Manual Muscle Test

WRIST & HAND MODULE – Full Clean Format

Abduction of the Thumb (Abductor Pollicis Longus)

1. Neurological & Functional Insights

• - Primary radial abductor of thumb at the carpometacarpal joint.
• - Critical for thumb positioning during grasping and precision grip.
• - Controls stability during radial deviation actions.

2. Clinical Relevance

• - Weakness reduces grip width and thumb positioning.
• - Overuse common in De Quervain’s pattern.
• - Important for dynamic stabilization in multitask hand use.

3. Origin

• - Posterior ulna
• - Posterior radius
• - Interosseous membrane

4. Insertion

• - Base of 1st metacarpal

5. Innervation

• - Radial nerve (C7–C8)

6. Actions – Open Kinetic Chain (OKC)

• - Thumb abduction (CMC)
• - Radial deviation assistance

7. Actions – Closed Kinetic Chain (CKC)

• - Thumb stabilization during loaded grasp

8. Associated Ligaments

• - Dorsal thumb CMC ligaments

9. Associated Organs

Fascial:

• - Dorsal radial fascia

Viscerosomatic:

• - C7–C8

TCM:

• - Large Intestine meridian region

VM:

• - Radial fascial tension altering thumb abduction

Adduction of the Thumb (Adductor Pollicis)

1. Neurological & Functional Insights

• - Provides strong adduction, essential for pinch and grip strength.
• - Two-headed structure gives mechanical advantage in power grip.
• - Important proprioceptive stabilizer for thumb–index precision.

2. Clinical Relevance

• - Weakness reduces key-pinch and overall grip strength.
• - Overactivity increases medial thumb compression loads.
• - Vital in musicians, clinicians, and fine-motor workers.

3. Origin

• - Oblique head: capitate & 2–3 metacarpals
• - Transverse head: 3rd metacarpal

4. Insertion

• - Medial side of proximal phalanx of thumb

5. Innervation

• - Ulnar nerve (C8–T1)

6. Actions – Open Kinetic Chain (OKC)

• - Thumb adduction (CMC & MCP)

7. Actions – Closed Kinetic Chain (CKC)

• - Precision pinch stabilization

8. Associated Ligaments

• - Ulnar thumb ligaments

9. Associated Organs

Fascial:

• - Thenar fascia

Viscerosomatic:

• - C8–T1

TCM:

• - Heart / Small Intestine channels

VM:

• - Palmar fascial tension influencing adductor pollicis mechanics

Flexion of the Thumb (Flexor Pollicis Longus)

1. Neurological & Functional Insights

• - Sole flexor of the thumb IP joint.
• - Allows strong gripping and fine manipulation.
• - Important for hand dexterity and coordinated motion.

2. Clinical Relevance

• - Overuse common in gripping and climbing.
• - Tendinopathy affects IP joint motion.
• - Weakness reduces fine motor performance.

3. Origin

• - Anterior radius
• - Interosseous membrane

4. Insertion

• - Base of distal phalanx of thumb

5. Innervation

• - Median nerve (anterior interosseous C8–T1)

6. Actions – Open Kinetic Chain (OKC)

• - Thumb IP flexion
• - Assists MCP flexion

7. Actions – Closed Kinetic Chain (CKC)

• - Stabilizes thumb during gripping tasks

8. Associated Ligaments

• - Volar plate of IP joint

9. Associated Organs

Fascial:

• - Anterior thumb flexor fascia

Viscerosomatic:

• - C8–T1

TCM:

• - Lung meridian region

VM:

• - Anterior thumb fascial drag affecting FPL glide

Extensor of the Thumb (Extensor Pollicis Longus)

1. Neurological & Functional Insights

• - Primary extensor of the thumb IP joint.
• - Controls extension for release phase in gripping.
• - Key stabilizer of thumb column during precision tasks.

2. Clinical Relevance

• - Injured in repetitive extension tasks.
• - Tendon rupture risk around Lister’s tubercle.
• - Important for coordinated grip–release mechanics.

3. Origin

• - Posterior ulna
• - Interosseous membrane

4. Insertion

• - Base of distal phalanx of thumb

5. Innervation

• - Radial nerve (C7–C8)

6. Actions – Open Kinetic Chain (OKC)

• - Thumb extension (IP & MCP)

7. Actions – Closed Kinetic Chain (CKC)

• - Thumb stabilization during load release

8. Associated Ligaments

• - Dorsal IP joint capsule

9. Associated Organs

Fascial:

• - Posterior thumb fascia

Viscerosomatic:

• - C7–C8

TCM:

• - Large Intestine meridian region

VM:

• - Posterior thumb fascial tension affecting EPL

Opponens Pollicis

1. Neurological & Functional Insights

• - Critical for functional opposition of thumb.
• - Key muscle for precision pinch mechanics.
• - Provides rotational component of thumb metacarpal.

2. Clinical Relevance

• - Weakness reduces fine-motor precision.
• - Important in pinch, writing, tool handling.
• - Overuse contributes to thenar fatigue.

3. Origin

• - Flexor retinaculum
• - Trapezium

4. Insertion

• - Lateral side of 1st metacarpal

5. Innervation

• - Median nerve (C8–T1)

6. Actions – Open Kinetic Chain (OKC)

• - Thumb opposition (CMC rotation & flexion)

7. Actions – Closed Kinetic Chain (CKC)

• - Stabilizes thumb during pinch tasks

8. Associated Ligaments

• - Thenar retinacular ligaments

9. Associated Organs

Fascial:

• - Thenar fascia

Viscerosomatic:

• - C8–T1

TCM:

• - Lung meridian region

VM:

• - Thenar fascial tension influencing opposition

Opponens Digiti Minimi

1. Neurological & Functional Insights

• - Controls little finger rotation enabling grasp width.
• - Important for cupping of the palm.
• - Enhances grip stability and hand contouring.

2. Clinical Relevance

• - Weakness reduces grip width and power.
• - Overactivity increases ulnar hand tension.
• - Key stabilizer in tool grip and sports techniques.

3. Origin

• - Hook of hamate
• - Flexor retinaculum

4. Insertion

• - Medial border of 5th metacarpal

5. Innervation

• - Ulnar nerve (C8–T1)

6. Actions – Open Kinetic Chain (OKC)

• - Opposition of little finger
• - CMC rotation

7. Actions – Closed Kinetic Chain (CKC)

• - Stabilizes ulnar side of hand during gripping

8. Associated Ligaments

• - Hypothenar retinacular ligaments

9. Associated Organs

Fascial:

• - Hypothenar fascia

Viscerosomatic:

• - C8–T1

TCM:

• - Heart / Small Intestine meridian

VM:

• - Hypothenar fascial mechanics influencing ODM action

General Finger Extension (Extensor Digitorum)

1. Neurological & Functional Insights

• - Primary extensor of digits 2–5.
• - Coordinates finger extension with wrist positioning.
• - Essential for releasing grip and controlling fine-motor extension.

2. Clinical Relevance

• - Weakness causes poor finger opening and reliance on lumbricals.
• - Extensor overuse common in keyboard and mouse users.
• - Key muscle in handwriting and tool management.

3. Origin

• - Lateral epicondyle

4. Insertion

• - Extensor expansions of digits 2–5

5. Innervation

• - Radial nerve (C7–C8)

6. Actions – Open Kinetic Chain (OKC)

• - Extension of digits 2–5
• - Assists wrist extension

7. Actions – Closed Kinetic Chain (CKC)

• - Stabilizes dorsal hand during loaded extension tasks

8. Associated Ligaments

• - Dorsal hood mechanism

9. Associated Organs

Fascial:

• - Dorsal hand fascia

Viscerosomatic:

• - C7–C8

TCM:

• - Triple Burner / Large Intestine meridian region

VM:

• - Dorsal fascial tension affecting ED glide

General Finger Flexion (Flexor Digitorum Superficialis)

1. Neurological & Functional Insights

• - Primary flexor of digits 2–5 at PIP joints.
• - Provides key gripping force for midrange tasks.
• - Works synergistically with FDP for graded grip control.

2. Clinical Relevance

• - Overuse common in climbers and gripping sports.
• - Weakness reduces precision in pinch and gripping tasks.
• - Important stabilizer for finger flexion under load.

3. Origin

• - Medial epicondyle
• - Ulna coronoid process
• - Radius

4. Insertion

• - Middle phalanges of digits 2–5

5. Innervation

• - Median nerve (C7–T1)

6. Actions – Open Kinetic Chain (OKC)

• - PIP flexion
• - Assists MCP flexion
• - Assists wrist flexion

7. Actions – Closed Kinetic Chain (CKC)

• - Gripping stability during closed-chain hand tasks

8. Associated Ligaments

• - Flexor tendon sheath

9. Associated Organs

Fascial:

• - Flexor fascia

Viscerosomatic:

• - C7–T1

TCM:

• - Pericardium meridian region

VM:

• - Palmar fascial loading affecting FDS recruitment

Flexor Carpi Radialis (Hand Version)

1. Neurological & Functional Insights

• - Key stabilizer for radial side of wrist during fine movements.
• - Supports precision grip mechanics.
• - Coordinates with thumb flexors.

2. Clinical Relevance

• - Overworked in repeated wrist-flexion jobs.
• - Contributes to medial elbow patterns.
• - Weakness reduces wrist stability in handwriting.

3. Origin

• - Medial epicondyle

4. Insertion

• - Base of 2nd metacarpal

5. Innervation

• - Median nerve

6. Actions – Open Kinetic Chain (OKC)

• - Wrist flexion
• - Radial deviation

7. Actions – Closed Kinetic Chain (CKC)

• - Stabilization during pinch and writing

8. Associated Ligaments

• - Flexor retinaculum

9. Associated Organs

Fascial:

• - Anterior wrist fascia

Viscerosomatic:

• - C6–C7

TCM:

• - Pericardium region

VM:

• - Palmar fascial drag altering FCR action

Flexor Carpi Ulnaris (Hand Version)

1. Neurological & Functional Insights

• - Strong flexor stabilizing ulnar wrist column.
• - Essential for power grip and control of wrist alignment.
• - Works with hypothenar muscles during force transmission.

2. Clinical Relevance

• - Tight in throwing athletes.
• - Key muscle involved in medial elbow strain.
• - Weakness destabilizes ulnar hand.

3. Origin

• - Medial epicondyle
• - Ulna

4. Insertion

• - Pisiform
• - Hamate
• - Base of 5th metacarpal

5. Innervation

• - Ulnar nerve

6. Actions – Open Kinetic Chain (OKC)

• - Wrist flexion
• - Ulnar deviation

7. Actions – Closed Kinetic Chain (CKC)

• - Ulnar wrist stabilization in grip

8. Associated Ligaments

• - Pisohamate ligament

9. Associated Organs

Fascial:

• - Ulnar wrist fascia

Viscerosomatic:

• - C8–T1

TCM:

• - Heart / SI meridians

VM:

• - Ulnar fascial tension influencing FCU mechanics

Extensor Carpi Radialis (Longus/Brevis – Hand Version)

1. Neurological & Functional Insights

• - Primary extensor supporting radial wrist stability.
• - Works synergistically with finger extensors.
• - Essential for lifting, typing, and precision tool use.

2. Clinical Relevance

• - Highly involved in lateral elbow pain.
• - Weakness reduces grip and wrist endurance.
• - Overused in racquet sports and computer work.

3. Origin

• - Lateral epicondyle
• - Lateral supracondylar ridge

4. Insertion

• - Base of 2nd & 3rd metacarpals

5. Innervation

• - Radial nerve

6. Actions – Open Kinetic Chain (OKC)

• - Wrist extension
• - Radial deviation

7. Actions – Closed Kinetic Chain (CKC)

• - Dorsal wrist stability under load

8. Associated Ligaments

• - Dorsal wrist capsule

9. Associated Organs

Fascial:

• - Dorsal radial fascia

Viscerosomatic:

• - C6–C7

TCM:

• - Large Intestine

VM:

• - Dorsal fascial tension affecting ECR

Extensor Carpi Ulnaris (Hand Version)

1. Neurological & Functional Insights

• - Stabilizer of ulnar wrist during flexion and extension.
• - Critical in forceful gripping and throwing.
• - Controls ulnar deviation and rotational balance.

2. Clinical Relevance

• - ECU sheath instability causes snapping wrist.
• - Common source of ulnar-sided wrist pain.
• - Weakness reduces grip stability.

3. Origin

• - Lateral epicondyle
• - Posterior ulna

4. Insertion

• - Base of 5th metacarpal

5. Innervation

• - Radial nerve (C7–C8)

6. Actions – Open Kinetic Chain (OKC)

• - Wrist extension
• - Ulnar deviation

7. Actions – Closed Kinetic Chain (CKC)

• - Stabilizes ulnar column during gripping

8. Associated Ligaments

• - TFCC region

9. Associated Organs

Fascial:

• - Dorsal ulnar fascia

Viscerosomatic:

• - C7–C8

TCM:

• - Triple Burner

VM:

• - Dorsal–ulnar fascial tension influencing ECU glide

MASTER REFERENCES – Wrist & Hand Module

- Gray’s Anatomy: The Anatomical Basis of Clinical Practice.

- Netter FH. Atlas of Human Anatomy.

- Kendall FP. Muscles: Testing and Function.

- Neumann DA. Kinesiology of the Musculoskeletal System.

- Blumenfeld H. Neuroanatomy Through Clinical Cases.

- Barral JP. Visceral Manipulation Volumes 1–2.

- Deadman P. A Manual of Acupuncture.

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