Procedure
- The patient is seated with the lower arms resting on a table or the examination table if necessary.
- Examine the muscles under isometeric tension (without movement). To do this, offer resistance (white arrow on photos) to the force elicited by the patient (black arrow on photos) in response to a request to initiate a certain movement. Ensure good fixation, possibly using the other hand (be aware of compensatory tensing of other muscles). Whilst performing the test inquire about any pain. Compare left and right, especially if pain is felt.
- If necessary, palpate the muscles:
- to determine the tone and the maximum point of pain
- to differentiate between lipomas and such like and muscle herniation
- if an avulsion or muscle rupture is suspected.
- Initially, an isometric test for pain in the various muscle groups should suffice.
If the patient indicates pain symptoms during this test, if possible examine the individual muscles of the muscle group in question (following a left-right comparison). Ensure that these are tensed as selectively as possible.
- The pronators (particularly the pronator teres muscle, pronator quadratus muscle, flexor carpi radialis muscle and anconeus muscle) [Figure 79].
Offer the patient a hand. Ask him to make a pronation movement, during which you make a supination movement (away from the patient).
Figure 79
- The supinators (particularly the supinator muscle and biceps brachii muscle) [Figure80]
Offer the patient a hand. Ask him to make a supination movement, during which you make a pronation movement (away from the patient).
Figure 80
- the extensors of the wrist and the fingers (particularly the extensor digitorum muscle, extensor carpi radialis longus and brevis muscles, and extensor carpi ulnaris muscle) [Figure 81].
Figure 81
- the flexors of the wrist and the fingers (particularly the palmaris longus muscle, flexor digitorum profundus and superficialis muscles, flexor carpi radialis muscle and flexor carpi ulnaris muscle) [Figure 82]
Ask the patient to make a fist with the thumb enclosed, starting from a position of slight palmar flexion of the wrist, and have them hold this position. Attempt to unclench the wrist.
Figure 82
- the ulnar abductors (particularly the flexor carpi ulnaris muscle, extensor carpi ulnaris muscle) [Figure 83].
Figure 83
- the radial abductors (particularly the flexor carpi radialis muscle, extensor carpi radialis longus and brevis muscles) [Figure 84].
Figure 84
- the extensors of the elbow (triceps brachii muscle and anconeus muscle) (refer to the “shoulder girdle”) the flexors of the elbow (particularly the biceps brachii muscle, brachialis muscle, brachioradialis muscle, extensor carpi radialis longus and brevis muscles) (refer to the “shoulder girdle”).
The following muscles can be more or less tested selectively:
- brachioradialis muscle [Figure 85].
- Function: flexion of the elbow with the lower arm in midpoint position.
Figure 85
- flexor carpi ulnaris muscle [Figure 86].
- Function: palmar flexion and ulnar abduction of the wrist;
- Disorder: tendonitis
Figure 86
- palmaris longus muscle [Figure 87].
- Function: palmar flexion of the wrist.
Figure 87
- flexor digitorum profundus muscle [Figure 88].
- Function: flexion of metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints II through to V; palmar flexion of the wrist;
- Disorder: peritendonitis
Figure 88
- flexor digitorum superficialis muscle [Figure 89].
- Function: flexion of MCP, PIP and DIP joints II through to V; palmar flexion of the wrist;
- Disorder: peritendonitis
Figure 89
- extensor carpi radialis longus and brevis muscles [Figure 90].
- Function: dorsal flexion and radial abduction of the wrist; flexion of the elbow;
- Disorder: tendonitis
Figure 90
- extensor digitorum muscle [Figure 91].
- Function: dorsal flexion of the wrist and extension of phalanges II through to V;
- Disorder: tendonitis
Figure 91
- extensor carpi ulnaris muscle [Figure 92].
- Function: dorsal flexion and ulnar abduction of the wrist;
- Disorder: tendonitis
Figure 92
- flexor carpi radialis muscle [Figure 93].
- Function: palmar flexion and radial abduction of the wrist;
- Disorder: tendonitis
Figure 93
The following muscles cannot be tested selectively (without numerous other muscles engaging):
- biceps muscle (refer to “the shoulder girdle”)
- brachialis muscle
- triceps brachii muscle (refer to “the shoulder girdle”).
For the examination of muscle strength see “The Neurological Examination”.
For the vascular examination see “The Cardiovascular Examination”.