Manual Muscle Testing: A Clinician’s Guide

Demonstrate a manual muscle test for the coracobrachialis by passively flexing and adducting the shoulder with elbow flexion and supination, then apply force into extension and abduction while monitoring symptoms.

Assess supraspinatus, a rotator cuff muscle that abducts and externally rotates the shoulder, by passive flexion–abduction with external rotation, palpating activation and resisting internal rotation.

Perform the teres minor manual muscle test in supine to assess external rotation strength and shoulder stabilization, noting axillary nerve innervation for clinical differentiation of the rotator cuff.

Perform manual muscle testing of the subscapularis, a rotator cuff muscle, in prone with internal rotation and extension, assessing force, pain, substitutions, and glenoid stabilization.

Perform the teres major manual muscle test with the shoulder in adduction, internal rotation, and extension, hand on the posterior iliac crest, then apply abduction and external rotation while palpating.

Learn to perform the upper trapezius manual test, outlining its origin, insertion, and actions, then perform a shoulder shrug with targeted cervical flexion and rotation while monitoring pain.

Learn to test the middle trapezius by positioning the shoulder at 90 degrees of flexion with scapular adduction and slight upward rotation, assessing proper middle trapezius firing and preventing substitution.

Perform a prone manual muscle test of the lower trap, aligning the shoulder in line with its fibers to depress and externally rotate the scapula, then apply downward resistance.

Test the anterior deltoid flexion and abduction with rotation, applying extension force to isolate its action while palpating for firing and preventing trapezius substitution, noting axillary nerve and c4-c5 innervation.

Perform a manual test of the middle deltoid, abducting the shoulder in neutral rotation. Originates on the acromion and inserts at the deltoid tuberosity; axillary nerve (C4–C5) supplies it.

Test the posterior deltoid by placing the shoulder in slight abduction and extension with internal rotation. Apply resistance toward shoulder flexion and adduction toward midline while monitoring pain and force.

Test Latissimus dorsi, a broad muscle originating from T7–T12, lower ribs, thoracolumbar fascia, and iliac crest, with the patient prone, performing internal rotation, adduction, and extension while applying abduction force.

Test clavicular fibers of pectoralis major, origin on clavicle and insertion on greater tubercle, and their flexion, internal rotation, and horizontal adduction; supplied by lateral pectoral nerve.

Assess the sternal pec portion of the pectoralis major by testing internal rotation and horizontal adduction toward the opposite iliac crest, stabilizing the iliac crest and noting pain and force.

The pectoralis minor originates on ribs 3–5 and inserts on the coracoid process, tilting the scapula anteriorly and aiding rib elevation during inspiration and expiration, affecting posture.

Assess rhomboids and levator scapula by testing scapular adduction, downward rotation, and elevation in prone position, with resisted depression and abduction to gauge function and innervation (c4–c5, dorsal scapular).

Explore the levator scapulae in the manual muscle test, with origin on c1–c4 and insertion on the medial scapula, showing elevation, downward rotation, same-side flexion and rotation, and bilateral extension.

Assess serratus anterior function with a seated test: flex the shoulder to 120–130 degrees to abduct and upwardly rotate the scapula, applying extension resistance with slight downward rotation.

Perform a manual test of the biceps brachii (short head and long head origins) with elbow flexion and forearm supination, applying downward resistance to assess muscle integrity and C5–C6 involvement.

perform a manual muscle test of the brachialis by pronating the forearm and flexing the elbow to about 90 degrees, isolating elbow flexion away from the biceps and aiding diagnosis.

Test the brachioradialis with forearm in neutral and elbow flexed under 90 degrees, palpating the muscle as you apply elbow extension; note radial nerve innervation at C6 and C7.

Evaluate the supinator with a seated resisted supination test, keeping shoulder and elbow extended to minimize biceps; hold against pronation, watch for substitutions, and note radial nerve innervation (C5–C7).

Describe the three heads of the triceps brachii, their origins, and insertion at the olecranon. Explain elbow extension, long head shoulder extension and adduction, and radial nerve roots C6–T1.

Assess flexor carpi radialis, a wrist flexor and radial deviator. Origin: medial epicondyle; insertion: second metacarpal base; innervation: median nerve C6–C8. Test seated with supination, flexion, and radial deviation.

Perform a manual muscle test for the flexor carpi ulnaris, with wrist flexion and ulnar deviation, supported at the wrist, applying resistance at the hypothenar eminence while monitoring symptoms.

Assess extensor carpi radialis longus strength with a manual muscle test, guiding wrist extension and radial deviation, while applying dorsal resistance into wrist flexion and ulnar deviation and monitoring symptoms.

Perform a muscle test of the gluteus maximus in prone with knee flexion to isolate hip extension and external rotation, monitoring substitution, pain, and using a pillow to maximize range.

Perform manual muscle testing of the gluteus medius, focusing on its posterior fibers to evaluate hip stability, abduction, extension, and external rotation.

Learn the manual muscle test for the gluteus minimus, including origin, insertion, actions (abduction, hip flexion, internal rotation), palpating, applying force, and assessing hip stability.

Perform a manual muscle test of the hip's lateral rotators, emphasizing the piriformis origins from the sacrum and sacrotuberous ligament, insertion at the greater trochanter, and sacral plexus innervation (L5–S2).

The quadratus femoris originates on the ischial tuberosity and inserts at the quadrate line of the femur, innervated by the sacral plexus roots L4 through S2.

Describe the obturator internus, a hip lateral rotator from the pelvic membrane to the medial greater trochanter, innervated by L5 S1 S2, linked to hip pain and leg symptoms.

Highlight the obturator externus as a hip lateral rotator originating from the pubic and ischial rami, inserting into the trochanteric fossa and innervated by the obturator nerve (L3–L4).

Explore superior gemellus, a hip lateral rotator originating from the ischial spine, sharing a tendon with obturator internus and inserting on the medial greater trochanter, innervated by sacral plexus L5–S2.

Explore the inferior gemellus, a hip lateral rotator originating at the ischial tuberosity and inserting with the obturator internus tendon at the medial greater trochanter, innervated by sacral plexus L4–S2.

Stabilize distal femur in a seated hip, rotate into external rotation to isolate the external rotators, hold at end range, then apply internal rotation while monitoring compensations and numbness.

Demonstrates a hip internal rotation test for medial rotators, targeting the gluteus medius anterior fibers, tensor fascia lata, and gluteus minimus, with distal femur stabilization and tibial anchoring.

Master manual muscle testing of hip adductors by examining five hip adductor muscles, using a sideline test, and reviewing each muscle’s origin and insertion.

Describe the pectineus, a hip adductor: origin at the superior pubic ramus, insertion on the pectineal line of the femur, and innervation by the femoral and obturator nerves (L2–L4).

Learn about adductor magnus, a hip adductor that extends slightly, originating from the inferior pubic ramus and inserting on linea aspera and adductor tubercle; innervated by obturator and sciatic nerves.

Learn how the gracilis, a hip adductor, originates from the inferior pubic symphysis and pubic rami and inserts on the medial tibia, innervated by the obturator nerve (L2–L4).

Explore the adductor brevis: origin on the inferior pubic ramus, insertion at the distal pectineal line and proximal linea aspera, hip abduction towards midline, innervation by obturator nerve (L2–L4).

The adductor longus originates on the anterior pubis and inserts into medial third of the linea aspera to adduct the hip, innervated by the obturator nerve (L2, L3, L4).

Assess the sartorius muscle with a manual muscle test in a supine patient, focusing on hip flexion, abduction, external rotation, and knee flexion to evaluate hip and knee stability.

Conduct a manual muscle test of the tensor fascia lata to evaluate hip flexion, abduction, and internal rotation, noting its ASIS origin and iliotibial band insertion with knee extension influence.

Perform a manual muscle test of the iliopsoas, including the iliacus and psoas major, to assess end-range hip flexion and lumbar spine involvement in a seated position, monitoring for pain.

Assess the quadriceps by testing end-range knee extension in a seated patient, stabilizing the distal femur, palpating the quads, and applying distal tibial force to flex the knee.

Explore the hamstrings anatomy, including semimembranosus, semitendinosus, and biceps femoris, their origins, insertions, and actions, and learn knee flexion testing with hip rotation to isolate muscles.

Perform a manual muscle test of the soleus in prone with the knee flexed, stabilizing the ankle and applying dorsiflexion resistance to assess plantar flexion strength and pain.

Test the gastrocnemius, a two-headed muscle of the posterior leg, by having the patient rise onto both toes. Then compare single-leg plantar flexion to the two-leg height and monitor pain.

Perform a manual test of peroneus longus to assess ankle plantar flexion and eversion in supine patient, applying resistance into dorsiflexion and inversion and palpating superficial peroneal nerve innervation (L4–S1).

Perform a manual muscle test of tibialis posterior in supine, stabilizing above the ankle to assess plantar flexion and inversion, then resist dorsiflexion and eversion, monitoring tibial nerve involvement.

Assess the tibialis anterior with a manual muscle test to evaluate dorsiflexion and inversion, applying plantarflexion and eversion resistance, noting deep peroneal nerve (l4, l5, s1) supply.

The course jumpstarts manual muscle testing with objective methods to diagnose conditions, and emphasizes clear test positions, force directions, and practical handling skills.