脊髓损伤肌力检查课件

脊髓损伤神经学分类国际标准(2011年修订) 肌力检查,C5 屈肘| 肱二头肌, 肱肌,3级 病人体位: 肩关节内收，肘伸直，前臂旋后，腕关节放松位. 治疗师体位: Support the wrist. 提示: Bend your elbow and try to reach your hand to your nose. Action: The patient attempts to move through the full range of motion in elbow flexion.,C5 屈肘| 肱二头肌, 肱肌,4&5级 病人体位: 肩关节内收，肘关节屈曲90， 前臂旋后. 治疗师体位: 固定肩前部，抓住腕关节施加伸肘的力. 提示: Hold your arm. Dont let me move it. Action: The patient resists the examiners pull and attempts to maintain the elbow flexed at 90.,C5 屈肘| 肱二头肌, 肱肌,2级 病人体位: 肩关节内收，内旋，前臂放在腹部上方。肘关节屈曲30，前臂肘关节放松. 治疗师体位: Support the arm. 提示: Bend your elbow and try to bring your hand to your nose. Action: The patient attempts to move the elbow through a full range of motion in elbow flexion.,C5 屈肘| 肱二头肌, 肱肌,0&1级 病人体位: 同2级 治疗师体位: 一手托住前臂，一手握住肘关节，触诊或看到肌腱的收缩. 提示: Bend your elbow and try to bring your hand to your nose. Action: The patient attempts to move the elbow through a full range of motion in elbow flexion.,C6 伸腕| 腕长、腕短伸肌,3级 病人体位: 肩关节内收，肘关节伸直，前臂旋前，腕关节屈曲. 治疗师体位:One hand supports the distal forearm to allow the wrist to be pre-positioned in sufficient flexion for testing. 提示: Bend your wrist upwards. Lift your fingers toward the ceiling. Action: The patient attempts to extend the wrist through a full range of motion.,C6 伸腕| 腕长、腕短伸肌,4&5级 病人体位:同上，除腕关节伸展. 治疗师体位: 一手握住腕关节，一手在掌骨施加屈腕的力. 提示: Hold your wrist up. Dont let me push it down. Action: The patient resists the examiners push and attempts to maintain the wrist in the fully extended position.,C6 伸腕| 腕长、腕短伸肌,0，1&2级 病人体位: 同3级/肩关节稍屈曲，内旋，内收，上臂放在腹部上方，屈肘90，前臂旋前，腕关节屈曲. 治疗师体位: 一手握住腕关节，一手触诊腕背侧. 提示: Bend your wrist backwards. Action: The patient attempts to extend the wrist though a full range of motion in wrist extension.,C7 伸肘| 肱三头肌,3级 病人体位: 肩前屈90，肘关节屈曲，手贴近耳朵. 治疗师体位: Support the upper arm. 提示: Straighten your arm. Action: The patient attempts to move through the full range of elbow extension.,C7 伸肘| 肱三头肌,4&5级 病人体位: Same as grade 3, except the elbow is in 45 of flexion. 治疗师体位: Support the upper arm. Grasp the wrist and apply resistance to the distal forearm in the direction of elbow flexion. 提示: Hold this position. Dont let me bend your elbow. Action: The patient resists the examiners pressure and attempts to maintain the position of the elbow in 45 of flexion.,C7 伸肘| 肱三头肌,2级 病人体位: 肩内旋内收，前臂在腹部上方，肘关节屈曲. When checking Grade 2, sufficient flexion of the shoulder must be permitted to allow the forearm to clear and move over the chest and abdomen. 治疗师体位: Support the patients arm 提示: Straighten your arm. Action:The patient attempts to move through the full range of elbow extension.,C7 伸肘| 肱三头肌,0&1级 病人体位: 同上，除屈肘30 治疗师体位: 一手托住腕关节，一手触诊三头肌腱. 提示: Straighten your arm. Action: The patient attempts to fully extend the elbow.,C8 屈中指| 指深屈肌,3级 病人体位: 内收，肘伸直，前臂旋后，腕关节伸展，MCP和PIP固定在伸展位. 治疗师体位: 两手抓住手掌，固定中指MCP和PIP. 提示: Bend the tip of your middle finger. Action: The patient attempts to flex the distal interphalangeal (DIP) joint through the full range of motion in flexion.,C8 屈中指| 指深屈肌,4&5级 病人体位: The same as grade 3, except the DIP joint is fully flexed. 治疗师体位: 固定中指MCP、PIP，在指腹施加力. 提示: Hold the tip of your finger in this bent position. Dont let me move it. Action: The patient attempts to maintain the fully flexed position of the DIP joint, and resist the pressure applied by the examiner in the direction of finger extension.,C8 屈中指| 指深屈肌,0，1&2级 病人体位: 同上，除前臂旋前. 治疗师体位: 固定中指MCP、PIP。 提示: Bend the tip of your middle finger. Action: The patient attempts to flex the distal interphalangeal (DIP) joint through the full range of motion in flexion.,T1 外展小指| 小指展肌,3级 病人体位: 肩关节内收内旋，屈曲15，肘关节屈曲90，前臂旋前. 治疗师体位: 握住腕关节，固定MCP防止过度后伸. 提示: Move your little finger away from your ring finger. Action: The patient attempts to move the little finger through the full range of motion in abduction.,T1 外展小指| 小指展肌,4&5级 病人体位: Same as grade 3, except the little finger is fully abducted. 治疗师体位: 固定掌侧MCP防止过度后伸. 远端施加阻力. 提示: Hold your little finger away from your ring finger. Dont let me push it in. Action: The examiner exerts a pushing force against the side of the distal phalanx, and the patient attempts to resist the examiners force and keep the little finger fully abducted.,T1 外展小指| 小指展肌,0，1&2级 病人体位: 肩内收，肘伸直，前臂旋前，固定MCP/肩内收内旋，肘屈曲90，固定MCP. 治疗师体位: 固定腕关节，手背施加轻微向下的力，防止MCP过度后伸，触诊外展肌. 提示: Move your little finger away from your ring finger. Action: The patient attempts to abduct the little finger through the full range of motion.,L2 屈髋| 髂腰肌,3级 病人体位: 髋膝屈曲15. 治疗师体位:托住腘窝和小腿，检查屈曲时不要让髋关节超过90，避免对腰椎增加脊柱后凸的压力. 提示: Lift your knee towards your chest as far as you can, trying not to drag your foot on the exam table. Action:The patient attempts to flex hip to 90 of flexion.,L2 屈髋| 髂腰肌,4&5级 病人体位: The hip is in 90 of flexion with the knee relaxed. 治疗师体位:一手固定膝关节，一手固定对侧髂嵴. 提示: Hold your knee in this position. Dont let me push it down. Action:The patient attempts to resist the examiners push and keep the hip flexed at 90.,L2 屈髋| 髂腰肌,2级 病人体位: 屈髋外旋45，屈膝90 治疗师体位:Support the leg. 提示: Try to bring your knee out to the side,” or “Try to flex your thigh toward the side of the body.” Action:The patient attempts to move through the full range of motion in hip flexion.,L2 屈髋| 髂腰肌,0&1级 病人体位: Same as grade 3. 治疗师体位:Support the thigh to eliminate friction while palpating the superficial hip flexors just distal to the anterior superior iliac spine. 提示: lift your knee towards your chest as far as you can. Action:The patient attempts to flex the hip.,L3 伸膝| 股四头肌,3级 病人体位:屈髋15，屈膝30 . 治疗师体位: Place the arm under the tested knee and rest the hand on the patients distal thigh. This causes the tested knee to flex to approximately 30. 提示: Straighten your knee. Action: The patient attempts to straighten the knee through the full range of motion in extension.,L3 伸膝| 股四头肌,4&5级 病人体位: Same as grade 3, except the knee is in 15of flexion. 治疗师体位: Place the arm under the tested knee and rest the hand on the patients opposite thigh. Grasp the leg to be tested, just proximal to the ankle. 提示: Hold this position. Dont let me bend your knee. Action: Examiner exerts downward force into knee flexion while the patient attempts to hold the knee in 15 degrees of flexion.,L3 伸膝| 股四头肌,2级 病人体位: The hip is in external rotation and 45of flexion. The knee is flexed at 90. 治疗师体位: Support the distal thigh and leg. 提示: Straighten your knee. Action: The patient attempts to move through the full range of motion.,L3 伸膝| 股四头肌,0&1级 病人体位: 屈髋屈膝15. 治疗师体位: Support the leg. Palpate the patellar tendon or the belly of the quadriceps muscle for trace function. The muscle belly may also be observed for movement. 提示: Straighten your knee. Action: The patient attempts to straighten the knee.,L4 踝背屈| 胫骨前肌,3级 病人体位: 髋膝稍屈曲，手放在小腿下。 治疗师体位:At the patients side. Support the leg. 提示: Pull your toes upward toward your head, letting your ankle bend. Action:The patient attempts to dorsiflex ankle through a full range of motion.,L4 踝背屈| 胫骨前肌,4&5级 病人体位: Same as grade 3, except the ankle is fully dorsiflexed. 治疗师体位:手在足背施加跖屈的力量. 提示: Hold your ankle in this position. Dont let me push it down. Action:The patient attempts to resist the examiner and maintain the ankle in full dorsiflexion.,L4 踝背屈| 胫骨前肌,2级 病人体位: 髋外展外旋45 治疗师体位:Support the leg. 提示: Lift the toes upward toward the head, allowing the ankle to bend. Action:The patient attempts to dorsiflex ankle through the full range of motion.,L4 踝背屈| 胫骨前肌,0&1级 病人体位: The knee is fully extended and the ankle slightly plantarflexed. 治疗师体位:触诊肌腱或肌腹. 提示: Bring your toes upward toward your head, letting your ankle bend. Action:The patient attempts to dorsiflex the ankle.,L5 趾伸| 拇长伸肌,3级 病人体位: 下肢中立位. 治疗师体位:At the patients side. Support the foot. 提示: Lift your big toe upwards toward your knee. Action:The patient attempts to move the great toe through the full range of motion.,L5 趾伸| 拇长伸肌,4&5级 病人体位: Same as grade 3, except the toe is fully extended. 治疗师体位:拇指在大脚趾远端施加趾屈的力量. 提示: Keep your toe lifted upward. Dont let me push it down. Action:The patient attempts to resist the examiner and maintain the great toe in full extension.,L5 趾伸| 拇长伸肌,2级 病人体位: The hip is in external rotation, 45 abduction.The knee is flexed. The ankle and long toe are in a relaxed, neutral position. 治疗师体位:Support the leg. 提示: Lift your big toe upwards toward the knee. Action:The patient attempts to extend the great toe through the full range of motion.,L5 趾伸| 拇长伸肌,0&1级 病人体位: Same as grade 3. 治疗师体位:Support the leg and palpate the extensor tendon of the long toe for trace function. 提示: Lift your big toe upwards toward your knee. Action:The patient attempts to e