Wrist Flexion

I. Description of Motion

The motion of wrist flexion occurs in the sagittal plane with a frontal axis of rotation through the center of the capitate.1 At the radiocarpal joint, wrist flexion occurs as the convex surface of the lunate rolls ventrally on the radius and simultaneously slides dorsally.2 At the midcarpal joint, the head of the capitate rolls ventrally on the lunate and simultaneously slides in a dorsal direction.2

The median and ulnar nerves innervate all muscles that cross the palmar side of the wrist, including primary wrist flexors.2 Spinal nerve root levels C6-C8 innervate the primary muscles and levels C7-T1 innervate the secondary muscles.2

Primary Muscles (Act on Wrist Only):2

  • Flexor carpi radialis
  • Flexor carpi ulnaris
  • Palmaris longus

Secondary Muscles (Act on Wrist and Hand):2

  • Flexor digitorum profundus
  • Flexor digitorum superficialis
  • Flexor pollicis longus
  • Abductor pollicis longus
  • Extensor pollicis brevis

II. Mobilizing – Increasing Range of Motion:

Seated wrist flexion table stretch:

  • Start seated in a chair, with the involved forearm on a table, palm side up.
  • The hand and wrist are protruded past the table.
  • Use the other hand to apply a downward push to bend the wrist until a gentle stretch is felt on top of the forearm.
  • Hold 30 seconds and repeat 3 repetitions, twice per day.

Standing table stretch:

  • Stand with the palms of your hands on a table, fingers pointing away from your body and elbows straight.
  • Lean towards the table until a gentle stretch is felt in the forearm.
  • Hold 30 seconds and repeat 3 repetitions, twice per day.

Standing wall stretch:

  • Stand facing a wall with your arms outstretched and palms facing up.
  • Place your fingers on the wall pointing downwards.
  • Slowly try to place your whole hand flat on the wall while keeping elbows straight.
  • Hold 30 seconds and repeat 3 repetitions, twice per day.

III. Indications for Stretching:

Normal wrist flexion range of motion is 80 degrees with a firm end feel.3 Possible muscle limitations may include passive tension in the extrinsic finger extensors.3 Passive tension in the dorsal radio carpal ligaments may also limit wrist flexion range of motion.3

Medial epicondylitis is a condition characterized by pathologic changes to the musculotendonous origin at the medial epicondyle.4 The majority of the literature on epicondylitis suggests that the disorder’s primary etiology is a repetitive stress or overuse of the flexor-pronator musculature.4 Degenerative changes in the musculotendonous region of the medial epicondyle are the result of chronic repetitive concentric and eccentric contractile loading of the flexor-pronator group.4 Most often such changes are seen in the pronator teres and the flexor carpi radialis muscles, although larger diffuse tears can occur in the palmaris longus, flexor digitorum superficialis, and flexor carpi ulnaris.4 More information about treatment can be found here:


IV. Strengthening:

Seated Grip Squeeze:

  • Start seated in a chair with the involved forearm on a table.
  • Squeeze the stress ball with all fingers to make a fist. Slowly release grip.
  • Repeat 3 sets of 10. Once per day.
  • To progress, hold 10 seconds, then slowly release grip.

Theraband wrist curls:

  • Start seated in a chair.
  • Stabilize one end of the theraband loop under your foot.
  • Grasp the other end in your hand with your palm up and forearm resting on your thigh.
  • Bend the wrist upwards against the band.
  • Hold and slowly return.
  • Perform 3 sets of 10, once per day.
  • To progress, increase theraband resistance.

Seated wrist curls:

  • Start seated in a chair with the involved forearm on a table, palm side up.
  • The wrist is just past the edge of the table.
  • Bend the wrist upwards, then slowly lower it and return to starting position.
  • Perform 3 sets of 10. Once per day.
  • To progress, hold a dumbbell in the hand.

V. Potential Clinical Syndromes or Etiologies:

These techniques are ideal for any post-surgical procedures of the wrist and hand, especially carpal tunnel release, due to the lack of mobility of the median nerve through the carpal tunnel. More information on carpal tunnel syndrome can be found here:


VI. Additional Web Based Resources:

Wrist arthritis:

Carpal tunnel syndrome:

VII. References

1. Chai HM. Kinematics of the wrist. http://aptsaweb.org/hmchai/Kinesiology/KINupper/KINwrist.htm. Published September 18, 2002. Updated October 19, 2008. Accessed November 25, 2014.
2. Neumann DA. Wrist. In Neumann DA: Kinesiology of the Musculoskeletal System: Foundations for Rehabilitation. 2nd ed. St. Louis, MO: Mosby/Elsevier; 2010:216-236.
3. Bandy WD, Reese NB. Joint Range of Motion and Muscle Length Testing. 2nd ed. St. Louis, MO: Saunders Elsevier; 2010:99-107.
4. Ciccotti MC, Ciccotti MG, Schwartz MA. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med; 2004: 693-705. http://www.med.nyu.edu/pmr/residency/resources/Clinics_sports%20med/clinics%20NA%20sports_medial%20epicondylitis.pdf. Accessed December 3, 2014.

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