Test the grip (C7, C8, T1). Ask the patient to squeeze two of your fingers as A weak grip may be due to either hard as possible and not let them go. (To avoid getting hurt by hard central or peripheral nervous sys-
squeezes, place your own middle finger on top of your index finger.) You tem disease. It may also result from should normally have difficulty removing your fingers from the patient's painful disorders of the hands. grip. Testing both grips simultaneously with arms extended or in the lap facilitates comparison.
Test finger abduction (C8, T1, ulnar nerve). Position the patient's hand with palm down and fingers spread. Instructing the patient not to let you move the fingers, try to force them together.
Weak finger abduction in ulnar nerve disorders
Test opposition of the thumb (C8, T1, median nerve). The patient should try Weak opposition of the thumb in to touch the tip of the little finger with the thumb, against your resistance. median nerve disorders such as carpal tunnel syndrome
Assessment of muscle strength of the trunk may already have been made in other segments of the examination. It includes:
■ Flexion, extension, and lateral bending of the spine, and
■ Thoracic expansion and diaphragmatic excursion during respiration
Test flexion at the hip (L2, L3, L4—iliopsoas) by placing your hand on the patient's thigh and asking the patient to raise the leg against your hand.
Test adduction at the hips (L2, L3, L4—adductors). Place your hands firmly Symmetric weakness of the proxi-on the bed between the patient's knees. Ask the patient to bring both legs mal muscles suggests a myopathy together. or muscle disorder; symmetric weakness of distal muscles suggests a polyneuropathy, or disorder of peripheral nerves.
Test abduction at the hips (L4, L5, S1—gluteus medius and minimus). Place your hands firmly on the bed outside the patient's knees. Ask the patient to spread both legs against your hands.
Test extension at the hips (S1—gluteus maximus). Have the patient push the posterior thigh down against your hand.
Test extension at the knee (L2, L3, L4—quadriceps). Support the knee in flexion and ask the patient to straighten the leg against your hand. The quadriceps is the strongest muscle in the body, so expect a forceful response.
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