Occupational Therapy Student Guide to Range of Motion & MMT

Hand & Thumb MMT

Digit MCP extension

Start position

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm pronated, supported on a table, allowing the hand to hang over the edge and the fingers to be flexed. The practitioner will stabilize the hand/metacarpals and then ask the client to "Straighten your fingers at your larger joints up towards the ceiling and don't let me push you down." The client will extend the digits at the MCP joints while keeping the PIP and DIP joints flexed in a hook position. Resistance is applied to the proximal phalanges in flexion.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with the testing arm supported on a table with the forearm in a neutral position. The practitioner will support the hand and ask the client to "Straighten your fingers at your larger joints." The practitioner will palpate the functional digit MCP extensors (Extensor digitorum, extensor indices, and extensor digiti minimi)

Grades: Poor (2), Trace (1), No contraction (0)

Digit MCP extension video

Digit MCP Flexion

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, with their hand open and digits extended. The practitioner will stabilize the hand/metacarpals and then ask the client to "Bend the large joints of your hand, keeping the middle and end joints straight, and don't let me push them down." The client will flex the digits at the MCP joints while keeping the PIP and DIP joints straight. Resistance is applied to the volar proximal phalanges in extension.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with the testing arm supported on a table with the forearm in neutral position. The practitioner will support the hand and ask the client to "Straighten your fingers at your larger joints." The practitioner will palpate the functional digit MCP extensors (Extensor digitorum, extensor indices, and extensor digiti minimi)

Grades: Poor (2), Trace (1), No contraction (0)

Digit MCP Flexion

MMT Video

Digit MCP adduction (index)

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm pronated, supported on a table, and with the finger straight and abducted. The practitioner will stabilize the hand/metacarpals and then ask the client to "Bring your fingers together and I will resist the movement of each finger at a time." The client will adduct at the digits at the MCP joints while keeping the PIP and DIP joints straight, moving toward midline (third digit). Resistance is applied to the proximal phalanges in abduction away from midline (Index finger pictured)/.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand pronated and supported on a table, and with the finger straight and abducted. The practitioner will stabilize the hand/metacarpals and then ask the client to "Bring your fingers together. The practitioner will palpate the functional digit MCP adductors (palmar interossei).

Grades: Poor (2), Trace (1), No contraction (0)

Digit MCP adduction

MMT Video

Digit MCP abduction Index and small fingers

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm pronated, supported on a table, and with the finger straight and together/adducted. The practitioner will stabilize the hand/metacarpals and then ask the client to "Spread your fingers apart and I will resist the movement of each finger at a time." The client will abduct at the digits at the MCP joints while keeping the PIP and DIP joints straight, moving away from midline (third digit). Resistance is applied to the proximal phalanges in abduction toward midline (Index and small finger pictured).

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand pronated and supported on a table, and with the finger straight and adducted. The practitioner will stabilize the hand/metacarpals and then ask the client to "Spread your fingers apart." The practitioner will palpate the functional digit MCP abductors (Dorasl interossei, abductor digiti minimi).

Grades: Poor (2), Trace (1), No contraction (0)

Digit MCP abduction

MMT Video

Digit PIP/DIP Flexion

Start position

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the digits in extension. The practitioner will stabilize the hand/metacarpals and then ask the client to "Flex and bend your fingers to make a hook position and don't let me resist you." The client will flex the digits at the PIP and DIP joints. Resistance is applied to the volar middle and distal phalanges into digit PIP and DIP extension.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in a neutral position on the table. The practitioner will stabilize the hand/metacarpals and then ask the client to "Flex and bend your fingers to make a hook." The practitioner will palpate the functional digit muscle flexors (flexor digitorum superficialis and flexor digitorum profundus.

Grades: Poor (2), Trace (1), No contraction (0)

MMT: PIP Flexion

MMT Digit DIP Flexion

Digit PIP/DIP Extension

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm pronated, supported on a table, and the hand positioned over the edge of the table with the fingers flexed. The practitioner will stabilize the hand/metacarpals and then ask the client to "Straighten your fingers and don't let me resist the movement." The client will extend the digits at the PIP and DIP joints. Resistance is applied to the dorsal middle and distal phalanges into digit PIP and DIP flexion.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in a neutral position on the table. The practitioner will stabilize the hand/metacarpals and then ask the client to "Straighten your fingers as far as you can." The practitioner will palpate the functional digit muscle extensors (Extensor digitorum, extensor indices, extensor digiti minimi)

Grades: Poor (2), Trace (1), No contraction (0)

MMT DIP Extension

MMT Digit PIP extension

Thumb MP flexion

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the digits extended. The thumb is extended. The practitioner will stabilize the first metacarpal and wrist and then ask the client to " Move your thumb across your palm and don't let me resist the movement." The client will flex the thumb at the MP joint while resistance is applied to the proximal phalanx of the thumb.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in supination on the table. The practitioner will stabilize the wrist of the client and say, "Move your thumb across your palm." The practitioner will palpate the muscle movers of the thumb MP flexors (flexor pollicis brevis)

Grades: Poor (2), Trace (1), No contraction (0)

MMT Thumb MP flexion

Thumb MP Extension start position

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm neutral, supported on a table, and the thumb in slight flexion at the MP. The practitioner will stabilize the first metacarpal and wrist and then ask the client to "Straighten your thumb up toward the ceiling, don't let me resist you." The client will extend the thumb at the MP joint while resistance is applied to the dorsal proximal phalanx of the thumb into MP flexion.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in supination on the table. The practitioner will stabilize the wrist of the client and say, "Move your thumb away your palm." The practitioner will palpate the muscle movers of the thumb MP extensors (extensor pollicis brevis)

Grades: Poor (2), Trace (1), No contraction (0)

MMT THumb MP extension

MMT THumb IP Flexion position

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the digits extended. The thumb is extended, and the MP and IP joints are extended. The practitioner will stabilize the first metacarpal and MP joint, then ask the client to "Bend the tip of your thumb and I will resist the movement." The client will flex the thumb at the IP joint while resistance is applied to the distal phalanx of the thumb into extension.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in supination on the table. The practitioner will stabilize the wrist and first metacarpal and proximal phalanx and say, "Bend your thumb tip as far as you can go." The practitioner will palpate the muscle movers of the thumb IP flexors (flexor pollicis longus)

Grades: Poor (2), Trace (1), No contraction (0)

MMT THumb IP Flexion

Thumb IP extension MMT

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm neutral, supported on a table, and with theumb in MP extension and slight IP flexion. The practitioner will stabilize the first metacarpal and MP joint and then ask the client to "Straighten your thumb up toward the ceiling, don't let me resist you." The client will extend the thumb at the IP joint while resistance is applied to the dorsal proximal phalanx of the thumb into IP flexion.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in supination on the table. The practitioner will stabilize the wrist of the client and say, "Straighten the tip of your thumb." The practitioner will palpate the muscle movers of the thumb IP extensors (extensor pollicis longus)

Grades: Poor (2), Trace (1), No contraction (0)

MMT THumb IP Extension

Thumb cmc Extension (Radial Abduction)

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the digits extended. The thumb is adducted. The practitioner will stabilize the wrist and then ask the client to " Move your thumb away from your palm and don't let me resist the movement." The client will extend or radially abduct the thumb at the CMC joint. Resistance is applied to the first metacarpal in the direction of CMC flexion.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in pronation on the table. The practitioner will stabilize the wrist of the client and say, "Move your thumb away from your palm." The practitioner will palpate the muscle movers of the thumb CMC extensors (Abductor pollicus longus and Extensor pollicus brevis)

Grades: Poor (2), Trace (1), No contraction (0)

Thumb CMC flexion

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the thumb in slight abduction and extension. The practitioner will stabilize the wrist and then ask the client to "Move your thumb across your palm and don't let me resist the movement." The client will flex the thumb at the CMC joint. Resistance is applied to the first metacarpal on the thenar eminence in the direction of CMC extension.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm supinated on the table. The practitioner will stabilize the wrist of the client and say, "Move your thumb across your palm." The practitioner will palpate the muscle movers of the thumb CMC flexor (flexor pollicus brevis)

Grades: Poor (2), Trace (1), No contraction (0)

Thumb cmc Palmar abduction

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the digits extended. The thumb is adducted. The practitioner will stabilize the wrist and then ask the client to " Move your thumb away from your palm toward the ceiling and don't let me resist the movement." The client will palmarly abduct the thumb at the CMC joint. Resistance is applied to the first metacarpal in the direction of CMC adduction.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in pronation on the table. The practitioner will stabilize the wrist of the client and say, "Move your thumb away from your palm." The practitioner will palpate the muscle movers of the thumb CMC abductors (Abductor pollicus longus and abductor pollicus brevis)

Grades: Poor (2), Trace (1), No contraction (0)

Thumb cmc Palm Adduction

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the digits extended. The thumb is in palmar abduction. The practitioner will stabilize the wrist and place two fingers in the web space, then ask the client to " Move your thumb toward the palm, squeeze my fingers and don't let me resist the movement." The client will adduct the thumb at the CMC joint. Resistance is applied to the first metacarpal in the direction of CMC palmar abduction.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: Client is seated in a chair with their hand and forearm in supination on the table. The practitioner will stabilize the wrist of the client and say, "Move your thumb toward the palm." The client will move or attempt to move the thumb towards the palm. The practitioner will palpate the muscle movers of the thumb CMC adductor (Adductor pollicus)

Grades: Poor (2), Trace (1), No contraction (0)

thumb CMC and 5th digit Opposition

Gravity Resisted Instructions: Ask the client to sit in a chair with their forearm supinated, supported on a table, and the digits extended. The practitioner will stabilize the wrist at the fifth and first metacarpals and then ask the client to "Try to touch the tip of your thumb to the tip of your little finger." The client will oppose the thumb and the fifth digit. Resistance is applied to the thenar and hypothenar areas in the opposite directions.

Grades: Normal (5), Good (4), Fair (3)

Gravity Minimized: No resistance is applied, and the practitioner or the table supports the testing extremity. (Not pictured)

Instructions: The client is seated in a chair with their forearm supinated, supported on a table, and the digits extended. The practitioner will stabilize the wrist at the fifth and first metacarpals and then ask the client to "Try to touch the tip of your thumb to the tip of your little finger." The client will oppose the thumb and the fifth digit. " The practitioner will palpate the muscle movers of the thumb CMC opposer and fifth digit CMC opposers (opponens pollicus and opponens digit minimi)

Grades: Poor (2), Trace (1), No contraction (0)

CMC opposition

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