MMT Hand and Forearm
Finger MP Flexion prime movers
Dorsal interossei, palmar interossei, lumbricals
Wrist extension prime movers
ECRL, ECRB, ECU
Finger MP extension prime movers
ED, EI, EDM
Thumb abduction substitution
Extensor Pollicis Brevis
Elbow extension substitutions
External rotation or horizontal abduction
Wrist flexion prime movers
FCR, FCU
Thumb flexion Prime Movers
FPB
Elbow extension grade 1
Feel triceps for contraction
Wrist extension substitutions
Finger extensors
Elbow extension alternate positions
5-3: patient short sitting
Forearm supination substitution
externally rotate and adduct arm
Forearm pronation grade 2
partial ROM
Finger MP extension instructions to therapist
First show patient how to make an intrinsic minus hand, then support under wrist. Apply resistance with one finger between the MP and PIP.
Finger MP Flexion 2, 1, 0
Forearm in neutral. OT stabilizes MCs. Grade 1 has minimal motion.
Wrist extension grade 2
Forearm on table in neutral. OT supports wrist and palpates extends
Wrist extension grade 1
Forearm pronated on table. OT supports wrist and palpates/views extensor tendons contract.
Finger adduction test position
Forearm pronated with fingers extended and abducted. Pt. adducts fingers
Finger abduction test position
Forearm pronated with fingers extended and adducted. Pt. should abduct fingers
Thumb flexion test position
Forearm supinated and resting on table. Flex thumb while keeping IP straight
Thumb abduction test position
Forearm supinated and resting on table. Pt. raises thumb to 90
Wrist flexion grade 1
Forearm supinated on table, wrist supported in flexion. OT palpates tendons
Finger adduction grade 1
OT can't palpate because muscles are too deep so look for a slight contraction.
Thumb abduction grade 1
OT palpate base of 1st MC (for the most lateral tendon)
Forearm supination grade 1
OT should support forearm and palpate the supinator on forearm
Forearm pronation grade 1
OT supports forearm, palpates the pronator teres and watches for visible contraction
Thumb abduction prime movers
APL, APB
Elbow Flexion Prime Movers
Brachialis, Biceps, Brachioradialis
Elbow flexion substitutions
Brachialis: pronation, Brachioradialis: neutral forearm
Wrist flexion grade 2
Client has arm on table, neutral forearm. OT supports wrist while patient tries to flex wrist
Finger MP Flexion test position
Client sit with elbow flexed and resting on table. Forearm supinated
Forearm pronation substitutions
Internally rotate shoulder or abduct shoulder
Finger MP Flexion Substitutions
Long finger flexors
Thumb flexion substitution
Long thumb flexor
Finger adduction prime movers
Palmar interossei
Thumb flexion grade 1
Palpate to feel the FPB in the thenar eminence
Finger abduction grade 1
Palpate under (at the side of) pinky
Forearm supination grade 2
Partial ROM
Thumb abduction grade 2
Partial ROM
Thumb flexion grade 2
Partial ROM
Finger abduction grade 2
Partial abduction.
Finger adduction grade 2
Partial adduction
Forearm pronation prime movers
Pronator teres, pronator quadratus
Elbow extension patient position
Prone on table with shoulder abducted to 90 and elbow flexed to 90. Elbow hanging off table. Patient should straighten elbow.
Finger MP Extension test position
Pt. rests wrist pronated on the table with MPs and IPs slightly flexed. Tries to extend MPs ("straighten knuckles") while keeping IPs flexed.
Forearm supination test position
Pt. short sit with arm at side and elbow flexed to 90. Forearm should start pronated!
Finger adduction therapist instructions
Pull middle phalanges apart one at a time
Elbow extension grade 2
Short sit with shoulder abducted to 90 and elbow slightly flexed. OT supports elbow and palpates the triceps proximal to the olecranon.
Elbow Flexion Grade 2
Short sit with shoulder flexed to 90 and internally rotated and forearm supinated. OT should support proximal to elbow. Client tries to flex elbow with gravity minimized. OT palpate antecubital surface for biceps contraction
Elbow Flexion MMT Position
Short sitting with arm supinated
Finger MP Flexion Therapist instructions
Show client how to make an intrinsic plus hand with MPs flexed and IPs extended. Support under wrist. Resist by pushing fingers down.
Elbow Flexion grade 1
Sidelie with test arm up. OT supports proximal to wrist, try to bend elbow and palpate antecubital surface.
Forearm pronation and supination alternate positions
Sit facing table with arm resting on table.
Wrist extension test position
Sitting, elbow pronated on the table. Pt. extends wrist
Thumb abduction therapist instructions
Stabilize MCs 2-5 and wrist. Resistance applied to dorsal part of thumb.
Thumb flexion therapist instructions
Stabilize first MC, resist with one finger on proximal phalanx
Finger abduction therapist instructions
Stabilize wrist, resistance by pushing fingers together one at a time
Elbow Flexion Therapist Instructions
Stand at test side and stabilize anterior shoulder. Apply resistance over volar surface of forearm proximal to wrist.
Forearm supination therapist intructions
Support elbow, stand in front or to side. Resist with heel of the hand on dorsal wrist (like shaking hands)
Forearm pronation therapist instructions
Support elbow. Resistance by trying to supinate (shake hands)
Wrist extension therapist instructions
Support forearm. Resist over dorsal MCs
Wrist flexion therapist instructions
Support under wrist. Apply resistance with 4 fingers to the palmar surface
Elbow extension therapist instructions
Support with one hand proximal to elbow. Apply resistance to forearm, just proximal to the wrist.
Elbow Extension Prime movers
Triceps
Finger MP Extension substitution
Wrist flexion
Finger MP extension grades 2, 1, 0
Wrist on table but in neutral position. 1 has visible tendon contraction but no movement
Forearm supination prime movers
biceps, supinator
Finger Abduction prime movers
dorsal interossei and abductor digiti minimi
Finger adduction substitution
long finger flexors.
Forearm pronation test position
short sit, begin in full supination. Try to pronate
Elbow Flexion alternate positions
sidelying if patient can't sit
Wrist flexion test position
sitting with arm on table and forearm supinated.
