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

Isolated Manual Muscle Testing ■ 233 Figure 3-6-31 Start position for piriformis, quadratus femoris, Figure 3-6-32 End position for piriformis, quadratus femoris, obturator internis, obturator externus, gemellus superior, and gemellus obturator internis, obturator externus, gemellus superior, and gemellus inferior. inferior. Normal, Good, Fair Poor Client Position: Starting—client is sitting with Client Position: Starting—client is supine with testing hip in 90 degrees of flexion, knee flexed at testing hip in internal rotation and knee edge of testing surface. The midpoint of patella is extension. aligned with the ASIS (Figure 3-6-31). Motion—client moves the testing extremity into Motion—client moves the testing extremity in the maximal hip external rotation. direction of hip external rotation (Figure 3-6-32). Therapist Position: Stabilize the medial aspect of Therapist Position: The stabilizing hand applies the thigh. No resistance is applied in the gravity- counterpressure at the anterolateral aspect of the eliminated position. distal thigh while resistance is applied by the other hand. Resistance is applied over the medial aspect Trace of the lower leg proximal to the ankle in the direc- The external rotators are too deep to palpate. tion of internal rotation when testing Normal or Good strengths. No resistance is applied when testing Fair strength.

234 ■ Chapter 3 Knee: semitendinosus and semimembranosus (medial hamstring) (tested together) Figure 3-6-33 Semitendinosis Figure 3-6-34 Semimembranosis Semitendinosus Semimembranosus Origin: Superior aspect of the ischial tuberosity Origin: Superolateral aspect of the ischial tuberosity Insertion: Proximal aspect of the medial surface of the tibia Insertion: Medial tibial condyle and medial condyle of the femur Innervation: Sciatic nerve (tibial branch) Innervation: Sciatic nerve (tibial branch) Action: Knee flexion and knee internal rotation of tibia during flexion, hip extension when knee is Action: Knee flexion and knee internal rotation of flexed tibia during flexion, hip extension when knee is flexed

Isolated Manual Muscle Testing ■ 235 Figure 3-6-35 Start position for semitendinosis and Figure 3-6-36 End position for semitendinosis and semimembranosis. semimembranosis. Normal, Good, Fair Poor Client Position: Starting—client is prone. The Client Position: Starting—client is lying on non- testing knee is slightly flexed and internally test side. The testing hip and knee are extended. rotated (toes are pointed toward nontest side) (Figure 3-3-35). Motion—client moves the testing extremity into maximal knee flexion. Motion—while maintaining knee internal rota- tion of the tibia, the client flexes the knee in a Therapist Position: Stabilize the thigh. Therapist diagonal motion toward the lateral aspect of the supports the testing extremity to eliminate gravity testing extremity buttocks (Figure 3-3-36). without assisting the motion. No resistance is applied in the gravity-eliminated position. Therapist Position: Stabilize the testing thigh. Resistance is applied proximal to the ankle in the Trace direction of knee extension and external rotation The semitendinosus is palpated proximal to the when testing Normal or Good strengths. No knee joint on the medial aspect of the popliteal resistance is applied when testing Fair strength. fossa. The semimembranosus is palpated proximal to the knee joint on either side of the tendon.

236 ■ Chapter 3 Knee: biceps femoris (lateral hamstring) Origin: Long head—ischial tuberosity. Short head—posterior, distal femur Insertion: Lateral head of the fibula and lateral condyle of the tibia Innervation: Sciatic nerve (tibial and peroneal branches) Action: Knee flexion and knee external rotation of tibia during flexion Figure 3-6-37 Biceps femoris

Isolated Manual Muscle Testing ■ 237 Figure 3-6-38 Start position for biceps femoris. Figure 3-6-39 End position for biceps femoris. Normal, Good, Fair Poor Client Position: Starting—client is prone. The Client Position: Starting—client is lying on non- testing knee is slightly flexed and externally test side. The testing hip and knee are extended. rotated (toes are pointed away from nontest side) (Figure 3-6-38). Motion—client moves the testing extremity into maximal knee flexion. Motion—while maintaining knee external rota- tion of the tibia, the client flexes the knee in a Therapist Position: Stabilize the thigh. Therapist diagonal motion toward the contralateral buttocks supports the testing extremity to eliminate gravity (Figure 3-6-39). without assisting the motion. No resistance is applied in the gravity-eliminated position. Therapist Position: Stabilize the testing thigh. Resistance is applied proximal to the ankle on the Trace posterior aspect of the leg in the direction of knee The biceps femoris is palpated proximal to the extension and internal rotation when testing knee joint on the lateral margin of the popliteal Normal or Good strengths. No resistance is fossa. applied when testing Fair strength.

238 ■ Chapter 3 Knee: rectus femoris, vastus intermedius, vastus lateralis, and vastus medialis (tested together) Figure 3-6-40 Rectus femoris Figure 3-6-41 Vastus intermedius Rectus femoris Vastus intermedius Origin: Straight head—anterior aspect of the Origin: Anterior and lateral surfaces of the anterior inferior iliac spine. Reflected head—ilium femoral shaft above the acetabulum Insertion: Base of the patella and through the patellar ligament to the tibial tuberosity Insertion: Base of the patella and through the Innervation: Femoral nerve patellar ligament to the tibial tuberosity Action: Knee extension Innervation: Femoral nerve Action: Knee extension, hip fexion

Isolated Manual Muscle Testing ■ 239 Figure 3-6-42 Vastus lateralis Figure 3-6-43 Vastus medialis Vastus lateralis Vastus medialis Origin: Anterior femur Origin: Inferior aspect of the intertrochanteric Insertion: Lateral border of the patella and line, medial lip of the linea aspera, proximal aspect through the patellar ligament to the tibial of the supracondylar line, and the intermuscular tuberosity septum Innervation: Femoral nerve Action: Knee extension Insertion: Medial border of the patella and through the patellar ligament to the tibial tuberosity Innervation: Femoral nerve Action: Knee extension

240 ■ Chapter 3 Figure 3-6-44 Start position for rectus femoris, vastus inter- Figure 3-6-45 End position for rectus femoris, vastus inter- medius, vastus lateralis, and vastus medialis. medius, vastus lateralis, and vastus medialis. Normal, Good, Fair Motion—client moves the testing extremity into Client Position: Starting—client is sitting with a maximal knee extension. pad supported under the distal thigh. The testing knee is flexed and lower leg and feet are over edge Therapist Position: Stabilize the thigh. Therapist of testing surface (Figure 3-6-44). supports the testing extremity to eliminate gravity without assisting the motion. No resistance is Motion—the client moves the testing extremity applied in the gravity-eliminated position. into knee extension (no hyperextension) (Figure 3-6-45). Trace The rectus femoris is palpated on the anterior Therapist Position: Stabilize the testing thigh. midthigh. Resistance is applied on the anterior surface of the distal lower extremity in the direction of knee The vastus intermedius is too deep to be palpated. flexion when testing Normal or Good strengths. No resistance is applied when testing Fair The vastus lateralis is palpated on the lateral strength. aspect of the midthigh. Poor The vastus medialis is palpated on the medial Client Position: Starting—client is lying on non- aspect of the thigh. test side. The testing hip is extended and the knee is flexed.

Isolated Manual Muscle Testing ■ 241 SECTION 3-7: Isolated Manual Muscle Testing of the Ankle and Foot Ankle: tibialis anterior Origin: Lateral condyle of the tibia, 2/3 of lateral shaft of the tibia Insertion: Medial cuneiform bone and medial aspect of the base of first metatarsal Innervation: Deep peroneal nerve Action: Ankle dorsiflexion and foot inversion Figure 3-7-1 Tibialis anterior

242 ■ Chapter 3 Figure 3-7-2 Start position for tibialis anterior. Figure 3-7-3 End position for tibialis anterior. Normal, Good, Fair Poor Client Position: Starting—client is sitting with Client Position: Starting—client is lying on side lower leg and foot over edge of testing surface. on test side. The testing hip is extended, the knee The ankle is in plantar flexion and foot in slight is flexed, the ankle is in plantar flexion, and the eversion (Figure 3-7-2). foot in slight eversion. Motion—client moves the testing extremity into Motion—client moves the testing extremity into dorsiflexion and foot inversion with toes relaxed maximal ankle dorsiflexion and foot inversion. (Figure 3-7-3). Therapist Position: Stabilize the lower leg proxi- Therapist Position: Stabilize the lower leg proxi- mal to the ankle. Therapist supports the testing mal to the ankle. Resistance is applied on the extremity to eliminate gravity without assisting the medial side and dorsal aspect of the forefoot in the motion. No resistance is applied in the gravity- direction of plantar flexion and foot eversion eliminated position. when testing Normal or Good strengths. No resistance is applied when testing Fair strength. Trace The tibialis anterior is palpated on the anterior lat- eral portion of the lower leg.

Ankle: gastrocnemius Isolated Manual Muscle Testing ■ 243 Origin: Medial head—proximal and posterior aspect of the medial condyle of the femur. Lateral head—lateral and posterior aspect of the lateral condyle of the femur. Insertion: Via the Achilles tendon into the calcaneus Innervation: Tibial nerve Action: Ankle plantar flexion Figure 3-7-4 Gastrocnemius

244 ■ Chapter 3 Figure 3-7-5 Start position for gastrocnemius. Figure 3-7-6 End position for gastrocnemius. Normal, Good, Fair Motion—client moves the testing extremity into Client Position: Starting—client is prone with maximal ankle plantar flexion. knee extended and feet are over edge of testing sur- Therapist Position: Stabilize the lower leg proxi- face. The ankle is in dorsiflexion (Figure 3-7-5). mal to the ankle. No resistance is applied in the gravity-eliminated position. Motion—client moves the testing extremity into Trace plantar flexion with toes relaxed. (Figure 3-7-6). The gastrocnemius is palpated at the medial and lateral margin of the popliteal fossa, distal to the Therapist Position: Stabilize the lower leg proxi- knee joint. mal to the ankle. Resistance is applied on the pos- terior aspect of the calcaneus in the direction of Some references recommend isolating the dorsiflexion when testing Normal or Good gastrocnemius by completing heel raises in strengths. No resistance is applied when testing standing. This test is not included in this man- Fair strength. ual because of the variability of grading in the literature. Poor Client Position: Starting—client is lying on side on test side. The nontest knee is flexed. The testing knee is extended and the ankle is in dorsiflexion.

Ankle: soleus Isolated Manual Muscle Testing ■ 245 Origin: Posterior aspect of the head and proximal shaft of the fibula, soleal line, and medial border of the tibia Insertion: Via the Achilles tendon into the calcaneus Innervation: Tibial nerve Action: Ankle plantar flexion Figure 3-7-7 Soleus

246 ■ Chapter 3 Figure 3-7-8 Start position for soleus Figure 3-7-9 End position for soleus Normal, Good, Fair Poor Client Position: Starting—client is prone with Client Position: Starting—client is lying on test knee flexed. The ankle is in dorsiflexion (Figure side. The nontest knee is flexed. The testing knee 3-7-8). is flexed and the ankle is in dorsiflexion. Motion—the client moves the testing extremity Motion—client moves the testing extremity into into plantar flexion with toes relaxed (Figure maximal ankle plantar flexion. 3-7-9). Therapist Position: Stabilize the lower leg proxi- Therapist Position: Stabilize the lower leg proxi- mal to the ankle. No resistance is applied in the mal to the ankle. Resistance is applied on the pos- gravity-eliminated position. terior aspect of the calcaneum in the direction of dorsiflexion when testing Normal or Good Trace strengths. No resistance is applied when testing The soleus is palpated on either side of the gastroc- Fair strength. nemius midway down the calf.

Foot: tibialis posterior Isolated Manual Muscle Testing ■ 247 Origin: Posterolateral surface of the proximal tibia and medial aspect of the proximal fibula Insertion: Navicular, fibrous expansions to the three cuneiforms, cuboid, and the bases of the sec- ond, third, and fourth metatarsals Innervation: Tibial nerve Action: Foot inversion Figure 3-7-10 Tibialis posterior

248 ■ Chapter 3 Figure 3-7-11 Start position for tibialis posterior. Figure 3-7-12 End position for tibialis posterior. Normal, Good, Fair strengths. No resistance is applied when testing Client Position: Starting—client is sitting with Fair strength. lower leg and foot over edge of testing surface. The ankle is in slight plantar flexion and foot in Poor neutral (Figure 3-7-11). Client Position: Starting—client is supine. The testing knee is extended and the foot and ankle are Motion—client moves the testing extremity into in neutral. inversion with toes relaxed (Figure 3-7-12). Motion—client moves the testing extremity into Therapist Position: Stabilize the lower leg proxi- maximal foot inversion. mal to the ankle. Resistance is applied on the medial border of the forefoot in the direction of Therapist Position: Stabilize the lower leg proxi- foot eversion when testing Normal or Good mal to the ankle. No resistance is applied in the gravity-eliminated position. Trace The tibialis posterior is palpated between the medial malleolus and the navicular.

Isolated Manual Muscle Testing ■ 249 Foot: peroneus longus and peroneus brevis (tested together) Figure 3-7-14 Peroneus brevis Figure 3-7-13 Peroneus longus Peroneus brevis Origin: Lateral surface of the fibula, adjacent fas- Peroneus longus cia, and intermuscular septa Origin: The head and lateral surface of the fibula Insertion: Lateral aspect of the base of the fifth Insertion: Lateral aspect of the base of the fifth metatarsal and the medial cuneiform metatarsal Innervation: Superficial peroneal nerve Action: Foot eversion Innervation: Superficial peroneal nerve Action: Foot eversion

250 ■ Chapter 3 Figure 3-7-15 Start position for peroneus longus and brevis. Figure 3-7-16 End position for peroneus longus and brevis. Normal, Good, Fair Motion—client moves the testing extremity into Client Position: Starting—client is sitting with maximal foot eversion. lower leg and foot over edge of testing surface. The ankle and foot are in neutral (Figure 3-7-15). Therapist Position: Stabilize the lower leg proxi- mal to the ankle. No resistance is applied in the Motion—client moves the testing extremity into gravity-eliminated position. foot eversion (Figure 3-7-16). Trace Therapist Position: Stabilize the lower leg proxi- The peroneus longus is palpated posterior to the mal to the ankle. Resistance is applied on the lat- lateral malleolus or distal to the head of the fibula. eral border of the foot and on the plantar surface of the head of the first metatarsal in the direction The peroneus brevis is palpated proximal to the of foot inversion when testing Normal or Good base of the fifth metatarsal on the lateral border of strengths. No resistance is applied when testing the foot. Fair strength. Poor Client Position: Starting—client is supine with the testing knee extended and the heel resting over the edge of testing surface. The foot and ankle are in neutral.

Isolated Manual Muscle Testing ■ 251 Toes: flexor hallucis brevis and lumbricales (tested together) Figure 3-7-17 Flexor hallucis brevis Figure 3-7-18 Lumbricales Flexor hallucis brevis: great toe Lumbricales: toes #2–5 Origin: Medial aspect of the plantar surface of the Origin: Flexor digitorum longus cuboid, the lateral aspect of the cuneiform, and Insertion: Expansions of extensor tendons of toes the tendon of the tibialis posterior muscle #2–5 Innervation: Medial and lateral plantar nerves Insertion: Medial and lateral aspects of the base Action: MTP flexion of the proximal phalanx of the great toe Innervation: Medial plantar nerve Action: MTP joint flexion of the great toe In isolated manual muscle testing of the toes, gravity is not a consideration. Therefore, the muscle grade of “poor” is not assessed.

252 ■ Chapter 3 Figure 3-7-19 Start position for flexor hallucis brevis and Figure 3-7-20 End position for flexor hallucis brevis and lumbricales. lumbricales. Normal, Good, Fair on the plantar surface of the proximal phalanges Client Position: Starting—client is supine. The of each toe individually in the direction of MTP testing knee is extended and lower leg and foot extension when testing Normal or Good resting in neutral on the testing surface (Figure strengths. No resistance is applied when testing 3-7-19). Fair strength. Motion—client moves the testing extremity into Trace MTP flexion of each toe (Figure 3-7-20). The flexor hallucis brevis is palpated on the medial border of the sole of the foot. The lumbricales are Therapist Position: Stabilize the metatarsals and not palpable. maintain IP joint extension. Resistance is applied

Isolated Manual Muscle Testing ■ 253 Toes: flexor hallacis longus, flexor digitorum longus, and flexor digitorum brevis (tested together) Figure 3-7-21 Flexor hallucis longus Figure 3-7-22 Flexor digitorum longus Flexor hallucis longus: great toe Flexor digitorum longus: toes #2–5 Origin: Posterior surface of the fibula Origin: Posterior surface of the tibia Insertion: Plantar aspect of the base of the distal Insertion: Plantar aspects of the bases of the distal phalanx of the great toe phalanges of toes #2–5 Innervation: Tibial nerve Innervation: Medial plantar nerve Action: IP joint flexion of the great toe Action: DIP flexion

254 ■ Chapter 3 Flexor digitorum brevis: toes #2-5 Origin: Calcaneal tuberosity and medial and lat- eral intermuscular septa Insertion: Medial and lateral aspects of the mid- dle phalanges of toes #2–5 Innervation: Medial plantar nerve Action: PIP flexion Figure 3-7-23 Flexor digitorum brevis

Isolated Manual Muscle Testing ■ 255 Figure 3-7-24 Start position for flexor hallucis longus, flexor digi- Figure 3-7-25 End position for flexor hallucis longus, flexor digi- torum longus, and flexor digitorum brevis. torum longus, and flexor digitorum brevis. Normal, Good, Fair testing Normal or Good strengths. No resistance Client Position: Starting—client is supine. The is applied when testing Fair strength. testing knee is extended and lower leg and foot resting in neutral on the testing surface Trace (Figure 3-7-24). The flexor hallucis longus may be palpated on the plantar surface of the proximal phalanx of the Motion—client moves the testing extremity into great toe or inferior to the medial malleolus. IP flexion of each toe (Figure 3-7-25). The flexor digitorum brevis is not palpable. Therapist Position: Stabilize the MTP joint of each toe tested. Resistance is applied on the plan- The flexor digitorum longus may be palpated on tar surface of the distal phalanx of the great toe the plantar aspect of the proximal phalanges. and the distal and middle phalanges of toes #2–5 individually in the direction of IP extension when

256 ■ Chapter 3 Toes: abductor hallucis Origin: Medial process of the calcaneal tuberosity, flexor retinaculum, and medial intermuscular septa Insertion: Medial aspect of the base of the proxi- mal phalanx of the great toe Innervation: Medial plantar nerve Action: Abduction of the great toe Figure 3-7-26 Abductor hallucis

Isolated Manual Muscle Testing ■ 257 Figure 3-7-27 Start position for abductor hallucis. Figure 3-7-28 End position for abductor hallucis. Normal, Good, Fair proximal phalanx of the great toe in the direction Client Position: Starting—client is supine. The of adduction when testing Normal or Good testing knee is extended and lower leg and foot strengths. No resistance is applied when testing resting in neutral on the testing surface. The toes Fair strength. are in adduction (Figure 3-7-27). Trace Motion—client moves the great toe into abduc- The abductor hallucis is palpated on the medial tion (Figure 3-7-28). border of the foot superficial to the first metatarsal. Therapist Position: Stabilize the first metatarsal. Resistance is applied on the medial aspect of the

258 ■ Chapter 3 Toes: abductor digiti minimi and dorsal interossei (tested together) Figure 3-7-29 Abductor digiti minimi Figure 3-7-30 Dorsal interossei Abductor digiti minimi Dorsal interossei Origin: Medial and lateral process of the calcaneal Origin: Sides of metatarsals tuberosity Insertion: Medial and lateral aspect of toe #2 and Insertion: Lateral aspect of the base of the proxi- lateral aspect of toes #3 and #4 mal phalanx of the fifth toe Innervation: Lateral plantar nerve Innervation: Lateral plantar nerve Action: Abduction of the toes #2–4 Action: Abduction of the fifth toe

Isolated Manual Muscle Testing ■ 259 Manual muscle testing is not performed on these muscles. Observation of toes #2–5 provides a functional level as the tester stabilizes the great toe (Figure 3-7-31). Figure 3-7-31 Functional test of abductor digiti minimi and dor- sal interossei.

260 ■ Chapter 3 Toes: extensor hallucis longus, extensor digitorum longus, and extensor digitorum brevis (tested together) Figure 3-7-32 Extensor hallucis longus Figure 3-7-33 Extensor digitorum longus Extensor hallucis longus: great toe Extensor digitorum longus: toes #2–5 Origin: Anterior surface of the fibula and the Origin: Lateral condyle of the tibia, medial sur- interosseous membrane face of the fibula, anterior surface of the Insertion: Dorsal surface of the base of the distal interosseous membrane, and crural fascia phalanx of the great toe Innervation: Deep peroneal nerve Insertion: Dorsal aspect of the base of the middle Action: IP joint extension of the great toe phalanx of toes #2–5 and dorsal aspect of the base of the distal phalanx of toes #2–5 Innervation: Deep peroneal nerve Action: DIP flexion

Isolated Manual Muscle Testing ■ 261 Extensor digitorum brevis: great toe and #2–4 Origin: Dorsal surface of the calcaneum Insertion: Tendons to toes #2–4 of the correspon- ding extensor digitorum longus tendons and prox- imal phalanx of great toe Innervation: Deep peroneal nerve Action: MTP extension of the great toe and IP extension of toes #2–4 Figure 3-7-34 Extensor digitorum brevis

262 ■ Chapter 3 Figure 3-7-35 Start position for extensor hallucis longus, extensor Figure 3-7-36 End position for extensor hallucis longus, extensor digitorum longus, and extensor digitorum brevis. digitorum longus, and extensor digitorum brevis. Normal, Good, Fair ing Normal or Good strengths. No resistance is Client Position: Starting—client is supine. The applied when testing Fair strength. testing knee is extended and lower leg and foot resting in neutral on the testing surface. The toes Trace are flexed (Figure 3-7-35). The extensor hallucis longus is palpated on the dorsal aspect of the first MTP joint or on the Motion—client moves the great toe into MTP anterior aspect of the ankle joint lateral to the ten- extension and toes #2–4 into IP extension (Figure don of the tibialis anterior. 3-7-36). If it is too difficult for the client to extend toes in isolation, they may be tested as a The extensor digitorum brevis is palpated on the group. dorsal aspect of the foot anterior to the lateral malleolus. Therapist Position: Stabilize the metatarsals of each toe tested. Resistance is applied on the dorsal The extensor digitorum longus is palpated on the surface of the distal phalanx of the great toe and dorsal aspect of the metatarsal bones of toes #2–5 the distal surface of toes #2–5 individually (or or on the anterior aspect of the ankle joint lateral together) in the direction of IP flexion when test- to the tendon of the extensor hallucis longus.

Back Matter ■ 263 Glossary Active range of motion—movement of the extremity by the client through the available arc of motion without the thera- pist’s assistance Against gravity—a position in which the client moves the extremity or body part perpendicular to the floor because the force of gravity is exerted down toward the floor Axis of the body—the location around which movement of the body occurs Biomechanical frame of reference—the frame of reference that defines function and dysfunction in terms of an individual’s range of motion, strength, and endurance Clinical reasoning—the decision-making process used to determine the need for further assessment, taking into account all known factors and observations Compensation—use of alternative motions by the client to achieve the active range of motion that has been requested by the therapist End feel—the feeling that is elicited when the joint is brought through the entire available range of motion Frames of reference—a guide to the therapist for the evaluation and intervention process Fulcrum—part of the goniometer that is placed over the axis of motion when measuring range of motion Functional observation—observation of a client completing a functional activity Goniometer—the most commonly used instrument for measuring joint motion Goniometry—the measurement of arc of motion of a joint Gravity-eliminated—a position in which the client moves the extremity or body part parallel to the floor Gross manual muscle testing—a test of entire muscle groups rather than individual muscles Isolated manual muscle testing—a test of each specific muscle within a muscle group Movable arm—part of the goniometer that is aligned with the plane of motion but is distal to the joint being measured and follows the arc of motion Passive range of motion—movement of the extremity by the therapist through the available arc of motion without the client’s assistance Plane of the body—the flat surface along which movement of the body occurs Resistance—application of pressure by the therapist in order to determine which muscle strength grade a client demonstrates Screening—an informal functional assessment to determine quickly which joints need further assessment Stabilization—applied manually by the therapist in order to avoid compensation by the client Stationary arm—part of the goniometer that stays fixed and aligned with the plane of motion proximal to the joint being measured 263

264 ■■SCughgaepstedr XRXeadings References American Academy of Orthopedic Surgeons. (1965). Joint motion: Method of measuring and recording. Chicago: Author. American Medical Association. (1988). Guides to the evaluation of permanent impairment. Chicago: Author. Clarkson, H. M., & Gilewich, G. B. (1989). Musculoskeletal assessment: Joint range of motion and manual muscle strength. Baltimore, MD: Williams & Wilkins. Kendall, F. P., & McCreary, E. K. (1983). Muscles: Testing and function (3rd ed.). Baltimore, MD: Williams & Wilkins. Mosey, A.C. (1970). Three frames of references for mental health. Thorofare, NJ: Slack, Inc. Suggested Readings The American Society of Hand Therapists. (1992). Clinical assessment recommendations (2nd ed.). Chicago: Author. Cole, M.B. (1998). Group dynamics in occupational therapy. Thorofare, NJ: Slack, Inc. Daniels, L., & Worthingham, C. (1986). Muscle testing (5th ed.). Philadelphia, PA: W.B. Saunders Co. Jenkins, D. B. (1998). Hollinshead’s functional anatomy of the limbs and back (7th ed.). Philadelphia, PA: W.B. Saunders Co. Norkin, C. C., & White, D. J. (1995). Measurement of joint motion: A guide to goniometry (2nd ed.). Philadelphia, PA: F.A. Davis Company. Rockwood, C.A., & Matsen, F.M. (1990). The shoulder (Vol. 1). Philadelphia, PA: W.B. Saunders Co. 264

Back Matter ■ 265 Appendix A: Muscle Tables The Trunk MUSCLE ORIGIN INSERTION INNERVATION ACTION Rectus Pubic crest, ligaments Xyphoid process, Lower inter- Trunk flexion abdominus of the pubic ribs 5–7 costal nerves Internal oblique symphysis External oblique Iliopsoas fascia & Aponeurosis Lower intercostal Trunk flexion & inguinal ligament, into the linea nerves, iliohypo- trunk oblique Erector spinae anterior iliac crest, alba, lower ribs gastric & ilio- rotation thoracolumbar fascia inguinal nerves Interspinales Intertransversarii Lower 6 ribs Anterior iliac crest, Lower intercostal Trunk flexion & Multifidi aponeurosis into nerves, ilio- trunk oblique Semispinalis the linea alba hypogastric & rotation thoracis ilioinguinal nerves Quadratus lumborum Common tendon of Each specific muscle Dorsal rami of spinal Trunk extension origin: posterior of the erector spinae nerves specific to surface of the sacrum, group has its own each muscle in the iliac crest, spinous insertion erector spinae processes of lumbar & group last 2 thoracic verte- brae (each specific muscle of the erector spinae group also has its own specific origin) Spinous processes of Spinous processes of Dorsal & ventral Trunk extension vertebrae vertebrae rami of spinal nerves Transverse processes Transverse processes Dorsal & ventral Lateral flexion of vertebrae of vertebrae rami of spinal nerves Sacrum & transverse Spinous processes of Dorsal rami of spinal Trunk extension processes of C4–L5 lumbar through sec- nerves & trunk oblique ond cervical vertebrae rotation Transverse processes Spinous processes of Dorsal rami of Trunk extension of T6–T10 vertebrae C6, C7 & T1–4 cervical and thoracic spinal nerves Iliolumbar ligament, Inferior border of T12, L1–4 Pelvic elevation iliac crest last rib, transverse & trunk lateral processes of L1–4 flexion 265

266 ■ Appendix A: Muscle Tables The Neck MUSCLE ORIGIN INSERTION INNERVATION ACTION Longus capitus Transverse processes Occipital bone Ventral rami of C1–3 Neck flexion of C3–6 Ventral rami of C2–6 Neck flexion Longus colli Bodies of T1–3, trans- Transverse processes Rectus capitis verse processes of of C5–6, anterior anterior C3–5, bodies of C5–7 surface of atlas, Sternocleido- bodies of C2–4 mastoid Transverse processes Occipital bone Ventral rami of C1–2 Neck lateral of atlas flexion Sternum, medial Mastoid process of Accessory nerve Neck flexion 1/3 of clavicle temporal bone (motor), C2–3 (sensory) Scalenus anterior Transverse processes 1st rib Ventral rami of Neck flexion of C3–6 *see Trunk cervical spinal nerves Erector spinae *see Trunk Occipital bone *see Trunk Neck extension Obliquus capitus Inferior—spinous process of axis Dorsal ramus of C1 Inferior— neck rotation Superior—transverse process atlas Superior— neck extension & neck lateral flexion Rectus capitis Spinous process Occipital bone Dorsal ramus of C1 Neck extension posterior of axis & neck rotation Splenius capitus Mastoid process, Ligamentum nuchae, occipital bone Dorsal rami of Neck extension Splenius cervicis spinous processes of middle cervical & neck rotation C7 & T1–4 Transverse processes spinal nerves of C1–3 Spinous processes Dorsal rami of Neck extension of T3–6 lower cervical & neck rotation spinal nerves Semispinalis Transverse processes Spinous processes Dorsal rami of Neck extension cervicis cervical & thoracic of T1–6 of C2–5 spinal nerves Semispinalis Transverse processes Occipital bone Dorsal rami of Neck extension capitis of T1–7, articular cervical & thoracic processes of C5–7 spinal nerves

Appendix A: Muscle Tables ■ 267 The Shoulder & Scapula MUSCLE ORIGIN INSERTION INNERVATION ACTION Posterior deltoid Inferior lip, spine of Deltoid tuberosity of Axillary nerve Humeral exten- scapula the humerus sion, humeral Middle deltoid Axillary nerve horizontal abduc- Anterior deltoid Acromion process Deltoid tuberosity of Axillary nerve tion & humeral Lateral 1/3 of clavicle the humerus external rotation Coracobrachialis Musculocutaneous Pectoralis major Deltoid tuberosity of nerve Humeral (clavicular head) the humerus abduction Pectoralis major (sternal head) Coracoid process of Opposite the deltoid Humeral flexion, Latissimus dorsi the scapula tuberosity on the humeral hori- medial aspect of ontal adduction Subscapularis Anterior surface of the mid-humerus & humeral inte- Infraspinatus sternal 1/2 of clavicle nal rotation Greater tubercle of the humerus Humeral flexion Sternum, costal Greater tubercle of Lateral & medial Humeral flexion, cartilage ribs 1–6 the humerus pectoral nerves humeral hori- zontal adduc- Spinous process of the Bottom of inter- Lateral & medial tion & humeral last 6 thoracic verte- tubercular groove of pectoral nerves adduction brae, all lumbar & the humerus sacral vertebrae, Thoracodorsal Humeral hori- posterior iliac crest, nerves zontal adduc- posterior last 3 ribs, tion & humeral inferior angle of extension the scapula Humeral exten- sion, humeral adduction, humeral internal rotation & scapular depression Subscapular fossa of Lesser tubercle of Superior upper & Humeral inter- the scapula the humerus, capsule inferior lower nal rotation & is of the shoulder joint subscapular nerves one of the rota- tor cuff muscles Medial 2/3 of infra- Greater tubercle of Suprascapular nerve Humeral external spinatus fossa of the humerus, capsule rotation, humeral the scapula of the shoulder joint horizontal abduction & is one of the rotator cuff muscles (continues)

268 ■ Appendix A: Muscle Tables The Shoulder & Scapula (continued ) MUSCLE ORIGIN INSERTION INNERVATION ACTION Teres minor Upper 2/3 of the Greater tubercle of Axillary nerve Humeral exter- lateral, dorsal border the humerus, capsule nal rotation, of the scapula of the shoulder joint humeral hori- zontal abduc- tion & is one of the rotator cuff muscles Supraspinatus Medial 2/3 of the Greater tubercle of Suprascapular nerve Humeral abduc- supraspinatus fossa the humerus, capsule tion & is one of of the shoulder joint the rotator cuff muscles Upper trapezius Occipital protuberance, Lateral 1/3 of clavicle, Spinal accessory Scapular eleva- medial 1/3 of nuchal acromion process nerve tion & scapular line of the occipital upward rotation bone, ligamentum nuchae, spinous process of C7 Levator scapulae Transverse process Superior angle of Dorsal scapular Scapular of C1–C4 the scapula nerve elevation Middle trapezius Inferior aspect of Medial margin of Spinal accessory Scapular the ligamentum the acromion process, nerve adduction nuchae, C7–T5 superior spine of the scapula Lower trapezius T6–T12 Medial aspect of Spinal accessory Scapular the scapula, tubercle nerve depression & at the apex of the scapular upward spine of the scapula rotation Teres major Dorsal surface of the Below the lesser Inferior subscapular Humeral exten- inferior angle of the tuberosity of the nerve sion, humeral scapula humerus, posterior to internal rotation the latissimus dorsi & humeral insertion adduction Rhomboids Spinous process of Entire medial border Dorsal scapular Scapular adduc- C7–T5, ligamentum of the scapula tion & scapu- nuchae lar downward rotation Servatus anterior Ribs 1–9 Anterior medial border Long thoracic nerve Scapular of the scapula abduction Pectoralis minor Ribs 3, 4, 5 Coracoid process of Medial & lateral Scapular abduc- the scapula, superior pectoral nerve downward surface rotation

Appendix A: Muscle Tables ■ 269 The Elbow and Forearm MUSCLE ORIGIN INSERTION INNERVATION ACTION Biceps brachii Short head—coracoid Short head—posterior Musculocutaneous Elbow flexion & Brachialis process of the scapula aspect of the radial nerve forearm Brachioradialis supination Triceps tuberosity Anconeus Long head—supra- Long head—bicipital Supinator glenoid process of aponeurosis Pronator teres the scapula Pronator Distal 1/2 of the Tuberosity & coronoid Musculocutaneous & Elbow flexion quadratus radial nerves anterior aspect of the process of the ulna humerus, medial/lateral intermuscular septa Proximal 2/3 of lateral Lateral side of the base Radial nerve Elbow flexion supracondylar ridge of of ulnar styloid process the humerus, lateral intramuscular septa Long head— Posterior surface Radial nerve Elbow extension infraglenoid tubercle of the olecranon of the scapula process Lateral head—postero- lateral surface of the humerus between the radial groove and the insertion of the teres minor Medial head—posterior surface of the humerus below the radial groove Lateral epicondyle of Lateral side of the Radial nerve Elbow extension the humerus olecranon process, upper 1/4 of the ulna Lateral epicondyle of Proximal 1/3 of Posterior interosseus Forearm branch of the radial supination the humerus the radius nerve Humeral head— Lateral surface of the Median nerve Forearm pronation proximal to the medial radial shaft epicondyle and common flexor tendon Ulnar head—medial side of the coronoid process of the ulna Distal 1/4 of the Distal 1/4 of the Anterior inter- Forearm anterior surface of anterior surface of osseous branch of pronation the ulnar shaft the radial shaft the median nerve

270 ■ Appendix A: Muscle Tables The Wrist MUSCLE ORIGIN INSERTION INNERVATION ACTION Median nerve Flexor carpi Medial epicondyle, Base of the 2nd Ulnar nerve Wrist flexion & radialis common extensor metacarpal Median nerve wrist radial tendon Radial nerve deviation Flexor carpi ulnaris Medial epicondyle, Pisiform Radial nerve Wrist flexion & common flexor Radial nerve wrist ulnar Palmaris longus tendon, proximal ulna deviation Extensor carpi Medial epicondyle, Palmar aponeurosis Wrist flexion radialis longus common flexor tendon Wrist extension Extensor carpi Lateral supracondylar Base of the 2nd & wrist radial radialis brevis ridge, lateral epi- metacarpal deviation condyle, common Extensor carpi extensor tendon Wrist extension ulnaris & wrist radial Lateral epidondyle, Base of the 3rd deviation common extensor metacarpal tendon Wrist extension & wrist ulnar Lateral epicondyle, Base of the 5th deviation common extensor metacarpal tendon, proximal ulna The Hand MUSCLE ORIGIN INSERTION INNERVATION ACTION Flexor digitorum Medial epicondyle, Lateral & medial Median nerve PIP joint flexion superficialis coronoid process, surface of the middle of digits 2–5 ulna, proximal radius phalanx of digits 2–5 Flexor digitorum Body of the ulna DIP joint flexion profundus Through the insertions Ulnar nerve (digits of digits 2–5 Hook of the hamate of the flexor digitorum 4 & 5), Median Flexor digiti superficialis onto the nerve (digits 2 & 3) MCP flexion of minimi Lateral epicondyle distal phalanx of the 5th digit digits 2–5 Extensor Posterior ulna MCP extension digitorum Base of the 5th digit Ulnar nerve of digits 2–5 proximal phalanx, Extensor indicis ulnar side MCP, PIP, DIP extension of the Base of the middle & Radial nerve 2nd digit distal phalanges of digits 2–5 Tendon of the Radial nerve extensor digitorum, dorsal aponeurosis

Appendix A: Muscle Tables ■ 271 The Hand (continued ) MUSCLE ORIGIN INSERTION INNERVATION ACTION Lateral epicondyle MCP, PIP, DIP Extensor digiti Tendon of the extensor Radial nerve extension of the minimi digitorum—5th digit 5th digit MCP digit Lumbricals First digit—FDP 2nd Radial side of dorsal 1st & 2nd digits— flexion with PIP/ digit tendon aponeurosis median nerve DIP extension Second digit—FDP 3rd 3rd & 4th digits— MCP digit digit tendon ulnar nerve adduction Third digit—FDP 3rd & MCP digit 4th digit tendons abduction Fourth digit—FDP 4th (continues) & 5th digit tendons Palmar First interossei— First interossei— Ulnar nerve interosseus 1st metacarpal, base of the 1st digit ulnar surface proximal phalanx, ulnar side Second interossei— 2nd metacarpal, Second interossei— ulnar surface base of the 2nd digit proximal phalanx, Third interossei— ulnar side 4th metacarpal, radial surface Third interossei— base of the 4th digit Fourth interossei— proximal phalanx, 5th metacarpal, radial side radial side Fourth interossei—base of the 5th digit proximal phalanx, radial side Dorsal interosseus Each interossei has its First interossei—base Ulnar nerve origin on both of the of the 2nd digit adjacent metacarpals proximal phalanx, radial side Second interossei— base of the 3rd digit proximal phalanx, radial side Third interossei—base of the 3rd digit proximal phalanx, ulnar side Fourth interossei—base base of the 4th digit proximal phalanx, ulnar side

272 ■ Appendix A: Muscle Tables The Hand (continued ) MUSCLE ORIGIN INSERTION INNERVATION ACTION Abductor digit Pisiform Base of the 5th digit Ulnar nerve MCP abduction minimi proximal phalanx, of the 5th digit ulnar side Ulnar nerve Opponens digit Hamate Median nerve 5th digit minimi 5th digit metacarpal, Median & ulnar opposition ulnar side nerves 1st digit Opponens pollicis Trapezium opposition 1st digit metacarpal, Thumb MCP Flexor pollicis Trapezium, trapezoid radial side flexion & assist brevis with CMC Base of the 1st digit flexion proximal phalanx Thumb IP flexion Flexor pollicis Anterior radius Base of the 1st digit Median nerve Thumb CMC longus distal phalanx Median nerve abduction Radial nerve Abductor pollicis Scaphoid, trapezium Base of the 1st digit Ulnar nerve Thumb CMC brevis proximal phalanx, Radial nerve abduction radial side Radial nerve Thumb CMC adduction Abductor pollicis Posterior, middle radius Base of the 1st digit Thumb IP longus & ulna metacarpal extension Adductor pollicis 3rd digit metacarpal, Base of the 1st digit MCP extension capitate, trapezoid proximal phalanx, & assists with ulnar side CMC extension Extensor pollicis Middle, posterior ulna Base of the 1st digit longus distal phalanx, dorsal surface Extensor pollicis Posterior radius Base of the 1st digit brevis proximal phalanx, dorsal surface

Appendix A: Muscle Tables ■ 273 The Hip MUSCLE ORIGIN INSERTION INNERVATION ACTION Iliacus Superior 2/3 of ilium, Lesser trochanter of Femoral nerve Hip flexion anterior iliac crest the femur Psoas major Transverse processes Lesser trochanter of Lumbar plexus, Hip flexion of L1–L5, vertebral the femur L2–L4 bodies of T12–L5 Gluteus maximus Lateral surface of the Iliotibial tract of fascia Inferior gluteal nerve Hip extension ilium at the posterior latae, gluteal tuberosity gluteal line, posterior of the femur surface of sacrum, posterior coccyx & sacrotuberous ligaments Sartorius Anterior superior iliac Proximal aspect of the Femoral nerve Hip flexion, hip spine (ASIS) medial surface of the abduction& hip tibia external rotation Gluteus medius Lateral surface of the Greater trochanter of Superior gluteal Hip abduction & ilium, anterior & the femur nerve hip internal posterior gluteal line rotation Gluteus minimus Lateral surface of the Greater trochanter of Superior gluteal Hip abduction & ilium between the the femur nerve hip internal anterior & inferior rotation gluteal lines Tensor fascia latae Iliac crest posterior to Iliotibial tract Superior gluteal Hip flexion, hip the ASIS nerve abduction & hip internal rotation Pectineus Superior ramus of Between the lesser Femoral & obturator Hip adduction the pubis trochanter & linea nerves aspera of the posterior femur Adductor magnus Inferior pubic ramus, Linea aspera, adductor Obturator and sciatic Hip adduction ramus of the ischium, tubercle on the medial nerves ischial tuberosity condyle of the femur Gracilis Inferior ramus of the Proximal aspect of the Obturator nerve Hip adduction pubis & ischium tibia distal to the medial condyle Adductor longus Pubic tubercle/anterior Medial lip of the linea Obturator nerve Hip adduction crest of pubis aspera of the femur Adductor brevis Body & inferior ramus Between the lesser Obturator nerve Hip adduction of the pubis trochanter & linea aspera (continues)

274 ■ Appendix A: Muscle Tables The Hip (continued ) MUSCLE ORIGIN INSERTION INNERVATION ACTION Hip external Piriformis Anterior sacrum & Superior border of the Sacral plexus rotation sciatic notch of greater trochanter of the ilium the femur Hip external rotation Quadratus Lateral border of the Posterior surface of Sacral plexus femoris ischial tuberosity the femur between Hip external the greater & lesser rotation trochanters Hip external Obturator Obturator membrane, Medial surface of the Sacral plexus rotation internis margin of obturator greater trochanter foramin, internal proximal to the Hip external surface of the pelvis trochanter fossa rotation Hip external Obturator Obturator membrane, Trochanteric fossa of Obturator nerve rotation externus bone around foramen the femur on external surface of pelvis Gemellus Dorsal aspect of the Greater trochanter of Sacral plexus superior spine of ischium the femur Gemellus inferior Proximal aspect of the Greater trochanter of Obturator nerve ischial tuberosity the femur

Appendix A: Muscle Tables ■ 275 The Knee MUSCLE ORIGIN INSERTION INNERVATION ACTION Knee flexion & Semitendinosus Superior aspect of the Proximal aspect of the Sciatic nerve internal rotation of the tibia dur- ischial tuberosity the medial surface of (tibial branch) ing flexion & hip flexion when the tibia knee is flexed Knee flexion & Semimembranosus Superolateral aspect Medial tibial condyle Sciatic nerve internal rotation of the ischial & medial condyle of (tibial branch) of the tibia dur- tuberosity the femur ing flexion & hip flexion when Biceps femoris Long head— Lateral head of the Sciatic nerve knee is flexed ischial tuberosity fibula & condyle of (tibial & peroneal Knee flexion & the tibia branches) external rotation of the tibia dur- Short head— ing flexion posterior, distal femur Knee extension Rectus femoris Straight head— Base of the patella & Femoral nerve & hip flexion anterior aspect of the through the patellar Vastus anterior inferior ligament to the tibial Femoral nerve Knee extension intermedius iliac spine tuberosity Femoral nerve Vastus lateralis Femoral nerve Knee extension Vastus medialis Reflected head— ilium above the Knee extension acetabulum Anterior & lateral Base of the patella surfaces of the femoral through the patellar shaft of the femur ligament to the tibial tuberosity Anterior femur Lateral border of the patella through the patellar ligament to the tibial tuberosity Inferior aspect of the Medial border of the intertrochanteric line, patella through the medial lip of the linea patellar ligament to aspera, proximal the tibial tuberosity aspect of the supra- condylar & inter- muscular septum

276 ■ Appendix A: Muscle Tables The Ankle MUSCLE ORIGIN INSERTION INNERVATION ACTION Tibialis anterior Lateral condyle of Medial cuneiform Deep peroneal nerve Ankle dorsiflex- Gastrocnemius the tibia, 2/3 of bone, medial aspect ion ¶ foot lateral shaft of of the base of the inversion Soleus the tibia 1st metatarsal Tibialis posterior Medial head— Via the Achilles tendon Tibial nerve Ankle plantar proximal & posterior into the calcaneum flexion aspect of the medial condyle of the femur Lateral head— lateral & posterior aspect of the lateral condyle of the femur Posterior aspect of the Via the Achilles tendon Tibial nerve Ankle plantar head & proximal shaft into the calcaneum flexion of the fibula, soleal line, medial border of the tibia Posterolateral surface Navicular, fibrous Tibial nerve Foot inversion of the tibia, medial aspect of the proximal expansions to the 3 fibula cuneiforms, cuboid, bases of the 2nd, 3rd & 4th metatarsals

Appendix A: Muscle Tables ■ 277 The Foot MUSCLE ORIGIN INSERTION INNERVATION ACTION Peroneus longus The head & lateral Lateral aspect of the Superficial peroneal Foot eversion surface of the fibula base of the 5th nerve metatarsal, medial cuneiform bone Peroneus brevis Lateral surface of the Lateral aspect of the Superficial peroneal Foot eversion fibula, adjacent fascia, base of the 5th nerve intermuscular septa metatarsal Flexor hallucis Medial aspect of the Medial & lateral Medial plantar nerve MTP joint flex- brevis plantar surface of the aspects of the base of ion of the great cuboid, lateral aspect the proximal phalanx toe of the cuneiform, of the great toe tendon of the tibialis posterior muscle Lumbricales Flexor digitorum Expansions of extensor Medial & lateral MTP joint flex- longus tendons of toes #2–5 plantar nerves ion of toes #2–5 Flexor hallucis Posterior surface of Plantar aspect of the Tibial nerve IP joint flexion longus the fibula base of the distal of the great toe phalanx of the great toe Flexor digitorum Posterior surface of Plantar aspects of the Medial plantar nerve DIP joint flexion bases of the distal of toes #2–5 longus the tibia phalanges of toes #2–5 Flexor digitorum Calcaneus, medial & Medial & lateral Medial plantar nerve PIP joint flexion brevis lateral intermuscular septa aspects of the middle of toes #2–5 phalanges of toes #2–5 Abductor hallucis Medial process of the Medial aspect of the Medial plantar nerve Abduction of calcaneal tuberosity, base of the proximal the great toe flexor retinaculum, phalanx of the great medial intermuscular toe septa Abductor digit Medial & lateral Lateral aspect of the Lateral plantar nerve Abduction of minimi process of the calcaneal tuberosity base of the proximal the 5th toe phalanx of the 5th toe Dorsal interossei Side of the metatarsals Medial & lateral aspect Lateral plantar nerve Abduction of of toe #2 & lateral toes #2–4 aspect of toes #3 & 4 Extensor hallucis Anterior surface of the Dorsal surface of the Deep peroneal nerve IP joint exten- longus sion of the great fibula & interosseous base of the distal toe membrane phalanx of the great toe (continues)

278 ■ Appendix A: Muscle Tables The Foot (continued) MUSCLE ORIGIN INSERTION INNERVATION ACTION Extensor Lateral condyle of the Dorsal aspect of the Deep peroneal DIP joint flexion digitorum longus tibia, medial surface base of the middle nerve of toes #2–5 of the fibula, anterior phalanx of toes #2–5 & surface of the inter- dorsal aspect of the osseous membrane, base of the distal crural fascia phalanx of toes #2–5 Extensor Dorsal surface of the Tendons to toes #2–4 Deep peroneal nerve MTP joint exten- digitorum brevis calcaneum of the corresponding sion of the great extensor digitorum toe & IP joint longus tendons extension of toes #2–4

Back Matter ■ 279 Appendix B: Normal Range of Motion Tables Norms in Degrees for Upper Extremity Ranges of Motion from Selected References JOINT MOTION KENDALL & CLARKSON & AMERICAN AMERICAN Trunk MCCREARY GILEWICH ACADEMY OF MEDICAL Neck (1983) (1989) ORTHOPEDIC ASSOCIATION Shoulder SURGEONS (1988) (1965) Elbow Forearm Flexion 0–45 0–80 (4 in) 0–80 (4 in) 0–50 Extension 0–45 0–20–30 0–25 0–25 Lateral flexion 0–35 0–35 0–35 Oblique rotation 0–180 0–45 0–45 0–30 Flexion 0–45 0–45 0–45 0–60 Extension 0–180 0–45 0–45 0–75 Lateral flexion 0–90 0–45 0–45 0–45 Rotation 0–70 0–60 0–60 0–80 Flexion 0–180 0–180 0–150 Extension 0–145 0–60 0–60 0–50 Abduction/ 0–90 Adduction 0–90 0–180 0–180 0–180 External rotation 0–90 0–90 0–90 Internal rotation 0–70 0–70 0–90 Horizontal abduction 0–45 0–150 0–140 Horizontal 0–80 0–80 adduction 0–135 0–80 0–80 Flexion/Extension 0–150 (continues) Supination 0–90 Pronation 0–80 279

280 ■ Appendix B: Normal Range of Motion Tables Norms in Degrees for Upper Extremity Ranges of Motion from Selected References (continued) JOINT MOTION KENDALL & CLARKSON & AMERICAN AMERICAN MCCREARY GILEWICH ACADEMY OF MEDICAL Wrist Flexion (1983) (1989) ORTHOPEDIC ASSOCIATION Extension SURGEONS (1988) Digits Radial deviation (1965) #2–5 Ulnar deviation MCP 0–80 0–80 0–80 0–60 0–70 0–70 0–70 0–60 PIP 0–20 0–20 0–20 0–20 DIP 0–35 0–30 0–30 0–30 Thumb CMC Flexion 0–90 0–90 0–90 0–90 Hyperextension 0–45 0–45 0–20 MCP Abduction 0–20 IP Flexion 0–100 0–100 0–100 Extension 0 0 Flexion 0–90 0–90 0–70 Hyperextension 0 0–10 0–30 Flexion 0–45 0–15 0–15 0–8 cm Hyperextension 0–20 0–60 cm Abduction 0 0–70 0–15 Opposition 0–80 0–50 0–20 Flexion 0 Extension Pad of thumb 0–80 Tip of thumb Flexion to base or tip 0–20 to base or tip Extension of 5th digit of 5th digit 0–50 0–80 0–80

Appendix B: Normal Range of Motion Tables ■ 281 Norms in Degrees for Lower Extremity Ranges of Motion from Selected References JOINT MOTION CLARKSON & AMERICAN AMERICAN GILEWICH ACADEMY OF MEDICAL Hip Flexion ORTHOPEDIC ASSOCIATION 0–120 SURGEONS Extension 0–30 0–100 0–45 0–120 0–30 Abduction 0–30 0–30 0–40 0–45 0–45 0–20 Adduction 0–45 0–30 0–40 0–135/135–0 0–45 0–50 External rotation 0–20 0–45 0–150 0–50 0–135 0–20 Internal rotation 0–5 0–20 0–40 0–5 0–50 0–20 Knee Flexion/Extension 0–15 0–30 0–35 Ankle Dorsiflexion Plantar flexion Eversion Inversion Foot #1 MTP Flexion 0–45 0–45 0–30 0–70 0–70 Extension 0–90 0–90 0–50 0 0 IP Flexion 0–40 0–40 0–30 Extension 0–40 0–40 0 0–35 0–35 #2-5 MTP Flexion 0 0 #2—0–30, 0–60 0–60 #3—0–20, #4—0–10, #5—0–10 #2-5 PIP Extension #2-5 DIP Flexion Extension Flexion Extension

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