MMT Clinical Applications 3 — Questions and Answers
Question 1: A patient with lateral epicondylitis is being assessed. Which MMT finding would most directly support this diagnosis?
- Weakness of wrist flexors with pain on resisted wrist extension
- Weakness of wrist extensors with pain on resisted wrist extension (Correct answer)
- Weakness of finger extensors without pain
- Weakness of supinators with pain on resisted forearm pronation
Correct answer: Weakness of wrist extensors with pain on resisted wrist extension
Lateral epicondylitis involves the common extensor origin; resisted wrist extension reproduces pain and may reveal extensor weakness.
Question 2: Which MMT position best isolates the middle trapezius while minimizing upper trapezius substitution?
- Prone with shoulder at 90° abduction and elbow extended, resisting horizontal adduction (Correct answer)
- Seated with shoulder elevated against resistance
- Prone with arm at side, resisting shoulder extension
- Side-lying with shoulder at 90° and elbow flexed to 90°
Correct answer: Prone with shoulder at 90° abduction and elbow extended, resisting horizontal adduction
Prone horizontal abduction at 90° with elbow extended targets middle trapezius for scapular retraction while reducing upper trapezius involvement.
Question 3: A patient with Duchenne muscular dystrophy uses a Gowers' maneuver to rise from the floor. This sign primarily reflects weakness of which muscle group?
- Hip flexors and knee extensors
- Hip extensors and knee extensors (Correct answer)
- Hip abductors and ankle plantar flexors
- Core stabilizers and elbow extensors
Correct answer: Hip extensors and knee extensors
Gowers' maneuver compensates for weak hip extensors (gluteus maximus) and knee extensors (quadriceps) by using the arms to 'walk up' the thighs.
Question 4: During cervical spine assessment, weak shoulder shrug on MMT combined with weak head rotation to the opposite side suggests involvement of which structure?
- C3-C4 nerve roots
- Spinal accessory nerve (CN XI) (Correct answer)
- Phrenic nerve
- C5-C6 nerve roots
Correct answer: Spinal accessory nerve (CN XI)
The spinal accessory nerve innervates both the trapezius (shoulder shrug) and sternocleidomastoid (head rotation to opposite side).
Question 5: When testing the iliopsoas in a patient with a recent hip replacement, which modification is most important for safety?
- Avoid hip flexion beyond 90° to prevent dislocation risk (Correct answer)
- Test in prone to reduce load on the hip
- Apply resistance proximal to the knee rather than the ankle
- Skip MMT and use functional assessment only
Correct answer: Avoid hip flexion beyond 90° to prevent dislocation risk
Post-hip replacement precautions typically restrict hip flexion beyond 90° to prevent prosthetic dislocation during the healing phase.
Question 6: A patient with foot drop following common peroneal nerve injury is tested. Which MMT finding pattern is expected?
- Weakness of ankle dorsiflexion and eversion with intact plantar flexion and inversion (Correct answer)
- Weakness of ankle plantar flexion and inversion with intact dorsiflexion
- Global ankle weakness including plantar flexion
- Weakness of toe flexors only
Correct answer: Weakness of ankle dorsiflexion and eversion with intact plantar flexion and inversion
The common peroneal nerve innervates dorsiflexors (tibialis anterior) and evertors (peroneals), so injury causes weakness of these movements while tibial-nerve-supplied plantar flexion and inversion remain intact.
Question 7: In which clinical scenario is it most appropriate to test a muscle in a gravity-eliminated position rather than the standard antigravity position?
- When the patient reports muscle pain during resisted testing
- When the muscle cannot complete full ROM against gravity (grade ≤2) (Correct answer)
- When the patient has poor endurance and fatigues quickly
- When joint hypermobility is present
Correct answer: When the muscle cannot complete full ROM against gravity (grade ≤2)
Gravity-eliminated testing is indicated when the muscle cannot produce full ROM against gravity, allowing accurate grading at the lower end of the scale (grades 1–2).
MMT Clinical Applications 3
A patient with lateral epicondylitis is being assessed.
Which MMT finding would most directly support this diagnosis?