Examination Methods in Rehabilitation (2.11.2020)
Mgr. Veronika Mrkvicová (physiotherapist)
Manual muscle test:
Elbow, forearm, wrist, fingers
Výsledek obrázku pro hand muscles

Elbow
C:\Users\Verca\Desktop\scoi-elbow.jpg


Muscles of the elbow
C:\Users\Verca\Desktop\2863398_orig.jpg


Ligaments and tendons of the elbow
•
•
http://www.britishkendoassociation.com/wp-content/uploads/2015/02/elbowHE.png

Movements of the elbow
C:\Users\Verca\Desktop\elbow.jpg


Elbow flexion
C:\Users\Verca\Desktop\elbow flexion.png
Biceps brachii
Brachialis
Brachioradialis
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/biceps-brachi
i/atlasImage_large
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/brachialis/at
lasImage_large
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/brachioradial
is/atlasImage_large

Biceps brachii
•Origin
•Short head: tip of coracoid process of scapula;
•Long head: supraglenoid tubercle of scapula
•
•Insertion
•Tuberosity of radius and fascia of forearm via bicipital aponeurosis
•
•Action
•Supinates forearm and, when it is supine, flexes forearm
•
•Innervation
•Musculocutaneous nerve (C5 and C6 ) (C5, C6)

Brachialis
•Origin
•Distal half of anterior surface of humerus
•
•Insertion
•Coronoid process and tuberosity of ulna
•
•Action
•Major flexor of forearm - flexes forearm in all positions
•
•Innervation
•Musculocutaneous nerve (C5 and C6) (C5, C6)

Brachioradialis
•Origin
•Proximal 2/3 of lateral supracondyle ridge of humerus
•
•Insertion
•Lateral surface of distal end of radius
•
•Action
•Flexes forearm
•
•Innervation
•Radial nerve (C5, C6 and C7) (C5, C6, C7)

Elbow flexion – grade 5,4
•Position: patient sits, tested upper limb extended along body side, forearm: a. supine (m. biceps
brachii), b. in central position (brachioradialis), c. prone (brachialis)
•Fixation: lower part of the arm from behing
•Movement: elbow flexion in full range of motion
•Resistance: PT puts resistance on distal part of forearm  (arched)
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_051.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_052.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_053.jpg

Elbow flexion – grade 3
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_054.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_055.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_056.jpg
•Position: patient sits, tested upper limb extended along body side, forearm: a. supine (m. biceps
brachii), b. in central position (brachioradialis), c. prone (brachialis)
•Fixation: lower part of the arm from behing, and scapula (by the other hand) if needed
•Movement: elbow flexion in full range of motion

Elbow flexion – grade 2
•Position: lying supine, 90° shoulder abduction, external rotation, elbow extended, forearm on the
table: a. radial side (biceps brachii), b. dorsal side (brachioradialis), c. ulnar side
(brachialis)
•Fixation: shoulder, or lower part of the arm if needed
•Movement: elbow flexion in full range of motion
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_058.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_059.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_060.jpg

Elbow flexion – grade 2
•Position: patient sits next to the table, 90° shoulder abduction, elbow extended, forearm on the
table: a. ulnar side (biceps brachii), b. palm down (brachioradialis), c. radial side (brachialis)
•Fixation: one hand on the scapula, the other hand at the middle part of the arm
•Movement: elbow flexion in full range of motion, pushing the forearm on the table
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_062.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_063.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_065.jpg

Elbow flexion – grade 1,0
•Position: lying supine, shoulder slightly abducted and external rotated, elbow in semiflexion,
forearm: a. supine (biceps brachii), b. central position (brachioradialis), c. prone (brachialis)
•Attempt to move: PT palpates a trace of contraction of the muscles
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_066.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_068.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_069.jpg

Elbow flexion – notes:
•Biceps brachii, brachialis, brachioradialis need to be tested separately •Dont´ allow the patient
to contract the muscles of the forearm (flexors and extensors of the wrist) •Elbow should stay
stable, but should move independently

Elbow extension
•Triceps brachii
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/triceps-brach
ii/atlasImage_large

Triceps brachii
•Origin
•Long head: infraglenoid tubercle of scapula;
•Lateral head: posterior surface of humerus, superior to radial groove
•Medial head: posterior surface of humerus, inferior to radial groove
•
•Insertion
•Proximal end of olecranon process of ulna and fascia of forearm
•
•Action
•Chief extensor of forearm
•long head steadies head of abducted humerus
•
•Innervation
•Radial nerve (C6, C7 and C8) (C6, C7, C8)

Elbow extension – grade 5,4
•Position: lying prone, head on the forehead, tested upper limb in 90° shoulder abduction, forearm
hanging relaxed down the table
•Fixation: distal part of the arm from ventral side
•Movement: elbow extension
•Resistance: on the distal part of forearm (arched)
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_070.jpg

Elbow extension – grade 3
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_071.jpg
•Position: lying prone, head on the forehead, tested upper limb in 90° shoulder abduction, forearm
hanging relaxed down the table
•Fixation: distal part of the arm from ventral side
•Movement: elbow extension

Elbow extension – grade 2
•Position A: lying supine, tested upper limb in 90° shoulder abduction and external rotation, elbow
in 90° flexion, forearm supine
•Fixation: arm and the scapula
•Movement: elbow extension by pushing the forearm on the table
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_072.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_073.jpg
Position A: sitting next to the table, tested upper limb in 90° shoulder abduction, elbow in 90°
flexion, forearm in the central position
Fixation: arm and the scapula
Movement: elbow extension by pushing the forearm on the table

Elbow extension – grade 1,0
•Position: lying prone, head lying rotated to the tested side, tested upper limb in 90° shoulder
abduction, forearm hanging relaxed down the table, 90° elbow flexion
•Attempt to move: PT palpates the trace of contraction of triceps
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_074.jpg

Elbow extension – notes:
•Dont´ allow the patient to use extensors of the wrist •No protraction of the shoulder should be
allowed

Forearm
https://noexcuseshealth.files.wordpress.com/2013/03/forearm-muscles.jpg


Supination
•Supinator
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/supinator/atl
asImage_large
Biceps brachii
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/biceps-brachi
i/atlasImage_large

Supinator
•Origin
•Lateral epicondyle of humerus, radial collateral and annular ligaments, supinator fossa and crest
of ulna
•
•Insertion
•Lateral, posterior and anterior surfaces of proximal 1/3 of radius
•
•Action
•Supinates forearm (i.e., rotates radius to turn palm anteriorly)
•
•Innervation
•Deep branch of radial nerve (C5 and C6) (C5, C6)

Biceps brachii
•Origin
•Short head: tip of coracoid process of scapula;
•Long head: supraglenoid tubercle of scapula
•
•Insertion
•Tuberosity of radius and fascia of forearm via bicipital aponeurosis
•
•Action
•Supinates forearm and, when it is supine, flexes forearm
•
•Innervation
•Musculocutaneous nerve (C5 and C6 ) (C5, C6)

Supination – grade 5,4
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_075.jpg
Position: patient sits, arms relaxed along body side, tested upper limb 90° flexed, forearm in
prone position, muscles of the wrist and fingers relaxed
Fixation: lower part of the arm
Movement: supination in full range of motion
Resistance: PT puts resistance against the movement, holding patients hand like at the picture
(main resistance  by using PTs´ point finger on the patients´ processus styloideus ulnae)

Supination – grade 3
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_076.jpg
Position: patient sits, arms relaxed along body side, tested upper limb 90° flexed, forearm in
prone position, muscles of the wrist and fingers relaxed
Fixation: at the lower part of patients´ arm and support the forearm by the other hand
Movement: supination in full range of motion

Supination – grade 2
Position: lying prone, 90° shoulder abduction, 90° elbow flexion, forearm prone hanging from the
table, muscle of the wrist and fingers relaxed
Fixation: the lower part of the arm
Movement: supination in full range of motion
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_077.jpg

Supination – grade 1,0
Position: lying prone, 90° shoulder abduction, 90° elbow flexion, forearm prone hanging from the
table, muscle of the wrist and fingers relaxed
Attempt to move: PT palpates the trace of contraction of supinator and biceps during patients´
attempt to supinate the forearm
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_078.jpg

Pronation
C:\Users\Verca\Desktop\ereplace2.jpg
Pronator quadratus
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/pronator-quad
ratus/atlasImage_large
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/pronator-tere
s/atlasImage_large
Pronator teres

Pronator quadratus
•Origin
•Distal 1/4 of anterior surface of ulna
•
•Insertion
•Distal 1/4 of anterior surface of radius
•
•Action
•Pronates forearm; deep fibers bind radius and ulna together
•
•Innervation
•Anterior interosseous nerve from median nerve (C8 and T1) (C8, T1)

Pronator teres
•Origin
•Medial epicondyle of humerus and coronoid process of ulna
•
•Insertion
•Middle of lateral surface of radius
•
•Action
•Pronates and flexes forearm (at elbow)
•
•Innervation
•Median nerve (C6 and C7) (C6, C7)

Pronation – grade 5,4
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_079.jpg
Position: patient sits, arms relaxed along body side, tested upper limb 90° flexed, forearm in
prone position, muscles of the wrist and fingers relaxed
Fixation: lower part of the arm
Movement: pronation in full range of motion
Resistance: PT puts resistance against the movement, holding patients hand like at the picture
(main resistance  by using PTs´ point finger and middle finger on the patients´ processus
styloideus radii)

Pronation – grade 3
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_080.jpg
Position: patient sits, arms relaxed along body side, tested upper limb 90° flexed, forearm in
prone position, muscles of the wrist and fingers relaxed
Fixation: lower part of the arm, support the forearm by the other hand
Movement: pronation in full range of motion

Pronation – grade 2
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_081.jpg
Position: lying prone, 90° shoulder abduction, 90° elbow flexion, forearm supine hanging from the
table, muscle of the wrist and fingers relaxed
Fixation: the lower part of the arm
Movement: pronation in full range of motion

Pronation – grade 1,0
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_082.jpg
C:\Users\Verca\Desktop\MMT (4) Shoulder, scapula, elbow, fotky\WP_20151001_083.jpg
Position: lying supine, elbow slightly flexed and supinated
Attempt to move: PT palpates the trace of contraction of pronator teres  and pronator quadratus
during patients´ attempt to pronate the forearm

Pronation and supination – notes:
•Elbow should stay in 90° flexion during whole tested movement •No movement of the shoulder should
be allowed – fix the arm properly
•No activity of muscles of the wrist and fingers
•Proper grip of the hand
•Palpation of cotraction of supinator, pronator teres and pronator quadratus muscle is difficult

Wrist
http://graphicwitness.medicalillustration.com/imagescooked/26027W.jpg


Movements of the wrist joint
•
Výsledek obrázku pro movement of the wrist joint

Wrist flexion
•Flexor carpi radialis
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/flexor-carpi-
radialis/atlasImage_large
Flexor carpi ulnaris

Flexor carpi radialis
•Origin
•Medial epicondyle of humerus
•
•Insertion
•Base of 2nd metacarpal
•
•Action
•Flexes and abducts hand (at wrist)
•
•Innervation
•Median nerve (C6 and C7) (C6, C7)

Flexor carpi ulnaris
•Origin
•Humeral head: medial epicondyle of humerus;
•Ulnar head: olecranon and posterior border of ulna
•
•Insertion
•Pisiform bone, hook of hamate bone, and 5th metacarpal bone
•
•Action
•Flexes and adducts hand (at wrist)
•
•Innervation
•Ulnar nerve (C7 and C8) (C7, C8)

Wrist flexion with radial duction – grade 5,4
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_005.jpg
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between supination and pronation, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm (dont´t touch the main muscle)
•Movement: flex and abduct the wrist (both together), fingers relaxed
•Resistance: PT puts resistance on the thenar against the movement

Wrist flexion with radial duction – grade 3
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between supination and pronation, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm (dont´t touch the main muscle)
•Movement: flex and abduct the wrist (both together), fingers relaxed
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_006.jpg

Wrist flexion with radial duction – grade 2
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between supination and pronation, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm (dont´t touch the main muscle)
•Movement: flex and radial duction of the wrist (both together) by pushing the hand on the ulnar
side,  fingers relaxed
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_007.jpg

Wrist flexion with radial duction – grade 1,0
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between supination and pronation, wrist in the central position, fingers relaxed
•Attempt to move: PT palpates the trace of contraction of the flexor carpi radialis during patients
attempt to do flexion and abduction of the wrist
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_008.jpg

Wrist flexion with ulnar duction – grade 5,4
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm supinated, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm (dont´t touch the main muscle)
•Movement: flex and adduct the wrist (both together), fingers relaxed
•Resistance: PT puts resistance on the hypotenar against the movement
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_001.jpg

Wrist flexion with ulnar duction – grade 3
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm supinated, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm (dont´t touch the main muscle)
•Movement: flex and adduct the wrist (both together), fingers relaxed
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_002.jpg

Wrist flexion with ulnar duction – grade 2
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between supination and pronation, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm (dont´t touch the main muscle)
•Movement: flex and adduct the wrist (both together) by pushing the hand on the ulnar side,
fingers relaxed
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_003.jpg

Wrist flexion with ulnar duction – grade 1,0
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between supination and pronation, wrist in the central position, fingers relaxed
•Attempt to move: PT palpates the trace of contraction of the flexor carpi ulnaris during patients
attempt to do flexion and adduction of the wrist
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_004.jpg

Wrist flexion – notes:
•Initial position of the wrist should be maintained •Relaxation of the fingers is necessary as a
prevention of substitution •Palpate the trace of contraction of the muscles properly

Wrist extension
•Extensor carpi
•radialis brevis
Extensor carpi
ulnaris
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-carp
i-radialis-brevis/atlasImage_large
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-carp
i-radialis-longus/atlasImage_large
Extensor carpi
radialis longus
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-carp
i-ulnaris/atlasImage_large

Extensor carpi radialis brevis
•Origin
•Lateral epicondyle of humerus
•
•Insertion
•Base of 3rd metacarpal
•
•Action
•Extend and abduct hand at wrist joint
•
•Innervation
•Deep branch of radial nerve (C7 and C8) (C7, C8)

Extensor carpi radialis longus
•Origin
•Lateral supracondyle ridge of humerus
•
•Insertion
•Base of 2nd metacarpal
•
•Action
•Extend and abduct hand at wrist joint
•
•Innervation
•Radial nerve (C6 and C7) (C7, C6)

Extesor carpi ulnaris
•Origin
•Lateral epicondyle of humerus and posterior border of ulna
•
•Insertion
•Base of 5th metacarpal
•
•Action
•Extends and adducts hand at wrist joint
•
•Innervation
•Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve
(C7, C8)

Wrist extension with ulnar duction – grade 5,4
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_009.jpg
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm pronated, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm from the palmar side (dont´t touch the main muscle)
•Movement: extension and ulnar duction of the wrist (both together), fingers relaxed
•Resistance: PT puts resistance on the back of the hand (V. metatars)  against the movement

Wrist extension with ulnar duction – grade 3
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_010.jpg
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm pronated, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm from the palmar side (dont´t touch the main muscle)
•Movement: extension and ulnar duction of the wrist (both together), fingers relaxed

Wrist extension with ulnar duction – grade 2
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between pronation and suupination, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm from the palmar side (dont´t touch the main muscle)
•Movement: extension and ulnar duction of the wrist (both together) by pushing the hand on the
ulnar side of the hand, fingers relaxed
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_011.jpg

Wrist extension with ulnar duction – grade 1,0
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_012.jpg
Position: the same as testing before
Fixation: the lower part of the forearm from the palmar side
Attempt to move:  during patients attempt of extension and ulnar duction of the wrist PT palpates
the trace of contraction of extensor carpi ulnaris (at the back of the hand, at the processus
slyloideus ulnae area)

Wrist extension with radial duction – grade 5,4
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm pronated, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm from the palmar side (dont´t touch the main muscle)
•Movement: extension and radial duction of the wrist (both together), fingers relaxed
•Resistance: PT puts resistance on the back of the hand (II. metatars)  against the movement
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_013.jpg

Wrist extension with radial duction – grade 3
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm pronated, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm from the palmar side (dont´t touch the main muscle)
•Movement: extension and radial duction of the wrist (both together), fingers relaxed
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_014.jpg

Wrist extension with radial duction – grade 2
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_015.jpg
•Position: patient sits (or lies supine), tested upper limb on the table – slightly flexed in the
elbow, forearm between pronation and supination, wrist in the central position, fingers relaxed
•Fixation: fix the lower part of the forearm from the ulnar side
•Movement: extension and radial duction of the wrist (both together) by pushing the hand on the
ulnar side on the table, fingers relaxed

Wrist extension with radial duction – grade 1, 0
•Position: the same as testing before
•Fixation: the lower part of the forearm from the palmar side
•Attempt to move: during patients attempt of extension and radial duction of the wrist (both
together) PT palpates the trace of contraction of extensor radialis longus and brevis (radial side
of the back of the wrist), fingers relaxed
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_016.jpg

Wrist extension – notes:
•Elbow should be slightly flexed
•Fingers should be relaxed during the whole tested movement

Hand
http://efullcircle.com/wp-content/gallery/skeletal/right-hand-skeletal.jpg


[USEMAP]
Metacarpophalangeal joints of the fingers (MCP)
http://www.eorthopod.com/sites/default/files/images/hand_anatomy_mcp01.jpg

MCP flexion
•Lumbicales
Interosseals
palmares
Interosseals
dorsales
http://www.daviddarling.info/images/condyloid_joint.jpg
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/interosseous-
muscles-dorsal/atlasImage_large
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/interosseous-
muscles-palmar/atlasImage_large
http://efullcircle.com/wp-content/gallery/hand/intrinsic-muscle-lumbricals.jpg

Interosseus muscles, palmar (1-3)
•Origin
•Palmar surfaces of 2nd, 4th and 5th metacarpals (unipennate muscles)
•
•Insertion
•Extensor expansions of digits and bases of proximal phalanges of digits 2, 4 and 5
•
•Action
•Adduct digits toward axial line and assist lumbricals in flexing MCP joints and extending
interphalangeal joints
•
•Innervation
•Deep branch of ulnar nerve (C8 and T1) (C8, T1)

Interosseus muscles, dorsal (1-4)
•Origin
•Adjacent sides of two metacarpals (bipennate muscles)
•
•Insertion
•Extensor expansions and bases of proximal phalanges of digits 2 – 4
•
•Action
•Abduct digits from axial line and act with lumbricals to flex MCP joints and extend
interphalangeal joints
•
•Innervation
•Deep branch of ulnar nerve (C8 and T1) (C8, T1)

MCP flexion – grade 5,4
•Position: patient sits (or lies supine), elbow slightly flexed, forearm lying supine on the table,
fingers extended
•Fixation: the head of metacarps
•Movement: MCP flexion (except of the thumb) – all fingers together (a.), or one by one (b.), IP
joints extended
•Resistance: PT puts resistance on the volar side of proximal phalangs
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_017.jpg C:\Users\Verca\Desktop\MMT (5)
Hand\WP_20151008_018.jpg

MCP flexion – grade 3
•Position: patient sits (or lies supine), elbow slightly flexed, forearm lying supine on the table,
fingers extended
•Fixation: the head of metacarps
•Movement: MCP flexion (except of the thumb) – all fingers together, or one by one, IP joints
extended
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_019.jpg

MCP flexion – grade 2
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_020.jpg
Position: patient sits (or lies supine), forearm lying on the table between pronation and
supination, fingers extended
Fixation: the head of metacarps
Movement: MCP flexion (except of the thumb) – all fingers together, IP joints extended

MCP flexion – grade 1,0
Position: patient sits (or lies supine), elbow slightly flexed, forearm lying supine on the table,
fingers relaxed
Attempt to move: PT palpates the trace of contraction  of lumbricales during patients´ attempt to
flex the MCP joints (in the palm)
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_021.jpg

MCP flexion – notes:
•Don´t forget to fix the metacarps
•The wrist should stay in central position, fingers should stay extended during testing
•Put resistance against proximal phalanges

MCP extension
•Extensor
•digitorum
http://i1251.photobucket.com/albums/hh551/vladimirzec/zgloboviprstiju6_zps7cdca2da.jpg
http://i1251.photobucket.com/albums/hh551/vladimirzec/zgloboviprstiju6_zps7cdca2da.jpg
Extensor
indicis
Extensor
digiti minimi
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-digi
torum/atlasImage_large
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-digi
ti-minimi/atlasImage_large
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-indi
cis/atlasImage_large

Extensor digitorum
•Origin
•Lateral epicondyle of humerus
•
•Insertion
•Extensor expansions of medial four digits
•
•Action
•Extends medial four digits at metacarpophalangeal joints
•Extends hand at wrist joint
•
•Innervation
•Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve
(C7, C8)

Extensor indicis
•Origin
•Posterior surface of ulna and interosseous membrane
•
•Insertion
•Extensor expansion of 2nd digit
•
•Action
•Extends 2nd digit and helps to extend hand
•
•Innervation
•Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve
(C7, C8)

Extensor digiti minimi
•Origin
•Lateral epicondyle of humerus
•
•Insertion
•Extensor expansion of 5th digit
•
•Action
•Extends 5th digit at metacarpophalangeal and interphalangeal joints
•
•Innervation
•Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve
(C7, C8)

MCP extension – grade 5,4
•Position: patient sits or lies supine, elbow slightly flexed, forearm lying prone on the table,
wrist in central position, IP joints slightly flexed, MP joints flexed
•Fixation: wrist and metacarps from the palmar side
•Movement: MCP extension in full range of motion
•Resistance: PT puts resistance on the proximal phalangs (II.-V.) against the movement
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_022.jpg

MCP extension – grade 3
•Position: patient sits or lies supine, elbow slightly flexed, forearm lying prone on the table,
wrist in central position, IP joints slightly flexed, MP joints flexed
•Fixation: wrist and metacarps from the palmar side
•Movement: MCP extension in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_023.jpg

MCP extension – grade 2
•Position: patient sits or lies supine, elbow slightly flexed, forearm lying on the ulnar side on
the table, wrist in central position, IP joints slightly flexed, MP joints flexed
•Fixation: wrist and metacarps from the palmar side
•Movement: MCP extension in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_024.jpg

MCP extension – grade 1,0
•Position: patient sits or lies supine, elbow slightly flexed, forearm lying prone on the table,
wrist in central position, IP joints slightly flexed, MP joints flexed
•Fixation: wrist and metacarps from the palmar side
•Attempt to move: PT palpates a trace of contraction during patients´ attempt of MCP extension (on
the back of the hand over the metacarps)
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_025.jpg

MCP extension – notes:
•Don´t interchange extension of MCP and IP joints
•Fix the hand (wrist) firmly
•Fingers has to be relaxed during testing

MCP adduction
http://www.daviddarling.info/images/condyloid_joint.jpg
Interosseals palmares
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/interosseous-
muscles-palmar/atlasImage_large

MCP adduction – grade 5,4
•Position: patient sits or lies supine, forearm lying supine on the table, fingers supported in
abduction
•Fixation: support fingers and put resistance (at the same time)
•Movement: from maximal abduction do an adduction of II., IV., V. finger
•Resistance: PT put resistance against MCP adduction on the proximal IP joints
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_026.jpg

MCP adduction – grade 3
•Position: patient sits or lies supine, forearm lying:
a.ulnar side on the table (for testing IV., V. finger)
b.b. radial side on the table (for testing II. finger)
•Fixation: wrist
•Movement: from maximal abduction do an adduction of II., IV., V. finger (acording the position)
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_027.jpg C:\Users\Verca\Desktop\MMT (5)
Hand\WP_20151008_028.jpg

MCP adduction – grade 2
•Position: patient sits or lies supine, forearm lying prone on the table, fingers abducted
•Fixation: wrist (not necessary)
•Movement: from maximal abduction do an adduction of II., IV., V. finger
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_029.jpg

MCP adduction – grade 1,0
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_030.jpg
•Position: patient sits or lies supine, forearm lying prone on the table, fingers abducted
•Attempt to move: PT palpates the trace of contraction of interosseal palmares during patients
attempt to do an adduction of II., IV., V. finger (at the area of basis of proximal phalangs)

MCP abduction
http://www.daviddarling.info/images/condyloid_joint.jpg
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/interosseous-
muscles-dorsal/atlasImage_large
Interosseals dorsales
Abductor digiti minimi
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/abductor-digi
ti-minimi/atlasImage_large

Abductor digiti minimi
•Origin
•Pisiform
•
•Insertion
•Medial side of base of proximal phalanx of little finger
•
•Action
•Abducts little (5th) finger
•
•Innervation
•Deep branch of ulnar nerve (C8 and T1) (C8, T1)

MCP abduction – grade 5,4
•Position: patient sits or lies supine, the forearm prone, fingers adducted
•Fixation: wrist and lower part of the forearm
•Movement: MCP abduction in full range of motion
•Resistance: PT puts resistance on the basis of first phalanges of fingers (one by one) against the
MCP abduction
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_031.jpg

MCP abduction – grade 3
•Position: patient sits or lies supine, the forearm on the table:
a.Ulnar side
b.Radial side
•Fixation: wrist and lower part of the forearm
•Movement: MCP abduction in full range of motion
a.Ulnar side – for II., III. finger
b.Radial side – for III., IV., V. finger
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_032.jpg C:\Users\Verca\Desktop\MMT (5)
Hand\WP_20151008_033.jpg

MCP abduction – grade 2
•Position: patient sits or lies supine, the forearm prone, fingers adducted
•Fixation: wrist and lower part of the forearm
•Movement: MCP abduction in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_034.jpg

MCP abduction – grade 1,0
•Position: patient sits or lies supine, the forearm prone, fingers adducted
•Attempt to move: PT palpates the trace of contraction of interosseals dorsales at intermetacarpal
area (or see the vibration of fingers)
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_035.jpg

[USEMAP]
Interphalangeal joints of fingers (IP)
http://www.eorthopod.com/images/ContentImages/hand/hand_anatomy/hand_anatomy_ip01.jpg

Proximal IP flexion
•Flexor digitorum superficialis
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/flexor-digito
rum-superficialis/atlasImage_large

Flexor digitorum superficialis
•
•Origin
•Humeroulnar head: medial epicondyle of humerus, ulnar collateral ligament, and coronoid process of
ulna;
•Radial head: superior half of anterior border of radius
•
•Insertion
•Bodies of middle phalanges of digits 2 – 5
•
•Action
•Flexes middle phalanges at proximal IP joints of medial four digits
•acting more strongly, it also flexes proximal phalanges at MCP joints and hand
•
•Innervation
•Median nerve (C7, C8 and T1) (C7, C8, T1)

Proximal IP flexion – grade 5,4
•Position: patient sits or lies supine, elbow slightly flexed, forearm supine, wrist in central
position, fingers extended
•Fixation: fix proximal phalang to ensure MP joint hyperextension
•Movement: proximal IP flexion in full range of motion
•Resistance: PT put resistance on the volar side of middle phalang
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_036.jpg C:\Users\Verca\Desktop\MMT (5)
Hand\WP_20151008_037.jpg

Proximal IP flexion – grade 3,2
•Position: patient sits or lies supine, elbow slightly flexed, forearm supine, wrist in central
position, fingers extended
•Fixation: fix proximal phalang to ensure MP joint hyperextension
•Movement: proximal IP flexion in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_038.jpg

Proximal IP flexion – grade 1,0
•Position: patient sits or lies supine, elbow slightly flexed, forearm supine, wrist in central
position, fingers extended
•Attempt to move: PT palpates a trace of contraction during patients´ attempt of proximal IP
flexion (the tendon on volar side of proximal phalang)
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_039.jpg

Proximal IP flexion – notes:
•Wrist has to be in central position during whole test •Fixation of MCP joints is necessary: it has
to be slightly hyperextended •Distal IP joint has to be extended, no flexion during testing
•We don´t differentiate grade 3 and 2
•Test each finger individually

Distal IP flexion
•Flexor digitorum profundus
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/flexor-digito
rum-profundus/atlasImage_large

Flexor digitorum profundus
•Origin
•Proximal 3/4 of medial and anterior surfaces of ulna and interosseous membrane
•
•Insertion
•Base of the distal phalanx of digits 2 – 5
•
•Action
•Flexes distal phalanges at distal interphalangeal joints of medial four digits
•assists with flexion of hand
•
•Innervation
•Medial part: ulnar nerve (C8 and T1)
•Lateral part: anterior interosseous branch of median nerve (C8 and T1) (C8, T1)

Distal IP flexion – grade 5,4
•Position: patient sits or lies supine, elbow slightly flexed, forearm supine, wrist in central
position, fingers extended
•Fixation: the middle phalang (from the side)
•Movement: distal IP flexion in full range of motion
•Resistance: PT puts resistance on the volar side of distal phalang against the movement
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_040.jpg C:\Users\Verca\Desktop\MMT (5)
Hand\WP_20151008_041.jpg

Distal IP flexion – grade 3,2
•Position: patient sits or lies supine, elbow slightly flexed, forearm supine, wrist in central
position, fingers extended
•Fixation: the middle phalang (from the side)
•Movement: distal IP flexion in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_042.jpg

Distal IP flexion – grade 1,0
•Position: patient sits or lies supine, elbow slightly flexed, forearm supine, wrist in central
position, fingers extended
•Attempt to move:  PT palpates a trace of contraction during patients attempt of distal IP flexion
(on the volar side of the middle phalang)
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_043.jpg

Distal IP flexion – notes:
•Wrist should be in central position during whole testing •Fix the middle phalang from the side (no
compression of the tendon) •Proximal IP joint and MCP joint should be extended

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CMC joint of thumb
http://www.eorthopod.com/images/ContentImages/hand/hand_cmc/hand_cmc_anat02.jpg

CMC thumb joint adduction
Adductor pollicis
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/adductor-poll
icis/atlasImage_large

Adductor pollicis
•Origin
•Oblique head: bases of 2nd and 3rd metacarpals, capitate, and adjacent carpals
•Transverse head: anterior surface of body of 3rd metacarpal
•
•Insertion
•Medial side of base of proximal phalanx of thumb
•
•Action
•Draws 1st metacarpal laterally to oppose thumb toward center of palm and rotates it medially
•
•Innervation
•Deep branch of ulnar nerve (C8 and T1) (C8, T1)

CMC thumb joint adduction – grade 5,4
•Position: patient sits or lies supine, forearm lying prone on the table, wrist in central
position, thumb abducted
•Fixation: wrist
•Movement: CMC thumb joint adduction (in palm plane) in full range of motion
•Resistance: PT puts resistance on the ulnar side of thumb against movement
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_044.jpg

CMC thumb joint adduction – grade 3
•Position: patient sits or lies supine, forearm on the radial side on the table, wrist in central
position, thumb abducted
•Fixation: support forearm and wrist, fingers
•Movement: CMC thumb joint adduction (in palm plane) in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_045.jpg

CMC thumb joint adduction – grade 2
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_046.jpg
•Position: patient sits or lies supine, forearm lying prone on the table, wrist in central
position, thumb abducted
•Fixation: not necessary
•Movement: CMC thumb joint adduction (in palm plane) in full range of motion

CMC thumb joint adduction – grade 1,0
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_047.jpg
•Position: patient sits or lies supine, forearm lying supine on the table, wrist in central
position
•Attempt to move: PT palpates a trace of contraction during patients´ attempt of CMC thumb joint
adduction (in palm plane) – on the volar side between I. and II. metacarp

CMC thumb joint adduction – notes:
•The movement of the joint should be in the plane of the palm
•MCP  and IP joint should be extended

CMC thumb joint abduction
•Abductor pollicis longus
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/abductor-poll
icis-longus/atlasImage_large
Abductor pollicis brevis
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/abductor-poll
icis-brevis/atlasImage_large

Abductor pollicis longus
•Origin
•Posterior surfaces of ulna, radius and interosseous membrane
•
•Insertion
•Base of 1st metacarpal
•
•Action
•Abducts thumb and extends it at carpometacarpal joint
•
•Innervation
•Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve
(C7, C8)

Abductor pollicis brevis
•Origin
•Flexor retinaculum and tubercles of scaphoid and trapezium
•
•Insertion
•Lateral side of base of proximal phalanx of thumb
•
•Action
•Abducts thumb and helps oppose it
•
•Innervation
•Recurrent branch of median nerve (C8 and T1) (C8, T1)

CMC thumb joint abduction – grade 5,4
•Position: patient sits or lies supine, forearm lying prone on the table, wrist in central
position, thumb adducted, fingers extended
•Fixation: wrist
•Movement: CMC thumb joint abduction in full range of motion
•Resistance: PT puts resistance on the radial side of thumb against the movement
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_048.jpg

CMC thumb joint abduction – grade 3
•Position: patient sits or lies supine, forearm lying on the ulnar side on the table, wrist in
central position, thumb adducted, fingers extended
•Fixation: wrist
•Movement: CMC thumb joint abduction in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_049.jpg

CMC thumb joint abduction – grade 2
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_050.jpg
Position: patient sits or lies supine, forearm lying prone on the table, wrist in central position,
thumb adducted, fingers extended
Fixation: wrist
Movement: CMC thumb joint abduction in full range of motion

CMC thumb joint abduction – grade 1,0
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_051.jpg
Position: patient sits or lies supine, forearm lying prone on the table, wrist in central position,
thumb extended, relaxed, fingers extended
Attempt to move: PT palpates a trace of contraction during patients attempt of CMC thumb joint
abduction (in the processus styloideus radii area)

CMC thumb joint abduction – notes:
•Wrist and the hand should be fixed, in central position •The movement should be done in the plane
of the palm

Thumb and little finger opposition
•Opponnens pollicis
Opponnens digiti minimi
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/opponens-poll
icis/atlasImage_large image

Opponnens pollicis
•Origin
•Flexor retinaculum and tubercles of scaphoid and trapezium
•
•Insertion
•Lateral side of 1st metacarpal
•
•Action
•Draws 1st metacarpal laterally to oppose thumb toward center of palm and rotates it medially
•
•Innervation
•Recurrent branch of median nerve (C8 and T1) (C8, T1)

Opponnens digiti minimi
•Origin
•Hook of hamate and flexor retinaculum
•
•Insertion
•Medial border of 5th metacarpal
•
•Action
•Draws 5th metacarpal anteriorly and rotates it, bringing little finger (5th digit) into opposition
with thumb
•
•Innervation
•Deep branch of ulnar nerve (C8 and T1) (C8, T1)

Thumb and little finger opposition – grade 5,4
•Position: patient sits or lies supine, forearm lying supine on the table, wrist in central
position, fingers extended
•Fixation: not necessary
•Movement: thumb and little finger opposition
•Resistance: PT puts resistance on volar side of I. and V. metatars
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_052.jpg

Thumb and little finger opposition – grade 3,2
•Position: patient sits or lies supine, forearm lying supine on the table, wrist in central
position, fingers extended
•Fixation: not necessary
•Movement: thumb and little finger opposition
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_053.jpg

Thumb and little finger opposition – grade 1,0
•Position: patient sits or lies supine, forearm lying supine on the table, wrist in central
position, fingers extended
•Attempt to move: PT palpates  a trace of contraction during patients´ attempt of thumb and little
finger opposition – on the volar and radial side of I. metacarp, and in the area of hypothenar
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_054.jpg

Thumb and little finger opposition – notes:
•The movement should be done properly – it is not enought to do an adduction an flexion of the
thumb •Put the resistance in good way – against opposition

Metacarpophalangeal joint of the thumb (MCP)
http://www.eorthopod.com/images/ContentImages/hand/hand_cmc/hand_cmc_anat02.jpg


[USEMAP]
Thumb MCP flexion
•Flexor pollicis brevis
http://centralorthopedicgroup.com/wp-content/uploads/2015/02/adult_finger_fx_thumb_flex.jpg
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/flexor-pollic
is-brevis/atlasImage_large

Flexor pollicis brevis
•Origin
•Flexor retinaculum and tubercles of scaphoid and trapezium
•
•Insertion
•Lateral side of base of proximal phalanx of thumb
•
•Action
•Flexes thumb
•
•Innervation
•Recurrent branch of median nerve (C8 and T1) (C8, T1)

Thumb MCP flexion – grade 5,4
•Position: patient sits or lies supine, forearm lying supine on the table, thumb extended and
abducted, fingers relaxed
•Fixation: fix  first metacarp in starting position (don´t press the thenar)
•Movement: thumb MCP flexion in full range of motion
•Resistance: PT puts resistance against thumb MCP flexion on volar side of proximal phalang of the
thumb
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_055.jpg

Thumb MCP flexion – grade 3,2
•Position: patient sits or lies supine, forearm lying supine on the table, thumb extended and
abducted, fingers relaxed
•Fixation: fix  first metacarp in starting position (don´t press the thenar)
•Movement: thumb MCP flexion in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_056.jpg

Thumb MCP flexion – grade 1,0
•Position: patient sits or lies supine, forearm lying supine on the table, thumb extended and
abducted, fingers relaxed
•Attempt to move: PT palpates a trace of patients´ attempt of thumb MCP flexion on the palmar side
of I. metacarp
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_057.jpg

Thumb MCP extension
•Extensor pollicis brevis
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-poll
icis-brevis/atlasImage_large image

Extensor pollicis brevis
•Origin
•Posterior surfaces of radius and interosseous membrane
•
•Insertion
•Base of proximal phalanx of thumb
•
•Action
•Extends proximal phalanx of thumb at carpometacarpal joint
•
•Innervation
•Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve
(C7, C8)

Thumb MCP extension – grade 5,4
•Position: patient sits or lies supine, forearm lying prone on the table, wrist in central
position, thumb between adduction and abduction, MP joint flexed, fingers relaxed
•Fixation: fix slightly the I. metacarp
•Movement: thumb MCP extension
•Resistance: PT puts resistance against thumb MCP extension on dorsal side of prosimal thumb
phalang
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_058.jpg

Thumb MCP extension – grade 3,2
•Position: patient sits or lies supine, forearm lying prone on the table, wrist in central
position, thumb between adduction and abduction, MP joint flexed, fingers relaxed
•Fixation: fix slightly the I. metacarp
•Movement: thumb MCP extension
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_059.jpg

Thumb MCP extension – grade 1,0
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_060.jpg
•Position: patient sits or lies supine, forearm lying prone on the table, wrist in central
position, thumb between adduction and abduction, MP joint flexed, fingers relaxed
•Attempt to move: PT palpates a trace of contraction during patients´ attempt of thumb MCP
extension in the area of I. metacarp

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==
Interphalangeal joint of the thumb (IP)
http://www.eorthopod.com/sites/default/files/images/hand_anatomy_ip01.jpg

Thumb IP flexion
•Flexor pollicis longus
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/flexor-pollic
is-longus/atlasImage_large image

Flexor pollicis longus
•Origin
•Anterior surface of radius and adjacent interosseous membrane
•
•Insertion
•Base of distal phalanx of thumb
•
•Action
•Flexes phalanges of 1st digit (thumb)
•
•Innervation
•Anterior interosseous nerve from median nerve (C8 and T1) (C8, T1)

Thumb IP flexion – grade 5,4
•Position: patient sits or lies supine, forearm lying supine on the table, thumb extended and
abducted, fingers relaxed
•Fixation: proximal phalang of the thumb (from the side)
•Movement: thumb IP flexion in full range of motion
•Resistance: PT puts resistance against palmar side of distal phalang of the thumb
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_061.jpg

Thumb IP flexion – grade 3,2
•Position: patient sits or lies supine, forearm lying supine on the table, thumb extended and
abducted, fingers relaxed
•Fixation: proximal phalang of the thumb (from the side)
•Movement: thumb IP flexion in full range of motion
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_062.jpg

Thumb IP flexion – grade 1,0
•Position: patient sits or lies supine, forearm lying supine on the table, thumb extended and
abducted, fingers relaxed
•Fixation: proximal phalang of the thumb (from the side)
•Attempt to move: PT palpates a trace of contraction during patients´ attempt of thumb IP flexion
on the palmar side of proximal phalang of the thumb
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_063.jpg

Thumb IP extension
•Extensor pollicis longus
http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-poll
icis-longus/atlasImage_large image

Extensor pollicis longus
•Origin
•Posterior surface of middle 1/3 of ulna and interosseous membrane
•
•Insertion
•Base of distal phalanx of thumb
•
•Action
•Extends distal phalanx of thumb at carpometacarpal and interphalangeal joints
•
•Innervation
•Posterior interosseous nerve (C7 and C8), the continuation of the deep branch of the radial nerve
(C7, C8)

Thumb IP extension – grade 5,4
•Position: patient sits or lies supine, forearm lying prone on the table,  wrist in central
position, thumb IP flexion, MP extension, fingers relaxed
•Fixation: fix first phalang of the thumb from the side
•Movement: thumb IP extension
•Resistance: against the distal phalang of the thumb (on the nail)
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_064.jpg

Thumb IP extension – grade 3,2
•Position: patient sits or lies supine, forearm lying prone on the table,  wrist in central
position, thumb IP flexion, MP extension, fingers relaxed
•Fixation: fix first phalang of the thumb from the side
•Movement: thumb IP extension
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_065.jpg

Thumb IP extension – grade 1,0
C:\Users\Verca\Desktop\MMT (5) Hand\WP_20151008_066.jpg
•Position: patient sits or lies supine, forearm lying prone on the table,  wrist in central
position, thumb IP flexion, MP extension, fingers relaxed
•Fixation: fix first phalang of the thumb from the side
•Attempt to move: PT palpates a trace of  contraction during patients´ attempt of thumb IP
extension on dorsal side of first phalang

Literature, e-sources
•http://www.medicinenet.com/elbow_pain/article.htm
•http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/hand
•http://criticalcaremcqs.com/tag/aipgmee-mcqs/page/15/
•https://nervesurgery.wustl.edu/ev/upperextremity
•

Thank you for your attention J
http://thumbs.dreamstime.com/z/set-two-hands-pointing-finger-18933517.jpg