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Assessing muscle tone is an important part of a motor exam. It can be done by testing the upper and lower extremities. To test the upper extremities, the patient should be fully relaxed, which can be achieved by distracting them with conversation. The examiner should then move each upper extremity at several joints to feel for any resistance or rigidity. To test the lower extremities, the patient should lie on an examination table and relax their legs. The examiner should then place their hands behind the patient's knee and lift the leg in a sudden motion. If the patient has normal muscle tone, the heel will drag along the surface of the bed.
| Characteristics | Values |
|---|---|
| Muscle tone in lower extremities | Support the patient's thigh with one hand, hold the foot with the other, and alternately extend and flex the patient's foot. If the heel does not make contact with the bed, there may be an increased tone or spasticity. |
| Muscle tone in upper extremities | Have the patient fully relaxed. Distract the patient with conversation. Passively move each upper extremity at several joints to feel for any resistance or rigidity. |
| Muscle tone in biceps | Distract the patient with questions or conversation. Place your index and middle finger over the patient's biceps tendon, followed by passive extension and flexion of the patient's arm and simultaneous rotation of the wrist. |
| Muscle strength | Observe the patient performing the tests, and assess the muscle strength on a scale from 0 to 5. Encourage maximal effort, stabilize the joint, and isolate the muscle group across one joint. |
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What You'll Learn
Assessing muscle tone in the lower extremities
To assess muscle tone in the lower extremities, the patient should be asked to relax their legs while lying on an examination table. With the patient in a supine position, the examiner should place their hands behind the patient's knee and lift the leg in a sudden motion. If the patient's heel drags along the bed, this indicates normal muscle tone. If the foot does not make contact with the bed, this may indicate increased tone or spasticity.
Another technique for assessing muscle tone in the lower extremities is to support the patient's thigh with one hand, while holding the foot with the other hand, and alternately extending and flexing the patient's foot.
To assess for subtle gait abnormalities or asymmetries, the patient can be instructed to walk on their heels and then on their toes. When performing formal muscle testing, the examiner should remember which spinal nerve roots innervate each muscle. During the examination, the examiner should observe the patient performing the tests and assess the muscle strength on a scale from 0 to 5. General principles for examining muscle strength include encouraging maximal effort, stabilising the joint and isolating the muscle group across one joint, comparing one side to the other, and looking for patterns of weakness (e.g. upper motor neuron or proximal versus distal).
It is important to assess whether the muscle tone is normal, decreased (hypotonia) or increased (hypertonia). Two common patterns of pathologic hypertonia are spasticity and rigidity. Spasticity manifests as resistance to the initiation of passive movement followed by a decrease in resistance over the remaining range of passive motion, which is why it is often called a "clasp-knife response".
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Assessing muscle tone in the upper extremities
The examiner should feel the patient's tone. If there is an increased tone or spasticity, the patient's foot may not make contact with the bed. Spasticity manifests as resistance to the initiation of passive movement followed by a decrease in resistance over the remaining range of passive motion. This is often called a "clasp-knife response". Rigidity is another common pattern of pathologic hypertonia.
During the examination, the examiner should observe the patient performing the tests and assess the muscle strength on a scale from 0 to 5. General principles for examining muscle strength include encouraging maximal effort, stabilising the joint, and isolating the muscle group across one joint. The examiner should also compare one side to the other and look for patterns of weakness, such as upper motor neuron or proximal versus distal.
To assess for subtle gait abnormalities or asymmetries, the examiner can instruct the patient to first walk on their heels and then walk on their toes.
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Testing for gait abnormalities
When performing a formal muscle test, it is important to remember which spinal nerve roots innervate each muscle. Observe the patient performing the tests and assess their muscle strength on a scale from 0 to 5. Encourage maximal effort and compare one side of the body to the other to look for patterns of weakness.
To test the muscle tone in the upper extremities, have the patient seated and fully relaxed. You can distract the patient with conversation to help them relax. Passively move each upper extremity at several joints to feel for any resistance or rigidity. Move the arm through its full range of flexion and extension at the elbow, then pronate and supinate the forearm, and finally, roll the hand around at the wrist.
To assess the lower extremities, have the patient lie on an examination table and relax their legs. Place your hands behind the patient's knee and lift the leg in a sudden motion. Observe if the heel drags along the bed. With normal muscle tone, the heel will drag along the surface. However, if there is increased tone or spasticity, the foot may not make contact with the bed.
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Assessing normal, decreased or increased muscle tone
To test the muscle tone in the lower extremities, the patient should lie on an examination table with their legs relaxed. The examiner should place their hands behind the patient's knee and lift the leg in a sudden motion. If the patient has normal muscle tone, the heel will drag along the surface of the bed. However, if there is increased tone or spasticity, the foot may not make contact with the bed.
Another technique for assessing the muscle tone in the lower extremities is to support the patient's thigh with one hand while holding the foot with the other, and alternately extending and flexing the patient's foot.
To assess for subtle gait abnormalities or asymmetries, the patient can be instructed to walk on their heels and then on their toes. During the examination, the patient's muscle strength should be assessed on a scale from 0 to 5. General principles for examining muscle strength include encouraging maximal effort, stabilising the joint, and isolating the muscle group across one joint. The examiner should also compare one side to the other and look for patterns of weakness.
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Testing for spasticity
To test for spasticity, a common pattern of pathologic hypertonia, you should first ensure the patient is fully relaxed. This can be achieved by distracting the patient with conversation. To test the upper extremities, move each joint through its full range of flexion and extension, feeling for any resistance or rigidity. To test the lower extremities, support the patient's thigh with one hand and hold the foot with the other, alternately extending and flexing the foot. If there is an increased tone or spasticity, the foot may not make contact with the bed. Another technique is to place your hands behind the patient's knee and lift the leg in a sudden motion, observing whether the heel drags along the bed. If there is no contact, this may indicate spasticity.
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Frequently asked questions
One technique is to support the patient's thigh with one hand, while holding the foot with the other hand, and alternately extending and flexing the patient's foot. Another technique is to place your hands behind the patient's knee, and lift the leg in a sudden motion. Observe if the heel drags along the bed.
Have the patient fully relaxed. One way to do this is by distracting the patient with conversation. While the patient is seated, passively move each upper extremity at several joints to get a feeling for any resistance or rigidity that may be present. Hold the forearm and the elbow, and move the arm through the full range of flexion and extension at the elbow. Then take the hand as if to shake it, and hold the forearm. First pronate and supinate the forearm. Then roll the hand around at the wrist. Feel the patient's tone.
Muscle tone can be normal, decreased (hypotonia) or increased (hypertonia). Two common patterns of pathologic hypertonia are spasticity and rigidity.
Spasticity manifests as resistance to the initiation of passive movement followed by a decrease in resistance over the remaining range of passive motion, which is why it is often called a "clasp-knife response".
Instruct the patient to first walk on the heels, and then walk on the toes.
