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.