Examining muscle is fundamental in musculoskeletal conditions and neurology

Muscles is examined in following 3 domains

  1. Nutrition of muscles
  2. Tone of muscles
  3. Power of muscles

Nutrition of muscle

Inspection

  • Look for wasting or atrophy of muscles like deltoid or calf muscle
  • Prominent bony prominences
  • Prominent tendon ar foot and hand

Palpation

  • Soft and flabby muscle on palpation
  • Measure the girth of the muscle with a tape from a bony point(malleoli or elbow) and compare it to the other corresponding side

Tone of muscles

Move the muscles at the joint passively with your on either side of the joint and look for an resistance during range of movement.

It can be hypo or Hypertonia

Causes of hypotonia

  • Cerebellar lesion
  • Syndromes- Downs
  • Lower motor neuron disease
  • Posterior column lesion
  • Myopathies

Causes of hypertonia

  • Upper Motor neuron disease
  • Extrapyramidal lesions
  • Certain poisonings- Strychnine

Power of muscles

Ask the patient to do a series of movements at each joint. Always compare it with the other side

Power is graded from 0 to 5 grades

  • Grade 0- Complete paralysis
  • Grade 1-Flicker of muscle
  • Grade 2- Movement along gravity (Moving parallel to ground)
  • Grade 3-Movement against gravity but not against resistance
  • Grade 4- Movement against resistance but less power than normal
  • Grade 5- Normal power

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