OnExam
Muscle Strength
Assessing muscle strength is part of a complete neurologic exam.
Performing the Test
Test strength by asking the patient to move actively against resistance
Grade strength out of 5:
5 - Normal strength
4 - Movement against gravity ad some resistance
3 - Movement against gravity
2 - Movement with gravity eliminated
1 - Muscle flicker/trace of contraction
0 - No contraction detected
Upper Extremity Strength Testing
Elbow flexion - biceps (musculocutaneous n., C5-C6)
Elbow extension - triceps (radial n., C7-C8)
Wrist extension - extensor carpi radialis longus & brevis (radial n., C6)
Finger abduction (ulnar n., C8)
Thumb opposition (median n., C8-T1)
Lower Extremity Strength Testing
Hip flexion - illiopsoas (femoral n., L2-L3)
Hip extension - gluteus maximus (inferior gluteal n., S1)
Hip abductors - gluteus medius & minimus (superior gluteal n., L5)
Hip adduction - adductors (obturator n., L3)
Knee extension - quadriceps (femoral n., L3-L4)
Knee flexion - hamstrings (sciatic n., L5- S1)
Dorsiflexion – tibialis anterior (deep peroneal n., L5)
Plantarflexion – gastrocnemius & soleus (tibial n., S1)
References
Bickley, Lynn S. Bates' Guide to Physical Examination and History Taking. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins: 2003
LeBlond RF, DeGowin RL, Brown DD. Chapter 14. The Neurologic Examination. In: LeBlond RF, DeGowin RL, Brown DD, eds. DeGowin's Diagnostic Examination. 9th ed. New York: McGraw-Hill; 2009.