Procedure
- The patient stands or sits comfortably with their arms hanging down.
- Examine the muscles by having them tensed isometrically (without movement).
- Offer resistance to the force elicited from the patient by having them initiate a certain movement.
- Ensure good fixation with the other hand (be aware of compensatory movements).
- Whilst performing the test, inquire about any pain.
- If pain is indicated, compare left with right.
If necessary, palpate the muscles:
- To determine the tone and the maximum point of pain.
- To differentiate between lipoma and muscle herniation.
- If an avulsion or muscle rupture is suspected.
An isometric test for pain in the different muscle groups should suffice. If the patient indicates pain symptoms during this test, individually investigate the various muscles of the muscle group in question (following a left-right comparison). Ensure that these are tensed as selectively as possible.
- Anteflexion (deltoid muscle, pectoralis major muscle, coracobrachialis muscle) [Figure 36].
Figure 36
- Retroflexion (deltoid muscle, teres major muscle, latissimus dorsi muscle) [Figure 37].
Figure 37
- Abduction (deltoid muscle, supraspinatus muscle) [Figure 38].
Figure 38
- Adduction (pectoralis major muscle, latissimus dorsi muscle) [Figure 39].
Figure 39
- Outward rotation (infraspinatus muscle, teres minor muscle) [Figure 40].
Figure 40
- Inward rotation (subscapularis muscle, pectoralis major muscle, latissimus dorsi muscle, teres major muscle) [Figure 41].
Figure 41
- Elevation (trapezius muscle, levator scapulae muscle) [Figure 42].
Figure 42
- Extension of the elbow (triceps brachii muscle) [Figure 43].
Figure 43
- Flexion of the elbow (biceps brachii) [Figure 44].
Figure 44
The sternocleidomastoid muscle, the rhomboid muscles and the serratus anterior muscle can only be tested selectively.
The following muscles can be tested more or less selectively:
- Sternocleidomastoid muscle [Figure 45].
- Function: Homolateral flexion, contralateral rotation of the head.
- Disorder: Torticollis.
Figure 45
- Deltoid muscle (acromial origin) [Figure 46].
- Function: Abduction of the arm (in approximately 75° abduction).
- Disorder: Atrophy due to axillary nerve lesion with dislocation of the glenohumeral joint.
Figure 46
- Deltoid muscle (scapular spine origin) [Figure 47].
- Function: Retroflexion of the arm (starting from approximately 75° abduction).
- Disorder: Atrophy due to axillary nerve lesion.
Figure 47
- Serratus anterior muscle [Figure 48].
- Function: Fixation of the scapula dorsally against the thorax and outward rotation and gliding motion of the scapula.
- Disorder: Winging of the scapula.
Figure 48
- Rhomboid muscle [Figure 49].
- Function: Inward rotation, and upwards and medial gliding movement of the scapula.
- Disorder: Hypertonia.
Figure 49
- Latissimus dorsi muscle and teres major muscle [Figure 50].
- Function: Retroflexion, inward rotation and adduction of the arm.
Figure 50
The following muscles cannot be tested selectively (without numerous other muscles engaging):
- Trapezius muscle (descending part) and levator scapulae muscle.
- Disorder: Hypertonia, myogelosis.
- Pectoralis major muscle (clavicular part/sternocostal part).
- Disorder: Blunt trauma.
- Deltoid muscle (clavicular part).
- Disorder: Atrophy because of axillary nerve lesion.
- Coracobrachialis muscle.
- Disorder: Tendonitis.
- Rotator cuff muscles.
- Disorder: Tendonitis.
- Triceps brachii muscle.
- Disorder: Tendonitis.
- Biceps brachii muscle.
- Disorder: Tendonitis, involving the long head of the biceps muscles; ruptured long head of the biceps muscle.
For the examination of muscle strength, refer to The Neurological Examination.