REIDER PART 123

economy, common areas of palpation are identified on the surface anatomy photographs. Additional photo-graphs that show the palpation of specific individual landmarks are included. In some of these photographs, the hand placement of the examiner is modified to avoid obscuring the anatomy.

■ MANIPULATION

The Manipulation section of each chapter contains a wide variety of materiał. Any examination technique that did not seem to fit readily under the rubrics of inspection or palpation is included here. The passive ROM examina-tion can certainly be considered to involve manipulation, but it has bccn included with the Active Rangę of Motion section under Inspection for continuity and coherence.

Muscle Testing

Each chapter that deals with the examination of the limbs contains the section Muscle Testing. This section describes ways to evaluate the strength of the major mus-cles or muscle groups used to move the joint or joints described in that chapter. For this reason, testing of the biceps and triceps brachii is included in Chapter 3, Elbow and Forearm, and testing of the quadriccps and ham-strings is included in Chapter 6, Knee. This method is thought to provide the most logical grouping of tests, although it serves to point out the arbitrary and some-what artificial naturę of dividing the limbs into segments. When possible, the isolated testing of individual muscles is described. Often, it is not possible to fully isolate a par-ticular muscle, and it must be tested in concert with other muscles that perform a similar function.

Traditionally, muscle strength has been evaluated by assigning the muscle a grade from 0 to 5. Grade 0 indi-cates that no contraction of the muscle is detectable. Grade 1 is assigncd to a muscle in which a contraction can be seen or palpated but strength is insufficient to move the appropriate joint at all, even with gravity elim-inated. Grade 2 is assigncd to a muscle that can move the appropriate joint if the limb is oriented so that the force of gravity is eliminated. Grade 3 is assigned to a muscle that is strong enough to move a joint against the force of gravity but is unable to resist any additional applied force. Grade 4 is assigned to a muscle that is capable of moving

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