Download WRIST WRIST FLEXION Muscles tested: 1. Flexor carpi radialis

WRIST
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WRIST FLEXION

Muscles tested:
1. Flexor carpi radialis:
- Origins:
a) Common flexor tendon from medial epicondyle of humerus.
b) Deep ante-brachial fascia.
- Insertions:
a) Base of second metacarpal bone.
b) Slip to base of third metacarpal bone.
- Nerve supply: Median nerve (C6, C7, C8).
- Actions:
a) Flexes and abducts the wrist.
b) May assist in pronation of the forearm and flexion of the elbow.
2. Flexor carpi ulnaris:
- Origins:
a) Humeral head: Common flexor tendon from medial epicondyle of humerus.
b) Ulnar head: Proximal 2/3 of posterior border of ulna.
- Insertions: Pisiform bone.
b) By ligamentary prolongation, to hamate and fifth metacarpal bones.
- Nerve supply: Ulnar nerve (C7, C8, T1).
- Actions:
a) Flexes and adducts the wrist.
b) May assists in flexion of the elbow.
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
Accessory muscle
- Palmaris longus.

Range of motion:
The range of motion of the wrist flexion is approximately 0° to 80°-90°. This
range of motion may be limited by tension of dorsal radio-carpal ligament.

Test procedures:
* Grade 3 “Fair strength”:
- Patient starting position: Sitting with forearm resting on a table, while thumb and
fingers are relaxed:
a) Flexor carpi radialis: The forearm is slightly less than full supination.
b) Flexor Carpi Ulnaris: The forearm is in full supination.
* Grades 4 and 5 “Good and Normal strength”:
- Patient starting position: Same as for “Grade 3”.
- Therapist position and grasps: Same as for “Grade 3”; plus distal hand applies resistance:
a) Against the thenar eminence for testing flexor carpi ulnaris.
b) Against the hypo-thenar eminence for testing flexor carpi ulnaris.
- Resistance:
a) Flexor carpi radialis: In the direction of extension toward the ulnar side.
b) Flexor carpi ulnaris: In the direction of extension toward the radial side.
.. Grade 4: Moderate leading resistance through full range of motion.
.. Grade 5: Maximal resistance through full range of motion, plus a “hold” position is
kept at the end of the range.
- Command: Same as for “Grade 3”, plus “hold” at the end of the range of motion
when testing for “Grade 5”.
* Grade 2 “Poor strength”:
- Patient starting position: Sitting with forearm in mid position on a table. The hand
and forearm are resting on ulnar side and the thumb and fingers relaxed.
- Therapist position and grasps: Same as for “Grade 3”.
- Command: Same as for “Grade 3”.
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* Grades 1 and 0 “Trace and Zero strength”:
- Patient starting position: Same as for “Grade 2”.
- Therapist position and grasps: Same as for “Grades 2 and 3” but the distal hand
palpates the tendon of “Flexor carpi ulnaris” on the medial palmar surface.
NOTE: Do not allow “Curling” of fingers, prior to flexion or during application of
resistance to prevent substitution by finger flexors.
Effect of weakness:
a) Decreases the strength of wrist flexion.
b) Pronation strength may also be diminished.
c) Allows an ulnar deviation of the hand.
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MUSCLE TESTING FOR WRIST FLEXION
Grade “3”
Fair Strength
Grade “4, 5”
Good and Normal
Strength
Grade “2”
Poor Strength
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Grade “1, 0”
Trace and Zero
Strength
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WRIST EXTENSION

Muscles tested:
1. Extensor carpi radialis (Longus and Brevis):
a. Extensor carpi radialis longus
b. Extensor carpi radialis brevis
- Origins:
- Origins:
a) Distal 1/3 of lateral supracondylar ridge of
a)
humerus.
epicondyle of humerus.
b) Lateral inter-muscular septum.
- Insertions: Dorsal surface of base of the 2
Common
extensor
tendon
from
lateral
b) Radial collateral ligament.
nd
- Insertion: Dorsal surface of base of the 3rd
metatarsal bone (radial side).
metacarpal bone (radial side).
- Nerve supply: Radial nerve (C5, C6, C7, C8).
- Nerve supply: Radial nerve (C5, C6, C7, C8).
- Actions: Extends and abducts the wrist in flexion
- Actions: Extends and may assist in abduction of
of the elbow.
the wrist.
2. Extensor carpi ulnaris:
- Origins:
a) Common extensor tendon from lateral epicondyle of humerus.
b) By aponeurosis from posterior border of ulna.
- Insertion: Base of 5th metacarpal (ulnar side).
- Nerve supply: Radial nerve (C6, C7, C8).
- Action: Extends and adducts the wrist.

Range of motion:
The range of motion of wrist extension is approximately of 0° to 70°. This
range of motion may be limited by tension of the palmar radio-carpal ligament.
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
Test procedures:
* Grade 3: “Fair strength”:
- Patient starting position: Sitting with forearm resting on a table. The muscles of
fingers and thumb are relaxed:
a) Extensor carpi radialis longus and brevis: The forearm must be in slightly less than
full pronation.
b) Extensor carpi ulnaris: The forearm must be in full pronation.
- Therapist position and grasps: Therapist sits in front of the patient. The proximal
hand grasps the forearm above the wrist joint to stabilize it.
- Command:
a) Extensor carpi radialis longus and brevis: “Pull your hand up toward your thumb
side, relax”.
b) Extensor carpi ulnaris: “Pull your hand up toward your little finger side, relax”.
* Grades 4 and 5 “Good and Normal strength”:
- Patient starting position: Same as for “Grade 3”.
- Therapist position and grasps: Same as for “Grade 3”, plus the distal hand is used to
give resistance on the dorsal surface of the hand.
- Resistance:
a) Extensor carpi radialis longus and brevis: Resistance is given on dorsal surface of
2nd metacarpal bone, in the direction of flexion toward ulnar side.
b) Extensor carpi ulnaris: Resistance is given on dorsal surface of the 5th metacarpal
bone, in the direction of flexion toward the radial side.
.. Grade 4: Maximal resistance through full range of motion.
.. Grade 5: Maximal resistance through full range of motion, plus a “hold” position is
kept at the end of the range.
- Command: Same as for “Grade 3”, plus “hold” at the end of the range of motion
when testing for “Grade 5”.
* Grade 2 “Poor strength”:
- Patient starting position: Sitting with forearm supported on the table on the ulnar
side.
- Therapist position and grasps: Same as for “Grade 3”.
- Command: Same as for “Grade 3”.
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* Grades 1 and 0 “Trace and Zero strength”:
- Patient starting position: Same as for “Grade 2”.
- Therapist position and grasps: Same as for “Grades 2 and 3”, plus the distal hand is
used to palpate the tendons of:
a) Extensor carpi radialis longus and brevis: On the lateral dorsal surface of wrist, in
line with the 2nd and 3rd metacarpal bones.
b) Extensor carpi ulnaris: On the medial dorsal surface of the wrist, in line with the 5th
metacarpal bone.
- Command: Same as for “Grades 3 and 2”.
NOTE: Do not allow extension of fingers prior to wrist extension or during the
application of resistance to prevent substitution by fingers extensor muscles.
Effects of weakness:
- Weakness of the Extensor carpi radialis longus and brevis decreases the strength of
wrist extension and allows an ulnar deviation of the hand.
- Weakness of the Extensor carpi ulnaris decreases the strength of wrist extension and
may result in a radial deviation of the hand.
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MUSCLE TESTING FOR WRIST EXTENSION
Grade “3”
Fair Strength
Grade “4, 5”
Good and Normal
Strength
Grade “2”
Poor Strength
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Grade “1, 0”
Trace and Zero
Strength
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