Wrist/Hand MMT

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  1. WRIST FLEXION test which muscles?
    Flexor carpi radialis, Flexor carpi ulnaris
  2. Patient position (all tests) when performing wrist flexion MMT: Grades 5/5,4/5,3/5
    short sitting, forearm supported palm up on table.
  3. During wrist flexion MMT, to test radialis, focus resistance over ___MC in direction of extension and ulnar deviation. To test ulnaris, focus resistance over the ___MC in the direction of extension and ulnar deviation.
    2nd: 5th
  4. Test for both flexors patient flexes wrist without radial or ulnar deviation
    • For radialis: patient flexes wrist in radial deviation
    • For ulnaris: patient flexes wrist in ulnar deviation
    • Grading: completes ROM with no resistance
    • Wrist flexion Grade 3/5
  5. Wrist flexion Grading: 2/5 =completes ROM in ____________ __________ ________.
    gravity minimized position
  6. May test as both flexors or separate by asking pt to ulnarly or radially deviate wrist:
    Wrist flexion Grade 2/5
  7. Patient position: short sitting, elbow supported on table, forearm in mid position, hand resting on ulnar side.
    • Therapist position: support forearm
    • proximal to wrist
    • Wrist flexion MMT for Grade 2/5
  8. Wrist flexion MMT for grades 1,0
    • Patient position: short sitting, forearm supinated on table
    • Therapist position: support wrist in flexion, palpate tendon of FCU on medial palmar aspect of wrist and FCR on lateral palmar aspect of wrist.
    • Test: patient attempts to flex wrist
    • Grading: 1/5 = palpable contraction
    • 0/5= no palpable contraction
  9. Extensor carpi radialis longus and brevis, and Extensor carpi ulnaris muscles are tested when accomplishing MMT for?
    Wrist extension
  10. Patientposition: short sitting, elbow flexed, forearm pronated, supported on table
    • Therapistposition: sit or stand diagonal in front of patient. Support forearm, resist over dorsal MCs.
    • WRIST EXTENSION: Grade 5, 4, 3
  11. To test all 3 extensors during Wrist EXT MMT (grade 5,4,3): resist over ___-___ MCs toward flexion
    2nd-5th
  12. To test ECRL and ECRB during wrist EXT MMT (grade 5,4,3), resist over dorsal 2nd and 3rdMCs, toward _____ deviation and _______.
    ulnar: flexion
  13. To test ECU during MMT of wrist EXT (grade 5,4,3), resist over 5th MC toward _____ deviation and _____.
    radial: flexion
  14. Test:
    • To test all extensors, patient extends wrist in straight line without extending fingers
    • To test the radial extensors, patient extends wrist toward the radial side
    • To test ulnaris, patient extends wrist toward the ulnar side
    • MMT of wrist EXT (grade 5,4,3),
  15. Wrist EXT grade 4/5=
    completes available ROM against strong to moderate resistance. Full ROM will not be achieved in individual tests
  16. Wrist EXT Grade __
    • Patient position: forearm supported on table in neutral position, thumb toward ceiling
    • Therapist position: support patient’s wrist
    • 2
  17. Test: patient extends wrist
    Wrist EXT MMT grade 2
  18. Wrist EXT MMT grade 1,0 Therapist position: support patient’s wrist in extension.
    • ____: palpate on dorsum of wrist in line with 2ndMC
    • ____: palpate on dorsal surface inline with 3rdMC
    • ___: palpate on dorsal wrist between 5thMC and ulnar styloid process
    • ECRL: ECRB: ECU
  19. WRIST EXTENSION: Grade 1, 0
    • Patient position:
    • hand and forearm supported on table, hand fully pronated
  20. MMT FINGER MP FLEXION TEST THE...
    Lumbricales, Interossei
  21. Patient position: sitting, forearm supported in supination. MCP joint fully extended, IP joints fully flexed
    MMT finger MP flexion grade 5,4,3
  22. Therapist position: Stabilize MC proximal to MCP joint, Resist on palmar surface of proximal row of phalanges in direction of MCP extension
    • Test: patient simultaneously flexes MCP joints and extends IP joints…fingers must remain extended
    • Commands: "Uncurl your fingers and bend your knuckles. Hold it! Don’t let me straighten them."
    • MMT finger MP flexion grades 5,4,3
  23. Finger MP flexion MMT Grading: 5/5: patient completes simultaneous MCP flexion and finger extension and holds against maximal resistance. Resist individual fingers because of the differing innervations of the _________.
    lumbricales
  24. Patient position: forearm and wrist in mid position, MCP joints fully extended, IP joints flexed
    • Test: patient attempts to flex MCP joints while extending IP joints
    • Finger MP Flex MMT grades 2,1,0
  25. Finger MP flexion MMT grading 2,1,0?
    • 2/5=completes ROM
    • 1/5=cannot palpate lumbricales…
    • 1/5 = visible contraction
    • 0/5=no motion
  26. Flexor digitorum superficialis, and flexor digitorum profundus tested during ______and _______ flexion MMT.
    PIP: DIP
  27. Which muscle is isolated to PIP only?
    Flexor digitorum superficialis
  28. PIP Flexion MMT(superficialis) Grades 5/5, 4/5, 3/5
    • Patient position: forearm _________, wrist in _________, finger being tested in slight MCP flexion
    • supinated: neutral
  29. Test: test each finger separately. Pt flexes PIP joint without flexing the DIP joint. Do not allow other joint motion. Flick the terminal end of the finger to be tested to determine that FDP is not active.
    FINGER PIP FLEXION
  30. Therapist position: Hold all fingers except testing finger in extension at all joints, resist the distal end of middle phalanx toward extension
    FINGER PIP FLEXION
  31. Commands: "Bend your finger; Hold it! Don’t let me straighten it!"
    FINGER PIP FLEXION
  32. Finger DIP flexion grades 2,1,0 pt position:
    forearm in mid-position to eliminate influence of gravity
  33. Finger DIP flexion grades 1/5=
    palpable or visible contraction, possible flicker of motion
  34. Flexor profundus: DIP is allowed to bend.
    • Wrist extension can create tension in the finger flexors and can cause tenodesis action that mimics true finger flexion
    • FINGER PIP AND DIP FLEXION Substitutions
  35. FINGER DIP FLEXION MMT TEST WHICH MUSCLE?
    Flexor digitorum profundus
  36. Grades 5, 4, 3
    • Patient position: forearm in supination, wrist neutral, PIP in extension
    • Therapist position: stabilize middle phalanx in extension, grasping on either side; resist distal phalanx toward extension
    • Test: test each finger separately. Pt flexes the DIP
    • Commands: "Bend the tip of your finger; hold it! Don’t let me move you!"
    • Finger DIP Flexion MMT
  37. Grade 2, 1, 0
    • Same as 5/5 test except: forearm is in neutral position
    • Finger DIP Flexion MMT
  38. Finger DIP flexion substitutions:
    • Wrist must be in neutral to prevent tenodesis
    • Pt can extend the DIP then relax which can visually appear to be flexion
  39. Patient position: Forearm in pronation, wrist neutral. MCP and IP joints in relaxed flexion.
    Finger MP EXT grades 5,4,3
  40. Finger MP EXT grades 5,4,3
    • Therapist position:
    • stabilize wrist in neutral. Resist with index finger across the dorsum of the proximal phalanges just distal to the MCP joints
  41. Finger MP EXT muscles include;
    Extensor digitorum, Extensor indicis, Extensor digiti minimi
  42. Finger MP EXT Grades 5, 4, 3
    • Patient position:
    • Therapist position:
    • Patient position: Forearm in pronation, wrist neutral. MCP and IP joints in relaxed flexion
    • Therapist position: stabilize wrist in neutral. Resist with index finger across the dorsum of the proximal phalanges just distal to the MCP joints
  43. Finger MP EXT Tests:
    • Extensor Digitorum:
    • Pt extends all MCP joints, allowing IP joints to be in slight flexion
  44. Finger MP EXT Tests:
    • Extensor Digiti Minimi:
    • Pt extends MCP joint of 5thdigit
  45. Finger MP EXT Tests:
    • Extensor Indicis:
    • Pt extends MCP joint of index finger
  46. Commands: "Bend your knuckles back as far as they will go"
    Finger MP EXT MMT
  47. During MMT for finger MP EXT grades 2,1,0 the forearm is in what position?
    mid
  48. Finger MP EXT substitution:
    flexion of the wrist can produce IP extension via tenodesis effect
  49. Dorsal Interossei
    Finger ABD
  50. Finger ABD MMT Grades 5, 4, 3, 2
    • Patient position:
    • forearm pronated, wrist neutral. Fingers in extension and adduction, MCP joints neutral
  51. Abduction of individual fingers (middle finger abducts in _____ directions)
    both
  52. 5/5 & 4/5= these muscles do not tolerate much resistance. The difference between 4/5 and 5/5 is a judgment call comparing to opposite side as norm and clinical experience. Flicking the finger toward adduction and seeing a rebound indicates 5/5.
    Finger ABD MMT Grade
  53. Finger ABD MMT grade 3/5=
    Pt can abduct any given finger through ROM
  54. Finger ADD MMT test the
    Palmer Interossei
  55. Finger ADD MMT Patient position:
    forearm pronated, wrist neutral, fingers extended
  56. Finger ADD MMT
    • Therapist position: grasps ______ phalanx on each of 2 adjoining fingers. Resist in the direction of abduction, test each finger pair __________.
    • Commands: "Hold your fingers together"
    • middle: separately
  57. FInger ADD MMT grades: 5/5, 4/5: grade based on _________ ___ ______.
    experience with hands
  58. Thumb MP AND IP Flexion occur by which muscles?
    Flexor pollicis brevis and longus
  59. Grades 5, 4, 3, 2, 1, 0
    • MCP & IP flexion (brevis)
    • Pt position:
    • forearm supinated, wrist neutral. CMC 0°, IP joint 0°, thumb in adduction adjacent to 2ndMC
  60. Grades 5, 4, 3, 2, 1, 0
    • MCP & IP flexion (brevis)
    • Therapists pos.:
    • stabilize 1stMC firmly to avoid wrist or CMC motion. Give 1 finger resistance to MCP flexion on proximal phalanx in direction of extension
  61. Grading thumb MP flexion (flexor pollicis brevis):
    • 5/5=completes ROM against maximal thumb resistance
    • 4/5=tolerates strong to mod resistance with full ROM
    • 3/5=completes ROM with perhaps slight resistance since gravity is eliminated
    • 2/5=completes ROM
    • 1/5=palpable contraction at tendon in thenar eminence or muscle belly on ulnar side of the FPL on thenar eminence
    • 0/5=no contractile activity
  62. Flexor pollicis longus is responsible for?
    THUMB IP FLEXION
  63. Patient position:forearm supinated, wrist neutral, MCP of thumb in extension
    • Therapist position: stabilize MCP joint in extension grasping thumb across that joint. Resist against the palmar surface of the distal phalanx toward extension
    • Test: Pt flexes IP joint of thumb
    • Commands: "Bend the end of your thumb, Hold it."
    • THUMB IP FLEXION via the Flexor pollicis longus
  64. Thumb IP Flexion grade of 1/5= palpate _____ ________ on palmar surface of the proximal phalanx of thumb
    longus tendon
  65. THUMB MP AND IP EXTENSION test...
    Extensor pollicis brevis and longus
  66. THUMB MP AND IP EXTENSION pt. test position (all grades):
    forearm in mid position, wrist neutral; CMC, IP joints of thumb relaxed in slight flexion; thumb MCP joint in abd and flex
  67. When MMT thumb MP and IP EXT the therapist position is: stabilize ___MC firmly, allow motion only at MCP joint. Resist on _____ surface of proximal phalanx in flexion direction (not usually a strong muscle!)
    1st: dorsal
  68. Grading: 5/5 and 4/5= accuracy in grading depends on experience of examiner. Resist with caution as this is usually a weak muscle
    THUMB MP AND IP EXTENSION/ Extensor pollicis brevis and longus
  69. tendon of FPB palpated at base of 1stMC, between the tendons of the AbP and EPB
    Thumb MP and IP EXT grade 1/5
  70. Substitution: Ext of IP joint with CMC add in addition to ext of MCP joint indicates substitution by EPL
    Thumb MP and IP EXT
  71. Thumb IP Extension is innervated by which muscle?
    Extensor pollicis longus
  72. Thumb IP EXT Grades 5, 4, 3
    • Patient position:
    • forearm in mid position, wrist neutral, thumb relaxed in flexion position
  73. Therapist position: stabilize proximal phalanx of thumb, apply resistance over dorsal surface of distal phalanx of thumb toward flexion
    Thumb IP EXT Grades 5, 4, 3
  74. Test: Pt extends IP joint of thumb
    Thumb IP EXT MMT Grades 5, 4, 3
  75. Commands: "Straighten the end of your thumb, hold it."
    Thumb IP EXT MMT Grades 5, 4, 3
  76. Thumb IP EXT MMT Grading: 5/5 & 4/5= completes ROM; compare resistance to _______ side, not a strong muscle, experience grading hands important
    opposite
  77. Thumb MMT IP EXT Grades 2, 1, 0
    • Patient position:
    • pronated forearm, wrist neutral, thumb relaxed in flexion
  78. Therapist position: stabilize wrist over dorsum; stabilize fingers gently across area distal to MCP joints
    Thumb MMT IP EXT Grades 2, 1, 0
  79. palpable contraction ulnar side of anatomical snuffbox or dorsal proximal phalanx
    Thumb IP EXT grade 1/5
  80. Abductor pollicis longus and brevis are responsible for thumb ___________.
    ABD
  81. Patient position:forearm supinated, wrist neutral, thumb in relaxed adduction
    • Therapist position: stabilize MCs of 4 fingers and wrist. Resist distal end of 1stMC in direction of adduction
    • Test: Pt abducts thumb
    • Commands: "Lift your thumb straight up"
    • Isolating the Abductor pollicis longus during thumb ABD MMT
  82. Palpate AbPL at base of 1stMC on radial side of EPB
    Thumb ABD (longus) MMT grade 1/5
  83. Patient position: forearm supinated wrist neutral, thumb in relaxed adduction ( mid position for grades < 3/5)
    Thumb ABD (Abductor pollicis brevis) MMT
  84. Therapist position: stabilize MCs across patient’s palm with thumb on dorsal surface; apply resistance to lateral aspect of proximal phalanx of thumb in direction of adduction
    Thumb ABD (Abductor pollicis brevis) MMT
  85. 1/5= palpate AbPB in center of thenar eminence, medial to opponens
    Thumb ABD (Abductor pollicis brevis) MMT grade
  86. THUMB ADDUCTION caused by which muscle
    Adductor pollicis
  87. Grades 5, 4, 3
    • Patient position: forearm pronated, wrist neutral, thumb relaxed & handing down in abduction
    • Thumb ADD MMT
  88. During thumb ADD MMT the therapist stabilizes MCs of 4 fingers by grasping around pt’s hand from ______ side. Resist ________ side of proximal phalanx in direction of abduction
    ulnar: medial
  89. Thumb ADD substitutions:
    FPL & FPB will flex thumb; EPL will call CMC to extend
  90. Thumb ADD MMT Grade 2, 1, 0
    • Patient position:
    • forearm in mid position, wrist neutral, thumb abducted
  91. 1/5= palpate Adductor pollicis on palmar side of web space between 1stdorsal interosseus and 1st MC. *difficult to palpate*
    Thumb ADD grade
  92. OPPOSITION innervated by which muscles
    Opponens pollicis, Opponens digiti minimi
  93. Opposition MMT Grades 5, 4, 3, 2, 1, 0
    • Patient position:
    • forearm supinated, wrist neutral, thumb adducted with MCP and IP flexion
  94. During opposition MMT the therapist stabilizes the hand holding wrist on dorsal surface; or against table. Resist ______ ______ at head of 1stMC toward lateral rotation, extension and adduction; resist ______ ________ _______on palmar surface of 5thMC
    Opponens pollicis: Opponens digiti minimi
  95. Opposition MMT grade 1/5 = palpate Opponens pollicis along radial side of ___MC; palpate Opponens digiti minimi on ___________ eminence on radial side of 5thMC
    1st: hypothenar

Card Set Information

Author:
ALMitrchell05
ID:
328398
Filename:
Wrist/Hand MMT
Updated:
2017-02-13 18:31:24
Tags:
physiotherapy therapy
Folders:

Description:
MMT for wrist and hand
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