MANUAL MUSCLE
TESTING
Dr Santosh Metgud
INTRODUCTION
• Manual muscle testing is a procedure for the evaluation of strength of individual
muscle or muscle group, based upon the effective performance of a movement in
relation to the forces of gravity or manual resistance through the available ROM.
• Muscle testing is an integral part of physical examination. It provides information,
not obtained by other procedures, that is useful in differential diagnosis, prognosis
and treatment of neuromuscular and musculoskeletal disorders.
PRINCIPLES
• Place the subject in a position that offers the best fixation of the body as a whole
(usually supine, prone, or side-lying).
• Stabilize the part proximal to the tested part or, as in the case of the hand,
adjacent to the tested part.
• Stabilization is necessary for specificity in testing. Place the part to be tested in
precise antigravity test position, whenever appropriate, to help elicit the desired
muscle action and aid in grading.
• Use test movements in the horizontal plane when testing muscles that are too
weak to function against gravity.
• Use test movements in antigravity positions for most trunk muscle tests in which
body weight offers sufficient resistance.
• Apply pressure directly opposite the line of pull of the muscle or the muscle
segment being tested. Like the antigravity position, the direction of pressure helps
to elicit the desired muscle action.
• Apply pressure gradually but not too slowly, allowing the subject to "get set and
hold." Apply uniform pressure; avoid localized pressure that can cause discomfort.
• Use a long lever whenever possible, unless contraindicated. The length of the
lever is determined by the location of the pressure along the lever arm. Better
discrimination of strength for purposes of grading is obtained through use of a
long lever.
• Use a short lever if the intervening muscles do not provide sufficient fixation for
use of a long lever.
INDICATION
• Musculoskeletal disorders
• Neurological diseases
Multiple sclerosis
Muscular dystrophy
Amytrophic lateral sclerosis
Myasthenia gravis
GBS
• Lower motor neuron lesions
CONTRAINDICATIONS
• Cerebral palsy
• Cardiovascualr disease
• Dislocated / unhealed fracture
• Myositis ossificans
• Parkinson’s disease
• Pain
• Inflammation/ (inflammatory disease in muscles and or joints )
• Severe cardiac and respiratory disease.
GRADES OF MMT
1. MRC
2. OXFORD
3. ISOMETRIC
4. KENDALL
5. DANIELS
1 )MRC Grading
• 0 No muscle activation
• 1 Trace muscle activation, such as a twitch, flicker of contraction
• 2 Full range of motion without resistance in gravity eliminated
position
• 3 Full range of motion without resistance AGAINST gravity
• 4 Full range of motion with MODERATE resistance AGAINST
gravity
• 5 Full range of motion with MAXIMAL resistance AGAINST gravity
• Https://youtu.be/LjlqP1uMUo0
• https://youtu.be/6wAlFzaYl70
2) OXFORD GRADING
1- Flicker of movement
2- Through full range actively with gravity counter balance
3- Through full range actively against gravity
4- Through full range actively against some resistance
5- Through full range actively against strong resistance
3) ISOMETRICS
Normal (100%), 5+ : Complete ROM against gravity with maximal resistance
Good (75%), 4 : Complete ROM against gravity with some moderate resistance
Fair+, 3+ : Complete ROM against gravity with minimal resistance
Fair (50%), 3 : Complete ROM against gravity
Fair-,3- : Some but not complete ROM against gravity
Poor +,2+ : Initiates motion against gravity
Poor (25%),2 : Complete ROM with gravity elimintated
Poor -,2-: Initiates motion if gravity is eliminated
Trace, 1 : Evidence of slight contractility but no joint motion
Zero 0 : No contraction palpated
4) KENDALL
ZERO: No contraction
Trace: Tendon becomes prominent or feeble contraction felt
Poor(-): Moves through partial ROM
Poor: Moves through complete ROM
Poor(+): Moves to completion OR Moves through partial ROM
Fair(-): Gradual release from test position
Fair: Holds test position (no added pressure )
Fair (+): Holds test position (against slight pressure )
Good(-): Holds test position against slight to moderate pressure
Good: Holds test position against moerate pressure
Good (+): Holds the test position against moderate to strong pressure
Normal: Holds test position against strong pressure
5) DANIELS
5: Normal
4: good
3: Fair
2: Poor
1: Trace
0: No activity
UPPER LIMB
Shoulder flexors Shoulder extensors
• https://www.youtube.com/watch?v=WKW5Y3fyzyQ shoulder flexion
• https://www.youtube.com/watch?v=vEvJoV1z6Q8 shoulder extension
Shoulder abductors Shoulder adductors
• https://www.youtube.com/watch?v=5CWIH0SXtOo abduction
• https://www.youtube.com/watch?v=wUBqUOvX8-I horizontal
abduction
• https://www.youtube.com/watch?v=D4rjZQpl9Lo horizontal
adduction
• https://www.youtube.com/watch?v=6rJvL6Xyz6I adduction
Shoulder Internal rotators Shoulder External rotators
• https://www.youtube.com/watch?v=obfI4UAmd4I internal rotation
• https://www.youtube.com/watch?v=dy9DL7Pr7P0 external rotation
Elbow flexors Elbow extensors
Forearm supinators Forearm pronators
Wrist flexors Wrist extensors
MCP flexors MCP extensors
Finger abductors Finger adductors
Thumb MP and IP flexors Thumb MP and IP extensors
Thumb abductors Thumb adductors
Thumb opposition
LOWER EXTRIMITY
Hip flexors Hip extensors
Hip abductors Hip adductors
Hip external rotators Hip internal rotators
Knee flexors Knee extensors
Ankle plantar flexors Ankle dorsiflexors
Foot invertors Foot evertors
Trunk extensors Trunk flexors
INDIVIDUAL MUSCLE MMT
Flexor digitorum superficialis Flexor digitorum profundus
Pronator quadratus Supinator and biceps
Biceps brachii and brachials Triceps brachii and anconeus
Brachioradialis
Shoulder joint
Coracobrachialis Deltoid
Anterior deltoid Posterior deltoid
Pectoralis major Pectoralis minor
Infraspinatus Teres minor
Teres major Latissimus dorsi
Upper trapezius Middle trapezius
Lower trapezius Serratus anterior
LOWER LIMB
Semitendinosus and Biceps femoris
Semimembranosus
Quadriceps femoris iliopsoas and psoas major
Sartorius Gluteus medius
Tibialis anterior Tibialis posterior
Peroneus longus and brevis
