A narrative review of manual muscle testing and implications for muscle testing research

Objective

Manual muscle testing (MMT) is used for a variety of purposes in health care by medical, osteopathic, chiropractic, physical therapy, rehabilitation, and athletic training professionals. The purpose of this study is to provide a narrative review of variations in techniques, durations, and forces used in MMT putting applied kinesiology (AK) muscle testing in context and highlighting aspects of muscle testing important to report in MMT research.

Method

PubMed, the Collected Papers of the International College of Applied Kinesiology–USA, and related texts were searched on the subjects of MMT, maximum voluntary isometric contraction testing, and make/break testing. Force parameters (magnitude, duration, timing of application), testing variations of MMT, and normative data were collected and evaluated.

Results

“Break” tests aim to evaluate the muscle's ability to resist a gradually increasing pressure and may test different aspects of neuromuscular control than tests against fixed resistances. Applied kinesiologists use submaximal manual break tests and a binary grading scale to test short-term changes in muscle function in response to challenges. Many of the studies reviewed were not consistent in reporting parameters for testing.

Conclusions

To increase the chances for replication, studies using MMT should specify parameters of the tests used, such as exact procedures and instrumentation, duration of test, peak force, and timing of application of force.     

Assessment of Patient Preference for Constant Voltage and Constant Current Spinal Cord Stimulation

Objectives: Spinal cord stimulation devices control energy by generating either constant voltage (CV) pulses or constant current (CC) pulses. This study aimed to investigate: 1) whether patients feel differences between CV and CC stimulation; 2) if patients prefer CV or CC stimulation. Methods: Fourteen patients blinded to the type of pulse generation received 20 randomized pairs of 15‐sec pulse trains (CC‐CV, CV‐CC, CV‐CV, or CC‐CC). Patients identified whether the pairs were the same or different, and if they preferred the first or second train. Results: There was no difference in charge‐per‐pulse input between CV and CC modes. Patients performed at chance level in identifying identical pairs (55.7 ± 24.1% correct, 10 trials), and slightly better in identifying different pairs (67.1 ± 25.2% correct, 10 trials). No patients correctly identified all pairs. Patients were categorized based on their performance in this task. Only three patients fell into a category where preference could be established with some confidence with respect to the group averages. Two of these patients preferred CV, while one patient preferred CC. Conclusion: The lack of patient ability to discriminate in this preliminary investigation suggests that patient preference for a stimulation type should not be the key determining factor in choosing a spinal cord stimulation system.     

Primary failure of tooth eruptionA unique case

Primary failure of tooth eruption rarely occurs. This case represents a rare clinical situation and appears to reflect a generalized disturbance in the eruptive process, inasmuch as (1) deciduous and permanent dentition are affected, (2) incisors, molars, and premolars are involved in all quadrants, (3) skeletal and craniofacial growth are within normal limits, and (4) no systemic/genetic anomalies were detected. This is the first such case reported in the literature; diagnosis and management are discussed.     

Management of Periodontal Tissues for Restorative Dentistry

Proper management of periodontal tissues is required to achieve predictable long-term success with restorative dental procedures. Forced eruption as well as several surgical techniques may be used to achieve and maintain adequate biologic width during restorative and esthetic dental procedures. The technique that will yield optimal results depends on the relationship between the restoration's margins and the surrounding periodontium. A classification system that describes these interrelationships and provides treatment recommendations is included.     

Oncocytoid artifact of the parotid gland: A newly reported artifact

Electrocautery can induce significant alterations in the connective tissues and epithelium of specimens removed for diagnostic or therapeutic purposes. When electrocautery is used during parotid surgery, it can cause an oncocytoid artifact. The alterations described in this article are enlarged, tightly packed serous acinar cells with coarse to granular eosinophilic cytoplasm, distinct cell borders, and round basal nuclei that on cursory microscopic examination resemble oncocytes with respect to morphology. These changes are seen in conjunction with other, more recognized changes secondary to electrocautery and are believed to occur as a consequence of the electrothermal discharge. On the basis of our findings, this artifact is common in parotid surgical specimens and was misdiagnosed as benign oncocytic lesions in 5 cases.