certain limit.
- An example is attempting to touch toes from standing, which can result in hamstring pain.
Muscle Contraction Types
- Isometric (static) contraction: The muscle produces tension, but the origin and insertion points do not change position, resulting in no movement.
- Concentric contraction: Tension is produced as the origin and insertion points move closer together, causing the muscle to shorten.
- Eccentric contraction: Tension is produced as the origin and insertion points move further apart, causing the muscle to lengthen.
Functional Classification of Muscles
- Prime Mover or Agonist: The muscle or muscle group primarily responsible for a specific movement.
- Antagonist: The muscle or muscle group that opposes the prime mover, relaxing as the prime mover works.
-
Synergist: Muscles that contract and assist the agonist to produce the desired movement.
- Neutralizing or counteracting synergists: Muscles that prevent unwanted movements caused by the prime mover.
- Conjoint synergists: Two or more muscles working together to produce a movement that neither could achieve individually.
- Stabilizing or Fixating Synergists: Muscles that control movement at joints proximal to the moving joint, providing a stable base for the distal movement.
Manual Muscle Testing
- Manual muscle testing is a procedure for evaluating the function and strength of individual muscles or muscle groups.
- This involves assessing the performance of a movement against gravity and manual resistance throughout the available range of motion.
Objectives of Manual Muscle Testing
- Define manual muscle testing.
- Identify the purpose of muscle testing.
- Understand terminology related to muscle testing, including strength, endurance, range of muscle work, active and passive insufficiency, isometric, concentric and eccentric contraction.
- List functional classification of muscles (agonists, antagonists, synergists).
- Recognize elements for assessment of normal muscle strength (patient's position, stabilization, substitution).
- Understand the role and effect of gravity in muscle testing.
- Recognize factors affecting strength.
- Manipulate the grading system.
- Know precautions and contraindications of muscle testing.
Purpose of Muscle Test
- Provide information for health professionals in differential diagnosis, treatment planning, and prognosis.
- Assess muscle strength requiring knowledge of anatomy and surface anatomy.
- Detect minimal muscle contraction, movement, muscle wasting, substitutions, and trick movements.
Muscular Strength
- The maximal force a muscle or muscle group can exert in one maximal effort under specified conditions (muscle contraction type, limb velocity, and joint angle).
Muscular Endurance
- The ability to perform repeated contractions against resistance, or maintain an isometric contraction over a period of time.
Muscle Testing Assessment Procedure
- Explanation and Instruction: The therapist explains the movement or passively moves the limb.
- Assessment of Normal Muscle Strength: Assess and record the strength of the uninvolved limb to establish a baseline.
- Patient Position: Position the patient to isolate the muscle or muscle group being tested, either in gravity elimination or against gravity positions.
-
Stabilization:
- Patient's normal muscles: The patient uses their own muscles to help stabilize (e.g., holding the edge of a plinth during hip flexion).
- Patient's body weight: Utilize the patient's body weight for stabilization (e.g., shoulder or pelvic girdles).
- External forces: Apply external pressure directly or use devices like belts or sandbags.
- Substitution and Trick Movements: When muscles are weak or paralyzed, other muscles may compensate, or gravity may be used to perform movements normally done by the weak muscles.
Screen Test
- Streamlines muscle strength assessment by avoiding unnecessary testing and minimizing fatigue or discouragement.
- Screen the patient using information from:
- Previous assessment of active range of motion.
- Patient's chart or muscle test results.
- Observation of patient performing functional activities (e.g., shaking hands for finger flexor strength).
Conventional Methods
- Manual grading of muscle strength is based on three factors:
- Evidence of contraction: No or palpable muscle contraction (grade 0) or a palpable muscle contraction with no joint motion (grade 1).
- Gravity as a resistance: Ability to move through the full available range of motion with gravity eliminated (grade 2) or against gravity (grade 3).
- Amount of manual resistance: Ability to move through the full available range of motion against gravity with moderate (grade 4) or maximal (grade 5) manual resistance.
Grading System
| Numerals | Letters | Description |
|---|---|---|
| Against gravity test: | ||
| 5 | N | Full available ROM against gravity and against maximal resistance. |
| 4 | G | Full available ROM against gravity and against moderate resistance. |
Factors Affecting Strength
- Length tension relation: Tension is greater when the muscle is slightly stretched, decreasing as the muscle is fully stretched or fully contracted.
- Fatigue: Strength decreases as the patient fatigues.
- Motivation, pain, body type, occupation, and dominance: These factors can also influence strength.
Contraindications of Muscle Testing
- Inflammation in the region.
- Testing muscle strength in the presence of pain can worsen the injury.
Precautions During Muscle Testing
- Patients with cardiovascular problems: Avoid overly strenuous testing.
- Patients with abdominal surgery or hernias: Prevent strain on the abdominal wall.
- Patients with extreme debility: Limit testing to avoid fatigue.
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Description
Test your knowledge on muscle range of motion, focusing on inner, middle, and outer ranges. This quiz also covers the concepts of active and passive insufficiency in multi-joint muscles. Enhance your understanding of how muscle mechanics affect movement and performance.
