MMT Clinical Applications 2 — Questions and Answers
Question 1: A patient with a C5 spinal cord injury is being evaluated. Which muscle would you test to determine C5 motor function?
- Elbow flexors (biceps brachii) (Correct answer)
- Wrist extensors (extensor carpi radialis)
- Finger flexors (flexor digitorum profundus)
- Intrinsic hand muscles (interossei)
Correct answer: Elbow flexors (biceps brachii)
Elbow flexors (biceps brachii) are the key muscles for the C5 myotome in spinal cord injury assessment.
Question 2: During MMT of the hip abductors, a patient can hold the position against gravity but gives way with minimal resistance. What grade is assigned?
- Grade 3
- Grade 3+
- Grade 4- (Correct answer)
- Grade 4
Correct answer: Grade 4-
Grade 4- indicates the muscle holds against gravity and tolerates minimal resistance but yields before moderate resistance is applied.
Question 3: When testing the serratus anterior, winging of the scapula during a wall push-up test most likely indicates weakness or paralysis due to injury of which nerve?
- Suprascapular nerve
- Long thoracic nerve (Correct answer)
- Axillary nerve
- Dorsal scapular nerve
Correct answer: Long thoracic nerve
The long thoracic nerve innervates the serratus anterior; its injury causes medial scapular winging during pushing activities.
Question 4: A patient post-stroke has spasticity in the elbow flexors. Which modification is most important when performing MMT on this patient?
- Use a break test rather than active motion
- Test only in the antigravity position
- Apply resistance slowly to avoid triggering the stretch reflex (Correct answer)
- Grade the muscle one level higher to compensate for spasticity
Correct answer: Apply resistance slowly to avoid triggering the stretch reflex
Applying resistance slowly helps avoid triggering the stretch reflex in spastic muscles, which would give a falsely lower grade.
Question 5: In Guillain-Barré syndrome, MMT findings typically show which pattern of weakness?
- Proximal > distal, asymmetric
- Distal > proximal, symmetric ascending (Correct answer)
- Proximal only, unilateral
- Distal only, affecting intrinsics first
Correct answer: Distal > proximal, symmetric ascending
Guillain-Barré syndrome classically presents with symmetric ascending weakness that is more pronounced distally and progresses proximally.
Question 6: A therapist finds that a patient's tibialis anterior grades 3/5. Which functional activity would this patient most likely struggle with?
- Standing on one leg
- Heel walking (Correct answer)
- Toe walking
- Sit-to-stand transfers
Correct answer: Heel walking
Tibialis anterior dorsiflexes the foot; grade 3/5 means the muscle can only move against gravity without added resistance, making heel walking (requiring sustained dorsiflexion) very difficult.
Question 7: When performing MMT on a patient with myasthenia gravis, the therapist should be aware that muscle strength may:
- Be greater in the morning and deteriorate with repeated testing (Correct answer)
- Be consistent regardless of fatigue level
- Improve with repetitive testing due to warm-up effect
- Show proximal-to-distal progression of weakness during testing
Correct answer: Be greater in the morning and deteriorate with repeated testing
Myasthenia gravis causes fatigable weakness; muscles test stronger early in the day or after rest and weaken with repeated or sustained activity.
MMT Clinical Applications 2
A patient with a C5 spinal cord injury is being evaluated.
Which muscle would you test to determine C5 motor function?