Strength Tests Thumb And Fingers

Grade Description

0 No contraction is felt in the muscle

1 Feeble contraction in muscle belly or tendon is prominent

2 Muscle moves part through a small arc of motion

3 Muscle moves part through a moderate arc of motion

4 Muscle moves part through an almost complete arc of motion

5 Muscle moves part through complete arc of motion

6-7 Moves part through complete arc of motion, holds against slight pressure

8-9 Same as above, but holds against moderate pressure

10 Same as above against maximum pressure

Gravity is not an important consideration when testing the strength of thumb and finger muscles because the weight of the metacarpals and phalanges is insignificant in comparison with the strength of the muscles. In the first edition of this text, it was noted that "finger and toe muscles, and forearm rotators comprise approximately 40% of the extremity tests described." Improving relibil-ity in testing should follow Kendall guidelines, accord ing to the Clinical Assessment Recommendations published by the American Society of Hand Therapists (22).

Marked weakness of the finger or thumb muscles is often indicative of a tendon laceration or nerve entrapment. In cases where objective measurements of functional grip strength are required, dynamometers that measure grip and pinch strength are useful.

UPPER EXTREMITY (Except Fingers)

Date

Motion*

Normal Range

Date

Examiner

in Degrees

Examiner

Extension

45

Left Shoulder

Flexion

180

Range

225

Abduction

180

Right Shoulder

Adduction

0

Range

180

Horiz. Abduction

90

Horiz. Adduction

30

Range

120

Lateral Rotation

90

Medial Rotation

70

Range

160

Left Elbow

Extension

0

Right Elbow

Flexion

145

Range

145

Left Forearm

Supination

90

Right Forearm

Pronation

90

Range

180

Left Wrist

Extension

70

Flexion

80

Right Wrist

Range

150

Ullnar Deviation

45

Radial Deviation

20

Range

65

*The zero position is the plane of reference. When a part moves in the direction of zero but fails to reach the zero position, the degrees designating the joint motion obtained are recorded with a minus sign and subtracted in computing the range of motion.

JOINTS

The shoulder girdle is a complex structure, efficient in the performance of many movements yet vulnerable to injury because of the many and varied stresses it encounters.

To describe the structure and discuss the functions of the shoulder girdle, it is first necessary to identify certain commonly used terms:

Sterno—sternum Costal—rib Clavicular—clavicle

Acromial—acromion (process on the scapula) Gleno—glenoid cavity of scapula Humeral—humerus, long bone of upper arm Vertebral—vertebrae, spinal column Chondro—cartilage

In general, the name of the joint does not include reference to the type of tissue uniting the bones. One exception, however, is referred to rather frequently: the cartilaginous tissue between the sternum and the ribs. Inclusion may be justified on the basis that the cartilage is so extensive. If the joint between the sternum and the cartilage (i.e., the sternochondral joint) is named as part of the structure, however, it would become necessary to add the joining of the cartilage to the rib (i.e., costo-chondral or chondrocostal joint) in all instances. That should not be necesssary,.

With the above explanation, this text defines a joint as a skeletal, bone-to-bone connection that is held together by fibrous, cartilaginous, or synovial tissue. Joints are named according to the skeletal structures that are held together. Joints of the shoulder girdle are listed below.

1. Sternocostal: Connects the sternum with sternal ends of 10 ribs (seven directly and three indirectly).

2. Sternoclavicular: Connects the manubrium of the sternum with the medial end of the clavicle.

3. Acromioclavicular: Connects the acromial process of the scapula with the lateral end of the clavicle.

4. Glenohumeral: Connects the head of the humerus and the socket of the glenoid (hence, a ball-and-socket joint).

5. Costovertebral: Includes the connections of the head of each rib with two adjacent vertebral bodies and the connection of the tubercle of each rib with the transverse process of the vertebra.

ARTICULATIONS

Stedman's Concise Medical Dictionary defines an articulation as follows:

Articulation 1. Syn. Joint. 2. A joining together loosely so as to allow motion between the parts (23).

By definition 1, the terms joint and articulation have been—and no doubt will continue to be—used synonymously. Definition 2, however, provides for a legitimate use of the term with a broader meaning: In this text, articulation is defined as a musculoskeletal, bone to muscle to bone connection. They are named according to the bone of muscle origin and the bone of muscle insertion. Making a distinction between a joint and an articulation serves a very useful purpose. Whenever the term articulation is used, it will convey to the reader that muscles provide the tissue connecting the bones. See pages 300 and 301 for charts of articulations of the shoulder girdle showing 10 classifications according to the bones involved and 25 articulations according to the muscles involved.

The term "glenohumeral" applied to the joint is correct. However, the term "glenohumeral articulations" should not be used in reference to any shoulder girdle articulations. The two muscles that have their origins on the glenoid do not attach to the humerus, instead, one inserts on the radius and the other inserts on the ulna.

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