Forearm and Wrist Mmt

Forearm Supination

Supinator and Biceps brachii

Origin:

·        Supinator: lateral condyle of humerus and dorsal shaft of ulna

·        Biceps brachii: short head: coracoid apex of scapula, long head: supraglenoid tubercle of scapula

Insertion:

·        Supinator: dorsal and lateral body of radius

·        Biceps brachii: radial tuberosity of radius

Nerve Innervation:

·        Supinator: radial

·        Biceps brachii: musculocutaneous

Patient Position:

·        Patient is sitting with arm at side and elbow flexed 90°, wrist is in “hand shaking” position.

Therapist and Patient Instruction:

·        The therapist takes the patients hand as if going to shake it; resistance is applied in a clockwise direction.  The stabilizing hand is placed under the elbow joint.  Tell the patient to, “Try to turn your palm up, don’t let me push it down.”

MMT for Grades 2, 1, and 0:

Patient Position:

·        Same as above, therapist should support arm at the elbow.

Therapist and Patient Instructions:

·        The same instructions as above are used except the motion should be done without resistance.  Palpate the supinator and biceps for contractile activity.

Forearm Pronation

Pronator teres and Pronator quadratus

Origin:

·        Pronator teres: humeral head: supracondylar ridge and medial epicondyle of humerus, ulnar head: coronoid process

·        Pronator quadratus: distal ¼ of anterior surface of the ulna

Insertion:

·        Pronator teres: lateral surface of mid shaft of the radius

·        Pronator quadratus: distal anterior surface of radius

Nerve Innervation:

·        Pronator teres: median

·        Pronator quadratus: anterior interosseous

Patient Position:

·        Patient is sitting with arm at side and elbow flexed 90°, wrist is in “hand shaking” position.

Therapist and Patient Instructions:

·        The therapist takes the patients hand just above the wrist; resistance is applied in a counterclockwise direction from the therapist’s point of view.  The stabilizing hand is under the elbow.  Tell the patient to, “Try to turn your palm down, don’t let me pull it up.”

MMT for grades 2, 1, and 0:

Patient Position:

·        Same as above, therapist should support arm at the elbow.

Therapist and Patient Instructions:

·        The same instructions as above are used except the motion should be done without resistance.  Palpate the pronators for contractile activity.

Wrist Flexion

Flexor carpi radialis and Flexor carpi ulnaris

Origin:

·        Flexor carpi radialis: medial epicondyle of humerus

·        Flexor carpi ulnaris: medial epicondyle of humerus and olecranon process of ulna

Insertion:

·        Flexor carpi radialis: base of 2^nd and 3^rd metacarpals

·        Flexor carpi ulnaris: pisiform, hamate and base of 5^th metacarpal

Nerve Innervation:

·        Flexor carpi radialis: median

·        Flexor carpi ulnaris: ulnar

Patient Position:

·        Sitting, forearm is supinated

Therapist and Patient Instructions:

·        Resistance is given at the hand in the direction of wrist extension.  The stabilizing hand is placed around the wrist.  Ask the patient to, “keep your fingers relaxed, bend your wrist, don’t let me straighten it out.”  

MMT for Grades 2, 1, and 0:

Patient Position:

·        Sitting with forearm supported on table.  Have the ulnar side of the forearm resting on the table.

Therapist and Patient Instructions:

·        Ask the patient to, “try and bend your wrist.”  Palpate the tendons of the flexors at the wrist.

Wrist Extension

Extensor carpi radialis longus, Extensor carpi radialis brevis, Extensor carpi ulnaris

Origin:

·        Extensor carpi radialis longus: lateral supracondylar ridge of humerus

·        Extensor carpi radialis brevis: lateral epicondyle of humerus

·        Extensor carpi ulnaris: lateral epicondyle of humerus and dorsal border of ulna

Insertion:

·        Extensor carpi radialis longus: base of 2^nd metacarpal

·        Extensor carpi radialis brevis: base of 3^rd metacarpal

·        Extensor carpi ulnaris: 5^th metacarpal

Nerve Innervation:

·        Extensor carpi radialis longus: radial

·        Extensor carpi radialis brevis: radial

·        Extensor carpi ulnaris: radial

Patient Position:

·        Sitting with forearm and elbow supported on table, forearm is pronated.

Therapist and Patient Instructions:

·        Resistance is applied at the metacarpals in the direction of wrist flexion.  The stabilizing hand is placed around the wrist.  Ask the patient to, “bring your wrist up, don’t let me pull it down.”

MMT for Grades 2, 1, and 0:

Patient Position:

·        Forearm is pronated and supported on table.

Therapist and Patient Instructions:

·        Ask the patient to try and bend his/her wrist back.  Palpate the extensor tendons at the wrist for activity.

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