Manual Muscle Testing - Elbow, Wrist, and Hand

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Questions and Answers

What is the correct instruction for performing elbow extension in a gravity-eliminated position?

  • Try to lift your arm overhead.
  • Try to keep your elbow bent.
  • Try to flex your elbow.
  • Try to straighten your elbow. (correct)

In the gravity-eliminated position for pronation, what is the position of the forearm?

  • Neutral position.
  • Fully supinated. (correct)
  • Fully pronated.
  • Flexed at an angle.

When stabilizing during elbow extension against gravity, what part of the arm should be supported?

  • The shoulder.
  • The humerus. (correct)
  • The wrist.
  • The forearm.

Which muscle is primarily responsible for elbow extension?

<p>Triceps. (B)</p> Signup and view all the answers

What role does gravity play in performing pronation against gravity?

<p>It provides resistance against supination. (D)</p> Signup and view all the answers

Where is the pronator teres muscle located during palpation?

<p>Medial to the biceps tendon. (C)</p> Signup and view all the answers

What substitution might occur during the gravity-eliminated position for elbow extension?

<p>Shoulder abduction. (B)</p> Signup and view all the answers

What is the recommended position for the patient’s elbow when starting pronation against gravity?

<p>Elbow flexed to 90°. (A)</p> Signup and view all the answers

Which muscle is primarily engaged when the forearm is in supination during elbow flexion?

<p>Biceps brachii (B)</p> Signup and view all the answers

What is the correct stabilization point for elbow flexion in the against-gravity position?

<p>Distal end of the humerus (B)</p> Signup and view all the answers

In a gravity-eliminated position for elbow flexion, where should the starting position of the arm be?

<p>Supported at 90° of abduction and elbow extension (D)</p> Signup and view all the answers

Which muscle is primarily palpated when the forearm is pronated and the biceps is relaxed?

<p>Brachialis (D)</p> Signup and view all the answers

What is the prime mover for elbow extension?

<p>Triceps (A)</p> Signup and view all the answers

When applying resistance during elbow extension, what angle should the elbow be flexed to prevent locking?

<p>10°–15° (B)</p> Signup and view all the answers

In which position should the patient be to perform elbow extension against gravity?

<p>Prone with the humerus abducted to 90° (D)</p> Signup and view all the answers

Which muscle may substitute during elbow flexion in a gravity-eliminated plane?

<p>Wrist flexors (C)</p> Signup and view all the answers

What is the starting position for testing finger distal interphalangeal (DIP) flexion against gravity?

<p>Forearm supinated and supported on a table (B)</p> Signup and view all the answers

Which muscle is primarily responsible for finger distal interphalangeal (DIP) flexion?

<p>Flexor Digitorum Profundus (D)</p> Signup and view all the answers

In the gravity-eliminated position for DIP flexion, how should the forearm be positioned?

<p>Resting on the ulnar border (B)</p> Signup and view all the answers

What is required to prevent the influence of the Flexor Digitorum Profundus when testing the Flexor Digitorum Superficialis?

<p>Hold all IP joints of other fingers in extension (B)</p> Signup and view all the answers

What is the primary stabilizing action when testing the distal interphalangeal flexion?

<p>Hold the middle phalanx of each finger firmly (B)</p> Signup and view all the answers

During testing for proximal interphalangeal (PIP) flexion, which additional position modification is necessary?

<p>Hold other fingers in full extension (C)</p> Signup and view all the answers

What is a notable substitution that can occur during the testing of DIP flexion?

<p>Rebound effect from extensor contraction (B)</p> Signup and view all the answers

What action is encouraged by the therapist when testing the DIP flexion?

<p>Bend the last joint on the finger as far as possible (D)</p> Signup and view all the answers

What is the primary action being performed in the against-gravity position for thumb adduction?

<p>Bringing the thumb towards the palm (C)</p> Signup and view all the answers

Which muscle is palpated in the gravity-eliminated position for thumb adduction?

<p>Adductor pollicis (B)</p> Signup and view all the answers

What is the starting position for performing the opposition motion against gravity?

<p>Forearm supinated and supported with thumb adducted (D)</p> Signup and view all the answers

During the thumb opposition resistance, which structure does the therapist typically hold?

<p>First metacarpal or fifth metacarpal (D)</p> Signup and view all the answers

Which of the following muscles may substitute during the thumb adduction assessment?

<p>Flexor pollicis brevis (C)</p> Signup and view all the answers

In the gravity-eliminated position for opposition, what is emphasized in the instruction?

<p>Touch the pad of your thumb to the pad of your little finger (D)</p> Signup and view all the answers

What is required for stabilization during thumb adduction against gravity?

<p>Maintaining the MP joints of the fingers in neutral (C)</p> Signup and view all the answers

Which action is primarily performed by the opponens pollicis during thumb opposition?

<p>Opposition of the thumb (C)</p> Signup and view all the answers

Which muscle is primarily responsible for finger proximal interphalangeal (PIP) flexion?

<p>Flexor digitorum superficialis (FDS) (C)</p> Signup and view all the answers

What position should the forearm be in for testing gravity-eliminated finger PIP flexion?

<p>Supported in midposition (C)</p> Signup and view all the answers

Which of the following actions might substitute for pure PIP flexion during testing?

<p>Flexor digitorum profundus action (B)</p> Signup and view all the answers

What are the prime movers for finger metacarpophalangeal (MCP) flexion?

<p>Flexor digitorum superficialis and flexor digitorum profundus (A)</p> Signup and view all the answers

When testing the flexor digiti minimi in a gravity-eliminated position, how should the other fingers be positioned?

<p>In extension (C)</p> Signup and view all the answers

What is a key consideration when palpating for the flexor digiti minimi during testing?

<p>It is found on the volar surface of the hypothenar eminence (C)</p> Signup and view all the answers

Which tendon is located ulnar to the extensor digitorum (ED) tendon?

<p>Extensor indicis proprius (A)</p> Signup and view all the answers

What should the therapist ensure during resistance application for the flexor digiti minimi test?

<p>The IP joints remain extended (D)</p> Signup and view all the answers

Which muscle, besides FDP, is specifically mentioned as a prime mover for finger abduction?

<p>Dorsal interossei (B)</p> Signup and view all the answers

What is the starting position for testing the lumbrical function in Test 1?

<p>Forearm supinated with wrist in neutral position (C)</p> Signup and view all the answers

What is the primary action of the extensor digiti minimi tendon?

<p>Extension of the little finger (A)</p> Signup and view all the answers

In Test 2 for lumbrical function, what movement is required from the participants?

<p>Extend the metacarpophalangeal joints while flexing the interphalangeal joints (C)</p> Signup and view all the answers

What effect can wrist flexion have on finger extension?

<p>It leads to tenodesis action for finger extension (D)</p> Signup and view all the answers

Which muscles are considered prime movers for finger interphalangeal (IP) extension?

<p>Lumbricals, interossei, and extensor digitorum (A)</p> Signup and view all the answers

What is true about the extensor digitorum to the little finger?

<p>It is a slip from the ED tendon to the ring finger (A)</p> Signup and view all the answers

Why is there no reliable test for lumbrical function?

<p>Lumbrical muscles are too deep to be palpated (D)</p> Signup and view all the answers

Flashcards

Elbow Extension

A movement that straightens the elbow joint.

Gravity-Eliminated Position

A position where gravity does not assist or resist the movement. The arm is supported to eliminate the effects of gravity.

Prime Mover

A muscle that primarily performs a specific movement.

Pronation

A movement that rotates the forearm so the palm faces down.

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Pronator Teres

A muscle that helps to pronate the forearm.

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Pronator Quadratus

A muscle that helps to pronate the forearm, located deeper than the Pronator Teres.

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Supination

A movement that rotates the forearm so the palm faces up.

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Supinator

A muscle that helps to supinate the forearm.

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Elbow Flexion Prime Movers

The primary muscles responsible for bending the elbow upwards.

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Elbow Flexion - Against Gravity

The position where the elbow is bent against the force of gravity, requiring muscle effort to maintain the position.

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Elbow Flexion - Gravity Eliminated

The position where the elbow is bent with the arm supported, eliminating the force of gravity.

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Elbow Extension Prime Mover

The primary muscle responsible for straightening the elbow outwards.

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Elbow Extension - Against Gravity

The position where the elbow is straightened against the force of gravity.

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Elbow Extension (Gravity Eliminated)

The position where the elbow is straightened with the arm supported, eliminating the force of gravity.

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Manual Muscle Testing (MMT)

A technique used to evaluate muscle strength by applying resistance to a specific movement.

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Substitution during MMT

The action of a different muscle taking over the intended movement, due to weakness in the primary muscle.

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Thumb Abduction Against-Gravity

The thumb is lifted away from the palm of the hand against resistance, while the hand is stabilized. This assesses thumb abduction and helps identify any muscle substitutions.

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Thumb Adduction Gravity-Eliminated

The thumb is moved towards the palm of the hand, with the forearm in a neutral position. This assesses thumb adduction and helps identify any muscle substitutions.

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Thumb Opposition Against-Gravity

The thumb pad is moved to touch the little finger pad against resistance, with the forearm supinated and stabilized. This assesses thumb opposition and helps identify any muscle substitutions.

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Thumb Opposition Gravity-Eliminated

The thumb pad is attempted to be moved to touch the little finger pad, with the forearm perpendicular to the table and stabilized. This assesses thumb opposition in a gravity-eliminated position.

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Abductor Pollicis Brevis

The primary muscle responsible for thumb abduction, located on the radial side of the hand.

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Adductor Pollicis

This powerful muscle is located on the palmar side of the thumb, and is responsible for thumb adduction. When palpating, it can be felt in the thumb web space.

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Opponens Pollicis

The main muscle responsible for opposing the thumb, allowing it to touch other fingers. It is located on the radial side of the hand, deep to the ABductor Pollicis Brevis.

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Opponens Digiti Minimi

This muscle is responsible for opposition of the little finger, allowing it to touch the thumb.

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Finger MCP Extension

The tendons of the extensor digitorum muscle can be seen on the back of the hand, indicating extension of the metacarpophalangeal (MCP) joints of the fingers.

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Extensor Indicis Proprius

The extensor indicis proprius muscle extends only the index finger. It's located on the dorsal forearm, ulnar to the extensor digitorum.

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Extensor Digiti Minimi

The extensor digiti minimi muscle extends only the little finger. Its tendon is ulnar to the extensor digitorum tendon, even though it appears to be the main tendon to the little finger.

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Lumbrical Function

The lumbrical muscles are responsible for extending the interphalangeal (IP) joints of the fingers when the metacarpophalangeal (MCP) joints are extended. There is no reliable test to specifically isolate lumbrical function.

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Lumbrical Substitution

If the lumbrical muscles are not functioning, other muscles in the dorsal expansion can substitute for DIP extension when the MP joint is flexed. However, there is no substitute for DIP extension when the MP joint is extended.

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Tenodesis Action

Tenodesis action refers to the passive finger extension that occurs when the wrist is flexed. This is due to the tension created in the finger extensor tendons as the wrist flexes.

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Finger IP Extension

Finger interphalangeal (IP) extension involves extending the joints between the finger bones. The lumbricals, interossei, ED, extensor indicis proprius, and extensor digiti minimi are all involved in this movement.

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Palpating Lumbricals

The lumbrical muscles are too deep to be palpated effectively.

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Finger DIP Joint Flexion Prime Mover

A muscle that helps to bend a joint. In this case, the FDP (Flexor Digitorum Profundus) is the primary muscle responsible for bending the last joint of the finger.

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Stabilization for Finger DIP Flexion Testing

Holding the middle phalanx of each finger in a fixed position to prevent movement of the proximal IP joint. This allows for isolated testing of the DIP joint flexion.

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Against-Gravity Position for Finger DIP Flexion Testing

The position where the forearm is supported and the hand is resting with the wrist and IP joints relaxed. The patient is instructed to bend the last joint of the finger as far as possible while resistance is applied to the fingertip.

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Gravity-Eliminated Position for Finger DIP Flexion Testing

The position where the forearm is supported and the hand is resting with the wrist and IP joints relaxed. The patient is instructed to bend the last joint of the finger as far as possible while the therapist feels for muscle activation.

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Palpation of FDP for Finger DIP Flexion

The FDP muscle can be felt just below the ulna in the proximal third of the forearm and sometimes along the middle phalanges.

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Rebound Effect in Finger DIP Flexion

The action that occurs when the extensor muscles contract, resulting in a brief rebound movement of the finger, which might mimic flexion without actual muscle activation

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Tenodesis Action in Finger DIP Flexion

An action where the wrist extension forces the fingers to bend due to the tendon arrangement, mimicking finger flexion

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Finger PIP Joint Flexion Prime Mover

A muscle that helps to bend a joint. In this case, the FDS (Flexor Digitorum Superficialis) is the primary muscle responsible for bending the middle joint of the finger.

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Finger PIP Flexion

The movement of bending the middle joint of a finger (the proximal interphalangeal joint, or PIP joint) towards the palm.

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PIP Flexion Testing Position

The hand is held in a neutral position, with the forearm supported. The other fingers are held straight to prevent improper muscle action. The therapist stabilizes the finger and instructs the patient to bend only the PIP joint.

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PIP Flexion: Prime Mover and Palpation

The flexor digitorum superficialis (FDS) is the primary muscle responsible for this movement. The therapist can palpate the tendon on the volar surface of the forearm, near the ulnar side, and between the palmaris longus and flexor carpi ulnaris (FCU) at the wrist.

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PIP Flexion: Preventing Substitution

The flexor digitorum profundus (FDP) can substitute for the FDS during this movement. To prevent the FDP from substituting, all other fingers are held straight.

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Finger MCP Flexion

The movement of bending the knuckle of a finger towards the palm (the metacarpophalangeal joint, or MCP joint).

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MCP Flexion: Prime Movers

Several muscles are responsible for this movement, including the flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), dorsal interossei (DI), volar (palmar) interossei, and flexor digiti minimi. The flexor digiti minimi, which only acts on the little finger, is tested in this specific way.

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Flexor Digiti Minimi Testing Position

The hand is placed in supination with the forearm supported. Other fingers are kept straight, and the patient is instructed to bend only the MCP joint of the little finger while keeping the rest of the finger straight.

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Flexor Digiti Minimi Testing Resistance

The therapist provides resistance at the head of the proximal phalanx of the little finger, pushing against the patient's effort to bend the MCP joint. It's essential to ensure the IP joints remain extended.

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Study Notes

Manual Muscle Testing (MMT) of the Elbow, Wrist, and Hand

  • MMT assesses the strength of muscles in the elbow, wrist, and hand.
  • Procedures for testing are outlined for both against-gravity and gravity-eliminated positions.

Elbow Flexion

Prime Movers

  • Biceps, brachialis, brachioradialis

Against-Gravity Position

  • Start Position: Sitting with the arm at the side. Forearm position (supination/pronation/midposition) dictates the primary muscle engaged.
  • Stabilize: Stabilize the distal humerus while resisting the action
  • Instruction: Bend your elbow to touch your shoulder, do not let me pull it backward.
  • Resistance: Therapist resists extension, testing for different forearm positions.

Gravity-Eliminated Position

  • Start Position: Sitting with the arm supported by the therapist at 90° abduction and elbow extension. Forearm position determines the primary muscle engaged.
  • Stabilize: Distal humerus
  • Instruction: Try to move your hand towards the shoulder
  • Palpation: The biceps is palpable on the anterior humerus, the brachialis medial to the distal biceps' tendon, and the brachioradialis along the radial side of the proximal forearm.
  • Substitution: Wrist flexors

Elbow Extension

Prime Mover

  • Triceps

Against-Gravity Position

  • Start Position: Prone with humerus abducted at 90° and supported on the table. Elbow flexed, forearm hanging over the table edge.
  • Stabilize: Support the arm under the anterior surface of the distal humerus.
  • Instruction: Straighten your arm and do not let me push it back down.
  • Resistance: The therapist resists flexion, testing elbow at 10-15° less than full extension to avoid locking while testing strength.

Gravity-Eliminated Position

  • Start Position: Sitting with humerus supported in 90° abduction, elbow flexed.
  • Stabilize: Humerus stabilized and supported
  • Instruction: Try to straighten your elbow.
  • Palpation: Palpate triceps on the posterior humerus
  • Substitution: Wrist flexors

Pronation

Prime Movers

  • Pronator teres and pronator quadratus

Against-Gravity Position

  • Start Position: Sitting with humerus abducted, elbow flexed at 90°, and forearm supinated. Wrist and fingers relaxed.
  • Stabilize: Distal humerus
  • Instruction: “Turn your palm to the floor and do not let me turn it back over."
  • Resistance: Resist the forearm's supination.

Gravity-Eliminated Position

  • Start Position: Sitting with humerus flexed to 90° and supported. Forearm in full supination. Wrist and fingers relaxed.
  • Stabilize: Humerus stabilized
  • Instruction: "Try to turn your palm away from your face."
  • Palpation: Pronator teres medial to biceps tendon; pronator quadratus is deep to palpate.
  • Substitution: Shoulder abduction or wrist and finger flexion

Supination

Prime Movers

  • Supinator and biceps

Against-Gravity Position

  • Start Position: Sitting, humerus adducted, elbow flexed to 90°, forearm pronated. Wrist and fingers relaxed
  • Stabilize: Distal humerus
  • Instruction: Turn your palm up toward the ceiling, do not let me turn it back over.
  • Resistance: Resist pronation

Gravity-Eliminated Position

  • Start Position: Sitting with humerus flexed to 90° and supported. Forearm in full pronation, wrist and fingers relaxed.
  • Stabilize: Humerus stabilized and supported
  • Instruction: “Try to turn your palm toward your face.”
  • Palpation: Supinator distal to radius head,
  • Substitution: Wrist and finger extensors

Wrist and Hand Measurements

  • Test positions for individual muscles (wrist and hand) should minimize other muscles' influences.
  • A muscle's effect is minimized by placing it opposite the prime action.
  • For example, to minimize extensor pollicis longus on thumb proximal joint extension, flex the distal joint.

Wrist Extension

Prime Movers

  • Extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor carpi ulnaris (ECU).

Against-Gravity Position

  • Start Position: Forearm supinated, fingers relaxed/slightly flexed
  • Stabilize: The forearm on the table
  • Instruction: Lift the wrist as far as you can, do not let me push it down.

Resistance: Test the action for radial and ulnar deviation

Wrist Flexion

Prime Movers

  • Flexor carpi radialis (FCR), palmaris longus, flexor carpi ulnaris (FCU)

Against-Gravity Position

  • Start Position: Forearm supinated, wrist extended, fingers and thumb relaxed.
  • Stabilize: Forearm
  • Instruction: Bend the wrist as far as you can.
  • Resistance: Resist the wrist extension

Palmaris Longus

  • Tendon is prominent on palpation on the volar surface of the wrist.

Finger Metacarpophalangeal (MCP) Extension

  • Prime Movers: ED, extensor indicis proprius (EIP), extensor digiti minimi (EDM)
  • Against-Gravity Position: Forearm pronated, wrist in neutral, fingers flexed
  • Instruction: "Lift this knuckle straight as far as it will go. Keep the rest of your fingers bent."
  • Resistance: Therapists pushes the proximal phalanx toward flexion, one at a time.
  • Other relevant details are covered for both positions.

Finger Interphalangeal (IP) Extension

Prime Movers

  • Lumbricals, interossei, ED, EIP, EDM

Against-Gravity Position

  • Start Position: Forearm supinated, wrist neutral, fingers/thumb flexed
  • Test 1: MPs extended, IPs flexed.
  • Test 2: MPs flexed, IPs extended.
  • Instruction: For Test 1, "Bend your knuckles and straighten your fingers at the same time".
  • Instruction: For Test 2, "Straighten your knuckles and keep your fingers straight at the same time"

Finger Distal Interphalangeal (DIP) Flexion

  • Prime Mover: FDP
  • Against-Gravity Position: Forearm supinated, wrist neutral, IP joints relaxed.
  • Instruction: "Bend the last joint on your finger as far as you can."
  • Resistance: Resist extension

Finger Proximal Interphalangeal (PIP) Flexion

  • Prime Movers: FDS and FDP
  • Against-Gravity Position: Forearm supinated, wrist neutral, MP joints relaxed, fingers extended
  • Instruction: "Bend just the PIP joint."
  • Palpation: FDS at the volar surface of the forearm, closer to the ulnar side.

Finger Metacarpophalangeal (MCP) Flexion

Prime Movers

  • FDP, FDS, dorsal and volar interossei, flexor digiti minimi (FDMin)

Against-Gravity Position

  • Forearm supinated
  • Instruction: "Bend the knuckle of your little finger toward your palm while keeping the rest of your finger straight."

Gravity-Eliminated Position

  • Forearm supported in midposition
  • Instruction: "Try to bend the knuckle of your little finger toward your palm while you keep the rest of the finger straight."

Finger Abduction

Prime Movers

  • Dorsal interossei (DI) and abductor digiti minimi (ADmin).
  • Gravity-Eliminated Position: Pronated forearm, wrist neutral, fingers extended and adducted.
  • Instruction: "Spread your fingers apart, do not let me push them back together."
  • Actions: Each finger abduction is towards the midline of the hand.
  • Resistance: Resisted finger abduction

Finger Adduction

Prime Movers

  • Volar interossei(PI)
  • Gravity-Eliminated Position: Forearm pronated, wrist neutral, fingers extended.
  • Instruction: Bring your fingers together, do not let me pull them apart.
  • Actions: Finger adduction is towards the midline of the hand.
  • Resistance: Resisted adduction

Thumb Interphalangeal (IP) Extension

  • Prime Mover: EPL
  • Against-Gravity Position: Forearm midposition, wrist flexion 10-20°, thumb MP and IP flexion.
  • Instruction: Straighten the end of your thumb.
  • Resistance: Therapist placing finger over the dorsum of the distal phalanx and pushes toward flexion(DIP)
  • Other details like testing positions are given for both positions.

Thumb Metacarpophalangeal (MCP) Extension

  • Prime Movers: EPL and EPB
  • Against-Gravity Position: Forearm midposition, MP and IP flexed
  • Instruction: Straighten your thumb knuckle while keeping the DIP bent.
  • Resistance: Push the proximal phalanx toward flexion

Thumb Abduction

Prime Movers

  • Abductor pollicis longus (APL) and Abductor pollicis brevis (APB).

Against-Gravity Position

  • Forearm supinated, wrist neutral, thumb adducted.
  • Instruction: “Bring your thumb away from your palm, do not let me push it back in”
  • Action: Abduction of the thumb moving it away from the midline of the hand.
  • Resistance: Resisted thumb abduction

Thumb Adduction

  • Prime Mover: Adductor pollicis
  • Against-Gravity Position: Forearm pronated, wrist neutral, thumb abducted, and MP & IP joints of thumb in extension.
  • Instruction: "Lift your thumb into the palm of your hand, do not let me pull it out."
  • Resistance: Resist thumb adduction

Opposition

Prime Movers

  • Opponens pollicis, and opponens digiti minimi

Against-Gravity Position

  • Forearm supinated, wrist neutral, thumb adducted and extended.
  • Instruction: "Touch the pad of your thumb to the pad of your little finger, do not let me pull them apart."
  • Resistance: Resist the opposition movement

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