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Muscle testing depends on a thorough understanding of which muscles are used in performing certain movements. Testing is best performed when the patient is rested, comfortable, attentive, and relaxed. Pay attention to whether muscle weakness, atrophy, or abnormal muscle tone are segmental (at a particular loud along the neuraxis), on unilateral versus bilateral.
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Prior to testing strength, the examiner should assess muscle bulk (is there muscle atrophy, or hypertrophy and, if so, which muscles are affected?). The examiner should also note fasciculations, if present, and should record the specific muscles in which they are present.
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Because several muscles may function similarly, it is not always easy for the patient to contract a single muscle on request. Positioning or fixation of parts can emphasize the contraction of a particular muscle while other muscles of similar function are inhibited. The effect of gravity must be considered because it can enhance or reduce certain movements.
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Testing of individual muscles is useful for evaluating peripheral nerve and muscle function and dysfunction. The normal or least affected muscles should be tested first to gain the cooperation and confidence of the patient. The strength of the muscle tested should always be compared with that of its contralateral muscle.
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The strength of various muscles should also be graded and charted. Scales of various types are used, most commonly grading strength from 0 (no muscle contraction) to 5 (normal).
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See Tables B–1 and B–2 and Figures B–1 to B–52. Notice that in all the figures, blue arrows indicate the direction of movement in testing the given muscle. Black arrows indicate the direction of resistance, and the blocks show the site of application of resistance.
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