LAB PRACTICAL 4: Wrist and Hand MMT

What position is the pt for wrist flexion MMT? Where are you stabilizing?

-Forearm is supinated and on the table for support
-You stabilize the distal end of the forearm

What do you ask the pt to conduct a grade 3 wrist flexion MMT?

"Keeping your fingers relaxed, can you bring your wrist up towards the ceiling"

Where do you apply resistance for a grade 4/5 wrist flexion MMT?

Using your two fingers across their metacarpals, resistance is applied in a downward direction (back down towards the table)

What position is the pt in to conduct a grade 2 wrist flexion MMT?

Forearm on the table for support, but in a mid position (thumb towards the ceiling)

What do you say in order to conduct a grade 2 wrist flexion MMT?

"Can you bend your wrist for me?"

What position is the pt in order to conduct grade 1 wrist flexion MMT? Which muscles are involved?

-In grade 3,4,5 position, forearm supinated
-Flexor carpi ulnaris and flexor carpi radialis

What do you say to conduct a grade 1 wrist flexion MMT? Where do you apply resistance (flexor carpi ulnaris)

-"Can you bring your wrist up towards the ceiling, leading with your pinky?"
-Use two fingers at the 5th metacarpal and push downward

What do you say to conduct a grade 1 wrist flexion MMT? Where do you apply resistance (flexor carpi radialis)

-"Can you bring your wrist up towards the ceiling, leading with your thumb?"
-Use two fingers at the second metacarpal and push downaward

How do you palpate (trace) for flexor carpi ulnaris during wrist flexion MMT?

Tendons for flexor carpi ularis is directly under the heel of your hand medially

*Follow the tendons proximally to find muscle bellies

How do you palpate (trace) for flexor carpi radialis during wrist flexion MMT?

Tendons for flexor carpi radialis is directly under the heel of the hand laterally

*Follow the tendons proximally to find muscle bellies

What is a grade 2,3,4,5 compensation for wrist flexion?

Using their fingers, they are using flexor digitorum superificialis and profundus

What position is the pt in order to conduct a grade 3,4,5 wrist extension MMT? Where do you stabilize?

-Forearm on the table in prone with wrist and hand dangling off the side
-Distal end of the forearm, cup your hand underneath it

What do you say to the pt in order to conduct a grade 3 wrist extension MMT?

"While keeping your fingers bent, can you pick your wrist up for me?

What do you say to the pt in order to conduct a grade 3 wrist extension MMT to test for EXTENSOR CARPI RADIALIS LONGUS AND BREVIS?

"Can you bring your wrist up for me leading with your thumb"

What do you say to the pt in order to conduct a grade 3 wrist extension MMT to test for EXTENSOR CARPI ULNARIS?

"Can you bring your wrist up for me, leading with your pinky?"

Where do you apply resistance for grade 4/5 wrist extension MMT?

Using your two fingers on the dorsal side of the metacarpals, apply resistance downwards

Where do you apply resistance for EXTENSOR CARPI RADIALIS LONGUS AND BREVIS grade 4/5 wrist extension MMT

Using your two fingers across the dorsal surface of MC 2 and 3, apply resistance into flexion (down towards ground) and ulnar deviation (towards the pinky)

Where do you apply resistance for EXTENSOR CARPI ULNARIS to conduct a grade 4/5 wrist extension MMT?

Using your two fingers on the dorsal surface of MC 5, apply resistance to bring the wrist into flexion (downward) and into radial deviation (towards the thumb)

What is a compensation for wrist extension MMT?

Using your fingers, will be using extensor digitorum muscle

What position is the pt in order to conduct a grade 2 wrist extension MMT?

Forearm and wrist are in a mid-position with only forearm on the table

What do you say to the pt in order to conduct a grade 2 wrist extension MMT?

"Keeping your fingers relaxed, can you bring your hand backwards?"

What position is the pt in order to palpate the extensor carpi radialis longus tendon for wrist extension MMT?

Hand is on the table pronated. Palpate on the dorsal side of wrist just proximal to MC 2

What position is the pt in order to palpate extensor carpi radialis brevis for wrist extension MMT?

Hand is prone on the table. Palpate on the dorsal side of wrist, just proximal to MC 3

What position is the pt in order to palpate for extensor carpi ulnaris for wrist extension MMT?

Hand is fully on the table in prone. Palpate on the dorsal surface of the hand just proximal to MC 5 and distal to ulnar styloid process

What position is the pt in for finger MCP extension? (3)

-Forearm on the table in prone
-Wrist is in neutral
-Fingers flexed in a loose fistW

Where are you stabilizing for finger MCP extension?

Wrist and forearm

What do you tell the pt to conduct a grade 3 finger MCP extension MMT?

"Can you bring your knuckles up towards the ceiling?"

Where do you apply resistance for grade 4/5 finger MCP extension MMT?

Take your two fingers across the tops of their knuckles and apply resistance downwards towards the table

What position is the pt in to conduct a grade 2 finger MCP extension MMT?

Forearm in mid position (thumb towards the ceiling) with fingers still flexed in a loose fist

What do you say to the pt in order to conduct a grade 2 finger MCP extension MMT?

"Can you bring your knuckles back like this for me?"

What position is the pt in order to palpate for grade 1 finger MCP extension MMT? What muscle are you palpating?

-Same position as grade 3,4,5
-Extensor digitorum (can see tendons by doing motion or palpate muscle belly by lateral epicondyle)

What is a compensation for grade 2,3,4,5 finger MCP extension MMT?

Flexion of the wrist, uses IP extension instead through tendinosis action

What position is the pt in for grade 3,4,5 finger MCP flexion mmt? Where are you stabilizing?

-Forearm is supinated on the table with IP (finger tips) in full flexion
-Stabilizing the underside of the wrist/belly of the thumb

What are you looking for when conducting any grade finger MCP flexion MMT?

Simultaneous MP flexion and IP extension

What do you tell the pt in order to conduct a grade 3 finger MCP flexion MMT?

"Can you bring your finger tips up towards the ceiling? Your fingers will be going from bent, to straight up in the air"

Where do you apply resistance for grade 4/5 finger MCP flexion MMT? (2)

Distal end of the proximal phalanx (middle section knuckle)

*EACH FINGER GETS THEIR OWN TEST

What do you say to the pt in order to conduct a grade 4/5 finger MCP flexion MMT? (2)

"Don’t let me bring your finger down"

**SWITCH HANDS ONCE YOU GET TO MIDDLE FINGER

What position is the pt in order to conduct a grade 2 finger MCP flexion MMT? Where do you stabilize?

-Forearm still on the table with their hand in a mid position (thumb towards the ceiling), tips of fingers still in full flexion
-Stabilize metacarpals

What do you say to the pt to conduct a grade 2 finger MCP flexion MMT?

"Can you bring your fingers forward, straight out ahead?"

What position is the pt in order to palpate for grade 1 finger MCP flexion MMT? What muscle are you palpating?

-Forearm on the table in a pronated position
-1st Dorsal Interossei (pointer finger, just below the lowest knuckle, in the web space)

**can't palpate the lumbricals

What is a compensation for grade 3,4,5 finger MCP flexion?

Leading with the tips of the fingers, using flexor digitorum superficialis and profundus (kind of like a scooping motion with their fingers)

What position is the pt in order to conduct a grade 3 PIP flexion MMT? Where do you stabilize?

-Forearm on the table in a supinated position with all digits out in extension. EXCEPT for test finger
-Stabilize all of the other fingers down on the table, test finger should be lying on the back of your hand

What do you say to the pt in order to conduct a grade 3 PIP flexion MMT?

"Can you bend that middle knuckle for me?"

Where do you apply resistance for grade 4/5 for PIP flexion MMT?

Using one finger on their middle phalanx, apply resistance downwards towards extension

What position is the pt in order to conduct a grade 2 PIP flexion MMT?

In the same position (DIPs being stabilized back) with forearm just in a mid position

What do you tell the pt in order to conduct a grade 2 PIP flexion MMT? What do you do now and why?

-flick the tip of the finger
-Can you bend that middle knuckle for me?
-If they are not using their profundus, the tip of the finger should be floppy

What position is the pt in for grade 1 palpation of PIP flexion MMT? What tendon are you palpating?

-In grade 3,4,5 position
-Flexor digitorum superficialis (palpate tendon just medial to the palmaris longus tendon

What muscle do you palpate for PIP flexion MMT? Where is the muscle belly?

-Flexor digitorum superficialis
-Medial aspect of forearm, just distal to the medial epicondyle

What is a compensation for PIP flexion MMT?

Using flexor digitorum, prevent this by making sure you are holding the non-test DIPs down on the table

What position is the pt in order to conduct a grade 3,4,5 DIP flexion? Where are you stabilizing?

-Forearm on the table in supine
-Stabilize the proximal joints of test finger (leaving the DIP free to flex)

What do you say to the pt in order to conduct a grade 3 DIP flexion MMT?

"Relax your fingers, can you bend the tip of your finger for me?"

Where do you apply resistance for a grade 4/5 DIP flexion MMT?

Using one finger, apply resistance downward on tip of their testing finger

What position is the pt in order to conduct a grade 2 DIP flexion MMT? Where are you stabilizing?

-Forearm on the table but in a mid-position (thumb towards the ceiling)
-The same proximal IP joints, but have your hand across all of their non-test phalanges

What do you say to the pt to conduct grade 2 DIP flexion MMT?

"Relax your fingers. All right can you bend the tip of this finger for me?"

What position is the pt in order to palpate for a grade 1 DIP flexion MMT? What tendon are you palpating?

-Same position as grade 3,4,5 with forearm in supine
-Flexor digitorum profundus (palpate on the palmer aspect of the middle phalanx)

For grade 1 palpation for DIP flexion MMT, what muscle are you palpating and where is the belly?

-Flexor digitorum superficialis
-One hand palpating the tendons at middle phalanx, while the other hand is palpating just distal to medial epicondyle

What is a compensation for grade 2,3,4,5 DIP flexion MMT?

They are attempting to straighten the tip of the finger first (straightening tip of the finger and then relaxing it can give appearance of flexion)

What position is the pt in order to conduct a grade 3,4,5 finger abduction MMT? (2)

-Forearm flat on the table pronated with fingers together
-If there is friction on the table either put flour on the table or raise their wrist slightly off table

What do you tell your pt in order to conduct a grade 3 finger abduction MMT?

"Can you spread your fingers apart for me?"

Where do you apply resistance for grade 4/5 finger abduction MMT?

By using your pointer finger and thumb, try to pinch two of their phalanges together at their distal/middle phalanx

What would qualify the pt to be a grade 2 finger abduction MMT?

If they only had partial ROM

What muscle do you palpate for grade 1 finger abduction MMT? (2)

-1st Dorsal interossei only
-In their web space, right below the lowest knuckle on digit 2 (just on the side closest to thumb)

What is a compensation for grade 3,4,5 finger abduction MMT?

Fingers are going into extension while they are abducting, uses extensor digitorum instead

What position is the pt in order to conduct a grade 3,4,5 finger adduction MMT?

-Forearm is prone on the table with fingers already spread apart
-If there is any friction, spread flour on the table or lift up their wrist

What do you say to the pt in order to conduct a grade 3 finger adduction MMT?

"Can you bring your fingers together for me?"

How do you conduct a grade 4/5 finger adduction MMT? What do you tell them? (3)

-Have them start with their fingers wide apart
-Put your pointer finger in between their middle phalanx and tell them to close their fingers on yours
-"Don’t let me pull my finger out"

What makes a pt a grade 2 finger adduction MMT?

Partial ROM

What is a compensation for grade 2,3,4,5 finger adduction MMT

Flexion of the fingers

What position is the pt in for grade 3,4,5 thumb adduction MMT? Where are you stabilizing (if need be)

-Forearm pronated on the table with their test thumb hanging off the table
-Stabilizng dorsum of hand

What do you say to the pt in order to conduct a grade 3 thumb adduction MMT?

'Can you bring your thumb up, just under your index finger for me?"

Where do you apply resistance for grade 4/5 thumb adduction MMT?

Apply resistance at the proximal phalanx of thumb, trying to bring the thumb back down into the neutral position

What position is the pt in order to conduct a grade 2 thumb adduction MMT? Where are you stabilizing?

-Hand in a mid position with their thumb in full abduction (hand should be making an L)
-Stabilizing the DIPs of the non-test dingers

What do you say to the pt in order to conduct a grade 2 thumb adduction MMT?

"Can you bring your thumb to your index finger?"

What position is the pt in order to palpate for grade 1 thumb adduction MMT? What muscle are you palpating?

-Same position as grade 2, mid-position
-Adductor pollicis (in the farthest point of the web space triangle, pinch both sides against MC1)

What is a compensation for grade 2,3,4,5 thumb adduction MMT?

Having the thumb clear the table/index finger, using extensors instead of adductor pollicis (finger just coming to index finger)

What position is the pt in order to conduct a grade 3,4,5 thumb abduction MMT? Where are you stabilizing? **ABDUCTOR POLLICIS LONGUS

-Forearm resting on the table in mid-position, thumb starting at the index finger
-Holding the non-test phalanges (like you're shaking their hand)

What do you say to the pt in order to conduct a grade 3 thumb abduction MMT? **ABDUCTOR POLLICIS LONGUS

"Can you bring your thumb up towards the ceiling for me?"

Where do you apply resistance in order to conduct a grade 4/5 thumb abduction? **ABDUCTOR POLLICIS LONGUS

Use your pointer finger to apply resistance on the distal end of MC1, trying to bring the thumb back down towards the index finger

What position is the pt in order to conduct a grade 2 thumb abduction MMT? **ABDUCTOR POLLICIS LONGUS

Forearm pronated on the table with the thumb next to the index finger (be mindful if there is friction on the table)

What do you say to the pt in order to conduct a grade 2 thumb abduction MMT? **ABDUCTOR POLLICIS LONGUS

"Can you bring your thumb out to the side for me?"

What position is the pt in order to palpate for grade 1 thumb abduction MMT? **ABDUCTOR POLLICIS LONGUS

Same position as grade 2, forearm prone on table

How do you palpate the tendon for abductor pollicis longus (thumb abduction MMT)?

Find the snuffbox, and then follow the top tendon laterally

What is a compensation for grade 2,3,4,5 thumb abduction MMT
**ABDUCTOR POLLICIS LONGUS?

Bringing their thumb in front towards the palm (using abductor pollicis brevis)

What position is the pt in order to conduct a grade 3,4,5 thumb abduction MMT? Where are you stabilizing? **ABDUCTOR POLLICIS BREVIS

-Supinate the forearm, thumb in line with index finger
-Stabilize the metacarpals of the non-test fingers

What do you say to the pt in order to conduct a grade 3

"Can you bring your thumb up towards the ceiling?"

Where do you apply resistance for grade 4/5 thumb abduction MMT?
**ABDUCTOR POLLICIS BREVIS?

Use one of your fingers on the distal end of the proximal phalanx and try to bring their thumb back towards neutral

What position is the pt in order to conduct a grade 2 thumb abduction MMT?
**ABDUCTOR POLLICIS BREVIS

-Forearm in mid position with their thumb touching their index finger

What do you tell the pt in order to conduct a grade 2 thumb abduction MMT?
**ABDUCTOR POLLICIS BREVIS

"Can you bring your thumb straight out to the side?"

What position is the pt in order to palpate for grade 1 thumb abduction MMT?
**ABDUCTOR POLLICIS BREVIS

-Forearm in supine position on the table
-Find middle of thenar eminence (meaty part of the thumb on palmar side) and go laterally

What is a compensation for grade 2,3,4,5 for thumb abduction MMT?
**ABDUCTOR POLLICIS BREVIS

Bringing the thumb past the index finger, using their abductor pollicis longus

What position is the pt in order to conduct a grade 3,4,5 for opposition MMT?

Forearm is supine on table

What do you say to the pt in order to conduct a grade 3 opposition MMT?

"Can you bring the PAD of your thumb to the PAD of your middle finger?"

Where do you apply resistance for grade 4/5 opposition MMT?

Stabilize one side (either thumb side or pinky side) and use resistance on the other side. Then repeat on the other finger

*this one is stabilizing thumb and pulling out pinky

Picture of stabilizing the pinky and applying resistance to the thumb for grade 4/5 opposition MMT

What qualifies a pt to be a grade 2 opposition MMT?

If they show partial ROM

What 2 muscles are you palpating for grade 1 opposition MMT?

-Opponens digiti minimi
-Opponens pollicis

How do you palpate for grade 1 opponens digiti minimi (opposition MMT)?

How do you palpate for grade 1 opponens pollicis (opposition MMT)?

Most lateral part of thenar eminence

What is a compensation for grade 2,3,4,5 opposition MMT?

If they are having the tips of their thumb touch the tip of their pinky, uses the flexors of thumb and pinky

Where to palpate for:
-FPL
-APB
-FPB
-OP
-ODM

(drawing on palmar surface of hand)