Elbow & WristElbow & Wrist

Mazyad Alotaibi

1.1. Elbow FlexionElbow Flexion

2.2. Elbow ExtensionElbow Extension

3.3. Forearm SupinationForearm Supination

4.4. Forearm PronationForearm Pronation

5.5. Wrist FlexionWrist Flexion

6.6. Wrist Extension Wrist Extension

Elbow Flexion Elbow Flexion 1.1. Prime mover/agonist: Prime mover/agonist: Biceps brachii Biceps brachii Brachialis Brachialis BrachioradialisBrachioradialis

Synergist/ Accessory muscles: Synergist/ Accessory muscles: Pronator teres, Extensor carpi radialis longus, Pronator teres, Extensor carpi radialis longus, Flexor carpi radialis and ulnaris..Flexor carpi radialis and ulnaris..

2- Range of motion: 2- Range of motion: from 0from 0oo to 150 to 150oo

Elbow FlexionElbow Flexion3- Fixation:3- Fixation:

a. By weight of the arm. a. By weight of the arm.

b. By fixator muscles of scapula.b. By fixator muscles of scapula. 4- Effect of weakness/contracture/shortening: 4- Effect of weakness/contracture/shortening: Effect of weakness result in:Effect of weakness result in:

- Interference with ADL as feeding, combing.- Interference with ADL as feeding, combing. - Decrease the strength of elbow flexion and supination.. - Decrease the strength of elbow flexion and supination..

5- Factor limited range of motion: 5- Factor limited range of motion: a. Contact of muscle mass on Volar (anterior) aspect of arm with a. Contact of muscle mass on Volar (anterior) aspect of arm with

forearm. forearm. b. Contact of coronoid process with coronoid fossa.b. Contact of coronoid process with coronoid fossa.

c. Tension of elbow extensor muscles.

6- Substitution: 6- Substitution: None.None.

Elbow FlexionElbow Flexion

7- Procedures: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 Elbow Extension 1.1. Prime mover/agonist: Prime mover/agonist: origin insertion origin insertion

Triceps brachii Triceps brachii Long head Long head Scapula Scapula (infraglenoid tuberosity)(infraglenoid tuberosity) Ulna Ulna (olecranon process, upper surface)(olecranon process, upper surface)

Lateral head Lateral head Humerus Humerus (posterior surface)(posterior surface) Ulna Ulna (olecranon process, upper surface)(olecranon process, upper surface)

2. Synergist/ Accessory muscles: 2. Synergist/ Accessory muscles: Anconeus Anconeus

3. Nerve supply: 3. Nerve supply:

Triceps brachii Triceps brachii →→ Radial n.(Radial n.(C5-C6). C5-C6).

4.4. Range of motion: Range of motion: from 150from 150oo to 0 to 0oo

Elbow ExtensionElbow Extension

5.5. Fixation: Fixation: a. Contraction of fixator muscles of scapula. a. Contraction of fixator muscles of scapula.

6.6. Effect of weakness/contracture/shortening: Effect of weakness/contracture/shortening:

Effect of weakness result in:Effect of weakness result in:

-- Decrease the ability to extend the elbow against gravity. Decrease the ability to extend the elbow against gravity.

- Interfere with ADL.- Interfere with ADL.

7. Factor limited range of motion: 7. Factor limited range of motion: a. Tension of anterior redial and ulnar collateral ligaments of elbow joint. a. Tension of anterior redial and ulnar collateral ligaments of elbow joint.

b. Tension of flexor muscles of forearm. b. Tension of flexor muscles of forearm.

c. Contact of olecranon process with olecranon fossa on posterior c. Contact of olecranon process with olecranon fossa on posterior aspect of humerus.aspect of humerus.

b. Contact of coronoid process with coronoid fossa. b. Contact of coronoid process with coronoid fossa.

8.8. Substitution: Substitution:

by external rotation the arm and by horizontal adduction the arm.by external rotation the arm and by horizontal adduction the arm.

Elbow ExtensionElbow Extension

7- Procedures: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 Forearm Supination

1.1. Prime mover/agonist: Prime mover/agonist: SupinatorSupinator

Biceps brachiiBiceps brachii

Synergist/ Accessory muscles: Synergist/ Accessory muscles: NoneNone. .

2-Range of motion: 2-Range of motion: from 80from 80o o to to 00oo

Forearm SupinationForearm Supination

3-Fixation: 3-Fixation: a. By weight of the arm. a. By weight of the arm.

4-Effect of weakness/contracture/shortening: 4-Effect of weakness/contracture/shortening: Effect of weakness result in:Effect of weakness result in:

- - Interference with ADL as turning a doorknob, using a knife to cut meats.Interference with ADL as turning a doorknob, using a knife to cut meats. 5-Factor limited range of motion: 5-Factor limited range of motion: a. Tension of Volar radioulnar ligament and ulnar collateral ligament of wrist. a. Tension of Volar radioulnar ligament and ulnar collateral ligament of wrist.

b. Tension of oblique cord and lowest fibers of interosseous membrane. b. Tension of oblique cord and lowest fibers of interosseous membrane.

c. Tension of pronator muscle of forearm.c. Tension of pronator muscle of forearm.

6-Substitution: 6-Substitution: by externally rotate and adduct the arm.by externally rotate and adduct the arm.

by wrist extensor, so pt must instructed to keep the wrist and fingers as relaxed by wrist extensor, so pt must instructed to keep the wrist and fingers as relaxed as possible.as possible.

Forearm SupinationForearm Supination

7- Procedures: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 Forearm Pronation 1-Prime mover/agonist: 1-Prime mover/agonist: Pronator quadratus Pronator quadratus Synergist/ Accessory muscles: Synergist/ Accessory muscles: Flexor carpi radialis. Flexor carpi radialis.

2-Range of motion: 2-Range of motion: from 0from 0oo to 80 to 80oo

Forearm PronationForearm Pronation

3-Fixation: 3-Fixation: a. By weight of the arm. a. By weight of the arm.

4-Effect of weakness/contracture/shortening: 4-Effect of weakness/contracture/shortening: Effect of weakness result in:Effect of weakness result in:

- Interference with many daily activities as turning a doorknob, using a - Interference with many daily activities as turning a doorknob, using a

knife to cut meats.knife to cut meats. .. 5-Factor limited range of motion: 5-Factor limited range of motion: a. Tension of Dorsal radioulnar ligament and ulnar collateral ligament and a. Tension of Dorsal radioulnar ligament and ulnar collateral ligament and

dorsal readiocarpal ligament of wrist. dorsal readiocarpal ligament of wrist.

b. Tension of lowest fibers of interosseous membrane.b. Tension of lowest fibers of interosseous membrane.

c. Tension of forearm supinator muscles. c. Tension of forearm supinator muscles. 6-Substitution: 6-Substitution: by internally rotate the shoulder.by internally rotate the shoulder.

Forearm PronationForearm Pronation

7- Procedures: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 ulnarisSynergist/ 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 FlexionWrist 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 ExtensionWrist 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 ExtensionWrist Extension

7- Procedures:

a- Position of Patient: b- Position of Therapist : inner hand, Outer hand,

Direction of Resistance c- Test

d- Instruction to patient