Dominic Stone
The brachioradialis is the most superficial muscle on the radial side of the forearm, forming the lateral side of the cubital fossa. It is also known as supinator longus. Due to its location in the posterior compartment of the forearm, the brachioradialis is innervated by the radial nerve. Testing the brachioradialis reflex involves placing the patient in a seated position and supporting their forearm in a slightly pronated position. The physician then delivers a series of quick taps to the area of the styloid process of the radius at the point of brachioradialis insertion. The interpretation of the test depends on the muscle movement observed, with a negative test producing flexion and supination of the forearm, and a positive test indicated by finger flexion or slight elbow extension.
| Characteristics | Values |
|---|---|
| Muscle Type | Most superficial muscle on the radial side of the forearm |
| Location | Posterior compartment of the forearm |
| Innervation | C5-C6 nerve roots, radial nerve |
| Blood Supply | Radial recurrent artery |
| Action | Flexes the forearm at the elbow, supination and pronation of the forearm |
| Testing Method | Patient seated with forearm supported and slightly pronated, physician delivers quick hits to the styloid process of the radius |
| Test Result Interpretation | Negative test: forearm flexion and supination, Positive test: finger flexion or slight elbow extension |
| Associated Reflexes | Biceps, jaw jerk |
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What You'll Learn
Manual muscle testing (MMT)
When performing MMT for the brachioradialis muscle, the therapist typically focuses on the three main elbow flexors: the biceps, brachialis, and brachioradialis. The patient is asked to bend their elbow against resistance, with the wrist flexor muscles remaining relaxed, as strong contraction of these muscles may assist in elbow flexion. The forearm should be in a midposition, and the patient can be in a supine, sitting, or standing position. The therapist then slowly begins to bend the forearm, providing resistance in any suitable form, such as dumbbells, sand packs, or a theraband.
To stretch the brachioradialis muscle, the therapist extends the patient's elbow, interlacing their fingers with the patient's and using the other hand to flex the wrist of the affected arm, rotating it inward so that the patient's hand is facing outwards.
For elbow extension, the patient is seated with their arm on a table, shoulder at 90 degrees, and elbow fully flexed. The therapist applies resistance to the patient's wrist or hand, depending on the grade being tested. For grades 3 and 4, the therapist provides slight to moderate resistance as the patient attempts to extend their elbow.
The therapist's position and the amount of resistance provided depend on the grade being tested and the specific muscle being evaluated. It is important for the therapist to maintain proper body mechanics and avoid excessive force during the test to prevent injury to both the patient and themselves.
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Patient positioning
To test the brachioradialis muscle, the patient can be in a supine, sitting, or standing position. The patient's hand should be in a neutral position, like holding a cup, or with the palm facing sideways, like in a handshake. This position isolates the brachioradialis muscle and reduces assistance from other muscles, such as the wrist flexors, during the test.
For seated testing, the patient's arm should be at their side with the forearm in a mid-position between pronation and supination. The therapist should stand in front of the patient, facing the test side. The therapist's hand will apply resistance, contouring over the volar (flexor) surface of the forearm, just proximal to the wrist. Their other hand will be placed on the anterior surface of the patient's upper arm to apply a counterforce and resist any upper arm movement.
For supine testing, the patient lies on their back with their forearm in the midposition. The therapist will slowly initiate bending with any suitable type and degree of resistance, such as dumbbells, sand packs, or a theraband. The patient's wrist flexor muscles should remain relaxed throughout the test to ensure that the brachioradialis muscle is properly isolated.
The patient can also be in a standing position for the test. To stretch the brachioradialis muscle, the patient extends their elbow and interlaces the fingers of both hands. Using the opposite hand, the patient then flexes the wrist of the affected arm and inwardly rotates the arm so that the palm is facing outwards.
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Therapist positioning
Grade 5 (Normal Muscle):
The therapist stands or sits facing the patient, providing resistance at the end of the patient's full range of motion. Their hands are positioned just above the patient's wrist, with the patient's palm facing up and their arm fully extended.
Grade 4:
The therapist can be seated or standing, providing resistance midway through the patient's range of motion. Their hands are placed just above the patient's wrist, with the patient's palm facing up and their arm flexed to 90 degrees.
Grade 3:
The therapist provides resistance at the beginning of the patient's range of motion, with their hands positioned just above the patient's elbow. The patient's palm faces down, and their arm is flexed to 45 degrees.
Grade 2:
Similar to Grade 3, the therapist provides resistance at the beginning of the range of motion, supporting the patient's arm. Their hands are positioned just above the patient's elbow. The patient's palm faces down, and their arm is flexed to 45 degrees.
Grades 0-1:
For these grades, the therapist may need to adjust their position. They should be positioned at the side of the patient, supporting their arm. The patient is usually in a supine position, with their arm supported and in a comfortable, gravity-minimum position.
It is important for therapists to maintain proper body mechanics and avoid excessive force during the test to prevent potential injuries to both themselves and the patient. The therapist's role is to facilitate the patient's movement and provide resistance at the appropriate points, ensuring accurate assessment of the muscle's strength and function.
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Deep tendon reflexes
To test the brachioradialis reflex, the examiner positions the patient in a seated posture. The clinician then uses their forearm to support the patient's forearm in a slightly pronated position. This ensures relaxation of the muscle by removing the need for the patient to maintain the position. Once the patient is in position, the examiner delivers a series of quick taps to the area of the styloid process of the radius at the point of brachioradialis insertion.
The interpretation of the test depends on the observed muscle movement. Striking the muscle-tendon should result in forearm flexion and supination, indicating a negative test. A positive test is indicated by either finger flexion or slight elbow extension. If the test is positive due to finger flexion, it suggests a hyperactive finger jerk reflex.
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Elbow flexion
The Elbow Flexion Test is a neurological test used to determine if a patient has cubital tunnel syndrome (ulnar nerve). To perform the test, the patient is placed in a standing or sitting position and asked to actively flex their elbow fully while extending the wrist, and abducting and depressing their shoulder girdle at 90 degrees. The patient must hold this position for up to 3 to 5 minutes. A positive result is indicated by a feeling of numbness and/or tingling in the ulnar nerve root distribution area, although pain may also be present in other areas.
The Manual Muscle Testing (MMT) procedure is another way to test the brachioradialis muscle. This test is usually done for the three main elbow flexors (biceps, brachialis, and brachioradialis) by asking the patient to bend their elbow against resistance. To focus on the brachioradialis, the patient will be asked to bend their forearm with some degree of pronation (midposition). It is important that the wrist flexor muscles remain relaxed throughout the test, as strong contraction of the wrist flexors may assist in elbow flexion. The patient can be in a supine, sitting, or standing position. From this position, the patient slowly starts bending with any suitable type and degree of resistance given by the therapist, such as dumbbells, sand packs, or a theraband.
To test for a hyperactive reflex in the brachioradialis muscle, the patient is placed in a seated position. The clinician uses their forearm to support the patient's forearm in a slightly pronated position. The physician supports the patient's forearm to achieve relaxation of the muscle. The physician then delivers a series of quick taps to the area of the styloid process of the radius at the point of brachioradialis insertion. A negative test result is produced when the striking of the muscle-tendon causes flexion and supination of the forearm. A positive test result is indicated by either finger flexion or slight elbow extension.
The Elbow Flexion Test has been found to be a useful, reliable, and provocative test for patients with cubital tunnel syndrome. However, it has been shown to have less sensitivity than the shoulder internal rotation test.
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