Upper Extremity Strength Assessment

What is an Upper Extremity Strength evaluation?

An upper extremity strength evaluation is a vital part of a physical exam to measure muscle strength and identify any weaknesses or neurological issues. This evaluation typically involves three key steps:

• Hand grip strength assessment: This test measures the patient's hand grip strength. The examiner extends their index and second fingers towards the patient, asking them to squeeze as tightly as possible. This helps assess the strength of the hand muscles and can indicate potential issues with the hand muscles or nerve functions.
• Arm pull test: The patient extends their arms with palms facing upwards. The examiner then applies resistance to the patient's forearms and asks them to pull their arms towards their body. This test targets the upper arm muscles, including the biceps and muscles connected to the brachial plexus.
• Palm press test: In this test, the patient presses their palms against the examiner's while the examiner resists. This evaluates the strength of muscles involved in pushing movements, including those in the upper arm, shoulders, and chest.

These tests collectively assess various muscle groups in the upper extremities, such as the hand, forearm, and upper arm muscles. They are crucial for diagnosing conditions related to muscle weakness, nerve damage, or other musculoskeletal issues. Using these tests, healthcare providers can pinpoint specific areas of weakness or concern that might need further medical attention or rehabilitation.

When should you administer this assessment?

An upper extremity strength assessment should be administered in the following situations:

• Evaluating muscle strength: When there's a need to evaluate muscle strength in the upper extremities, particularly in cases of suspected muscle weakness. This includes assessing critical muscles like the flexor muscles in the hand and elbow flexors.
• Suspected neurologic disease: If there's a suspicion of neurologic disease affecting the upper extremities, this assessment can help identify issues related to important spinal nerve roots or the brachial plexus.
• After injury or surgery: Post-injury or post-surgical assessments of the upper extremities are used to evaluate the patient’s strength and healing, especially in cases involving soft tissues or broken bones.
• Diagnosing musculoskeletal conditions: To diagnose conditions affecting the muscle groups in the upper extremities, including issues with the metacarpal bones or joint problems in areas like the wrist and elbow.
• Physical examination routine: As part of a comprehensive physical examination, especially in clinical practice, assessing the full range of muscle strength and motor testing is essential.
• Differentiating true weakness from functional limitations: To distinguish between true muscle weakness and limitations due to other factors like poor endurance or soft tissue injuries.
• Monitoring rehabilitation progress: In rehabilitation settings, monitor patients' progress and adjust treatment plans accordingly, ensuring that exercises and therapies improve muscle strength.
• Validating clinical methods: To demonstrate reasonable interrater reliability and ensure valid and reproducible results in muscle strength testing, a commonly accepted method in clinical settings.

The assessment offers valuable insights into the patient's muscle health and functional capabilities in each scenario, aiding in accurate diagnosis and effective treatment planning.

Interpreting the results

The results from an upper extremity strength evaluation might indicate several conditions or issues:

Muscle weakness

Reduced strength in hand grip or resistance tests can indicate muscle weakness. This might be related to nerve supply conditions, like issues with the brachial plexus or spinal nerve roots, leading to weakened muscle groups in the upper extremities.

Neurological issues

Difficulty in performing these tests might point to suspected neurologic diseases. For example, inconsistent performance in the hand grip test could indicate problems with the carpal bones or nerves supplying the hand.

Musculoskeletal disorders

Difficulty with the Arm Pull Test or Palm Press Test might reveal problems with the shoulder's ball and socket joint or the elbow's hinge joint. It could also suggest issues with the surrounding soft tissue or indicate a history of broken bones that didn't heal properly.

Vascular conditions

Uneven muscle strength might also suggest problems with blood flow or deep vein thrombosis, especially if accompanied by other symptoms like swelling or discoloration.

Functional limitations

The tests may reveal limitations in performing daily activities, indicating poor endurance or functional impairments in the upper extremities. This could be due to soft tissue injuries or conditions affecting muscle groups like the wrist and elbow extensors or flexors.

Reliability of results

Consistent results across tests demonstrate reasonable interrater reliability, confirming the validity of the muscle strength assessment. Conversely, inconsistent results might require more precise methods or specialized equipment for a thorough evaluation.

In summary, an upper extremity strength evaluation can provide crucial insights into a patient's muscular and neurological health, helping healthcare professionals to diagnose conditions, plan treatments, and recommend appropriate rehabilitation measures.

Next steps for treatment

After completing an upper extremity strength assessment, several next steps and additional tests are typically considered, depending on the initial findings:

• Further neurological testing: Further neurological tests may be necessary if the upper extremity assessment suggests neurological issues. These can include nerve conduction studies or electromyography (EMG) to assess the health and function of nerves and muscles.
• Imaging studies: To get a more detailed look at the structures within the upper extremity, imaging tests like X-rays, MRI, or CT scans can be performed. These are especially useful if there's a suspicion of structural damage, such as broken bones or soft tissue injuries.
• Blood flow assessments: If there are indications of vascular issues, tests to assess blood flow, such as Doppler ultrasound, might be recommended. This is important for conditions like deep vein thrombosis or to check the status of major arteries like the subclavian artery.
• Joint mobility and flexibility tests: To assess the full range of motion and the health of joints, tests that measure joint mobility and flexibility can be conducted. These are particularly relevant for joints like the shoulder's ball and socket joint or the elbow's hinge joint.
• Functional assessments: Functional assessments may be conducted for a more comprehensive view of how the strength deficits impact daily activities. These tests evaluate how well a patient can perform tasks that are part of their daily routine.
• Lower extremity assessments: In cases where comprehensive evaluation is required, a lower extremity assessment might also be conducted, especially if there's a suspicion of a condition affecting both upper and lower extremities.
• Referral to specialists: Based on the results, patients may be referred to specialists such as orthopedists, neurologists, or physiatrists for more specialized care.
• Physical therapy or rehabilitation: If muscle weakness or functional limitations are identified, a referral to physical therapy or a rehabilitation program may be recommended to improve strength, flexibility, and overall function.
• Follow-up assessments: Regular follow-up assessments may be scheduled to monitor progress or changes in the patient’s condition over time, ensuring that any adjustments to treatment plans are made as needed.