Let J q (n, m) denote the Grassmann graph with vertex set X and diameter min{m, n − m}. Fix a vertex x ∈ X. Let T = T (x) denote the Terwilliger algebra of J q (n, m) corresponding to x. In this paper we study the structure of T under the assumption that m ≥ 3 and n ≥ 2m. Let U q (sl 2 ) be the quantum enveloping algebra of sl 2 and let q be the q-tetrahedron algebra. We first obtain an action of U q (sl 2 ) on the standard module of J q (n, m). Then we display a C-algebra homomorphism ϑ : U q (sl 2 ) → T and show that T is generated by the image of ϑ and some central elements of T . As an application, we also display an action of q on the standard module of J q (n, m). These results are obtained by using the theory of Leonard pairs.