Manual Muscle Testing

• Used to document muscle strength

• Actual test performance as well as muscle strength grading done systematically

Number Work Motor Deficit Definition

5 Normal 0 Complete joint range of motion (ROM) against gravity with full resistance
4 Good 1-25 Complete joint ROM against gravity with moderate force
3 Fair 26-50 Full joint ROM against gravity
2 Poor 51-75 Full joint ROM with gravity eliminated
1 Trace 76-99 Visible or palpable muscle contraction, no joint motion produced
0 Zero 100 No visible or palpable muscle contraction

Key Muscle for Assessment or Motor Function

Nerve Function Muscle

C5 Elbow flexors Biceps, brachioradialis

C6 Wrist extensors Brachioradialis
C7 Elbow extensors Triceps
C8 Finger flexors of middle distal phalanx Flexor digitorum profundus to middle finger
T1 Small finger abductors Abductor digiti minimi
T2 Hip flexors Iliopsoas
T3 Knee extensors Quadriceps
L4 Ankle dorsiflexors Tibialis anterior
L5 Long toe extensors Extensor hallucis longus
S1 Ankle plantar flexors Gastrocnemius, Soleus

Key Sensory Areas in Sensory Index Scoring

C2 Occipital protuberance (External)

C3 Supraclavicular fossa
C4 Top of the acromioclavicular joint (Acromion process)
C5 Lateral side of the antecubital fossa
C6 Thumb
C7 Middle Finger
C8 Little Finger
T1 Medial side of the antecubital fossa
T2 Apex of the axilla
rd
T3 3 intercostals space
th
T4 4 intercostals space (Nipple Line)
th
T5 5 intercostals space (midway between T4 and T6)
th
T6 6 intercostals space (Xiphisternum)
th
T7 Continuation of the 7 intercostals to the midline (Xiphoid)
th
T8 Continuation of the 8 intercostals to the midline
th
T9 Continuation of the 9 intercostals to the midline
th
T10 Continuation of the 10 intercostals to the midline (Umbilicus)
th
T11 Continuation of the 11 intercostals to the midline
T12 Inguinal ligament in the region of femoral artery
L1 1/3 distance between T12 and L2 (Inguinal region)
L2 Mid anterior thigh
L3 Medial femoral condyle (Anterior knee)
L4 Medial malleolus
rd st
L5 Dorsum of the foot at the 3 MTP joint (1 web space)
S1 Lateral Heel
S2 Popliteal fossa in the midline
S3 Ischial tuberosity (Perianal area)
S1-S5 Perianal area
Special Maneuvers

Cervical Spine

Name Testing Maneuver Positive Test Interpretation

Position

Spurling’s Sitting, head Apply vertical downward Pain radiates to Cervical

foramina laterally flexed force UE towards the radiculopathy due
compression test flexed side to nerve root
compression
Reverse Spurling’s Sitting, head Apply vertical downward Pain radiates to Myofascial pain
laterally flexed force the opposite UE syndrome,
from which neck whiplash
is flexed
Distraction test Sitting, Lift head upward Relief of Cervical
examiner’s hand radiating neck radiculopathy
on chin and pain
occiput
Shoulder Sitting, looking Passive lateral head Increased pain Irritation of
depression test forward flexion, downward compression of
pressure on shoulder nerve roots
opposite of flexed side
Lhermitte’s sign Long leg sitting Examiner passively Sharp pain Dural or
flexes neck and one hip down the spine meningeal
simultaneously keeping radiating to the irritation, cervical
knees straight UE or LE myelopathy
Valsalva test Sitting or supine Ask patient to take one Pain on the side Increased
deep breath and keep or vertebral disc intrathecal
mouth closed as he tries pathology in the pressure
to strain vertebral spine
Shoulder Sitting or supine Passive or active Relief of Sx, Neural
abduction relief shoulder abduction so relief of pain compression (C4-
test that the hand or forearm C5 roots),
rests on top of head increase pressure
in interscalene
triangle

Thoracic Outlet Syndrome

Name Testing Maneuver Positive Test Interpretation
Position

Adson’s test Hands resting Examiner palpates radial Disappearance Compression of

on thigh pulse while asking Px to of radial pulse subclavian artery
extend neck turn the between the
head on the side being anterior and
tested and take a deep middle scalene
breath muscle
Allen’s test Sitting Examiner flexes the Px Disappearance Compression of
elbow to 90 while the Px of radial pulse subclavian artery
shoulder is abducted to
90 and externally rotated
Halsted Maneuver Sitting Px extends neck and Disappearance
rotates toward the of radial pulse
opposite side of the limb
being tested, examiner
palpates radial pulse
 and applies downward
force on the arm
Costoclavicular Sitting Px retracts scapula, Disappearance Compression of
test examiner abducts of radial pulse subclavian artery
shoulder between the
st
clavicle and 1 rib
Hyperabduction Sitting Px abducts shoulder to Disappearance Compression of
test (Wright’s Test) 180 over head while of radial pulse neurovascular
externally rotated bundle under the
coracoids
process and
pectoralis minor

Thoracic Spine
Name Testing Maneuver Positive Test Interpretation
Position

Schober’s test Standing Examiner measures Distance less Ankylosing

distance between than 5cm spondylitis
midpoint of 2 dimples
(PSIS) & C7, Px flexes
trunk forward, examiner
measures again

Lumbar Spine

Name Testing Maneuver Positive Test Interpretation

Position

SLR Supine Examiner passively Shooting pain in Sciatic nerve

flexes one hip raising leg the raised leg compression
at the heel while keeping anywhere at 30- (>60=hamstring
knee straight 60 tightness)
Grossed SLR Supine Examiner passively Shooting pain on Radiculopathy
flexes one hip raising leg the other leg (large/central)
at the heel while keeping
knee straight
Ober’s Test Sidelying -lower leg flexed at hip Leg remains Iliotibial band
and knee abducted and tightness
- examiner passively does not fall to
abducts & extends hip of the table
upper leg then slightly
lowers it
Patrick’s (FABER) Supine -knee flexed Pain Osteoarthritis of
test -hip flexed, abducted & the hip
externally rotated until
the lateral malleolus
rests on the opposite
knee just above the
patella
-examiner gently
presses downward the
knee on side being
tested
Pelvis

Name Testing Maneuver Positive Test Interpretation

Position

Gaenslen’s test Sidelying ? -hyperextend upper leg Pain in the

at the hip sacroiliac joint
-lower leg flexed against
the chest

Shoulder

Name Testing Maneuver Positive Test Interpretation

Position

Yergason’s test Sitting -shoulder neutral Pain in the biceps Bicipital

-elbow flexed tendon in the tendinitis or
-examiner resist forearm area of the tendinitis of the
supination bicipital groove long head of the
biceps
Supraspinatus Sitting -shoulder horizontally Pain & weakness -supraspinatus
Empty can test abducted at 30 on side removal tear
-shoulder internally -suprascapular
rotated (thumbs down nerve
sign) neuropathy
-examiner applies
downward force on the
patient’s upper extremity
Drop arm or Sitting -examiner abducts Patient unable to Rotator cuff tear
Codman test patient shoulder to 90 lower arm slowly
-ask patient to slowly or has severe
lower arm to side pain on
attempting to do
so
Abrasion test Sitting -shoulder abducted to 90 Crepitations Rotator cuff
-shoulder is externally & fraying
internally rotated
Lift-off test Sitting -shoulder internally Pain or inability to Subscapularis &
rotated & extended perform task rhomboid
(hand on small of back) weakness
-ask patient to lift hand
off back
Neer’s Sitting Forcibly elevating Pain Supraspinatus
impingement test shoulder through or bicipital
forward flexion tendinitis
Impingement test Sitting -elbow extended Pain Rotator cuff
(painful arc) -shoulder fully externally impingement
rotated
-patient is instructed to
abduct shoulder to 90
Reverse Sitting -elbow extended No pain Rotator cuff
impingement test -shoulder fully externally impingement
rotated
-patient is instructed to
abduct shoulder to 90
-examiner pushes head
of the humerus inferiorly
while abducting
Elbow

Name Testing Maneuver Positive test Interpretation

position

Tennis elbow sitting

Cozen’s test Resist wrist extension w/ Pain on lateral Lateral epicondylitis

forearm pronation, radial epicondyle
deviation

Mill’s test Examiner passively

pronates forearm,flexes
wrist fully and extends
elbow

Metho3 Resist extension of

middle finger distal to
PIP joint w/ wrist and
other fingers extended
Golfer’s elbow sitting Examiner moves arm Pain on medial Medial epicondylitis
into forearm supination, epicondyle
elbow and wrist
extension

Hips

Name Testing Maneuver Positive test Interpretation

position

Thomas test supine Bring one LE to knee- Extended LE Contracture of hip

chest position while rises from the flexors
keeping other LE table
extended
Trendelenburg standing Stand on one leg Pelvic drop on Gluteus medius
sign one side weakness

Ortolani’s sign supine Examiner passively Relocation click Congenital hip

flexes,abducts, dislocation
(done in infants) externally rotates hip

Barlow’s sign supine Examiner passively Dislocation click Hip instability in

flexes, adducts, and infants
(done in infants) places post. pressure on
thigh
Galenzzi’s/ Allis supine Examiner passively One knee is highr Unilateral congenital
test flexes hip to 90 degrees than the other hip dislocation
and knees fully flexed (dislocated hip is
the side where the
knee is lower)
Knee

Name Testing Maneuver Positive test Interpretation

position

McMurray’s test supine -hip fully flexed Click or a painful "click"

-knee fully flexed crepitation indicates a tear of
-tibia rotated and held in (medial/lateral), the medial meniscus
external or internal (with/without of the knee joint.
rotation as the knee is pain) Inward rotation of
extended the foot with pain
indicates a tear in
the lateral meniscus.
Apleys’ test prone -knee flexed to 90
degrees
Pain/examiner Meniscal injury
examiner applies feels crepitations
1. Grinding test compressive force
through the foot and
rotates tibia internally Pain Ligamentous injury
and externally

instead of compressing,
2. Distraction test apply distractive force to
the leg
Lachman’s test Supine -examiner flexes -Mushy/soft Anterior cruciate
patient’s knee to 30 endfeel ligament(ACL) injury
degrees -excessive or instability
-femur is stabilized obsevable
-tibia is moved forward movement of tibia
Anterior drawer Supine Examiner flexes hip to Excessive ant. ACL injury
sign 45 degrees and knee to movement of the
90 degrees tibia w/ respect to
femur (>6mm)
Foot in neutral is held on
the table with the
examiner sitting on the
forefoot

Examiner pulls forward

on the prox. part of calf
Posterior drawer supine Examiner flexes hip to Excessive post. PCL injury or
sign 45 degrees and knee to movement of the instability
90 degrees tibia w/ respect to
femur
Foot slightly laterally
rotated

Examiner pushes tibia

posteriorly