MANUAL MUSCLE

TEST
A S S O C . P R O F. B A Ş A R Ö Z T Ü R K
MANUAL MUSCLE TEST
• Normal (5): The muscle completes ROM with maximum resistance to gravity.
• Good (4): The muscle completes the ROM with less than maximum resistance
to gravity.
• Fair (3): Muscle completes ROM against gravity.
• Weak (2): The muscle completes ROM in gravity-eliminated positions.
• Work (1): Contraction is felt in the joint without any movement.
• Total paralysis (0): No contraction is felt in the muscle.
NOTE

• The ROM should be evaluated before a muscle test is

administered.
TRUNK MUSCLES

Back extensors
Muscles: Erector spinae (Iliocostalis thoracis, Longissimus
thoracis, Spinalis thoracis, Iliocostalis lumborum)
NORMAL (5)

• Lumbar region: The patient lies face down, arms extended upwards parallel to the side of the
head. The pelvis and lower ext are fixed, the trunk is brought into hyperextension until the
lower thorax is lifted from the table.
• Thoracic region: By placing a pillow under the lower thorax, hyperextension is requested until
the thoracic region reaches a horizontal position.
GOOD (4)
FAIR (3)
WEAK (2)
TRACE (1) AND ZERO (0)
M. MULTİFİDUS
LATERAL TRUNK FLEXORS

Muscles:
M. Obliquus internus ve externus abdominis
M. Quadratus lumbarum
M. Latissimus dorsi
Lateral fibers of M. rectus abdominus on the tested side
LATERAL TRUNK FLEXORS

Nerves:
8-12 intercostal nerves
T12-L1-2
N.Thoracodorsalis
7-12 intercostal nerves
• A thin pillow is placed between the legs and the head-pelvis-lower ext is on the side. The
upper arm is extended towards the feet in extension, while the lower arm holds the opposite
shoulder with the elbow so that support is not taken from the bed. The legs are stabilized by
the therapist.
• Without rotation of the trunk, the patient is asked to raise his torso to the same side. There is
no need to give resistance manually.
• 5: Shoulder and torso rise 15cm from the table.
• 5-: Shoulder and torso rise 13-14 cm from the table.
• 4+: Shoulder and torso rise 11-12 cm from the table.
• 4: Shoulder and torso rise 10 cm from the table.
• 4-: Shoulder and torso rise 8-9 cm from the table.
• 3+: Shoulder and torso rise 6-7 cm from the table.
• 3: Shoulder and torso rise 5 cm from the table.
• 3-: Shoulder and torso rise 4 cm from the table.
• 2:The thorax and the crista iliaca converge each other.
• 1: Contraction is felt laterally to the abdominal muscles.
• 0: Contraction is not felt.
ANTERİOR TRUNK FLEXORS

• Muscles: M. Rectus abdominis

• Nerves: 7-12 intercostal nerves
UPPER ABDOMINALS
NORMAL (5)
GOOD (4)
FAIR (3)
WEAK (2)
TRACE (1) AND ZERO (0)
LOWER ABDOMINALS
NORMAL (5)
LOWER ABDOMINALS
• Good (4): 30 degrees
• Medium (3+) : 60 degrees
OBLIQUE TRUNK MUSCLES

• Muscles: M. Obliquus externus abdominis, M. Obliquus internus abdominis

• Nerves: 8-12 intercostal nerves
NORMAL (5)
GOOD (4)
FAIR (3)
WEAK (2)
PELVIC ELEVATION

Muscles:M. Quadratus lumborum, M. Iliocostalis lumborum

Auxiliary muscles: M. Obliquus abdominis externus ve internusun lateral lifleri, M.
Latissimus dorsi
Nerves: T12-L1-2-3 (lumbal plexus), T12-L1-2
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO
BASIC PRINCIPLES OF EXTREMITY
TESTS
• The individual must be in a position to provide the best fixation
• Proximal must be stabilized
• If it is suitable for the muscle, movement against gravity should be shown
• If the muscle is too weak to move against gravity, a horizontal plane should be used.
• It should be applied with a degree of resistance, but not too slowly. Resistance should be given
uniformly, not localized, so as not to cause discomfort.
• If not contraindicated, the long lever lever should be used
LOWER EXTREMITY
HIP FLEXION
• Muscles: M. Psoas major and minor, M. Iliacus
• Nerves: N. Femoralis
Auxiliary muscles: M. Sartorius, M. Tensor fasciae latae, M. Rectus femoris, M.
Pectineus, M. Adductor brevis, longus and magnusun oblik lifleri
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO

• A) Lie on your side with the leg to be tested at the bottom.The therapist takes the weight of
the upper leg with one hand and fixes the pelvis with the other. In knee flexion, the movement
is performed by sliding the limb on the bed.
• B) Lie on your side with the leg to be tested on top. The limb is supported on a slippery
platform or therapist's arm, the pelvis is fixed. The movement is completed while the knee is in
flexion so that the hamstring muscles do not get in the way.
M. ILIOSOAS TEST FOCUSED ON
PSOAS MAJOR
HIP HYPEREXTENSİON

Muscles:
A) M. Gluteus maximus,
B) The elongated head of M. Semitendinosus, M. Semimembranosus and M. Biceps femoris.
Nerves:
N. Gluteus inferior
N. Sciatus (Tibial branch)
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO

• Lie on the side with the leg to be tested at the bottom.

• The therapist takes the weight of the upper leg and stabilizes the pelvis.
• The tested leg is placed in 90 degree flexion while the knee is in 90 degree
flexion or in 90 degree flexion for M. Gluteus maximus.
HIP ABDUCTION

• Muscle: M. Gluteus medius

• Nerve: N. Gluteus superior
• Supplementary muscles: M. Gluteus minimus, M. Tensor fasciae latae, upper fibers of M. Gluteus
maximus
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO
HIP ADDUCTION

Muscles:
• A) M. Adductor magnus, brevis ve longus
• B) M. Pectineus
• C) M. Gracilis
Nerves:
• N. Obtuatorius
• N. Femoralis
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO
HIP EXTERNAL ROTATION

Muscles:
Nerves:
A) M. Obturator externus A) N. Obturatorius
B) M. Obturator internus B) Sacral plexus (L5, S1-2)
C) Sacral plexus (L4-5, S1)
C) M. Quadratus femoris D) Sacral plexus (S1-2)
D) M. Piriformis E) Sacral plexus (L5, S1-2)
E) M. Gemellus superior F) Sacral plexus (L4-5, S1)
F) M. Gemellus inferior
HIP EXTERNAL ROTATION

Auxiliary muscles:
A) M. Sartorius
B) M. elongated head of the biceps femoris
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO

• Lie on your back with the legs in extension, with the lower extremity to be
tested in full internal rotation. The pelvis is fixed by the therapist. Since gravity
will help the movement after the middle line, the movement is completed with
minimal resistance after this point, or
• On the foot, pelvic elevation is made to the lower extremity to be tested, and
contact with the ground is cut off, and support can be obtained from a place by
hand. The pelvis is supported by the therapist and the external rotation
movement is completed.
HIP INTERNAL ROTATION

Muscles
A) M. Gluteus minimus
B) M. Tensor fasciae latae
Nerves:
N. Gluteus superior
Auxiliary muscles:
C) M. Gluteus mediusun anterior lifleri
D) M. Semitendinosus ve Semimembranosus
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO

• It is tested in the same position as the external rotation, this time

by requesting movement from external rotation to internal
rotation.
ABDUCTION IN HIP FLEXION

Muscles: M. Tensor fasciae latae

Nerves: N. Gluteus superior
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO
M. SARTORIUS

• Nerve: N. Femoralis
FOR NORMAL, GOOD, AND FAIR
VALUES
WEAK, TRACE AND ZERO
TO PALPATE IF THERE IS A
CONTRACTION:
KNEE FLEXİON

Muscles:
M. Semitendinosus
M. Semimembranosus
M. Biceps femoris
Nerves:
N. Sciaticus
KNEE FLEXİON

Auxiliary muscles:
• M. Popliteus
• M. Sartorius
• M. Grasilis
• M. Gastrocnemius
FOR NORMAL, GOOD, AND FAIR
VALUES If there is a difference in strength
between the inner and outer
hamstrings, when the patient tries
to flex the knee;
For the biceps femoris muscle,
knee flexion is performed with
the toes facing outward, and the
resistance is given in the
downward direction
For the semitendinosus and
semimembranosus muscles, knee
flexion is performed with the toes
facing inward and the resistance is
given to the downward inward
direction
WEAK, TRACE AND ZERO
KNEE EXTENSION

• Muscle: M. Quadriceps femoris

• Nerve: N. Femoralis
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
ANKLE PLANTAR FLEXİON

Muscles
M. Gastrocnemius
• M. Soleus
Nerves
• N. Tibialis
• Auxiliary muscles: M. Tibialis posterior, M. Peroneus longus and brevis, M. Flexor
hallucis longus, M. Flexor digitorum longus, M. Plantaris
FOR NORMAL, GOOD AND FAIR
VALUES
 M. Gastrocnemius
M. Gastrosoleus
WEAK, TRACE AND ZERO
M. TIBIALIS ANTERIOR

• Nerve: N. Peroneus profundus

FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
PLANTAR FLEXION AND INVERSION

• Muscle: M. tibialis posterior

• Nerve: N. tibialis
• Auxiliary muscles: M. Flexor digitorum longus, M. Flexor hallucis longus, M. medial head of
gastrocnemius
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
FOOT EVERSION

• Muscles: M. Peroneus longus ve brevis

• Nerve: N. Peroneus superficialis
• Auxiliary muscles: M. Extensor digitorum longus, M. Peroneus tertius
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
MTF FLEXION

Muscles:
• A) Lumbrikaller
• B) Flexor hallucis brevis
Nerves:
• A) 1. Lumbrikalin N. Plantaris medialis; 2, 3 ve 4. Lumbrikallerin N. Plantaris
lateralis
• B) N. Plantaris medialis
MTF FLEXION

• Auxiliary muscles: dorsal and plantar interosseals, M. Flexor digiti quinti brevis,
M. Flexor digitorum longus, M. Flexor digitorum brevis
• In tests on the toes, the effect of gravity is not taken into account, since the
muscles are very small.
INTERPHALANGEAL FLEXION
Muscles:
A) For proximal joints: M. Flexor digitorum brevis
B) For distal joints: M. Flexor digitorum longus
C) M. Flexor hallucis longus
Nerves:
A) N. plantaris medialis
B) and C) N. Tibialis
INTERPHALANGEAL FLEXION

• The test position and evaluation are the same as the MTF
• Resistance is given by the plantar face of the distal phalanges
MTF AND IF EXTENSION

Muscles:
• A) M. Extansor digitorum longus
• B) M. Extansor digitorum brevis
• C) M. Extansor hallucis longus
Nerve: N. Peroneus profundus
NECK FLEXION

• M. Sternocleidomastoideus
• Nerve: N. Accessorius
• Auxiliary muscles: M. Longus capitis ve colli
• M. Scalenus anterior, medius ve posterior
• M. Rectus capitis anterior
• Infrathyroid group
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO

• In the side-lying position, the lower thorax is fixed, the head is supported by the therapist.
• The person is asked to bring his neck from full extension to flexion.
NECK EXTENSION

Muscles and nerves:

M. Trapezius -> N. Accessorius
M. Semispinalis capitis and M. Semispinalis cervicis -> Dorsal spinal nerves
M. Splenius capitis and M. Splenius cervivis -> Dorsal roots of the middle and lower cervical
nerves
M. Longissimus capitis ve cervicis, M. Spinalis capitis ve cervicis, M. Iliocostalis cervicis -> Spinal
nerves at the same level
Auxiliary muscles:
M. Multifideus
• M. Obliqus capitis superior ve inferior
• M. Rectus capitis major and minor
• M. Levator scapula
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO

• The weight of the head is taken by the therapist and the patient lies on his side in a full flexion
position. If the transaction is completed, a value of 2 is returned.
SCAPULAR ABDUCTION AND UPWARD
ROTATION
• M. Serratus anterior -> N. Thoracicus longus
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
SKAPULAR ELEVATION

• M. Trapezius (Upper part) -> N. Accessorius (C3-4)

• M. Levator scapula -> C3-4 ve N. Scapula dorsalis (C4-5)

Auxiliary muscles: M. Rhomboideus major and minor

FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
SCAPULAR DEPRESSION AND
ADDUCTION
• M. Trapezius (Lower part) -> N. Accessorius ve C3-4
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO

• Half of the movement is done.

SCAPULAR ADDUCTION AND
DOWNWARD ROTATION
• M. Rhomboideus major and minor-> N. Scapula dorsalis
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
90 DEGREE SHOULDER FLEXİON

Muscles:
M. Deltoideus (anterior lifleri)
M. Choracobrachialis
Nerves:
N. Axillaris
N. Musculocutaneus
Auxiliary muscles: M. deltoideus- middle fibers, clavicular part of M. pectoralis major, M. biceps
brachii
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
SHOULDER HYPEREXTENSION

• M. Latissimus dorsi -> N. Thoracodorsalis

• M. Teres Major -> N. Subscapularis
• M. Deltoideus posterior fibres -> N. Axillaris

Auxiliary muscles: M. Teres major, M. Long head of the triceps

FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
90 DEGREE SHOULDER ABDUCTION

• M. Deltoideus (middle fibers) -> N. Axillaris

• M. Supraspinatus -> N. Suprascapularis
Auxiliary muscles: anterior and posterior fibers of M. deltoideus, anterior of M. serratus
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
HORIZONTAL ABDUCTION OF THE
SHOULDER
• M. Deltoideus (posterior fibers) -> N. Axillaris

Auxiliary muscles: M. Teres minor, M. Infraspinatus

FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
HORIZONTAL ADDUCTION OF THE
SHOULDER
• M. Pectoralis major and minor -> N. Pectoralis lateralis and medialis
Auxiliary muscle: Anterior fibers of M. deltoideus
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
SHOULDER EXTERNAL ROTATION

• M. Infraspinatus -> N. Suprascapularis

• M. Teres minor -> N. Axillaris
Auxiliary muscle: posterior fibers of M. deltoideus
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO

• The arm is suspended from the bed from the shoulder and lies face down.
• The arm is in internal rotation, the scapula is fixed.
• If the movement is completed with the palm completely turned outward, a value of 2 is given.
SHOULDER INTERNAL ROTATION

• M. Subscapularis -> N. Subscapularis

Auxiliary muscles: M. pectoralis major, M. Latissimus dorsi, M. Teres major, anterior fibers of M.
deltoideus
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO

• The position is the same as external rotation. However, if the movement starts from external
rotation and is completed towards internal rotation, a value of 2 is given.
ELBOW FLEXION

• M. Biceps brachii -> N. Musculocutaneus

• M. Brachialis -> N. Musculocutaneus
• M. Brachioradialis -> N. Radialis

Auxiliary muscles: Forearm flexor muscles

FOR NORMAL, GOOD AND FAIR
VALUES

M. Biceps brachii
FOR NORMAL, GOOD AND FAIR
VALUES
• For M. Brachialis, the forearm is tested in pronation, and for M. Brachioradialis, the forearm is
tested in the neutral position.
WEAK, TRACE AND ZERO
WEAK, TRACE AND ZERO
ELBOW EXTENSION

• M. Triceps brachii -> N. Radialis

Auxiliary muscles: M. Anconeus and forearm extensors starting from the lateral condyle of the
humerus
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
FOREARM SUPINATION

• M. Biceps brachii -> N. Musculocutaneus

• M. Supinatorius -> N. Radialis

Auxiliary muscle: M. brachioradialis

FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
FOREARM PRONATION

• M. Pronator teres -> N. Medianus

• M. Pronator quadratus -> N. Medianus

Auxiliary muscle: M. Flexor carpi radialis

FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
WRIST FLEXION

• M. Flexor carpi radialis -> N. Medianus

• M. Flexor carpi ulnaris -> N. Ulnaris

Auxiliary muscle: M. palmaris longus

FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
WRIST EXTENSION

• M. Extansor carpi radialis longus and brevis -> N. Radialis

• M. Extensor carpi ulnaris -> N. Radialis
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
MCP FLEXION

• M. Lumbricales -> 1 ve 2: N. Medianus; 3 ve 4: N. Ulnaris

• M. Dorsal interrossealis -> N. Ulnaris
• M. Palmar interrossealis -> N. Ulnaris
• Auxiliary muscles: M. Flexor digiti minimi brevis, M. Flexor digitorum superficialis, M. Flexor
digitorum profundus
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
PIP FLEXION

• M. Flexor digitorum superficialis -> N. Medianus

DIP FLEXION

• M. Flexor digitorum profundus -> N. Ulnaris

MCP EXTENSION

• M. Extensor digitorum communis -> N. Radialis

• M. Extensor indicis proprius -> N. Radialis
• M. Extensor digiti minimi -> N. Radialis
FOR NORMAL, GOOD AND FAIR
VALUES
WEAK, TRACE AND ZERO
FINGER ABDUCTION

• M. Dorsal interrossealis -> N. Ulnaris

• M. Abductor digiti minimi -> N. Ulnaris
FINGER ADDUCTION

• M. Palmar interrossealis -> N. Ulnaris

BAŞPARMAK MTP FLEKSİYONU

• M. Flexor pollicis brevis -> Lateral kısmı N. Medianus, medial kısmı N. ulnaris
THUMB IP FLEXION

• M. Flexor pollicis longus -> N. Medianus

THUMB MCP EXTENSION
• M. Extensor pollicis brevis ->
N. Radialis
THUMB IP EXTENSION

• M. Extensor pollicis longus -> N. Radialis

THUMB ABDUCTION

• M. Abductor pollicis longus -> N. Radialis

• M. Abductor pollicis brevis -> N. Medianus
THUMB ADDUCTION

• M. Adductor pollicis -> N. Ulnaris

THUMB AND 5TH FINGER OPPOSITION

• M. Opponens pollicis -> N. Medianus

• M. Opponens digiti minimi -> N. Ulnaris