Grading of muscle power
Grading of muscle power:
Grade 0- complete paralysis
Grade 1 -flicker of contraction present
Grade 2- active movement with gravity eliminated
Grade 3-Active movement against gravity
Grade 4-Active movement against gravity and some resistance described as poor, fair, moderate strength.
Grade 5- Normal power.
Muscles of upper limb:
(1)Abductor pollicis brevis: The patient is asked to abduct his thumb in a plane at right angles to the palmar aspect of the index finger. The muscle can be seen and felt to contract.
(2) Opponens pollicis: Ask the person to touch the tip of his little finger with the point of his thumb against resistance
(3) First dorsal interosseous: Ask the person to abduct his index finger against resistance.
(4) lnterossei and lumbricals: Test the patient’s ability to flex his metacarpophalangeal joints and to extend the distal interphalangeal joints. In ulnar nerve palsy ‘claw hand’ deformity is seen.
(5) Flexors of the fingers: Ask the person to squeeze the examiner’s middle and index fingers. (6) Flexors of the wrist: Ask the person to bring the tip of his fingers to forwards the front of the forearm.
(7) Extensors of the wrist: Ask the person to make a fist and then try to forcibly flex the wrist against his effort to extend the wrist. In radial nerve palsy, wrist drop occurs.
(8) Brachioradialis: Place the forearm midway between prone and supine position. Then ask the person to flex the forearm at the elbow joint against resistance.
(9) Biceps: Ask the person to flex the forearm at the elbow joint against resistance in the supine position. (10) Triceps: Ask the person to straighten his forearm against resistance.
(11) Supraspinatus: Ask the person to lift his arm laterally. The first 300 of this movement is carried out by the supraspinatus. The remaining 600 is produced by the deltoid.
(12) Deltoid: The anterior and posterior fibres help to draw the abducted arm forwards and back wards respectively.
(13)lnfraspinatus: The patient isasked to hold hiselbowfirmlyto hissidewiththeforearm flexed atrightangle. He is then asked to rotate the limb outwards against the examiner’s resistance. The elbow is held against the side throughout.
(14) Pectoralis: Ask the person to stretch out his arms forwards and then to clap his hands against resistance. (15) Serratus anterior: When this muscle is paralysed the scapula is ‘Winged’, the vertebral border projects out. Pushing forwards with the hands against a wall can also bring out this deformity:
(16) Latissimus dorsi - The person is asked to clasp his hands behind his back, while the examiner standing behind the patient offers passive resistance to the downward and backward movement.
Muscles of trunk:
(1) Muscles of abdomen: Weakness of abdomen is shown by the patient’s inability to sit up from the supine position without the aid of his hands.
Beevor’s sign: paralysis of a portion of the anterior abdominal wall can be detected by displacement of umbilicus when the patient attempts to lift up his head from the pillow against resistance. When the lower segment is paralysed the umbilicus moves upwards, and when the upper segment is affected the umbilicus is pulled downwards. It helps in localizing the level of spinal cord lesion.
(2) Erector spinae and muscles of the back - The person lies down in the prone position and he raises his head by extending the neck and back.
a) Upper part tested by asking him to shrug his shoulders against resistance.
b) Lower part tested by asking him to approximate the shoulder blades.
(4) Diaphragm: In paralysis paradoxical movement is seen i.e. when the patient coughs or sniffs the diaphragm descends (instead of ascending)
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