lab 5 - upper MMT

Elbow flexion muscles

Biceps brachii, brachialis, brachioradialis

Elbow flexion patient position

Sitting with arms at sides

What three forearm positions should be tested during elbow flexion MMT?

Supination, pronation, and neutral

Elbow flexion stabilization

Top of shoulder, avoiding anterior shoulder

Elbow flexion resistance

Forearm just proximal to wrist

Why should the shoulder not be stabilized anteriorly during elbow flexion testing?

May interfere with proper muscle assessment

Elbow extension muscle

Triceps brachii

Elbow extension patient position

Supine with shoulder and elbow flexed

Elbow extension stabilization

Open hand over biceps

Elbow extension resistance

At wrist, pulling toward head of bed

Important cue during elbow extension testing

Do not allow patient to lock the elbow

Why is the D&W elbow extension test not used in this course?

The author notes it is not an ideal testing position

Forearm supination muscles

Biceps brachii and supinator

Forearm supination patient position

Sitting, elbow flexed, humerus held at side

Forearm supination stabilization

Elbow if needed

Forearm supination resistance

At wrist, rotating into pronation

What forearm position should NOT be used during supination testing?

Handshake position

Forearm pronation muscles

Pronator teres and pronator quadratus

Forearm pronation patient position

Sitting, elbow flexed, humerus held at side

Forearm pronation stabilization

Elbow if needed

Forearm pronation resistance

At wrist, rotating into supination

What forearm position should NOT be used during pronation testing?

Handshake position

Wrist flexion muscles

Flexor carpi radialis and flexor carpi ulnaris

Wrist flexion patient position

Sitting with forearm supinated

Wrist flexion stabilization

Under forearm, avoiding pressure on flexors

Wrist flexion resistance

Palm of hand

How is FCR isolated during wrist flexion testing?

Resistance toward radial side

How is FCU isolated during wrist flexion testing?

Resistance toward ulnar side

Important wrist flexion testing rule

Do not allow finger flexion

Wrist extension muscles

ECRL, ECRB, and ECU

Wrist extension patient position

Sitting with forearm pronated

Wrist extension stabilization

Under forearm, avoiding pressure on extensors

Wrist extension resistance

Dorsum of hand

How is ECU isolated during wrist extension testing?

Resistance toward ulnar side

How are ECRL/ECRB isolated during wrist extension testing?

Resistance toward radial side

Important wrist extension testing rule

Do not allow finger extension

What should be assessed before individual finger flexor tests?

Combined finger curl with MCP extension

Combined finger flexion screen tests what muscles?

FDS and FDP

How is combined finger flexion screened?

Curl fingers toward palm while keeping MCPs extended

Combined finger flexion resistance

Under fingers pulling toward extension

PIP flexion muscles

Flexor digitorum superficialis and profundus

PIP flexion patient position

Sitting, forearm supinated or neutral

PIP flexion stabilization

Distal forearm near dorsal wrist

PIP flexion resistance

Sides of phalanx distal to tested joint

DIP flexion muscles

Flexor digitorum profundus primarily

DIP flexion stabilization

Middle phalanx proximal to tested joint

DIP flexion resistance

Sides of distal phalanx

Key DIP testing modification from lab

Block the PIP joint more than described in the textbook

MCP extension muscles

Extensor digitorum, extensor indicis, extensor digiti minimi

MCP extension patient position

Sitting with forearm pronated

MCP extension resistance

Dorsal surface of finger between MCP and PIP

How are MCP extensors tested?

One finger at a time

MCP flexion with IP extension tests what muscles?

Lumbricals assisted by interossei

Common name for MCP flexion with IP extension position

Intrinsic plus position

MCP flexion/IP extension patient position

Sitting with forearm supinated

MCP flexion/IP extension resistance

Base of each finger individually

How are lumbricals tested in this course?

One finger at a time rather than as a group

Finger abduction muscles

Dorsal interossei and abductor digiti minimi

Finger abduction patient position

Sitting with hand off the table

Finger abduction stabilization

Under wrist and forearm

Finger abduction resistance

Distal phalanx toward adduction

Why should the hand not rest on the table during finger abduction testing?

Prevents substitution and assistance

Finger adduction muscles

Palmar interossei

Finger adduction patient position

Sitting with forearm pronated

Finger adduction resistance

Pull fingers apart at mid-finger

Why is there no stabilization during finger adduction testing?

Both therapist hands are needed to separate fingers

Thumb MCP flexion muscle

Flexor pollicis brevis

Thumb IP flexion muscle

Flexor pollicis longus

Thumb flexion patient position

Sitting with forearm supinated

Thumb MCP flexion stabilization

Stabilize CMC joint

Thumb IP flexion stabilization

Stabilize MCP joint

Thumb flexion resistance

Sides of thumb distal to tested joint

Important thumb flexion testing rule

Do not allow IP flexion when testing MCP flexion

Thumb extension muscles

Extensor pollicis longus and brevis

Thumb extension patient position

Sitting with forearm supinated or neutral

Thumb extension stabilization

Stabilize joint proximal to test joint

Thumb extension resistance

Dorsal aspect of thumb into flexion

Thumb abduction muscles

Abductor pollicis longus and brevis

Thumb abduction patient position

Sitting with forearm supinated

Thumb abduction stabilization

Under wrist and hand

Thumb abduction resistance

Lateral aspect of thumb toward adduction

Thumb adduction muscle

Adductor pollicis

Thumb adduction patient position for Fair grade

Forearm pronated

Thumb adduction patient position for Good/Normal grades

Forearm supinated

Thumb adduction resistance

Between MCP and IP joints

Opposition muscles

Opponens pollicis and opponens digiti minimi

Opposition patient position

Sitting or standing with forearm supinated

Opposition resistance

Palmar surface near 5th MCP

How are opposition muscles graded?

Separately even though fingers oppose together

How many trials should be averaged for grip strength testing?

Three

Functional grip strength needed for ADLs

At least 20 lb

Strongest age range for grip strength

25–50 years

Average male grip strength

Right 104 lb, Left 93 lb

Average female grip strength

Right 63 lb, Left 54 lb

Three pinch grip types

Tip-to-tip, lateral pinch, three-jaw chuck

Functional pinch strength needed for ADLs

5–7 lb

What handle position is typically used for dynamometer testing?

Second handle notch

Who supports the dynamometer during testing?

Therapist

Why are grip and pinch dynamometers used?

Objective measurement of hand strength and function