MMT The Fingers

Question 0

Finger PIP Flexion

Answer 0

Flexor digitorum superficialis
Grades 5,4,3
Pt position: forearm supinated, wrist in neutral, finger being tested in slight MCP flexion
Therapist position: hold all fingers except testing finger in extension at all joints, resist the distal end of middle phalanx toward extension
Test: test each finger separately. Pt flexes PIP joint without flexing DIP joint. Do not allow other joint motion. Flick terminal end of finger to be tested to determine that FDP is not active.
Command: “bend your finger, hold it, don’t let me straighten it”
Grades 2,1,0
Pt position: forearm in mid position to eliminate influence of gravity

Question 1

Finger MP flexion

Answer 1

Lumbricales, interossei
Grades 5,4,3
Pt position: sitting, forearm supported in supination, MCP joint fully extended, IP joints fully flexed
Therapist position: stabilize MC proximal to MCP joint, resist on palmar surface of proximal row of phalanges in direction of MCP extension
Test: pt simultaneously flexes MCP joints and extends IP joints- fingers must remain extended
Command: “uncurl your fingers and bend your knuckles. Hold it, don’t let me straighten them”
Resist each finger individually bc of different innervation
Grades 2,1,0
Pt position: forearm and wrist in mid position, MCP joints fully extended, IP joints flexed

Question 2

Finger DIP Flexion

Answer 2

Flexor Digitorum profundus
Grades 5,4,3
Pt position: forearm in supination, wrist neutral, PIP in extension
Therapist position: stabilize middle phalanx in extension, grasping on either side; resist distal phalanx toward extension
Test: test each finger separately pt flexes DIP
Commands: “bend the tip of your finger; hold it, don’t let me move you”
Grades 2,1,0
Same as 5,4,3 test except forearm is in neutral position

Question 3

Finger MP Extension

Answer 3

Extensor digitorum, extensor indicis, extensor digiti minimi
Grades 5,4,3
Pt position: forearm in pronation, wrist neutral, MCP and IP joints in relaxed flexion
Therapist position: stabilize wrist in neutral. Resist with index finger across the dorsum of the proximal phalanges just distal to the MCP joints
Tests:
Extensor digitorum- pt extends all MCP joints, allowing IP joints to be in slight flexion
Extensor indicis- pt extends MCP joint of index finger
Extensor digiti minimi- pt extends MCP joint of 5th digit
Commands: “bend your knuckles back as far as they will go”
Grades 2,1,0
Same as 5,4,3 except that the forearm is in mid position

Question 4

Finger Abduction

Answer 4

Dorsal interossei
Grades 5,4,3,2
Pt position: forearm pronated, wrist neutral. Fingers in extension and adduction, MCP joints neutral
Therapist position: support wrist in neutral; use other hand to give resistance to abduction
Test: abduction of individual fingers (middle finger abducts in both directions)
Commands: “spread your fingers. Hold”

Question 5

Finger Adduction

Answer 5

Palmar Inerossei
Grades 5,4,3,2
Pt position: forearm pronated, wrist neutral, fingers extended
Therapist position: grasp middle phalanx on each of 2 adjoining fingers. Resist in the direction of abduction, test each finger pair separately
Commands: “hold your fingers together”