Elbow & Wrist Mazyad Alotaibi

Elbow Flexion Elbow Extension Forearm Supination Forearm Pronation Wrist Flexion Wrist Extension

Elbow Flexion Prime mover/agonist: Synergist/ Accessory muscles: 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

c. Tension of elbow extensor muscles. 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 a- Position of Patient: 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 Prime mover/agonist: origin insertion Triceps brachii Long head Scapula (infraglenoid tuberosity) Ulna (olecranon process, upper surface) Lateral head Humerus (posterior surface) Ulna (olecranon process, upper surface) 2. Synergist/ Accessory muscles: Anconeus 3. Nerve supply: Triceps brachii → Radial n.(C5-C6). Range of motion: from 150o to 0o

Elbow Extension Fixation: Effect of weakness/contracture/shortening: a. Contraction of fixator muscles of scapula. 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. Substitution: by external rotation the arm and by horizontal adduction the arm.

Elbow Extension a- Position of Patient: 7- Procedures: a- Position of Patient: b- Position of Therapist : inner hand, Outer hand, Direction of Resistance c- Test d- Instruction to patient

Synergist/ Accessory muscles: 2-Range of motion: Forearm Supination 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 a- Position of Patient: 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

c. Tension of forearm supinator muscles. 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 a- Position of Patient: 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: 4-Effect of weakness/contracture/shortening: 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 a- Position of Patient: 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: Synergist/ Accessory muscles: 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 a- Position of Patient: 7- Procedures: a- Position of Patient: b- Position of Therapist : inner hand, Outer hand, Direction of Resistance c- Test d- Instruction to patient