Elbow Mmt

Elbow Flexion

Biceps brachii, Brachialis, and Brachioradialis

Origin:

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

·        Brachialis: anterior shaft of distal 2/3 of humerus

·        Brachioradialis: supracondylar ridge of humerus

Insertion:

·        Biceps brachii: radial tuberosity of radius

·        Brachialis: ulnar tuberosity of ulna

·        Brachioradialis: Proximal to the styloid process of the radius

Nerve Innervation:

·        Biceps brachii: musculocutaneous

·        Brachialis: musculocutaneous and radial

·        Brachioradialis: radial

Patient Position:

·        Patient is sitting with slight shoulder flexion and the elbow flexed past 90°, forearm is supinated.

Therapist and Patient Instructions:

·        Ask the patient to, “hold your elbow bent, don’t let me straighten it out.”  Resistance is given at the wrist in a downward direction.  The stabilizing hand is placed on the shoulder.  

Alternate Test for Elbow Flexion

·        *This alternate test is performed if the biceps and brachialis are weak.  Pronating the hand will instead use the brachioradialis, extensor carpi radialis longus, pronator teres, and other wrist flexors. 

·        Patients positioning is the same, except the forearm is now pronated and the stabilizing hand is under the elbow joint.  Testing procedure is the same as above.

MMT for Grades 2, 1, and 0:

Patient Position:

·        Patient should be lying prone, arm at side.

Therapist and Patient Instructions:

·        Have the patient try to flex their elbow, palpate the flexors on the forearm.

Elbow Extension

Triceps Brachii

Origin:

·        Triceps brachii: long head: infraglenoid tuberosity of humerus, lateral head: posterior humerus, medial head: posterior humerus below the lateral head

Insertion:

·        Triceps brachii: long head, medial head, and lateral head: olecranon process of ulna

Nerve Innervation:

·        Triceps brachii: radial

Patient Position:

·        Patient is prone on the table with the shoulder abducted to 90°, the entire arm should be off the table and the therapist can stabilize the arm at the humerus just above the elbow.  The elbow should be in full extension.

Therapist and Patient Instructions:

·        At the wrist resistance is applied in a downward direction.  Ask the patient to, “straighten your elbow, don’t let me bend it down.”

MMT for Grades 2, 1, and 0:

Patient Position:

·        Patient is sitting, Arm is abducted at the shoulder 90° and the forearm is flexed at the elbow.  The therapist supports the limb.

Therapist and Patient Instructions:

·        The therapist should palpate the triceps of the posterior arm proximal to the olecranon process, ask the patient to straighten out his/her arm.

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