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ELBOW FLEXION Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair) Position of Patient: Short sitting with arms at sides. Biceps brachii: forearm in supination Brachialis: forearm in pronation Brachioradialis: forearm in midposition between pronation and supination

Position of Therapist: Standing in front of patient toward the test side. Hand giving resistance is contoured over the volar (flexor) surface of the forearm proximal to the wrist. The other forearm is placed over the anterior surface of the upper arm and applies counterforce by resisting any upper arm movement. Instructions to Patient (All Three Tests) GRADES 5 AND 4: “Bend your elbow. Hold it. Don’t let me pull it down.” GRADE 3: “Bend your elbow.”

GRADE 2 Position of Patient: Short sitting with arm abducted to 90° and supported by examiner. Forearm is supinated (biceps), pronated (brachialis), and in midposition (brachioradialis). Position of Therapist: Standing in front of patient and supporting abducted arm under the elbow and wrist if necessary. Palpate the tendon of the biceps in the antecubital space (see Figure 5-115). On the arm, the muscle fibers may be felt on the anterior surface of the middle two thirds with the short head lying medial to the long head. Palpate the brachialis in the distal arm medial to the tendon of the biceps. Palpate the brachioradialis on the lateral surface of the neutrally positioned forearm, where it forms the lateral border of the cubital fossa. Instructions to Patient: “Try to bend your elbow.”

GRADE 1(TRACE) & GRADE 0 (ZERO) Positions of Patient and Therapist: Supine for all three muscles with therapist standing at test side All other aspects are the same as for the Grade 2 test.

Grading (ELBOW FLEXION) Grade 5 (Normal): Completes available range and holds firmly against maximal resistance. Grade 4 (Good): Completes available range against strong to moderate resistance, but the end point may not be firm. Grade 3 (Fair): Completes available range with each forearm position with no manual resistance. Grade 2 (Poor): Completes range of motion (in each of the muscles tested). Grade 1 (Trace): Examiner can palpate a contractile response in each of the three muscles for which a Trace grade is given. Grade 0 (Zero): No palpable contractile activity.

ELBOW EXTENSION Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair) Position of Patient: Prone on table. The patient starts the test with the arm in 90° of abduction and the forearm flexed and hanging vertically over the side of the table. Position of Therapist: For the prone patient, the therapist provides support just above the elbow. The other hand is used to apply downward resistance on the dorsal surface of the forearm. Instructions to Patient: “Straighten your elbow. Hold it. Don’t let me bend it.”

Grade 2 (Poor), Grade 1 (Trace), and Grade 0 (Zero) Position of Patient: Short sitting. The arm is abducted to 90° with the shoulder in neutral rotation and the elbow flexed to about 45°. The entire limb is horizontal to the floor. Position of Therapist: Standing at test side of patient. Grade 2: support the limb at the elbow Grade 1: support the limb under the forearm and palpate the triceps on the posterior surface of the arm just proximal to the olecranon process

Grade 0: support the limb under the forearm and palpate the triceps on the posterior surface of the arm just proximal to the olecranon process. Instructions to Patient: “Try to straighten your elbow.”

GRADING (ELBOW EXTENSION) Grade 5 (Normal): Completes available range and holds firmly against maximal resistance. Grade 4 (Good): Completes available range against strong resistance, but there is a “give” to the resistance at the end range. Grade 3 (Fair): Completes available range with no manual resistance. Grade 2 (Poor): Completes available range in the absence of gravity. Grade 1 (Trace): Examiner can feel tension in the triceps tendon just proximal to the olecranon or contractile activity in the muscle fibers on the posterior surface of the arm. Grade 0 (Zero): No evidence of any muscle activity....