Deck 25: Evaluation of Muscle Strength

Question 1

An occupational therapy (OT)practitioner is testing a client's wrist flexion strength.The client is able to flex the wrist to 50 degrees against gravity.What should the therapist do next in the assessment?

A) Apply resistance.
B) Reposition the client to test in the gravity-minimized plane.
C) Assist the client into full wrist flexion and then apply resistance.
D) Flex the wrist passively to assess available range of motion.

Answer 1

D
It is necessary for the OT practitioner to know the client's available range of motion (ROM)before grading muscle strength.The therapist cannot assume that the 50 degrees of flexion represents full available ROM,so applying resistance is premature and may result in inaccurate grading of strength.The therapist also cannot assume that the 50 degrees of flexion does not represent full available ROM because there could be a joint limitation,so testing in a gravity-minimized plane may result in inaccurate grading of strength.The client should not be assisted into a testing position because this will result in inaccurate muscle grading.

Question 2

An OT practitioner is testing thumb interphalangeal (IP)flexion strength.The therapist definitely observes flexion of the IP joint but cannot palpate a contraction of the flexor pollicis longus (FPL).What is the most likely reason?

A) The FPL may be too weak to palpate.
B) The client is giving less than maximal effort.
C) The flexor pollicis brevis may be substituting.
D) The extensor pollicis longus may be substituting.

Answer 2

D
It is common for other muscles to compensate for the function of a weaker muscle to accomplish a movement.The therapist should be familiar with possible substitutions and be vigilant in detecting them.For thumb IP flexion a quick contraction and release of the extensor pollicis longus may cause apparent flexion of the IP.If the FPL is contracting enough to cause visible IP joint flexion,the contraction should be palpable.Client effort is an important factor in manual muscle testing,but lack of effort is not a likely cause in this instance because there is visible IP joint flexion.It is not possible for the flexor pollicis brevis to flex the thumb IP joint because it inserts proximal to the distal phalanx.

Question 3

An OT practitioner is screening a client's wrist extension strength.The client is able to actively extend the wrist partially against gravity.Because of a joint limitation,the client's forearm cannot be placed in neutral rotation.What is the appropriate muscle grade?

A) 0
B) 1
C) 2
D) 3

Answer 3

C
In this situation the therapist must use clinical judgment and modify the grading.Even though testing could not be done in the gravity-minimized plane,partial motion against gravity would be graded as 2.Grades 0 and 1 are not appropriate because the client has more than a trace contraction.Grade 3 is not appropriate because the client could not move through complete motion against gravity.

Question 4

An OT practitioner is testing a client's shoulder strength.The client is able to actively abduct to 90 degrees against gravity.What should the therapist do next?

A) Apply resistance.
B) Reposition the client to test in the gravity-eliminated plane.
C) Assist the client into full abduction and then apply resistance.
D) Abduct the shoulder passively to assess available range of motion.

Question 5

An OT is performing manual muscle testing on a client's shoulders.Initial screening found all muscles were below a grade of 3-.Which tests can be performed with the client seated?

A) Flexion, abduction, internal rotation, external rotation
B) Internal rotation, external rotation, horizontal adduction, horizontal abduction
C) Horizontal adduction, horizontal abduction, extension, abduction
D) External rotation, internal rotation, flexion, horizontal abduction