Elbow & Wrist
Mazyad Alotaibi
1.
2.
3.
4.
5.
6.
Elbow Flexion
Elbow Extension
Forearm Supination
Forearm Pronation
Wrist Flexion
Wrist Extension
Elbow Flexion
1.
Prime mover/agonist:
Biceps brachii
Brachialis
Brachioradialis
Synergist/ Accessory muscles:
Pronator teres, Extensor carpi radialis longus,
Flexor carpi radialis and ulnaris..
2- Range of motion:
from 0o to 150o
Elbow Flexion
3- Fixation:
a. By weight of the arm.
b. By fixator muscles of scapula.
4- Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Interference with ADL as feeding, combing.
- Decrease the strength of elbow flexion and supination..
5- Factor limited range of motion:
a. Contact of muscle mass on Volar (anterior) aspect of arm with
forearm.
b. Contact of coronoid process with coronoid fossa.
c. Tension of elbow extensor muscles.
6- Substitution:
None.
Elbow Flexion
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand,
Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient
Elbow Extension
1.
Prime mover/agonist:
origin
insertion
Triceps brachii
Long head
Scapula (infraglenoid tuberosity)
Lateral head Humerus (posterior surface)
2.
Ulna (olecranon process, upper surface)
Ulna (olecranon process, upper surface)
Synergist/ Accessory muscles:
Anconeus
3.
Nerve supply:
Triceps brachii → Radial n.(C5-C6).
4. Range of motion:
from 150o to 0o
Elbow Extension
5.
Fixation:
a. Contraction of fixator muscles of scapula.
6.
Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Decrease the ability to extend the elbow against gravity.
- Interfere with ADL.
7. Factor limited range of motion:
a. Tension of anterior redial and ulnar collateral ligaments of elbow joint.
b. Tension of flexor muscles of forearm.
c. Contact of olecranon process with olecranon fossa on posterior
aspect of humerus.
b. Contact of coronoid process with coronoid fossa.
8.
Substitution:
by external rotation the arm and by horizontal adduction the arm.
Elbow Extension
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand,
Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient
Forearm Supination
1. Prime mover/agonist:
Supinator
Biceps brachii
Synergist/ Accessory muscles:
None.
2-Range of motion:
from 80o to 0o
Forearm Supination
3-Fixation:
a. By weight of the arm.
4-Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Interference with ADL as turning a doorknob, using a knife to cut meats.
5-Factor limited range of motion:
a. Tension of Volar radioulnar ligament and ulnar collateral ligament of wrist.
b. Tension of oblique cord and lowest fibers of interosseous membrane.
c. Tension of pronator muscle of forearm.
6-Substitution:
by externally rotate and adduct the arm.
by wrist extensor, so pt must instructed to keep the wrist and fingers as relaxed
as possible.
Forearm Supination
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner
hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient
Forearm Pronation
1-Prime mover/agonist:
Pronator quadratus
Synergist/ Accessory muscles:
Flexor carpi radialis.
2-Range of motion:
from 0o to 80o
Forearm Pronation
3-Fixation:
a. By weight of the arm.
4-Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Interference with many daily activities as turning a doorknob, using a
knife to cut meats. .
5-Factor limited range of motion:
a. Tension of Dorsal radioulnar ligament and ulnar collateral ligament and
dorsal readiocarpal ligament of wrist.
b. Tension of lowest fibers of interosseous membrane.
c. Tension of forearm supinator muscles.
6-Substitution:
by internally rotate the shoulder.
Forearm Pronation
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner
hand, Outer hand, Direction of
Resistance
c- Test
d- Instruction to patient
Wrist Flexion
1-Prime mover/agonist:
Flexor carpi radialis)
Flexor carpi ulnaris
Synergist/ Accessory muscles:
Flexor digitorum superficialis,
Flexor digitorum profundus,
Flexor pollicis longus and
palmaris Longus
2-Range of motion:
from 0o to 80o _ 90o
Wrist Flexion
3-Fixation:
By weight of the arm.
4-Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Interference with many daily activities as grasping things from
ground or holding things.
5-Factor limited range of motion:
a. Tension of Dorsal radiocarpal ligament.
b. Tension of wrist extensor muscles.
6- Substitution:
by allowing the finger flexors to participate. Ask the pt to relax
fingers.
Wrist Flexion
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand,
Direction of Resistance
c- Test
d- Instruction to patient
Wrist Extension
1-Prime mover/agonist:
Extensor carpi radialis Longus &
Extensor carpi radialis brevis)
Extensor carpi ulnaris
Synergist/ Accessory muscles:
extensor digitorum, extensor digiti minimi, and
extensor indicis.
2- Range of motion:
from 0o to 70o
Wrist Extension
3-Fixation:
a. By weight of the arm.
4-Effect of weakness/contracture/shortening:
Effect of weakness result in:
- Interference with many daily activities as hand writing,
typing..
5-Factor limited range of motion:
a. Tension of Palmar radiocarpal ligament.
b. Tension of wrist flexor muscles.
6-Substitution:
by allowing the finger extensors to participate. Ask the pt to
relax fingers.
Wrist Extension
7- Procedures:
a- Position of Patient:
b- Position of Therapist : inner hand, Outer hand,
Direction of Resistance
c- Test
d- Instruction to patient