This topic include PNF upper extremity diagonal patterns with detailed explanations of D1 and D2 flexion and extension, movement sequences, techniques and rehabilitation applications.
D1 Flexion (Flexion–Adduction–External Rotation)
Starting Position on right arm
Shoulder: Extension, Abduction, Internal Rotation
Elbow: Extension
Forearm: Pronation
Wrist & Fingers: Extension
Hand positioned 8–12 inches away from the hip
Therapist Hand Placement
One hand in the patient’s palm (holding fingers)
Other hand on the front (volar surface) of the forearm or at elbow region
Give Verbal Commands to patient
“Squeeze my fingers.” Then “Turn your palm up.” Then say “Pull your arm up and across your face.”
Ending Position
Shoulder: Flexion, Adduction, External Rotation
Elbow: Slight Flexion
Forearm: Supination
Wrist & Fingers: Slight Flexion
Functional Activity for example of ending position
Bringing a spoon or glass to the mouth.
Combing hair on the opposite side.
D1 Extension (Extension–Abduction–Internal Rotation)
Starting Position
Arm across the face
Shoulder: Flexion, Adduction, External Rotation
Elbow: Slight Flexion
Forearm: Supination
Wrist & Fingers: Flexion
Therapist Hand Placement
One hand on the back (dorsal surface) of the hand
Other hand on the back of the arm above the elbow
Verbal Commands first “Open your hand.” Then “Push your arm down and out.”
Ending Position
Shoulder: Extension, Abduction, Internal Rotation
Elbow: Extension
Forearm: Pronation
Wrist & Fingers: Extension
Functional Activity for example of ending position
Reaching down to place an object beside the body.
Putting something into a pocket.
D2 Flexion (Flexion–Abduction–External Rotation)
Starting Position
Shoulder: Extension, Adduction, Internal Rotation
Elbow: Extension
Forearm: Pronation
Wrist & Fingers: Flexion
Forearm resting across the umbilicus
Therapist Hand Placement
One hand on the back of the patient’s hand
Other hand on the back of the forearm near the elbow
Verbal Commands start with “Open your hand.” Then “Turn your hand toward your face.” “Lift your arm up and out.” End with “Point your thumb out.”
Ending Position
Shoulder: Flexion, Abduction, External Rotation
Elbow: Extension
Forearm: Supination
Wrist & Fingers: Extension
Arm 8–10 inches away from the ear
Functional Activity of activity
Drawing a sword.
Reaching overhead to pick up an object.
D2 Extension (Extension–Adduction–Internal Rotation)
Starting Position
Shoulder: Flexion, Abduction, External Rotation
Elbow: Extension
Forearm: Supination
Wrist & Fingers: Extension
Arm positioned 8–10 inches from the ear
Therapist Hand Placement
One hand in the patient’s palm
Other hand on the front (volar surface) of the forearm or distal humerus
Verbal Commands start with “Squeeze my fingers.” Than “Pull down and across your chest.”
Ending Position
Shoulder: Extension, Adduction, Internal Rotation
Elbow: Extension
Forearm: Pronation
Wrist & Fingers: Flexion
Forearm crosses the umbilicus
Functional Activity for pattern
Fastening a seat belt.
Bringing an object from overhead down across the body.
Easy Memory Trick
| Pattern | Movement | Example |
| D1 Flexion | Up and Across | Feeding yourself |
| D1 Extension | Down and Out | Putting hand in pocket |
| D2 Flexion | Up and Out | Drawing a sword |
| D2 Extension | Down and Across | Sheathing a sword / Seat belt movement |
Remember:
- D1 = Across the body
- D2 = Away from the body
- Flexion = Up
- Extension = Down
Click for Lower Extremity Diagonal Patterns
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