Elbow And Wrist MMT & ROM

Question 1

What muscles flex the elbow?

Answer 1

Biceps, Brachialis, brachioradialis

Question 2

What muscles extend the elbow?

Answer 2

Triceps

Question 3

What muscles supinate?

Answer 3

Supinator, biceps brachii

Question 4

What muscles pronate?

Answer 4

Pronator teres and pronator quadratus

Question 5

Normal elbow ROM

Answer 5

140-150 degrees

Question 6

Testing position for elbow flexion ROM

Answer 6

Supine
Place towel under humerus to allow full elbow extension

Question 7

Landmarks for elbow extension/flexion ROM

Answer 7

Stationary: lateral midline of humerus

Center: lateral epicondyle of humerus

Moving: lateral midline of radius, reference radial head and radial styloid process

Question 8

Normal end feel for elbow flexion

Answer 8

Soft tissue approximation

Question 9

Testing position for elbow extension ROM

Answer 9

Supine
Forearm in full supination, towel under distal humerus

Question 10

Normal range for elbow extension? End feel?

Answer 10

0 degrees; hard b/c olecranon process and olecranon fossa OR firm b/c tension in joint capsule, collateral ligaments, and Brachialis

Question 11

Elbow pronation ROM testing position

Answer 11

Sitting
Arm next to body so shoulder at 0 degrees flex, ext, abd, add, and rotation. Elbow flexed to 90 degrees and forearm supported. Thumb starts up to ceiling

Question 12

Elbow pronation landmarks

Answer 12

Stationary: parallel to anterior midline of humerus

Center: laterally to ulnar styloid process

Moving: across dorsal surface of the forearm proximal to styloid processes of ulna and radius

Question 13

Elbow pronation normal ROM

Answer 13

75-80 degrees

Question 14

Elbow pronation normal end feel

Answer 14

Hard
Contact between ulna and radius

Firm
Tension in the dorsal radioulnar ligament, interosseous membrane and supinator

Question 15

Supination normal testing position

Answer 15

Sitting
Arm next to body so shoulder at 0 degrees flex, ext, abd, add, and rotation. Elbow flexed to 90 degrees and forearm supported. Thumb starts up to ceiling

Question 16

Elbow supination landmarks

Answer 16

Stationary: parallel to anterior midline of humerus

Center: medially to ulnar styloid process

Moving: across ventral surface of the forearm proximal to styloid processes of ulna and radius

Question 17

Normal elbow supination ROM

Answer 17

80 degrees

Question 18

Normal end feel for elbow supination

Answer 18

Firm
Tension palmar radioulnar ligament, interosseous membrane and pronator teres and quadratus muscles

Question 19

Elbow flexion MMT testing positions against gravity

Answer 19

Seated (2-5)
Thumb up: brachioradialis
Palm down: brachialis
Palm up: biceps

2 - short sit w/ arm flexed to 90 degrees, IR and supported by PT (completes ROM w/ gravity minimized in each of the muscles tested)
Alternate 2 (pts unable to sit)
Sidelying w/ arm supported at the elbow in 90 degrees flexion

3 - completes available range

4 - moderate resistance applied at forearm and stabilize the shoulder; end point may not be firm

5 - max resistance applied at forearm and stabilize the shoulder

Question 20

Elbow flexion MMT gravity reduced

Answer 20

Sidelying (0-1)

1 - palpable contraction at each of the three muscles

0 - no palpable contraction

Question 21

Elbow extension MMT against gravity

Answer 21

Prone (3-5)
Pt’s test shoulder in 90 degrees ABD and elbow flexed to 90 degrees. One hand supports underneath arm and the other applies downward force on distal dorsal surface of extended forearm just proximal to wrist

3 - pt completes available range

4 - strong resistance held but there is “give” at end range

5 - max resistance held

Question 22

Elbow extension MMT gravity reduced

Answer 22

Short Sit (0-2)
Shoulder ABD to 90 degrees and elbow flexed to about 45 degrees

2 - pt completes available range w/ support under elbow

1 - palpable contraction

0 - no palpable contraction

Question 23

Elbow pronation MMT against gravity

Answer 23

Short Sit (2-5)
Arm at side and elbow flexed to 90 degrees. Forearm in full supination to neutral

2 - completes partial ROM

3 - pt completes available ROM

4 - moderate resistance held. One hand supports the elbow while the other applies resistance w/ base of thumb over radius on the volar surface of forearm and wrist

5 - max resistance held. One hand supports the elbow while the other applies resistance w/ base of thumb over radius on the volar surface of forearm and wrist

Question 24

Elbow pronation MMT gravity reduced

Answer 24

Short Sit (1-0)
Support arm distal to elbow

1 - palpable contraction w/ no motion of part

0 - no palpable contraction

Question 25

Elbow pronation MMT against gravity

Answer 25

Short Sit (2-5)
Arm at side and elbow flexed to 90 degrees. Forearm in full supination to neutral

2 - completes partial ROM

3 - pt completes available ROM

4 - moderate resistance held. One hand supports the elbow while the other applies resistance w/ base of thumb over radius on the volar surface of forearm and wrist

5 - max resistance held. One hand supports the elbow while the other applies resistance w/ base of thumb over radius on the volar surface of forearm and wrist

Question 26

Elbow pronation MMT gravity reduced

Answer 26

Short Sit (1-0)
Support arm distal to elbow

1 - palpable contraction w/ no motion of part

0 - no palpable contraction

Question 27

Wrist extension ROM testing position

Answer 27

Sitting
Shoulder abd to 90 degrees elbow flexed to 90 degrees, palm of hand facing the ground (standard). Think of pt comfort, shoulder doesn’t have to be at 90 degrees abd, can be somewhere between 0-45

Question 28

Wrist extension/flexion ROM landmarks

Answer 28

Stationary: lateral midline of ulna

Center: lateral aspect of wrist, triquetrum (ulnar styloid)

Moving: lateral midline of 5th metacarpal

Question 29

Wrist extension normal ROM

Answer 29

60-70 degrees