Quiz 3 Flashcards
what are the 3 key elements of muscle performance?
1) strength
2) power
3) endurance
what is muscle strength?
ability of contractile tissue to produce tension and a resultant force based on the demands placed on the muscle
what is muscle power?
related to strength and speed of movement
F x D/T
what is muscle endurance?
ability to perform low-intensity, repetitive, or sustained activities over a prolonged period of time
what can MMT give us insights into?
muscle strength
pain/level of irritability
differentiating inert vs contractile lesions
what is inert tissue?
ligaments and bursa
what is contractile tissue?
muscles and tendons
what is the accuracy of MMT based upon?
comparison w/a cohort of norms
if there is a greater difference bw active and passive tests is there likely a weakness or stiffness problem?
weakness
if there is a smaller difference bw active and passive tests is there likely a weakness or stiffness problem?
stiffness
what are contraindications for MMT?
unhealed fx/potential fx
post-surgery protective phase (6 wks for tendons)
inflammation/pain
dislocation
bone carcinoma
osteoporosis
myositis ossificans
what is grade 5 (normal)?
completes full ROM against gravity w/max resistance
inability of therapist to break contraction
what is a make test?
testing though ROM
what is a break test?
testing isometrically
what is grade 4 (good)
completes full ROM against gravity w/mod resistance
fails the break test with mod resistance
what is 4+?
completes full ROM against gravity w/mod to max resistance
what is 4-?
completes full ROM against gravity w/min to mod resistance
what is grade 3 (fair)?
complete full ROM against gravity w/o resistance
represents the “functional threshold”
what is 3+?
complete full ROM against gravity w/min resistance
what is 3-?
completes >50% <100% ROM against gravity w/o resistance
can passively go through full ROM
what is grade 2 (poor)?
completes full ROM in a “gravity-lessened” position
what is a gravity lessened position?
usually in a transverse plane or parallel to the ground
what is 2+?
initiates motion against gravity and completes <50% ROM
what is 2-?
unable to complete full ROM in “gravity-lessened” position
what is grade 1 (trace)?
visual and/or palpable contraction w/o jt movement
tests by moving jt into test position and asking pt to hold
what is grade 0 (absent)?
no active muscle contraction seen or felt
what is the general procedure for MMT?
position limb against gravity
test major action against gravity w/o resistance
add resistance if they can complete ROM
unable to finished 50%-put pt in gravity minimized position and test ROM
how should a pt be seated when performing a grip dynamometry test?
back, pelvis, and knees as close to 90 deg as possible
shoulder adducted (at their sides) and neutrally rotated
elbow flexed to 90 deg
forearm neutral (no pro/sup)
wrist bw 0-15 deg ulnar deviation
arm isn’t supported by examiner or armrest
dynamometer is vertical and in line w/the forearm
how many trials is standard for grip dynanometry?
3 trials
what position of the grip dynamometer is usually used?
2 or 3
how long should the contraction be held with grip dynamometry?
3 secs
how long of a rest periods should be taken bw trials of grip dynamometry?
60 secs
how often should the grip dynamometers be calibrated?
annually (sooner if used more often)
what is the acceptable CV (coefficient of variation) for women?
12%
what is the acceptable CV (coefficient of variation) for men?
10%
a change of >__kg is necessary to detect genuine change in grip strength 95% of the time with grip dynamometry
6
t/f: grip is typically a bit stronger in the dominant hand
true
what is a key grip?
thumb and side of index finger grip
what is a chuck grip?
pads of thumb and index finger grip
what is a tip to tip grip?
tips of thumb and index finger grip
what are the outer core/global muscles?
erector spinae
rectus abdominis
external obliques
gluteal muscles
thoracolumbar fascia (quad lumborum , lats)
t/f: the outer core is the same thing as the core stabilizers
false, the core stabilizers are deeper
what are the 2 phases of upper abdominal trunk raises?
1) trunk curl
2) hip flexion
what is the trunk curl phase of upper abdominal trunk raises?
trunk flexion
posterior pelvic rotation
what is the hip flexion phase of upper abdominal trunk raises?
hip flexors lift the trunk anteriorly
anterior pelvic rotation
what is a 5/5 grading for upper abdominal trunk raises?
hand behind head
trunk stays flexed
what is a 4/5 grading for upper abdominal trunk raises?
arms folded (reduced level arm length)
trunk stays flexed
what is a 3+/5 grading for upper abdominal trunk raises?
arms flexed
trunk stays flexed
what is a 3/5 grading for upper abdominal trunk raises?
arms extended
only trunk curl
what is the procedure for lower abdominal leg lowering?
assist in raising both legs
perform posterior pelvic rot and flatten the back
hold as the legs are lowered
monitor for lordosis and ant pelvic rot
who should probably not performance a lower abdominal leg lowering test?
pts with LBP
what is a 5/5 grading for lower abdominal leg lowering?
lower to table
back flat
what is a 4/5 grading for lower abdominal leg lowering?
lower 30 deg from table
back flat
what is a 3+/5 grading for lower abdominal leg lowering?
lower 60 deg from table
back flat
how is an inflatable stabilizer used?
pt lies on it and contracts muscle to see it on the reader and can use this as biofeedback to teach pts how to use their muscles
what is the purpose of selective tissue tension?
determine what tissue is causing the problem
inert vs contractile lesion
what are the components of selective tissue tension?
AROM
PROM
mid-range isometric testing
what is the purpose of PROM in STT?
identify increase/decrease in symptoms
identify the nature of end feels
identify the quantity of motion (capsular vs non-capsular)
what does positive PROM in STT mean?
noncontractile, inert soft tissue lesion
what is the purpose of AROM in STT?
identify increase/decrease in symptoms
identify weakness
identify quantity of motion (capsular vs non-capsular)
what does positive AROM in STT mean?
contractile soft tissue lesion
what does strong and painless mid-range isometrics mean?
normal
what does strong and painful mid-range isometrics mean?
minor contractile (tendinopathy, micro-tear)
nerve entrapment
underlying tissue impairment
what does weak and painful mid-range isometrics mean?
major contractile (partial thickness tear)
bony insertion fx
what does weak and painless mid-range isometrics mean?
neurological impairment
major contractile (full thickness tear)
poor muscle length
what does pain with repeat movements in mid-range isometrics mean?
minor contractile (tendinopathy, micro-tear)
what does pain with >1 test in mid-range isometrics mean?
double lesion
emotional overlay
discogenic in spine
reproduction of symptoms could include…
pain
abnormal movement pattern
weakness
functional deficit
t/f: minor contractile lesions may not be irritated unless after repeated contractions or stress
true
what is the MMT for the biceps?
90 deg of elbow flexion
supinated forearm
pt pushes up while PT resists down
normal grading scale
what is the MMT of the brachialis?
90 deg elbow flexion
forearm pronation
pt pushes up while PT resists down
normal grading scale
what is the MMT of the brachioradialis?
90 deg elbow flexion
neutral forearm
pt pushes up while PT resists down
normal grading scale
what is the MMT for the triceps?
pt in prone with arm off the side of the table and your hand under their arm for cushioning
pt pushes straight out and PT resists down at the wrist
normal grading scale
what is the MMT for supination?
pt sitting with arm resting on table
grip under the forearm and have pt move into supination while pushing against your thenar eminence as you resist
normal grading scale
what is the MMT for pronation?
pt in sitting with arm resting on table
start in a bit of supination and resist going “uphill” into pronation
stand in front of patient
grip under the arm with them pushing into your thumb/thenar eminence
normal grading scale
what is the MMT for wrist flexion?
forearm supination
have pt flex and you try to pull them into extension
ulnaris: start in radially deviated position
- resistance over 5th metacarpal trying to pull into extension and radial deviation
radialis: start in ulnarlly deviated position
- resistance over the 1st metacarpal trying to pull into extension and ulnar deviation
normal grading scale
what is the MMT for wrist extension?
pt with forearm on the table
extensor carpi radialis brevis and longus
- resist extension and radial deviation
extensor carpi ulnaris
- resist extension and ulnar deviation
normal grading scale
what is the MMT for thumb adduction?
forearm pronation
pull thumb up to the second metacarpal
try to hold on the metacarpal and pull down (DON’T PULL ON THE PHALYNX)
gravity lessened-neutral
palpate in the web space to palpate for contraction
Fromen sign: squeeze paper and try to pull the paper away
- flexed IP-using flexor pullicus instead of adductor-(+) sign
normal grading scale
what is the MMT for thumb opposition?
bring thumb and pinky together
resist on the ulnar side of the thumb and ulnar side of the palm
normal grading scale
what is the MMT for thumb abduction?
pt in sitting resting arm on table
longus-push distal at the metatarsal
brevis-push proximal on the first phalynx
normal grading scale
what is the MMT for thumb flexion?
pt in sitting resting arm on table
longus: bends IP
- stabilize at the proximal phalynx and bend the IP jt
brevis: flexes MCP jt
- resist at proximal phalynx without bending the IP jt
hold the metacarpal stable to stop opposition
normal grading scale
what is the MMT for thumb extension?
pt sitting with arm resting on table
resistance at proximal phalynx or distal phalynx
hold the metacarpal stable
normal grading scale
what is the MMT for finger flexion?
pt sitting with arm resting on table
IP jts:
- supination
- stabilize MCPs with your thumb and grab under their flexed fingers to resist
- resist each finger at the same time
- superficialis: resist at middle phalanges
- profudus: extend finger and flex the tip
- lumbricals: extend phalanges and resist at proximal phalanges
normal grading scale
what is the MT for finger extension?
fingers off the table
extend at the MCP joints (at IP would be lumbricals)
in tabletop hand position resist extension to test lumbricals
normal grading scale
what is the MMT for the interossei of the hand?
palmar: adduction
dorsal: abduction
flick finger in and it comes back out=5
what is the MMT for the illiospoas?
sitting and ask pt to lift knee against your resistance (may do in supine)
gravity minimized: sidelying supporting the knee
be sure it’s illiosoas and not rectus bc it’s strictly hip flexion and no knee extension
normal grading scale
what is the MMT for the sartorius?
ask pt to try to draw their heel up to opposite knee in sitting
2 hands doing 2 dif things
- one hand pushing pt into extension and adduction
- one hand pushing pt into internal rotation and pulling knee into extension
- “try to resist me”
not a commonly tested muscle
below 3=in supine ask pt to bring heel up to opposite knee
normal grading scale
what is the MMT for hip extension?
testing hamstrings and glut max
ask pt to lift whole leg off the table
5=max resistance at the ankle
4=max resistance at the knee, mod resistance at the ankle
what is the MMT for hip abduction?
pt tend to substitute a lot here
- ER
- pelvis drifts up and/or back
bring leg back and straight up
- leg needs to be in line with the body
grav min: supine and bring leg out to the side with toes pointing up at the ceiling
normal grading scale
what is the MMT for the TFL?
hip at about 45 deg flexion in sidelying
lift leg against resistance
long sitting for gravity minimized and bring leg out
normal grading scale
what is the MMT for the hip adductors?
pt in sidelying
lift leg 25 deg and ask pt to lift the other leg to it and resist the leg coming up tot the ceiling
grav min in supine – ask pt to slide heel to other leg
- can put support at the ankle and lift ever so slightly to lessen friction in grav min
normal grading scale
what is the MMT for hip ER?
testing the PGOGOQ muscles
lift foot up and in
try to push tibia out and femur in
max and mod-5 and 4
add light resistance to grade it a 3 here
full active motion here is a 2 (same with IR)
grav min in supine – add light resistance at the femur
what is the MMT for hip IR?
tests glut med and min
lift foot out
push tibia in and femur out
max and mod-5 and 4
add light resistance to grade it a 3 here
full active motion here is a 2 (same with ER)
what is the MMT for the hamstrings?
prone
bend the knee to 45 deg
add resistance to knee extension
scoop the knee to support it
grav min: sidelying: bend knee and bring heel to body
med hamstrings: semtendinosis/semimembranosis
- pull down and out
- pt going into IR
lat hamstrings: biceps fem
- pull down and in
- pt going into ER
what is the MMT for the quads?
15 deg ext and kick leg up towards ceiling
grav min: sidelying
good quad set-shouldn’t be able to move their knee cap
normal grading scale
what is the MMT for the gastrocs?
pt standing next to table and balance with 2 fingers if necessary
ask pt to go up on toes 25 times
25=5
2-24=4
1=3
up and down as long as calcaneous raises 2 inches
lie on table in long sitting and push against your hand with strong resistance=2
what is the MMT for tibialis anterior?
dorsiflex foot and invert foot
push down and out on the pt
palpate ant tib for a 1
normal grading scale
what can result from a weak ant tib?
foot slap, steppage gait (high lift to try to clear the toe), toe drop
what is the MMT for the tibialis posterior?
ask pt to point foot down and in
resistance is out and up like trying to uncurl the foot
pt long sitting or short sitting on a table
sidelying-grav resistance
normal grading scale
what is the MMT for the peroneus longus and brevis?
eversion and plantarflexion
pt in long or short sitting on the table
pt pushes down and out
PT pushes up and in
normal grading scale
what is the MMT for the toes/big toe?
lumbricals: flex toes and resist it
flexor digitorum: flex toes and resist at the middle phalynx or distal phalynx
flexor hallicus: flex big toe and resist
curl toes and give pressure at each
extensor digitorum: resist at toes
extensor hallicus-resist at proximal phalynx
normal grading scale
what is the MMT for capital extension?
pt in prone
nodding up (OA jt)
head off table, with your hand under their head for support
ask pt to look up at the wall ahead of them
resistance at occiput
gravity minimized=pt in supine-have them look up behind at you
don’t lift head all the way up bc that will include cervical spine
normal grading scale
what is the MMT for cervical extension?
pt in prone
head off table with your hand supporting
lift head toward ceiling while looking at the floor – like a retraction
resist at the occiput
gravity minimized-supine
- ask patient to push towards table into your hands
normal grading scale
what is the MMT for combined extension at the neck?
pt prone with arms at their side
guard head
ask pt to try and look up at the ceiling
pressure at occipital region with force down and forward
normal grading scale
what is the MMT for capital flexion?
pt in supine and have pt bring chin down
palpate SCM and rotate – should be relaxed muscle during this test
give resistance under the chin pulling up
what is the MMT for cervical flexion?
lift face to ceiling in protrusion like motion
pt in supine
2 finger resistance at the chin
4-mild resistance
5-moderate resistance
palpate SCM rotating R and L
what is the MMT for combined neck flexion?
lift head all the way
give resistance at the forehead
full motion-3
mod-4
max-5
1s and 2s=rotation
what is the MMT for the SCM?
turn head and lift towards the ceiling and give resistance to test combined rotation flexion?
max 5
mod 4
min 3+
rotation alone to test below 3
can resist rotation to test direct rotation
rotate L tests R SCM
what is the MMT for lumbar extension?
pt in prone
lift head shoulders and chest off the table with hands behind the head
may give pressure at the LE to keep them down
no resistance, just observation
5-full motion
4-gets to motion then gives a bit
3-partial motion
3 or below, look at lumbar and thoracolumbar together
what is the MMT for thoracic extension?
pt in prone
nipple line and above off the table
hand up to head
lift head neck and shoulders up
full strong motion-5
horizontal-4
what is the MMT for thoracolumbar extension?
pt prone on table
arms at the side, fully on the table
lift head neck and chest off the table
clear xiphoid process-3
partially up-2
palpate contraction-1
what is the MMT for lower abdominals?
lift legs up to the ceiling and feel for pelvis movement
split lunge position (PT)
lower legs while keep back flat against the table
60 deg from table=3+
30 deg from table=4+
what is the MMT for the quadratus lumborum?
pt laying in supine and PT pulls on one leg while the pt tries to hip hike
what is the MMT for trunk flexion?
rectus abdominis
hands on side of head
legs bent
head neck and shoulders off the table with chin up to ceiling
arms at the head and scapulae clear the table-5
hands across chest and scapulae clear the table-4
hands at the side and scapulae clear the table-3
can’t clear the scap with arms at the side-evaluate for a 2
raise head off the table= 2 if they elevate the head
tell pt to lean forward, if rib cage depresses=2
ask pt to cough and if the rib cage depresses=2
rib cage doesn’t depress, but there’s a palpable contraction=1
what is the MMT for the obliques?
lift head neck and shoulders off table and bring R elbow to L knee: R ext, L int
lift head neck and shoulders off table and bring L elbow to R knee: L ext, R int
5=arms at the sides of the head
4=arms across chest
3=arms at the sides
2=partial clearing of the scapulae
1=palpate contraction and look for ribs to depress
what is the MMT for the serratus anterior?
arm up in 130 deg flex
resist patient pushing up
normal grading scale
what is the MMT for the rhomboids?
in prone with arm behind the back and lift hand off the back
add resistance to the distal forearm
resistance is down and out
palpate in the medial scapular border
5-finger pops out of the medial border
4-tolerates mod resistance and finger may get pushed out a little but not as much as a 5
3-lift off actively and scap retracts
2-support arm, try to lift hand off back and scap moves actively all the way through
1- palpating the contraction with no visible movement
what is the MMT for the lower and mid traps?
140 deg scaption
GM: prone with support under the arm
max resistance distal to the elbow-5
mod distal to the elbow-4
max resistance proximal to the elbow-4
what is the MMT for the lats?
resistance at the forearm in prone
arm straight at the side
resistance anterior and lateral as pt tries to lift arm up and in
normal grading scale
use yoga blocks and have pt lift their body up using upper body
- full range-5
- partial range-4
- less range-3
what is the MMT for shoulder flexion?
give resistance proximal to the elbow
arm straight out in front
GM=sidelying, move arm through flexion range
normal grading scale
what is the MMT for shoulder extension?
prone
arm at the side
IR
lift arm up to the ceiling and give resistance
testing lats, teres major, post delt, triceps
resistance in straight sagittal plane just pushing straight down
resistance above the elbow
normal grading scale
what is the MMT for shoulder abduction?
lift arm over head in neutral rotation in sitting
have to have some deg of external rotation to avoid impingement
gravity minimized: supine and lift to at least 90 deg
tests the delts and supraspinatus
normal grading scale
what is the MMT for horizontal abduction?
prone
push down with arm to side and elbow flexed to 90 deg
GM: in sitting hold arm out to side and have them pull their elbow back towards you
normal grading scale
what is the MMT for the pec major/shoulder horizontal adduction?
resist above the elbow pulling out when pt pulls in
sternal-120 deg abduction and pull down and across to opposite hip – out and up resistance
clavicular-60 deg abduction and pull across and up - down and out to resist
GM: sitting and support the arm and ask pt to pull their arm across
normal grading scale
what is the MMT for the rotator cuff?
arm to side, elbow flexed to 90 deg
IR and ER
GM: neutral pro/sup in sitting with supported arm on table; just have them move arm in and out
