This document provides instructions for testing range of motion and muscle strength of the wrist and forearm. It describes positioning, stabilization, desired motion, and grading for flexion and extension of the wrist. Key muscles that contribute to wrist flexion and extension are identified. Methods of testing individual muscles like the flexor carpi radialis and extensor carpi ulnaris are outlined. Normal range of motion and factors limiting motion are also noted.

1. Note
• Range of motion: 0º to 90º Pronation from
midposition
• Factors Limiting Motion:
1-Tension of dorsal radioulnar, ulnar collateral and
dorsal radiocarpal ligaments.
2-Tension of lowest fibers of interosseous membrane.
• Fixation:
• Weight of arm

2. Normal & Good
• Position:
• Sitting with arm at side, elbow flexed to 90º
to prevent rotation at the shoulder and
forearm supinated. Muscles of wrist and
fingers are relaxed.
• Stabilization:
• Stabilize arm.
• Desired Motion:
• Patient pronates forearm through ROM.
• Resistance :
• Is given on volar surface of distal end of
radius with counterpressure against the
dorsal surface of the ulna.

3. Fair & Poor
• Position:
• Sitting with arm at side, elbow flexed
to 90º, forearm supinated and
supported by examiner. Muscles of
wrist and fingers are relaxed.
• Desired Motion:
• Patient pronates forearm through full
range of motion for fair grade and
through partial range for poor grade
Fair
Poor

4. Trace & Zero
• Position:
• Sitting.
• Palpation:
• Examiner palpates fibers of
Pronator teres on upper third of
volar surface of forearm on a
diagonal line from medial condyle
of humerus to lateral border of
radius

5. Note
• Patient should not be allowed to medially rotate or abduct
upper arm during pronation.
• This movement makes the ROM in pronation appear complete
and allows forearm to roll into pronated position

6. Wrist Joint

7. Painful Wrist
• Trigger finger
• De Quvarian syndrome
• Fractures
• Arthritis
• Tendonitis
• Peripheral nerve Injuries

8. Trigger finger

10. Muscles contribute to Wrist Flexion
Wrist Flexion
Flexor carpi radialis Flexor carpi ulnarisFlexor carpi radialis Flexor carpi ulnaris

11. Flexor carpi radialisFlexor carpi radialis
• Origin: Medial epicondyle of humerusMedial epicondyle of humerus
• Insertion: Base of 2nd & 3rd metacarpals,
anterior surface
• Nerve supply: Median Nerve (C6, C7)

12. Flexor carpi ulnarisFlexor carpi ulnaris
• Origin: Medial epicondyle of humerusMedial epicondyle of humerus
• Insertion: Pisiform, hamate & base of 5th
metacarpal
• Nerve supply: Ulnar Nerve C7, T1)

13. Note
• Range of Motion: Wrist flexion: 0 to 90 ْ
• Factors Limiting Motion:
• Tension of dorsal radiocarpal ligament
• Fixation:
• Weight of arm

14. Normal & Good
• Position: Sitting with forearm resting on table
with forearm supinated.
• Muscles of thumb and fingers relaxed.
• Stabilization: Stabilize forearm.
• Desired Motion: Patient flexes wrist

15. Note
• To test Flexor carpi radialis, resistance is
given at base of second metacarpal bone in
direction of extension and ulnar deviation

16. Note
• To test Flexor carpi ulnaris, resistance is given
at base of fifth metacarpal bone in direction of
extension and radial deviation

17. Fair
• Position: Sitting with forearm resting on table with forearm
supinated. Muscles of thumb and fingers relaxed.
• Stabilization: Stabilize forearm.
• Desired Motion: Patient flexes wrist with radial deviation or
ulnar deviation
Flexor carpi radialis
Flexor carpi ulnaris

18. Poor
• Position: Sitting, forearm supported, hand resting on medial
border. Muscles of thumb and fingers relaxed.
• Stabilization: Stabilize forearm.
• Desired Motion: Patient flexes wrist, sliding hand along
table. Deviation should be observed and muscles graded
accordingly.

19. Trace & Zero
• Examiner palpates tendon of Flexor carpi radialis
on lateral palmar aspect of wrist and tendon of
Flexor carpi ulnaris on medial palmar surface.

20. Muscles contribute to Wrist Extension
Extensor carpi radialis longus Extensor carpi radialis Brevis Extensor carpi UlnarisExtensor carpi radialis longus Extensor carpi radialis Brevis Extensor carpi Ulnaris

21. Muscles contribute to Wrist Extension
Extensor carpi radialis longusExtensor carpi radialis longus
• Origin: Humerus, lower 3Humerus, lower 3rdrd
of lateral supracondylar ridgeof lateral supracondylar ridge
and lateral epicondyle of humerusand lateral epicondyle of humerus
• Insertion: Base of 2nd
metacarpal (dorsal surface)
• Nerve supply: Radial Nerve

22. Extensor carpi radialis BrevisExtensor carpi radialis Brevis
• Origin: Lateral epicondyle of humerus
• Insertion: Base of 3rd
metacarpal (dorsal surface)
• Nerve supply: Radial Nerve

23. Extensor carpi UlnarisExtensor carpi Ulnaris
• Origin: Lateral epicondyle of humerus
• Insertion: Base of 5th
metacarpal
• Nerve supply: Ulnar Nerve

24. Note
• Range of Motion:
• Wrist extension beyond midline; 0 to 70º
• Factors Limiting Motion:
• Tension of palmar radiocarpal ligament
• Fixation:
• Weight of arm
Caution!!!!

25. Normal & Good
• Position:
• Sitting with forearm resting on the table and pronated.
• Muscles of fingers and thumb relaxed.
• Stabilization: Stabilize forearm.
• Desired Motion: Patient extends wrist.

26. Note
• To test Extensor carpi radialis longus and
Brevis, resistance is given on dorsal surface of second
and third metacarpal bones in direction of flexion and
ulnar deviation.

27. Note
• To test Extensor carpi ulnaris, resistance is given on
dorsal surface of fifth metacarpal bone in direction of
flexion and radial deviation.

28. Fair
• Position:
• Sitting with forearm resting on the table and pronated.
• Muscles of fingers and thumb relaxed.
• Stabilization: Stabilize forearm.
• Desired Motion: Patient extends wrist with radial
deviation or ulnar deviation.

29. Poor
• Position: Sitting, forearm supported, hand resting on medial
border.
• Stabilization: Stabilize forearm.
• Desired Motion:
• Patient extends wrist, sliding hand along table through range of
motion.
• Deviation should be observed and muscles graded accordingly

30. Trace & Zero
• Tendons of wrist extensors may be found on lateral dorsal
surface of wrist in line with second and third metacarpal
bones and on medial dorsal surface proximal to fifth
metacarpal bone.