Occupational Therapy Manual for the Evaluation of Range of Motion and Muscle Strength [1st edition] ( PDFDrive )

Digit: flexor digitorum profundus Isolated Manual Muscle Testing ■ 183 Origin: Body of the ulna Insertion: Through the insertions of the flexor digitorum superficialis onto the distal phalanx of digits 2–5 Innervation: Ulnar nerve (digits 4 and 5), Median nerve (digits 2 and 3) Action: Flexion of the digit DIP joint Figure 3-5-18 Flexor digitorum profundus

184 ■ Chapter 3 Figure 3-5-19 Start position for flexor digitorum profundus. Figure 3-5-20 End position for flexor digitorum profundus. Normal, Good, Fair Motion—client moves the testing extremity in the Client Position: Starting—client is sitting with direction of DIP flexion. the testing extremity placed on a table in forearm supination and digit extension (Figure 3-5-19). Therapist Position: Stabilize at the middle pha- lanx to avoid compensation. No resistance is Motion—client moves the testing extremity in the applied when testing in the gravity-eliminated direction of DIP flexion with MCPs and PIPs position. remaining in extension (Figure 3-5-20). Trace Therapist Position: Stabilize at the middle pha- The flexor digitorum profundus tendon can be pal- lanx to avoid compensation. Resistance is applied pated over the middle phalanges of the digits, at the distal phalanx when testing Normal or palmar surface. Good strengths. No resistance is applied when testing Fair strength. Poor Client Position: Starting—client is sitting with the testing extremity placed on a table in forearm neutral rotation and digit extension.

Digit: flexor digiti minimi Isolated Manual Muscle Testing ■ 185 Origin: Hook of hamate Insertion: Base of the fifth digit proximal pha- lanx, ulnar side Innervation: Ulnar nerve Action: Fifth digit MCP flexion Figure 3-5-21 Flexor digiti minimi

186 ■ Chapter 3 Figure 3-5-22 Start position for flexor digiti minimi. Figure 3-5-23 End position for flexor digiti minimi. Normal, Good, Fair Motion—client moves the fifth digit in the direc- Client Position: Starting—client is sitting with tion of MCP flexion. the testing extremity placed on the table with the forearm in supination (Figure 3-5-22). Therapist Position: Stabilize at the fifth metacarpal. No resistance is applied when testing Motion—client moves the fifth digit in the direc- in the gravity-eliminated position. tion of MCP flexion (Figure 3-5-23). Trace Therapist Position: Stabilize at the fifth The flexor digiti minimi tendon is palpated over metacarpal. Resistance is applied at the fifth proxi- the proximal phalanx of the fifth digit, palmar mal phalanx in the direction of MCP extension surface. when testing Normal or Good strengths. No resistance is applied when testing Fair strength. Poor Client Position: Starting—client is sitting with the testing extremity placed on the table with the forearm in neutral.

Digit: extensor digitorum Isolated Manual Muscle Testing ■ 187 Origin: Lateral epicondyle Insertion: Base of the middle and distal phalanges digits 2–5 Innervation: Radial nerve Action: Extension of the MCP of digits 2–5 Figure 3-5-24 Extensor digitorum

188 ■ Chapter 3 Figure 3-5-25 Start position for extensor digitorum. Figure 3-5-26 End position for extensor digitorum. Normal, Good, Fair Poor Client Position: Starting—client is sitting with Client Position: Starting—client is sitting with the testing extremity placed on a table edge (digits the testing extremity placed on a table in forearm off the table) in forearm pronation and digit flex- neutral rotation and digit flexion. ion (Figure 3-5-25). Motion—client moves the testing extremity in the Motion—client moves the testing extremity in the direction of digit extension. direction of digit MCP extension with PIP and DIP flexed (Figure 3-5-26). Therapist Position: Stabilize at the metacarpals to avoid compensation. No resistance is applied Therapist Position: Stabilize at the metacarpals to when testing in the gravity-eliminated position. avoid compensation. Resistance is applied at the proximal phalanges in the direction of digit MCP Trace flexion when testing Normal or Good strengths. The extensor digitorum tendon is palpated over the No resistance is applied when testing Fair metacarpal heads, dorsal surface. strength.

Digit: extensor indicis Isolated Manual Muscle Testing ■ 189 Origin: Posterior ulna Insertion: Tendon of extensor digitorum, dorsal aponeurosis Innervation: Radial nerve Action: Extension of the MCP, PIP, DIP of the second digit Normal, Good, Fair & Poor The testing positions are the same as for the extensor digitorum. Trace The extensor indicis tendon is palpated over the second digit metacarpal head, dorsal surface. Figure 3-5-27 Extensor indicis

190 ■ Chapter 3 Digit: extensor digiti minimi Origin: Lateral epicondyle Insertion: Tendon of extensor digitorum fifth digit Innervation: Radial nerve Action: Extension of the MCP, PIP, DIP of the fifth digit Normal, Good, Fair, & Poor The testing positions are the same as for the extensor digitorum. Trace The extensor digiti minimi tendon is palpated over the fifth digit metacarpal head, dorsal surface. Figure 3-5-28 Extensor digiti minimi

Digit: lumbricals Isolated Manual Muscle Testing ■ 191 4 Origin: First—FDP second digit tendon 23 Second—FDP third digit tendon 1 Third—FDP third and fourth digit tendons Fourth—FDP fourth and fifth digit tendons Insertion: Radial side dorsal aponeurosis Innervation: First and second—median nerve, third and fourth—ulnar nerve Action: MCP flexion and PIP/DIP extension Figure 3-5-29 Lumbricals

192 ■ Chapter 3 Figure 3-5-30 Start position for the lumbricals. Figure 3-5-31 End position for the lumbricals. Normal, Good, Fair Poor Client Position: Starting—client is sitting with Client Position: Starting—client is sitting with the testing extremity placed on a table in forearm the testing extremity placed on a table in forearm supination and MCP extension/ PIP and DIP neutral rotation, and MCP extension/ PIP and flexion (Figure 3-5-30). DIP flexion. Motion—client moves the testing extremity in the Motion—client moves the testing extremity in the direction of MCP flexion while PIP and DIP direction of MCP flexion while PIP and DIP enter extension (Figure 3-5-31). enter extension. Therapist Position: Stabilize at the metacarpals to Therapist Position: Stabilize at the metacarpals to avoid compensation. Resistance is applied at the avoid compensation. No resistance is applied proximal phalanx in the direction of MCP exten- when testing in the gravity-eliminated position. sion when testing Normal or Good strengths. No resistance is applied when testing Fair strength. Trace The lumbricals are too deep for palpation.

Digit: palmar interossei Isolated Manual Muscle Testing ■ 193 1 4 Origin: First interosseous—ulnar surface of 2 3 second metacarpal Second interossseous—ulnar surface of second metacarpal Third interosseous—radial surface of fourth metacarpal Fourth interosseous—radial surface of fifth metacarpal Insertion: First interosseous—base of the first digit proximal phalanx, ulnar side Second interosseous—base of the sec- ond digit proximal phalanx, ulnar side Third interosseous—base of the fourth digit proximal phalanx, radial side Fourth interosseous—base of the fifth digit proximal phalanx, radial side Innervation: Ulnar nerve Action: Digit MCP adduction Figure 3-5-32 Palmar interossei

194 ■ Chapter 3 Figure 3-5-33 Start position for palmar interosseous. Figure 3-5-34 End position for palmar interosseous. Normal, Good, Fair digits when testing Normal or Good strengths. Client Position: Starting—client is sitting with No resistance is applied when testing Fair the testing extremity on a table in forearm supina- strength. The third digit does not adduct. tion and MCP abduction (Figure 3-5-33). Poor Motion—client moves the testing extremity in the The client and therapist positions are the same direction of MCP adduction (Figure 3-5-34). and no resistance is applied. Therapist Position: Stabilize at the metacarpals to Trace avoid compensation. Resistance is applied at the The interossei are too deep for palpation. proximal phalanx on the ulnar side of the second digit, and the radial side of the fourth and fifth

Digit: dorsal interossei Isolated Manual Muscle Testing ■ 195 41 Origin: Each interosseous has its origin on both 32 of the adjacent metacarpals Insertion: First interosseous—base of the second digit proximal phalanx, radial side Second interosseous—base of the third digit proximal phalanx, radial side Third interosseous—base of the third digit proximal phalanx, ulnar side Fourth interosseous—base of the fourth digit proximal phalanx, ulnar side Innervation: Ulnar nerve Action: Digit MCP abduction Figure 3-5-35 Dorsal interosse

196 ■ Chapter 3 Figure 3-5-36 Start position for dorsal interosseous. Figure 3-5-37 End position for dorsal interosseous. Normal, Good, Fair digit as it abducts in two directions, the ulnar side Client Position: Starting—client is sitting with of the fourth and fifth digits when testing Normal the testing extremity on a table in forearm prona- or Good strengths. No resistance is applied when tion and MCP adduction (Figure 3-5-36). testing Fair strength. Motion—client moves the testing extremity in the Poor direction of MCP abduction (Figure 3-5-37). The client and therapist positions are the same and no resistance is applied. Therapist Position: Stabilize at the metacarpals to avoid compensation. Resistance is applied at the Trace proximal phalanx on the radial side of the second The interossei are too deep for palpation. digit, both the radial and ulnar side of the third

Isolated Manual Muscle Testing ■ 197 Digit: abductor digiti minimi (can be tested with dorsal interossei) Origin: Pisiform Insertion: Base of the fifth digit proximal pha- lanx, ulnar side Innervation: Ulnar nerve Action: MCP abduction of the fifth digit Normal, Good, Fair, & Poor The testing positions are the same as for the dorsal interosseous. Trace The abductor digiti minimi is palpated on the lat- eral aspect of the fifth digit metacarpal. Figure 3-5-38 Abductor digiti minimi

198 ■ Chapter 3 Digit: opponens digiti minimi Origin: Hamate Insertion: Fifth digit metacarpal, ulnar side Innervation: Ulnar nerve Action: Fifth digit opposition Figure 3-5-39 Opponens digiti minimi

Isolated Manual Muscle Testing ■ 199 Figure 3-5-40 Start position for opponens digiti minimi. Figure 3-5-41 End position for opponens digiti minimi. Normal, Good, Fair metacarpal in the opposite direction of opposition Client Position: Starting—client is sitting with (extension and abduction) when testing Normal the testing extremity on a table in forearm supina- or Good strengths. No resistance is applied when tion (Figure 3-5-40). testing Fair strength. Motion—Client moves the testing extremity in Poor the direction of opposition (flexion and adduc- The client and therapist positions are the same tion) (Figure 3-5-41). and no resistance is applied. A grade of poor is given when the client is unable to move through Therapist Position: Stabilize at the first the complete ROM. metacarpal. Resistance is applied at the fifth Trace Opponens digiti minimi is palpated on the hypothenar eminence.

200 ■ Chapter 3 Thumb: opponens pollicis Origin: Trapezium Insertion: First digit metacarpal, radial side Innervation: Median nerve Action: First digit opposition Figure 3-5-42 Opponens pollicis

Isolated Manual Muscle Testing ■ 201 Figure 3-5-43 Start position for opponens pollicis. Figure 3-5-44 End position for opponens pollicis. Normal, Good, Fair strengths. No resistance is applied when testing Client Position: Starting—client is sitting with Fair strength. the testing extremity placed on the table in fore- arm supination (Figure 3-5-43). Poor The testing positions are the same as above. A Motion—client moves the testing extremity in the grade of poor is given when the client can move direction of thumb opposition (CMC flexion and through only a small portion of the range in this abduction) (Figure 3-5-44). position. Therapist Position: Stabilize at the fifth Trace metacarpal to avoid compensation. Resistance is Opponens pollicis is palpated in the thenar emi- applied at the first metacarpal in the opposite nence, lateral to the abductor pollicis. direction from opposition (CMC extension and adduction) when testing Normal or Good

202 ■ Chapter 3 Thumb: flexor pollicis brevis Origin: Trapezium, trapezoid Insertion: Base of the first digit proximal phalanx Innervation: Median and ulnar nerves Action: Thumb MCP flexion, and assist with CMC flexion Figure 3-5-45 Flexor pollicis brevis

Isolated Manual Muscle Testing ■ 203 Figure 3-5-46 Start position for flexor pollicis brevis. Figure 3-5-47 End position for flexor pollicis brevis. Normal, Good, Fair Good strengths. No resistance is applied when Client Position: Starting—client is sitting with testing Fair strength. the testing extremity placed on the table in fore- arm supination (Figure 3-5-46). Poor The testing positions are the same as above. A Motion—client moves the testing extremity in the grade of poor is given when the client can move direction of thumb MCP flexion (Figure 3-5-47). the testing extremity through only a small portion of the range in this position. Therapist Position: Stabilize at the metacarpal to eliminate any compensation. Resistance is applied Trace at the proximal phalanx of the thumb in the direc- Flexor pollicis brevis is palpated over the first meta- tion of MCP extension when testing Normal or carpal, palmar surface.

204 ■ Chapter 3 Thumb: flexor pollicis longus Origin: Anterior radius Insertion: Base of the first digit distal phalanx Innervation: Median nerve Action: Thumb IP flexion Figure 3-5-48 Flexor pollicis longus

Isolated Manual Muscle Testing ■ 205 Figure 3-5-49 Start position for flexor pollicis longus. Figure 3-5-50 End position for flexor pollicis longus. Normal, Good, Fair Good strengths. No resistance is applied when Client Position: Starting—client is sitting with testing Fair strength. the testing extremity placed on the table in fore- arm supination (Figure 3-5-49). Poor The testing positions are the same as above. A Motion—client moves the testing extremity in the grade of poor is given when the client can move direction of thumb IP flexion while maintaining the testing extremity through only a small portion thumb MCP extension (Figure 3-5-50). of the range in this position. Therapist Position: Stabilize at the proximal pha- Trace lanx to eliminate any compensation. Resistance is Flexor pollicis brevis tendon is palpated over the applied at the distal phalanx of the thumb in the first proximal phalanx, palmar surface. direction of IP extension when testing Normal or

206 ■ Chapter 3 Thumb: abductor pollicis brevis Origin: Scaphoid, trapezium Insertion: Base of the first digit proximal phalanx, radial side Innervation: Median nerve Action: Thumb CMC abduction Figure 3-5-51 Abductor pollicis brevis

Isolated Manual Muscle Testing ■ 207 Figure 3-5-52 Start position for abductor pollicis brevis. Figure 3-5-53 End position for abductor pollicis brevis. Normal, Good, Fair Good strengths. No resistance is applied when Client Position: Starting—client is sitting with testing Fair strength. the testing extremity placed on the table in fore- arm supination (Figure 3-5-52). Poor The testing positions are the same as above. A Motion—client moves the testing extremity in grade of poor is given when the client can move the direction of thumb CMC abduction the testing extremity through only a small portion (Figure 3-5-53). of the range in this position. Therapist Position: Stabilize the hand to elimi- Trace nate any compensation. Resistance is applied at Abductor pollicis brevis is palpated over the first the proximal phalanx of the thumb in the direc- digit metacarpal, lateral surface. tion of CMC adduction when testing Normal or

208 ■ Chapter 3 Thumb: abductor pollicis longus Origin: Posterior, middle radius and ulna Insertion: Base of the first digit metacarpal Innervation: Radial nerve Action: Thumb CMC abduction Figure 3-5-54 Abductor pollicis longus

Isolated Manual Muscle Testing ■ 209 Figure 3-5-55 Start position for abductor pollicis longus. Figure 3-5-56 End position for abductor pollicis longus. Normal, Good, Fair strengths. No resistance is applied when testing Client Position: Starting—client is sitting with Fair strength. the testing extremity placed on the table with the forearm in neutral (Figure 3-5-55). Poor The testing positions are the same as above. A Motion—client moves the testing extremity in the grade of poor is given when the client can move direction of thumb CMC abduction (Figure 3-5- the testing extremity through only a small portion 56). of the range in this position. Therapist Position: Stabilize at the wrist to elimi- Trace nate any compensation. Resistance is applied at Abductor pollicis longus tendon is palpated at the the thumb metacarpal in the direction of CMC base of the first digit metacarpal, lateral surface. adduction when testing Normal or Good

210 ■ Chapter 3 Thumb: adductor pollicis Origin: Third digit metacarpal, capitate, traezoid Insertion: Base of the first digit proximal phalanx, ulnar side Innervation: Ulnar nerve Action: Thumb CMC adduction Figure 3-5-57 Adductor pollicis

Isolated Manual Muscle Testing ■ 211 Figure 3-5-58 Start position for adductor pollicis. Figure 3-5-59 End position for adductor pollicis. Normal, Good, Fair tion of CMC abduction when testing Normal or Client Position: Starting—client is sitting with Good strengths. No resistance is applied when the testing extremity placed on the table in fore- testing Fair strength. arm supination. Thumb is placed in CMC abduc- tion (Figure 3-5-58). Poor The testing positions are the same as above. A Motion—client moves the testing extremity in grade of poor is given when the client can move the direction of thumb CMC adduction the testing extremity through only a small portion (Figure 3-5-59). of the range in this position. Therapist Position: Stabilize at the wrist to elimi- Trace nate any compensation. Resistance is applied at Adductor pollicis is palpated between the first and the proximal phalanx of the thumb in the direc- second metacarpals, palmar surface.

212 ■ Chapter 3 Thumb: extensor pollicis longus Origin: Middle, posterior ulna Insertion: Base of the first digit distal phalanx, dorsal surface Innervation: Radial nerve Action: Thumb IP extension Figure 3-5-60 Extensor pollicis longus

Isolated Manual Muscle Testing ■ 213 Figure 3-5-61 Start position for extensor pollicis longus. Figure 3-5-62 End position for extensor pollicis longus. Normal, Good, Fair testing Normal or Good strengths. No resistance Client Position: Starting—client is sitting with is applied when testing Fair strength. the testing extremity placed on the table with the forearm in neutral and thumb IP flexed (Figure 3- Poor 5-61). The testing positions are the same as above. A grade of poor is given when the client can move Motion—client moves the testing extremity in the the testing extremity through only a small portion direction of thumb IP extension (Figure 3-5-62). of the range in this position. Therapist Position: Stabilize at the thumb proxi- Trace mal phalanx to eliminate any compensation. Extensor pollicis longus tendon is palpated over the Resistance is applied at the distal phalanx of the first proximal phalanx, dorsal surface. thumb in the direction of thumb IP flexion when

214 ■ Chapter 3 Thumb: extensor pollicis brevis Origin: Posterior radius and ulna Insertion: Base of the first digit proximal phalanx, dorsal surface Innervation: Radial nerve Action: MCP and assists CMC extension Figure 3-5-63 Extensor pollicis brevis

Isolated Manual Muscle Testing ■ 215 Figure 3-5-64 Start position for extensor pollicis brevis. Figure 3-5-65 End position for extensor pollicis brevis. Normal, Good, Fair when testing Normal or Good strengths. No Client Position: Starting—client is sitting with resistance is applied when testing Fair strength. the testing extremity placed on the table with the forearm in neutral and thumb in slight MCP flex- Poor ion (Figure 3-5-64). The testing positions are the same as above. A grade of poor is given when the client can move Motion—client moves the testing extremity in the testing extremity through only a small portion the direction of thumb MCP extension of the range in this position. (Figure 3-5-65). Trace Therapist Position: Stabilize at the thumb Extensor pollicis brevis tendon is palpated at the metacarpal to eliminate any compensation. base of the first metacarpal, dorsal surface. Resistance is applied at the proximal phalanx of the thumb in the direction of thumb MCP flexion

216 ■ Chapter 3 SECTION 3-6: Isolated Manual Muscle Testing of the Hip and Knee Hip: iliacus and psoas major (Iliacus and psoas major may be referred to as the iliopsoas.) (tested together) Figure 3-6-1 Iliacus Figure 3-6-2 Psoas major Iliacus Psoas major Origin: Superior 2/3 of ilium, anterior iliac crest Origin: Transverse processes of L1–L5, vertebral Insertion: Lesser trochanter of femur bodies of T12–L5 Innervation: Femoral nerve Insertion: Lesser trochanter of femur Action: Hip flexion Innervation: Lumbar plexus L2–L4 Action: Hip flexion

Isolated Manual Muscle Testing ■ 217 Figure 3-6-3 Start position for iliacus and psoas major (iliopsoas). Figure 3-6-4 End position for iliacus and psoas major (iliopsoas). Normal, Good, Fair Poor Client Position: Starting—client is sitting with Client Position: Starting—client is lying on non- the testing extremity in 90 degrees of hip flexion, test side. Client holds nontest extremity in maxi- neutral hip rotation, and the lower leg over the mal hip and knee flexion. The testing extremity is edge of the testing surface. The knee is flexed and in hip extension and knee flexion. the foot is unsupported (Figure 3-6-3). Motion—client moves the testing extremity into Motion—client moves the testing extremity in the maximal hip flexion. direction of hip flexion while allowing the knee to follow into flexion (Figure 3-6-4). Therapist Position: While standing behind the client, stabilize the side-lying position and the Therapist Position: Stabilize at the contralateral pelvis. Therapist supports the testing extremity to iliac crest of the pelvis. Resistance is applied over eliminate gravity without assisting the motion. the anterior aspect of the thigh proximal to the No resistance is applied in the gravity-eliminated knee in the direction of hip extension when test- position. ing Normal or Good strengths. No resistance is applied when testing Fair strength. Trace The iliopsoas cannot be palpated.

218 ■ Chapter 3 Hip: gluteus maximus Origin: Lateral surface of the ilium at posterior gluteal line, posterior surface of sacrum, posterior coccyx, and sacrotuberous ligaments Insertion: Iliotibial tract of fascia latae and gluteal tuberosity of femur Innervation: Inferior gluteal nerve Action: Hip extension Figure 3-6-5 Gluteus maximus

Isolated Manual Muscle Testing ■ 219 Figure 3-6-6 Start position for gluteus maximus. Figure 3-6-7 End position for gluteus maximus. Normal, Good, Fair maximal hip and knee flexion. Testing hip is in Client Position: Starting—client is prone with neutral and knee is flexed. both legs extended and resting on testing surface. Client is asked to hold onto edge of testing surface Motion—client moves the testing extremity into as resistance is applied (Figure 3-6-6). maximal hip extension. Motion—client moves the testing extremity in the Therapist Position: While standing behind the direction of hip extension while knee remains client, stabilize the side-lying position and the flexed (Figure 3-6-7). pelvis. Therapist supports the testing extremity to eliminate gravity without assisting the motion. Therapist Position: Stabilize at the pelvis. No resistance is applied in the gravity-eliminated Resistance is applied over the posterior aspect of position. the thigh proximal to the knee in the direction of flexion when testing Normal or Good strengths. Trace No resistance is applied when testing Fair The gluteus maximus is palpated medial to its strength. insertion on the gluteal tuberosity. Poor Client Position: Starting—client is lying on non- test side. The client holds the nontest extremity in Alternate Position If hip flexors are tight, client may stand with trunk flexed and trunk in prone position, resting on testing surface.

220 ■ Chapter 3 Hip: sartorius Origin: Anterior superior iliac spine (ASIS) Insertion: Proximal aspect of the medial surface of tibia Innervation: Femoral nerve Action: Hip flexion, hip abduction, and hip exter- nal rotation Figure 3-6-8 Sartorius

Isolated Manual Muscle Testing ■ 221 Figure 3-6-9 Start position for sartorius. Figure 3-6-10 End position for sartorius. Normal, Good, Fair Poor Client Position: Starting—client is sitting with Client Position: Starting—client is supine with knee flexed and over edge of testing surface both legs extended and resting on testing surface. (Figure 3-6-9). Motion—client moves the testing extremity in the Motion—client moves testing extremity into max- direction of hip flexion, abduction, and external imal hip flexion, abduction, and external rotation rotation while knee flexes. while the knee remains flexed (Figure 3-6-10). Therapist Position: Therapist supports the test- Therapist Position: Resistance is applied over the ing extremity to eliminate gravity without assist- anterolateral aspect of the thigh proximal to the ing the motion. No resistance is applied in the knee and the posterior aspect of the lower leg gravity-eliminated position. proximal to the ankle in the direction of hip extension, adduction, and internal rotation when Trace testing Normal or Good strengths. No resistance The sartorius is palpated on the anterior aspect of is applied when testing Fair strength. the thigh medial to tensor fascia latae, above the medial aspect of the knee.

222 ■ Chapter 3 Hip: gluteus medius and gluteus minimus (tested together) Figure 3-6-11 Gluteus medius Figure 3-6-12 Gluteus minimus Gluteus medius Gluteus minimus Origin: Lateral surface of the ilium, anterior and Origin: Lateral surface of the ilium between the posterior to the gluteal line anterior and inferior gluteal lines Insertion: Greater trochanter of femur Insertion: Greater trochanter of femur Innervation: Superior gluteal nerve Innervation: Superior gluteal nerve Action: Hip abduction and hip internal rotation Action: Hip abduction and internal rotation

Isolated Manual Muscle Testing ■ 223 Figure 3-6-13 Start position for gluteus medius and gluteus Figure 3-6-14 End position for gluteus medius and gluteus minimus. minimus. Normal, Good, Fair Poor Client Position: Starting—client is lying on non- Client Position: Starting—client is supine with test side. Client holds nontest extremity in maxi- hip and knees extended resting on testing surface. mal hip and knee flexion. Testing extremity is in slight hip extension, neutral rotation, and knee Motion—client moves the testing extremity into extension. The pelvis is rotated slightly forward maximal hip abduction. (Figure 3-6-13). Therapist Position: Stabilize the pelvis on the Motion—client moves the testing extremity in the contralateral side. Therapist supports the testing direction of hip abduction (Figure 3-6-14). extremity to eliminate gravity without assisting the motion. No resistance is applied in the gravity- Therapist Position: Stabilize at the pelvis. eliminated position. Resistance is applied over the lateral aspect of the thigh proximal to the knee in the direction of Trace adduction when testing Normal or Good The gluteus medius is palpated distal to the lateral strengths. No resistance is applied when testing lip of the iliac crest or proximal to the greater Fair strength. trochanter of the femur. The gluteus minumus is too deep to be palpated.

224 ■ Chapter 3 Hip: tensor fascia latae Origin: Iliac crest posterior to the ASIS Insertion: Iliotibial tract Innervation: Superior gluteal nerve Action: Hip flexion, hip abduction, and hip inter- nal rotation Figure 3-6-15 Tensor fascia latae

Isolated Manual Muscle Testing ■ 225 Figure 3-6-16 Start position for tensor fascia latae. Figure 3-6-17 End position for tensor fascia latae. Normal, Good, Fair Poor Client Position: Starting—client is lying on non- Client Position: Starting—client is supine with test side. Client holds nontest extremity in maxi- hip and knees extended resting on testing surface. mal hip and knee flexion. Testing extremity is in 45 degrees of hip flexion, and in internal rotation Motion—client moves the testing extremity into and knee extension. The pelvis is rolled backward maximal hip abduction and slight hip flexion. (Figure 3-6-16). Therapist Position: Stabilize the pelvis. Therapist Motion—client moves the testing extremity in the supports the testing extremity to eliminate gravity direction of hip abduction while maintaining hip without assisting the motion. No resistance is flexion (Figure 3-6-17). applied in the gravity-eliminated position. Therapist Position: Stabilize at the pelvis. Trace Resistance is applied on the anterolateral aspect of The tensor fascia latae is palpated lateral to the the thigh proximal to the knee in the direction of upper portion of the sartorius or distal to the hip adduction and extension when testing Normal greater trochanter on the iliotibial band. or Good strengths. No resistance is applied when testing Fair strength.

226 ■ Chapter 3 Hip: pectineus, adductor magnus, gracilis, adductor longus, and adductor brevis (tested together) Figure 3-6-18 Pectineus Figure 3-6-19 Adductor magnus Pectineus Adductor magnus Origin: Superior ramus of the pubis Origin: Inferior pubic ramus, ramus of the Insertion: Between the lesser trochanter and the ischium, and ischial tuberosity linea aspera of the posterior femur Insertion: Linea aspera and the adductor tubercle Innervation: Femoral and obturator nerves on the medial condyle of the femur Action: Hip adduction Innervation: Obturator and sciatic nerves Action: Hip adduction

Isolated Manual Muscle Testing ■ 227 Figure 3-6-20 Gracilis Figure 3-6-21 Adductor longus Gracilis Adductor longus Origin: Inferior ramus of the pubis and ischium Origin: Pubic tubercle/anterior crest of pubis Insertion: Proximal aspect of the tibia distal to Insertion: Medial lip of linea aspera of femur the medial condyle Innervation: Obturator nerve Innervation: Obturator nerve Action: Hip adduction Action: Hip adduction

228 ■ Chapter 3 Adductor brevis Origin: Body and inferior ramus of the pubis Insertion: Between the lesser trochanter and linea aspera of the femur Innervation: Obturator nerve Action: Hip adduction Figure 3-6-22 Adductor brevis

Isolated Manual Muscle Testing ■ 229 Figure 3-6-23 Start position for pectineus, adductor magnus, gra- Figure 3-6-24 End position for pectineus, adductor magnus, gra- cilis, adductor longus, and adductor brevis. cilis, adductor longus, and adductor brevis. Normal, Good, Fair Poor Client Position: Starting—client is lying on side Client Position: Starting—client is supine with on testing extremity with hip in neutral and knee hip in abduction and knee extended on testing extended on testing surface. Nontest extremity is surface. in abduction and knee is extended (Figure 3-6-23). Motion—client moves the testing extremity into Motion—client moves the testing extremity in the maximal hip adduction. direction of hip adduction toward the nontest extremity (Figure 3-6-24). Therapist Position: Stabilize the pelvis. Therapist supports the testing extremity to eliminate gravity Therapist Position: Support the nontest extrem- without assisting the motion. No resistance is ity in hip abduction. Resistance is applied over the applied in the gravity-eliminated position. medial aspect of the thigh proximal to the knee in the direction of abduction when testing Normal Trace or Good strengths. No resistance is applied when The adductors are palpated as a group on the testing Fair strength. medial and proximal aspect of the thigh.

230 ■ Chapter 3 Hip: piriformis, quadratus femoris, obturator internis, obturator externus, gemellus superior, and gemellus inferior (tested together) Figure 3-6-25 Piriformis Figure 3-6-26 Quadratus femoris Piriformis Quadratus femoris Origin: Anterior sacrum and sciatic notch of Origin: Lateral border of ischial tuberosity ilium Insertion: Posterior surface of the femur between Insertion: Superior border of the greater the greater and lesser trochanters trochanter of the femur Innervation: Sacral plexus Innervation: Sacral plexus Action: Hip external rotation Action: Hip external rotation

Isolated Manual Muscle Testing ■ 231 Figure 3-6-27 Obturator internis Figure 3-6-28 Obturator externus Obturator internis Obturator externus Origin: Obturator membrane, margin of obtura- Origin: Obturator membrane: bone around fora- tor foramin, and internal surface of the pelvis men on external surface of pelvis Insertion: Medial surface of the greater trochanter Insertion: Trochanteric fossa of the femur proximal to the trochanter fossa Innervation: Obturator nerve Innervation: Sacral plexus Action: Hip external rotation Action: Hip external rotation

232 ■ Chapter 3 Figure 3-6-29 Gemellus superior Figure 3-6-30 Gemellus inferior Gemellus superior Gemellus inferior Origin: Dorsal aspect of the spine of ischium Origin: Proximal aspect of the ischial tuberosity Insertion: Greater trochanter of the femur Insertion: Greater trochanter of the femur Innervation: Sacral plexus Innervation: Obturator nerve Action: Hip external rotation Action: Hip external rotation