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To test the supinator muscle, a patient begins in a pronation position and then moves to supination until their palm faces the ceiling. A therapist will apply resistance in the direction of pronation. To test the muscle's grade, the level of resistance is varied from none to a maximum amount. To test for contractile activity, the patient supinates the forearm through a partial range of motion.
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What You'll Learn
- Forearm supination: patient begins in pronation and supinates until palm faces ceiling
- Therapist applies resistance in the direction of pronation
- Grade 1: palpate supinator muscle distal to the head of the radius
- Grade 2: short sitting, shoulder flexed between 45° and 90°, elbow flexed to 90°
- Grades 3-5: short sitting, arm at side, elbow flexed to 90°
Forearm supination: patient begins in pronation and supinates until palm faces ceiling
Forearm supination is an important test to assess the functionality of the supinator muscle in the forearm. The patient begins the test in pronation, which is the position where the palm faces the floor. From this starting point, the patient then rotates their forearm until their palm faces the ceiling. This movement is called supination.
The therapist applies a resistance motion in the direction of pronation. The patient supinates their forearm through a partial range of motion, with the level of resistance depending on the grade being tested. For Grade 3, no resistance is given, Grade 4 has minimum resistance, and Grade 5 has maximum resistance.
The supinator muscle is located distal to the head of the radius on the dorsal aspect of the forearm. During the test, the therapist palpates this muscle to detect contractile activity. If no limb movement is observed but contractile activity is present, the grade is 1. If there is no contractile activity, the grade is 0.
This test is crucial in evaluating the strength and functionality of the supinator muscle, which plays a significant role in forearm rotation and overall upper limb functioning.
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Therapist applies resistance in the direction of pronation
To test the supinator muscle, the patient begins in a pronation position and tries to supinate until their palm faces the ceiling. The therapist then applies resistance in the direction of pronation. This resistance can vary in intensity, depending on the grade being tested for.
For Grade 3, the therapist applies no resistance, whereas for Grade 4, a minimum amount of resistance is applied. For Grade 5, the therapist applies maximum resistance. The patient should then attempt to supinate through a partial range of motion against this resistance.
During the test, the patient's arm is typically flexed to 90 degrees, with the elbow also flexed to 90 degrees. The forearm can be in a neutral position or pronated, depending on the grade being assessed. It is important that the therapist applies resistance gradually and smoothly to prevent injury and ensure accurate results.
The therapist should also be mindful of muscle fatigue, stopping the test if the patient's strength decreases to avoid any potential harm. Clear communication between the therapist and patient is essential to ensure the patient understands what is expected of them during the test.
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Grade 1: palpate supinator muscle distal to the head of the radius
To test Grade 1 contractile activity of the supinator muscle, palpate the muscle distal to the head of the radius on the dorsal aspect of the forearm. No limb movement is expected, but contractile activity should be present. If there is no contractile activity, the grade is 0.
The supinator muscle has a broad origin from the ulna and humerus. The two layers of fibres originate from the supinator crest of the ulna, the lateral epicondyle of the humerus, the radial collateral ligament, and the annular radial ligament. The muscle then wraps around the proximal third of the radius, inserting into the upper third of its lateral, posterior, and anterior surfaces. This anatomy enables the supinator muscle to rotate the radius laterally, producing forearm supination.
The supinator muscle is innervated by the deep branch of the radial nerve, which becomes the posterior interosseous nerve upon exiting the muscle. The radial nerve divides into deep and superficial branches just proximal to the supinator muscle. This can lead to entrapment and compression of the deep branch, potentially resulting in selective paralysis of the muscles served by this nerve.
Supination is a simple movement, such as rotating the hand to grab popcorn from a bowl. For a quick, strong, or forceful supination movement, or when there is resistance, the supinator muscle is assisted by the biceps brachii muscle. The biceps brachii cannot act as a supinator when the forearm is fully extended, so the most powerful supination occurs when the elbow joint is flexed to 90 degrees.
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Grade 2: short sitting, shoulder flexed between 45° and 90°, elbow flexed to 90°
To test the supinator muscle, one of the tests that can be performed is the 'Grade 2' test, which involves a specific positioning of the shoulder and elbow. This test is typically carried out with the individual in a short-sitting position, which means they are upright and leaning forward slightly. Their shoulder should be flexed at a specific angle—imagine drawing a right angle and then cutting the corner off, so the angle is slightly greater than 45 degrees but less than 90 degrees. This position is important to isolate and target the supinator muscle effectively.
With the shoulder in this position, the elbow is then flexed to a 90-degree angle. This elbow flexion ensures that the biceps and brachioradialis muscles are relaxed and do not come into play during the test, allowing for an isolated assessment of the supinator. Maintaining this position, the individual being tested will then be instructed to rotate their forearm so that their palm faces forward or upward, depending on the starting position.
During this forearm supination movement, the tester or clinician will apply resistance. They will do this by pressing down on the individual's hand, creating a force that the person needs to work against. The person being tested will attempt to resist this downward force and hold their forearm in the rotated position for a brief period. This resistance is what isolates and tests the strength of the supinator muscle.
The strength of the supinator can be graded based on the individual's ability to resist the force applied by the tester. If the person can offer minimal resistance, it may indicate a Grade 2 level of strength, which suggests some weakness or impairment in the muscle. A qualified clinician or therapist would then be able to advise on appropriate exercises or treatments to improve the strength and function of the supinator muscle if required.
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Grades 3-5: short sitting, arm at side, elbow flexed to 90°
To test the supinator muscle for Grades 3-5, the patient should be in a short-sitting position, with their arm at their side and their elbow flexed to 90°. The patient's arm should be in a flexed position, with their forearm at a 90° angle to their upper arm.
For Grade 3, the patient begins in the pronation position and supinates until their palm faces the ceiling. The therapist applies no resistance to the patient's movement.
For Grade 4, the therapist applies minimum resistance to the patient's movement. The patient should be able to supinate their forearm through a partial range of motion.
For Grade 5, the therapist applies maximum resistance. To satisfy the 'normal muscle' performance criteria, the patient must be able to move through a complete range of motion (active resistance testing) or maintain an end-point range (break testing) against the maximum resistance.
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Frequently asked questions
The patient should begin in a short sitting position, with their arm at their side and elbow flexed to 90 degrees.
The patient starts in the pronation position and begins to supinate until their palm faces the ceiling. The therapist applies resistance in the direction of pronation.
Grade 3 to 5 involves a short sitting position with the arm at the side and elbow flexed to 90 degrees. Grade 2 involves the same position but with the shoulder flexed between 45 and 90 degrees and the forearm in a neutral position. Grade 1 and 0 are determined by palpating the supinator muscle distal to the head of the radius on the dorsal aspect of the forearm; contractile activity is present but no limb movement.
