Evaluate the patient's muscle strength by isometric testing, which can be enhanced by establishing a graded scale for focusing the patient's responses. Six possible responses to isometric muscle testing for grading are:
• Strong and painful—suggests a minor lesion of muscles or tendon.
• Weak and painless—complete rupture of muscle or tendon or disorder of the nerves.
• Weak and painful—suggests gross lesion.
• Painful on repetition—suggests intermittent claudication (10).
If all movements are painful this may suggest emotional hypersensitivity.
Weakness denotes a demonstrable loss of muscular power and should be differentiated from fatigue. Try to localize any weakness in a neuroanatomic pattern, to determine whether there is a disorder of the nerves innervating the muscle group.
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