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At the completion of this chapter, the reader will be able to:


  1. Understand the importance of manual muscle testing

  2. Perform a gross muscle screening of a patient's strength

  3. Perform specific manual muscle tests to the shoulder

  4. Perform specific manual muscle tests to the elbow

  5. Perform specific manual muscle tests to the wrist and forearm

  6. Perform specific manual muscle tests to the hand

  7. Perform specific manual muscle tests to the hip

  8. Perform specific manual muscle tests to the knee

  9. Perform specific manual muscle tests to the leg and foot

  10. Perform specific manual muscle tests of the trunk

  11. Describe the strengths and weaknesses of the various grading systems used with manual muscle testing.

  12. Interpret the different results that can be obtained from a manual muscle test.




Movement occurs through the interaction between the nervous and musculoskeletal systems. The nervous system provides cognition, perception, and sensory integration and is primarily involved in the control of movement, while the musculoskeletal system provides the power for movement. A basic overview of the neurologic structures is provided in Chapter 4. This chapter provides an overview of the anatomy and physiology of the musculoskeletal system and then describes how the muscular system can be assessed.




Muscle testing requires that the patient be able to voluntarily control the tension developed in the muscles. A patient with a disorder of the central nervous system who demonstrates spasticity is not an appropriate candidate for muscle testing.


A gross muscle screening is performed on a patient when a quick assessment of the patient's general level of muscle strength is required. If any weakness is found during the gross muscle screening test, a specific muscle test is then performed. It is important to remember that the gross muscle screening does not detail the determination of strength; it only provides the clinician with information as to whether a region of the body is either normal or weak. An example when a gross muscle screening would be used is when the clinician is preparing the patient to get out of a wheelchair and to ambulate using a standard walker—the clinician needs to determine whether the patient has sufficient strength to weight bear through the lower extremities and to weight bear through the upper extremities. Regardless of the type of muscle testing used, the procedure is innately subjective and depends on the subject's ability to exert a maximal contraction. This ability can be negatively affected by such factors as pain, poor comprehension, motivation, cooperation, fatigue, and fear.


The gross muscle testing procedures for each of the main regions of the body are described in Table 12-1. As mentioned, one of the more common gross muscle testing procedures is the one performed by the clinician before gait training with an assisted device when the clinician is not sure ...

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