Download JointEvalWrist1.doc

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