International Standards for the Classification of Spinal Cord Injury
Motor Exam Guide
February 2020 page 5
Grades 0 & 1
Patient Position: Maintain the Grade 2 position with the shoulder
in internal rotation, and the forearm positioned above the
abdomen. The forearm is in neutral pronation/supination and the
elbow is in 30° of flexion.
Examiner Position: Support the arm. For trace function,
palpate the distal triceps at its insertion on the olecranon.
The belly of the triceps muscle may also be palpated and
observed for movement.
Instructions to Patient: “Straighten your arm.”
Action: The patient attempts to fully extend the elbow.
C7 Common Muscle Substitution
Elbow extension can be mimicked by externally rotating the shoulder, by quickly flexing the elbow and then relaxing,
and with spasticity of the triceps. These substitutions can be minimized by maintaining the correct position for testing,
correct instructions to the patient, and avoiding elbow flexion. Palpation of the triceps should be done to confirm the
patient is using the correct muscle for the test.
C8 Long Finger Flexors | Flexor Digitorum Profundus
Grade 3
Patient Position: The shoulder is in neutral rotation, neutral
flexion-extension, and neutral ab/adduction. The elbow is fully
extended with the forearm fully supinated. The wrist is in neutral
flexion-extension. The metacarpal phalangeal (MCP) and
proximal interphalangeal joints (PIP) are stabilized in extension.
Examiner Position: Using two hands grasp the patient’s hand
and stabilize the wrist in neutral. Secure the PIP and MCP joints
in extension with both hands while isolating the middle finger for
testing. Stabilize the volar aspect of the 3
rd
middle phalanx with
the thumb of the opposite hand.
As an alternate method, one hand may be used to stabilize
instead of two, with the patient’s hand fully supinated on the
bed/mat. The PIP and MCP joints are stabilized as previously
described and securing the middle phalanx, and the examiner
assuring wrist tenodesis is avoided with forearm stabilization.
Instructions to Patient: “Bend the tip of your middle finger.”
Action: The patient attempts to flex the distal interphalangeal
(DIP) joint through the full range of motion in flexion.