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Muscle Test and Tendon Exam: Flexor Carpi Radialis (FCR)

Exams and Signs
Origin:Humerus (medial epicondyle via common flexor tendon)
Antebrachial fascia
Intermuscular septum
Insertion:2nd and 3rd metacarpals (base, palmar surface)
Innervation:Cervical root(s):  C6–C7
Nerve: median nerve

 

Grading of muscle strength:

Grade

Strength

Description

  5*

Normal

Normal strength

  4*

Good

Movement against external resistance but less than normal

3

Fair

Movement against gravity but not against added resistance

2

Poor

Movement at the joint with gravity eliminated

1

Trace

Trace of contraction but no movement at the joint

0

Zero

No contraction or muscle movement
*The distinction between Grades 4 and 5 is based on comparison with the normal hand and, barring that, extensive experience in testing the hand.

Position of patient's hand and upper extremity

  • Forearm is supinated; wrist is in neutral position or slightly extended. 

Examiner’s Actions

  • One hand supports the patient’s forearm under the wrist.

Instructions for the patient

  • “Bend your wrist. Hold it. Don’t let me pull it down. Keep your fingers relaxed.”
Presentation Photos and Related Diagrams
  • Testing Flexor Carpi Radialis muscle and tendon.
    Testing Flexor Carpi Radialis muscle and tendon.
  • FCR anatomy illustration
    FCR anatomy illustration
  • This illustration represents the anatomy of the muscle and tendon origin and insertion. Should an individual sustain a laceration as depicted, the observer can assume that the underlying tendon may be at risk for complete transection. A proper examination is needed to determine the integrity of the tendon.
    This illustration represents the anatomy of the muscle and tendon origin and insertion. Should an individual sustain a laceration as depicted, the observer can assume that the underlying tendon may be at risk for complete transection. A proper examination is needed to determine the integrity of the tendon.
Definition of Positive Result
  • In muscle testing, a normal result is a positive one. During a normal muscle test, the examiner should observe a normal muscle contraction that can move the joint or tendon against full resistance.
Definition of Negative Result
  • In muscle testing, an abnormal result is a negative one. During an abnormal muscle test, the examiner should observe an abnormal muscle contraction that can move the joint or tendon. In a complete denervation injury, such as a complete nerve laceration, there will be no evidence of any muscle function, and the muscle testing grade will be 0.
Comments and Pearls
  • To test the two wrist flexors separately, hold the forearm so that the wrist does not lie on the table and ask the patient to perform the flexion motion while the wrist is in the ulnar and then radial deviations.
Diagnoses Associated with Exams and Signs
References
  1. Hislop JH, Avers D, Brown M. Daniels and Worthingham's Muscle Testing, Techniques of Manual Examination and Performance Testing. 9th ed. St. Louis, Missouri: Elsevier Saunders, 2014, pp. 138–202.
  2. Kendall FP, McCreary EK, Provance PG. Muscles Testing and Function. 4th ed. Baltimore, MD: Williams & Wilkins, 1993, pp. 235–298.
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