How is manual muscle testing used in the evaluation of cervical radiculopathy?

Updated: Oct 08, 2018
  • Author: Gerard A Malanga, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Manual muscle testing is an important aspect of determining an affected nerve root level on physical examination. Perform manual muscle testing to detect subtle weakness in a myotomal distribution.

Place the limb of the affected side in the antigravity position and apply resistance proximal to the next distal joint. For example, to test the extensor carpi ulnaris muscle, have the patient's forearm in full pronation and resting on a table or supported. The patient is then instructed to extend the hand and deviate it toward the ulnar side, while the examiner applies resistance against the dorsum of the fifth metacarpal bone. Muscle strength is then graded on a scale of 0 to 5, as follows:

  • 0 – No muscle contraction

  • 1 – Muscle contracts but is not able to move the joint/limb

  • 2 – Muscle is able to move the joint/limb, but not against gravity

  • 3 – Muscle is able to move the joint/limb against gravity, but not through a full ROM

  • 4 – Muscle is able to move the joint/limb through a full ROM, but the strength against resistance is not equal to the opposite limb (if normal)

  • 5 – Muscle strength is normal (equal to the opposite, normal limb)

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