Manual Muscle Testing and Goniometry Notes

Gravity Sideline

  • Starting position: Halfway to the motion.

  • Example: Going up to the 50% mark.

  • Application: Examiner applies pressure, preventing the patient from moving.

Gravity Reduced Position (Supine)

  • Patient lies on their back.

  • The examiner applies force to resist the patient's movement.

  • Adjustments may be needed to ensure resistance is applied appropriately to the targeted muscle group (e.g., shoulder).

  • Example: Applying pressure in front of the shoulder to ensure proper resistance.

External Rotation Adjustments

  • If external rotation feels awkward, reposition the patient.

  • Ensure resistance is correctly positioned.

External and Internal Rotation

  • External Rotation: Palm faces up to the sky

  • Internal Rotation: Back of the palm faces up to the sky (backhand position)

  • Patient attempts to move into external rotation against the resistance.

50% Rule

  • For most manual muscle testing, return to the 50% range of motion to apply resistance.

  • Exception: Shoulder abduction is an exception, where going back to 50% is not required.

Horizontal Adduction

  • Patient position: Supine.

  • Motion: Reaching across the body.

  • Examiner stabilizes the patient and applies resistance.

Scapular Plane

  • Stabilization on the plank, resist on the dorsal forearm.

  • Patient instructed to move their palm up to the sky to test external rotation.

Stabilizing Hand Placement

  • Internal rotation: Stabilize on the humerus.

Shoulder Manual Muscle Testing

  • Horizontal adduction is tested with the patient laying down.

  • Gravity minimized position involves a slight side motion.

  • Internal and external rotation are tested similarly.

Elbow and Wrist Testing

  • Focus on palpation during manual muscle testing, especially when assessing a grade of 1.

Pronation and Supination Testing

  • Examiner applies pressure and resists the patient’s movement into pronation or supination.

  • Examiner stabilizes the patient, while they try to break the movement.

  • Gravitiy Reduced: Supporting the patient while applying pronation and supination.

Supine Positioning

  • Stabilization is on the humerus.

  • Examiner supports the patient and applies resistance to pronation or supination.

Minimal Pressure

  • Apply minimal pressure during manual muscle testing.

  • Stabilizing hand placement is important; stabilize at the elbow.

Body Mechanics

  • Proper technique is important, but may take a back seat in real-world scenarios.

Supination Gross Motor Testing

  • Place your hand at their elbows still and grasp on the wrist while doing it

  • The patient goes against gravity

Goniometry

  • Axis placement: Acromion.

  • Stationary arm: Midline to the humerus.

  • Moving arm: Aligned with the humerus.

  • Record the range of motion (e.g., 0 to 70 degrees of right horizontal abduction).

Scapular Retraction and Protraction

  • Axis: Superior aspect of the scapula.

  • Stationary arm: Midline to the trunk.

  • Moving arm: Aligned with the acromion.

  • Protraction: Shoulders hunched forward.

  • Retraction: Shoulders moving backward.

  • Record measurements.

  • Active range of motion is calculated.

Hip Flexion

  • Gross motor assessment: Patient raises knee to chest.

  • Manual muscle testing: Apply slight pressure against hip flexion.

  • Gravity eliminated position: Sideline.

Ankle Inversion and Eversion

  • Patient points toes towards the examiner.

  • Apply slight pressure and resist movement.

  • Gravity reduced position: Sideline