Overview
This lecture covers the assessment of range of motion and muscle strength in the upper extremities, focusing on the shoulders, elbows, wrists, and hands.
Shoulder Assessment
- Inspect shoulders with the gown off for visible range of motion.
- Assess shoulder movements: forward flexion (arms forward), backward extension (arms behind), abduction (arms up/out), adduction (arms together).
- Test external rotation (hands behind head) and internal rotation (hands behind back, "in The Slammer").
- Check circumduction (circular motion like throwing a softball/jump rope).
- Evaluate muscle strength against resistance for abduction/adduction and flexion/extension.
Muscle Strength Grading
- 5/5: Full strength against full resistance.
- 4/5: Some strength against resistance ("four plus").
- 3/5: Full movement against gravity but not resistance.
- 2/5: Passive movement only, unable to lift against gravity.
- 1/5: Slight muscle contraction, no movement.
- 0/5: No contraction; paralysis.
Elbow Assessment
- Test extension (arms straight) and flexion (bend towards body).
- Supination (palms up, "holding a cup of soup") and pronation (palms down, "pouring out soup").
- Check strength: flexion (pull in) and extension (push out) against resistance.
Wrist Assessment
- Evaluate flexion (wave hand down) and extension (wave hand up).
- Test radial deviation (move wrist towards thumb) and ulnar deviation (towards little finger).
- Check strength of wrist flexion/extension against resistance.
Hand and Finger Assessment
- Test finger abduction (spread fingers) and adduction (bring together).
- Assess flexion (bend fingers) and extension (straighten fingers).
- Check circumduction of fingers (circular motion).
- Thumb opposition (touch thumb to each fingertip rapidly) tests opposition and cerebellar function.
- Test grip strength by squeezing examiner’s fingers.
Key Terms & Definitions
- Abduction — movement away from the body’s midline.
- Adduction — movement toward the body’s midline.
- Flexion — bending a joint toward the body.
- Extension — straightening a joint away from the body.
- Supination — rotating the forearm to turn the palm up.
- Pronation — rotating the forearm to turn the palm down.
- Circumduction — circular movement of a limb.
- Opposition — movement of the thumb across the palm to touch fingertips.
Action Items / Next Steps
- Review and memorize the grading scale for muscle strength.
- Practice identifying and demonstrating each upper extremity movement.
- Study key definitions and be ready to apply them in practical exams.