MODULE 4: ELBOW, FOREARM, WRIST, AND HAND

ROM FOR EFWH

ELBOW

MOVEMENT PT. POSITION + GONIOMETER STABILIZATION AROM END

FEEL

Elbow Flexion Pt. supine with arms close to the body. Stabilize the 150° Soft
- Towel under distal end of humerus to
humerus (for full extension) prevent flexion of
- FA: Full supination the shoulder.

Fulcrum: lateral epicondyle of the

humerus.

Prox. Arm: lateral midline of the

humerus, center of the acromion
process for reference.

Distal Arm: lateral midline of the radius,

radial head and radial styloid process
for reference.

Elbow Extension Pt. supine with the shoulder in 0 Towel under 0° Soft
***Same position with Elbow degrees of flexion, extension, and distal humerus
Flexion*** abduction so that the arm is close to
the side of the body.

● Towel under distal end of

humerus (for full extension)
● FA: Full supination

Fulcrum: lateral epicondyle of the

humerus
Prox. arm: lateral midline of the
humerus
Distal arm: lateral midline of the radius,
using the radial head and radial styloid

Forearm Pronation Pt. sitting with the shoulder in 0 Stabilize the 75 - 85° Hard
degrees of flexion, extension, distal end of the
abduction, adduction, and rotation so humerus to
that the upper arm is close to the side prevent medial
of the body. rotation and
abduction of the
Flex the elbow to 90 degrees and shoulder.
support the forearm.

Fulcrum: laterally and proximally to the

ulnar styloid process.

Prox. Arm: parallel to the anterior

midline of the humerus.

Distal Arm: across the dorsal surface of

the forearm, just proximal to the styloid
processes of the radius and ulna,
where the forearm is most level and
free of muscle bulk.

Forearm Supination Pt. sitting with the shoulder in 0 Stabilize the 80 - 90° Firm
degrees of flexion, extension, distal end of the
abduction, adduction, and rotation so humerus to
that the upper arm is close to the side prevent lateral
of the body. rotation and
adduction of the
Flex the elbow to 90 degrees and shoulder.
support the forearm.
 Fulcrum: medially and just proximally
to the ulnar styloid process.
Prox. Arm: parallel to the anterior
midline of the humerus.

Distal Arm: across the ventral surface

of the forearm, just proximal to the
styloid processes, where the forearm is
most level and free of muscle bulk
● should be parallel to the styloid
processes of the radius and ulna.

WRIST

MOVEMENT PT. POSITION + GONIOMETER STABILIZATION AROM END

FEEL

Wrist Extension Pt. sitting next to a supporting surface Stabilize the 60-75° Firm
with the shoulder abducted to 90 radius and ulna
degrees, the elbow flexed to 90 to prevent
degrees, and the palm of the hand supination or
facing the ground pronation of the
forearm and
Fulcrum: lateral aspect of the wrist over motion of the
the triquetrum elbow.

Prox. Arm: lateral midline of the ulna,

using the olecranon and ulnar styloid
processes for reference

Distal Arm: lateral midline of the fifth

metacarpal
● Do not use the soft tissue of
the hypothenar eminence for
reference

Wrist Radial Deviation Pt. sitting next to a supporting surface Stabilize the 20-25° Hard
with the shoulder abducted to 90 radius and ulna
degrees, the elbow flexed to 90 to prevent
degrees, and the palm of the hand pronation or
facing the ground. supination of the
forearm and
FA will be midway between supination elbow flexion
and pronation. beyond
90 degrees.
Rest the
forearm and hand on the supporting
surface.

If the individual cannot be positioned in

90
degrees of shoulder abduction, a more
adducted shoulder position may be
used.

However, the bony landmark of the

lateral epicondyle of the humerus will
not be accurate for aligning the
proximal arm of the goniometer.

Fulcrum: dorsal aspect of the wrist over

the capitate
 Prox. Arm: dorsal midline of the
forearm
● If the shoulder is in 90 degrees
of abduction and the elbow is in
90 degrees of flexion, the lateral
epicondyle of the humerus can
be used for reference.

Distal Arm: dorsal midline of the third

metacarpal
● Do not use the third phalanx for
reference.

Wrist Ulnar Deviation Pt. sitting next to a supporting surface Stabilize the 30-40° Firm
with the shoulder abducted to 90 radius and ulna
degrees, the elbow flexed to 90 to prevent
degrees, and the palm of the hand pronation or
facing the ground. FA midway between supination of the
supination and pronation. forearm and less
than 90 degrees
Rest the forearm and hand on the of elbow flexion.
supporting surface.

Fulcrum: dorsal aspect of the wrist over

the capitate

Prox. Arm: dorsal midline of the

forearm
● If the shoulder is in 90 degrees
of abduction and the elbow is in
90 degrees of flexion, the lateral
epicondyle of the humerus can
be used for reference.

Distal Arm: dorsal midline of the third

metacarpal
● Do not use the third phalanx for
reference.

FINGERS

MOVEMENT PT. POSITION + GONIOMETER STABILIZATION AROM END

FEEL

MCP Flexion Pt. sitting, with the forearm and hand Stabilize the 90-100° Hard
resting on a supporting surface. metacarpal to
prevent wrist
FA midway between pronation and motion.
supination, the wrist in 0 degrees of
flexion, extension, and radial and ulnar Do not hold the
deviation and the MCP joint in a neutral MCP joints of the
position relative to abduction and other fingers in
adduction. extension
because tension
Avoid extreme flexion of the PIP and in the transverse
DIP joints of the finger being examined. metacarpal
ligament will
restrict the
Fulcrum: over the dorsal aspect of the motion.
MCP joint

Prox. Arm: over the dorsal midline of

the metacarpal

Distal Arm: over the dorsal midline of

the
proximal phalanx

MCP Extension Pt. sitting, with the forearm and hand Stabilize the 20-45° Firm
resting on a supporting surface. metacarpal to
prevent wrist
FA midway between pronation and motion.
supination; the wrist in 0 degrees of
flexion, extension, and radial and ulnar
deviation; and the MCP joint in a
neutral position relative to abduction
and adduction.

Fulcrum: over the dorsal aspect of the

MCP joint
 Prox. Arm: over the dorsal midline of
the metacarpal

Distal Arm: over the dorsal midline of

the proximal phalanx

MCP Abduction Pt. sitting, with the forearm and hand Stabilize the Maximal Firm
resting on a supporting surface. metacarpal to range of
prevent wrist abduction–a
Place the wrist in 0 degrees of flexion, motions. dduction
extension, and radial and ulnar is 25
deviation; the forearm in full pronation degrees
so that the palm of the hand faces the
ground; and the MCP joint in 0 degrees
of flexion and extension.

Fulcrum: over the dorsal aspect of the

MCP joint

Prox. Arm: over the dorsal midline of

the metacarpal

Distal Arm: over the dorsal midline of

the
proximal phalanx

MCP Adduction
***Same position with MCP
Abduction***

PIP Flexion Place the individual sitting, with the Stabilize the 100-110 deg Hard
forearm and hand resting on a proximal phalanx
supporting surface. Position the to prevent
forearm in 0 degrees of supination and motion of the
pronation; the wrist in 0 degrees of MCP joint.
flexion, extension, and radial and ulnar
deviation; and the MCP joint in 0
degrees of flexion, extension,
abduction, and adduction.

Fulcrum: over the dorsal aspect of the

PIP joint.

Prox. Arm: over the dorsal midline of

the proximal phalanx.

Distal Arm: over the dorsal midline of

the middle phalanx.

PIP Extension Place the individual sitting, with the Stabilize the 0 Firm
***Starting position for PIP forearm and hand resting on a proximal phalanx
Flexion ROM*** supporting surface. Position the to prevent
forearm in 0 degrees of supination and motion of the
pronation; the wrist in 0 degrees of MCP joint.
flexion, extension, and radial and ulnar
deviation; and the MCP joint in 0
degrees of flexion, extension,
abduction, and adduction.
 Fulcrum: over the dorsal aspect of the
PIP joint.

Prox. Arm: over the dorsal midline of

the proximal phalanx.

Distal Arm: over the dorsal midline of

the middle phalanx.

DIP Flexion Pt. sitting, with the forearm and hand Stabilize the 70-90 Firm
resting on a supporting surface. middle and
proximal phalanx
FA in 0 degrees of supination and to prevent further
pronation; the wrist in 0 degrees of flexion of the PIP
flexion, extension, and radial and ulnar joint.
deviation; and the MCP joint in 0
degrees of flexion,
extension, abduction, and adduction.

PIP joint in approximately 70 to 90

degrees of flexion.

(If the wrist and the MCP and PIP joints

are fully flexed, tension in the extensor
digitorum communis, extensor indicis,
or extensor digiti minimi muscles may
restrict DIP flexion. If the PIP joint is
extended, tension in the oblique
retinacular ligament may restrict DIP
flexion.)

Fulcrum: over the dorsal aspect of the

DIP joint

Prox. Arm: over the dorsal midline of

the middle phalanx

Distal Arm: over the dorsal midline of

the distal phalanx

DIP Extension Position the individual sitting, with the Stabilize the Firm
***Starting position for DIP forearm and hand resting on a middle and
Flexion*** supporting surface. proximal phalanx
to prevent
Place the forearm in 0 degrees of extension of the
supination and pronation; the wrist in 0 PIP joint.
degrees of flexion, extension, and
radial and ulnar deviation; and the
MCP joint in 0 degrees of flexion,
extension, abduction, and adduction.

Position the PIP joint in approximately

70 to 90 degrees of flexion.

(If the PIP joint, MCP joint, and wrist

are fully extended, tension in the flexor
digitorum profundus muscle may
restrict DIP extension.)

Fulcrum: over the dorsal aspect of the

DIP joint

Prox. Arm: dorsal midline of the middle

phalanx

Distal Arm: dorsal midline of the distal

phalanx

Composite Flexion of the Pt. sitting, with the forearm and hand Stabilize the Soft
MCP, PIP, and DIP Joints resting on a supporting surface. metacarpals to
***Composite finger flexion prevent motion
(CFF) is a simple method of FA in neutral supination and pronation of the wrist.
quickly assessing multiple joints and the wrist in
in a finger to indicate the 0 degrees of flexion, extension, and
functional ability to make a radial and ulnar deviation.
fist.***
Alternatively, the forearm could be
positioned in full supination.
 Measurement:
Measure the perpendicular distance
between the distal palmar crease and
the tip of the finger.

Alternatively, the distance between the

distal palmar crease and the distal
corner of the nail bed on the radial
border of the finger can be measured.

MMT FOR EFWH

Grade 5 (Normal): Holds test position against maximal resistance
Grade 4 (Good): Holds test position against strong to moderate resistance
Grade 3 (Fair): Completes available ROM without resistance
Grade 2 (Poor): Completes partial ROM
Grade 1 (Trace): No limb movement; slight contractile activity
Grade 0: No discernable palpable contractile activity

MMT FOR MUSCLES OF THE ELBOW

Movement Muscles Pt. Position Stabilization Resistance

Elbow Flexion Biceps Brachii Grade 5 (Normal), The test elbow is Hand giving
Grade 5, 4, 3 Brachialis Grade 4 (Good), and cupped by the resistance is
Brachioradialis Grade 3 (Fair) therapist's hand for contoured
Short sitting with arms support over the volar
at sides. (flexor) surface of
The brachialis in the forearm
particular is inde proximal to
pendent of forearm the wrist
position.

Biceps brachii:
forearm in supination

Brachialis: forearm in
Grade 2, 1, 0 pronation

Brachioradialis:
forearm in mid position
between pronation and
supination

***No resistance for

Grade 3***

Alternate position to those who

cannot sit

Elbow Extension Triceps Brachii Grade 5 (Normal), Grade 5 (Normal), Grade 5 (Normal),
Anconeus Grade 4 (Good), and Grade 4 (Good), Grade 4 (Good),
Grade 5, 4 Grade 3 (Fair) and Grade 3 (Fair) and Grade 3 (Fair)

Pt. prone, starts the For the prone The other hand is
test with the arm in 90° patient, the used to apply
of abduction and the therapist provides downward
forearm flexed and support just above resistance on the
hanging vertically over the elbow. dorsal surface of
the side of the table. the forearm
Grade 2 (Poor),
Instructions to Patient: Grade 1 (Trace), Grade 2 (Poor),
Grade 3 “Straighten your and Grade 0 Grade 1 (Trace),
 elbow. Hold it. Don’t let (Zero) and Grade 0
me bend it.” (Zero)
For the Grade 2
Grade 2 (Poor), test, support the ***No resistance
Grade 1 (Trace), limb at the elbow. for Grade 2***
and Grade 0 (Zero)
For a Grade 1 or 0
Short sitting. The arm test, support the
Grade 2, 1, 0 is abducted to 90° with limb under the
the shoulder in neutral forearm and palpate
rotation and the elbow the triceps on the
flexed to about 45°. posterior surface of
The entire limb is the arm just
horizontal to the floor. proximal to the
olecranon process.
Instructions to
Patient: “Try to
straighten your elbow.”

Forearm Supination Supinator Grade 5 (Normal), Grade 5 (Normal), Grade 5

Grade 5, 4, 3, 2 Biceps Brachii Grade 4 (Good), Grade 4 (Good), (Normal), Grade
and Grade 3 (Fair) and Grade 3 4 (Good), and
(Fair) Grade 3 (Fair)
Short sitting; arm at Therapist resists
side and elbow flexed Standing at the side motion in the
to 90°; forearm in full or in front of the direction of
pronation to neutral. patient. One hand pronation.
Alternatively, patient supports the elbow.
may sit at a table.
Grade 2 (Poor)
Alternate Test: Grasp Support the test
patient’s hand as if arm by cupping the
shaking hands; cradle hand under the
the elbow and resist elbow
Grade 1, 0 via the hand grip. This
test is used if the Grade 1 (Trace)
patient has Grade 5 or and Grade 0
4 wrist and hand (Zero)
strength. Support the forearm
just distal to the
Instructions to Patient: elbow.
“Turn your palm up.
Hold it. Don’t let me
turn it down. Keep
your wrist and fingers
relaxed.”

​For Grade 3: “Turn

your palm up.”

Grade 2 (Poor)
Short sitting with
shoulder flexed
between 45° and 90°
and elbow flexed to
90°. Forearm in
neutral.

Instructions to Patient:
“Turn your palm
toward your
face.”

Grade 1 (Trace) and

Grade 0 (Zero)
Short sitting. Arm and
elbow are
flexed as for the Grade
3 test.

Instructions to Patient:
“Try to turn your palm
so it
faces the ceiling.”
Forearm Pronation Pronator Teres Grade 5 (Normal), Grade 5 (Normal), Grade 5
Grade 5, 4 Pronator Grade 4 (Good), Grade 4 (Good), (Normal), Grade
Quadratus and Grade 3 (Fair) and Grade 3 4 (Good), and
(Fair) Grade 3 (Fair)
Position of Patient:
Short sitting or may sit Standing at the side Therapist resists
at a table. Arm at side or in front of the motion at the wrist
with elbow flexed to patient. Support the in the direction of
90° and forearm in elbow. supination for
supination. Grades 4 and 5.

Instructions to Patient: ***No resistance

“Turn your palm down. for Grade 3***
Hold it. Don’t let me
turn it up. Keep your
wrist and fingers
relaxed.”
Grade 2, 1, 0

MMT FOR MUSCLES OF THE WRIST AND HAND

Movement Muscles Pt. Position Stabilization Resistance

Wrist Flexion Flexor Carpi All Tests: Short One hand supports Testing BOTH
Testing BOTH wrist flexors Radialis Sitting. Forearm is the patient's wrist flexors:
Flexor Carpi supinated. Wrist is in a forearm under the Resistance is given
Ulnaris neutral position or wrist while the other evenly across the
slightly extended. hand applies hand in a
resistance over the straight-down
Patient flexes the volar (palmar) direction into wrist
wrist, keeping the surface of the hand extension.
digits and thumb
relaxed. Grade 2: Testing FCR:
Testing FCR Support the Place the patient's
Instructions to patient's forearm wrist in radial
Patient (All Tests): proximal to the deviation and slight
“Hold it. Don't let me wrist. wrist extension.
pull it down. Keep your Resistance is
fingers relaxed.” Grade 1, 0: applied with the
Position of Patient: index and long
Grade 3: Supinated forearm fingers over the
Both Wrist Flexors: supported on table. first and second
Patient flexes the wrist metacarpal (radial
Testing FCU through full range Instructions to side of the hand) in
without resistance and Therapist: Support the direction of
without radial or ulnar the wrist in flexion; extension and
deviation. the index finger of ulnar deviation
the other hand is
Flexor Carpi Radialis: used to palpate the Testing FCU:
Patient flexes the wrist appropriate Place the wrist in
in radial deviation tendons. Palpate ulnar deviation and
through full range the tendons of the slight wrist
without resistance. flexor carpi radialis extension.
This is a small and the flexor carpi Resistance is
movement as ulnaris in separate applied over the
Grade 2: compared with ulnar tests. fifth metacarpal
deviation described (ulnar side of the
below hand) in the
direction of
Flexor Carpi Ulnaris: extension and
Patient flexes the wrist radial deviation
in ulnar deviation
through full range
without resistance

Grade 2:
Sitting with elbow
 supported on the
Grade 1, 0: table. Forearm in mid
position with hand
resting on ulnar side

Wrist Extension Extensor carpi Grade 5 (Normal), Grade 5

radialis longus Grade 4 (Good), Grade 5 (Normal), (Normal), Grade
and Grade 3 (Fair) Grade 4 (Good), 4 (Good), and
Extensor carpi and Grade 3 Grade 3 (Fair)
radialis brevis Short sitting. Elbow is (Fair)
flexed, forearm is fully To test all three
Extensor carpi pronated, and both are Support the muscles:
ulnaris supported on the patient’s forearm. Resistance for
table. The hand used for Grades 4 and 5 is
resistance is placed given in a forward
For the combined test over the dorsal and downward
of the three wrist (exten- sor) surface direction over the
extensor muscles, the of the metacarpals. 2nd to 5th
patient extends the metacarpals with
wrist straight up Grade 2 (Poor) four fingers or
through the full hypothenar
available range. Support the eminence.
patient’s wrist.
To test the two radial To test the
extensors, the patient ​Grade 1 (Trace) extensor carpi
extends the wrist, and Grade 0 radialis longus and
leading with the thumb (Zero) brevis: resistance
side of the hand. is given with two
Support the fingers on the
Instructions to Patient: patient’s wrist in dorsal (extensor)
“Bring your wrist up. extension. The surface of the 2nd
Hold it. Don’t let me other hand is used and 3rd
push it down.” for palpation. metacarpals (radial
side of hand) in the
For Grade 3: “Bring direction of flexion
your wrist up.” and ulnar
deviation.
Grade 2 (Poor)
Forearm supported on To test the
table in extensor carpi
neutral position. ulnaris: (for
extension and
Instructions to ulnar deviation),
Patient: “Bend your resistance is given
wrist back.” on the dorsal
(exten- sor)
Grade 1 (Trace) and surface of the 5th
Grade 0 (Zero) metacarpal (ulnar
Hand and forearm side of hand) in the
supported on direction of flexion
table with hand fully and radial
pronated. deviation.

Instructions to Patient:
“Try to bring your wrist
back.”

Finger MP Flexion Lumbricals (4) Grade 5 (Normal), Grade 5 (Normal), Grade 5

Dorsal Grade 4 (Good), Grade 4 (Good), (Normal), Grade
interossei and Grade 3 (Fair) and Grade 3 4 (Good), and
1st dorsal (Fair) Grade 3 (Fair)
interosseous Short sitting or supine Stabilize the Resistance is given
Palmar with forearm in metacarpals proxi- on the palmar
interossei supination. Wrist is mal to the MP joint. surface of the
maintained in neutral. proximal row of
The meta- Grade 2 (Poor), phalanges in the
 carpophalangeal (MP) Grade 1 (Trace), direction of MP
joints should be fully and Grade 0 extension
extended; all (Zero)
interphalangeal (IP)
joints are flexed Stabilize
metacarpals.
Instructions to
Patient: “Uncurl your
fingers while flexing
your knuckles. Hold it.
Don’t let me straighten
your knuckles.”

The final position is a

right angle at the MP
joints. Demonstrate
motion to patient and
insist on practice to get
the motions performed
correctly and
simultaneously.

Grade 2 (Poor),
Grade 1 (Trace),
and Grade 0 (Zero

Forearm and wrist in

midposition to remove
influence of gravity.
MP joints are fully
extended; all IP joints
are flexed.

Instructions to
Patient: “Try to uncurl
your fingers while
bending your
knuckles.”
Demonstrate motion to
patient and allow
practice.

Finger PIP and DIP Flexion Flexor Grade 5, Grade 4, Stabilization is With a finger of the
digitorum and Grade 3 provided by the hand providing
superficialis Forearm supinated, hand position resistance in the
Flexor wrist in neutral. patient's palm
digitorum Fingers are relaxed. under the digits,
profundus pull up to try to
Instructions to straighten the
Therapist: Sit in front digits
of the patient, with
patient's forearm and
hand supported on a
table with wrist fully
supinated. Ask patient
With Resistance to touch the pads of
the fingers to the distal
palm while keeping the
metacarpals extended
(flat on the table)

PIP Tests Flexor Grade 5, Grade 4, Hold all fingers Therapist resists
digitorum and Grade 3 Position (except the one the distal end of
superficialis of Patient: Forearm being tested) in the middle phalanx
supinated, wrist in extension at all of the test finger in
neutral. Finger to be joints so as to block the direction of
tested is in slight the action of the extension
flexion at the profundus action.
metacarpophalangeal Isolation of the
(MCP) join index finger may
not be complete.
Patient flexes the PIP Ask the patient to
joint without flexing the bend the middle
 DIP joint. Do not allow joint towards the
motion of any joints of proximal palm.
the other fingers.
Repeat for other
fingers, if indicated.
Alternatively, you can
test all fingers together

Instructions to Patient:
“Bend your index [then
long, ring, and little]
finger at the middle
joint; hold it. Don't let
me straighten it. Keep
your other fingers
relaxed.”

Grade 2, Grade 1,
and Grade 0 Position
of Patient: Forearm is
in mid position to
eliminate the influence
of gravity on finger
flexion.

DIP Tests Flexor Grade 5, Grade 4, Stabilize the middle apply appropriate
digitorum and Grade 3 Position phalanx in resistance.
profundus of Patient: Forearm in extension by Resistance is
supination, wrist in grasping it on either provided on the
neutral, and proximal side distal phalanx in
PIP joint in extension. the direction of
extension
Ask the patient to
bend the tip of the
finger

Test: Test each finger

individually if
indicated. Patient
flexes the distal
phalanx of each finger.
Test all digits together
by patient flexing all
distal phalanxes
together.

Instructions to
Patient: “Bend the tip
(or tips) of your finger.
Hold it (them). Don't let
me straighten it
(them).”

Grade 2, Grade 1,
and Grade 0 Testing:
grades 2, 1, and 0 is
the same as that used
with higher grades
except that the
position of the forearm
is in neutral to
eliminate the influence
of gravity.

Finger MP Extension Extensor Grade 5, Grade 4, Place the index Give resistance in
digitorum and Grade 3: finger of the the direction of
Extensor indicis Position of Patient: resistance hand flexion.
Extensor digiti Forearm in pronation, across the dorsum
minimi wrist in neutral. MCP of all proximal
and IP joints are in phalanges just
relaxed flexion distal to the MCP
posture. joints to stabilize

Instructions to
Therapist: Sit at table
or side of patient.
Stabilize the wrist in
neutral. Ask the
patient to straighten
 the knuckles as far as
possible. Demonstrate
motion to patient and
instruct to copy.

Instructions to Patient:
“Straighten (lift) your
knuckles as far as they
will go.”

Grade 2, Grade 1,
and Grade 0
Procedures: Test is the
same as that for
Grades 5, 4, and 3
except that the
forearm is in the mid
position.

Finger Abduction Dorsal Grade 5 and Grade 4: Support the wrist in The fingers of the
interossei Position of Patient: neutral other hand are
Forearm pronated, used to give
wrist in neutral. resistance on the
Fingers start in distal phalanx, on
extension and the radial side of
adduction. MCP joints the finger, and the
in neutral and avoid ulnar side of the
hyperextension adjacent finger
(i.e., they are
Ask patient to spread squeezed
finger together).

Grade 2, Grade 1,
and Grade 0
Procedures and
Grading: Same as for
higher grades in this
test. A Grade 2 should
be assigned if the
patient can complete
only a partial range of
abduction for any
given finger.

Finger Adduction Palmar Grade 5 and 4: Grasp the middle

interossei Position of Patient: phalanx on each of
Forearm pronated two adjoining
(palm down), wrist in fingers and try to
neutral, and fingers pull the finger in
extended and the direction of
adducted. MCP joints abduction for each
are neutral; avoid finger tested.
flexion.

Ask the patient to hold

the fingers together.

Instructions to Patient:
“Hold your fingers
together. Don't let me
spread them apart.”

Grade 2, Grade 1,
and Grade 0
Procedures and
Grading: For Grade 2,
the patient can adduct
each of the fingers
tested through a
partial range of
motion. The test for
Grade 2 begins with
the fingers abducted.
Thumb MP and IP Flexion Flexor pollicis Grade 5 to 0: Stabilize the first Apply resistance
brevis (MAIN) Position of Patient: metacarpal firmly to with one-finger
Flexor pollicis Forearm in supination, avoid any wrist or resistance to MCP
longus wrist in neutral. CMC motion flexion on the
Carpometacarpal proximal phalanx in
(CMC) joint is at 0°; IP the direction of
joint is at 0°. Thumb in extension
adduction, lying
relaxed and adjacent
to the second
metacarpal.

Instructions to Patient:
“Don't bend the tip of
the finger. Hold it.
Don't let me pull it
back.”

Thumb MP and IP Flexion *** Wala kami nakita sa book pero very similar lang ‘to with the combined na nasa
Tests taas ***

Thumb IP Flexion Tests Flexor pollicis Grade 5 to 0: Stabilize the MCP Apply resistance
longus Position of Patient: joint of the thumb with the tip of your
Forearm supinated firmly in extension finger against the
with wrist in neutral by grasping the palmar surface of
and MCP joint of patient's thumb the distal phalanx
thumb in extension. across that joint. of the thumb in the
direction of
Ask the patient to extension
bend the tip of the
thumb

Instructions to Patient:
“Bend the end of your
thumb. Hold it. Don't
let me straighten it.”

Thumb MP and IP Extension Extensor Grade 5, 4, and 3: Grade 5, 4, 3: Apply resistance

pollicis brevis Position of Patient: Stabilize the MCP over the dorsal
Grade 5, 4, 3 Extensor Forearm in mid joint of the thumb surface of the
pollicis longus position, wrist in distal phalanx of
neutral with ulnar side Grade 2, 1, 0: the thumb in the
of hand resting on the Stabilize the wrist direction of flexion
table. Thumb relaxed over its dorsal
in a flexion posture. surface. Stabilize
the fingers by gently
Ask patient to lift just placing the other
the thumb hand across the
fingers just below
Instructions to Patient: the MCP joints
“Hold it. Don't let me
push it down.”

Grade 2, 1, and 0:
Grade 2, 1, 0
Position of Patient:
Forearm in pronation
with wrist in neutral
and thumb in relaxed
flexion posture to start.

Instructions to Patient:
“Straighten the end of
your thumb.”

Thumb MP Extension Tests *** Wala kami nakita sa book pero very similar lang ‘to with the combined na nasa
taas ***
Thumb IP Extension Tests

Thumb Abduction Abductor The palmaris longus Stabilize the Apply resistance
pollicis longus can abduct the metacarpals of the on the distal end of
Abductor thumb, if present four fingers and the the first metacarpal
pollicis brevis Grade 5 to 0: wrist. in the direction of
Position of Patient: adduction
Forearm supinated
and wrist in neutral;
thumb relaxed in
adduction.
 Ask the patient to lift Abductor Pollicis
the thumb straight up Brevis
to 90° from the palm
Apply resistance
Instructions to Patient: with index finger to
“Lift your thumb the lateral aspect
straight up” of the proximal
phalanx of the
Abductor Pollicis thumb in the
Brevis direction of
Grade 5, 4, 3: adduction
Position of Patient:
Dorsum of hand is on
table with forearm in
supination, wrist in
neutral, and thumb
relaxed in adduction.

Ask the patient to lift

the thumb to point
towards the ceiling.

Instructions to Patient:
“Lift your thumb
vertically until it points
to the ceiling.”

Grade 2, 1, 0:
Position of Patient:
Forearm in mid
position, wrist in
neutral, and thumb
relaxed in adduction.

Instructions to Patient:
“Try to lift your thumb
so it points at the
ceiling.”

APL Tests Abductor Abductor Pollicis Stabilize the Apply appropriate

Pollicis Longus Longus Grade 5 to metacarpals of the resistance on the
Grade 0 four fingers and the distal end of the
Position of Patient: wrist. first metacarpal in
Forearm supinated the direction of
and wrist in neutral; adduction
thumb relaxed in
adduction.

Test: Patient abducts

the thumb away from
the hand in a plane
parallel to the finger
metacarpals.

Instructions to Patient:
“Lift your thumb
straight up.”

APB Tests Abductor Grade 5, Grade 4, Apply appropriate

Pollicis Brevis and Grade 3 resistance with
Position of Patient: index finger to the
Dorsum of hand is on lateral aspect of
table with forearm in the proximal
supination, wrist in phalanx of the
neutral, and thumb thumb in the
relaxed in adduction. direction of
adduction
Instructions to
Therapist: Sit or stand
near the patient.
Demonstrate the
movement. Ask the
patient to lift the thumb
to point towards the
ceiling

Thumb Adduction Adductor Grade 5, 4, 3: Grade 5, 4, 3: Apply resistance

pollicis Position of Patient: Stabilize the on the medial side
Grade 5, 4, 3 Forearm in pronation, metacarpals of the of the proximal
wrist in neutral, and four fingers by phalanx of the
 thumb relaxed and grasping the thumb in the
hanging down in patient's hand direction of
abduction. around the ulnar abduction. Do not
. side. allow ulnar
Instructions to Patient: deviation.
“Bring your thumb up Grade 2, 1, 0:
to your index finger” Stabilize wrist on
the table, and use a
Grade 2, 1, 0: hand to stabilize the
Grade 2, 1, 0 Position of Patient: finger metacarpals (
Forearm in mid
position, wrist in
neutral resting on
table, and thumb in
abduction.

Patient moves thumb

horizontally in
adduction.

Opposition (Thumb to little Opponens Grade 5, 4, 3: the table provides Apply finger
finger) pollicis Position of Patient: stabilization of the resistance at CMP
Opponens digiti Forearm is supinated hand. joint of thumb and
minimi and supported on digit to test both
table, wrist in neutral, actions
and thumb in simultaneously
adduction with MCP
and IP flexion. Opponens
Pollicis
Ask patient to bring Apply resistance
the thumb and little for the opponens
finger together pollicis (OP) at the
Instructions to Patient: head of the 1st
“Bring your thumb to metacarpal in the
your little finger and direction of lateral
Opponens Pollicis
touch the two pads, rotation, extension,
forming the letter ‘O’ and adduction
with your thumb and
little finger” Opponens Digiti
Minimi
Resistance for the
opponens digiti
minimi on the
palmar surface of
Opponens Digiti Minimi
the 5th metacarpal
in the direction of
medial rotation
(flattening the
palm)