Muscle Testing PDF

Muscle testing Muscle testing What is muscle testing Is manual muscle test of voluntary muscle strength of individual muscle in their function as prime mover History of muscle testing Wilhelmine wright & Robert.lovett , professor of orthopedic surgery 1917 book ( resistance gravity system...

Muscle testing Muscle testing What is muscle testing Is manual muscle test of voluntary muscle strength of individual muscle in their function as prime mover History of muscle testing Wilhelmine wright & Robert.lovett , professor of orthopedic surgery 1917 book ( resistance gravity system ) grade 0- 6 Legg & janet Merrill PT , 1932 book on muscle testing in polio Lowman 1940 use muscle testing in physiotherapy Lucille daiels& marian willams PT, 1946 BOOK manual muscle testing 0- 5 Basic principle 1- learn how much resistance of normal muscle can tolerate 2- start test unaffected side 3- all test must be bilateral To know the normal for the patient Factors Subjective The PT know how much resistance to give and how much resistance the patient can tolerate Objective If the patient can complete the ROM Move against the gravity Can hold in the postion grading scale 1932 Gone : no contraction felt Trace : muscle contraction be felt to be tight , no move Poor : movement with gravity eliminated Fair : can raise part against gravity Good : can raise part against gravity and resistance Normal : can over come resistance greater than in normal Grading scale Daniel & Worthingham 1995 Grade 5 : can hold the position against maximum resistance and through complete ROM Grade 4 : can hold the position against strong to moderate resistance , with full ROM Grade 3 : can tolerate no resistance but can do movement through the full ROM Grade 2 : has all or partial ROM in the gravity eliminated Grade 1 : muscle can be palpated while do action with gravity eliminated Grade 0 : no contractile activity can be felt in the gravity eliminated Factors considering muscle strength In assessment muscle strength 1- ability of the muscle to contract 2- ability or inability of the muscle to move through range 3- amount of resistance which can be given to the working muscle Requirement for muscle testing 1- knowledge of muscle & joint structure 2- knowledge of nerve supply & function of muscle 3- knowledge of test procedure & grading of muscle 4- the ability to observe , handle, palpate any muscle accurately 5- the ability to recognize muscle substitution Preparation for manual muscle testing 1- room should quiet , worm, light 2-firm examination table 3-give explanation to the patient about the test 4-maintain comfortable , supported position ( pt. can see) 5- PT should read the medical note 6-observe posture & muscle wasting Technique of muscle testing 1- adequate fixation should be maintained 2- all joint should be tested through ROM active or passive 3- the resistance given by PT hand 4- resistance should be smooth adjustable , directed opposite to line of pull of muscle tendon 5- all test should be done in one position , before moving patient to anther position 6-the patient should not fatigue 7- record on the muscle test chart  During test grade 0 - 2 provide more support in horizontal plane During test grade 3- 5 the position are against gravity  5 Normal strength 5- Uncertain muscle weakness 4+ Ability to move through full range of motion and hold against strong pressure 4 Ability to move through full range of motion and hold against moderate pressure 4- Ability to move through full range of motion and hold against slight pressure; or breaks abruptly with pressure 3 Ability to move through full range of motion against gravity 3- Ability to move through partial range of motion against gravity 2 Ability to move through any range of motion only with gravity eliminated 1 A flicker of movement is seen or felt in the muscle 0 No contraction palpable Break test At end of ROM , when reach the position the patient was asked to hold The PT will applies resistance force , trying to break , the hold and the part will move downward This procedure most commonly used Active resistance test Alternative to break test Application manual resistance against active muscle contraction ( prevent the movement ) PT gradually increase the amount of resistance until reach the maximal level , the patient can tolarate