Data Test 5 - MMT

What is another name for dynamic testing?

Isotonic

Dynamic strength testing is....

Examples....

Testing a constant resistance

Examples - free weights or 1RM

What is another name for anterior surface?

Volar

Isokinetic strength testing is....

Examples....

Provide resistant through ROM @ a constant velocity

Examples - isokinetic dynamometer

Isometric strength testing is....

Examples....

Muscle generating force against an immovable resistance with muscle @ a fixed length

Examples - MMT or handheld dynamometry

Functional testing is....

Examples.....

designed to examine the capacity of synergistic muscle groups to generate force output adequate to complete a specific task

Examples - chair rise test

What is the purpose of MMT?

- Measure a muscle/muscle group ability to develop tension against resistance

- determine the extent and degree of muscular weakness from disease, injury, disuse

What is one problem with the 1RM test?

Patient will get fatigued through multiple attempts of 'finding' 1RM so is it really a true measurement of maximal strength?

What is the definition of manual muscle testing?

using hands and unaided visual observation to determine strength

How do you isolate muscles?

- If two joint muscle you put one on slack (like bending the knee during hip extension or sitting up to perform SLR)

- Put the muscle in direct line of pull

Why do we palpate the muscle during MMT?

- To look for activation

- Feel for substitutions

When do we palpate the muscle during MMT?

During AROM but not during active resistance

What is the purpose of the therapist performing PROM? 2 reasons

To establish TEST ROM and to demonstrate the required motion to the patient

What is the purpose of recommended positioning in MMT? 4 reasons

- ensure appropriate muscles are tested

- ensure motions are not restricted

- minimize substitutions

- optimize examiners body mechanics for a good test

Complete the sentence -

The proximal joint segment must be ...... in order for a ...... contraction to occur.

Stable, maximum

With MMT grading what words are associated with the following numbers?

5

4

3

2

1

0

5 - Normal

4 - Good

3 - Fair

2 - Poor

1 - Trace

0 - zero

How is resistance applied during MMT?

Gradually and smoothly

Contrainidications for MMT?

- unhealed fx/surgery related to joint or motion being tested

- significant pain associated with testing

What can be said about the use of MMT vs HHD/ Isokinetic dynamometry?

MMT not as valid with higher grades of strength but more effective when detecting low levels of strength

Which three movements do we not stablilze with?

- Ankle PF

- Ankle DF

- Trunk Flexion

Where do you apply resistance during the break test?

Distal segment of the joint

In order to help consistency with MMT what should the therapist do?

Document whenever alternate positioning is used

Where do we stabilise?

Proximal joint segment

What are the 4 things we can do to help limit substitutions?

Positioning, Observing, Palpating, stablizing

What muscles perform shoulder IR?

Subscapularis, lats, teres major, pectoralis major

What muscles perform shoulder ER?

Infraspinatus, teres minor

What muscles perform shoulder flexion?

Anterior deltoid, coracobrachialis

How do you isolate the brachioradialis?

Wrist in neutral (thumbs up)

How do you isolate the brachialis?

Pronate the forearm

How do you isolate the glute max with hip extension?

Bend the knees (straight legs puts more emphasis on HS)

How do you isolate (not fully isolate but make the primary mover) the biceps for forearm supination?

Bend the elbow to 90 degrees flexion

How do you make the supinator muscle the primary muscle for wrist supination?

Extend the elbow

What are the actions of the sartorius?

Hip:

Flexion

Abduction

ER

What are the actions of the TFL?

Hip:

Flexion

Abduction

IR

What muscle is a substitute for DF?

Flexor hallucis longus

Muscle for scapular adduction?

Middle Trap

Muscle for scapular adduction and depression?

Lower Trap

Muscle for scapular adduction and downward rotation?

Rhomboid major and minor

Muscle for scapular ABduction and upward rotation?

Serratus Anterior

List of two joint muscles in the LE?

- Rectus Femoris

- Hamstrings (except short head biceps)

- Sartorius

- TFL

- Gastroc

- Gracilis

List of two joint muscles in the UE?

- Biceps Brachii

- Brachioradialis

- Triceps Brachii

- Extensor carpi radialis longus

- Flexor carpi radialis/ulnaris

Which two shoulder movements do not have a GE position?

Shoulder Abduction (scapular plane) THUMB up and down

Muscles for shoulder ABD (frontal) vs (scapular plane)

Frontal plane - mid delt, supraspinatus

Scapular plane - supraspinatus, mid delt

Same muscles but more emphasis on supraspinatus in scapular plane

ROM Shoulder ABD (scapular plane) Thumbs up vs down

Thumbs up - 180

Thumbs down - 120

When stabilising the superior ipsilateral shoulder during shoulder FLX and ABD, what is it important to be conscious of?

Not to place your hand over the 'test' muscles and restrict ROM

Shoulder Flexion:

Palpation

Stabilization

Palpation - Anterior deltoid

Stabilization - Superior ipsilateral shoulder

Shoulder Extension:

Palpation

Stabilization

Palpation - Just lateral to the inferior angle of scapula (here can palpate lats and teres major)

Stabilization - Ipsilateral thorax

Shoulder Abduction (frontal):

Palpation

Stabilization

Palpation - Middle deltoid

Stabilization - Superior ipsilateral shoulder

Shoulder Abduction (scapular):

Palpation

Stabilization

Palpation - supraspinatus over supraspinous fossa

Stabilization - Superior ipsilateral shoulder

Shoulder IR:

ROM

Palpation

Stabilization

ROM - 70

Palpation - Subscapularis deep in axilla

Stabilization - Ipsilateral thorax (avoiding pressure on test muscles)

Shoulder ER:

ROM

Palpation

Stabilization

ROM - 90

Palpation - Infraspinatus and teres minor below spine of the scapula

Stabilization - Ipsilateral thorax (avoiding pressure on test muscles)

Elbow Flexion:

ROM

Palpation

Stabilization

ROM - 150

Palpation - Biceps brachii over middle 1/3

Stabilization - superior Ipsilateral shoulder

Elbow Extension:

ROM

Palpation

Stabilization

ROM - 150-0

Palpation - Triceps over posterior humerus

Stabilization - superior Ipsilateral shoulder

Wrist Flexion:

ROM

Palpation

Stabilization

ROM - 80

Palpation - Medial muscle mass of forearm

Stabilization - distal radius and ulna

Where would you palpate for both ulnar and radial deviation with wrist flexion?

RD - Palpate tendon of flexor carpi radialis at base of second metacarpal, just lateral to midline of forearm

UD - Palpate tendon of flexor carpi ulnaris just proximal to pisiform bon

Where would you apply resistance for wrist flexion radial and ulnar deviation?

RD - direction of ulnar deviation and wrist extension

UD - direction of radial deviation and wrist extension

Wrist Extension:

ROM

Palpation

Stabilization

ROM - 70

Palpation - Lateral muscle mass of forearm

Stabilization - distal radius and ulna

Where would you palpate for both ulnar and radial deviation with wrist extension?

RD - just proximal to bases of second and third metacarpals

UD - Palpate tendon of extensor carpi ulnaris on ulnar side of wrist, just distal to ulnar styloid process

Where would you apply resistance for wrist extension radial and ulnar deviation?

RD - along dorsal aspect of first and second metacarpals in direction of wrist flexion and ulnar deviation

UD - along dorsal aspect of fifth metacarpal in direction of wrist flexion and radial deviation

What is the AG position for scapular adduction and downward rotation?

Prone with arm behind back. Dorsal surface of hand has to stay above glute

What is the AG position for neck flexion?

Supine reverse T

What is something different about grading for hip flexion?

There is no grade of 1 as you cannot palpate iliopsoas

With all lower extremities what must you do?

Take off shoes and socks so that there is no additional weight

Hip Flexion:

ROM

Palpation

Stabilization

ROM - 120

Palpation - NONE

Stabilization - Ipsilateral iliac crest

Hip Extension (HS & Glute max):

ROM

Palpation

Stabilization

ROM - 20

Palpation - HS or Glute max

Stabilization - Superior part of pelvis

Difference to remember for HS vs glute max hip extension

Glute max knee bent HS knee extended

Hip ABD:

ROM

Palpation

Stabilization

ROM - 45

Palpation - gluteus medius just above greater trochanter

Stabilization - pelvis and lateral pelvis

Hip ABD with Flexion

Muscle

AG position

GE position

Muscle - TFL

AG position - sidelying 30 ABD 45 FLEX

GE position - long sitting 45 , 30 ABD

Hip ADDUCTION

Muscles

AG position

Muscles - Pectineus, Gracillis, Adducot Brevis, longus, Magnus (PGBLM)

AG position - sidelying, facing away holding table for support. Hold leg up with test leg on bottom

GE position - Supine

HIP IR/ER -

ROM

Palpation

Stabilization

ROM - 45

Palpation - TFL, None

Stabilization - Ipsilateral pelvis

One major difference between hip IR/ER?

No palpation for ER therefore no grade of 1

Grading for ankle PF (Gastroc + Soleus) MMT?

5 - 25 reps +

4 - 10-24 reps

3 - 1-9 reps

2, 2-, 1, 0 Normal

7 muscles for this test with no GE position

- Shoulder ABD (scapular)

- Scap ADD + Depression

- Scap ABD + Upwards rotation

- Neck Flexion

- Anterolateral flexion

- Trunk flexion

- Trunk extension

Trunk Flexion positioning

Supine, legs extended, PPT

Grading for Trunk flexion

5 - Hands behind head + inferior angles of scapula clear table

4 - arms across chest + inferior angles of scapula clear table

3 + - arms @ side + inferior angles of scapula clear table

3 - arms @ side and inferior angles do not clear the table

2 - arms @ side and only head and cervical spine clear the table but entire scapula stays on table

1 - only tractor but no motion

0 - nothing felt or moved

Stabilization for trunk rotation?

Thighs (Quads)

Grading for Trunk flexion

5 - Hands behind head + inferior angles of scapula clear table

4 - arms across chest + inferior angles of scapula clear table

3 - arms @ side + inferior angles of scapula clear table

2 - sitting with full ROM

-2 - sitting with partial ROM

1 - only trace but no motion

0 - nothing felt or moved

1 - only tractor but no motion

0 - nothing felt or moved

Grading for Trunk extension

5 = hands behind head and xiphoid clears table

4 = hands behind back and xiphoid clears table

3 = hands at side and xiphoid clears table

2 = hands at side and xiphoid does not clear table

1 = only trace but no motion

0= nothing felt or moved

With trunk flexion and rotation you are looking at the inferior angle of the scapula as a marker, but what is the marker for trunk extension?

Xiphoid process

Pelvic Elevation MMT - Muscles

quadratus lumborum, iliocostalis lumborum

Pelvic elevation grading

5 - Patient maintains pelvic elevation against maximum resistance.

4 - Patient maintains pelvic elevation against moderate resistance.

3 - Patient maintains pelvic elevation against minimum resistance.

2 - Patient elevates pelvis through full ROM without resistance.

1 - No motion, but a palpable contraction is present.

0 - No motion or contraction is present.

AG + GE position for hip flexion, abduction and lateral rotation

Sartorius - AG seated flex, abd, ER hip

GE - same in supine