Wrist & Hand

  1. Thumb MCP flexion-ext
    0-50 degrees
  2. Capsular pattern: equal restrictions of flex-ext
    Finger MCP's
  3. Finger PIP/ DIP capsular pattern:
    equal restrictions of flex-ext
  4. Thumb IP flexion-ext
    0-80 degrees
  5. Thumb CMC abd-add
    0-70 degrees
  6. Thumb CMC flexion
    0-15 degrees
  7. Thumb CMC extension
    0-50 degrees
  8. Finger MCP flexion 0-__ degrees
    90
  9. Finger MCP extension 0-__ degrees
    45
  10. Finger MCP abd-add 0-__ degrees
    20
  11. Finger PIP flex-ext 0-___ degrees
    100
  12. Finger ___ flex-ext 0-90 degrees
    DIP
  13. Wrist Flexion 0-__degrees
    80
  14. Extension 0-70 degrees
    Wrist
  15. Radial deviation 0-__ degrees
    20
  16. Ulnar deviation 0-__ degrees
    30
  17. ___________ Joint: distal radius and radioulnar articular disc proximally; scaphoid, lunate, pisiform, and triquetrium distally
    Radiocarpal
  18. Midcarpal Joint: (Include)
    scaphoid, lunate, and triquetrium proximally; trapezium, trapezoid, capitate, and hamate distally
  19. –2 degrees of freedom: flexion-extension and radial-ulnar deviation
    • –Both joints contribute to these motions
    • Radiocarpal and midcarpal joints Osteokinematics
  20. Capsular pattern: equal limitation of flexion and extension and slight limitation of radial and ulnar deviation
    Radiocarpal and midcarpal joints
  21. Interphalangeal joint (IP)
    Thumb
  22. CMC
    Thumb: Carpometacarpal joint
  23. Proximal and Distal Interphalangeal joints (PIP and DIP)
    Fingers
  24. Finger MCP anatomy: ______ metacarpal and ______ base of proximal phalanx
    convex; concave
  25. 2 degrees of freedom; permits movement of flexion-extension and abduction-adduction
    Finger MCP osteokinematics
  26. ABD-ADD limited when MCPs in flexion
    Finger MCP osteokinematics
  27. Finger MCP arthrokinematics: _____phalanx glides over _____ metacarpal in ____ direction as shaft of phalanx
    concave; convex; same
  28. Distal moving on proximal row
    Finger MCP osteokinematics
  29. Each phalanx has concave base and convex head
    PIP and DIP anatomy
  30. Finger PIP/DIP osteokinematics
    Synovial hinge joints with 1 degree of freedom: flexion-extension
  31. Finger PIP/DIP arthrokinematics: sliding of concave base of distal phalanx on convex head of proximal phalanx in the ______ direction.
    same
  32. Anatomy: articulation between trapezium and base of first metacarpal
    Thumb CMC joint
  33. Osteokinematics:
    • –Saddle joint with 2 degrees of freedom
    • –Flexion-extension and abduction-adduction
    • Thumb CMC joint
  34. CMC joint arthrokinematics: concave first metacarpal slides on convex portion of __________ in ______ direction as metacarpal shaft during flex-ext. During abd-add there is a _____ in the ________ direction
    • trapezium; same
    • slide; opposite
  35. Capsular pattern: limitation of abduction and extension
    Thumb CMC joint
  36. During thumb CMC joint flex/ext, movement occurs in the __________ plane.
    frontal
  37. During thumb CMC joint ABD/Add, movement occurs in the __________ plane.
    sagittal
  38. Anatomy: articulation between convex head of first metacarpal and concave base of first proximal phalanx
    Thumb MCP joint
  39. Osteokinematics:
    • –Condyloid joint with 2 degrees of freedom
    • –Flexion-extension and minimal abduction-adduction
    • Thumb MCP joint
  40. Capsular pattern: restriction of motions in all directions but flexion more limited than extension
    Thumb MCP joint
  41. Thumb MCP joint arthrokinematics: concave base of first phalanx glides on convex head of first metacarpal in the _____ direction as the shaft
    same
  42. Osteokinematics:
    • –Synovial hinge joints with 1 degree of freedom: flexion-extension
    • Thumb IP joint
  43. Thumb IP joint Anatomy:
    identical to IP joint of fingers
  44. Capsular pattern: equal restrictions of flex-ext
    Thumb IP joint
  45. Thumb IP joint arthrokinematics: gliding of concave base of ________ phalanx on convex head of _______ phalanx, in the same direction as the shaft of the bone. Same as 2-5.
    distal; proximal
  46. ROM: WRIST FLEXION/EXTENSION TEST POSITION
    sitting next to supporting surface, shld ABD 90, elbow flex 90, forearm between supination and pronation, palm facing down
  47. ROM: WRIST FLEXION/EXTENSION STABILIZATION
    at radius and ulna
  48. ROM: WRIST FLEXION/EXTENSION GONIO ALIGNMENT
    • –Axis: lateral aspect of wrist over triquetrium
    • –Prox arm: lateral midline of ulna, using olecranon and ulnar styloid process for reference
    • –Dist arm: lateral midline of 5thmetacarpal-DO NOT use soft tissue as reference
  49. ROM: WRIST FLEXION/EXTENSION END FEEL
    FIRM
  50. ROM: WRIST RADIAL/ULNAR DEVIATION TEST POSITION
    sitting next to supporting surface with shld ABD 90, elbow flex 90, palm faces towards surface (table)
  51. ROM: WRIST RADIAL/ULNAR DEVIATION STABILIZATION
    at radius and ulna
  52. ROM: WRIST RADIAL/ULNAR DEVIATION GONIO ALIGNMENT
    • –Axis: dorsal aspect of wrist over capitate
    • –Prox arm: dorsal midline of forearm (lateral epidcondyle of humerus if 90 shld ABD and 90 elbow flex)
    • –Dist arm: dorsal midline of 3rdmetacarpal-DO NOT use 3rdphalanx as reference
  53. ROM: WRIST RADIAL/ULNAR DEVIATION END FEEL
    HARD
  54. MCP flexion end feel during ROM testing
    Hard or firm
  55. Alignment:
    • –Axis: dorsal aspect of MCP joint
    • –Prox arm: dorsal midline of metacarpal
    • –Dist arm: dorsal midline of proximal phalanx
    • Measuring MCP flexion and ext
  56. MCP flexion stabilization
    metacarpals to prevent wrist motion-DO NOT hold other fingers in extension
  57. Test Position: sitting with forearm resting on supporting surface, 0 degrees of supination/pronation, ext/flex, rad/ulnar dev, and MCPs in neutral position
    ROM MCP flexion and ext
  58. ROM MCP extension end feel
    firm
  59. Stabilization: at metacarpal to prevent wrist motion
    ROM MCP ext
  60. ROM: MCP ABD Alignment:
    • –Axis: over dorsal aspect of MCP joint
    • –Prox arm: ______ ______ __ ________
    • –Dist arm: dorsal midline of proximal phalanx
    • dorsal midline of metacarpal
  61. ROM: MCP ABD test position
    sitting with forearm resting on supporting surface, fully pronated, MCPs in 0 degrees extension and flexion
  62. Stabilization: at metacarpals to prevent wrist motion
    ROM: MCP ABD
  63. ROM: PIP Flexion
    • •Test Position:
    • •Stabilization: proximal phalanx to prevent motion of wrist and MCP joint
    • •Alignment:
    • –Axis:
    • –Prox arm: over dorsal midline of proximal phalanx
    • –Dist arm: over dorsal midline of middle phalanx
    • •End Feel:
    • Position: sitting with forearm and hand resting on table, all joints in neutral/0 degrees
    • Axis: over dorsal aspect of PIP joint
    • End Feel: usually hard
  64. ROM: PIP EXT
    • •Test Position:
    • •Stabilization: proximal phalanx to prevent motion of wrist and MCP joint
    • •Alignment:
    • –Axis:
    • –Prox arm: over dorsal midline of proximal phalanx
    • –Dist arm: over dorsal midline of middle phalanx
    • •End Feel:
    • Position: sitting with forearm and hand resting on table, all joints in neutral/0 degrees
    • Axis: over dorsal aspect of PIP joint
    • End Feel: firm
  65. Test Position: sitting with forearm and hand resting on table, all joints in neutral/0 degrees, plus PIP joint in about 70-90 degrees flexion
    ROM: DIP FLEXION and EXT
  66. ROM: DIP FLEXION end feel
    firm
  67. Alignment:
    • –Axis: over dorsal aspect of DIP joint
    • –Prox arm: over dorsal midline of middle phalanx
    • –Dist arm: dorsal midline of distal phalanx
    • ROM: DIP FLEXION and EXT
  68. Stabilization: at middle and proximal phalanx to prevent further flexion of wrist, MCP, and PIP joints
    ROM: DIP FLEXION and EXT
  69. ROM: DIP EXTENSION END FEEL
    firm
  70. ROM: THUMB CMC FLEXION pt position
    forearm and hand supported in full supination, wrist neutral, CMC in 0°of ABD. Fingers and thumb relaxed
  71. End feel: may be soft due to soft tissue approximation, firm due to tension in the capsule and EPB and AbPB muscles
    ROM: THUMB CMC FLEXION
  72. Stabilization for ROM Thumb CMC Flexion/Extension:
    prevent wrist motion
  73. Thumb CMC Flexion/Extension: Goniometer alignment
    • Axis: over palmar aspect of CMC joint
    • Stationary arm: over ventral midline of radius using radial head and radial styloid process for references
    • Moving arm: ventral midline of the 1stMC
  74. Test: extend the CMC joint by pushing in the palmar surface of the MC moving the thumb toward the radial side of the hand
    ROM: Thumb CMC Extension
  75. End Feel: firm from tension in capsule and FPB, AddP, OP, and 1stdorsal interossei muscle
    ROM: Thumb CMC Extension
  76. ROM: THUMB CMC ABDUCTION/ADDUCTION
    • •Test Position:
    • forearm supported on table in mid position, wrist neutral, all thumb joints neutral
  77. End Feel: firm from tension in the fascia and skin of the web space as well as AdPB and 1stdorsal interossei
    ROM: THUMB CMC ABDUCTION/ADDUCTION
  78. ROM: THUMB CMC ABDUCTION/ADDUCTION goniometer alignment:
    • Axis
    • over lateral aspect of radial styloid process
  79. ROM: THUMB CMC ABDUCTION/ADDUCTION goniometer alignment:
    • Proximal arm
    • lateral midline of 2ndMC, using midline of 2ndMCP for reference
  80. ROM: THUMB CMC ABDUCTION/ADDUCTION goniometer alignment:
    • Distal arm
    • lateral midline of 1stMC, using center of 1stMCP joint as reference
  81. •Test: move the 1stMC away from the palm of the hand toward the little finger, allowing the 5thMC to move toward the thumb
    • •Alignment: use the ruler end of the goniometer to measure the distance between the tip of the thumb and the tip of the 5thfinger, or the tip of the thumb and the palm or the base of the 5thfinger
    • •End Feel: soft from soft tissue approximation, firm from tension in the capsule, fascia and muscles and skin
    • ROM: THUMB CMC OPPOSITION
  82. End Feel: soft from soft tissue approximation, firm from tension in the capsule, fascia and muscles and skin
    ROM: THUMB CMC OPPOSITION
  83. ROM: THUMB MCP FLEXION/EXTENSION:
    • Test Position:
    • supported forearm and hand in full supination, wrist neutral, fingers neutral
  84. ROM: THUMB MCP FLEXION/EXTENSION Goniometer Alignment:
    • –Axis:
    • –Prox arm:
    • –Dist arm:
    • –Axis: dorsal aspect of MCP joint
    • –Prox arm: dorsal midline of the metacarpal
    • –Dist arm: dorsal midline of proximal phalanx
  85. End Feel:
    • –Flex: hard (prox phalanx and 1stmetacarpal) or firm (tension on joint capsule, collatoral ligaments, EPB muscle)
    • –Ext: firm (tension in jt capsule, palmer plate, cruciate ligaments, FPB muscle)
    • ROM:THUMB MCP FLEXION/EXTENSION
  86. End Feel:
    • –Flex: usually firm (collateral ligaments, joint capsule), sometimes hard (distal phalanx, prox phalanx)
    • –Ext: firm (tension in joint capsule, palmer ligament)
    • ROM: THUMB IP FLEXION/EXTENSION
  87. Alignment:
    • –Axis: over dorsal aspect of IP joint
    • –Prox arm: dorsal midline of proximal phalanx
    • –Dist arm: dorsal midline of distal phalanx
    • ROM: THUMB IP FLEXION/EXTENSION
  88. Test Position: supported forearm and hand in full supination, wrist neutral, fingers neutral
    • Stabilization: at proximal phalanx to prevent flexion or extension of MCP joint
    • ROM: THUMB IP FLEXION/EXTENSION
Author
ALMitrchell05
ID
328351
Card Set
Wrist & Hand
Description
ROM, Gonio,
Updated