ROM
What is the normal ROM for forearm pronation?
0 to 75–85 degrees
Which muscle performs forearm supination along with the biceps brachii?
Dorsal interossei (DAB)
Your client can’t fully turn their palm downward when writing. Which motion and muscle are limited?
Pronation; Pronator Teres
What is the normal ROM for MCP flexion?
0 to 90–100 degrees
A client can’t bring their thumb back toward the palm to hold a coin. Which motion and muscle are limited?
Adduction; Adductor Pollicis
Case:
A client reports pain when bending the wrist forward to type on a keyboard. Goniometric measurement shows motion from 0° to 45°.
Question:
Which motion is limited, what is the normal ROM, and which plane does this occur in?
Motion: Wrist flexion
Normal ROM: 0–60 to 80°
Plane: Sagittal plane
Which muscle performs forearm pronation with the pronator quadratus?
Pronator teres
A client reports wrist pain when pouring a drink. Which two muscles flex the wrist?
Flexor carpi radialis and flexor carpi ulnaris
Which muscles are the prime movers for MCP flexion?
Lumbricals and interossei
The client has trouble touching the tip of their thumb to their pinky. Which motion and muscles are involved?
Opposition; Opponens Pollicis & Opponens Digiti Minimi
Case: A client has difficulty turning a key in a door and shows restricted rotation of the forearm with the palm facing up.
Question: Identify the limited motion and its typical ROM range.
Limited forearm supination
Normal ROM = 0–80 to 90°
Case:
During MMT, a client can rotate the forearm so the palm faces upward only through partial range against gravity. The therapist feels contraction in the proximal forearm.
Question:
Which motion and muscle are being tested, and what MMT grade should be recorded?
Motion: Forearm supination
Prime mover: Supinator (assisted by biceps brachii)
MMT grade: 2/5
Which motion uses the extensor carpi radialis longus and brevis together with extensor carpi ulnaris as prime movers?
Wrist extension
A pianist reports difficulty flexing the PIP joints without also flexing the DIP joints. Which muscle is likely weak
Flexor Digitorum Superficialis
When asked to straighten their thumb, the client can’t extend the IP joint. Which muscle is weak?
Extensor Pollicis Longus
Case: While reaching across her body to fasten a seatbelt, your client reports discomfort along the outer wrist and limited lateral movement.
Question: Which motion is limited, and what is the expected normal range?
Limited ulnar deviation
Normal ROM = 0–30 to 40°
Case:
When trying to hold a piece of paper between the fingers, your client cannot bring their fingers back together toward the midline.
Question:
Which muscles are weak, and what is their primary action?
Palmar interossei (PAD) — adduct the fingers at the MCP joints.
During forearm pronation MMT, what common substitution may occur?
Shoulder internal rotation and abduction
Your client struggles to make a full fist. Which muscle flexes the DIP joints?
Flexor Digitorum Profundus
Which two muscles work together during thumb opposition?
Opponens pollicis and opponens digiti minimi
Case:
A patient demonstrates the following active ranges:
• Wrist extension = 40°
• Ulnar deviation = 15°
• Pronation = 60°
Question:
Identify which movements fall outside normal ROM and provide the expected normative values.
All three are limited
Wrist extension normal = 60–75°
Ulnar deviation normal = 30–40°
Pronation normal = 75–85°
Case:
While performing a reaching task, a client exhibits weak wrist extension and compensatory finger extension to lift the hand.
Question:
Identify the likely prime movers that are weak, describe the substitution, and name one strengthening exercise.
Weak extensor carpi radialis longus & brevis, extensor carpi ulnaris
Substitution by finger extensors
Strengthening: resisted wrist extension with fist closed over a light dumbbell or putty
Case:
During a functional task, your client reports difficulty pouring a drink from a pitcher. You observe limited wrist extension and the forearm remains pronated throughout the motion.
Question:
Which forearm motion is limited, which prime mover should be strengthened, and what MMT grade would describe palpable contraction without visible movement?
Limited supination
Strengthen the supinator
MMT grade = 1/5
!!!!!!!DAILY DOUBLE!!!!!!!
Case:
A client cannot maintain grip on a pen while writing and shows excessive flexion at the PIP joints with minimal DIP movement.
Question:
Which muscle is weak, what compensatory pattern is observed, and what correction should the therapist make during MMT?
Weak flexor digitorum profundus
Compensation from flexor digitorum superficialis (dominant PIP flexion)
Stabilize the middle phalanx to isolate DIP flexion
Case:
While buttoning a shirt, the client struggles to oppose the thumb and pinky pad-to-pad, instead touching tip-to-tip.
Question:
Which two muscles are primarily involved in proper opposition, and what verbal cue or adjustment should the therapist provide?
Opponens pollicis and opponens digiti minimi
Cue “pad-to-pad” contact and stabilize the wrist to prevent substitution