Muscle Examination

A detailed study of the muscular system, including the detection of various disorders of development, tone, muscle strength, the functions of individual muscles, is usually conducted by a neurologist and is therefore studied in detail in the course of neural diseases. However, a doctor of any specialty must possess the basic methods of studying the muscular system, since some of its changes may occur in diseases of the internal organs.

Assessing Complaints

First of all, note the presence of patient complaints of muscle weakness and muscle fatigue when performing various movements. Sometimes these complaints concern many groups of muscles, but more often affect quite certain groups (for example, chewing muscles, facial muscles, etc.). The patient may also complain of involuntary fibrillar twitching of certain muscle groups, the restriction and total absence of active (voluntary) movements.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Examination and palpation

On examination, attention is first of all paid to the degree of development of muscle tissue, the presence of atrophy or hypertrophy of individual muscles and muscle groups. Muscle atrophy is often observed in patients with peripheral paralysis and paresis, with damage to the spinal cord, prolonged involuntary immobility (so-called atrophy from inactivity). If there is atrophy of individual muscles or asymmetry in their development, measure and compare the circumference of the shin, hip, shoulder, forearm on the healthy side and on the side of the lesion. Hypertrophy of the muscles is much less common (for example, with some hereditary diseases) and usually refers to separate muscle groups (gastrocnemius, quadriceps, deltoid).

When palpation of individual muscles, you can find soreness (for example, in myositis). By direct sensation of the muscles of the symmetrical parts of the body, muscle tone is also determined , the changes of which in a number of cases are of great diagnostic significance. With a decrease in muscle tone (hypotension), the muscle tissue appears soft, flabby, doughy. With increasing muscle tone (hypertension), muscle tissue becomes, on the contrary, more dense than normal.

[10], [11], [12], [13], [14], [15],

Evaluation of muscle tone and strength

To assess the muscle tone, some special techniques are also used. Asking the patient not to resist, the doctor himself produces passive movements (flexion and extension) of the patient's limbs in the shoulder, elbow and radiocarpal joints. In the horizontal position of the patient on the back, the same movements are performed in the hip, knee and ankle joints. It is necessary to compare the tone of the muscles of the right and left extremities. With a decrease in muscle tone, the passive flexion and extension of the corresponding limb is extremely easy, in the absence of an insignificant resistance in the norm. With hypertension, the muscle resistance, on the contrary, is increased. Raising and lowering the patient's head, you can assess the tone of the muscles of the neck. Reducing the tone of these muscles is easy to detect if, lifting the patient's head, suddenly take her hand away from her. More precisely, muscle tone is determined with the help of special instruments (myotonometers).

Muscular strength is assessed by the resistance that the patient is able to overcome. The doctor suggests the patient to bend his arm in the elbow joint, after which, asking the patient to resist, tries to unbend it. Similarly, the muscular strength of the patient can be checked by inviting him to bend the leg in the knee joint, the brush in the wrist joint, the foot in the ankle, and so on. When examining the muscular strength of the extensor muscles of the shoulder, the doctor tries to bend the patient's arm at the elbow joint, which the patient keeps in the unfolded state. It is clear that the study is carried out separately for the muscles of the right and left extremities.

Muscular strength is assessed on a five-point (sometimes - six-point) system. In this case, in the case of normal muscle strength, the highest scores are set, and in the absence of normal muscle force, the lowest scores (0) are set. For a more accurate determination of muscular strength, special dynamometers are used.

One of the indicators of muscle strength is muscle fatigue. It is easily detected if you ask the patient several times to quickly squeeze his fingers into a fist and unclench them. You can also offer the patient to pull both hands forward. In the presence of muscle fatigue, the patient's hand (or one of them) quickly falls.

In the study of the muscular system, attention is drawn to the presence of another variant of motor disorders - violent movements ( hyperkinesis ) that can occur in patients with rheumatism ( rheumatic chorea ), alcoholism, Parkinson's disease, and sometimes in elderly and senile individuals (senile tremor). In addition, with certain diseases, involuntary muscle contractions, called convulsions, are also observed . It is accepted to distinguish between clonic convulsions, when muscle contractions are replaced by distinct periods of their relaxation, and tonic convulsions, in which spasmodic contractions of muscles occur, and the periods of relaxation are very weak and practically invisible.

[16], [17], [18], [19], [20]