A comparison of manual and quantitative elbow strength testing

Leili Shahgholi, Keith A. Bengtson, Allen T. Bishop, Alexander Y. Shin, Robert J. Spinner, Jeffrey R. Basford, Kenton R. Kaufman

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


OBJECTIVE: The aim of this study was to compare the clinical ratings of elbow strength obtained by skilled clinicians with objective strength measurement obtained through quantitative testing. DESIGN: A retrospective comparison of subject clinical records with quantitative strength testing results in a motion analysis laboratory was conducted. A total of 110 individuals between the ages of 8 and 65 yrs with traumatic brachial plexus injuries were identified. Patients underwent manual muscle strength testing as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent) and quantitative elbow flexion and extension strength measurements. RESULTS: A total of 92 subjects had elbow flexion testing. Half of the subjects clinically assessed as having normal (5/5) elbow flexion strength on manual muscle testing exhibited less than 42% of their age-expected strength on quantitative testing. Eighty-four subjects had elbow extension strength testing. Similarly, half of those displaying normal elbow extension strength on manual muscle testing were found to have less than 62% of their age-expected values on quantitative testing. Significant differences between manual muscle testing and quantitative findings were not detected for the lesser (0-4) strength grades. CONCLUSIONS: Manual muscle testing, even when performed by experienced clinicians, may be more misleading than expected for subjects graded as having normal (5/5) strength. Manual muscle testing estimates for the lesser strength grades (1-4/5) seem reasonably accurate.

Original languageEnglish (US)
Pages (from-to)856-862
Number of pages7
JournalAmerican Journal of Physical Medicine and Rehabilitation
Issue number10
StatePublished - Oct 2012


  • Biomechanics
  • Manual Muscle Test
  • Muscle Strength

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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