Hand Surgery Source

Muscle Testing by Cervical Root

Test, Exam and Signs

 

Primary Rami

Root

Ventral

Dorsal

C1

Rectus capitis anterior/lateralis

Rectus capitis posterior major/minor

 

Longus capitis

Obliquus capitis superior/inferior

 

Geniohyoid

Obliquus capitis inferior

 

Sternothyroid

 

 

Thyrohyoid

 

 

Omohyoid

 

C2

Rectus capitis anterior/lateralis

Longissimus capitis

 

Longus capitis

Semispinalis capitis

 

Longus colli

Semispinalis cervicis

 

Sternocleidomastoid

Multifidi

 

Sternothyroid

 

 

Sternohyoid

 

 

Omohyoid

 

C3

Intertransversarii cervicis

Longissimus capitis

 

Longus capitis

Splenius capitis

 

Longus colli

Semispinalis capitis

 

Sternothyroid

Spinalis capitis

 

Sternohyoid

Longissimus cervicis

 

Omohyoid

Semispinalis cervicis

 

Levator scapulae (dorsal)

Spinalis cervicis

 

Scalenus medius

Interspinales cervicis

 

Sternocleidomastoid

Intertransversarii cervicis (posterior)

 

Diaphragm (C4)

Rotatores cervicis

 

Trapezius

Multifidi

C4

Longus colli

Splenius capitis

 

Intertransversarii cervicis (anterior)

Semispinalis capitis

 

Levator scapulae (dorsal)

Spinalis capitis

 

Scalenus anterior/medius

Longissimus cervicis

 

Diaphragm (phrenic)

Semispinalis cervicis

 

 

Iliocostalis cervicis

 

 

Splenius cervicis

 

 

Spinalis cervicis

 

 

Interspinalis cervicis

 

 

Intertransversarii cervicis (posterior)

 

 

Rotatores cervicis

 

 

Multifidi

C5

Longus colli

Longissimu capitis

 

Intertransversarii cervicis (anterior)

Splenius capitis

 

Scalenus anterior/medius

Semispinalis capitis

 

Subclavius

Longissimus cervicis

 

Diaphragm

Semispinalis cervicis

 

Levator scapulae

Iliocostalis cervicis

 

Rhomboid major

Splenius cervicis

 

Rhomboid minor

Spinalis cervicis

 

Serratus anterior

Interspinalis cervicis

 

Pectoralis major/minor

Rotatores cervicis

 

Supraspinatus

Multifidi

 

Infraspinatus

 

 

Subscapularis

 

 

Teres major/minor

 

 

Deltoid

 

 

Coracobrachialis

 

 

Biceps brachii

 

 

Brachialis

 

 

Brachioradialis

 

C6

Longus colli

Longissimus capitis

 

Intertransversarii cervicis (anterior)

Splenius capitis

 

Scalenus anterior/medius/posterior

Semispinalis capitis

 

Latissimus dorsi

Spinalis capitis

 

Subclavius

Longissimus cervicis

 

Serratus anterior

Semispinalis cervicis

 

Pectoralis major/minor

Ilocostalis cervicis

 

Infraspinatus

Splenius cervicis

 

Supraspinatus

Spinalis cervicis

 

Subscapularis

Interspinales cervicis

 

Teres major/minor

Intertransversarii cervicis (posterior)

 

Deltoid

Rotatores cervicis

 

Coracobrachialis

Multifidi

 

Biceps brachii

 

 

Brachialis

 

 

Triceps brachii

 

 

Brachioradialis

 

 

Anconeuss

 

 

Supinator

 

 

Extensor carpi radialis longus

 

 

Pronator teres

 

 

Flexor carpi radialis

 

C7

Intertransversarii cervicis (anterior)

Longissimus capitis

 

Scalenus medius/posterior

Semispinalis capitis

 

Serratus anterior

Spinalis capitis

 

Latissimus dorsi

Longissimus cervicis

 

Pectoralis major/minor

Semispinalis cervicis

 

Coracobrachialis

Ilocostalis cervicis

 

Brachialis

Splenius cervicis

 

Triceps brachii

Spinalis cervicis

 

Anconeus

Interspinales cervicis

 

Supinator

Intertransversarii cervicis (posterior)

 

Extensor carpi radialis longus/brevis

Rotatores cervicis

 

Extensor carpi ulnaris

Multifidi

 

Extensor digitorum

 

 

Extensor indicis

 

 

Extensor digiti minimi

 

 

Abductor pollicis longus

 

 

Extensor pollicis longus/brevis

 

 

Pronator teres/quadratus

 

 

Flexor carpi radialis

 

 

Palmaris longus

 

 

Flexor carpi ulnaris

 

Flexor pollicis longus

 

C8

Intertransversarii cervicis (anterior)

Longissimus capitis

 

Scalenus medius/posterior

Semispinalis capitis

 

Latissimus dorsi

Spinalis capitis

 

Pectoralis major/minor

Longissimus cervicis

 

Triceps brachii

Semispinalis cervicis

 

Anconeus

Ilocostalis cervicis

 

Extensor carpi radialis brevis

Splenius cervicis

 

Extensor carpi ulnaris

Spinalis cervicis

 

Extensor digitorum

Interspinales cervicis

 

Extensor indicis

Intertransversarii cervicis (posterior)

 

Extensor digiti minimi

Rotatores cervicis

 

Abductor pollicis longus

Multifidi

 

Extensor pollicis longus/brevis

 

 

Pronator quadratus

 

 

Palmaris longus

 

 

Flexor digitorum superficialis

 

 

Flexor digitorum profundus

 

 

Lumbricales

 

 

Flexor pollicis longus/brevis (deep head)

 

 

Abductor pollicis brevis

 

 

Opponens pollicis

 

 

Adductor pollicis

 

 

Flexor carpi ulnaris

 

 

Interossei (dorsal/palmar)

 

 

Opponens digiti minimi

 

 

Flexor digiti minimi brevis

 

 

Palmaris brevis

 

 

Grading of muscle strength:

Grade

Strength

Description

  5*

Normal

Completes range of motion and holds against maximal finger resistance

  4*

Good

Completes range against moderate resistance

3

Fair

Completes range of motion with no resistance

2

Poor

Completes range of motion

1

Trace

Palpable or visible contractile activity, which may or may not be accompanied by a flicker of motion

0

Zero

No contractile activity

*The distinction between Grades 4 and 5 is based on comparison with the normal hand and, barring that, extensive experience in testing the hand.

Presentation Photos and Related Diagrams
  • C5 motor activity examined by testing biceps and deltoid muscle.
    C5 motor activity examined by testing biceps and deltoid muscle.
  • C6 motor activity examined by testing biceps and wrist extensor muscle function
    C6 motor activity examined by testing biceps and wrist extensor muscle function
  • C7 motor activity examined by testing triceps, wrist flexors and finger extensor muscle function
    C7 motor activity examined by testing triceps, wrist flexors and finger extensor muscle function
  • C8 motor activity examined by testing finger flexors and ulnar intrinsic muscle function
    C8 motor activity examined by testing finger flexors and ulnar intrinsic muscle function
Definition of Positive Result
  • In muscle testing, a normal result is a positive one. During a normal muscle test, the examiner should observe a normal muscle contraction that can move the joint or tendon against full resistance.
Definition of Negative Result
  • In muscle testing, an abnormal result is a negative one. During an abnormal muscle test, the examiner should observe an abnormal muscle contraction that can move the joint or tendon. In a complete denervation injury, such as a complete nerve laceration, there will be no evidence of any muscle function and the muscle testing grade will be zero.
Comments and Pearls

Quick Root Based Muscle Testing Summary

  • C5 - Elbow Flexion - Test Biceps
  • C6 - Wrist Extension - Test Radial wrist extensors (ECRL & ECRB)
  • C7 - Elbow Extension - Test Triceps
  • C8 - Long Finger Flexion - Test Long finger flexor digitrum profundus (FDP)
  • T1 - Little Finger Abduction - Test hypothenar muscles
Diagnoses Associated with Tests, Exams and Signs
References
  1. Hislop JH, Avers D, Brown M. Daniels and Worthingham's Muscle Testing, Techniques of Manual Examination and Performance Testing. 9th ed. St. Louis, Missouri: Elsevier Saunders, 2014, pp. 138–202.