Manual Muscle Testing: Elbow & Forearm Muscles

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Questions and Answers

Which primary muscles are involved in forearm pronation?

Biceps brachii and Brachialis

Triceps brachii and Anconeus

Pronator quadratus and Pronator teres (correct)

Flexor carpi radialis and Supinator

What is the range of motion (ROM) for forearm pronation?

0°- 80° (correct)

0°- 90°

0°- 60°

0°- 100°

What grade of forearm pronation indicates full range of motion and strength?

Grade 2

Grade 5 (correct)

Grade 4

Grade 3

Which accessory muscle is involved in forearm pronation?

Flexor carpi radialis Signup and view all the answers

What substitution may occur if the forearm pronation test is improperly performed?

Shoulder abductors and internal rotators Signup and view all the answers

What is the primary muscle responsible for elbow flexion?

Biceps Signup and view all the answers

In which position is the isolation of the biceps brachii tested at grades 5 and 4?

Forearm supinated Signup and view all the answers

Which accessory muscle assists in elbow flexion?

Brachioradialis Signup and view all the answers

What is the range of motion (ROM) for elbow flexion?

0°- 150° Signup and view all the answers

During grade 2 testing for elbow flexion, which position does the patient assume?

Side-lying with arm at 90° flexion Signup and view all the answers

What occurs at grade 3 elbow flexion testing for the biceps brachii?

Elbow is flexed against gravity Signup and view all the answers

What position should be avoided during elbow extension testing at grades 5 and 4?

Closed packed position Signup and view all the answers

In the gravity-minimized position for elbow extension testing at grade 2, how should the elbow be positioned?

In 45° flexion Signup and view all the answers

What muscle is primarily responsible for elbow extension?

Triceps brachii Signup and view all the answers

Which position is typically used for gravity-resisted elbow extension testing?

Prone with arm in 90° of abduction Signup and view all the answers

At grade 3 for forearm supination, what position should the forearm initially be in?

In pronation Signup and view all the answers

What is the primary substitution movement during forearm supination testing?

Shoulder external rotation Signup and view all the answers

Which muscle is primarily responsible for pure forearm supination?

Supinator Signup and view all the answers

During testing for elbow extension, when using the alternate gravity-resisted position from sitting, the elbow should be flexed to what degree?

90° Signup and view all the answers

When palpating for grade 1 or 0 forearm supination, where should the palpation be performed?

Distal to the head of the radius Signup and view all the answers

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What is the range of motion (ROM) for forearm supination as indicated?

0° - 80° Signup and view all the answers

Signup and view all the answers

Study Notes

Manual Muscle Testing of Elbow, Forearm Muscles

Objectives: After this lecture, students will be able to describe and apply muscle testing procedures for elbow flexion, extension, forearm supination, and pronation.

Elbow Flexion

Primary Muscles: Biceps brachii, brachalis, and brachioradialis.
Range of Motion (ROM): 0° to 150°.
Biceps Brachii:
- Origin: Supraglenoid tubercle and coracoid process.
- Insertion: Radial tuberosity.
- Action: Major forearm flexor, especially when forearm is pronated.
- Innervation: Musculocutaneous nerve (C5 and C6).
Brachialis:
- Origin: Distal half of anterior surface of humerus.
- Insertion: Coronoid process and tuberosity of ulna.
- Action: Major flexor of forearm, in all positions, primarily when forearm is pronated.
- Innervation: Musculocutaneous nerve (C5 and C6).
Brachioradialis:
- Origin: Lateral ridge of distal humerus.
- Insertion: Lateral surface of distal radius near the styloid process.
- Action: Flexion of elbow, supination of forearm, pronation of forearm. Most effective as a flexor with forearm in neutral position.
- Innervation: Radial nerve.
Accessory Muscles: Pronator teres, extensor carpi radialis longus, flexor carpi radialis, flexor carpi ulnaris, and palmaris longus (may be absent).

Elbow Flexion Testing Procedures

Grade 5 & 4 (Isolation of biceps brachii): Test position 120°; resistance at mid-range, contoured over flexor surface of forearm proximal to wrist; other hand cups anterior superior surface of shoulder.
Grade 5 & 4 (Isolation of Brachialis): Forearm pronated; isolation of individual muscles during strong effort; all types of contraction. Innervated by 2 nerves
Grade 5 & 4 (Isolation of brachioradialis): Forearm neutral (mid-position)
Grade 3 (biceps brachii): Specific testing position.
Grade 2 (biceps brachii): Sitting with arm at 90° flexion or abduction; support the upper arm; palpate biceps tendon, brachalius (medially) and brachioradialis (laterally)
Grade 2, 1 & 0 (Alternate Position): Side-lying position. Substitutions include shoulder extension, (incorrect stabilization) or strong wrist flexion.

Elbow Extension

Primary Muscle: Triceps brachii.
Accessory Muscle: Anconeus.
ROM: 150°-0°.
Triceps Brachii:
- Origin: Long head (infraglenoid tubercle of scapula), lateral head (humerus above radial groove), medial head (humerus below radial groove).
- Insertion: Olecranon of ulna.
- Action: Extends forearm. Medial head is active in all intensities of extension.
Anconeus:
- Origin: Lateral epicondyle.
- Insertion: Lateral side of olecranon process.
- Action: Extension of elbow.

Elbow Extension Testing Procedures

Grade 5 & 4 (from prone): Avoid closed packed position (locked position); resistance on dorsal surface of forearm above the wrist (20°).
Grade 3 (from prone): Specific testing position.
Grade 2 (Gravity-minimized): Sitting with arm supported at 90° shoulder abduction and elbow in 45° flexion. Palpate on the posterior surface, proximal to olecranon process.
Grades 1 & 0: Specific testing position.
Substitutions: Shoulder external rotation (assistance by gravity), horizontal shoulder adductors. Prevent with table or powder board, and proper stabilization of upper arm.

Forearm Supination

Primary Muscles: Supinator (pure supination) and biceps brachii (powerful supination with elbow flexion).
ROM: 0° to 80°.
Supinator:
- Origin: Lateral epicondyle of humerus and crest of ulna
- Insertion: Lateral surface of proximal 1/3 of radius.
- Action: Supinates the forearm.

Forearm Supination Testing Procedures

Grades 5 & 4: Sitting; arm at side; elbow 90° flexed; arm in pronation; grasp forearm on dorsal surface at wrist; other hand supports elbow.
Grade 3: Specific testing position.
Grade 2 (Alternate Test): Sitting, shoulder flexed between 45° and 90°, elbow flexed to 90°,Forearm in neutral with arm supported.
Grade 1 & 0: Specific testing position.
Substitutions: Shoulder adductors and external rotators, avoided by maintaining arm adducted beside the body. Wrist extensors.

Forearm Pronation

Primary Muscles: Pronator teres and pronator quadratus.
Accessory Muscle: Flexor carpi radialis and brachioradialis (with elbow flexion).
Other info: Pronator teres works in rapid/strong pronation. Pronator quadratus is a deep muscle.
ROM: 0° to 80°.

Forearm Pronation Testing Procedures

Grades 5 & 4: From supination; keep wrist and fingers relaxed; grasp patient’s hand as if shaking hands.
Grade 3: Tested in the same position as Grade 3 for supination; partial ROM.
Grade 2 (Alternate Test): Sitting, shoulder flexed between 45° and 90°, elbow flexed to 90°, Forearm in neutral with arm supported.
Palpate: Over the upper third of anterior surface of forearm, diagonal line from medial condyle of humerus to lateral border of radius.
Substitutions: Shoulder abductors & internal rotators, avoid with arm adducted by the body. Wrist and finger flexors;

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Description

This quiz focuses on the manual muscle testing procedures for elbow flexion, extension, as well as forearm supination and pronation. Students will learn the primary muscles involved, their range of motion, and the anatomical details relevant to each muscle. Perfect for those studying kinesiology or physical therapy.