Neurological examination falls outside the scope of this theme. It is described in detail in The Neurological Examination. The same applies for the peripheral vascular examination, The Cardiovascular Examination.
This section comments briefly on the examination of muscle strength. The testing of the muscle(s) for strength is mainly indicated if the patient complains about loss of strength and/or if upon inspection visible atrophy is observed. This atrophy can be objectified by measuring muscle circumference.
For the examination of the muscle strength, the patient tenses the muscle as powerfully as possible and the examiner tries to force an opposite movement (e.g. testing the strength of the psoas major muscle: the patient tries to bring the hip and knee into maximum flexion and maintain this position while the examiner tries to extend the hip).
Intra-individual differences in the muscle strength of comparable muscles or groups of muscles are investigated by means of left/right comparison.
A scale of 0 to 5 is used to indicate the strength:
0 = No movement possible, no tension of the muscle can be felt.
1 = The muscle is tensed (visible contraction), however there is no movement.
2 = In the case of no gravity or reduced gravity (e.g. in water), the patient is able to make a movement.
3 = The patient is able to overcome gravity.
4 = The resistance applied by the patient is less than the examiner would expect in view of the patient’s posture.
5 = The resistance applied by the patient is normal.