Manual Muscle Testing

An evaluation system for diagnosis of disease or dysfunction of the musculoskeletal and nervous systems

Purpose

Measures the capability of muscles or groups to provide support and movement Diagnostic tool
Postural balance Gait impairment Range of motion

Uses little equipment Obtains information not defined by other procedures

Precautions

Do No Harm (use gentleness) Know ROM limits Follow procedure Record

Promptly Accurately

To Get Standardized Results

Proper training and education Knowledge base of anatomy, physiology and neurology of muscle function Follow precise testing protocol Practice, Practice, Practice A skill developed and maintained with number of cases

Validity and Accuracy

Coordinate the muscle testing findings with other standard diagnostic procedures The amount of pressure used to test may vary between persons performing the test. The amount of strength loss must be greater than approximately 20to 30% to be dependably measurable Comparison of both sides is a better indicator of loss

Muscles

3 Types: Skeletal, Smooth, Cardiac

Skeletal around 40% of muscle composition

Generally voluntarily controlled

Composed of fibers Work in groups Movement depends on how the muscles are attached

Structure of Muscle

http://en.wikibooks.org/wiki/Anatomy_and_Physiology_of_Animals/Muscles

How Do Muscles Cause Movement

Origin- where the muscle is attached to the bone; this bone will move very little Insertion- muscle attachment to bone with most motion Belly of muscle- part of muscle that enlarges on contraction

Muscle Groups

Quadriceps Hamstrings Calf Low back Abdominals Pectoralis major Rhomboids

Trapezius Latisimus dorsi Deltoids Biceps Triceps

Conduct Strength Testing

Correct positioning is essential (Start in extended anatomical position) Place muscle to be tested in a supported position directly opposed to gravity Exert uniform force directly on the line opposing movement

Testing of Bicep & Tricep

Support humerus where gravity is against the bicep and tricep, client in anatomical position Move elbow through full ROM (Passive ROM)
Flexion Extension Internal rotation External rotation

Maneuver to Assess Muscle Strength

With arm in full extension, pull downward on forearm while client attempts to flex. With arm flexed, apply pressure against forearm, ask client to straighten arm. When performing muscle tests, be sure to evaluate for asymmetry of the muscle groups (i.e. atrophy on one side and not the other) and landmarks prior to testing.

Use the following scale to rate strength:

0-No movement, no contraction of the muscle 1- Trace, evidence of muscle contraction but no joint movement 2- Poor, complete range of motion with gravity eliminated 3-Fair, complete range of motion against gravity 4- Good, complete range of motion against gravity with moderate resistance 5-Normal, complete range of motion against gravity with maximal resistance without evidence of fatigue

Other Test Results

Weakness defined as a strength below fair in non weight bearing muscles; below fair + in weight bearing muscles Contracture degree of shortness in muscle, so it cannot move through ROM Substitution weak muscles are supported by other muscles to move

Active ROM

Instruct client to move the elbow through ROM

Flexion Extension Internal rotation External rotation

Normal ROM is measured by goniometer

Elbow flexion 0-160 Elbow extension 145-0 Elbow pronation (rotation inward) 0-90 Elbow supination (rotation outward) 0-90

Strength Test Example

Gastrocnemius (Ankle plantar flexion) Patient Standing Rises on toes, pushing weight upward

Case Study to Follow

Take patient hx to determine diagnosis Assessment of muscle strength Set objectives Implement a plan Evaluate progress

Case Study

Drop Foot

weakness of muscles that are involved in flexing the ankle and toes.

Clinical Muscle Evaluation

Typical podiatric ankle strength evaluation consists of plantar flexion, dorsiflexion, eversion and inversion testing

Dorsiflection Testing

Tibialis Anterior
Support leg above ankle Apply pressure against medial side, dorsal surface of the foot, in the direction of plantar flexion of the ankle joint and eversion of the foot. Test dorsiflection directly.

Dorsiflection Testing

Extensor Hallucis Longus

Stabilize foot in slight plantar flexion Pressure applied against dorsal surface of distal and proximal phalanges of the great toe in direction of flexion. Test big toe extension.

Dorsiflection Testing

Extensor Digitorum Longus

Stabilize foot in slight plantar flexion Apply pressure against dorsal surface of the toes in the direction of flexion. Test extension of toes.

Summary

Manual Muscle Testing is clinical tool used to evaluate patient Need information in order to develop orthotic treatment plan

END

Questions?

Conditions

A list of conditions treatable with Applied Kinesiology

All about muscles

http://www.emporia.edu/ksn/v42n1january1996/shape.htm

This power point is based on information found on the Illinois Institute of Technology web site where students developed resources to be used in education in Latin America. I modified the original power point to be used by high school students in the Healthcare Science classroom. Pat Rape

http://www.lhup.edu/yingram/jennifer/webpa ge/homepage2.htm http://www.iit.edu/~ipro309s08/links.html http://www.bulowbiotech.com/intromov.html

Careers

http://francistuttle.com/classes/ctp/details.aspx?PRGID=13 Orthotic & Prosthetic (O & P) Technicians assist the disabled by fabricating the orthopedic braces (orthoses) and artificial limbs (prostheses) necessary for their rehabilitation. O & P Technicians are trained and skilled to provide comprehensive O & P technical support services and possess the knowledge to interact with clinical prosthetists and orthotists. You will acquire knowledge in polymer processes, strength of materials and applied biomechanical principles to develop and totally customize an orthosis or prosthesis. Providing O & P care involves the application of clinical and technical processes to meet patient rehabilitation objectives.