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Manual Muscle Manual Muscle TestingTesting
An evaluation system for An evaluation system for diagnosis of disease or diagnosis of disease or
dysfunction of the musculo-dysfunction of the musculo-skeletal and nervous systemsskeletal and nervous systems
PurposePurpose
Measures the capability of muscles or Measures the capability of muscles or groups to provide support and groups to provide support and movementmovement
Diagnostic toolDiagnostic tool Postural balancePostural balance Gait impairmentGait impairment Range of motionRange of motion
Uses little equipmentUses little equipment Obtains information not defined by Obtains information not defined by
other proceduresother procedures
PrecautionsPrecautions
Do No Harm (use Do No Harm (use gentleness)gentleness)
Know ROM limitsKnow ROM limits Follow procedureFollow procedure Record Record
PromptlyPromptly AccuratelyAccurately
To Get Standardized To Get Standardized Results Results
Proper training and educationProper training and education Knowledge base of anatomy, Knowledge base of anatomy,
physiology and neurology of muscle physiology and neurology of muscle functionfunction
Follow precise testing protocolFollow precise testing protocol Practice, Practice, PracticePractice, Practice, Practice A skill developed and maintained A skill developed and maintained
with number of caseswith number of cases
Validity and AccuracyValidity and Accuracy
Coordinate the muscle testing findings with Coordinate the muscle testing findings with other standard diagnostic proceduresother standard diagnostic procedures
The amount of pressure used to test may The amount of pressure used to test may vary between persons performing the test.vary between persons performing the test.
The amount of strength loss must be greater The amount of strength loss must be greater than approximately 20to 30% to be than approximately 20to 30% to be dependably measurabledependably measurable
Comparison of both sides is a better Comparison of both sides is a better indicator of lossindicator of loss
MusclesMuscles
3 Types: Skeletal, Smooth, Cardiac3 Types: Skeletal, Smooth, Cardiac Skeletal around 40% of muscle Skeletal around 40% of muscle
compositioncomposition Generally voluntarily controlledGenerally voluntarily controlled
Composed of fibersComposed of fibers Work in groupsWork in groups Movement depends on how the Movement depends on how the
muscles are attachedmuscles are attached
Structure of MuscleStructure of Muscle
http://en.wikibooks.org/wiki/Anatomy_and_Physiology_of_Animals/Muscles
How Do Muscles Cause How Do Muscles Cause MovementMovement
Origin- where the muscle is attached Origin- where the muscle is attached to the bone; this bone will move very to the bone; this bone will move very littlelittle
Insertion- muscle attachment to Insertion- muscle attachment to bone with most motionbone with most motion
Belly of muscle- part of muscle that Belly of muscle- part of muscle that enlarges on contractionenlarges on contraction
Muscle GroupsMuscle Groups
QuadricepsQuadriceps HamstringsHamstrings CalfCalf Low backLow back AbdominalsAbdominals Pectoralis majorPectoralis major RhomboidsRhomboids
TrapeziusTrapezius Latisimus dorsiLatisimus dorsi DeltoidsDeltoids BicepsBiceps TricepsTriceps
Conduct Strength Conduct Strength TestingTesting
Correct positioning is essential (Start Correct positioning is essential (Start in extended anatomical position)in extended anatomical position)
Place muscle to be tested in a Place muscle to be tested in a supported position directly opposed to supported position directly opposed to gravitygravity
Exert uniform force directly on the Exert uniform force directly on the line opposing movement line opposing movement
Testing of Bicep & TricepTesting of Bicep & Tricep
Support humerus where gravity is Support humerus where gravity is against the bicep and tricep, client against the bicep and tricep, client in anatomical positionin anatomical position
Move elbow through full ROM Move elbow through full ROM (Passive ROM)(Passive ROM) FlexionFlexion ExtensionExtension Internal rotationInternal rotation External rotationExternal rotation
Maneuver to Assess Maneuver to Assess Muscle StrengthMuscle Strength
With arm in full extension, pull With arm in full extension, pull downward on forearm while client downward on forearm while client attempts to flex.attempts to flex.
With arm flexed, apply pressure against With arm flexed, apply pressure against forearm, ask client to straighten arm.forearm, ask client to straighten arm.
When performing muscle tests, be sure When performing muscle tests, be sure to evaluate for asymmetry of the muscle to evaluate for asymmetry of the muscle groups (i.e. atrophy on one side and not groups (i.e. atrophy on one side and not the other) and landmarks prior to the other) and landmarks prior to testing.testing.
Use the following scale Use the following scale to rate strength: to rate strength:
0-No movement, no contraction of the muscle0-No movement, no contraction of the muscle 1- Trace, evidence of muscle contraction but 1- Trace, evidence of muscle contraction but
no joint movementno joint movement 2- Poor, complete range of motion with gravity 2- Poor, complete range of motion with gravity
eliminatedeliminated 3-Fair, complete range of motion against 3-Fair, complete range of motion against
gravitygravity 4- Good, complete range of motion against 4- Good, complete range of motion against
gravity with moderate resistancegravity with moderate resistance 5-Normal, complete range of motion against 5-Normal, complete range of motion against
gravity with maximal resistance without gravity with maximal resistance without evidence of fatigueevidence of fatigue
Other Test ResultsOther Test Results
Weakness – defined as a strength Weakness – defined as a strength below fair in non weight bearing below fair in non weight bearing muscles; below fair + in weight muscles; below fair + in weight bearing musclesbearing muscles
Contracture – degree of shortness in Contracture – degree of shortness in muscle, so it cannot move through muscle, so it cannot move through ROMROM
Substitution – weak muscles are Substitution – weak muscles are supported by other muscles to movesupported by other muscles to move
Active ROMActive ROM
Instruct client to move the elbow through Instruct client to move the elbow through ROMROM FlexionFlexion ExtensionExtension Internal rotationInternal rotation External rotationExternal rotation
Normal ROM is measured by goniometerNormal ROM is measured by goniometer Elbow flexion 0-160 Elbow flexion 0-160 Elbow extension 145-0 Elbow extension 145-0 Elbow pronation (rotation inward) 0-90 Elbow pronation (rotation inward) 0-90 Elbow supination (rotation outward) 0-90Elbow supination (rotation outward) 0-90
Strength Test ExampleStrength Test Example
Gastrocnemius (Ankle Gastrocnemius (Ankle plantar flexion)plantar flexion)
Patient StandingPatient Standing Rises on toes, Rises on toes,
pushing weight pushing weight upwardupward
Case Study to FollowCase Study to Follow
Take patient hx to determine Take patient hx to determine diagnosisdiagnosis
Assessment of muscle strengthAssessment of muscle strength Set objectivesSet objectives Implement a plan Implement a plan Evaluate progressEvaluate progress
Case StudyCase Study
Drop FootDrop Foot weakness of muscles that are involved weakness of muscles that are involved
in flexing the ankle and toes. in flexing the ankle and toes.
Clinical Muscle Clinical Muscle EvaluationEvaluation
Typical podiatric ankle strength Typical podiatric ankle strength evaluation consists of plantar evaluation consists of plantar flexion, dorsiflexion, eversion and flexion, dorsiflexion, eversion and inversion testinginversion testing
Dorsiflection TestingDorsiflection Testing
Tibialis AnteriorTibialis Anterior Support leg above ankleSupport leg above ankle Apply pressure against medial side, Apply pressure against medial side,
dorsal surface of the foot, in the dorsal surface of the foot, in the direction of plantar flexion of the ankle direction of plantar flexion of the ankle joint and eversion of the foot. Test joint and eversion of the foot. Test dorsiflection directly.dorsiflection directly.
Dorsiflection TestingDorsiflection Testing
Extensor Hallucis LongusExtensor Hallucis Longus Stabilize foot in slight plantar flexionStabilize foot in slight plantar flexion Pressure applied against dorsal surface Pressure applied against dorsal surface
of distal and proximal phalanges of the of distal and proximal phalanges of the great toe in direction of flexion. Test big great toe in direction of flexion. Test big toe extension.toe extension.
Dorsiflection TestingDorsiflection Testing
Extensor Digitorum LongusExtensor Digitorum Longus Stabilize foot in slight plantar Stabilize foot in slight plantar
flexionflexion Apply pressure against dorsal Apply pressure against dorsal
surface of the toes in the direction surface of the toes in the direction of flexion. Test extension of toes.of flexion. Test extension of toes.
SummarySummary
Manual Muscle Testing is clinical Manual Muscle Testing is clinical tool used to evaluate patient tool used to evaluate patient
Need information in order to develop Need information in order to develop orthotic treatment planorthotic treatment plan
ENDEND
Questions?Questions?
Conditions Conditions
A list of conditions treatable with A list of conditions treatable with Applied Kinesiology Applied Kinesiology
All about musclesAll about muscles
http://www.emporia.edu/ksn/v42n1-http://www.emporia.edu/ksn/v42n1-january1996/shape.htmjanuary1996/shape.htm
This power point is based on This power point is based on information found on the Illinois information found on the Illinois Institute of Technology web site where Institute of Technology web site where students developed resources to be students developed resources to be used in education in Latin America. I used in education in Latin America. I modified the original power point to modified the original power point to be used by high school students in the be used by high school students in the Healthcare Science classroom.Healthcare Science classroom.
Pat RapePat Rape
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