Manual muscle test for upper limb muscles:

1- Shoulder Flexion:

Test Position Normal Range

Subject Supine
Flatten lumbar spine (flex knees)
Shoulder no abduction, adduction or
rotation
(note: to measure gleno-humeral
motion, stabilize scapula)
- (for shoulder complex flexion)
167 4.7 (American Academy of
Orthopedic Surgeons)
150 (American Medical Association)
166 (mean), 4.7 (standard deviation),
(Boone and Azen)

Goniometer Alignment Normal End Feel

Axis center of humeral head near Muscle Stretch
acromion process.
Stationary arm parallel mid-
axillary line.
Moving arm aligned with midline of
humerus (lateral epicondyle).
 2- Shoulder Extension:

Test Position Normal Range

Subject Supine
Shoulder no abduction, adduction or
rotation
(note: to measure gleno-humeral
motion, stabilize scapula)
(for shoulder complex flexion)
62 9.5 (American Academy of
Orthopedic Surgeons)
50 (American Medical Association)
62.3 (mean), 9.5 (standard deviation),
(Boone and Azen)

Goniometer Alignment Normal End Feel

Axis center of humeral head near Capsular or ligamentous
acromion process
Stationary arm parallel mid-axillary
line
Moving arm aligned with midline of
humerus (lateral epicondyle)
 3- Shoulder Abduction:

Test Position Normal Range

Subject Supine
Shoulder 0 flexion and extension
Shoulder laterally (externally)
rotated
Shoulder abducted
Stabilize thorax (note: to measure
gleno-humeral motion, stabilize
scapula)
(for shoulder complex abduction)
184 7.0 (American Academy of
Orthopedic Surgeons)
180 (American Medical Association)
184 (mean), 7.0 (standard deviation),
(Boone and Azen)

Goniometer Alignment Normal End Feel

Axis center of humeral head near Muscle Stretch
acromion process
Stationary arm parallel to sternum
Moving arm aligned with midline
of humerus
 4- Shoulder Medial (Internal) Rotation:

Test Position Normal Range

Subject Supine 69 4.6 (American Academy of
Shoulder 90 abduction Orthopedic Surgeons)
Forearm neutral 90 (American Medical Association)
Elbow fixed 90 68.8 (mean), 4.6 (standard deviation),
Stabilize arm (Boone and Azen)

Goniometer Alignment Normal End Feel

Axis olecranon process of ulna Capsular
Stationary arm aligned vertically
Moving arm aligned with ulna
(styloid process)
 5- Shoulder Lateral (External) Rotation:

Test Position Normal Range

Subject Supine 104 8.5 (American Academy of
Shoulder 90 abduction Orthopedic Surgeons)
Forearm neutral 90 (American Medical Association)
Elbow fixed 90 103 (mean), 8.5 (standard
Stabilize arm deviation), (Boone and Azen)

Goniometer Alignment Normal End Feel

Axis olecranon process of ulna Capsular
Stationary arm aligned vertically
Moving arm aligned with ulna
(styloid process)
 6- Elbow Flexion:

Test Position Normal Range

Subject Supine 141 4.9 (American Academy of
Shoulder neutral (arm at side) Orthopedic Surgeons)
Forearm supinated 140 (American Medical Association)
Elbow fixed 142.9 (mean) 5.6 (standard
Stabilize arm deviation), (Boone and Azen)

Goniometer Alignment Normal End Feel

Axis lateral epicondyle of humerus Soft tissue approximation (capsular for
Stationary arm aligned humerus thin subjects)
(center of acromion process)
Moving arm aligned with radius
(styloid process)
 7- Elbow Extension:

Test Position Normal Range

Subject Supine 0.3 2.0 (American Academy of
Shoulder neutral (arm at side) Orthopedic Surgeons)
Forearm supinated 0.0 (American Medical Association)
Elbow fixed 0.6 (mean) 3.1 (standard deviation),
Stabilize arm (Boone and Azen)

Goniometer Alignment Normal End Feel

Axis lateral epicondyle of humerus Bone on bone (hard).
Stationary arm aligned humerus
(center of acromion process)
Moving arm aligned with radius
(styloid process)
 8- Forearm Supination:

Test Position Normal Range

Subject sitting 81 4.0 (American Academy of
Shoulder neutral (arm at side) Orthopedic Surgeons)
Elbow fixed at 90 80 (American Medical Association)
Stabilize arm 82.1 (mean) 3.8 (standard deviation),
Supinate forearm (Boone and Azen)

Goniometer Alignment Normal End Feel

Axis medial to ulnar styloid Capsular
Stationary arm parallel to humerus
Moving arm aligned with ventral
aspect of radius
 9- Forearm Pronation:

Test Position Normal Range

Subject sitting 75 5.3 (American Academy of
Shoulder neutral (arm at side) Orthopedic Surgeons)
Elbow fixed at 90 80 (American Medical Association)
Stabilize arm 75.8 (mean) 5.1 (standard deviation),
Supinate forearm (Boone and Azen)

Goniometer Alignment Normal End Feel

Axis lateral to ulnar styloid Capsular
Stationary arm parallel to
humerus
Moving arm aligned with dorsum
of radius
 10- Wrist Flexion:

Test Position Normal Range

Subject sitting
Forearm stabilized on table
Flex wrist (fingers relaxed)
75 6.6 (American Academy of
Orthopedic Surgeons)
60 (American Medical Association)
76.4 (mean) 6.3 (standard deviation),
(Boone and Azen)

Goniometer Alignment Normal End Feel

Axis lateral wrist Capsular
Stationary arm aligned with ulna
Moving arm aligned with fifth
metacarpal
 11- Wrist Extension:

Test Position Normal Range

Subject sitting
Forearm stabilized on table
Extended wrist (fingers relaxed)
74 6.6 (American Academy of
Orthopedic Surgeons)
60 (American Medical Association)
74.9 (mean) 6.4 (standard deviation),
(Boone and Azen)

Goniometer Alignment Normal End Feel

Axis lateral wrist (triquetrum) Capsular
Stationary arm aligned with ulna
Moving arm aligned with fifth
metacarpal
 12- Wrist Radial Deviation:
Test Position
Subject sitting with forearm
resting on table
Stabilize forearm to prevent
pronation or supination
Goniometer Alignment
Axis capitate
Stationary arm aligned with
forearm (lateral epicondyle)
Moving arm aligned with
metacarpal of middle finger
Normal Range
21 4.0 (American Academy of
Orthopedic Surgeons)
20 (American Medical Association)
21.5 (mean) 4.0 (standard deviation),
(Boone and Azen)
Normal End Feel
Ligamentous (ulnar collateral ligament)
 13- Wrist Ulnar Deviation:
Test Position
Subject sitting with forearm resting
on table
Stabilize forearm to prevent
pronation or supination
Goniometer Alignment
Axis capitate
Stationary arm aligned with
forearm (lateral epicondyle)
Moving arm aligned with
metacarpal of middle finger
Normal Range
35 3.8 (American Academy of
Orthopedic Surgeons)
30 (American Medical Association)
36.0 (mean) 3.8 (standard
deviation), (Boone and Azen)
Normal End Feel
Ligamentous (radial collateral
ligament)
 14- Metacarpophalangeal Joint Flexion:

Test Position Normal Range

Subject sitting with forearm resting 86 (index), 91 (ring), 105 (little)
on table (American Academy of Orthopedic
Wrist and interphalangeal joints Surgeons - active motion)
relaxed 90 (American Medical Association)
Forearm neutral
Stabilize metacarpal to prevent
motion

Goniometer Alignment Normal End Feel

Dorsal metacarpophalangeal joint capsular
Stationary arm - aligned with
metacarpal
Moving arm aligned with proximal
phalange
 15- Metacarpophalangeal Joint Extension:

Test Position Normal Range

Subject sitting with forearm resting 22 (index), 18 (long), 23 (ring), 19
on table (little) (American Academy of
Wrist and interphalangeal joints Orthopedic Surgeons - active motion)
relaxed 20 (American Medical Association)
Forearm neutral
Stabilize metacarpal to prevent
motion

Goniometer Alignment Normal End Feel

Dorsal metacarpophalangeal joint capsular
Stationary arm - aligned with
metacarpal
Moving arm aligned with proximal
phalange
 16- Metacarpophalangeal Joint Abduction:

Test Position Normal Range

Subject sitting with forearm ???
resting on table
Wrist neutral
Forearm neutral
Stabilize metacarpal to prevent
motion

Goniometer Alignment Normal End Feel

Dorsal metacarpophalangeal joint capsular
Stationary arm - aligned with
metacarpal
Moving arm aligned with
proximal phalange