Manual Muscle Testing: Elbow Flexion

Muscles Involved:

Biceps Brachii



Patient Positioning

Grades 2 to 5 testing - patient is seated

Grades 0 to 1 testing - patient is supine for 'gravity minimal' position

Hand positioning depends on specific muscle:

Biceps: supination

Brachialis: pronation

Brachioradialis: midposition

Therapist Position

Therapist at test side

Ensure wrist flexors are not contracting

Palpation over intended test muscle

To Test

  • Patient is to flex the elbow
  • Grades 4 and 5 with resistance over flexor surface at the distal forearm with force in the direction opposite to flexion.[1]
  • To satisfy grade 5 'normal muscle' performance criteria, the patient must have the ability to move through complete range of motion (active resistance testing) OR maintain an end point range (break testing) against maximum resistance.


  1. Hislop H, Avers D, Brown M. Daniels and Worthingham's muscle Testing-E-Book: Techniques of manual examination and performance testing. Elsevier Health Sciences; 2013 Sep 27.