Manual Muscle Testing of Elbow, Forearm Muscles PDF
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Uploaded by HumorousNephrite3509
Horus University - Egypt
Dr. Doaa Said Sallam
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Summary
This document is a lecture on manual muscle testing of the elbow and forearm muscles. It covers the techniques and procedures for testing various muscles, including biceps, brachialis, brachioradialis, pronator teres, and others. The document notably includes different positions and grades for each muscle group with detailed descriptions.
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Dr. Doaa Said Sallam PT, PhD. Lecturer of Physical Therapy for Basic Science Department Horus University-Egypt. Lecture objectives: After this lecture, you will be able to describe & apply muscle testing of: Elbow flexion. Elbow exte...
Dr. Doaa Said Sallam PT, PhD. Lecturer of Physical Therapy for Basic Science Department Horus University-Egypt. Lecture objectives: After this lecture, you will be able to describe & apply muscle testing of: Elbow flexion. Elbow extension. Forearm supination. Forearm pronation. Elbow Flexion Primary muscle: Biceps, Brachialis, and Brachioradialis. ROM: 0°- 150° Elbow Flexion Accessory muscles: ▪ Pronator teres. ▪ Extensor carpi radialis longus. ▪ Flexor carpi radialis. ▪ Flexor carpi ulnaris. ▪ Palmaris longus (may be absent). Elbow Flexion Grades 5 & 4 (isolation of biceps brachii) Position: Test position 120°. Resistance: at mid range contoured over the flexor surface of the forearm proximal to the wrist. The other hand applies counterforce by cupping the palm over the anterior superior surface of the shoulder. Elbow Flexion Grades 5 & 4 (isolation of brachialis) Forearm Pronated Recent evidence: Independent of forearm position. Isolation of individual muscles during strong effort. Work in all types of contraction. Innervated by 2 nerves. Elbow Flexion Grades 5 & 4 (isolation of brachioradialis) Forearm: Neutral (mid-position). Elbow Flexion Grade 3 (biceps brachii) Elbow Flexion Grade 2 (biceps brachii) Position: Sitting with arm 90° flexion or abduction rested on a smooth surface. support the upper arm against the testing surface Palpation: Biceps: (tendon) in the antecubital space. Brachialis: medial to the tendon of the biceps (Deep muscle). Brachioradialis: on the proximal anterior surface of the forearm, where it forms the lateral border of the cubital fossa. Elbow Flexion Grade 2, 1 & 0 (Alternate Position) Position of Patient: Side- lying. Substitutions: ▪ Shoulder extension (incorrect stabilization), ▪ Strong wrist flexion. Surface Anatomy of brachioradialis Elbow Flexion Elbow Extension Primary muscle: Triceps brachii. Accessory muscles: Anconeus. ROM: 150°- 0°. Medial head: active in all intensities of extension. Elbow Extension Gravity- resisted position from prone Position: Prone on table with the arm in 90° of abduction and the forearm flexed. Less active position: because of active insufficiency. Elbow Extension Grades 5 & 4 from prone Avoid closed packed position (locked position. Resistance: on the dorsal surface of the forearm above wrist. (20°) Elbow Extension Grade 3 from prone Elbow Extension Alternate gravity- resisted position from sitting Sitting, 90° shoulder abduction, elbow flexed. Alternate position: Supine, 90° shoulder flexion. Elbow Extension Gravity- minimized position (Grade 2) Position: Sitting with the upper extremity resting on a smooth surface with 90° degrees shoulder abduction and in neutral position with the elbow in 45° flexion. Palpation: on the posterior surface of the arm just proximal to the olecranon process. Elbow Extension Grades 1 & 0 Elbow Extension Substitution: by shoulder external rotation→ assistance by gravity. Prevented by using a table or powder board. Elbow Extension Substitution: by shoulder horizontal adductors. Prevented by stabilization of upper arm. Elbow Extension Forearm Supination Primary muscles: Supinator (pure supination) Biceps brachii (powerful supination with elbow flexion). ROM: 0°- 80°. Forearm Supination Grades 5 & 4 Position : Sitting; arm at side and elbow flexed to 90°; forearm in pronation. Resistance: grasp the forearm on the dorsal surface at the wrist. other hand supports the elbow. Begins in pronation and supinates the forearm. Keep the wrist and fingers relaxed. Forearm Supination Alternate grasp for Grades 5 & 4 Grasp patient's hand as if shaking hands, Grade 5 or 4 Wrist & hand strength, wrist stability. Forearm Supination Grade 3 Grade 2 from this Position: Partial ROM. Forearm Supination Grade 2 (Alternate Test) Position: Sitting with shoulder flexed between 45° and 90° and elbow flexed to 90°. Forearm in neutral with arm Supported. Forearm Supination (Grades 1 & 0) Palpate the supinator distal to the head of the radius on the dorsal aspect of the forearm. Forearm Supination Substitution: by shoulder adductors & external rotators. Avoided by maintaining arm adducted beside the body. Another substitution: Wrist extensors. N.B: The effect of gravity could be neglected in supination/ pronation muscle testing. Therefore, all grades can be tested in sitting; arm at side and elbow flexed to 90°. Forearm Supination Forearm Supination Forearm Pronation Primary muscles: Pronator quadratus and Pronator teres. Accessory muscle: ▪ Flexor carpi radialis. ▪ brachioradialis (with elbow flexion). ROM: 0°- 80°. Pronator teres: Only works in rapid & strong pronation. Pronator quadratus: is deep muscle. Forearm Pronation Grades 5 & 4 From supination. Keep wrist & fingers relaxed. Grasp patient's hand as if shaking hands, Grade 5 or 4 Wrist & hand strength, wrist stability. Forearm Pronation Grade 3 Can be tested in the same position of G 3 (Partial ROM) Forearm Pronation Grade 2 (Alternate Test) Position: Sitting with shoulder flexed between 45° and 90° and elbow flexed to 90°. Forearm in neutral with arm Supported. Forearm Pronation Palpation: Over the upper third of the anterior surface of the forearm on a diagonal line from the medial condyle of the humerus to the lateral border of radius. Forearm Pronation Substitution by shoulder abductors & internal rotators. Maintaining arm adducted beside the body. Another substitution: Wrist & finger flexors, flexor carpi radialis. N.B: The effect of gravity could be neglected in supination/ pronation muscle testing. Therefore, all grades can be tested in sitting; arm at side and elbow flexed to 90°. Forearm Pronation 42 References ▪ Avers, D., & Brown, M. (2019). Daniels and Worthingham’s Muscle Testing: Techniques of Manual Examination and Performance Testing. Elsevier Health Sciences. ▪ Reese, N. B. (2012). Muscle and Sensory Testing. Elsevier Health Sciences. ▪ Clarkson, H. M. (2013). Musculoskeletal assessment: joint motion and muscle testing. Wolters Kluwer/Lippincott Williams & Wilkins Health.
