Manual Muscle Testing PDF

MANUAL MUSCLE TESTING Prof. Dr. Amir N Wadee  Definition Manual muscle testing is a procedure for the evaluation of the function and strength of individual muscles and muscles group based on effective performance of a movement in relation to the forces of gravity and manu...

MANUAL MUSCLE TESTING Prof. Dr. Amir N Wadee  Definition Manual muscle testing is a procedure for the evaluation of the function and strength of individual muscles and muscles group based on effective performance of a movement in relation to the forces of gravity and manual resistance through the available ROM.  The purpose of muscle test differential diagnosis treatment planning prognosis  limitations neurological disorders loss of cortical control due to lesions of the central nervous system alteration altered in muscle reflex tone activity  Therapist must have a sound knowledge of surface anatomy anatomy (including joint (to know where motions, muscle a muscle or its origin and tendon is best insertion, and palpated). muscle function) muscle wasting substitutions keen observer & minimal muscle or trick experienced in contraction & movements detecting movement  Terminology Muscular strength: The maximal amount of tension or force that a muscle or muscle group can voluntarily exert in one maximal effort, when specifying: type of muscle contraction limb velocity joint angle  Terminology Muscular Endurance: The ability of a muscle or a muscle group to perform: repeated contractions Against minimal to moderate resistance for a period of time  Terminology Range of motion (ROM): The full range in which the muscle changing from a position of full stretch and contracting to a position of maximal shortening. The full range is divided into parts: outer middle inner  Terminology Outer ROM: Is from a position where the muscle is on full stretch to a position halfway through the full range of motion. Inner ROM: Is from a position halfway through the full range to a position where the muscle is fully shortened. Middle ROM: Is the portion of the full range between the mid-point of the outer range and the midpoint of the inner range.  Terminology Active insufficiency: The active insufficiency of a muscle that crosses two or more joints, occurs when the muscle produces simultaneous movement at all of the joints it crosses and reaches such a shortened position that it no longer has the ability to develop effective tension. When a muscle is placed in a shortened position of active insufficiency it is described as putting the muscle on slack.  Terminology Isometric (static) contraction: This is when there is tension developed in the muscle but no movement occurs, the origin and insertion of the muscle do not change position, and the muscle length does not change. Isotonic contraction: The muscle develops constant tension against a load or resistance. Concentric contraction: Tension is developed in the muscle and the origin and insertion of the muscle move closer together, the muscle shortens. Eccentric contraction: Tension is developed in the muscle and the origin and insertion of the muscle move farther a part, the muscle lengthens.  Antagonist Prim Mover Synergist or agonist Functional classification of muscle Neutralizing or counter acting Stabilizing or Fixating Synergists Conjoint synergists synergists prevent movement or control work together prevent unwanted movements the movement Eg. extensor Eg. During finger flexion the Eg. During acting elbow flexors carpiradialis longus wrist extensors contract to scapula and glenohumeral joint and brives and prevent wrist flexion from must contract as stabilizers extensor carpiulnaris occurring  Individual versus group muscle test Muscles with a common action or actions may be tested as a group or a muscle may be tested individually. For example, flexor carpiulnaris and flexor carpiradialis may be tested together as a group in the action of wrist flexion. Flexor carpiulnaris may be tested more specifically in the action of wrist flexion with ulnar deviation.  Assessment of normal muscle strength (age, sex, dominance and Explanation occupation) and Patient instruction Muscle testing position assessment procedure Stabilization patient's normal muscles (holds scapular muscles when glenohumeral ), The patient's body weight The patient position Substitution External forces and trick therapist movements (belt and sandbags)  Gravity as a resistance (grade 2) Amount (grade 3) of manual Evidence of contraction resistance (grade 0) (grade 4) (grade 1). (grade 5) Manual grading of muscle strength is based on Lowest grade(+): do grade only in (outer range) Highest grade (-): do grade only in (inner range).  CONVENTIONAL GRADING Numerals Letters Description Against gravity test: The patient is able to move through: The full available ROM against 5 N (normal) gravity and against maximal resistance. The full available ROM against gravity and against moderate 4 G (good) resistance. Greater than one half the available ROM against gravity and 4 G- against moderate resistance. Less than one half the available ROM against gravity and against 3+ F+ moderate resistance. 3 F (Fair) The full available ROM against gravity. 3- F- Greater than one half the available ROM against gravity. 2+ P+ Less than one half the available ROM against gravity.  CONVENTIONAL GRADING Gravity eliminated test: The patient is able to actively move through: 2 P (Poor) The full available ROM gravity eliminated. Greater than one half the available 2- P- ROM gravity eliminated. Less than one half the available ROM gravity 1+ T+ eliminated. None of the available ROM gravity eliminated and there 1 T (Trace) is palpable or observable flicker of a muscle contraction. None of the available ROM gravity eliminated and 0 0 (zero) there is no palpable or observable muscle contraction.  Type of Age Sex muscle Muscle fibers decrease contraction Muscle in size and number, eccentric size there is an increase in isometric connective tissue and fat, and the respiratory Factors Affecting Speed of muscle capacity of the muscle contraction decreases Strength force of Fatigue contraction Joint position Previous training level of repetitions decreases as the (Angle of effect motivation speed of muscle pull or ability of the nervous contraction body Length tension system to activate the increases type level of relation) muscle mass pain more force familiar with and dominance when it is learns the test occupation stretched situation Inflammation Pain MMT Assessment contraindication not give an accurate cause further indication of muscle injury. strength  cardiovascular fatigue abdominal extreme surgery debility (herniation) (do not have the energy) MMT Assessment precautions resisted movements might aggravate the condition mal pulmonary disease malignancy (sever chronic obstructive) nutrition JOINT RANGE OF MOTION  Goniometry reveals joint limitations To aid in diagnosing goals and a treatment plan joint function (but does not identify the dysfunction) (Hypermobility, hypomobility, Laxity, tightness To establish reassess Purpose of joint range of the existing motion evaluation effectiveness ROM of treatment (database patient's programs. & compare) interest in. and motivation  duplications of positions used removal of measuring tight and at the same restrictive time of day clothing How to increase ROM measurement reliability  Joint structures the capsule, Sex genetics or ligaments, and women posture tendons (dense, greater Body type regular connective tissue) Factors affecting ROM the bony configuration Age Younger have greater ROM A decline 20 - 30 soft tissue A plateau 30- 60 Muscles bulk after which a decline  Disease abnormal Trauma Abnormal Factors affecting ROM postures  Passive