MMT The Thumb

Question 0

Thumb IP flexion

Answer 0

Flexor pollicis longus
Grades 5,4,3,2,1,0
Pt position: forearm supinated, wrist neutral, MCP of thumb in extension
Therapist position: stabilize MCP joint in extension grasping thumb across that joint. Resist against the palmer surface of the distal phalanx toward extension
Test: pt flexes IP joint at thumb
Commands: “bend the end of your thumb. Hold it”

Question 1

Thumb MP flexion

Answer 1

Flexor pollicis brevis
Grades 5,4,3,2,1,0
Patient position: forearm supinated, wrist neutral, thumb in adduction adjacent to 2nd metacarpal
Therapist position: stabilize 1st MC firmly to avoid wrist or CMC motion. Give 1 finger resistance to MCP flexion on proximal phalanx in direction of extension
Test: pt flexes MCP joint of thumb, keeping IP joint extended
Command: “bring your thumb across the palm of your hand, hold”

Question 2

Thumb MP extension

Answer 2

Extensor pollicis brevis
Grades 5,4,3,2,1,0
Pt position: forearm in mid-position, wrist neutral, CMC, IP joints of thumb relaxed in slight flexion; thumb MCP joint in abd and flex
Therapist position: stabilize 1st MC firmly, allow motion only at MCP joint. Resist on dorsal surface of proximal phalanx in flexion direction (not usually a strong muscle)
Test: pt extends MCP joint of thumb keeping IP joint slightly flexed
Commands: “bring your thumb up so it points to the ceiling. Hold it”

Question 3

Thumb IP extension

Answer 3

Extensor pollicis longus
Grades 5,4,3
Pt position: forearm in mid position, wrist neutral, thumb relaxed in flexion position
Therapist position: stabilize proximal phalanx of thumb, apply resistance over dorsal surface of distal phalanx (over thumbnail) of thumb toward flexion
Test: pt extends IP joint of thumb
Commands: “straighten the end of your thumb, hold it”
Grades 2,1,0
Pt position: pronated forearm, wrist neutral, thumb relaxed in flexion

Question 4

Thumb Abduction

Answer 4

Abductor pollicis longus, abductor pollicis brevis
Longus- grades 5,4,3,2,1,0
Pt position: forearm supinated, wrist neutral, thumb in relaxed adduction
Therapist position: stabilize MCs of 4 fingers and wrist. Resist distal end of 1st MC in direction of adduction
Test: pt abducts thumb
Commands: “lift your thumb straight up”

Question 5

Thumb Abduction

Answer 5

Abductor pollicis longus, abductor pollicis brevis
Brevis- grades 5,4,3,2,1,0
Pt position: forearm supinated, wrist neutral, thumb in relaxed adduction (mid position for grades

Question 6

Thumb Adduction

Answer 6

Adductor Pollicis
Grades 5,4,3
Pt position: forearm pronated, wrist neutral, thumb relaxed and hand down in abduction- thumb off the table
Therapist position: stabilize MCs of 4 fingers by grasping around pts hand from the ulnar side. Resist medial side of proximal phalanx in direction of abduction
Test: pt addicts thumb
Commands: “bring your thumb up to your index finger”
Grades 2,1,0
Pt position: forearm in mid position, wrist neutral, thumb abducted

Question 7

Thumb Opposition

Answer 7

Opponens pollicis, opponens digiti minimi
Grades 5,4,3,2,1,0
Pt position: forearm supinated, wrist neutral, thumb adducted with MCP and IP flexion
Therapist position: stabilize hand holding wrist on dorsal surface; or against table. Resist opponens pollicis at head of 1st MC toward lateral rotation, extension, and adduction; resist opponens digiti minimi on palmer surface of 5th MC
Test: pt raises thumb away from palm toward 5th finger, placing pad of thumb against pad of 5th finger (not tip to tip)
Commands: “bring thumb to your little finger, forming the letter ‘O’”