Manualmusletesting 301 330
- 1. Normal & Good • Position: • Sitting with hand resting palm upward on table and fingers extended. • Stabilization: • Stabilize middle phalanx of finger. • Desired Motion: • Patient flexes distal phalanx. • Resistance: • Is given on palmar surface of distal phalanx of finger
- 2. Fair & Poor • Patient flexes distal phalanx through full ROM for fair grade and through partial range for poor grade.
- 3. Trace & Zero • Flexor digitorum profundus may be palpated on the palmar surface of the middle phalanx
- 4. Caution!!!!
- 5. Extension of metacarpophalangeal joints of fingers Extensor digitorum communis Extensor indicis proprius Extensor digiti minimiExtensor digitorum communis Extensor indicis proprius Extensor digiti minimi
- 6. Muscles contribute to Extension of metacarpophalangeal joints of fingers Extensor digitorum communisExtensor digitorum communis • Origin: • Common extensor origin on anterior aspect of lateral epicondyle of humerus • Insertion: • External expansion to middle and distal phalanges by four tendons. Tendons 3 and 4 usually fuse and little finger just receives a slip • Action: • Extension of MP joints • Nerve supply
- 7. Muscles contribute to Extension of metacarpophalangeal joints of fingers Extensor indicis propriusExtensor indicis proprius • Origin: • Lower posterior shaft of ulna (below extensor pollicis longus) and adjacent interosseous membrane • Insertion: • Extensor expansion of index finger (tendon lies on ulnar side of extensor digitorum tendon) • Action: • Extension of MP joints • Nerve supply
- 8. Muscles contribute to Extension of metacarpophalangeal joints of fingers Extensor digiti minimiExtensor digiti minimi • Origin: • Common extensor origin on anterior aspect of lateral epicondyle of humerus • Insertion: • Extensor expansion of little finger-usually two tendons which are joined by a slip from extensor digitorum at metacarpophalangeal joint • Action: • Extension of MP joints • Nerve supply
- 9. Normal & Good • Position: • Arm resting on table, hand supported, wrist in midposition, fingers flexed. • Stabilization: • Stabilize metacarpals. • Desired Motion: • Patient extends proximal row of phalanges with IP joints partially flexed. • Resistance : • Is given on dorsal surface of proximal row of phalanges of fingers.
- 10. Fair & Poor • Position: • Sitting with hand supported, fingers flexed and wrist in midposition. • Stabilization: • Stabilize metacarpals. • Desired Motion: • Patient extends proximal row of phalanges to end of range, with IP joints partially flexed. • Patient extends MCP joints through full ROM for grade of fair and through partial range for grade of poor
- 11. Trace & Zero • The tendons of the finger extensors may easily be located on dorsum of hand where they pass over metacarpals.
- 12. Finger Abduction Interossei dorsales Abductor digiti minimiInterossei dorsales Abductor digiti minimi
- 13. Muscles contribute to Finger Abduction Interossei dorsalesInterossei dorsales • Origin: • Bipennate from inner aspects of shafts of all metacarpals • Insertion: • Proximal phalanges and dorsal extensor expansion on radial side of index and middle fingers and ulnar side of middle and ring fingers • Action: • Finger Abduction • Nerve supply
- 14. Muscles contribute to Finger Abduction Abductor digiti minimiAbductor digiti minimi • Origin: • Pisiform bone, pisohamate ligament and flexor retinaculum • Insertion: • Ulnar side of base of proximal phalanx of little finger and extensor expansion • Action: • Finger Abduction • Nerve supply
- 15. Normal & Good ►Test for first and third Interossei dorsales • Position: • Sitting with hand supported palm downward, fingers adducted. • Stabilization: • Stabilize metacarpals. • Desired Motion: • Patient abducts fingers. • Resistance: • Is given on radial side of second and ulnar side of third finger, (To test individual fingers, resistance is given on first phalanx)
- 16. Normal & Good ►Test for second and fourth Interossei dorsales and Abductor digiti minimi • Position: • Sitting with hand supported palm downward, fingers adducted. • Stabilization: • Stabilize metacarpals. • Desired Motion: • Patient abducts fingers. • Resistance: • Is given on ulnar side of fourth and fifth fingers and on radial side of third finger.
- 17. Fair & Poor • Position: • Sitting with palm resting on table, fingers adducted. • Desired Motion: • Patient abducts fingers through ROM. (Third finger must be moved in both directions.) • Patient abducts fingers through full ROM for fair grade and through partial range for poor grade.
- 18. Trace & Zero • The Interossei dorsales lie deep between the metacarpal bones on the dorsum of the hand. • (Palpation of first Interosseus dorsales shown in illustration.)
- 19. Fingers Adduction Interossei palmaresInterossei palmares
- 20. Muscles contribute to Finger Adduction Interossei palmaresInterossei palmares • Origin: • Entire length of second, fourth and fifth metacarpal bones on palmar surface • Insertion: • Side of base of proximal phalanx of corresponding finger: first into ulnar side of index finger; second and third into radial side of ring and little fingersInto aponeurotic expansion of Extensor digitorum tendon of same finger • Action: • Finger Adduction • Nerve supply
- 21. Normal & Good • Position : • Sitting with hand supported palm clown ward, fingers abducted. • Desired Motion: • Patient adducts fingers. • Resistance: • Is given in radial direction on second finger and in ulnar direction on fourth and fifth fingers.
- 22. Fair & Poor • Position: • Sitting with hand resting palm downward on table, fingers in abduction. • Desired Motion: • Patient adducts fingers through full range of motion for fair grade and through partial range for poor grade
- 23. Trace & Zero • Presence of contraction of the Interossei palmares may be determined by outward pressure on the second, fourth and fifth fingers as the patient attempts to adduct
- 25. Flexion of Metacarpophalangeal & Interphalangeal of Thumbs joints Flexor pollicis Brevis Flexor pollicis LongusFlexor pollicis Brevis Flexor pollicis Longus
- 26. Muscles contribute to Flexion of Metacarpophalangeal & Interphalangeal of Thumbs joints Flexor pollicis BrevisFlexor pollicis Brevis • Origin: • Flexor retinaculum and tubercle of trapezium • Insertion: • Base of proximal phalanx of thumb (via radial sesamoid) • Action: • Flexion of MP & IP of the thumb • Nerve supply
- 27. Muscles contribute to Flexion of Metacarpophalangeal & Interphalangeal of Thumbs joints Flexor pollicis LongusFlexor pollicis Longus • Origin: • Anterior surface of radius below anterior oblique line and adjacent interosseous membrane • Insertion: • Base of distal phalanx of thumb • Action: • Flexion of MP & IP of the thumb • Nerve supply
- 28. Flexion of MCP Joint of Thumb
- 29. Normal & Good • Position: • Sitting with hand resting palm upward on table. • Stabilization: • Stabilize first metacarpal. • Desired motion: • Patient Flexes first phalanx of thumb. & distal phalanx remains relaxed. • Resistance: • Is given on palmar surface of proximal phalanx
- 30. Fair & Poor • Patient flexes first phalanx of thumb through full ROM for fair grade and through partial range for poor grade