Clinical Palpation Techniques and Muscle Strength Assessment

Objectives of Clinical Palpation

According to Philip Greenman, the primary objectives of palpation are:

• To detect normal or abnormal tissue texture.
• To examine the symmetry of anatomical structures.
• To detect and assess changes in movement quality, flow, and feel.
• To determine the position in space of various structures.
• To detect and evaluate pathological changes.

Tactile Discrimination and Sensory Areas

Tactile discrimination is defined as the minimum distance between two point stimuli that are perceptible as distinct. The areas of the body with the greatest capacity for discrimination (high capacity of 1-3 mm) are the tongue, the lips, and the fingertips.

Sensory Receptors and Stimuli Types

• Mechanoreceptors: Indicate mechanical deformation.
• Proprioceptors: Indicate the position of the body.
• Nociceptors: Capture painful stimuli.
• Thermoreceptors: Capture variations in temperature.

The Daniels Scale for Muscle Strength

The Daniels Scale considers six distinct grades of muscle strength:

• Grade 0: No muscle contraction is visible or palpable.
• Grade 1: There is a visible or palpable contraction, but no joint movement.
• Grade 2: Total amplitude of movement in a gravity-minimized (horizontal) position.
• Grade 3: Maintains position against gravity without additional manual pressure.
• Grade 4: Maintains position against gravity and against moderate manual pressure.
• Grade 5: Maintains position against gravity and against intense manual pressure.

Manual Muscle Testing Procedures

The Rupture Test (Break Test)

The Rupture Test consists of applying manual resistance after the patient has reached the full joint range, either actively or passively. The patient attempts to maintain the position while the therapist tries to "break" it using an isometric contraction. This test is used to assess whether the patient qualifies for a Grade 4 or 5 on the Daniels Scale.

Active Resistance Test

In the Active Resistance Test, the patient performs an active movement against gravity while the practitioner applies standard and progressive manual resistance from the beginning to stop the movement (concentric isotonic contraction). This is also used to assess if the patient reaches a Grade 4 or 5 on the Daniels Scale.

Understanding Functional Impairments

Active Functional Impairment

This occurs when the prime mover governing the action has a specific problem, such as dysfunction or weakness, which limits the movement.

Passive Functional Impairment

This occurs when the agonist-antagonist muscle that governs the action is shortened, thereby limiting the range of movement.