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In the modified Allen test, one hand is examined at a time: [2] The patient is asked to clench their fist for about 30 seconds. Pressure is applied over the ulnar and the radial arteries so as to occlude both of them. Still elevated, the hand is then opened. It should appear blanched (pallor may be observed at the finger nails).
In this scale, muscle strength is graded on a scale from 0 to 5. For evaluating the strength of the intrinsic hand muscles, a small modification to the standard MRC grading has been made so that grade 3 indicates ‘full active range of motion’ as compared to ‘movement against gravity’: [2]
Radial side of the proximal phalanx of the index finger: 2 Radial side of the middle phalanx of the index finger: 3 Tip of the index finger: 4 Tip of the middle finger: 5 Tip of the ring finger: 6 Tip of the little finger: 7 Distal interphalangeal joint crease of the little finger: 8 Proximal interphalangeal joint crease of the little finger: 9
The patient must stand unsupported with eyes open and hands on hips for 30 seconds. If the patient takes a step or removes a hand from the hip, the timer is stopped. The patient may make two attempts to complete the 30 seconds. Similar to the sensory organization test, the visual pathway would then be removed by closing the eyes.
The test involves two different abilities: gross movements of arms, hands, and fingers, and fine motor extremity, also called "fingerprint" dexterity. [2] Poor Pegboard performance is a sign of deficits in complex, visually guided, or coordinated movements that are likely mediated by circuits involving the basal ganglia .
The relative length of the digit varies during motion of the IP joints. The length of the palmar aspect decreases during flexion while the dorsal aspect increases by about 24 mm. The useful range of motion of the PIP joint is 30–70°, increasing from the index finger to the little finger.
To perform the test, a patient is asked to hold an object, usually a flat object such as a piece of paper, between the thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject's hands. [2] A normal individual will be able to maintain a hold on the object without difficulty.
The hand is grasped like a handshake and the arm is moved in various directions to determine the tone. [1] The tone is the baseline contractions of the muscles at rest. The tone may be normal or abnormal which would indicate an underlying pathology. The tone could be lower than normal (floppy) or it could be higher (stiff or rigid).