Test: Wrist Flexion (Flexor carpi radialis and Flexor carpi ulnari

Video Link

Background/Purpose

Grade 5 (Normal) and Grade 4 (Good)

Have patient sitting. Forearm is supported on its dorsal surface on the exam table. To start, the forearm is supinated. Wrist is in neutral or slightly extended.

Position of examiner: One hand supports the patient’s forearm under the wrist.

To test both wrist flexors: The examiner grasps the palm of the test hand with the thumb circling around to the dorsal surface. Resistance is given evenly across the hand in a straight-down direction into wrist extension.

To test the flexor carpi radialis: resistance is focused over the 2nd metacarpal (radial side of the hand) in the direction of extension and ulnar deviation.

To test the flexor carpi ulnaris: resistance is focused over the 5th metacarpal (ulnar side of the hand) in the direction of extension and radial deviation.

Test: Patient flexes the wrist, keeping the digits and thumb relaxed. Instructions to the patient: “Bend your wrist. Hold it. Don’t let me pull it down. Keep your fingers relaxed.”

Grading
Grade 5 (Normal): Completes available range of wrist flexion and holds against maximal resistance.
Grade 4 (Good): Completes available range of wrist flexion and holds against strong to moderate resistance.

Procedure

Grade 3 (Fair)
Position of patient: Starting position with forearm supinated and wrist neutral as in Grade 5 and 4 tests.
Position of examiner: Support the patient’s forearm under the wrist.

To test both wrist flexors: patient flexes the wrist straight up without resistance and without radial or ulnar deviation.
To test for flexor carpi radialis: patient flexes the wrist in radial deviation.
To test for flexor carpi ulnaris: patient flexes the wrist in ulnar deviation.

Instructions to patient for both wrists: “Bend your wrist.” Keep it straight with your fingers relaxed.”
For flexor carpi radialis: “Bend your wrist leading with the thumb side.” For flexor carpi ulnaris: “Bend your wrist leading with the little fingers.”

Grading
Grade 3 (Fair) Completes available range without resistance.

Grade 2 (Poor)

Position of patient: Short sitting with elbow supported on exam table. Forearm in midposition with hand resting on ulnar side.
Position of examiner: Support patient’s forearm proximal to the wrist.
Test: Patient flexes wrist with the ulnar surface gliding across or not touching the table. To test the two wrist flexors separately, the examiner holds the forearm so that the wrist does not lie on the exam table and asks the patient to perform the flexion motion while the wrist is in ulnar and then radial deviation.
Instruction to patient: “Bend our wrist, keeping our fingers relaxed.”
Grade 2 (Poor): Completes available range of wrist flexion without assistance of gravity.

Grade 1 (Trace) and Grade 0 (Zero)
Position of patient: Supinated forearm supported on exam table.
Position of examiner: Support the wrist in flexion; the index finger of the other hand is used to palpate the appropriate tendons. Palpate the tendons of the flexor carpi radialis and the flexor carpi ulnaris in separate tests. The flexor carpi radialis lies on the lateral palmar aspect of the wrist lateral to the Palmaris longus, if patient has one! The tendon of the flexor carpi ulnaris lies on the medial palmar aspect of the wrist.

Test: Patient attempts to flex the wrist.
Instructions to the patient: “Try to bend your wrist. Relax. Bend it again.” Patient should be asked to repeat the test so the examiner can feel the tendons during both relaxation and contraction.

Grading
Grade 1 (Trace): One or both tendons may exhibit visible or palpable contractile activity, but the part does not move.
Grade 0 (Zero): No contractile activity.

Performed: Unilaterally

Dialog

Patient flexes the wrist, keeping the digits and thumb relaxed.

Criteria

• Completes available range of wrist flexion and holds against maximal resistance for Grade 5 (normal).
• Completes available range of wrist flexion and holds against strong to moderate resistance for Grade 4 (Good).
• Completes available range without resistance for Grade 3 (Fair).
• Completes available range of wrist flexion without assistance of gravity for Grade 2 (Poor).

Measurement

LOINC Code

0

Scale/Grading

Pass/Fail