Lecture 12, Wrist and Hand Flashcards
The wrist has both ____ and ______ segments
fixed/stable
mobile
Fixed segment consists of
distal row of carpal bones
2nd and 3rd MC
Why is having fixed and mobile segments important?
stability without rigidity
enables the hand to move more discretely
enhances function of digits
Mobile segment makeup
5 phalanges
1st, 4th, 5th MC
Contributions of arches
enable hand to grasp objeects
direct motor skill of fingers and control power of grasp
intrinsic muscles maintain arches
Proximal transverse arch
at distal row of carpals. rigid, very little movement
Distal transverse arch
heads of MC, mobile, allows the palm to flatten & cup
Longitudinal arch
rigid proximally @ CMC and mobile distally for fingers
Conjunct rotation
can be tested by folding and fanning the hand
Tenodesis
passive changes in finger posture
passive finger exntesion occurs when wrist is flexed
finger flexion occurs when wrist is extended
Wrist tenodesis reflects _____ length tension relationships
passive
Active extensor mechanism
stabilization during grip
As the fingers and thumb flex, wrist extensors stabilize the wrist to prevent flexor digitorum superficialis from flexing wrist at the same time
Active flexor mechanism
stabilization during release of grip
During finger and thumb extension, wrist flexors stabilize so that EDC, ext indicus & others can function more efficiently
Key features of thumb
60% of hand function
mobility and force
Index finger features
strength and its interaction with thumb
loss = pinch and power grip
Middle finger
strongest in flexion
important for precision and power grips
Ring finger
least functional role in hand
Little finger
enhances power grips, holds objects, affects capacity of hand
Power grip types
hook
cylinder
fist
spherical
What is a power grip?
clamping object against palm of hand w/partially flexed fingers and adducted thumb
isometric muscle action, fingers are flexed, ER, ulnar deviation
Precision patterns
involve manipulating object that is not in contact with palm
fingers and thumb work in opposition to hold object
input from sensory surfaces, help with fine adjustments
small objects are manipulated btwn index and thumb
Types of precision patterns
pap to pad (holding pencil)
tip to tip (pinch)
pad to lateral prehension (keys)
Combined grips
include pinch where index or middle and thumb hold isometrically and 3-5 supplement with power
What structural and functional impairments would you expect to see related to finger joint hypomobility?
decreased ROM
weakness
adherent tendon sheath
effusion
What would you expect to detect with PROM?
hard end feel, pain with overpressure
caused by tendon adhesion from inflammation
What would you expect to detect with RROM?
decreased muscle performance
OA and post-trauma arthrosis
OA most commonly involves CMC of thumb, DIPs
trauma can occur at any joint
PIP joint common articular fracture site resulting in degeneration
be mindful of fractures that might not appear on x-ray
Ulnar drift
rupture of collateral ligaments at MCP resulting bowstringing of tendons
caused by subluxation of proximal phalanges
Swan neck deformity
hyperextension of PIP and flexion of DIP
Boutonniere deformity
PIP flexion and DIP extension
Z deformity of thumb
MCP dislocation of thumb with swan or boutonniere deformity
What is the diagnostic gold standard for RA?
lab tests for inflammatory markers
medical treatment to slow deformity
Work with CHT to provide splinting for joint protection
Acute stage of Finger hypomobility
control pain and protect joints
patient education (joint protection)
pain management (gd 1 distractions)
splinting
conserve energy (w/RA)
Goals of acute phase
maintain joint and tendon mobility and muscle integrity
Interventions for finger hypomobility, post trauma
passive, assistive, active ROM
tendon-gliding exercises to prevent adhesions
multiple angle muscle setting exercises
Return to function phases interventions
increase joint play and accessory motions –> joint mob
improve joint tracking and pain free motion –> MWM, tendon blocking
progressive strengthening –> putty, rubber bands
Zone 2
FDP and FDS share the same tendon sheath up to this point
