2. PRINCIPLES
• 1. always look for pain, tenderness or
contracture in muscles
• 2. fix the proximal joint before testing a
movement
• 3. for certain movements , synergistic action
of other muscle is essential
3. PRINCIPLES
• Muscle power can be tested in 2 ways :-
1. isotonic
2. isometric
Isotonic – child is asked to do movement and
examiner resist
Isometric – child is asked to keep the muscle
contracted and examiner tries to break it
29. BRACHIO RADIALIS
• TEST: The patient
flexes the elbow
with the FA semi
pronated against
resistance
30. ECRL & ECRB
• FUNCTION:
EXTENDS AND ABDUCTS
• TEST : patient keeps the wrist up
press over the dorsum of the hand at
2nd meta carpal head and resist extension and
abduction
32. EXT. DIGITORUM & EDM
• FUNCTION: Extends the MP joints of the
index, long, ring and small fingers.
• TEST: Keep the fingers extended at MP joint
against resitance (with the forearm in the line
with the hand)
33. ECU
• patient keeps the wrist up
press over the dorsum of the hand at 5th
meta carpal head and resist extension and
adduction
37. SUPINATOR
• FUNCTION: SUPINATES
FOREARM WHEN
ELBOW IS EXTENDED
• TEST: GRASP THE
PATIENT IN A HAND
SHAKE WITH THE
PATIENENT’S ELBOW
EXTENDED AND RESIST
SUPINATION
38.
39. Ab P L
• Abducts and extends
the thumb carpal-
metacarpal joint.
Assists in radial
deviation of the
wrist. Resistance is
applied to the thumb
metacarpal in the
direction of
adduction and
flexion.
42. EPL
• Test: Position – the thumb metacarpal-
phalangeal joint in extension.
• Resist – thumb interphalangeal joint extension
by applying pressure over the dorsal distal
phalanx (in the direction of flexion).
43. EPB
• Test: Position – the
thumb metacarpal-
phalangeal joint in
FLEXION.
• Resist – thumb
interphalangeal joint
extension by applying
pressure over the dorsal
distal phalanx (in the
direction of flexion).
46. Muscle of palm
Thenar muscles (lateral group)
1. Abd pollicis brevis
2 Flexor pollicis brevis
3 Opponens pollicis
4 Adductor pollicis
Hypothenar muscles(medial
group)
1.Palmaris brevis
2.Abductor digiti minimi
3.Flexor digiti minimi brevis
4.Opponens digiti minimi
Central muscles:
1.Lumbricals
2.Palmar interossei
3.Dorsal interossei
47. Thenar muscles
• AbPL + OP + FPB –
MEDIAN NERVE
• FPB (deep head)+ Ad
Pol - deep branch of
ulnar nerve
48. Ab P B
• Function : abducts
thumb
• Origin : scaphoid,
trapezium, flex
retinaculum
• Insertion: lateral aspect
of base of proximal
phalanx
49. Ab PB
• Palmar abduction of the
thumb at the at the
carpal-metacarpal and
metacarpal-phalangeal
joint. Resistnace is
applied in the direction
of palmar adduction
50. Fl P B
• Patient is asked to bend
the thumb towards the
palm from the MP joint.
Resistance is applied to
the volar proximal
phalanx in the direction
of MP extension.
51. Opponens Pollicis
• Origin: trapezium and
flexor retinaculum
• Insertion: antero lateral
surface of 1st MC Shaft
• function: opposes
thumb to other digits
52. Opponens pollicis
• Once patient
demonstrates ability to
position thumb in
opposition to the small
finger, resistance is
applied in the opposite
direction.
53. Opponens pollicis
• Without normal
function of the
opponens pollicis the
patient can't shake
hands normally. This is
due to inability to wrap
the thumb over the
other person's hand.
57. Palmaris brevis
• It is a subcutaneous
muscle .
• It wrinkles skin on
medial side of palm
• N supply: superficial
branch of ulnar nerve
58. Abductor digiti minimi
• Origin: pisiform. Tendon
of fcu, pisiform hamate
ligament
• Insertion: base of
proximal phalynx of
little finger
• Function: abducts little
finger
59. Ab DM
• Abducts small finger.
Resistance is applied in
the direction of
adduction.
60. Fl DM BREVIS
• O: flexor retinaculum ,
hook of hamate
• I: base of proximal
phalynx of little finger
• F: flexes little finger
61. Fl D M BREVIS
• Patient is asked to flex
the
Metacarpophalangeal
joint of the small finger
while keeping the
interphalangeal joints
extended. Resistance is
applied to the volar
proximal phalanx in the
direction of extension.
62. OPPONENS DIGITI MINIMI
• O- Flexor retinaculum ,
hook of hamate
• I- antero medial side of
5th metacarpal shaft
• F- OPPOSES little finger
to thumb ,deepens the
hollow of palm
• N supply: ulnar nerve
63. OPPONENS POLLICIS
• Opposition of small
finger towards thumb.
• Resistance is applied to
the palmar aspect of
the MCP joint of the
small finger in the
opposite direction.
65. LUMBRICALS MUSCLE
• 4 LUMBRICALS
• N supply:
• 1 & 2- median nerve
• 3 & 4 – ulnar N
• Function : flex MP joint
and extend the IP joint
66. Lumbricals
• Extends the IP joints
while flexing the MP
joint of the small finger.
Here, the patients
ability to maintain this
position is tested with
resistance applied to
the dorsal distal phalanx
in the direction of IP
flexion.
67. Palmar and dorsal interossei
• 4 in numbers
• N supply : ulnar nerve
• Palmar : adducts digits,
flex MP joint, Extend IP
joint
• Dorsal : abducts fingers
, flex MP joints , Extend
IP joint.
• Test : Adducts the small
finger towards midline
of hand. Resistance is
applied in the direction
of finger abduction.
70. Grip test
• C7, C8,T1
• Ask the patient to squeeze two of your fingers
as hard as possible and not let them go.
• You should normally have difficulty removing
your fingers from the patients grip.
74. Muscles of iliac region
• Psoas major
• Psoas minor
• Iliacus
• N supply: roots of
lumbar n and femoral N
• They are thigh flexors (
mainly iliopsoas)
• Test : patient flexex
thigh against resistance
75. Muscles of gluteal region
• Gluteus max – inf gluteal N
• Gluteus med – sup gluteal N
• Gluteus min – sup gluteal N
• Piriformis – n to piroformis
• Obturator internus – n to obturator internus
• Gamellus superior – n to obturator internus
• Gamellus inferior – n to quadratus femoris
• Quadratus femoris- n to quadratus femoris
76.
77. Gluteal maximus
• TEST :
• Patient lies prone
• Knee slightly flexed
• Extends the hip against
resistance
78. Abductors of hip
• Gluteus medius
• Gluteus minimus
• piriformis
• obturator internus
79. Abductors of hip
• Patient lies supine
• Both knees close
together
• Ask him to separate the
thigh against resistance
• For testing against
gravity – patient lies in
lateral position
80. Lateral rotator of hip
• Gamellus superior
• Gamellus inferior
• Quadratus femoris
82. Anterior thigh muscles
Tensor fascia lata Abducts and medially rotates thigh
Sartorius Flexes, abducts, lateral rotation of
thigh
QUADRICEPS FEMORIS:
rectus femoris Flexes the thigh
vastus lateralis, Extend the leg
Vastus medialis Extend the leg
Vastus intermedius Extend the leg
Articularis genu Pulls the synovial membrane upward
83. Adductors of thigh
Gracillis Ant division of obturator n Adducts the thigh, flexes
and rotates the leg
pectineus Ant division of obturator n,
Femoral N,
Adducts and flexes the
thigh
Adductor longus Ant division of obturator n Adducts and flexes the
thigh
Adductor brevis Ant division of obturator n Adducts and flexes the
thigh
Adductor magnus post division of obturator n Adducts and extend the
thigh
Obturator externus post division of obturator n Lateral rotator of thigh
84.
85. Adductors of thigh
Test :
• Patient lies supine
• Keep the limbs abducted
• Ask to move the limb towards midline
• Adduction against gravity also can be tested
by keeping the patient in lateral position
86. Posterior thigh muscles
• Biceps femoris
• Semitendinosus
• Semimembranosus
• All supplied by tibial part
of sciatic N
• Short head of biceps
femoris by common
peroneal part of sciatic N
• These 3 + Ad magnus
called hamstring M
87. Hamstring muscle
• Patient lies in a prone
position with the legs
extended straight out.
• Examiner puts one hand
lightly on the thigh just
about the knee and then
provides light resistance as
the person being tested
draws the heel towards the
pelvis.
• Examiner puts his hand
behind the patient’s heel
and tries to push the foot
and leg straight.
88. Hamstring ms
• Test :
• The patient lies supine with knee flexed at
90 0.
Hold the leg at the ankle and resist pulling of
the heel in towards the buttock
90. Anterior and lateral muscle of leg
Tibialis anterior Dorsiflexion of ankle
EHL Extends the great toe
EDL Extends the other 4 toes
Dorsiflexion of ankle
Peroneus tertius Dorsiflexion of ankle
91. Tibialis anterior
• N supply : DPN
• Fn :- ankle dorsiflexion
• The patient lies supine
with leg extended and
foot dosri flexed.
• Hold the foot over
dorsal surface and resist
dorsi flexion
92. Tibialis posterior
• Supplied by Tibialis N.
• Fn :- Ankle inversion
• Hold the patient’s foot medially at the first
metatarsal and resist inversion
93. Peronei longus and brevis
• Superficial peroneal N
• Ankle eversion
• Hold the patient’s foot
laterally at the fifth
metatarsal and resist
eversion
94. EHL
• N supply : DPN
• Great toe extension
• The patient dorsiflexes
the distal phalynx of the
great toe
• Press against the dorsal
surface of the distal
phalynx to resist
dorsiflexion
95. EDL
• Tibial N
• Toe flexion
• Hold the patient’s toes
with your fingers over
the planter surface and
resist flexion
96. EDB
• N. supply – DPN
• Toe extension
• The patient dorsiflexes the proximal phalanges
of the toes and attempts to spread the toes.
Alternatively , press against the dorsal surface
of the middle phalanges.
• Observe and palpate the muscle belly 4 cm
distal to the lateral malleolus
97. Planter flexors
• Muscles of Posterior compartment of leg
gastrocnemius
soleus
plantaris
popliteus
flexor hallucis longus
fl digitorum longus
tibialis posterior
98. Planter flexors
Test :
• child kicks examiners hand kept on the sole
of the foot while examiner tries to resist it
99. Abdominal muscles
• Ask the child to get up from supine posture
without using the UL and feel for the
contraction of muscle
BEVOR SIGN:
• Seen with B/L lower abdominal muscle
paralysis
• Child hand over the chest – ask him to flex the
neck forward – the umblicus will move up
100. Respiratory muscles
• Examine the movement of chest
• Look for paradoxical movement
• Single breath count
• Power of intercostal muscle can be checked by
splinting of abdominal muscles
