HAND MMT TESTS

Flexor digitorum superficialis (FDS)

Position: sit or lie supine, back of hand on table, wrist and MCP neutral, forearm supinated, test each finger separately. Movement: flex the PIP joint while keeping the DIP joint relaxed. Palpate: FDS tendon on palmar side of proximal phalanx. Resistance: palmar surface of middle phalanx toward PIP extension. Stabilise: proximal phalanx and palm.

Flexor digitorum profundus (FDP)

Position: sit or lie supine, back of hand on table, wrist and MCP neutral, forearm supinated, test each finger separately. Movement: flex the DIP joint, other fingers may relax and flex. Palpate: FDP tendon on palmar side of middle phalanx. Resistance: palmar surface of distal phalanx toward DIP extension. Stabilise: middle phalanx and PIP joint.

Lumbricals

Position: forearm pronated, hand palm down, middle and distal phalanges hang flexed over table edge with table supporting MCP joints in extension. Movement: extend the IP joints while keeping MCP joints extended. Palpate: usually cannot be palpated, trace or grade 1 cannot be given. Resistance: backs of middle and distal phalanges toward IP flexion. Stabilise: support under proximal phalanx of the tested finger. Alternate test: flex the MCP joint with proximal and DIP joints extended, resisted on palm side of proximal phalanx toward MCP extension.

Abductor pollicis longus (APL)

Position: hand on its ulnar border or forearm supinated, wrist neutral, thumb starts adducted. Movement: move the thumb away from the palm in the plane of the palm. Palpate: APL tendon just proximal to thumb CMC joint, the most anterior of three tendons at its base. Resistance: distal end of first metacarpal toward thumb adduction. Stabilise: palm of the hand.

Abductor pollicis brevis (APB)

Position: hand on ulnar border or forearm supinated, wrist neutral, thumb adducted. Movement: lift the thumb away from the palm at a right angle to the palm. Palpate: along anterior surface of first metacarpal shaft. Resistance: proximal phalanx toward thumb adduction. Stabilise: palm, and avoid letting the first metacarpal lift toward the middle of the hand.

Flexor pollicis longus (FPL)

Position: forearm supinated and supported, hand on its back, wrist neutral, thumb starts adducted. Movement: flex the thumb IP joint. Palpate: FPL tendon on palmar side of proximal phalanx. Resistance: distal phalanx toward IP extension. Stabilise: proximal phalanx.

Flexor pollicis brevis (FPB)

Position: forearm supinated and supported, hand on its back, wrist neutral, thumb starts adducted. Movement: flex the thumb MCP joint. Palpate: FPB muscle belly on ulnar side of first metacarpal. Resistance: proximal phalanx toward MCP extension. Stabilise: first metacarpal.

Extensor pollicis longus (EPL)

Position: hand on ulnar border, MCP abducted and IP flexed. Movement: extend the thumb IP joint, with MCP and IP extension tested individually. Palpate: EPL tendon on back of thumb near first MCP joint, tracking toward distal phalanx. Resistance: dorsal surface of distal phalanx toward IP flexion. Stabilise: proximal phalanx and first metacarpal.

Extensor pollicis brevis (EPB)

Position: hand on ulnar border, MCP flexed and abducted. Movement: extend the thumb MCP joint. Palpate: EPB tendon along lateral side of base of first MCP joint, tracking toward proximal phalanx. Resistance: dorsal surface of proximal phalanx toward MCP flexion. Stabilise: first metacarpal.

Dorsal interossei

Position: forearm pronated, palm on table, fingers extended. Movement: abduct the index, ring and little fingers away from the middle finger, which moves toward index and ring. Palpate: radial side of second metacarpal, both sides of the middle finger proximal phalanx, and ulnar side of ring finger proximal phalanx. Resistance: side of distal end of proximal phalanx toward finger adduction. Stabilise: hand and fingers not being tested.

Palmar interossei

Position: forearm pronated, palm on table, wrist and fingers extended, finger abducted to start. Movement: adduct the index, ring or little finger toward the middle finger. Palpate: ulnar side of index proximal phalanx, radial side of ring and little finger proximal phalanges. Resistance: side of distal end of proximal phalanx toward finger abduction. Stabilise: hand and fingers not being tested.

Abductor digiti minimi (ADM)

Position: palm on table, wrist neutral, fingers extended. Movement: move the little finger away from the ring finger. Palpate: along ulnar border of fifth metacarpal. Resistance: side of distal end of proximal phalanx toward adduction. Stabilise: hand and fingers not being tested.

Flexor digiti minimi

Position: hand on its back, forearm supinated. Movement: flex the fifth MCP joint while keeping the IP joints extended. Palpate: along lateral side of fifth metacarpal shaft. Resistance: palmar surface of proximal phalanx toward MCP extension. Stabilise: fifth metacarpal and palm.

Opponens pollicis

Position: hand on its back, forearm supinated. Movement: roll the first metacarpal toward the ulnar side so the thumb tip touches the pad or base of the little finger. Palpate: deep along lateral shaft of first metacarpal, moving APB toward the ulna and palpating underneath. Resistance: distal ends of first and fifth metacarpals, trying to undo the rotation. Stabilise: first and fifth metacarpals and palm.

Opponens digiti minimi

Position: hand on its back, forearm supinated. Movement: roll the fifth metacarpal toward the radial side, bringing the little finger pad toward the thumb. Palpate: along fifth metacarpal shaft, deep to ADM. Resistance: distal end of fifth metacarpal, trying to undo the rotation. Stabilise: palm.