• A portable device used as a quantitative method of muscle contraction (primarily for upper limb).
  • Testing is performed using one of two techniques, 1) make or 2) break.
    • The ‘make’ technique requires the examiner to resist a maximal voluntary contraction by the patient, thereby producing an isometric contraction.
    • In the ‘break’ technique, the examiner applies adequate force to overcome the patient, thereby producing an eccentric contraction.

Clinical Considerations

  • Myometer testing presents an objective, quantifiable method of measuring muscle strength. However this does not necessarily reflect function.
  • Initial cost of the myometer may be seen as a limitation to its general use.
  • Computer software is available to assist with data analyses.
  • It is superior to manual muscle testing for detection of mild to moderate weakness and changes in muscle strength. It also eliminates potential bias from the evaluator for various age groups and gender.

ICF Domain

Body Function and Structures ▶ Neuromusculoskeletal and Movement-Related Functions & Structures

Administration

  • Clinician administered; performance measure
  • The mean force of three administrations for each muscle group tested is preferred and some investigators suggest a practice trial. A 5 to 10 seconds rest break between trials is suggested.
  • The starting position of the individual and the myometer is critical (though it seems starting position has not been standardized in the literature for different muscles).
  • Encouragement to maximize muscle contraction is suggested.
  • 30 minutes is required for a bilateral assessment of the upper extremities. Additionally, multiple position changes are required to capture maximal muscle contractions.

Number of Items

N/A

Equipment

A myometer

Scoring

The recommended unit of measurement is kg in order avoid interpretation issues. Measurements are generally rounded to the nearest kg.

Languages

English

Training Required

No formal training required. However, knowledge of techniques, appropriate body positioning for patient and tester, and proper administration is beneficial.

Availability

The hand-held myometer worksheet can be found here.

Measurement Property Summary

Number of studies reporting psychometric properties: 8

Interpretability

  • MCID: Not established in SCI
  • SEM & MDC:

SEM and MDC calculated from data in Aufsesser et al. 2003:

Tester 1

Tester 2
Muscle

SEM (lbs)

MDC (lbs)

SEM (lbs)

MDC (lbs)
Left biceps

5.05

14.01

1.84

5.10
Right biceps

2.94

8.15

2.96

8.21
Left triceps

2.91

8.08

2.17

6.01
Right triceps

3.26

9.04

2.44

6.76
Left wrist extensors

2.71

7.51

1.73

4.80
Right wrist extensors

2.94

8.14

0.26

0.73

Reliability – High

Number of studies reporting reliability data: 7

  • High inter-rater reliability:
    • Make Technique: ICC = 0.94-0.97
    • Break Technique: ICC = 0.94-0.95
  • High intra-rater reliability:
    • Make technique: ICC = 0.91-0.94
    • Break Technique: ICC = 0.93-0.94

(Burns et al. 2005; n=19; 19 males; 6 ASIA A, 3 ASIA B, 10 ASIA D; inpatient, 3 < 6 months post-injury, 16 >1 year post-injury, 2 testers)

Validity – Low to High

Number of studies reporting validity data: 5

  • Low to High correlation with Manual Muscle Testing:
    • People with paraplegia: r = 0.26-0.67

(Noreau & Vachon 1998; n=38; 31 males, 7 females; tetraplegia and paraplegia; mean time since injury (SD) at admission: 1.6 (0.7) months, mean time since injury (SD) at discharge: 2.1 (2.1) months)

    • People with tetraplegia: r = 0.59-0.94

(Schwartz et al. 1992; n=122; 122 males; quadriplegia, over 6 time points b/w 72 hours and 12 months post-injury)

  • Moderate to High correlation with Isokinetic Dynamometry:
    • People with paraplegia: r = 0.70-0.90
    • People with tetraplegia: r = 0.57-0.96

(Noreau & Vachon 1998; n=38; 31 males, 7 females; tetraplegia and paraplegia; mean time since injury (SD) at admission: 1.6 (0.7) months, mean time since injury (SD) at discharge: 2.1 (2.1) months)

Responsiveness

No values were reported for the responsiveness of hand-held myometry for the SCI population at this time.

Floor/Ceiling Effect

No values were reported for the presence of floor/ceiling effects in hand-held myometry for the SCI population.

Reviewers

Dr. Carlos L. Cano-Herrera

Date Last Updated

December 31, 2024

Andrews AW, Thomas MW, Bohannon RW. Normative Values for Isometric Muscle Force Measurements Obtained With Hand-held Dynamometers. Physical Therapy 1996; 76:248-259.
http://www.ncbi.nlm.nih.gov/pubmed/8602410

Aufsesser PM, Horvat M, Austin R. The reliability of hand held muscle testers with individuals with spinal cord injury. Clinical Kinesiology, 2003; 57(4):71-75.
https://www.researchgate.net/publication/266462733_The_Reliability_of_Hand_Held_Muscle_Testers_with_Individuals_with_Spinal_Cord_Injury

Burns SP, Breuninger A, Kaplan C, Marin H. Hand-Held Dynamometry in Persons with Tetraplegia: comparison of make versus break-testing techniques. Am. J. Phys. Med. Rehabil. 2005;84:22-29.
http://www.ncbi.nlm.nih.gov/pubmed/15632485

Herbison GJ, Isaac Z, Cohen ME, Ditunno JF Jr. Strength post-spinal cord injury: myometer vs manual muscle test. Spinal Cord, 1996; 34:543-548.
http://www.ncbi.nlm.nih.gov/pubmed/8883189

Jacquemin GL, Burns SP, Little JW. Measuring hand intrinsic muscle strength: normal values and interrater reliability. J Spinal Cord Med, 2004; 27:460-467.
http://www.ncbi.nlm.nih.gov/pubmed/15648801

Lamontagne A, Malouin F, Richards CL, Dumas F. Evaluation of reflex and nonreflex-induced muscle resistance to stretch in adults with spinal cord injury using hand-held and isokinetic dynamometry. Phys Ther,  1998; 78: 964-975.
https://www.ncbi.nlm.nih.gov/pubmed/9736894

May LA, Burnham RS, Steadward RD. Assessment of isokinetic and hand-held dynamometer measures of shoulder rotator strength among individuals with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 1997; 78(3): 251-255.
http://www.archives-pmr.org/article/S0003-9993(97)90029-0/abstract

Noreau L & Vachon J. Comparison of three methods to assess muscular strength in individuals with spinal cord injury. Spinal Cord 1998;36:716-723.
http://www.ncbi.nlm.nih.gov/pubmed/9800275

Schwartz S, Cohen ME, Herbison GJ, Shah A. Relationship Between Two Measure of Upper Extremity Strength: Manual Muscle Test Compared to Hand-Held Myometry. Arch Phys Med Rehabil 1992;73:1063-1068.
http://www.ncbi.nlm.nih.gov/pubmed/1444773

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