Orthopedics - Oleksa A.P. 2006

Examination of the orthopedic patient
Assessment of muscle strength

When it is necessary to determine the cause of an orthopedic deformity (paralytic myopathy, Muscle hypotrophy) and properly plan Surgical Treatment to improve the functional capability of a limb, Muscle contraction strength is measured. This is done using a dynamometer (Collin) or subjectively by the resistance exerted by the patient in response to the examiner's pressure.

In clinical practice, the subjective method of assessing muscle strength is most commonly used. To do this, the patient is asked to flex, adduct, or abduct a limb segment with maximum effort while the examiner creates a counter-resistance to these movements. By comparing the strength of an individual muscle or a group of synergistic Muscles in the affected limb with that of the healthy limb, an approximate assessment of its strength can be made. However, when deciding on the feasibility of tenomyotransposition in polio patients, a more precise evaluation of individual muscle strength is required, for which a point scoring system is used.

A paralyzed muscle is graded 0 points, while a normal muscle with full strength is graded 5 points. In cases of impaired Muscle Function with 10% of its mass preserved, the muscle contracts without producing movement, and its strength is rated at 1 point. With 25% of the mass preserved, the muscle can produce movement, but only when the weight of the moving segment is eliminated, which is scored as 2 points. A muscle that causes movement of the segment against gravity (with 50% preserved mass) but cannot overcome additional resistance is graded 3 points. If the weakened muscle can overcome resistance, it is rated 4 points.

For a more precise determination of muscle strength, the "+" sign can be used for a stronger muscle and the "-" sign for a weaker one. To determine the strength of each individual muscle, the limb segments should be positioned so as to exclude the function of synergistic muscles as much as possible.

Clinical experience shows that after surgery, a transplanted muscle loses 1 point of strength. Therefore, based on the five-point muscle grading system, only muscles with a strength of 4 and 5 points are suitable for tenomyoplasty, as they are capable of compensating for the function of a paralyzed muscle.