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Joint Detail Last saved by T.J. Robbins 4/29/2017 Specifically known Metacrapophalangeal as Joint type Condyloid joint Close packed position Extension Loose packed position Flexion Degrees of freedom 20-80 degrees Bones & specific bony Pisiform, Scaphoid, Scaphoid tubercle, Triquetrum, landmarks Trapezoid, Capitate, Hamate, Lunate, Hamate, Metacarpals 1-5, Metacarpal heads 1-5, Metacarpal bases 1-5, Proximal phalanxes 1-5, Middle phalanxes 2-5, Distal phalanxes 1-5 Specific articulating bony Radius, Ulna, Metacarpals 1-5, Metacarpal heads 1-5, Metacarpal surfaces bases 1-5, Proximal phalanxes 1-5, Middle phalanxes 2-5, Distal phalanxes 1-5 Wrist joint Movement Agonists Motion: Flexion Flexor Carpi Range: Radialis 70-90 degrees Plane: Transverse Axis: Palmaris Frontal Longus Flexor Carpi Ulnaris Muscles Proximal Attachment Anterior surface of the Medial wrist, slightly lateral in epicondyle of line with the second humerus and third metacarpal with resisted flexion and abduction The palmaris longus is Medial absent in either one or epicondyle of both forearms in some humerus people. Anteriormedial and central aspect of the anterior forearm just proximal to the wrist, particularly with slight wrist flexion and opposition of the thumb to the 5th finger Anteromedial surface Medial of the forearm a few epicondyle of inches below the humerus and medial epicondyle of posterior aspect the humerus to just of proximal proximal to the wrist ulna with resisted flexion/adduction Palpation Distal Attachment Second and third metacarpal Joint Stability Anterior Posterior Medial Lateral Innervation Median nerves (C6, C7) Palmaris Median nerve aponeurosis (C6, C7) second, third, fourth, and fifth metacarpals Base of 5th metacarpal (palmar surface), pisiform and hamate 2:43:00 AM Name: Ulnar nerve (C8, T1) Date: Static (ligaments) Palmar ligament; deep transverse metacarpal ligament Collateral ligament; Dynamic (muscles) Flexor carpi ulnaris; palmaris ulnaris; flexor carpi radialis; flexor digitorum superficialis; supinator; flexor pollicis longus; pronator quadratus; flexor digitorum profundus; extensor carpi radialis brevis; extensor carpi radialis longus; abductor pollicis longus; extensor pollicis longus; supinator; extensor pollicis brevis Palmar ligament; collateral Extensor indicis; externsor carpi ulnaris ligament extensor digiti minimi; anconeus Goniometry Manual Muscle Testing Recommend Sitting next to supporting Motion Muscle specific, ed Testing surface. G-H abduction or list ↓ Position 900, Elbow flexed 900, Muscle(s) Forearm in 00 supination-Recommend The patient sits with pronation, resting on ed Testing forearm in supination supporting surface, hand Position and wrist in neutral. free to move. Avoid wrist The therapist stabilizes radial-ulnar flexion & the patient's forearm finger flexion against table with one Stabilization Stabilize radius & ulna to hand and the other hand prevent supination or grasps the patient's pronation hand in a handshake Center Lateral aspect of wrist position. over triquetrum Resistance Resistance is given on Proximal Lateral midline of ulna. Hand the palmar surface of Arm Reference olecranon & Placement the hand in the ulnar styloid process direction of extension. Distal Arm Lateral midline of 5th Patient The patient actively metacarpal Instruction flexes the wrist. Special notes 1 Joint Detail Last saved by T.J. Robbins Flexor digitorum superficialis Motion: Extension Medial Each tendon In depressed area epicondyle of splits and between palmaris lonus humerus attaches to the and flexor carpi ulnaris Ulnar head: sides of middle tendons, particularly medial phalanx of four when making a fist but coronoid fingers on keeping the distal process palmar surface. interphalangeals Radial head: extended and slightly upper 2/3 of resisted wrist flexion; anterior border also on anterior mid of the radius forearm during same just distal to the activity radial tuberosity Flexor Deep to the flexor Proximal ¾ of Base of distal digitorum digitorum superficialis, anterior and phalanges of profundus but on anterior mid medial ulna four fingers forearm while flexing the distal interphalangeal joints in extensions; over the palmar surface of the 2nd, 3rd, 4th, and 5th, metacarpophalangeal joints during finger flexion against resistance Flexor pollicis Middle anterior Base of distal longus surface of the phalanx of the Anterior surface of the radius and the thumb on thumb on the proximal anterior medial palmar surface phalanx, and just border of the lateral to the palmaris ulna just distal longus and medial to to the coronoid the flexor carpi radialis process; on the anterior distal occasionally a forearm especially small head is during active flexion of present the thumb attaching on the interphalangeal joint medial epicondyle of the humerus Agonists Palpation Proximal Distal Attachment Attachment 4/29/2017 2:43:00 AM Median nerve (C7, C8, T1) Median nerve (C8, T1) to 2nd and 3rd fingers; ulnar nerve (C8, T1) to 4th and 5th fingers Median nerve palmar interosseous branch (C8, T1) Innervation Recommend Sitting next to supporting ed Testing surface. G-H abduction Motion or Muscle specific, list ↓ 2 Joint Detail Range: 65-85 degrees Plane: Frontal Axis: Sagittal Last saved by T.J. Robbins 4/29/2017 Extensor carpi Just lateral to the ulnar Lateral Base of fifth Radial nerve ulnaris styloid process and epicondyle of metacarpal on (C6-C8) crossing the humerus and dorsal surface posteromedial wrist, middle ½ of the particularly with wrist posterior border extension/adduction or the ulna Extensor carpi Just proximal to the Lateral Base of 3rd Radial nerve radialis brevis dorsal aspect of the epicondyle of metacarpal on (C6- C7) wrist and humerus dorsal surface approximately 1 cm medial to the radial styloid process, the tendon may be felt during extension and traced to base of 3rd metacarpal, particularly when making a fist; proximally and posteriorly, just medial to the bulk of the brachioradialis Extensor All four fingers Lateral Four tendons to Radial nerve digitorum extended on the epicondyle of bases of the (C6-C8) posterior surface of the humerus middle and distal forearm distal phalanges immediately medial to of four fingers extensor pollicis longus tendon and lateral to the extensor carpi ulnaris and extensor digiti minimi Extensor Dorsal aspect of the Posterior Base of Radial nerve pollicis longus hand to its insertion on surface of lower proximal (C6-C7) the base of the distal middle ulna phalanx of phalanx/ lateral to the thumb on dorsal extensor pollicis longus surface tendon on the dorsal side of the hand to hand to it insertion on the proximal phalanx Extensor carpi Just proximal to the Lower third of Base of second Radial nerve radialis longus dorsal aspect of the lateral metacarpal on (C6, C7) wrist and supracondylar dorsal surface approximately 1 cm ridge of 2:43:00 AM 900, Elbow flexed 900, Muscle(s) Forearm in 00 supination-R commen pronation, resting on ded Testing supporting surface, hand Position free to move. Avoid wrist radial-ulnar flexion & finger flexion Stabilization Stabilize radius & ulna to prevent supination or pronation Center Lateral aspect of wrist over triquetrum Resistance Hand Proximal Lateral midline of ulna. Arm Reference olecranon & Placement ulnar styloid process Patient Distal Arm Lateral midline of 5th Instruction metacarpal Special notes Position The patient sits with forearm in pronation and wrist in neutral. The therapist stabilizes the patient's forearm against table with one hand and the other hand is placed on the dorsal aspect of the patient's hand . Resistance is given on the dorsal surface of the hand in the direction of flexion. The patient actively extends the wrist. 3 Joint Detail Motion: Abduction Range: 15-25 degrees Plane: Frontal Axis: Sagittal Last saved by T.J. Robbins Agonists Extensor carpi radialis brevis Extensor carpi radialis longus Flexor pollicis medial to the radial humerus and styloid process, the lateral tendon may be felt epicondyle of during extension and the humerus traced to base of 3rd metacarpal, particularly when making a fist; proximally and posteriorly, just medial to the bulk of the brachioradialis Palpation Proximal Attachment Just proximal to the Lateral dorsal aspect of the epicondyle of wrist and humerus approximately 1 cm medial to the radial styloid process, the tendon may be felt during extension and traced to base of 3rd metacarpal, particularly when making a fist; proximally and posteriorly, just medial to the bulk of the brachioradialis Just proximal to the Lower third of dorsal aspect of the lateral wrist and supracondylar approximately 1 cm ridge of medial to the radial humerus and styloid process, the lateral tendon may be felt epicondyle of during extension and the humerus traced to base of 3rd metacarpal, particularly when making a fist; proximally and posteriorly, just medial to the bulk of the brachioradialis Anterior surface of the Middle anterior 4/29/2017 Distal Attachment Base of 3rd metacarpal on dorsal surface Innervation Radial nerve (C6- C7) Base of second Radial nerve metacarpal on (C6, C7) dorsal surface Base of distal 2:43:00 AM Recommend Sitting next to supporting Motion ed Testing surface. G-H abd 900, or Position Elbow flexed 900, Muscle Forearm in 00 supination- (s) pronation, resting on Recommen supporting surface, hand ded Testing free to move. Avoid wrist Position radial-ulnar flexion & finger flexion Resistance Stabilization Stabilize distal ends of Hand radius & ulna to prevent Placement proation & supination of forearm & elbow flexion beyond 900 Center Middle of dorsal aspect of wrist over capitate Patient Proximal Dorsal midline of Instruction Arm forearm. Reference lateral Special epicondyle of humerus notes Distal Arm Dorsal midline of 3rd metacarpal. Reference 3rd phalanx Muscle specific, list ↓ The patient sits with forearm in neutral (thumb side up) with hand hanging off table. The therapist stabilizes the forearm against the table with one hand and uses the other hand to apply downward resistance toward wrist adduction. The patient actively abducts the wrist. Median nerve 4 Joint Detail Last saved by T.J. Robbins longus 4/29/2017 2:43:00 AM thumb on the proximal surface of the phalanx of the palmar phalanx, and just radius and the thumb on interosseous lateral to the palmaris anterior medial palmar surface branch (C8, T1) longus and medial to border of the the flexor carpi radialis ulna just distal on the anterior distal to the coronoid forearm especially process; during active flexion of occasionally a the thumb small head is interphalangeal joint present attaching on the medial epicondyle of the humerus Extensor Dorsal aspect of the Posterior Base of Radial nerve pollicis longus hand to its insertion on surface of lower proximal (C6-C7) the base of the distal middle ulna phalanx of phalanx/ lateral to the thumb on dorsal extensor pollicis longus surface tendon on the dorsal side of the hand to hand to it insertion on the proximal phalanx Abductor Lateral aspect of the Posterior aspect Base of 1st Radial nerve pollicis wrist joint just of radius and metacarpal on (C6, C7) proximal to the 1st midshaft of the dorsal surface metacarpal ulna Extensor Just lateral to the Posterior Base of Radial nerve pollicis brevis extensor pollicis longus surface of lower proximal (C6, C7) tendon on the dorsal middle radius phalanx of side of the hand to its thumb on dorsal insertion on the surface proximal phalanx with extension of the thumb carpometacarpal and metacarpophalangeal and flexion of the interphalangeal joints Movement Agonists Motion: Adduction Flexor carpi Range: ulnaris 25-40 Muscles Proximal Attachment Anteromedial surface Medial of the forearm a few epicondyle of Palpation Distal Attachment Base of 5th metacarpal Innervation Ulnar nerve (C8, T1) Goniometry Recommended Sitting next to Testing Position supporting surface. GH abd 900, Elbow flexed 900, Forearm in Manual Muscle Testing Motion or Muscle specific, list ↓ Muscle(s) 5 Joint Detail degrees Plane: Frontal Axis: Sagittal Last saved by T.J. Robbins inches below the medial epicondyle of the humerus to just proximal to the wrist with resisted flexion/adduction Extensor carpi Just lateral to the ulnar ulnaris styloid process and crossing the posteromedial wrist, particularly with wrist extension/adduction 4/29/2017 humerus and (palmar posterior aspect surface), of proximal ulna pisiform and hamate Lateral Base of fifth Radial nerve epicondyle of metacarpal on (C6-C8) humerus and dorsal surface middle ½ of the posterior border or the ulna 2:43:00 AM 00 supinationRecommen pronation, resting on ded Testing supporting surface, Position hand free to move. Avoid wrist radialulnar flexion & finger flexion Stabilization Stabilize distal ends of radius & ulna to prevent proation & supination of forearm & elbow flexion beyond 900 Center Middle of dorsal aspect of wrist over Resistance Hand capitate Placement Proximal Arm Dorsal midline of forearm. Reference lateral epicondyle of humerus Distal Arm Dorsal midline of 3rd metacarpal. Reference 3rd phalanx The patient lies prone with forearm and wrist in neutral (thumb side down). The test arm should slightly hang off the edge of the table. The therapist stabilizes the forearm against the table with one hand and uses other hand to apply downward resistance toward wrist abduction. Patient The patient Instruction actively adducts the wrist. Special notes 6