Procedure
- The patient sits with lower arms resting on a table and the elbows in 90° flexion.
- Examine the muscles by allowing them to be tensed isometrically (without movement).
- During this, offer resistance (white arrow on photos) to the force elicited by the patient (black arrow on photos) in response to a request to initiate a certain movement.
- Whilst performing the test, enquire about any pain.
- If pain is indicated, compare left with right.
Muscle Test Wrist/Hand
- If necessary, palpate the muscles:
- To determine the tone and the maximum point of pain.
- To differentiate between lipoma etc. and muscle herniation.
- If an avulsion or muscle rupture is suspected.
- In principle, an isometric test of pain of the different muscle groups should suffice.
- If the patient indicates pain symptoms during this test, examine the individual muscles of the muscle group in question (following a left-right comparison).
- Ensure that these are tensed as selectively as possible.
Muscle Tests Groups Lower Arm/Wrist
- The extensors of the wrist (particularly the extensor digitorum muscle, extensor carpi radialis longus and brevis muscles, and extensor carpi ulnaris muscle).
- the pronators (particularly the pronator teres muscle, pronator quadratus muscle, flexor carpi radialis muscle)
- the supinators (particularly the supinator muscle and biceps brachii muscle)
- the flexors of the wrist and the fingers (particularly the palmaris longus muscle, flexor digitorum profundus and superficialis muscles, flexor carpi radialis muscle, flexor carpi ulnaris muscle, flexor pollicis longus muscle, palmar and dorsal interosseous muscles, lumbrical muscles)
- the ulnar abductors (particularly the flexor carpi ulnaris muscle, extensor carpi ulnaris muscle)
- the radial abductors (particularly the flexor carpi radialis muscle, extensor carpi radialis longus and brevis muscles)
NB. For a description of how to carry out the above mentioned muscle tests, refer to “The Elbow”.
Muscle strength tests fingers
- the thenar and hypothenar muscles (opposition of the thumb against the individual fingers) (particularly opponens pollicis muscle, opponens digiti minimi muscle) [Figure 122]
NB. The extensor pollicis longus and brevis muscles and the abductor pollicis longus muscle can only be tested selectively.
Figure 122
The following muscles can be tested more or less selectively:
- extensor pollicis longus muscle [Figure 123].
- Function: extension (in CMC I, MCP I and IP) and repositioning (in CMC I) of the thumb:
- Disorder: tendonitis
Figure 123
- extensor pollicis brevis muscle [Figure 124].
- Function: extension (in MCP I) and repositioning (in CMC I) of the thumb:
- Disorder: crepitating tenosynovitis
Figure 124
- abductor pollicis longus muscle [Figure 125].
- Function: extension and abduction (both in CMC I) of the thumb;
- Disorder: crepitating tenosynovitis
Figure 125
- palmar interosseous muscles [Figure 126] and dorsal muscles [Figure 127].
- Function: adduction and abduction (closing and spreading) of the fingers, respectively; flexion of the MCP joints;
- Disorder: atrophy due to ulnar nerve lesion
Figure 126
Figure 127
- flexor pollicis longus muscle [Figure 128].
- Function: flexion of the thumb (in CMC I, MCP I and IP joints);
- Disorder: stenosing tenosynovitis
Figure 128
- lumbrical muscles [Figure 129].
- Function: flexion of the MCP joints; extension of PIP and DIP joints II through to V.
Figure 129
NB. For selective tests of the following muscles, refer to the section “The Elbow”:
- brachioradialis muscle
- extensor digitorum muscle
- extensor carpi radialis longus and brevis muscles
- extensor carpi ulnaris muscle
- flexor carpi radialis muscle
- palmaris longus muscle
- flexor digitorum profundus and superficialis muscles
- flexor carpi ulnaris muscle.
For the examination of muscle strength, refer to “The Neurological Examination, and for the vascular examination, refer to “The Cardiovascular Examination”.