Test the strength of wrist extension by asking the patient to extend their wrist while the examiner resists the movement. Compare the strength of each arm.Ĭ6- Elbow flexion & wrist extension Test the strength of lower arm flexion by holding the patient's wrist from above and instructing them to "flex their hand up to their shoulder". The muscle strength grading scale, which assigns a rating to the degree of muscle weakness, is often used.īegin by asking the client to perform a movement as per instructions and hold an isometric contraction against therapist resistance for a count of 5.Ĭ5- Shoulder abduction, Ask the patient to raise both their arms to the side of them simultaneously as strongly as then can while the examiner provides resistance to this movement. Results may indicate lesion to the spinal cord nerve root, or intervertebral disc herniation pressing on the spinal nerve roots. During myotome testing, you are looking for muscle weakness of a particular group of muscles. Testing of myotomes, in the form of isometric resisted muscle testing, gives information about the level in the spine where a lesion may be present. C8 – Thumb Extension and wrist ulnar deviation.The list below details which movement(s) has the strongest association with each myotome: All three of these spinal nerve roots can be said to be associated with elbow flexion. It is innervated by the musculocutaneous nerve, which is innervated by C5, C6 and C7 nerve roots. Eg Biceps Brachii muscle flexes the elbow. Most muscles in the limbs receive innervation from more than one spinal nerve root, and are hence comprised of multiple myotomes. 16 of these 31 nerves has a specific myotome that controls voluntary muscle movement. There are 8 cervical nerves, 12 thoracic nerves, 5 lumbar nerves, 5 sacral nerves,1 coccygeal nerve. The nerves are categorized by the vertebra which house them. No patient lost wrist function as a result of the operation.There are 31 spinal nerves, each vertebrae has a spinal nerve. Two patients had limited thumb abduction postoperatively. No patient had difficulty in phase conversion. Postoperatively, mean pinch force was doubled. In those patients treated for weakness due to adductor paralysis or avulsion, the mean tip-to-side pinch in the injured hand was 25% that of the normal hand. Of the 18 patients operated upon, eight had tendon transfers for abduction of the index finger performed simultaneously with thumb adductor-aplasty. For patients with weak thumb abduction due to combined median and ulnar nerve palsy, the graft was made slightly longer. Tendon length was adjusted so that the radial side of the thumb was in the plane of the palm with the wrist straight. Proximally, the graft was tunneled subcutaneously at the dorsum of the wrist and sutured to the detached ECRB. At operation, a tendon graft was passed distally through the interspace between the second and third metacarpals, deep to the adductor pollicis, and then sutured to the tendon of the adductor pollicis. Weakness was due to loss of function of the adductor pollicis because of ulnar nerve injury, peripheral neuropathy, local muscle avulsion, partial amputation, or aplasia. Eighteen patients with disability due to weak pinch were treated with extensor carpi radialis brevis (ECRB) adductor-plasty.
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