MUSCLE LENGTH TESTING of the UPPER EXTREMITY

In contrast to the lower extremity, only a few tests exist for examining the length of muscles in the upper extremity. Moreover, very little research has been conducted on the reliability of tests described in the literature. The purpose of this section is to describe some early tests suggested in the literature for measurement of muscle length of the upper extremity and the rationale for not including these tests in this chapter on upper extremity muscle length measurement techniques. Additionally, 10 tests for the examination of upper extremity muscle length are presented.

Apley’s Scratch Test

In 1959, a physical education text published by Scott and French ⁸ introduced a test for upper extremity flexibility, called the “opposite arm across the back” test. Hoppenfeld³ later referred to this test as “Apley’s scratch test.” In 1960, Myers⁷ described these tests to measure the muscle length of the shoulder and elbow, referring to this combination of tests as the “y position of the arms.” The test (herein referred to as Apley’s scratch test) consists of two parts that, depending on the author, could be performed on one extremity at a time or on two extremities simultaneously. One part involves asking the individual who is being tested to place the palm of the hand on the back by reaching behind the head and down between the shoulder blades as far as possible (Fig. 6-1). Hoppenfeld³ suggested that this maneuver yielded a measurement of shoulder lateral rotation and abduction, and Sullivan and Hawkins⁹ suggested that the test was a measurement for shoulder lateral rotation.

Fig. 6-1 Apley’s scratch test, a composite test measuring multiple motions and muscles that is not included in this chapter. From Magee DJ: Orthopedic Physical Therapy Assessment, 3rd ed. Philadelphia, WB Saunders, 1997, with permission.

The second part of Apley’s scratch test consists of asking the subject to place the dorsum of the hand against the back and to reach behind the back and up the spine as far as possible (see Fig. 6-1). Hoppenfeld³ suggested that this maneuver measured shoulder medial rotation and adduction; Sullivan and Hawkins⁹ suggested that the test examined shoulder medial rotation; and Mallon et al⁶ suggested that the test measured shoulder medial rotation and extension, elbow flexion, and scapular movement.

Techniques for documentation of the measurement have varied. Scott and French ⁸ suggested measuring the distance between the tips of the fingers of both hands when the two parts of the test are performed simultaneously. Goldstein² suggested performing the test one upper extremity at a time and recording the distance between the spinous process of C7 and the tips of the fingers. Finally, an alternative measurement presented by Magee⁵ is to have the individual perform the test one extremity at a time and record the levels of the vertebrae that the fingers most closely approximate.

Shoulder and Wrist Elevation Test

In a text on flexibility written in 1977, Johnson ⁴ described the shoulder and wrist elevation test used to measure shoulder flexibility. This test requires the individual to lift a stick or broom handle until the upper extremities are fully elevated overhead while the individual is lying in a prone position with the chin on a stable surface (Fig. 6-2). The individual raises the stick upward as high as possible by flexion at the shoulders.

Fig. 6-2 Shoulder and wrist elevation test, a composite test measuring multiple motions and muscles that is not included in this chapter.

Two methods have been described for documenting the amount of shoulder elevation achieved in this test. The first is simply to measure the distance from the stable surface to the stick.¹ In the second, which takes into consideration the length of the individual’s upper extremity, the length of the upper extremity is measured, and the test score is determined by subtracting the height to which the stick is raised from the length of the arm.⁴ A score of 0 is considered perfect.

As the techniques to be included in this chapter were selected, an effort was made to present techniques that can be performed easily and that give the clinician the option of having the test performed passively or actively. The shoulder and wrist elevation test was not included because of the need for a minimal strength level in the shoulder and trunk musculature of the subject for the test to be performed, the difficulty in controlling back extension by the individual during testing, and the inability of the test to be performed passively.

TECHNIQUES FOR TESTING MUSCLE

Length: Upper Extremity

Figures 6-3 through 6-33 illustrate the techniques for flexibility testing for the upper extremity that are included in this chapter. These measurement techniques were chosen because they can be performed passively by the clinician or actively by the patient, the tests do not require patient strength, and the examination can be performed easily.