Distal half of anterior surface of humerus & medial & latera intermuscular septa
Insertion
Tuberosity & coranoid process of ulna
Action
With origin fixed, flexes the elbow joint moving the forearm toward the humerus
With the insertion fixed, flexes the elbow joint moving the humerus toward the forearm
Common flexor tendon from medial epicondyle of humerus & deep antebrachial fascia
Insertion
Flexor retinaculum & palmar aponeurosis
Action
Tenses the palmar fascia, flexes the wrist & may assist elbow flexion
Nerve
Median, C6–8 & T1
Patient
Sitting or supine
Fixation
Provided by table
Test
Tensing the palmar fascia by strongly cupping the palm pf the hand & flexion of the wrist
Pressure
Against the thenar & hypothenar eminences in the direction of flattening the hand & against the hand in the direction of wrist extension
Extensor Digitorum
Origin
Common flexor tendon from lateral epicondyle of humerus & deep antebrachial fascia
Insertion
By four tendons of the second to fifth digits which divide over the proximal phalanx into one middle and two lateral bands, the middle band inserts to the base of the middle phalanx while the lateral bands reunite over the middle phalanx & insert at the base of the distal phalanx
Action
Extends the metacarpophalangeal (MCP) joints, assists with interphalaneal (IP) joint extension of second to fifth digits & also assists wrist extension
Nerve
Radial & C6–8
Patient
Sitting or supine
Fixation
Examiner stabilizes wrist avoiding full extension
Test
Extension of the MCP joints of second to fifth digits with IP joints relaxed
Pressure
Against the dorsal surface of the proximal phalanges in the direction of flexion
Flexor Digitorum Superficialis
Origin
Humeral Head: common flexor tendon from medial epicondyle of humerus, ulnar collateral ligament & deep antebracial fascia
Ulnar Head: medial side of coronoid process
Radial Head: oblique line of radius
Insertion
By four tendons of the second to fifth digits to side of middle phalanges
Action
Flexes proximal interphalangeal (PIP) joints of digits two to five & assists flexion of wrist & metacarpophalaneal (MCP) joints
Nerve
Median, C7–8 & T1
Patient
Sitting or supine
Fixation
Examiner stabilizes MCP joint with wrist in neutral position or slight extension
Test
Flexion of PIP joints with distal interphalangeal (DIP) joints extended on digits two to five
Pressure
Against the palmar surface of the middle phalange in the direction of extension
Flexor Digitorum Profundus
Origin
Anterior & medial surfaces of the proximal three fourths of the ulna, interosseous membrane, & deep antebrachial fascia
Insertion
By four tendons into base of distal phalanges of second to fifth digits
Action
Flexes distal interphalangeal (DIP) joints of digits two to five & assists flexion of the metacarpophalaneal (MCP) joints, proximal interphalangeal (PIP) joints & wrist
Nerve
Profundus I: median, C7–8 & T1
Profundus II: radial, C7–8 & T1
Patient
Sitting or supine
Fixation
With the wrist in slight extension the examiner stabilizes the proximal & middle phalandes
Test
Flexion of the DIP joints two to five
Pressure
Against the palmar surface of the distal phalange in the direction of extension
Flexor Carpi Radialis
Origin
Common flexor tendon from medial epicondyle of humerus & deep antebrachial fascia
Insertion
Base of second & third metacarpal
Action
Flexion & abduction (radial deviation) of the wrist, may assist flexion of the elbow & forearm pronation
Nerve
Median & C6–8
Patient
Sitting or supine
Fixation
The forearm is in slightly less than full supination & rests on the table for support or is supported by the examiner
Test
Flexion of the wrist toward radial deviation
Pressure
Against the thenar eminence in the direction of extension toward ulnar deviation
Flexor Carpi Ulnaris
Origin
Humeral Head: common flexor tendon from medial epicondyle of humerus
Ulnar Head: by aponeurosis from the medial margin of olecranon, proximal two thirds of the posterior borser of the ulna & from the deep antebrachial fascia
Insertion
Pisiform bone, by ligaments to hamate & fifth metacarpal
Action
Flexion & adduction (ulnar deviation) of the wrist & may assist flexion of the elbow
Nerve
Ulnar, C7–8 & T1
Patient
Sitting or supine
Fixation
The forearm is in slightly less than full supination & rests on the table for support or is supported by the examiner
Test
Flexion of the wrist toward ulnar deviation
Pressure
Against the hypothenar eminence in the direction of extension toward radial deviation
Extensor Carpi Radialis Longus
Origin
Distal one third of the lateral supracondylar ridge of the humerus & lateral intermuscular septum
Insertion
Dorsal surface of the second metacarpal on the radial side
Action
Extension & abduction (radial deviation) of the wrist & may assist flexion of the elbow
Nerve
Radial & C5–8
Patient
Sitting with elbow resting on table in approximately 30° of flexion
Fixation
The forearm is in slightly less than full pronation & rests on the table for support
Test
Extension of the wrist toward radial deviation
Pressure
Against the dorsum of the hand along the second & third metacarpals in the direction of flexion toward ulnar deviation
Extensor Carpi Radialis Brevis
Origin
Common extensor tendon from the lateral epicondyle of the humerus, radial collateral ligament & deep antebrachial fascia
Insertion
Dorsal surface of the third metacarpal
Action
Extension & assists abduction (radial deviation) of the wrist
Nerve
Radial & C6–8
Patient
Sitting with elbow completely flexed
Fixation
The forearm is in slightly less than full pronation & rests on the table for support
Test
Extensionion of the wrist toward radial deviation
Pressure
Against the dorsum of the hand along the second and third metacarpals in the direction of flexion toward ulnar deviation
Extensor Carpi Ulnaris
Origin
Common extensor tendon from the lateral epicondyle of the humerus, by aponeurosis to the posterion border of the ulna & deep antebrachial fascia
Insertion
On the ulnar side of the base of the fifth metacarpal
Action
Extension & assists adduction (ulnar deviation) of the wrist
Nerve
Radial & C6–8
Patient
Sitting or supine
Fixation
The forearm is in full pronation & rests on the table for support
Test
Extension of the wrist toward ulnar deviation
Pressure
Against the dorsum of the hand along the fifth metacarpal in the direction of flexion toward radial deviation
Pronator Teres
Origin
Humeral Head: immediately above the medial epicondyle, common extensor tendon from the medial epicondyle of the humerus & deep antebrachial fascia
Ulnar Head: medial side of the coronoid process of the ulna
Insertion
Middle of lateral surface of ulna
Action
Pronates the forearm & assists with elbow flexion
Nerve
Median & C6–7
Patient
Supine or sitting
Fixation
The elbow should be held against the patients side, or stabilized by the examiner to avoid any shoulder abduction
Test
Pronation of the forearm with the elbow flexed approximately 40°
Pressure
At lower forearm above the wrist in the direction of supination
