Manual Muscle testINg
2 Positions: Against gravity and gravity eliminated
Graded 0-5
0=No movement visibly or palpably
1=Palpable contraction, no visual contraction
2-=Movement through partial range of motion in gravity eliminated position
2=Movement through complete range of motion in gravity-eliminated position
2+=Movement through complete range of motion in gravity eliminated position and through up to one half of test range against gravity
3-=Movement through complete range of motion in gravity eliminated position and through more than one half of test range against gravity
3=Able to contract against gravity through full range of motion
3+=Movement through complete test range against gravity and able to hold against minimum resistance
4=Movement thought complete range of motion against gravity and able to hold against moderate resistance 3-4 seconds
5=Go through complete range of motion and able to contract against maximum resistance for 5 seconds
Biceps
O – Short head: coracoids process of the scapula
Long head: Supraglenoid tuberosity of the scapula
I – Tuberosity of the radius
N – Musculocutaneous nerve (C5, C6)
Hook seated with arm at side and forearm supinated, flex elbow. Stabilize over anterosuperior aspect of ipsilateral humerus. Apply resistance just proximal to wrist in direction of elbow extension.
Gravity Eliminated Sitting with arm supported on table with a towel between table and arm, shoulder abducted to 90 degrees, and elbow extended with the forearm fully supinated. Stabilization is same and have subject flex the elbow without resistance.
Triceps
O – Long head: infraglenoid tuberosity of the scapula
Lateral head: Posterior and lateral surfaces of the humeral shaft
Medial head: Posterior and medial surfaces of the humeral shaft
I – Olecranon process of the ulna
N – Radial nerve (C7, C8)
Supine with arm in 90 degrees shoulder flexion, and full elbow flexion, and full forearm supination, extend elbow. Stabilize over anterior aspect of ipsilateral shoulder. Have patient flex elbow slightly then apply resistance just proximal to wrist in direction of elbow flexion.
Gravity Eliminated Sitting with arm supported on table with a towel between table and arm, shoulder abducted to 90 degrees, and elbow flexed with the forearm fully supinated. Stabilization is same and have subject extend the elbow without resistance.
Brachialis
O – Distal ½ of the anterior aspect of the humeral shaft; medial and lateral intermuscular septa
I – Tuberosity and coronoid process of the ulna
N – Musculocutaneous nerve (C5, C6)
Hook seated with arm at side and forearm pronated, flex elbow. Stabilize over anterosuperior aspect of ipsilateral humerus. Apply resistance just proximal to wrist in direction of elbow extension.
Gravity Eliminated Sitting with arm supported on table with a towel between table and arm, shoulder abducted to 90 degrees, and elbow extended with the forearm fully pronated. Stabilization is same and have subject flex the elbow without resistance.
Brachioradialis
O – Upper ¾ of the lateral supracondylar ridge of the humerus; lateral intermuscular septum.
I – Styloid process of the radius
N – Radial nerve (C5-C6)
Seated, shoulder and elbow at 0 degrees, neutral forearm. Stabilize over anterior aspect of shoulder, palpate muscle. Resistance in the direction of elbow extension
Gravity eliminated Seated, arm supported on table, shoulder abducted to 90, elbow extended, forearm in neutral.
Anconeus
O – lateral epicondyle of the humerus
I – Lateral surface of the olecranon, superior ¼ of the posterior aspect of the ulna
N – Radial nerve (C7-C8)
Supine, 90 shoulder flexion, full elbow extension, supinated. Stabilize anterior aspect of shoulder. Move patient through extension. Resist with patient flexed slightly and apply force into elbow flexion.
Gravity eliminated Seated, arm supported by table
Shoulder abducted 90, flexed elbow, supinated, patient extends
Pronator Teres
O – humeral head: medial epicondylar ridge of the humerus, common forearm flexor tendon.
Ulnar head: Coronoid process of the ulna.
I – Lateral surface of the midshaft of the radius
N – Median nerve (C6,C7)
Seated, shoulder at 0, 90 elbow flexion, supinated. Stabilize inferolateral aspect of humerus. Patient pronates, resist into supination.
Gravity eliminated
Seated, shoulder flexion 90, elbow flexion 90, arm supported on table. Stabilize anterior surface of arm. Have patient pronate.
Pronator Quadratus
O – anterior aspect of the distal ¼ of the ulna
I – anterior aspect of the distal 1/4 of the radius
N – Median nerve (C8, T1)
Seated, shoulder at 0, 90 elbow flexion, supinated. Stabilize inferolateral aspect of humerus. Patient pronates, resist into supination
Gravity eliminated
Seated, shoulder flexion 90, elbow flexion 90, arm supported on table. Stabilize anterior surface of arm. Have patient pronate.
Flexor Carpi Radialis
O – medila epicondylo of the humerus via the common forearm flexor tendon; antebrachial fascia.
I - Base of 2nd and 3rd metacarpals
N – Median nerve (C6, C7)
Seated, supinated and supported. Stabilize posterior aspect of distal forearm, have patien flex wrist. Resist into wrist extension
Gravity Elimanted
Seated, forearm in neutral, supported, palpated muscle while patient moves through wrist flexion
Flexor Carpi Ulnaris
O – Humeral head: Medial epicondyle of the humerus via the common flexion tendon.
Ulnar head: upper ¾ of the posterior border of the ulna.
I – Pisiform
N – Ulnar nerve (C8-T1)
Seated, supinated, supported, wrist in neutral. Stabilize poseterior aspect of forearm. Instruct patient through flexion and ulnar deviation. Resist through wrist extension and radial deviation.
Gravity eliminated
Seated, forearm in neutral, supported, stabilized forearm and palpated muscle during action.
Palmaris Longus
O – Medial epicondyle.
I – palmar aponeurosis, flexor retinaculum.
N – Median nerve (C6, C7)
Seated, supinated, supported, wrist in neutral. Stabilize poseterior aspect of forearm. Instruct patient through flexion and ulnar deviation. Resist through wrist extension and radial deviation.
Gravity eliminated Seated, forearm in neutral, supported, stabilized forearm and palpated muscle during action.
Extensor Pollicis Longus
O – Dorsolateral surface of the ulna: interosseous membrane
I – Base of the distal phalanx of the thumb
N – Deep radial nerve (C6,C7,C8)
MMT Seated, forearm in neutral, supported, neutral wrist, thumb slightly flexed. Stabilize proximal phalanx. Instruct to extend. Resist towards IP flexion
Flexor Carpi Radialis
O – medial epicondyle of the humerus via the common forearm flexor tendon; antebrachial fascia
I – base of the 2nd and 3rd metacarpals
N - median nerve (C6-C7)
Seated, forearm supinated and supported, wrist neutral, stabilized posterior distal forearm. Instruct flexion while palpating tendon. Resist back into extension
Gravity eliminated
Seated, neutral forearm, neutral wrist. Stabilize radial forearm, palpated tendon and instruct flexion
Flexor Carpi Ulnaris
O – Humeral head: medial epicondyle of th ehumerus via the common forearm flexor tendon.
Ulnar head; upper 2/3 of the posterior border of the ulna
I – pisiform
N – Ulnar nerve (C8, T1)
Seated, forearm supinated and supported. Wrist in neutral. Stabalize posterior aspect of forearm, palpate muscle
Instruct flexion and ulnar deviation. Resist into extension and radial deviation
Gravity eliminated
Seated, forearm in neutral, wrist in neutral, stabilize radial side of forearm, palpate muscle, instruct flexion and ulnar deviation
Brachioradialis
O – upper ¾ of the lateral supracondylar ridge of the humerus; lateral intermuscular septum
I – styloid process of radius
N – Radial nerve (C5,C6)
Seated, shoulder at 0, elbow at 0, neutral forearm. Stabilize over anterior shoulder, palpate muscle, instruct through elbow flexion, resist into elbow extension.
Gravity eliminated Seated, arm supported on table, shoulder at 90 abduction, elbow extended, forearm in neutral, instruct through flexion.
Extensor Carpi Radialis Longus
O – lateral supracondylar ridge of the humerus; the common extensor tendon.
I – Base of the 2nd metacarpal bone.
N – radial nerve (C6, C7)
Seated, forearm pronated and supported. Wrist neutral. Stabilize anterior aspect of forarm, palpate tendon. Instruct wrist extension, resist into wrist flexion
Gravity eliminated Seated, forearm in neutral and supported, wrist in neutral. Palpated tendon. Instruct wrist extension
Extensor Carpi Ulnaris
O – lateral epicondyle of the humerus via the common extensor tendon; dorsal border of the ulna.
I – Base of 5th metacarpal bone
N – deep radial nerve (C6,C7,C8)
Seated, forearm pronated and supported. Wrist in neutral. Stabilize anterior aspect of distal forearm. Palpate tendon. Instruct through wrist extension and ulnar deviation. Resist into wrist flexion and radial deviation.
Gravity eliminated Seated. Forearm in neutral rotation and supported. Stabilize anterior aspect of distal forearm. Palpate tendon. Instruct through wrist extension and ulnar deviation
Extensor Digitorum
O – lateral epicondyle of the humerus via the common extensor tendon; antebrachial fascia.
I – middle and distal phalanges of digits 2-5 via the extensor hood or expansion
N – deep radial nerve (C6,C7,C8)
Seated, forearm pronated and supported, wrist in neutral. Fingers in relaxed flexion. Stabilize over palmar aspect of second through fifth metacarpals. Palpate tendons. Instruct MCP joint extension while keeping IP joints flexed. Resist into MCP joint flexion.
Gravity eliminated
Seated, forearm neutral and supported, wrist in neutral. Fingers in relaxed flexion. Stabilize over palmar aspect of second through fifth metacarpals. Palpate tendons. Instruct MCP joint extension while keeping IP joints flexed
Lumbricales
O – tendons of the flexor digitorum profundus.
I –radial side of the extensor hood of the corresponding fingers
N – peripheral nerve for 1st and 2nd. Median nerve for 3rd and 4th. (C8, T1)
Seated forearm supinated and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended. Resist into MCP extension.
Gravity eliminated
Seated forearm neutral and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended
Palmar Interossei
O – palmar surface of metacarpal bones 2,4, and 5
I – 1st: ulnar side of the base of the proximal phalanx and the extensor hood of the 2nd digit; 2nd: radial side of the base of the proximal phalanx and the extensor hood of the 4th digit. 3rd: radial side of the base of the proximal phalanx and the extensor hood of the 5th digit.
N – ulnar nerve (C8,T1)
Seated forearm supinated and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended. Resist into MCP extension.
Gravity eliminated
Seated forearm neutral and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended
Dorsal Interossei
O – By two heads from adjacent metacarpal bones.
I – 1st: radial side of the proximal phalanx and the extensor hood of the 2nd digit:
2nd : radial side of the proximal phalanx and the extensor hood of the 3rd digit. 3rd: ulnar side of the proximal phalanx and the extensor hood of the 3rd digit. 4th: ulnar side of the proximal phalanx and the extensor hood of the 4th digit.
N – ulnar nerve (C8, T1)
Seated forearm supinated and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended. Resist into MCP extension.
Gravity eliminated Seated forearm neutral and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended
11. What are some ways patients can cheat?
12. How can cheating affect the outcome of the test?
13. What is the importance of proper hand placement?
Graded 0-5
0=No movement visibly or palpably
1=Palpable contraction, no visual contraction
2-=Movement through partial range of motion in gravity eliminated position
2=Movement through complete range of motion in gravity-eliminated position
2+=Movement through complete range of motion in gravity eliminated position and through up to one half of test range against gravity
3-=Movement through complete range of motion in gravity eliminated position and through more than one half of test range against gravity
3=Able to contract against gravity through full range of motion
3+=Movement through complete test range against gravity and able to hold against minimum resistance
4=Movement thought complete range of motion against gravity and able to hold against moderate resistance 3-4 seconds
5=Go through complete range of motion and able to contract against maximum resistance for 5 seconds
Biceps
O – Short head: coracoids process of the scapula
Long head: Supraglenoid tuberosity of the scapula
I – Tuberosity of the radius
N – Musculocutaneous nerve (C5, C6)
Hook seated with arm at side and forearm supinated, flex elbow. Stabilize over anterosuperior aspect of ipsilateral humerus. Apply resistance just proximal to wrist in direction of elbow extension.
Gravity Eliminated Sitting with arm supported on table with a towel between table and arm, shoulder abducted to 90 degrees, and elbow extended with the forearm fully supinated. Stabilization is same and have subject flex the elbow without resistance.
Triceps
O – Long head: infraglenoid tuberosity of the scapula
Lateral head: Posterior and lateral surfaces of the humeral shaft
Medial head: Posterior and medial surfaces of the humeral shaft
I – Olecranon process of the ulna
N – Radial nerve (C7, C8)
Supine with arm in 90 degrees shoulder flexion, and full elbow flexion, and full forearm supination, extend elbow. Stabilize over anterior aspect of ipsilateral shoulder. Have patient flex elbow slightly then apply resistance just proximal to wrist in direction of elbow flexion.
Gravity Eliminated Sitting with arm supported on table with a towel between table and arm, shoulder abducted to 90 degrees, and elbow flexed with the forearm fully supinated. Stabilization is same and have subject extend the elbow without resistance.
Brachialis
O – Distal ½ of the anterior aspect of the humeral shaft; medial and lateral intermuscular septa
I – Tuberosity and coronoid process of the ulna
N – Musculocutaneous nerve (C5, C6)
Hook seated with arm at side and forearm pronated, flex elbow. Stabilize over anterosuperior aspect of ipsilateral humerus. Apply resistance just proximal to wrist in direction of elbow extension.
Gravity Eliminated Sitting with arm supported on table with a towel between table and arm, shoulder abducted to 90 degrees, and elbow extended with the forearm fully pronated. Stabilization is same and have subject flex the elbow without resistance.
Brachioradialis
O – Upper ¾ of the lateral supracondylar ridge of the humerus; lateral intermuscular septum.
I – Styloid process of the radius
N – Radial nerve (C5-C6)
Seated, shoulder and elbow at 0 degrees, neutral forearm. Stabilize over anterior aspect of shoulder, palpate muscle. Resistance in the direction of elbow extension
Gravity eliminated Seated, arm supported on table, shoulder abducted to 90, elbow extended, forearm in neutral.
Anconeus
O – lateral epicondyle of the humerus
I – Lateral surface of the olecranon, superior ¼ of the posterior aspect of the ulna
N – Radial nerve (C7-C8)
Supine, 90 shoulder flexion, full elbow extension, supinated. Stabilize anterior aspect of shoulder. Move patient through extension. Resist with patient flexed slightly and apply force into elbow flexion.
Gravity eliminated Seated, arm supported by table
Shoulder abducted 90, flexed elbow, supinated, patient extends
Pronator Teres
O – humeral head: medial epicondylar ridge of the humerus, common forearm flexor tendon.
Ulnar head: Coronoid process of the ulna.
I – Lateral surface of the midshaft of the radius
N – Median nerve (C6,C7)
Seated, shoulder at 0, 90 elbow flexion, supinated. Stabilize inferolateral aspect of humerus. Patient pronates, resist into supination.
Gravity eliminated
Seated, shoulder flexion 90, elbow flexion 90, arm supported on table. Stabilize anterior surface of arm. Have patient pronate.
Pronator Quadratus
O – anterior aspect of the distal ¼ of the ulna
I – anterior aspect of the distal 1/4 of the radius
N – Median nerve (C8, T1)
Seated, shoulder at 0, 90 elbow flexion, supinated. Stabilize inferolateral aspect of humerus. Patient pronates, resist into supination
Gravity eliminated
Seated, shoulder flexion 90, elbow flexion 90, arm supported on table. Stabilize anterior surface of arm. Have patient pronate.
Flexor Carpi Radialis
O – medila epicondylo of the humerus via the common forearm flexor tendon; antebrachial fascia.
I - Base of 2nd and 3rd metacarpals
N – Median nerve (C6, C7)
Seated, supinated and supported. Stabilize posterior aspect of distal forearm, have patien flex wrist. Resist into wrist extension
Gravity Elimanted
Seated, forearm in neutral, supported, palpated muscle while patient moves through wrist flexion
Flexor Carpi Ulnaris
O – Humeral head: Medial epicondyle of the humerus via the common flexion tendon.
Ulnar head: upper ¾ of the posterior border of the ulna.
I – Pisiform
N – Ulnar nerve (C8-T1)
Seated, supinated, supported, wrist in neutral. Stabilize poseterior aspect of forearm. Instruct patient through flexion and ulnar deviation. Resist through wrist extension and radial deviation.
Gravity eliminated
Seated, forearm in neutral, supported, stabilized forearm and palpated muscle during action.
Palmaris Longus
O – Medial epicondyle.
I – palmar aponeurosis, flexor retinaculum.
N – Median nerve (C6, C7)
Seated, supinated, supported, wrist in neutral. Stabilize poseterior aspect of forearm. Instruct patient through flexion and ulnar deviation. Resist through wrist extension and radial deviation.
Gravity eliminated Seated, forearm in neutral, supported, stabilized forearm and palpated muscle during action.
Extensor Pollicis Longus
O – Dorsolateral surface of the ulna: interosseous membrane
I – Base of the distal phalanx of the thumb
N – Deep radial nerve (C6,C7,C8)
MMT Seated, forearm in neutral, supported, neutral wrist, thumb slightly flexed. Stabilize proximal phalanx. Instruct to extend. Resist towards IP flexion
Flexor Carpi Radialis
O – medial epicondyle of the humerus via the common forearm flexor tendon; antebrachial fascia
I – base of the 2nd and 3rd metacarpals
N - median nerve (C6-C7)
Seated, forearm supinated and supported, wrist neutral, stabilized posterior distal forearm. Instruct flexion while palpating tendon. Resist back into extension
Gravity eliminated
Seated, neutral forearm, neutral wrist. Stabilize radial forearm, palpated tendon and instruct flexion
Flexor Carpi Ulnaris
O – Humeral head: medial epicondyle of th ehumerus via the common forearm flexor tendon.
Ulnar head; upper 2/3 of the posterior border of the ulna
I – pisiform
N – Ulnar nerve (C8, T1)
Seated, forearm supinated and supported. Wrist in neutral. Stabalize posterior aspect of forearm, palpate muscle
Instruct flexion and ulnar deviation. Resist into extension and radial deviation
Gravity eliminated
Seated, forearm in neutral, wrist in neutral, stabilize radial side of forearm, palpate muscle, instruct flexion and ulnar deviation
Brachioradialis
O – upper ¾ of the lateral supracondylar ridge of the humerus; lateral intermuscular septum
I – styloid process of radius
N – Radial nerve (C5,C6)
Seated, shoulder at 0, elbow at 0, neutral forearm. Stabilize over anterior shoulder, palpate muscle, instruct through elbow flexion, resist into elbow extension.
Gravity eliminated Seated, arm supported on table, shoulder at 90 abduction, elbow extended, forearm in neutral, instruct through flexion.
Extensor Carpi Radialis Longus
O – lateral supracondylar ridge of the humerus; the common extensor tendon.
I – Base of the 2nd metacarpal bone.
N – radial nerve (C6, C7)
Seated, forearm pronated and supported. Wrist neutral. Stabilize anterior aspect of forarm, palpate tendon. Instruct wrist extension, resist into wrist flexion
Gravity eliminated Seated, forearm in neutral and supported, wrist in neutral. Palpated tendon. Instruct wrist extension
Extensor Carpi Ulnaris
O – lateral epicondyle of the humerus via the common extensor tendon; dorsal border of the ulna.
I – Base of 5th metacarpal bone
N – deep radial nerve (C6,C7,C8)
Seated, forearm pronated and supported. Wrist in neutral. Stabilize anterior aspect of distal forearm. Palpate tendon. Instruct through wrist extension and ulnar deviation. Resist into wrist flexion and radial deviation.
Gravity eliminated Seated. Forearm in neutral rotation and supported. Stabilize anterior aspect of distal forearm. Palpate tendon. Instruct through wrist extension and ulnar deviation
Extensor Digitorum
O – lateral epicondyle of the humerus via the common extensor tendon; antebrachial fascia.
I – middle and distal phalanges of digits 2-5 via the extensor hood or expansion
N – deep radial nerve (C6,C7,C8)
Seated, forearm pronated and supported, wrist in neutral. Fingers in relaxed flexion. Stabilize over palmar aspect of second through fifth metacarpals. Palpate tendons. Instruct MCP joint extension while keeping IP joints flexed. Resist into MCP joint flexion.
Gravity eliminated
Seated, forearm neutral and supported, wrist in neutral. Fingers in relaxed flexion. Stabilize over palmar aspect of second through fifth metacarpals. Palpate tendons. Instruct MCP joint extension while keeping IP joints flexed
Lumbricales
O – tendons of the flexor digitorum profundus.
I –radial side of the extensor hood of the corresponding fingers
N – peripheral nerve for 1st and 2nd. Median nerve for 3rd and 4th. (C8, T1)
Seated forearm supinated and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended. Resist into MCP extension.
Gravity eliminated
Seated forearm neutral and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended
Palmar Interossei
O – palmar surface of metacarpal bones 2,4, and 5
I – 1st: ulnar side of the base of the proximal phalanx and the extensor hood of the 2nd digit; 2nd: radial side of the base of the proximal phalanx and the extensor hood of the 4th digit. 3rd: radial side of the base of the proximal phalanx and the extensor hood of the 5th digit.
N – ulnar nerve (C8,T1)
Seated forearm supinated and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended. Resist into MCP extension.
Gravity eliminated
Seated forearm neutral and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended
Dorsal Interossei
O – By two heads from adjacent metacarpal bones.
I – 1st: radial side of the proximal phalanx and the extensor hood of the 2nd digit:
2nd : radial side of the proximal phalanx and the extensor hood of the 3rd digit. 3rd: ulnar side of the proximal phalanx and the extensor hood of the 3rd digit. 4th: ulnar side of the proximal phalanx and the extensor hood of the 4th digit.
N – ulnar nerve (C8, T1)
Seated forearm supinated and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended. Resist into MCP extension.
Gravity eliminated Seated forearm neutral and supported. Wrist in neutral. Fingers extended. Stabilize over distal dorsal surface of 2nd through 5th metacarpals. Instruct flexion at MCP joints keeping IP joints extended
11. What are some ways patients can cheat?
12. How can cheating affect the outcome of the test?
13. What is the importance of proper hand placement?