Muscle Test: Biceps | Hand Surgery Resource

Exams and Signs

Origin:	Short Head: Scapula (coracoids apex) Long Head: Scapula (supraglenoid tubercle) Capsule of glenohumeral joint and glenoid labrum
Insertion:	Radius (radial tuberosity) Bicipital aponeurosis
Innervation:	Cervical root(s): C5-C6 Nerve: musculocutaneous

Grading of muscle strength:

Grade	Strength	Description
5*	Normal	Normal strength
4*	Good	Movement against external resistance but less than normal
3	Fair	Movement against gravity but not against added resistance
2	Poor	Movement at the joint with gravity eliminated
1	Trace	Trace of contraction but no movement at the joint
0	Zero	No contraction or muscle movement
*The distinction between Grades 4 and 5 is based on comparison with the normal hand and, barring that, extensive experience in testing the hand.

Position of patient's hand and upper extremity

Short sitting, arm at side and elbow flexed to 90°; forearm in full pronation to neutral. Alternatively, patient may sit at a table. For Grade 2, some suggest the patient sit with shoulder flexed between 45° and 90°, with the forearm in neutral, and that for Grades 0 and 1, the patient be positioned as for Grades 3–5.

Examiner’s Actions

While standing at the patient’s side or in front of the patient, support the elbow with one hand and apply resistance with the heel of the other hand over the dorsal (extensor) surface at the wrist. Some suggest that for Grade 2, the examiner cups their hand under the elbow, and that for Grades 1 and 2, the examiner supports the forearm just distal to the elbow and palpates the head of the radius on the dorsal aspect of the forearm.

Instructions for the patient

“Turn your palm up.” Some suggest “Turn your palm to your face” for Grade 2, and “try to turn your palm so it faces the ceiling” for Grades 0 and 1.

Presentation Photos and Related Diagrams

Definition of Positive Result

In muscle testing, a normal result is a positive one. During a normal muscle test, the examiner should observe a normal muscle contraction that can move the joint or tendon against full resistance.

Definition of Negative Result

In muscle testing, an abnormal result is a negative one. During an abnormal muscle test, the examiner should observe an abnormal muscle contraction that can move the joint or tendon. In a complete denervation injury, such as a complete nerve laceration, there will be no evidence of any muscle function and the muscle testing grade will be 0.

Comments and Pearls

Take care not to grip the flexor surface of the forearm when testing for Grades 3–5.
Patients may externally rotate and adduct the arm across the body when attempting forearm suppination. When this happens, the forearm rolls into suppination with no activity of the supinator muscle.
An alternative test is to grasp the patient’s hand as if shaking hands, cradle the elbow, and resist via the hand grip. This test is used if the patient has Grade 4 or 5 wrist and hand strength.

Diagnoses Associated with Exams and Signs

Videos

Testing biceps strength by resisting and grading elbow flexion.

References

Hislop JH, Avers D, Brown M. Daniels and Worthingham's Muscle Testing, Techniques of Manual Examination and Performance Testing. 9th ed. St. Louis, Missouri: Elsevier Saunders, 2014, pp. 138–202.
Kendall FP, McCreary EK, Provance PG. Muscles Testing and Function. 4th ed. Baltimore, MD: Williams & Wilkins, 1993, pp. 235–298.