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Manual muscle testing (MMT) is common, but inconsistencies in grading systems and procedures hinder cross\u2010study comparisons. This study aims to examine how MMT is reported for assessing shoulder and elbow muscle strength in patients with tetraplegia undergoing elbow extension restoration. The review focuses on grading systems, targeted muscles, and testing procedures and positions used in MMT to advocate for standardization. A literature survey was conducted in September 2021 and repeated in September 2023 across five databases: Allied and Complementary Medicine Database, Embase, Medline, CINAHL, and Scopus. The search strategy utilized subject headings and keywords related to \u201cupper limb reconstructive surgery,\u201d \u201ctendon transfer surgery,\u201d \u201cnerve transfer surgery,\u201d and \u201ctetraplegia.\u201d Studies describing clinical information about assessment or outcomes of shoulder and elbow muscle strength using MMT in surgical elbow extension restoration in tetraplegia were included. Extracted data included study characteristics, surgical intervention, muscles tested, and description of how MMT is performed. These data were then analyzed to categorize and interpret existing practices. A total of 29 studies met the inclusion criteria. Among these, 66% focused on muscle\u2010tendon, and 34% addressed nerve transfers. Donor strength was assessed preoperatively in 55% and postoperatively in 34%. Elbow extension strength was consistently reported postoperatively but only preoperatively in 83% of studies. Only five studies specified the positions used for muscle testing, but these positions varied. Despite numerous studies on elbow extension restoration outcomes in people with tetraplegia, there is no consistent approach for reporting muscle strength. Consistent reporting of pre\u2010 and postoperative muscle strength, including testing positions, is required to obtain standardized MMT positions. Similarly, the adoption of a universal scale could improve outcome reporting and synthesis.<\/jats:p>","DOI":"10.1002\/pmrj.13348","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T10:28:07Z","timestamp":1741948087000},"page":"850-860","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual muscle testing of upper limb muscle strength in persons with tetraplegia undergoing surgical restoration of elbow extension: A scoping review"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0015-0282","authenticated-orcid":false,"given":"Sabrina","family":"Koch\u2010Borner","sequence":"first","affiliation":[{"name":"Swiss Paraplegic Research  Nottwil Switzerland"},{"name":"Swiss Paraplegic Center  Nottwil Switzerland"},{"name":"Department of Health Sciences and Medicine University of Lucerne  Lucerne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ursina","family":"Arnet","sequence":"additional","affiliation":[{"name":"Swiss Paraplegic Research  Nottwil Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann\u2010Sofi","family":"Lamberg","sequence":"additional","affiliation":[{"name":"Center for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital\/M\u00f6lndal  M\u00f6lndal Sweden"},{"name":"Physiotherapy Department, Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Schibli","sequence":"additional","affiliation":[{"name":"Swiss Paraplegic Center  Nottwil Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Medicine University of Otago  Christchurch New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0840"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2009.193"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101481"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/17531934211027460"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/17531934241270116"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2008.02.003"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(03)00485-4"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31143-2"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5435\/JAAOS-D-22-00348","article-title":"Current concepts in elbow extension reconstruction for the tetraplegic patient","volume":"31","author":"Zlotolow DA","year":"2023","journal-title":"J Am Acad Orthop Surg"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/17531934221113739"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/1746-1340-15-4"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100646"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/36.1.21"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2006.10.020"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.46292\/sci2702-1"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(86)80213-1"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(02)00024-0"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/8194537"},{"volume-title":"Aids to the Examination of the Peripheral Nervous System","year":"2000","author":"Riddoch G","key":"e_1_2_8_20_1"},{"volume-title":"Daniels and Worthingham's Muscle Testing Techniques of Manual Examination and Performance Testing","year":"2018","author":"Brown M","key":"e_1_2_8_21_1"},{"volume-title":"Kendall's Muscles: Testing and Function with Posture and Pain","year":"2022","author":"Conroy VM","key":"e_1_2_8_22_1"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-016-0116-4"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0850"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.04.264"},{"key":"e_1_2_8_26_1","first-page":"195","article-title":"Restoration of elbow extension in the tetraplegic by transplantation of the posterior deltoid. 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