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Clinical Practice MMT > Elbow, Forearm, Wrist, & Hand MMT > Flashcards

Elbow, Forearm, Wrist, & Hand MMT Flashcards

1
Q

TESTING ELBOW FLEXION: ___________________

  • What is the normal ROM?
  • What are some assisting muscles?
  • To test each of the main elbow flexors in isolation, how does forearm position need to be modified?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Biceps Brachii, Brachioradialis, Brachialis
  • 0-150°
  • pronator teres, wrist flexor group
  • Modifications
    • Biceps- forearm supinated
    • Brachioradialis- forearm neutral
    • Brachialis- forearm pronated
  • In a grade 3-5 test, the patient is in short sitting with their elbow flexed to around 60-70°. The PT will try and pull the patients forearm down while supporting with the other hand on the shoulder. In a grade 0-2 test the patient can be lying in supine and go through the same tests. (Arm can either be supinated, neutral, o pronated depending on muscle testing)
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2
Q

TESTING ELBOW EXTENSION: _______________

  • What is the normal ROM?
  • What is an assisting muscle?
  • What do we want to limit while testing?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Triceps Brachii (long, lateral, and medial head)
  • 0-150°
  • We want to prevent elbow locking or hyperextension
  • In a grade 3-5 test, the patient is in prone and will be instructed to bring their arm up from 90° to horizontal. The PT will then apply pressure to the dorsal forearm while the other hand is supporting the elbow. In a grade 0-2 test, the patient will be in a seated position, with the table supporting the shoulder at 90°.
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3
Q

Common Substitutes for Elbow Extension:

  • When the patient has arm abducted, elbow extension can be accomplished without activation of the triceps. This occurs when the patient _____________ the shoulder, thus dropping the arm below the forearm.
  • With the distal segment fixed (as when the examiner stabilizes the hand or wrist, the patient _________ the arm and the thrust pulls the elbow into extension
A
  • externally rotates

- horizontally adducts

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4
Q

TESTING FOREARM SUPINATION: ______________

  • What is the normal ROM?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Biceps Brachii, Supinator
  • In a grade 3-5 test, the patient is short sitting with their arm flexed at 90°. The forearm is put in pronation and the patient is told to turn their hand over (supinate). The PT has one arm supporting the elbow while the other is applying pressure to the dorsal side of the forearm. In a 2 test, the patients arms will be supported by the PT, and they will try to go through the full ROM. In a 0 or 1 test, the patient will be put back at 90° flexion and the PT will support the forearm while palpating for the supinator.
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5
Q

What is the most common substitution for supination?

A

Shoulder external rotation combined with horizontal adduction.

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6
Q

TESTING FOREARM PRONATION:_______________

  • What is the normal ROM?
  • What muscle assists?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Pronator Teres, Pronator Quadratus
  • 0-80°
  • flexor carpi radialis
  • In a grade 3-5 test, the patient is short sitting with their arm flexed at 90°. The forearm is put into supination and the patient is told to turn their hand over (pronate). The PT has one arm supporting the elbow while the other is applying pressure to the palmar (ventral) forearm trying to pull it back into supination. In a 2 test, the patients arm will be supported by the PT, and they will try to go through the full ROM. In a 0 or 1 test, the patient will be put back at 90° flexion and the PT will support the forearm while palpating for the pronator teres.
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7
Q

TESTING WRIST FLEXION: _______________

  • What is the normal ROM?
  • What are some assisting muscles?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Flexor Carpi Ulnaris and Radialis
  • 0-80°
  • Assisting Muscles:
    • palmaris longus
    • flexor digitorum (profundus and superficialis)
    • flexor pollicis
    • abductor pollicis
  • In a grade 3-5 test, the patient is in short sitting with their forearm supinated. After ROM is assessed the PT will put the patients wrist into flexion and use 4 fingers to pull the wrist back down while using their other hand to support the wrist. For a 2 test the patients hand will be put on the side on the table to allow for a gravity minimized test. For a 0 or 1 test, the wrist will be put back into flexion and palpated by the PT.
  • To test the flexor carpi radialis, the patient will be put into radial deviation and instructed to bring wrist up to flexion. The PT will then support the wrist while pulling the wrist into extension/ulnar deviation.
  • To test the flexor carpi ulnaris, the patient will be put into ulnar deviation and instructed to bring wrist up to flexion. The PT will then support the wrist while pulling the wrist into extension/ radial deviation.
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8
Q

TESTING WRIST EXTENSION: ______________
-What is the normal ROM?
Difference between a grade 3-5 test vs a grade 0-2?

A
  • ECRL, ECRB, ECU
  • 0-70°
  • In a grade 3-5 test, the patient has the forearm pronated. The PT instructs the patient to bring their hand up. The PT supports the wrist with one hand while applying pressure to the dorsal side of the hand. For a 2 test, the patients hand will be put on its side on the table to allow for a gravity minimized test. For a 0 or 1 test, the wrist will be put back into extension to allow for palpation.
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9
Q

Where are the palpation points for each muscle of wrist extension?

A

ECRL- over 2nd metacarpal
EBRB- over 3rd metacarpal
ECU- between 5th metacarpal and styloid process

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10
Q

TESTING METACARPALS- Phalangeal Joint Flexion (MP): __________________

  • What is the normal ROM?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Interossei, Lumbricals (lumbrical grip)
  • 0-90°
  • In a grade 3-5 test, the patient begins with their forearm supinated and IPs fully flexed. The PT tells the patient to uncurl their fingers while flexing their MP joint. The PT will then apply pressure proximal to the MP joint, making sure the patients IP joints stay extended. For a 0-2 test, the hand will be turned on the side to allow for a gravity minimized situation.
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11
Q

TESTING FLEXION OF DIPs and PIPs: ____________

  • What are the normal ROMs?
  • Difference between a grade 3-5 test vs a grade 0-2?
A

-PIP=Flexor Digitorum Superficialis
DIP=Flexor Digitorum Profundus
-PIP=0-100° and DIP=0-90°
-For a grade 3-5 test, the patient has wrist in neutral. The PT holds all fingers except the one being tested in extension. The other hand is used to resist the phalanx.
-For a 0-2 test of the PIP, the PT will palpate for the flexor digitorum superficialis.
-For a 0-2 test of the DIP, the PT palpate for the flexor digitorum profundus on the palmar surface of the middle phalanx of each finger.

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12
Q

TESTING MCP EXTENSION: ___________

  • What is the normal ROM?
  • What are assisting muscles?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Extensor Digitorum
  • 0-45°
  • extensor indices, extensor digiti minimi
  • For a grade 3-5 test, the patient has their forearm pronated. The PT tells the patient to extend their knuckles as fa back as they can. The PT then uses one arm to support the wrist and a finger to provide resistance. For a 0-2 test, the patients hand is placed on its side. Palpation of the muscles are apparent on the dorsal side.
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13
Q

TESTING FINGER ABDUCTION: _____________

  • What is the normal ROM?
  • Difference between a grade 3-5 test vs a grade 0-2?
A
  • Dorsal Interossei (DABS test)
  • 0-20°
  • Patient is told to resist PT pushing their fingers back toward the midline. Palpation is hard to find.
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14
Q

TESTING FINGER ADDUCTION: ______________

A
  • Palmar Interossei (PADS test)
  • 20-0°
  • For a grade 3-5 test, the patient has their forearm pronated with their fingers adducted together. The patient is told to resist the PT bringing the fingers apart. The palmar interossei is not easily palpated.
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15
Q

TESTING THUMB MCP AND IP FLEXION:___________

  • What are the normal ROMs?
  • Difference between a grade 3-5 test vs a grade 0-2?
A

-MCP=Flexor Pollicus Brevis
IP=Flexor Pollicis Longus
-MCP=0-50°
IP=0-80°
-In a grade 3-5 test, the patient is told to bring their thumb across the palm and touch their palm. The PT then applies force to the MCP joint. In a grade 0-2 test, the PT would palpate for the flexor pollicis brevis.
-In a grade 3-5 test, the patient is told to extend their IP joint and the PT then applies pressure. In a grade 0-2 test, the PT would palpate for the flexor pollicis longus tendon.

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16
Q

TESTING THUMB MCP AND IP EXTENSION: ________

  • What are the normal ROMs?
  • Difference between a grade 3-5 test vs a grade 0-2?
A

-MCP=Extensor Pollicus Brevis
IP=Extensor Pollicus Longus
-In a grade 3-5 test, the patients hand is on its side. The PT instructs the patient to lift their thumb toward the ceiling while they provide a downward force for both MCP and IP extension. In a grade 0-2 test the PT will palpate for the extensor pollicus brevis for MCP and longus for IP.

17
Q

TESTING THUMB AB/ADDUCTION: __________

  • What are the normal ROMs?
  • Difference between a grade 3-5 test vs a grade 0-2?
A

-Ab/Adductor Pollicis Longus/Brevis, Adductor Policis
-AB=0-70°
AD=70-0°
-For a grade 3-5 test, the patient has their forearm in supination for abduction and pronation for adduction. The PT instructs the patient to resist the pressure. For a grade 0-2 test, the PT would palpate for the muscles while the patients hand is on its side (gravity minimized).

18
Q

TESTING THUMB OPPOSITION: ______________

-Difference between a grade 3-5 test vs a grade 0-2?

A
  • Opponens Pollicis, Opponens Digiti Minimi
  • In a grade 3-5 test, the patient is instructed to touh the tips of their thumb and little finger. The PT will then apply resistance to opponens pollicis. In a 0-2 test, the PT would palpate for the opponens muscle.

Clinical Practice MMT (5 decks)

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