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muscle strength testing Flashcards

1
Q

Correlates of strength

A

Age
Sex
Muscle fat ratio
Muscle size
mechanical properties, tone, elasticity, stiffness
Physical activities
Co-morbidity
Medication
Cross-sectional area
Pennation angle

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2
Q

Physiological considerations of strength

A

Muscle fibre types
Neural factors
Connective tissue integrity (brain signals)
Age: muscle mass, fibres, functional motor units, cross sectional area

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3
Q

key things to note down

A

muscle being tested
Amendments in positioning to complete test
grade
Symptoms that may influence strength outcome

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4
Q

two joint muscles in lower limb and what they do

A

Long head bicep femoris, semitend, semimem = hip extension + knee flexion
Rec fem = hip flexion + knee extension
Gastroc = knee flexion + ankle plantar flexion

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5
Q

ways to assess strength

A

Manual eg oxford scale
Functional assessment
Dynamometers
Muscle bulk/girth, indicative of strength or swelling but significant limitations

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6
Q

contras and cautions

A

Unhealed fracture
Dislocation or unstable joint
where active RoM or resistance are contra (e.g. post- op protocols etc)
Pain
Severe inflammation
Severe osteoporosis (CI), any degree of osteoporosis is a caution
Haemophilia
Cognitive concerns
Abdominal Surgery or Hernia
Bony Ankylosis
Haematoma
CV Disease
Pulmonary Disease
Prolonged Immobilisation
where fatigue may be harmful or exacerbate condition ( e.g. lower motor neuron disease)

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7
Q

how many parts to oxford grading scale

A

0-5

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8
Q

what is grade 0

A

no contraction

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9
Q

what is grade 1

A

Flicker or trace of contraction

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10
Q

what is grade 2

A

Full range of active movement with gravity minimised

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11
Q

what is grade 3

A

Full range of active movement against gravity

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11
Q

what is grade 4

A

Full range of active movement against gravity with minimal resistance

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12
Q

what is grade 5

A

Full range of motion against gravity with maximal resistance/ normal strength

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13
Q

how to perform grading/testing

A

test unaffected side first
ensure appropriate comfortable position
Determine if they can move through full RoM against gravity
If cant move through any part of RoM against gravity, reposition to eliminate gravity (movement in horizontal plane)
May need to support limb on friction free surface or manually
If can do grade 3 assess against resistance
If they can hold resistance for 5+s or overcome = grade 5
If not = grade 4

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14
Q

general points about grading/testing

A

Apply resistance slowly and gradually at distal end
Don’t apply resistance directly to a joint
When testing through RoM, start in full outer RoM and go all the way through to full inner RoM
Isolate muscle or group being tested
substitute movements

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15
Q

what range to perform test and why

A

mid range for optimal contraction force
inner (short) and outer (long) have less force

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16
Q

what to do pre test

A

unaffected limb first
discuss how you’ll do the same on affected
set expectations
painful part last
cautions and contras

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17
Q

to remember during test

A

consent
clearly communicate why
explain + demonstrate passive
discuss exposure

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18
Q

how to do isometric tetsing

A

Start mid range
Identify position, mid range for max force
Consider variation in strength through RoM
consistency, re-assessment routine, data collection, clinical notes

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19
Q

what may happen if not adequately stabilised

A

substitute movements at other joints

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20
Q

where to stabilise

A

gravity and weight provide initial stabilisation
Stabilisation proximal joints as resistant placed distally

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21
Q

where to apply resistance for one joint muscle

A

at end of range for consistency

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22
Q

where to apply resistance for two joint muscle

A

mid range, length tension more favourable

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23
Q

what to do if you cant distinguish between Grade 5 and 4

A

put patient at a mechanical disadvantage

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24
how to apply resistance
slowly and gradually at the distal end applied opposite to line of pull of the muscle
25
position for hip extension grade 0 and 1
prone
26
position for hip extension grade 2
side lying
27
position for hip extension grade 3, 4 and 5
prone
28
position for hip flexion grade 0 and 1
supine
29
position for hip flexion grade 2
side lying
30
position for hip flexion grade 3, 4 and 5
supine (msk says sitting)
31
position for hip abduction grade 0 and 1
supine
32
position for hip abduction grade 2
supine
33
position for hip abduction grade 3, 4 and 5
side lying or standing
34
position for hip adduction grade 0 and 1
supine
35
position for hip adduction grade 2
supine
36
position for hip adduction grade 3, 4 and 5
side lying or standing
37
position for hip external rotation grade 0 and 1
prone
38
position for hip external rotation grade 2
supine
39
position for hip external rotation grade 3, 4 and 5
sitting, hip and knees 90
40
position for hip internal rotation grade 0, 1and 2
supine
41
position for hip internal rotation grade 3, 4 and 5
sitting, hip and knee 90
42
position for knee flexion grade 0 and 1
prone
43
position for knee flexion grade 2
side lying
44
position for knee flexion grade 3, 4 and 5
prone or standing
45
how to isolate bicep femoris when testing knee flexion
externally rotate ankle
46
how to isolate semitendinosus/semimembranosus when testing knee flexion
internally rotate ankle
47
position for knee extension grade 0 and 1
supine
48
position for knee extension grade 2
side lying
49
position for knee extension grade 3, 4 and 5
sitting
50
position for ankle plantarflexion grade 0 and 1
prone
51
position for ankle plantarflexion grade 2
side lying
52
position for ankle plantarflexion grade 3, 4 and 5
prone or standing 1 calf raise = 3 3-5 = 4 5+ = 5
53
how to isolate soleus when testing ankle plantarflexion
knee flexion
54
position for ankle dorsiflexion grade 0 and 1
supine
55
position for ankle dorsiflexion grade 2
side lying
56
position for ankle dorsiflexion grade 3, 4 and 5
supine or sitting
57
position for ankle in and eversion grade 0, 1 and 2
supine
58
position for ankle in and eversion grade 3, 4 and 5
side lying
59
how to test ankle dorsiflexion
grip calcaneus one hand grip mid foot with other hand push down on their foot tell them don’t let me push your foot down so they are pushing foot up against hand
60
position for shoulder extension grade 0 and 1
prone
61
position for shoulder extension grade 2
side lying
62
position for shoulder extension grade 3, 4 and 5
prone
63
position for shoulder flexion grade 0 and 1
supine
64
position for shoulder flexion grade 2
side lying
65
position for shoulder flexion grade 3, 4 and 5
supine
66
position for shoulder add and abduction grade 0, 1 and 2
supine
67
position for shoulder add and abduction grade 3, 4 and 5
side lying or standing
68
position for shoulder external rotation grade 0 and 1
prone
69
position for shoulder external rotation grade 2
supine
70
position for shoulder external rotation grade 3, 4 and 5
sitting, hip and knees 90
71
position for shoulder internal rotation grade 0, 1 and 2
supine
72
position for shoulder internal rotation grade 3, 4 and 5
sitting, hip and knee 90
73
position for elbow extension grade 0 and 1
prone
74
position for elbow extension grade 2
side lying or sitting
75
position for elbow extension grade 3, 4 and 5
prone or sitting
76
position for elbow flexion grade 0 and 1
supine
77
position for elbow flexion grade 2
side lying or sitting
78
position for elbow flexion grade 3, 4 and 5
supine or sitting
79
position for elbow pro and supination grade 0, 1 and 2
supine or sitting difficult to eliminate gravity
80
position for elbow pro and supination grade 3, 4 and 5
supine or sitting difficult to complete against gravity
81
position for wrist flexion and extension grade 0,1 and 2
supine or sitting 2 - forearm in mid position
82
position for wrist flexion grade 3, 4 and 5
supine or sitting forearm supinated
83
position for wrist extension grade 3, 4 and 5
supine or sitting forearm pronated
84
position for ulnar and radial deviation grade 0, 1 and 2
supine or sitting 2 - forearm pronated
85
position for radial deviation grade 3, 4 and 5
supine or sitting forearm in mid position
86
position for ulnar deviation grade 3, 4 and 5
supine or sitting forearm pronated

clinical physio (4 decks)

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