OnExam

Assessing muscle strength is part of a complete neurologic exam.

Performing the Test

  • Test strength by asking the patient to move actively against resistance
  • Grade strength out of 5:
    • 5 - Normal strength
    • 4 - Movement against gravity ad some resistance
    • 3 - Movement against gravity
    • 2 - Movement with gravity eliminated
    • 1 - Muscle flicker/trace of contraction
    • 0 - No contraction detected

  • Upper Extremity Strength Testing
    • Elbow flexion - biceps (musculocutaneous n., C5-C6)
    • Elbow extension - triceps (radial n., C7-C8)
    • Wrist extension - extensor carpi radialis longus & brevis (radial n., C6)
    • Finger abduction (ulnar n., C8)
    • Thumb opposition (median n., C8-T1)

  • Lower Extremity Strength Testing
    • Hip flexion - illiopsoas (femoral n., L2-L3)
    • Hip extension - gluteus maximus (inferior gluteal n., S1)
    • Hip abductors - gluteus medius & minimus (superior gluteal n., L5)
    • Hip adduction - adductors (obturator n., L3)
    • Knee extension - quadriceps (femoral n., L3-L4)
    • Knee flexion - hamstrings (sciatic n., L5- S1)
    • Dorsiflexion – tibialis anterior (deep peroneal n., L5)
    • Plantarflexion – gastrocnemius & soleus (tibial n., S1)

References

  1. Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins: 2003
  2. LeBlond RF, DeGowin RL, Brown DD. Chapter 14. The Neurologic Examination. In: LeBlond RF, DeGowin RL, Brown DD, eds. DeGowin's Diagnostic Examination. 9th ed. New York: McGraw-Hill; 2009.