OCC 501 Occupational Therapy Manual Muscle Testing (MMT) Clinical Practical Examination: Elbow, Forearm, Wrist, Fingers, and Thumb – Comprehensive Assessment Techniques, Grading Scales, Functional Implications, and Evidence-Based Intervention Strategies ( 44 questions and answers + diagrams )

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44 Terms

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MMT: elbow extension (against gravity)

Muscles: Triceps brachii and anconeus

Patient Position: Supine with shoulder flexed to 90 degrees and internally rotated; elbow flexed to 90 degrees

Stabilize: distal humerus supporting shoulder in flexed position

Resistance: Distal ulnar forearm

Compensations: Shoulder extension & lateral trunk flexion

<p>Muscles: Triceps brachii and anconeus</p><p>Patient Position: Supine with shoulder flexed to 90 degrees and internally rotated; elbow flexed to 90 degrees</p><p>Stabilize: distal humerus supporting shoulder in flexed position</p><p>Resistance: Distal ulnar forearm</p><p>Compensations: Shoulder extension & lateral trunk flexion</p>

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MMT: elbow extension (gravity eliminated)

Patient Position: Sitting with arm supported on tabletop in 90 degree shoulder abduction

Palpation: Triceps at posterior elbow

Compensations: Shoulder extension & lateral trunk flexion

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MMT: elbow flexion (against gravity)

Muscles: Brachioradialis, Brachialis, Biceps Brachii, & Pronator teres

Patient Position: Standing or sitting with elbow flexed to 90 degrees and forearm supinated

Stabilize: Superior aspect of shoulder girdle

Resistance: Distal forearm

Compensations: Scapular elevation & Contralateral trunk flexion

<p>Muscles: Brachioradialis, Brachialis, Biceps Brachii, & Pronator teres</p><p>Patient Position: Standing or sitting with elbow flexed to 90 degrees and forearm supinated</p><p>Stabilize: Superior aspect of shoulder girdle</p><p>Resistance: Distal forearm</p><p>Compensations: Scapular elevation & Contralateral trunk flexion</p>

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MMT: elbow flexion (gravity eliminated)

Patient Position: Sitting with arm supported on tabletop in 90 degree shoulder abduction

Palpation: Brachialis and Biceps Brachii at anterior elbow

Compensations: Scapular elevation & Contralateral trunk flexion

<p>Patient Position: Sitting with arm supported on tabletop in 90 degree shoulder abduction</p><p>Palpation: Brachialis and Biceps Brachii at anterior elbow</p><p>Compensations: Scapular elevation & Contralateral trunk flexion</p>

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MMT: forearm pronation (against gravity)

Muscles: Pronator teres & Pronator quadratus

Patient Position: Standing or sitting with elbow flexed to 90 degrees and stabilized against lateral trunk; thumb up position

Stabilize: Lateral humerus stabilizing against trunk

Resistance: Medial distal forearm, fingers grasp ulna with base of palm resisting anterior aspect of radius

Compensations: Shoulder abduction, shoulder internal rotation, & contralateral trunk flexion

<p>Muscles: Pronator teres & Pronator quadratus</p><p>Patient Position: Standing or sitting with elbow flexed to 90 degrees and stabilized against lateral trunk; thumb up position</p><p>Stabilize: Lateral humerus stabilizing against trunk</p><p>Resistance: Medial distal forearm, fingers grasp ulna with base of palm resisting anterior aspect of radius</p><p>Compensations: Shoulder abduction, shoulder internal rotation, & contralateral trunk flexion</p>

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MMT: forearm pronation (gravity eliminated)

Patient Position: Supine with elbow flexed to 90 degrees

Palpation: Pronator teres at proximal aspect of radial forearm

Compensations: Shoulder abduction, shoulder internal rotation, & contralateral trunk flexion

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MMT: forearm supination (against gravity)

Muscles: Biceps brachii & supinator fully flex elbow to test supinator only

Patient Position: Standing or sitting with elbow flexed to 90 degrees and stabilized against lateral trunk; thumb up position

Stabilize: Lateral humerus stabilizing against trunk

Resistance: Lateral distal forearm; fingers grasp ulna with base of palm resisting posterior aspect of radius

Compensations: Shoulder adduction, shoulder external rotation, & ipsilateral trunk flexion

<p>Muscles: Biceps brachii & supinator fully flex elbow to test supinator only</p><p>Patient Position: Standing or sitting with elbow flexed to 90 degrees and stabilized against lateral trunk; thumb up position</p><p>Stabilize: Lateral humerus stabilizing against trunk</p><p>Resistance: Lateral distal forearm; fingers grasp ulna with base of palm resisting posterior aspect of radius</p><p>Compensations: Shoulder adduction, shoulder external rotation, & ipsilateral trunk flexion</p>

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MMT: forearm supination (gravity eliminated)

Patient Position: Supine with elbow flexed to 90 degrees

Palpation: Biceps brachii at anterior elbow

Compensations: Shoulder adduction, shoulder external rotation, & ipsilateral trunk flexion

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MMT: wrist extension (against gravity)

Muscles: ECRL, ECRB, & ECU

Patient Position: Sitting with the forearm in pronation on tabletop or forearm support; wrist in midrange extension, fingers relaxed

Stabilize: Mid-dorsal forearm stabilizing against tabletop or forearm support

Resistance: Dorsal metacarpals

Compensations: Elbow extension & finger extension

<p>Muscles: ECRL, ECRB, & ECU</p><p>Patient Position: Sitting with the forearm in pronation on tabletop or forearm support; wrist in midrange extension, fingers relaxed</p><p>Stabilize: Mid-dorsal forearm stabilizing against tabletop or forearm support</p><p>Resistance: Dorsal metacarpals</p><p>Compensations: Elbow extension & finger extension</p>

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MMT: wrist extension (gravity eliminated)

Patient Position: Sitting with forearm in thumb up position and ulnar forearm and hand resting on tabletop

Palpation: ECU, ECRL, & ECRB at dorsal wrist

Compensations: Elbow extension & finger extension

<p>Patient Position: Sitting with forearm in thumb up position and ulnar forearm and hand resting on tabletop</p><p>Palpation: ECU, ECRL, & ECRB at dorsal wrist</p><p>Compensations: Elbow extension & finger extension</p>

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MMT: wrist flexion (against gravity)

Muscles: FCR, FCU, & Palmaris Longus

Patient Position: Sitting with the forearm in supination on tabletop or forearm support; wrist in midrange extension, fingers relaxed

Stabilize: Mid-volar forearm stabilizing against tabletop or forearm support

Resistance: Mid-volar palm

Compensations: Elbow flexion & finger flexion

<p>Muscles: FCR, FCU, & Palmaris Longus</p><p>Patient Position: Sitting with the forearm in supination on tabletop or forearm support; wrist in midrange extension, fingers relaxed</p><p>Stabilize: Mid-volar forearm stabilizing against tabletop or forearm support</p><p>Resistance: Mid-volar palm</p><p>Compensations: Elbow flexion & finger flexion</p>

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MMT: wrist flexion (gravity eliminated)

Patient Position: Sitting with forearm in thumb up position and ulnar forearm and hand resting on tabletop

Palpation: FCR & FCU at volar wrist

Compensations: Elbow flexion & finger flexion

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MMT: wrist ulnar deviation (against gravity)

Muscles: FCU & ECU

Patient Position: sitting with forearm resting in pronation on tabletop or forearm support; wrist in ulnar deviation and hand elevated; fingers and thumb relaxed

Stabilize: Dorsal forearm stabilizing against tabletop or forearm support

Resistance: Ulnar aspect of 5th metacarpal

Compensations: Elbow extension and finger abduction

<p>Muscles: FCU & ECU</p><p>Patient Position: sitting with forearm resting in pronation on tabletop or forearm support; wrist in ulnar deviation and hand elevated; fingers and thumb relaxed</p><p>Stabilize: Dorsal forearm stabilizing against tabletop or forearm support</p><p>Resistance: Ulnar aspect of 5th metacarpal</p><p>Compensations: Elbow extension and finger abduction</p>

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MMT: wrist ulnar deviation (gravity eliminated)

Patient Position: Sitting with forearm pronated and hand resting on tabletop

Palpation: ECU at dorsal wrist and FCU at volar wrist

Compensations: Elbow extension and finger abduction

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MMT: wrist radial deviation (against gravity)

Muscles: FCR, ECRL, & ECRB

Patient Position: Sitting with forearm resting in thumb-up on tabletop or forearm support; wrist in midrange radial deviation; hand elevated or off table; fingers and thumb relaxed

Stabilize: Radial forearm stabilizing against tabletop or forearm support

Resistance: Radial aspect of 2nd metacarpal in webspace of thumb

Compensations: Elbow flexion & finger/thumb abduction

<p>Muscles: FCR, ECRL, & ECRB</p><p>Patient Position: Sitting with forearm resting in thumb-up on tabletop or forearm support; wrist in midrange radial deviation; hand elevated or off table; fingers and thumb relaxed</p><p>Stabilize: Radial forearm stabilizing against tabletop or forearm support</p><p>Resistance: Radial aspect of 2nd metacarpal in webspace of thumb</p><p>Compensations: Elbow flexion & finger/thumb abduction</p>

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MMT: wrist radial deviation (gravity eliminated)

Patient Position: Sitting with forearm pronated and hand resting on tabletop

Palpation: ECRL & ECRB at dorsal wrist + FCR at volar wrist

Compensations: Elbow flexion & finger/thumb abduction

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MMT: finger MCP flexion (against gravity)

Muscles: Lumbricals 1,2,3,4, Dorsal interossei (digits 2-4), Palmar interossei (digits 2,4,5), FDS, FDP, & FDM

Patient Position: Sitting with hand elevated and forearm supported in supination or propped on elbow; wrist neutral; MCP flexed, PIP and DIP extended (intrinsic hand position)

Stabilize: Volar & dorsal aspect of distal metacarpals

Resistance: Volar aspect of proximal phalanx and dorsal aspect of middle or distal phalanx

Compensations: Wrist flexion tenodesis (wrist extension may produce passive finger flexion)

<p>Muscles: Lumbricals 1,2,3,4, Dorsal interossei (digits 2-4), Palmar interossei (digits 2,4,5), FDS, FDP, & FDM</p><p>Patient Position: Sitting with hand elevated and forearm supported in supination or propped on elbow; wrist neutral; MCP flexed, PIP and DIP extended (intrinsic hand position)</p><p>Stabilize: Volar & dorsal aspect of distal metacarpals</p><p>Resistance: Volar aspect of proximal phalanx and dorsal aspect of middle or distal phalanx</p><p>Compensations: Wrist flexion tenodesis (wrist extension may produce passive finger flexion)</p>

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MMT: finger MCP flexion (gravity eliminated)

Patient Position: Forearm neutral lying on ulnar border

Palpation: Volar side of hand between metacarpals (lumbricals) & volar proximal side of forearm (flexor muscle bellies)

Compensations: Wrist flexion tenodesis (wrist extension may produce passive finger flexion)

<p>Patient Position: Forearm neutral lying on ulnar border</p><p>Palpation: Volar side of hand between metacarpals (lumbricals) & volar proximal side of forearm (flexor muscle bellies)</p><p>Compensations: Wrist flexion tenodesis (wrist extension may produce passive finger flexion)</p>

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MMT: finger MCP extension (against gravity)

Muscles: Extensor digitorum, Extensor indicis, EDM, Lumbricals 1,2,3,4, Dorsal interossei (digits 2-4), & Palmar interossei (digits 2,4,5)

Patient Position: Sitting with hand elevated and forearm supported in pronation or propped on elbow; wrist neutral; MCP flexed, PIP and DIP relaxed flexion

Stabilize: Volar & dorsal aspect of distal metacarpals

Resistance: Dorsal aspects of proximal phalanx applying against extension (downwards)

Compensations: wrist extension

<p>Muscles: Extensor digitorum, Extensor indicis, EDM, Lumbricals 1,2,3,4, Dorsal interossei (digits 2-4), & Palmar interossei (digits 2,4,5)</p><p>Patient Position: Sitting with hand elevated and forearm supported in pronation or propped on elbow; wrist neutral; MCP flexed, PIP and DIP relaxed flexion</p><p>Stabilize: Volar & dorsal aspect of distal metacarpals</p><p>Resistance: Dorsal aspects of proximal phalanx applying against extension (downwards)</p><p>Compensations: wrist extension</p>

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MMT: finger MCP extension (gravity eliminated)

Patient Position: Forearm neutral lying on ulnar border

Palpation: Dorsum or hand (tendons) or dorsal proximal forearm (extensor muscle bellies)

Compensations: Wrist extension

<p>Patient Position: Forearm neutral lying on ulnar border</p><p>Palpation: Dorsum or hand (tendons) or dorsal proximal forearm (extensor muscle bellies)</p><p>Compensations: Wrist extension</p>

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MMT: finger PIP flexion (against gravity)

Muscles: FDS & FDP

Patient Position: Sitting with hand elevated and forearm supported in supination or propped on elbow; wrist neutral; PIP being tested in mild flexion; DIP relaxed; non-test fingers held in extension

Stabilize: Holding non-test fingers in extension and stabilizing the proximal phalanx

Resistance: Volar aspect of middle phalanx applying against flexion (downwards)

Compensations: MCP flexion, DIP flexion, & wrist flexion

<p>Muscles: FDS & FDP</p><p>Patient Position: Sitting with hand elevated and forearm supported in supination or propped on elbow; wrist neutral; PIP being tested in mild flexion; DIP relaxed; non-test fingers held in extension</p><p>Stabilize: Holding non-test fingers in extension and stabilizing the proximal phalanx</p><p>Resistance: Volar aspect of middle phalanx applying against flexion (downwards)</p><p>Compensations: MCP flexion, DIP flexion, & wrist flexion</p>

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MMT: finger PIP flexion (gravity eliminated)

Patient Position: Forearm neutral lying on ulnar border

Palpation: Volar proximal forearm or anterior aspect of proximal phalanx (FDS & FDP)

Compensations: MCP flexion, DIP flexion, & wrist flexion

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MMT: finger PIP extension (against gravity)

Muscles: Lumbricals 1,2,3,4, Dorsal interossei (digits 2-4), & Palmar interossei (digits 2,4,5), & Extensor digitorum (isolates the central slip if the DIP is relaxed)

Patient Position: Sitting with hand elevated and forearm supported in pronation or propped on elbow; wrist neutral; MCP extended

Stabilize: Volar and dorsal aspects of proximal phalanx

Resistance: Dorsal aspect of middle phalanx

Compensations: MCP extension, DIP extension, & wrist extension

<p>Muscles: Lumbricals 1,2,3,4, Dorsal interossei (digits 2-4), & Palmar interossei (digits 2,4,5), & Extensor digitorum (isolates the central slip if the DIP is relaxed)</p><p>Patient Position: Sitting with hand elevated and forearm supported in pronation or propped on elbow; wrist neutral; MCP extended</p><p>Stabilize: Volar and dorsal aspects of proximal phalanx</p><p>Resistance: Dorsal aspect of middle phalanx</p><p>Compensations: MCP extension, DIP extension, & wrist extension</p>

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MMT: finger PIP extension (gravity eliminated)

Patient Position: Forearm neutral lying on ulnar border

Palpation: Dorsal proximal forearm (extensor muscle bellies)

Compensations: MCP extension, DIP extension, & wrist extension

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MMT: finger abduction (digits 2-5) (against gravity)

Muscles: Dorsal interossei (digits 2-4) & Abductor digiti minimi

Patient Position: 2nd + 3rd: forearm in midrange position, 4th + 5th: thumb down, shoulder abducted and 90 degrees, All: digits extended and in adduction

Stabilize: Volar and dorsal aspects of distal metacarpal

Resistance: Lateral or medial aspect of proximal phalanx relative to middle finger

Compensations: Wrist radial for IF to MF or ulnar deviation

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MMT: finger abduction (digits 2-5) (gravity eliminated)

Patient Position: forearm pronated

Palpation: Dorsum of hand between metacarpals (dorsal interossei) & medial aspect of 5th metacarpal (abductor digit minimi)

Compensations: Wrist radial for IF to MF or ulnar deviation

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MMT: finger DIP flexion (against gravity)

Muscles: FDP

Patient Position: Sitting with hand elevated and forearm supported in supination or propped on elbow; wrist neutral; PIP extended and DIP in mild flexion

Stabilize: Volar and dorsal aspects of middle phalanx

Resistance: Volar aspect of distal phalanx applying against flexion

Compensations: MCP flexion, PIP flexion, & wrist flexion

<p>Muscles: FDP</p><p>Patient Position: Sitting with hand elevated and forearm supported in supination or propped on elbow; wrist neutral; PIP extended and DIP in mild flexion</p><p>Stabilize: Volar and dorsal aspects of middle phalanx</p><p>Resistance: Volar aspect of distal phalanx applying against flexion</p><p>Compensations: MCP flexion, PIP flexion, & wrist flexion</p>

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MMT: DIP flexion (gravity eliminated)

Patient Position: Forearm neutral lying on ulnar border

Palpation: proximal forearm (FDP tendons)

Compensations: MCP flexion, PIP flexion, & wrist flexion

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MMT: DIP extension (against gravity)

Muscles:

Patient Position: Sitting with hand elevated and forearm supported in pronation or propped on elbow; wrist neutral; MCPs, PIPs, & DIPs extended

Stabilize: volar and dorsal aspects of middle phalanx

Resistance: dorsal aspect of distal phalanx

Compensations: MCP extension & wrist extension

<p>Muscles:</p><p>Patient Position: Sitting with hand elevated and forearm supported in pronation or propped on elbow; wrist neutral; MCPs, PIPs, & DIPs extended</p><p>Stabilize: volar and dorsal aspects of middle phalanx</p><p>Resistance: dorsal aspect of distal phalanx</p><p>Compensations: MCP extension & wrist extension</p>

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MMT: DIP extension (gravity eliminated)

Patient Position: Forearm neutral lying on ulnar border

Palpation: Dorsal aspect of distal phalanx

Compensations: MCP extension & wrist extension

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MMT: finger adduction (against gravity)

Muscles: Palmar interossei (digits 2,4,5)

Patient Position: 2nd: thumb down, shoulder abducted to 90 degrees, 4th and 5th: forearm in midposition, All: digits extended and abducted

Stabilize: volar and dorsal aspects of distal metacarpal

Resistance: lateral or medial aspect of proximal phalanx relative to middle finger applying against ADD

Compensations: wrist radial for IF to MF or ulnar deviation for MF-LF

<p>Muscles: Palmar interossei (digits 2,4,5)</p><p>Patient Position: 2nd: thumb down, shoulder abducted to 90 degrees, 4th and 5th: forearm in midposition, All: digits extended and abducted</p><p>Stabilize: volar and dorsal aspects of distal metacarpal</p><p>Resistance: lateral or medial aspect of proximal phalanx relative to middle finger applying against ADD</p><p>Compensations: wrist radial for IF to MF or ulnar deviation for MF-LF</p>

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MMT: finger adduction (gravity eliminated)

Patient Position: forearm pronated

Palpation: Volar hand between metacarpals (palmar interossei)

Compensations:wrist radial for IF to MF or ulnar deviation for MF-LF

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MMT: thumb MCP extension (against gravity)

Muscles: EPB & EPL

Patient Position: Sitting with the forearm and hand supported in thumb up; thumb CMC supported in neutral; thumb MCP extended

Stabilize: Volar and dorsal aspects of distal 1st metacarpal

Resistance: Dorsal surface of proximal phalanx

Compensations: Wrist radial deviation, Thumb IP extension, Thumb CMC extension

<p>Muscles: EPB & EPL</p><p>Patient Position: Sitting with the forearm and hand supported in thumb up; thumb CMC supported in neutral; thumb MCP extended</p><p>Stabilize: Volar and dorsal aspects of distal 1st metacarpal</p><p>Resistance: Dorsal surface of proximal phalanx</p><p>Compensations: Wrist radial deviation, Thumb IP extension, Thumb CMC extension</p>

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MMT: thumb MCP extension (gravity eliminated)

Patient Position: Forearm in resting supination on a towel. Thumb in front of palm, pronation acceptable if extending across gravity

Palpation: EPB or radial side of snuff box, on the dorsolateral aspect of the base of the 1st metacarpal

Compensations: Wrist radial deviation, Thumb IP extension, Thumb CMC extension

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MMT: thumb MCP flexion (against gravity)

Muscles: FPB & FPL

Patient Position: Shoulder is internally rotated and flexed to 90 degrees, elbow flexed to 90 degrees (UE parallel to floor). The forearm will be fully pronated with the thumbnail facing the floor

Stabilize: Volar and dorsal aspects of distal 1st metacarpal

Resistance: Volar surface of proximal phalanx

Compensations: Wrist ulnar deviation, Thumb IP flexion, Thumb CMC flexion

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MMT: thumb MCP flexion (gravity eliminated)

Patient Position: Forearm in resting supination on a towel. Thumb in front of palm

Palpation: Thenar eminence for FPB

Compensations: Wrist ulnar deviation, Thumb IP flexion, Thumb CMC flexion

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MMT: thumb IP extension (against gravity)

Muscles: EPL

Patient Position: Sitting with the forearm and hand supported in thumb up; thumb CMC supported in neutral; thumb CMC and MCP supported in neutral

Stabilize: Volar and dorsal aspects of proximal phalanx

Resistance: Dorsal surface of distal phalanx

Compensations: Wrist radial deviation, Thumb MCP extension, Thumb CMC extension

<p>Muscles: EPL</p><p>Patient Position: Sitting with the forearm and hand supported in thumb up; thumb CMC supported in neutral; thumb CMC and MCP supported in neutral</p><p>Stabilize: Volar and dorsal aspects of proximal phalanx</p><p>Resistance: Dorsal surface of distal phalanx</p><p>Compensations: Wrist radial deviation, Thumb MCP extension, Thumb CMC extension</p>

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MMT: thumb IP extension (gravity eliminated)

Patient Position: Forearm in resting supination on a towel. Thumb in front of palm, pronation acceptable if extending across gravity

Palpation: EPL ulnar side of snuffbox near dorsum of hand

Compensations: Wrist radial deviation, Thumb MCP extension, Thumb CMC extension

<p>Patient Position: Forearm in resting supination on a towel. Thumb in front of palm, pronation acceptable if extending across gravity</p><p>Palpation: EPL ulnar side of snuffbox near dorsum of hand</p><p>Compensations: Wrist radial deviation, Thumb MCP extension, Thumb CMC extension</p>

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MMT: thumb IP flexion (against gravity)

Muscles: FPL

Patient Position: Shoulder is internally rotated and flexed to 90 degrees, elbow flexed to 90 degrees (UE parallel to floor). The forearm will be fully pronated with the thumbnail facing the floor

Stabilize: Volar and dorsal aspects of proximal phalanx

Resistance: Volar aspect of distal phalanx

Compensations: Wrist ulnar deviation, Thumb MCP flexion, & Thumb CMC flexion

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MMT: thumb IP flexion (gravity eliminated)

Patient Position: Forearm in resting supination on a towel. Thumb in front of palm

Palpation: Volar proximal phalanx (FPL)

Compensations: Wrist ulnar deviation, Thumb MCP flexion, & Thumb CMC flexion

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MMT: palmar abduction (CMC) (against gravity)

Muscles: Abductor pollicis brevis & Abductor pollicis longus

Patient Position: Sitting with forearm supinated

Stabilize: Radial aspect of distal forearm stabilizing against tabletop or forearm support

Resistance: Lateral aspect of 1st metacarpal

Compensations: Wrist flexion

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MMT: palmar abduction (CMC) (gravity eliminated)

Patient Position: Forearm in neutral

Palpation: Volar radial wrist (APL) and superior surface of the thenar eminance (APB)

Compensations: Wrist flexion

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MMT: radial abduction (CMC) (against gravity)

Muscles: Abductor pollicis longus, Abductor pollicis brevis, Extensor pollicis longus, and Extensor pollicis brevis.

Patient Position: Sitting with hand elevated and forearm supported in thumb up position; thumb in mild radial abduction

Stabilize: Dorsal aspect of distal forearm stabilizing against tabletop or forearm supported

Resistance: Lateral aspect of 1st metacarpal

Compensations: Wrist radial deviation

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MMT: radial abduction (CMC) (gravity eliminated)

Patient Position: Forearm in supination

Palpation: Radial lateral wrist (APL, EPL, and EPB)

Compensations: Wrist radial deviation