脊髓损伤肌力检查-

脊髓损伤神经学分类国际标准(2011年修订)肌力检查编辑版ppt1C5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:Supportthewrist.提示:Bendyourelbowandtrytoreachyourhandtoyournose.Action:Thepatientattemptstomovethroughthefullrangeofmotioninelbowflexion.编辑版ppt2C5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:Holdyourarm.Don’tletmemoveit.Action:Thepatientresiststheexaminer’spullandattemptstomaintaintheelbowflexedat90°.编辑版ppt3C5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:Supportthearm.提示:Bendyourelbowandtrytobringyourhandtoyournose.Action:Thepatientattemptstomovetheelbowthroughafullrangeofmotioninelbowflexion.编辑版ppt4C5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:Bendyourelbowandtrytobringyourhandtoyournose.Action:Thepatientattemptstomovetheelbowthroughafullrangeofmotioninelbowflexion.编辑版ppt5C6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:Onehandsupportsthedistalforearmtoallowthewristtobepre-positionedinsufficientflexionfortesting.提示:

Bendyourwristupwards.Liftyourfingerstowardtheceiling.Action:Thepatientattemptstoextendthewristthroughafullrangeofmotion.编辑版ppt6C6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:Holdyourwristup.Don’tletmepushitdown.Action:Thepatientresiststheexaminer’spushandattemptstomaintainthewristinthefullyextendedposition.编辑版ppt7C6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:Bendyourwristbackwards.Action:Thepatientattemptstoextendthewristthoughafullrangeofmotioninwristextension.编辑版ppt8C7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:Supporttheupperarm.提示:Straightenyourarm.Action:Thepatientattemptstomovethroughthefullrangeofelbowextension.编辑版ppt9C7伸肘|肱三头肌4&5级病人体位:Sameasgrade3,excepttheelbowisin45°offlexion.治疗师体位:Supporttheupperarm.Graspthewristandapplyresistancetothedistalforearminthedirectionofelbowflexion.提示:Holdthisposition.Don’tletmebendyourelbow.Action:Thepatientresiststheexaminer’spressureandattemptstomaintainthepositionoftheelbowin45°offlexion.编辑版ppt10C7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.

WhencheckingGrade2,sufficientflexionoftheshouldermustbepermittedtoallowtheforearmtoclearandmoveoverthechestandabdomen.治疗师体位:Supportthepatient’sarm提示:Straightenyourarm.Action:Thepatientattemptstomovethroughthefullrangeofelbowextension.编辑版ppt11C7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:Straightenyourarm.Action:Thepatientattemptstofullyextendtheelbow.编辑版ppt12C8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:Bendthetipofyourmiddlefinger.Action:

Thepatientattemptstoflexthedistalinterphalangeal(DIP)jointthroughthefullrangeofmotioninflexion.编辑版ppt13C8屈中指|指深屈肌4&5级病人体位:Thesameasgrade3,excepttheDIPjointisfullyflexed.治疗师体位:固定中指MCP、PIP，在指腹施加力.提示:

Holdthetipofyourfingerinthisbentposition.Don’tletmemoveit.Action:

ThepatientattemptstomaintainthefullyflexedpositionoftheDIPjoint,andresistthepressureappliedbytheexaminerinthedirectionoffingerextension.编辑版ppt14C8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:Bendthetipofyourmiddlefinger.Action:Thepatientattemptstoflexthedistalinterphalangeal(DIP)jointthroughthefullrangeofmotioninflexion.编辑版ppt15T1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:Moveyourlittlefingerawayfromyourringfinger.

Action:

Thepatientattemptstomovethelittlefingerthroughthefullrangeofmotioninabduction.编辑版ppt16T1外展小指|小指展肌4&5级病人体位:Sameasgrade3,exceptthelittlefingerisfullyabducted.治疗师体位:固定掌侧MCP防止过度后伸.远端施加阻力.提示:Holdyourlittlefingerawayfromyourringfinger.Don’tletmepushitin.Action:Theexaminerexertsapushingforceagainstthesideofthedistalphalanx,andthepatientattemptstoresisttheexaminer’sforceandkeepthelittlefingerfullyabducted.编辑版ppt17T1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:Moveyourlittlefingerawayfromyourringfinger.Action:Thepatientattemptstoabductthelittlefingerthroughthefullrangeofmotion.编辑版ppt18L2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:Liftyourkneetowardsyourchestasfarasyoucan,tryingnottodragyourfootontheexamtable.Action:Thepatientattemptstoflexhipto90°offlexion.编辑版ppt19L2屈髋|髂腰肌4&5级病人体位:Thehipisin90°offlexionwiththekneerelaxed.治疗师体位:一手固定膝关节，一手固定对侧髂嵴.提示:Holdyourkneeinthisposition.Don’tletmepushitdown.Action:Thepatientattemptstoresisttheexaminer’spushandkeepthehipflexedat90°.编辑版ppt20L2屈髋|髂腰肌2级病人体位:屈髋外旋45°，屈膝90°治疗师体位:Supporttheleg.提示:Trytobringyourkneeouttotheside,”or“Trytoflexyourthightowardthesideofthebody.”Action:Thepatientattemptstomovethroughthefullrangeofmotioninhipflexion.编辑版ppt21L2屈髋|髂腰肌0&1级病人体位:Sameasgrade3.治疗师体位:Supportthethightoeliminatefrictionwhilepalpatingthesuperficialhipflexorsjustdistaltotheanteriorsuperioriliacspine.提示:liftyourkneetowardsyourchestasfarasyoucan.Action:Thepatientattemptstoflexthehip.编辑版ppt22L3伸膝|股四头肌3级病人体位:屈髋15°，屈膝30°.治疗师体位:

Placethearmunderthetestedkneeandrestthehandonthepatient’sdistalthigh.Thiscausesthetestedkneetoflextoapproximately30°.提示:Straightenyourknee.Action:

Thepatientattemptstostraightenthekneethroughthefullrangeofmotioninextension.编辑版ppt23L3伸膝|股四头肌4&5级病人体位:Sameasgrade3,exceptthekneeisin15°offlexion.治疗师体位:

Placethearmunderthetestedkneeandrestthehandonthepatient’soppositethigh.Graspthelegtobetested,justproximaltotheankle.提示:Holdthisposition.Don’tletmebendyourknee.Action:

Examinerexertsdownwardforceintokneeflexionwhilethepatientattemptstoholdthekneein15degreesofflexion.编辑版ppt24L3伸膝|股四头肌2级病人体位:Thehipisinexternalrotationand45°offlexion.Thekneeisflexedat90°.治疗师体位:

Supportthedistalthighandleg.提示:Straightenyourknee.Action:

Thepatientattemptstomovethroughthefullrangeofmotion.编辑版ppt25L3伸膝|股四头肌0&1级病人体位:屈髋屈膝15°.治疗师体位:Supporttheleg.Palpatethepatellartendonorthebellyofthequadricepsmusclefortracefunction.Themusclebellymayalsobeobservedformovement.提示:Straightenyourknee.Action:

Thepatientattemptstostraightentheknee.编辑版ppt26L4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:Atthepatient’sside.Supporttheleg.提示:Pullyourtoesupwardtowardyourhead,lettingyouranklebend.Action:Thepatientattemptstodorsiflexanklethroughafullrangeofmotion.编辑版ppt27L4踝背屈|胫骨前肌4&5级病人体位:Sameasgrade3,excepttheankleisfullydorsiflexed.治疗师体位:手在足背施加跖屈的力量.提示:Holdyourankleinthisposition.Don’tletmepushitdown.Action:Thepatientattemptstoresisttheexaminerandmaintaintheankleinfulldorsiflexion.编辑版ppt28L4踝背屈|胫骨前肌2级病人体位:髋外展外旋45°治疗师体位:Supporttheleg.提示:Liftthetoesupwardtowardthehead,allowingtheankletobend.Action:Thepatientattemptstodorsiflexanklethroughthefullrangeofmotion.编辑版ppt29L4踝背屈|胫骨前肌0&1级病人体位:Thekneeisfullyextendedandtheankleslightlyplantarflexed.治疗师体位:触诊肌腱或肌腹.提示:Bringyourtoesupwardtowardyourhead,lettingyouranklebend.Action:Thepatientattemptstodorsiflextheankle.编辑版ppt30L5趾伸|拇长伸肌3级病人体位:下肢中立位.治疗师体位:Atthepatient’sside.Supportthefoot.提示:Liftyourbigtoeupwardstowardyourknee.Action:Thepatientattemptstomovethegreattoethroughthefullrangeofmotion.编辑版ppt31L5趾伸|拇长伸肌4&5级病人体位:Sameasgrade3,exceptthetoeisfullyextended.治疗师体位:拇指在大脚趾远端施加趾屈的力量.提示:Keepyourtoeliftedupward.Don’tletmepushitdown.Action:Thepatientattemptstoresisttheexaminerandmaintainthegreattoeinfullextension.编辑版ppt32L5趾伸|拇长伸肌2级病人体位:Thehipisinexternalrotation,45°abduction.Thekneeisflexed.Theankleandlongtoeareinarelaxed,neutralposition.治疗师体位:Supporttheleg.提示:Liftyourbigtoeupwardstowardtheknee.Action:Thepatientattemptstoextendthegreattoethroughthefullrangeofmotion.编辑版ppt33L5趾伸|拇长伸肌0&1级病人体位:Sameasgrade3.治疗师体位:Supportthelegandpalpatetheextensortendonofthelongtoefortracefunction.提示:Liftyourbigtoeupwardstowardyourknee.Action:Thepatientattemptstoexte