Test: Forearm Supination (Supinator and Biceps brachii)

Video Link

Background/Purpose

Grade 5 (Normal), Grade 4 (Good), and Grade 3 (Fair)
Position of patient: short sitting; arm at side and elbow flexed to 90 degrees; forearm in neutral or midposition. Alternatively, patient may sit at the exam table.

Position of examiner: Stand at side or in front of patient. One hand supports the elbow. For resistance, grasp the forearm on the volar surface at the wrist.

Procedure

Test: Patient begins at the neutral wrist position and supinates the forearm until the palm faces the ceiling. Examiner resists motion in the direction of pronation. No resistance is given for Grade 3.

Alternate test: Grasp patient’s hand as if shaking hands; cradle the elbow and resist via the hand grip. This test is used if the patient has Grade 5 or 4 wrist and hand strength. If wrist flexion is painful, give resistance at the wrist (a more difficult level).

Instructions to patient: “Turn your palm up. Hold it. Don’t let me turn it down. Keep your wrist and fingers relaxed.” For Grade 3: “Turn your palm up.”

Grade 2 (Poor)
Position of patient: Short sitting with shoulder flexed between 45 and 90 degrees and elbow flexed to 90 degrees. Forearm in neutral.
Position of examiner: Support the test arm by cupping the hand under the elbow.
Test: Patient supinates forearm through partial range of motion.
Instructions to patient: “Turn your palm toward your face.”

Grade 1 (Trace) and Grade 0 (Zero)
Positiotion of patient: Short sitting; arm at side and elbow flexed at 90 degrees; forearm in neutral or midposition. Alternatively, patient may sit at the exam table.
Position of examiner: Stand at side or in front of patient. One hand supports the elbow. For resistance, grasp the forearm on the volar surface at the wrist.
n of patient: Short sitting. Arm and elbow are flexed as for the Grade 3 test.
Position of examiner: Support the forearm just distal to the elbow. Palpate the supinator distal to the head of the radius on the dorsal aspect of the forearm.
Test: Patient attempts to supinate the forearm.
Instructions to patient: “Try to turn your palm so it faces the ceiling.”

Grading
Grade 1 (Trace): Slight contractile activity but no limb movement.
Grade 0 (Zero): No contractile activity.

Performed: Unilaterally

Dialog

Patient supinates the forearm until the palm faces the ceiling.

Criteria

• Grade 5 (Normal): Completes full available range of motion and holds against maximal resistance.
• Grade 4 (Good): Completes full range of motion against strong to moderate resistance.
• Grade 3 (Fair): Completes available range of motion without resistance.
• Grade 2 (Poor): Completes a partial range of motion.

Measurement

LOINC Code

0

Scale/Grading

Pass/Fail