Muscle tests<\/strong> <\/span>(isometric examinations<\/em>) are performed in the directions of movement for which symptoms of a lesion were present<\/span> during the active movement examination. Alternatively, if a mild muscle\/tendon lesion is suspected, it is the direction in which the muscle and tendon concerned are active<\/span>.<\/span><\/p>\n During isometric muscle tests<\/strong><\/span>, the examiner asks the patient to resist the force<\/strong><\/span> that they are applying in a certain direction of movement. It is important to instruct the patient that the aim is not to exceed the strength of the examiner. No movement<\/strong><\/span> should occur in the joint under examination<\/span> and in the neighbouring joints<\/span>.<\/span><\/p>\n The following two conditions should be kept in mind:<\/span><\/p>\n During this examination, the examiner should pay particular attention to the occurrence of pain<\/strong><\/span>, as this is often indicative of a muscle\/tendon<\/strong><\/span> cause.<\/span><\/p>\n The isometric examination<\/strong><\/span> only tests groups of muscles that jointly realease<\/span> a movement. If pain symptoms arise during testing of various muscle groups, the examiner (after comparing left and right<\/em>) should also test the various muscles as selectively as possible. A detailed examination of muscle strength forms part of the neurological examination. Nonetheless, major changes<\/strong><\/span> or left\/right differences<\/strong><\/span>, as well as coordination disorders<\/strong><\/span> should be noted during this examination.<\/span><\/p>\n The examiner should be aware that the reason for examining muscle(s<\/em>) will influence the result obtained. An orthopaedic<\/em> examination is an isometric test<\/span> and may only be one-sided<\/em>. However, a neurological<\/em> examination focuses on the absolute strength<\/em> and the left\/right comparison<\/em>. A muscle or muscle group that causes pain when tensed may subsequently be tensed less powerfully<\/span> (a muscle test is considered positive if pain can be established<\/em>).<\/span><\/p>\n For minimal lesions<\/strong><\/span>, extend the muscle<\/em>\/group of muscles<\/em> to the maximum length<\/span> before<\/em> performing the muscle test. Besides the isometric contraction, this applies an additional force as a result of which a possible lesion<\/strong><\/span> may be more clearly established. It’s advisable to perform the test in a different posture and more specifically, in the functional posture<\/span> in which symptoms occur in daily life. Be aware that a positive test can also arise as a consequence of referred pain<\/strong><\/span>, or mechanically as a consequence of an increase in pressure <\/strong><\/span>(bursitis, hernia, abscess<\/em>). A basic functional examination<\/span> can be used to determine the functional system in which the complaint is located.<\/span><\/p>\n Once the muscle tests have been performed, data obtained by the examiner is combined (a likely diagnosis or hypothesis is established<\/em>) such that a further course of management can be determined.<\/span><\/p>\n Palpation<\/strong><\/span>, specialised tests<\/strong><\/span> and other additional examination techniques<\/strong><\/span> can be used to determine the location<\/span> more accurately. The likely diagnosis can be rejected<\/em>, confirmed<\/em> or established<\/em> with even greater specificity<\/span>. To obtain a better insight into the interpretation of the data obtained, 6 regularly-occurring situations<\/span> from everyday practice will now be described in the following paragraphs.<\/span><\/p>\n #1 – There is a limitation in one or more directions of movement (active and passive) and pain occurs in the same direction of movement(s). The muscle tests are negative.<\/em><\/span><\/strong><\/p>\n We may conclude that this is:<\/span><\/p>\n Note 1.<\/strong><\/span><\/em> For both the active<\/em> and passive<\/em> movement examination, the non-contracting structures are tensed. A lesion should therefore exhibit the same pattern of symptoms in both examinations.<\/span> Possible location of the lesion:<\/span><\/p>\n #2 – There are no limitations during active or passive movement, yet pain occurs in the same direction of movement. The muscle tests are negative.<\/em><\/span><\/strong><\/p>\n If we combine these results, this points to a non-contractile<\/strong><\/span> structure with a capsular<\/span> or extracapsular location<\/span>. Pathological changes that are located within the capsule usually result in movement limitation and are therefore less likely to be considered.<\/span><\/p>\n #3 – There is no limitation during active or passive movement and no change occurs in the existing pain. The muscle tests are negative.<\/em><\/span><\/strong><\/p>\n The entire basic function examination is negative<\/span>, whereas the patient still clearly indicates pain symptoms. In this situation, we are confronted with referred pain<\/strong><\/span> on the basis of a non-acute lesion that is located elsewhere in the body. This is usually pain that develops in a visceral organ<\/strong><\/span> (heart<\/em>, gallbladder<\/em>), radiating<\/span> to a more superficially<\/strong><\/span> situated area (dermatome or myotome<\/em>).<\/span><\/p>\n #4 – The amplitude of the excursions (active and passive) in the same direction are increased, possibly in the presence of pain. The muscle tests are negative.<\/em><\/span><\/strong><\/p>\n There is hypermobility<\/strong><\/span> which may be caused by:<\/span><\/p>\n #5 – Active excursion is limited, but passive excursion in the same direction is not. In both cases pain may be present. The muscle tests are positive and\/or abnormal.<\/em><\/span><\/strong><\/p>\n This is a situation in which a contractile structure<\/strong><\/span> causes complaints. In particular, the findings from the isometric muscle test examination give us a clear indication for this. Possible causes of this pattern of complaint:<\/span><\/p>\n #6 – Pain is felt upon active movement, possibly with a limitation in one direction, whereas upon passive movement pain and possibly limitation in the opposite direction are experienced. The muscle test in the direction that gave rise to pain in the active movement examination and possible limitation of movement, is also positive.<\/em><\/span><\/strong><\/p>\n In this case, only one diagnosis is possible – a muscle\/tendon<\/span> lesion<\/span><\/strong>. Actively, the pain is elicited due to the contraction and passively due to bringing the injured structure to its full length.<\/span><\/p>\n
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\nNote 2.<\/em><\/strong><\/span> If muscle shortening is present, these muscles will be painful<\/em> if extended<\/span>. The principle of the muscle length test is based on this phenomenon. The pain location therefore provides extra information.<\/span><\/p>\n\n
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