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DR NEETI CHRISTIAN (PT)
MPT (Musculoskeletal & Sports)
1
 The wrist is the distal joint of the upper limb
and allows the hand to assume the optimal
position for prehension.
DR NEETI CHRISTIAN (PT) 2
 The articular complex of the wrist contain
two joints:
 The radio-carpal joint between the distal
radius and the proximal row of carpal bones.
 The mid-carpal joint between the proximal
and distal rows of carpal bones.
DR NEETI CHRISTIAN (PT) 3
DR NEETI CHRISTIAN (PT) 4

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The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It is formed by the acetabulum of the pelvis articulating with the femoral head. The primary function is to support the weight of the upper body. Key biomechanical aspects include the angles of inclination and torsion of the femur, congruence of the joint surfaces, and forces transmitted during weight bearing that are balanced by the joint capsule and trabecular bone structure. Motion occurs through tilting and rotation of the pelvis on a fixed femur. Surrounding muscles provide dynamic stability and control movement.

 Type of Joint
 Proximal and Distal articulating surfaces
 Basic Anatomy: Capsule
Ligaments
Muscles
 Kinematics: Axis of Motion
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DR NEETI CHRISTIAN (PT) 5
 Radio-carpal joint is an ellipsoidal joint and
the carpal aspect presents two convexities
transverse convexity and antero-posterior
convexity.
DR NEETI CHRISTIAN (PT) 6
 The distal radius has a
single continuous,
biconcave curvature that
is long and shallow side to
side (frontal plane) and
shorter and sharper
anteroposteriorly (sagittal
plane).
DR NEETI CHRISTIAN (PT) 7
DR NEETI CHRISTIAN (PT) 8
 The proximal joint surface is composed of
(1) the lateral radial facet, which
articulates with the scaphoid;
(2) the medial radial facet, which
articulates with the lunate; and
(3) the TFCC, which articulates with the
triquetrum, also with the lunate in the
neutral wrist.

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The document discusses static and dynamic stability of the glenohumeral joint. Statically, the joint is stabilized by the humeral head resting in the glenoid fossa, creating negative pressure. The rotator cuff muscles and deltoid provide a vertical force to counteract gravity. Dynamically, the deltoid, rotator cuff, biceps and scapulohumeral rhythm work together to precisely guide humeral movement and stabilize the joint throughout its range of motion. Scapulohumeral rhythm involves greater scapular movement in the first 90 degrees of arm elevation compared to humeral movement.

DR NEETI CHRISTIAN (PT) 9
•The radiocarpal joint is formed by the radius and radioulnar
disk as part of the triangular fibrocartilage complex (TFCC)
proximally and by the scaphoid, lunate,and triquetrum
distally.
The TFCC consists of the radioulnar disk and the various fibrous
attachments that provide the primary support for the distal
radioulnar joint.
 The radiocarpal joint is enclosed by a strong
but somewhat loose capsule and is reinforced
by capsular and intracapsular ligaments.
DR NEETI CHRISTIAN (PT) 10
The ligaments of the radio-carpal joint are,,,,
1. collateral ligaments (lateral and medial)
2. The anterior ligaments [attached to the
anterior edge of the distal surface of the radius and
neck of the capitates]
3. Posterior ligament [forms a strap posteriorly].
DR NEETI CHRISTIAN (PT) 11
DR NEETI CHRISTIAN (PT) 12
Action of the ligaments:
 During adduction-abduction the medial and
lateral ligaments are active. Starting from
the rest position .
 Adduction  lateral ligament is stretched,
medial slackened
 Abduction  vice versa
 During flexion-extension the anterior and
posterior ligaments are most active.
 Flexion  posterior ligament stretched
 Extension  anterior ligament stretched

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This document discusses strategies to reduce force on the hip joint for individuals with hip osteoarthritis or weak hip abductor muscles. It analyzes using a lateral lean, cane on the same side, or cane on the opposite side. A lateral lean reduces gravitational torque but increases energy expenditure. A cane on the same side provides some relief but a cane on the opposite side may offset gravity's torque, reducing the need for abductor muscle force and joint compression to just body weight. However, the full distance between hand and hip may overestimate the cane's effectiveness.

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Here are potential answers to your questions: If you fall down to the ground with wrist hyperextension, you could injure the ligaments and bones in your wrist. The most common injuries are: - Ligament sprains of the dorsal radiocarpal ligaments which stabilize the wrist in extension. A sprain means the ligament is stretched or torn. - Fractures of the distal radius bone. Since the wrist bone is forcefully hyperextended, it can fracture at the end of the radius bone near the wrist joint. Instability generally refers to a lack of stability in a joint. In the wrist, instability means the bones and ligaments can no longer properly control and

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 Wrist Flexion: Flexor Carpi Ulnaris
Flexor Carpi Radialis
Palmaris Longus
 Wrist Extension:
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris
DR NEETI CHRISTIAN (PT) 13
 Radial Deviation: Flexor Carpi Radialis
Extensor Carpi Radialis Longus
 Ulnar Deviation: Flexor Carpi Ulnaris
Extensor Carpi Ulnaris
DR NEETI CHRISTIAN (PT) 14
 The articular complex of the wrist has
basically two degree of freedom.
DR NEETI CHRISTIAN (PT) 15
 Transverse axis takes place in the sagittal
plane with movement:
 Flexion the anterior palmar surface of the
hand moves towards the anterior aspect of
the forearm
 Extension the posterior dorsal surface of
the hand moves towards the posterior aspect
of the forearm.
DR NEETI CHRISTIAN (PT) 16

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DR NEETI CHRISTIAN (PT) 17
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 Antero-posterior axis takes place in the
frontal plane with movements:
 Adduction or ulnar deviation: the hand
moves toward the body and its medial (ulnar)
border forms an angle with the medial
border of the forearm.
 Abduction or radial deviation: the hand
moves away from the body and its lateral
(radial) border forms an angle with the
lateral border of the forearm.
DR NEETI CHRISTIAN (PT) 19
 Range of movement of the wrist, range of
abduction does not exceed 15 , of adduction
is 45, of flexion is 85, and range of
extension is also 85.
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RD : Hard
DR NEETI CHRISTIAN (PT) 20

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DR NEETI CHRISTIAN (PT) 21
OSTEOKINEMATICS ARTHROKINEMATICS
(Sliding Motion
of Proximal
Row of
Carpals)
(Rolling Motion of
Proximal Row of
Carpals)
Flexion Dorsal Volar
Extension Volar Dorsal
Ulnar Deviation Radial Ulnar
Radial Deviation Ulnar Radial
 Close packed Position: Full extension
 Loose packed Position: Neutral with slight
Ulnar deviation
DR NEETI CHRISTIAN (PT) 22
 Extensor muscles of the wrist act
synergistically with the flexors of the fingers.
E.g. during extension of the wrist the fingers
are automatically flexes and, to extend the
fingers in this position, a voluntary
movement is required.
 Flexor muscles of the wrist act
synergistically with the extensors of the
fingers. When the wrist is flexed, extension
of the proximal phalanx follows
automatically.
DR NEETI CHRISTIAN (PT) 23
DR NEETI CHRISTIAN (PT) 24
•The compound proximal radiocarpal
joint surface is oblique, angled
slightly volarly and ulnarly.
• The average inclination of the distal
radius is 23 degrees.
•This inclination occurs because the
radial length (height) is greater
(approx.12 mm ) on the radial side
than on the ulnar side.
•The distal radius is also tilted volarly
with the posterior radius slightly
longer than the anterior (volar)
radius.

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 The curvature of the distal radiocarpal joint
surface is sharper than the proximal joint
surface, which makes the joint somewhat
incongruent.
 Joint incongruence and the angulation of the
proximal joint surface result in a greater range
of flexion than extension and in greater ulnar
deviation than radial deviation for the
radiocarpal joint.
DR NEETI CHRISTIAN (PT) 25
 The length of the ulna in relation to the
radius is also a factor which affects the
functions of wrist joint.
 Ulnar negative variance is described as a
short ulna in comparison with the radius at
their distal ends,
 ulnar positive variance, the distal ulna is
long in relation to the distal radius.
DR NEETI CHRISTIAN (PT) 26
DR NEETI CHRISTIAN (PT) 27
 The midcarpal joint is a functional rather
than anatomic unit because it does not form
a single uninterrupted articular surface.
DR NEETI CHRISTIAN (PT) 28

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The document provides information on the biomechanics of the wrist joint. It discusses the basic anatomy including the ligaments and muscles. It describes the two joints of the wrist complex - the radiocarpal and midcarpal joints. It details the range of motion of the wrist in flexion, extension, ulnar deviation, and radial deviation. It explains the osteokinematics and arthrokinematics of wrist movement including the convex-concave rule and how the bones roll and slide during flexion, extension, ulnar deviation, and radial deviation.

 The extrinsic ligaments are those that
connect the carpals to the radius or ulna
proximally or to the metacarpals distally.
 The intrinsic ligaments are those that
interconnect the carpals themselves and are
also known as intercarpal or interosseous
ligaments.
DR NEETI CHRISTIAN (PT) 29
 Volar Ligament includes Three bands:
1) The radioscaphocapitate (radiocapitate),
2) Radiolunate (radiolunotriquetral), and
3) Radioscapholunate
 The radial collateral ligament may be
considered an extension of the volar
radiocarpal ligament and capsule.
 The two intrinsic ligaments (scapholunate and
lunotriquetral) are maintains the scaphoid
stability.
DR NEETI CHRISTIAN (PT) 30
DR NEETI CHRISTIAN (PT) 31
DR NEETI CHRISTIAN (PT) 32
•Dorsal Radiocarpal ligaments
•Dorsal Intercarpal Ligaments
•These ligaments forms a horizontal V
shape , adding to radiocarpal
stability.

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This document provides information about the anatomy and biomechanics of the wrist joint. It discusses the following key points: 1. The wrist joint is made up of the radiocarpal and midcarpal joints, which allow for fine adjustment of grip. It has ligaments and muscles that provide stability and control rather than maximize torque. 2. The wrist joint involves the lower end of the radius articulating with three carpal bones. It is stabilized by various intrinsic and extrinsic ligaments. Flexion and extension occurs in the sagittal plane while ulnar and radial deviation occurs in the coronal plane. 3. During flexion and extension, the convex lunate bone rolls and slides on the

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The document provides an overview of hand biomechanics and examination. It discusses the components of hand movement including muscles, tendons, joints, and spatial movement. It describes the 27 degrees of freedom of the hand and details the stabilizing structures like ligaments. The document reviews biomechanics concepts including arthrokinematics, osteokinematics, and degrees of freedom. It examines the biomechanics of different grips and pinches. The joints, muscles, tendons, and stabilizing ligaments of the hand are described.

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 It is a unique combination of active muscular
and passive ligamentous and joint reaction
forces.
1. Flexion/Extension of the Wrist
2. Radial/Ulnar Deviation of the Wrist
DR NEETI CHRISTIAN (PT) 33
 During flexion/extension of the wrist, the
scaphoid seems to show the greatest motion
of the three proximal carpal bones, whereas
the lunate moves least.
 As wrist extension is initiated from full
flexion,
(1) the distal carpal row moves on the
proximal carpal row;
(2) the scaphoid and distal row move on
the lunate/triquetrum;
(3) the carpals move as a unit on the
radius and TFCC to achieve.
DR NEETI CHRISTIAN (PT) 34
 Wrist motion from full extension to full
flexion occurs in the reverse sequence.
 In the context of this conceptual framework,
the scaphoid participates at different times
in scaphoid-capitate, scaphoid-lunate, or
radioscaphoid motion.
DR NEETI CHRISTIAN (PT) 35
 More Complex.
 The proximal carpal row displays a unique
“reciprocal” motion with radial and ulnar
deviation.
 In radial deviation, the carpals slide medially on
the radius, The carpal motion not only produces
deviation of the proximal and distal carpals
radially, but simultaneous flexion of the proximal
carpals and extension of the distal carpals.
 The Opposite motion occurs at Ulnar deviation.
DR NEETI CHRISTIAN (PT) 36

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This document provides information about the anatomy and kinesiology of the wrist joint. It discusses the following key points: 1. The wrist joint is made up of the radiocarpal joint between the radius and carpal bones, and the midcarpal joint between carpal bones. 2. Ligaments connecting the radius, ulna, carpals and metacarpals provide stability to the joint. Muscles crossing the volar and dorsal aspects of the wrist allow for flexion, extension, ulnar and radial deviation motions. 3. Kinesiologically, flexion and extension occur in the sagittal plane around a coronal axis. Ulnar and radial deviation occur in the cor

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 In full radial deviation, both the radiocarpal
and midcarpal joints are in close-packed
position.
 The ranges of wrist radial and ulnar deviation
are greatest when the wrist is in neutral.
DR NEETI CHRISTIAN (PT) 37
 Carpometacarpal Joints of the Fingers
 Meta carpophalangeal joints
 Interphalangeal joints
DR NEETI CHRISTIAN (PT) 38
 They have articulations between the distal
carpal row and the bases of the second
through fifth metacarpal joints.
 2nd metacarpal articulates primarily with the
trapezoid and secondarily with the trapezium
and capitate.
 3rd metacarpal articulates primarily with the
capitate,
 4th metacarpal articulates with the capitate
and hamate.
 5th metacarpal articulates with the hamate.
DR NEETI CHRISTIAN (PT) 39
 All finger CMC joints are supported by strong
transverse and weaker longitudinal ligaments
volarly and dorsally.
 The ligamentous structure is primarily
responsible for controlling the total ROM
available at each CMC joint.
DR NEETI CHRISTIAN (PT) 40

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DR NEETI CHRISTIAN (PT) 41
TCL
Intercarpal ligaments
•The proximal transverse arch, or carpal
arch,
forms the tunnel through which the
median nerve and long finger flexors
travel.
•The transverse carpal ligament and
intercarpal ligaments assist in maintaining
this concavity.
 The second through fourth CMC joints are
plane synovial joints with one degree of
freedom: flexion/extension.
 2nd and 3rd CMC joints are not mobile and
sometimes they have zero degrees of
freedom, but 3rd and 4th CMC joints are most
mobile.
DR NEETI CHRISTIAN (PT) 42
DR NEETI CHRISTIAN (PT) 43
•Three arches balance stability and mobility in
the hand.
1. Proximal transverse arch
2. Distal transverse arch
3. Longitudinal arch
•The proximal transverse arch is rigid, but the
other two arches are flexible, and are
maintained by activity in the hand's intrinsic
muscles.
 PROXIMAL TRANSVERSE ARCH
 A stable bony arch that forms the posterior
border of the carpal tunnel.
 The arch's integrity is maintained by a soft
tissue "strut" formed by the flexor retinaculum
or transverse carpal ligament (also called the
volar carpal ligament).
 This ligamentous strut connects the scaphoid
and trapezium on the arch's radial side with
the hamate on its ulnar side, and forms the
anterior border of the carpal tunnel.
DR NEETI CHRISTIAN (PT) 44

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2) DISTAL TRANSVERSE ARCH
 Hertling and Kessler (p. 257) call this the
metacarpal arch, because it is formed by the
metacarpal heads; metacarpals 2 and 3 are stable
while 4 and 5 are relatively mobile.
 You can observe the arch's combination of "radial"
stability and "ulnar" mobility by loosely closing your
fist, then squeezing more tightly, when you will
observe movement in the more mobile fourth and
fifth metacarpals.
3) LONGITUDINAL ARCH
 Observe this arch's behavior as you loosely close
your fist. Tighten the fist and watch the fourth and
fifth metacarpals.
DR NEETI CHRISTIAN (PT) 45
 The arches provide a balance between
stability and mobility for grasping.
 For instance, we produce the so-called
"chuck grasp" by using the more stable
second and third metacarpals, instead of
the more mobile fourth and fifth
metacarpals.
 Therapeutic splints must support these
three arches.
DR NEETI CHRISTIAN (PT) 46
 The convex metacarpal head proximally and
the concave base of the first phalanx distally.
 The MP joint is condyloid with two degrees of
freedom: 1)flexion/extension
2)abduction/adduction.
DR NEETI CHRISTIAN (PT) 47
Metacarpophalangeal (MP)
 condyloid, biaxial joints
 joint's palmar aspect is palpable at level of distal palmar
crease
 proximal joint surface is convex and distal surface is concave
 roll and glide occur in same direction
 anterior with flexion
 posterior with extension.
 large metacarpal joint surface
 a fibrocartilaginous volar plate is lined with hyaline cartilage
so that it augments or enlarges the proximal phalanx' relatively
small articular surface.
 superficial to volar plate is the transverse metacarpal ligament
 joint capsule supported by two collateral ligaments
 close-packed position:
 MP joints of digits 2 through 5: close-packed in flexion; you cannot
abduct or adduct these joints when they are flexed.
 MP joint of thumb: close-packed in extension
DR NEETI CHRISTIAN (PT) 48

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The wrist joint, or radiocarpal joint, connects the forearm to the hand. It is formed by the distal end of the radius articulating with the proximal row of carpal bones. The ulna does not directly articulate with the wrist joint. The wrist joint allows for flexion, extension, adduction and abduction through movement along two axes. Common injuries to the wrist joint include fractures of the scaphoid, anterior dislocation of the lunate, and Colles' fractures of the radius.

 The MP joint is surrounded by a capsule that is generally
considered to be lax in extension.
 Given the incongruent articular surfaces, capsular laxity in
extension allows some passive axial rotation of the
proximal phalanx.
 Two collateral ligaments at the volarly located transverse
metacarpal ligament enhance joint stability.
DR NEETI CHRISTIAN (PT) 49
DR NEETI CHRISTIAN (PT) 50
 It is a unique structure at MCP joint.
 It improves joint congruency.
 It also provides stability to the MP joint by
limiting hyperextension.
 It also provides indirect support to the
longitudinal arch.
 The volar plate is composed of
fibrocartilage.
DR NEETI CHRISTIAN (PT) 51
DR NEETI CHRISTIAN (PT) 52
Volar
plateMC
P1
•The volar plate attaches to the base of
the proximal phalanx.
•The plate lies deep to the MP joint
capsule and the deep transverse
metacarpal ligament volarly.
In MP joint flexion, the flexible
attachments of the plate allow the
plate to slide proximally on the
metacarpal head without preventing
motion.
The collateral ligament proper is
loose in MP joint extension, The
reverse occurs in MP joint flexion.

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 The four volar plates and their respective
capsules of the MP joints of the fingers also
interconnected superficially by the deep
transverse metacarpal ligament.
DR NEETI CHRISTIAN (PT) 53
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 Each IP joint is a true synovial hinge joint
with one degree of freedom
(flexion/extension), a joint capsule, a volar
plate, and two collateral ligament.
DR NEETI CHRISTIAN (PT) 57
 uniaxial hinge joints
 supported by two collateral ligaments, and by
smaller versions of a volar plate.
 Like MP joint, proximal joint surface is convex
and distal surface is concave
 roll and glide occur in same direction
 anterior with flexion
 posterior with extension
 close-packed in extension
DR NEETI CHRISTIAN (PT) 58
 The muscles of the fingers and thumb that
have proximal attachments above the wrist
(radiocarpal joint) are known as extrinsic
muscles.
 whereas those with all attachments distal to
the radiocarpal joint are known as intrinsic
muscles.
DR NEETI CHRISTIAN (PT) 59
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 Optimal function of the FDS and FDP muscles
depends not only on stabilization by the wrist
musculature but also on intact flexor gliding
mechanisms.
 The gliding mechanisms consist of the flexor
retinaculae, bursae, and digital tendon
sheaths.
DR NEETI CHRISTIAN (PT) 61
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cross the wrist to enter the hand, they first
pass beneath the proximal flexor
retinaculum and through the carpal tunnel.
 The radial and ulnar bursae contain a
synovial-like fluid that minimizes frictional
forces.
 The FDS and FDP tendons of each finger pass
through a fibro-osseous tunnel that
comprises five transversely oriented annular
pulleys as well as three obliquely oriented
cruciate pulleys.
DR NEETI CHRISTIAN (PT) 62
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DR NEETI CHRISTIAN (PT) 64
Flexor pulley system consists of following
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• 5 Annular Pulleys
• 3 Cruciform Culleys.
Together, these form a fibro-osseous tunnel on the palmar aspect of
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 We can extend the PIP and DIP joints without
also extending the MP joints.
 But we can't extend the PIP joint without
extending the DIP joint at the same time.
 Flexing only the DIP joint without also flexing
the PIP joint is difficult.
 Full (active or passive) flexion of the PIP
joint prevents active extension of the DIP
joint.
DR NEETI CHRISTIAN (PT) 65
 The extensor mechanism is an elaboration of
the extensor digitorum (ED) tendon on the
dorsum of each phalanx.
 The extensor indicis (EI) and the extensor
digiti minimi (EDM) insert into the extensor
mechanisms of the second and fifth digits,
respectively.
DR NEETI CHRISTIAN (PT) 66
DR NEETI CHRISTIAN (PT) 67
The ED tendon attaches by a tendinous slip to the
proximal phalanx, through which it extends the MP joint.
The central tendon (or "slip") proceeds dorsally to
attach to base of middle phalanx, where tension can
extend the PIP joint.
DR NEETI CHRISTIAN (PT) 68
• Two lateral bands proceed on either side of dorsal
midline and rejoin before attaching to the distal
phalanx. Tension in the lateral bands extends the DIP
joint.
• The extensor hood surrounds the MP joint laterally,
medially, and dorsally, and receives tendinous fibers
from the lumbricales and interossei.

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 Dorsal interossei (DI)
 The dorsal interossei attach proximally
between adjacent metacarpals.
 Abduction is stronger at the second MP
joint because the most of the first DI's
muscle fibers attach directly to the
second proximal phalanx.
 Abduction of the fourth MP joint is
relatively weak because the fourth DI
attaches largely to the extensor
mechanism itself.
• The dorsal interossei produce MP
abduction and, in certain instances, MP
flexion.
DR NEETI CHRISTIAN (PT) 69
 Palmar interossei (PI):
 palmar interossei attach
proximally to a
metacarpal, and distally to
the same digit's proximal
phalanx and/or its extensor
mechanism.
 They produce MP adduction
and, in certain instances,
MP flexion.
 They also produce PIP and
DIP extension when they
introduce tension into the
extensor mechanism.
DR NEETI CHRISTIAN (PT) 70
 Lumbricales:
 The four lumbricales attach proximally to the
tendons of the flexor digitorum profundus, and
distally to the extensor mechanism on its radial
side at the level of the lateral bands.
 If they act alone, they produce MP flexion. They
also produce PIP and DIP extension when they
introduce tension into the extensor mechanism.
 They permit a dynamic interaction between
flexors and extensors.
 Their attachments transmit their force to both
the Flexor and the extensor mechanism.
 Specifically, lumbrical activity:
 increases passive tension in the extensor mechanism.
 decreases passive tension in FDP tendon's distal
portion.
DR NEETI CHRISTIAN (PT) 71
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grasping or taking hold of an object between
any two surfaces in the hand; the thumb
participates in most but not all prehension
tasks.
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 Two types of grasp are differentiated according
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and MP joints. (Smith, Weiss, & Lehmkuhl, 1995, pp.
216-219; Hertling & Kessler, 1996,pp.259-260)
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2. Precision grip
DR NEETI CHRISTIAN (PT) 74
DR NEETI CHRISTIAN (PT) 75
 The fingers in power grip usually function in
concert to clamp on and hold an object into
the palm.
 The palm is likely to contour to the object as
the palmar arches form around it. The thumb
may serve as an additional surface to the
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object, or it may be removed from the
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 In this, the hand's position is static.
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A. Cylindrical grip
 It may orient the finger tips toward the
thumb. This is accomplished by ulnarly
deviating the MP joints using the interossei
muscles.
 eg: Holding a glass or any object.
DR NEETI CHRISTIAN (PT) 77
B. spherical grip (Hand curves to hold a round or
sphere shaped object)
 eg: Holding a ball, Grasping a jar when twisting
the lid open.
DR NEETI CHRISTIAN (PT) 78
C. Hook grip (MP extended with flattening of
transverse arch; the person may or may include
the thumb in this grasp)
 eg: Holding a bag, barbell
DR NEETI CHRISTIAN (PT) 79
D. Lateral prehension is a rather unique form of
grasp. Contact occurs between two adjacent
fingers.The MP and IP joints are usually
maintained in extension.
DR NEETI CHRISTIAN (PT) 80

Recommended for you

 Muscles are active that abduct or oppose the
thumb; the hand's position is dynamic.
 The three varieties of precision grasp:
 pad-to-pad prehension, tip-to-tip
prehension, and pad-to-side prehension.
 Each tends to be a dynamic function with
relatively little static holding.
DR NEETI CHRISTIAN (PT) 81
DR NEETI CHRISTIAN (PT) 82
 Wrist
 extended 20 degrees
 ulnarly deviated 10 degrees
 Digits 2 through 5
 MP joints flexed 45degrees
 PIP joints flexed 30-45 degrees
 DIP joints flexed 10-20 degrees
 Thumb
 first CMC joint partially abducted and opposed
 MP joint flexed 10 degrees
 IP joint flexed 5 degrees
DR NEETI CHRISTIAN (PT) 83
 When therapists immobilize a patient's hand,
they often position it this way.
 During a period of immobilization, the resting
lengths of the hand's ligaments and muscles
change.
 This hand position provides the best balance of
resting length and force production so the hand
can function when the patient mobilizes it again.
 In making splints for the hand, a normal
transverse arch is maintained and the thumb is
in abduction and aligned with pads of all four
fingers.
DR NEETI CHRISTIAN (PT) 84

Recommended for you

DR NEETI CHRISTIAN (PT) 85
 Median:
 Often due to carpal tunnel sd.
 Wasting of thenar eminence
 Decreased thumb function, especially opposition.
DR NEETI CHRISTIAN (PT) 86
 Ulnar:
 Damage to ulnar nerve can occur with trauma to
elbow region. Ulnar neuropathy is a frequent
complication of diabetes mellitus
 Wasting of web space and interosseous spaces.
 Affects strength of intrinsic muscles of hand, so
person can't hold a piece of paper between
extended but adducted fingers
DR NEETI CHRISTIAN (PT) 87
 Radial:
 Associated with gunshot or stab wounds, fracture
of humerus, "Saturday night palsy."
 person demonstrates a "dropped wrist," and
cannot reposition thumb.
 lack of wrist extension may cause hand grip to be
weak.
DR NEETI CHRISTIAN (PT) 88

Recommended for you

 Carpal tunnel syndrome (CTS) is an entrapment
neuropathy caused by compression of
the median nerve as it travels through the wrist's
carpal tunnel.
 It is the most common nerve
entrapment neuropathy, accounting for 90% of
all neuropathies.
 Early symptoms of carpal tunnel syndrome
include pain, numbness, and paresthesias.
 Pain also can radiate up the affected arm. With
further progression, hand weakness, decreased
fine motor coordination, clumsiness, and thenar
atrophy can occur.
DR NEETI CHRISTIAN (PT) 89
 De Quervain's Tenosynovitis is a painful inflammation
of tendons on the side of the wrist at the base of the
thumb.
 These tendons include the extensor pollicis brevis
(EPB) and the abductor pollicis longus (APL).
 The pain, which is the main complaint, gets worse
with abduction of the thumb, grasping action of the
hand and an ulnar deviation of the wrist. Thickening
and swelling can also be present.
DR NEETI CHRISTIAN (PT) 90
 A wrist sprain is an injury to the ligaments of the
wrist region.
There are three grades:
1. A mild overstretching of the ligaments, without
joint instability.
2. A partial rupture of the ligaments, with no or
mild joint instability.
3. A complete rupture of a ligament with severe
joint instability.
DR NEETI CHRISTIAN (PT) 91
HAND AND WRIST OSTEOARTHRITIS:
 Hand osteoarthritis(OA) is a common chronic
condition involving one or more joints of the thumb
and fingers. It is associated with pain, reduced grip
strength, loss of range of motion (ROM), and joint
stiffness, leading to impaired hand function and
difficulty with daily activities.
 Estimates of the prevalence of symptomatic hand OA
range from 13% to 26% and are greater in women.
DR NEETI CHRISTIAN (PT) 92

Recommended for you

Rheumatoid arthritis (RA) :
 It is a systemic autoimmune disease characterized by
inflammatory arthritis and extra-articular involvement.
 C/F : Polyarthritis of small joints of hands: proximal
interphalangeal (PIP), metacarpophalangeal (MCP) joints
and wrist.
 Stiffness in the joints in the morning may last up to several
hours, usually greater than an hour. The patient may have
a "trigger finger" due to flexor tenosynovitis.
DR NEETI CHRISTIAN (PT) 93
 Complex regional pain syndrome (CRPS) is a
term for a variety of clinical conditions
characterized by chronic persistent pain and
are subdivided into Type I and Type II CRPS.
 It is a condition that can develop after a limb
trauma and appears mostly in one or more
limbs.
DR NEETI CHRISTIAN (PT) 94
 Colles fracture
 Smith s fracture
 Scaphoid fracture
 Lunate Instability
 Hamate frcture
 Metacarpal fracture
DR NEETI CHRISTIAN (PT) 95
 Ape thumb :Paralysis of thenar muscles due
to Median nerve injury or polio or leprosy.
 Claw hand : Inability to extend fingers from
IP joints due to ulnar nerve injury.
 Deformities of RA
DR NEETI CHRISTIAN (PT) 96

Recommended for you

 Dupuytren contracture is a progressive disease of the palmar
fascia which results in shortening, thickening and fibrosis of
the fascia and aponeurosis of the palm.
 The most commonly affected digits are the third and fourth
digits.
 The disease begins in the palm as painless nodules that form
along longitudinal lines of tension.
 The nodules form cords that produce contracture deformities
within fascial bands and tissues of the hand.
DR NEETI CHRISTIAN (PT) 97
 A crush injury is defined as compression of the
extremities causing muscular and neurological
disturbance and in the upper limb is sustained
when the fingers, hand or wrist are caught
between two surfaces (sharp, blunt, smooth or
irregular) forcibly producing damage to the skin.
DR NEETI CHRISTIAN (PT) 98
DR NEETI CHRISTIAN (PT) 99

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Biomechanics of wrist complex

  • 1. DR NEETI CHRISTIAN (PT) MPT (Musculoskeletal & Sports) 1
  • 2.  The wrist is the distal joint of the upper limb and allows the hand to assume the optimal position for prehension. DR NEETI CHRISTIAN (PT) 2
  • 3.  The articular complex of the wrist contain two joints:  The radio-carpal joint between the distal radius and the proximal row of carpal bones.  The mid-carpal joint between the proximal and distal rows of carpal bones. DR NEETI CHRISTIAN (PT) 3
  • 5.  Type of Joint  Proximal and Distal articulating surfaces  Basic Anatomy: Capsule Ligaments Muscles  Kinematics: Axis of Motion Osteo and Arthrokinematics Normal ROM End feel  Synergistic and stabilizing action DR NEETI CHRISTIAN (PT) 5
  • 6.  Radio-carpal joint is an ellipsoidal joint and the carpal aspect presents two convexities transverse convexity and antero-posterior convexity. DR NEETI CHRISTIAN (PT) 6
  • 7.  The distal radius has a single continuous, biconcave curvature that is long and shallow side to side (frontal plane) and shorter and sharper anteroposteriorly (sagittal plane). DR NEETI CHRISTIAN (PT) 7
  • 8. DR NEETI CHRISTIAN (PT) 8  The proximal joint surface is composed of (1) the lateral radial facet, which articulates with the scaphoid; (2) the medial radial facet, which articulates with the lunate; and (3) the TFCC, which articulates with the triquetrum, also with the lunate in the neutral wrist.
  • 9. DR NEETI CHRISTIAN (PT) 9 •The radiocarpal joint is formed by the radius and radioulnar disk as part of the triangular fibrocartilage complex (TFCC) proximally and by the scaphoid, lunate,and triquetrum distally. The TFCC consists of the radioulnar disk and the various fibrous attachments that provide the primary support for the distal radioulnar joint.
  • 10.  The radiocarpal joint is enclosed by a strong but somewhat loose capsule and is reinforced by capsular and intracapsular ligaments. DR NEETI CHRISTIAN (PT) 10
  • 11. The ligaments of the radio-carpal joint are,,,, 1. collateral ligaments (lateral and medial) 2. The anterior ligaments [attached to the anterior edge of the distal surface of the radius and neck of the capitates] 3. Posterior ligament [forms a strap posteriorly]. DR NEETI CHRISTIAN (PT) 11
  • 12. DR NEETI CHRISTIAN (PT) 12 Action of the ligaments:  During adduction-abduction the medial and lateral ligaments are active. Starting from the rest position .  Adduction  lateral ligament is stretched, medial slackened  Abduction  vice versa  During flexion-extension the anterior and posterior ligaments are most active.  Flexion  posterior ligament stretched  Extension  anterior ligament stretched
  • 13.  Wrist Flexion: Flexor Carpi Ulnaris Flexor Carpi Radialis Palmaris Longus  Wrist Extension: Extensor Carpi Radialis Longus Extensor Carpi Radialis Brevis Extensor Carpi Ulnaris DR NEETI CHRISTIAN (PT) 13
  • 14.  Radial Deviation: Flexor Carpi Radialis Extensor Carpi Radialis Longus  Ulnar Deviation: Flexor Carpi Ulnaris Extensor Carpi Ulnaris DR NEETI CHRISTIAN (PT) 14
  • 15.  The articular complex of the wrist has basically two degree of freedom. DR NEETI CHRISTIAN (PT) 15
  • 16.  Transverse axis takes place in the sagittal plane with movement:  Flexion the anterior palmar surface of the hand moves towards the anterior aspect of the forearm  Extension the posterior dorsal surface of the hand moves towards the posterior aspect of the forearm. DR NEETI CHRISTIAN (PT) 16
  • 19.  Antero-posterior axis takes place in the frontal plane with movements:  Adduction or ulnar deviation: the hand moves toward the body and its medial (ulnar) border forms an angle with the medial border of the forearm.  Abduction or radial deviation: the hand moves away from the body and its lateral (radial) border forms an angle with the lateral border of the forearm. DR NEETI CHRISTIAN (PT) 19
  • 20.  Range of movement of the wrist, range of abduction does not exceed 15 , of adduction is 45, of flexion is 85, and range of extension is also 85.  Movement of circumduction [combination of the movement of flexion, extension, adduction and abduction] takes place in two axes of the wrist.  End feel : Flexion ;Ext. ;UD: Firm RD : Hard DR NEETI CHRISTIAN (PT) 20
  • 21. DR NEETI CHRISTIAN (PT) 21 OSTEOKINEMATICS ARTHROKINEMATICS (Sliding Motion of Proximal Row of Carpals) (Rolling Motion of Proximal Row of Carpals) Flexion Dorsal Volar Extension Volar Dorsal Ulnar Deviation Radial Ulnar Radial Deviation Ulnar Radial
  • 22.  Close packed Position: Full extension  Loose packed Position: Neutral with slight Ulnar deviation DR NEETI CHRISTIAN (PT) 22
  • 23.  Extensor muscles of the wrist act synergistically with the flexors of the fingers. E.g. during extension of the wrist the fingers are automatically flexes and, to extend the fingers in this position, a voluntary movement is required.  Flexor muscles of the wrist act synergistically with the extensors of the fingers. When the wrist is flexed, extension of the proximal phalanx follows automatically. DR NEETI CHRISTIAN (PT) 23
  • 24. DR NEETI CHRISTIAN (PT) 24 •The compound proximal radiocarpal joint surface is oblique, angled slightly volarly and ulnarly. • The average inclination of the distal radius is 23 degrees. •This inclination occurs because the radial length (height) is greater (approx.12 mm ) on the radial side than on the ulnar side. •The distal radius is also tilted volarly with the posterior radius slightly longer than the anterior (volar) radius.
  • 25.  The curvature of the distal radiocarpal joint surface is sharper than the proximal joint surface, which makes the joint somewhat incongruent.  Joint incongruence and the angulation of the proximal joint surface result in a greater range of flexion than extension and in greater ulnar deviation than radial deviation for the radiocarpal joint. DR NEETI CHRISTIAN (PT) 25
  • 26.  The length of the ulna in relation to the radius is also a factor which affects the functions of wrist joint.  Ulnar negative variance is described as a short ulna in comparison with the radius at their distal ends,  ulnar positive variance, the distal ulna is long in relation to the distal radius. DR NEETI CHRISTIAN (PT) 26
  • 28.  The midcarpal joint is a functional rather than anatomic unit because it does not form a single uninterrupted articular surface. DR NEETI CHRISTIAN (PT) 28
  • 29.  The extrinsic ligaments are those that connect the carpals to the radius or ulna proximally or to the metacarpals distally.  The intrinsic ligaments are those that interconnect the carpals themselves and are also known as intercarpal or interosseous ligaments. DR NEETI CHRISTIAN (PT) 29
  • 30.  Volar Ligament includes Three bands: 1) The radioscaphocapitate (radiocapitate), 2) Radiolunate (radiolunotriquetral), and 3) Radioscapholunate  The radial collateral ligament may be considered an extension of the volar radiocarpal ligament and capsule.  The two intrinsic ligaments (scapholunate and lunotriquetral) are maintains the scaphoid stability. DR NEETI CHRISTIAN (PT) 30
  • 32. DR NEETI CHRISTIAN (PT) 32 •Dorsal Radiocarpal ligaments •Dorsal Intercarpal Ligaments •These ligaments forms a horizontal V shape , adding to radiocarpal stability.
  • 33.  It is a unique combination of active muscular and passive ligamentous and joint reaction forces. 1. Flexion/Extension of the Wrist 2. Radial/Ulnar Deviation of the Wrist DR NEETI CHRISTIAN (PT) 33
  • 34.  During flexion/extension of the wrist, the scaphoid seems to show the greatest motion of the three proximal carpal bones, whereas the lunate moves least.  As wrist extension is initiated from full flexion, (1) the distal carpal row moves on the proximal carpal row; (2) the scaphoid and distal row move on the lunate/triquetrum; (3) the carpals move as a unit on the radius and TFCC to achieve. DR NEETI CHRISTIAN (PT) 34
  • 35.  Wrist motion from full extension to full flexion occurs in the reverse sequence.  In the context of this conceptual framework, the scaphoid participates at different times in scaphoid-capitate, scaphoid-lunate, or radioscaphoid motion. DR NEETI CHRISTIAN (PT) 35
  • 36.  More Complex.  The proximal carpal row displays a unique “reciprocal” motion with radial and ulnar deviation.  In radial deviation, the carpals slide medially on the radius, The carpal motion not only produces deviation of the proximal and distal carpals radially, but simultaneous flexion of the proximal carpals and extension of the distal carpals.  The Opposite motion occurs at Ulnar deviation. DR NEETI CHRISTIAN (PT) 36
  • 37.  In full radial deviation, both the radiocarpal and midcarpal joints are in close-packed position.  The ranges of wrist radial and ulnar deviation are greatest when the wrist is in neutral. DR NEETI CHRISTIAN (PT) 37
  • 38.  Carpometacarpal Joints of the Fingers  Meta carpophalangeal joints  Interphalangeal joints DR NEETI CHRISTIAN (PT) 38
  • 39.  They have articulations between the distal carpal row and the bases of the second through fifth metacarpal joints.  2nd metacarpal articulates primarily with the trapezoid and secondarily with the trapezium and capitate.  3rd metacarpal articulates primarily with the capitate,  4th metacarpal articulates with the capitate and hamate.  5th metacarpal articulates with the hamate. DR NEETI CHRISTIAN (PT) 39
  • 40.  All finger CMC joints are supported by strong transverse and weaker longitudinal ligaments volarly and dorsally.  The ligamentous structure is primarily responsible for controlling the total ROM available at each CMC joint. DR NEETI CHRISTIAN (PT) 40
  • 41. DR NEETI CHRISTIAN (PT) 41 TCL Intercarpal ligaments •The proximal transverse arch, or carpal arch, forms the tunnel through which the median nerve and long finger flexors travel. •The transverse carpal ligament and intercarpal ligaments assist in maintaining this concavity.
  • 42.  The second through fourth CMC joints are plane synovial joints with one degree of freedom: flexion/extension.  2nd and 3rd CMC joints are not mobile and sometimes they have zero degrees of freedom, but 3rd and 4th CMC joints are most mobile. DR NEETI CHRISTIAN (PT) 42
  • 43. DR NEETI CHRISTIAN (PT) 43 •Three arches balance stability and mobility in the hand. 1. Proximal transverse arch 2. Distal transverse arch 3. Longitudinal arch •The proximal transverse arch is rigid, but the other two arches are flexible, and are maintained by activity in the hand's intrinsic muscles.
  • 44.  PROXIMAL TRANSVERSE ARCH  A stable bony arch that forms the posterior border of the carpal tunnel.  The arch's integrity is maintained by a soft tissue "strut" formed by the flexor retinaculum or transverse carpal ligament (also called the volar carpal ligament).  This ligamentous strut connects the scaphoid and trapezium on the arch's radial side with the hamate on its ulnar side, and forms the anterior border of the carpal tunnel. DR NEETI CHRISTIAN (PT) 44
  • 45. 2) DISTAL TRANSVERSE ARCH  Hertling and Kessler (p. 257) call this the metacarpal arch, because it is formed by the metacarpal heads; metacarpals 2 and 3 are stable while 4 and 5 are relatively mobile.  You can observe the arch's combination of "radial" stability and "ulnar" mobility by loosely closing your fist, then squeezing more tightly, when you will observe movement in the more mobile fourth and fifth metacarpals. 3) LONGITUDINAL ARCH  Observe this arch's behavior as you loosely close your fist. Tighten the fist and watch the fourth and fifth metacarpals. DR NEETI CHRISTIAN (PT) 45
  • 46.  The arches provide a balance between stability and mobility for grasping.  For instance, we produce the so-called "chuck grasp" by using the more stable second and third metacarpals, instead of the more mobile fourth and fifth metacarpals.  Therapeutic splints must support these three arches. DR NEETI CHRISTIAN (PT) 46
  • 47.  The convex metacarpal head proximally and the concave base of the first phalanx distally.  The MP joint is condyloid with two degrees of freedom: 1)flexion/extension 2)abduction/adduction. DR NEETI CHRISTIAN (PT) 47
  • 48. Metacarpophalangeal (MP)  condyloid, biaxial joints  joint's palmar aspect is palpable at level of distal palmar crease  proximal joint surface is convex and distal surface is concave  roll and glide occur in same direction  anterior with flexion  posterior with extension.  large metacarpal joint surface  a fibrocartilaginous volar plate is lined with hyaline cartilage so that it augments or enlarges the proximal phalanx' relatively small articular surface.  superficial to volar plate is the transverse metacarpal ligament  joint capsule supported by two collateral ligaments  close-packed position:  MP joints of digits 2 through 5: close-packed in flexion; you cannot abduct or adduct these joints when they are flexed.  MP joint of thumb: close-packed in extension DR NEETI CHRISTIAN (PT) 48
  • 49.  The MP joint is surrounded by a capsule that is generally considered to be lax in extension.  Given the incongruent articular surfaces, capsular laxity in extension allows some passive axial rotation of the proximal phalanx.  Two collateral ligaments at the volarly located transverse metacarpal ligament enhance joint stability. DR NEETI CHRISTIAN (PT) 49
  • 51.  It is a unique structure at MCP joint.  It improves joint congruency.  It also provides stability to the MP joint by limiting hyperextension.  It also provides indirect support to the longitudinal arch.  The volar plate is composed of fibrocartilage. DR NEETI CHRISTIAN (PT) 51
  • 52. DR NEETI CHRISTIAN (PT) 52 Volar plateMC P1 •The volar plate attaches to the base of the proximal phalanx. •The plate lies deep to the MP joint capsule and the deep transverse metacarpal ligament volarly. In MP joint flexion, the flexible attachments of the plate allow the plate to slide proximally on the metacarpal head without preventing motion. The collateral ligament proper is loose in MP joint extension, The reverse occurs in MP joint flexion.
  • 53.  The four volar plates and their respective capsules of the MP joints of the fingers also interconnected superficially by the deep transverse metacarpal ligament. DR NEETI CHRISTIAN (PT) 53
  • 54. DR NEETI CHRISTIAN (PT) 54 •Dorsal to the deep transverse metacarpal ligament are sagittal bands on each side of the metacarpal head that connect each volar plate (via the capsule and deep transverse metacarpal ligament) to the ED tendon and extensor expansion. • The sagittal bands help stabilize the volar plates over the four metacarpal heads.
  • 56. DR NEETI CHRISTIAN (PT) 56 Annular pullies Deep transverse metacarpal ligament
  • 57.  Each IP joint is a true synovial hinge joint with one degree of freedom (flexion/extension), a joint capsule, a volar plate, and two collateral ligament. DR NEETI CHRISTIAN (PT) 57
  • 58.  uniaxial hinge joints  supported by two collateral ligaments, and by smaller versions of a volar plate.  Like MP joint, proximal joint surface is convex and distal surface is concave  roll and glide occur in same direction  anterior with flexion  posterior with extension  close-packed in extension DR NEETI CHRISTIAN (PT) 58
  • 59.  The muscles of the fingers and thumb that have proximal attachments above the wrist (radiocarpal joint) are known as extrinsic muscles.  whereas those with all attachments distal to the radiocarpal joint are known as intrinsic muscles. DR NEETI CHRISTIAN (PT) 59
  • 60. Two muscles:  FDS- primarily flexes the PIP joint, but it also contributes to MP joint flexion.  FDP- flex the MP, PIP, and the DIP joints and is considered to be the more active of the two muscles. DR NEETI CHRISTIAN (PT) 60
  • 61.  Optimal function of the FDS and FDP muscles depends not only on stabilization by the wrist musculature but also on intact flexor gliding mechanisms.  The gliding mechanisms consist of the flexor retinaculae, bursae, and digital tendon sheaths. DR NEETI CHRISTIAN (PT) 61
  • 62.  As the tendons of the FDS and FDP muscles cross the wrist to enter the hand, they first pass beneath the proximal flexor retinaculum and through the carpal tunnel.  The radial and ulnar bursae contain a synovial-like fluid that minimizes frictional forces.  The FDS and FDP tendons of each finger pass through a fibro-osseous tunnel that comprises five transversely oriented annular pulleys as well as three obliquely oriented cruciate pulleys. DR NEETI CHRISTIAN (PT) 62
  • 63. DR NEETI CHRISTIAN (PT) 63 Ulnar bursa Radial bursaFlexor retinaculum and TCL Digital tendon sheath
  • 64. DR NEETI CHRISTIAN (PT) 64 Flexor pulley system consists of following • Palmar Aponeurosis Pulley • 5 Annular Pulleys • 3 Cruciform Culleys. Together, these form a fibro-osseous tunnel on the palmar aspect of the hand through which passes the deep and superficial flexor tendons.
  • 65.  We can extend the PIP and DIP joints without also extending the MP joints.  But we can't extend the PIP joint without extending the DIP joint at the same time.  Flexing only the DIP joint without also flexing the PIP joint is difficult.  Full (active or passive) flexion of the PIP joint prevents active extension of the DIP joint. DR NEETI CHRISTIAN (PT) 65
  • 66.  The extensor mechanism is an elaboration of the extensor digitorum (ED) tendon on the dorsum of each phalanx.  The extensor indicis (EI) and the extensor digiti minimi (EDM) insert into the extensor mechanisms of the second and fifth digits, respectively. DR NEETI CHRISTIAN (PT) 66
  • 67. DR NEETI CHRISTIAN (PT) 67 The ED tendon attaches by a tendinous slip to the proximal phalanx, through which it extends the MP joint. The central tendon (or "slip") proceeds dorsally to attach to base of middle phalanx, where tension can extend the PIP joint.
  • 68. DR NEETI CHRISTIAN (PT) 68 • Two lateral bands proceed on either side of dorsal midline and rejoin before attaching to the distal phalanx. Tension in the lateral bands extends the DIP joint. • The extensor hood surrounds the MP joint laterally, medially, and dorsally, and receives tendinous fibers from the lumbricales and interossei.
  • 69.  Dorsal interossei (DI)  The dorsal interossei attach proximally between adjacent metacarpals.  Abduction is stronger at the second MP joint because the most of the first DI's muscle fibers attach directly to the second proximal phalanx.  Abduction of the fourth MP joint is relatively weak because the fourth DI attaches largely to the extensor mechanism itself. • The dorsal interossei produce MP abduction and, in certain instances, MP flexion. DR NEETI CHRISTIAN (PT) 69
  • 70.  Palmar interossei (PI):  palmar interossei attach proximally to a metacarpal, and distally to the same digit's proximal phalanx and/or its extensor mechanism.  They produce MP adduction and, in certain instances, MP flexion.  They also produce PIP and DIP extension when they introduce tension into the extensor mechanism. DR NEETI CHRISTIAN (PT) 70
  • 71.  Lumbricales:  The four lumbricales attach proximally to the tendons of the flexor digitorum profundus, and distally to the extensor mechanism on its radial side at the level of the lateral bands.  If they act alone, they produce MP flexion. They also produce PIP and DIP extension when they introduce tension into the extensor mechanism.  They permit a dynamic interaction between flexors and extensors.  Their attachments transmit their force to both the Flexor and the extensor mechanism.  Specifically, lumbrical activity:  increases passive tension in the extensor mechanism.  decreases passive tension in FDP tendon's distal portion. DR NEETI CHRISTIAN (PT) 71
  • 73.  Prehension activities of the hand involve the grasping or taking hold of an object between any two surfaces in the hand; the thumb participates in most but not all prehension tasks. DR NEETI CHRISTIAN (PT) 73
  • 74.  Two types of grasp are differentiated according to the position and mobility of the thumb's CMC and MP joints. (Smith, Weiss, & Lehmkuhl, 1995, pp. 216-219; Hertling & Kessler, 1996,pp.259-260) 1. Power grip 2. Precision grip DR NEETI CHRISTIAN (PT) 74
  • 76.  The fingers in power grip usually function in concert to clamp on and hold an object into the palm.  The palm is likely to contour to the object as the palmar arches form around it. The thumb may serve as an additional surface to the finger-palm vise by adducting against the object, or it may be removed from the object.  In this, the hand's position is static. DR NEETI CHRISTIAN (PT) 76
  • 77. A. Cylindrical grip  It may orient the finger tips toward the thumb. This is accomplished by ulnarly deviating the MP joints using the interossei muscles.  eg: Holding a glass or any object. DR NEETI CHRISTIAN (PT) 77
  • 78. B. spherical grip (Hand curves to hold a round or sphere shaped object)  eg: Holding a ball, Grasping a jar when twisting the lid open. DR NEETI CHRISTIAN (PT) 78
  • 79. C. Hook grip (MP extended with flattening of transverse arch; the person may or may include the thumb in this grasp)  eg: Holding a bag, barbell DR NEETI CHRISTIAN (PT) 79
  • 80. D. Lateral prehension is a rather unique form of grasp. Contact occurs between two adjacent fingers.The MP and IP joints are usually maintained in extension. DR NEETI CHRISTIAN (PT) 80
  • 81.  Muscles are active that abduct or oppose the thumb; the hand's position is dynamic.  The three varieties of precision grasp:  pad-to-pad prehension, tip-to-tip prehension, and pad-to-side prehension.  Each tends to be a dynamic function with relatively little static holding. DR NEETI CHRISTIAN (PT) 81
  • 83.  Wrist  extended 20 degrees  ulnarly deviated 10 degrees  Digits 2 through 5  MP joints flexed 45degrees  PIP joints flexed 30-45 degrees  DIP joints flexed 10-20 degrees  Thumb  first CMC joint partially abducted and opposed  MP joint flexed 10 degrees  IP joint flexed 5 degrees DR NEETI CHRISTIAN (PT) 83
  • 84.  When therapists immobilize a patient's hand, they often position it this way.  During a period of immobilization, the resting lengths of the hand's ligaments and muscles change.  This hand position provides the best balance of resting length and force production so the hand can function when the patient mobilizes it again.  In making splints for the hand, a normal transverse arch is maintained and the thumb is in abduction and aligned with pads of all four fingers. DR NEETI CHRISTIAN (PT) 84
  • 86.  Median:  Often due to carpal tunnel sd.  Wasting of thenar eminence  Decreased thumb function, especially opposition. DR NEETI CHRISTIAN (PT) 86
  • 87.  Ulnar:  Damage to ulnar nerve can occur with trauma to elbow region. Ulnar neuropathy is a frequent complication of diabetes mellitus  Wasting of web space and interosseous spaces.  Affects strength of intrinsic muscles of hand, so person can't hold a piece of paper between extended but adducted fingers DR NEETI CHRISTIAN (PT) 87
  • 88.  Radial:  Associated with gunshot or stab wounds, fracture of humerus, "Saturday night palsy."  person demonstrates a "dropped wrist," and cannot reposition thumb.  lack of wrist extension may cause hand grip to be weak. DR NEETI CHRISTIAN (PT) 88
  • 89.  Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve as it travels through the wrist's carpal tunnel.  It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies.  Early symptoms of carpal tunnel syndrome include pain, numbness, and paresthesias.  Pain also can radiate up the affected arm. With further progression, hand weakness, decreased fine motor coordination, clumsiness, and thenar atrophy can occur. DR NEETI CHRISTIAN (PT) 89
  • 90.  De Quervain's Tenosynovitis is a painful inflammation of tendons on the side of the wrist at the base of the thumb.  These tendons include the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL).  The pain, which is the main complaint, gets worse with abduction of the thumb, grasping action of the hand and an ulnar deviation of the wrist. Thickening and swelling can also be present. DR NEETI CHRISTIAN (PT) 90
  • 91.  A wrist sprain is an injury to the ligaments of the wrist region. There are three grades: 1. A mild overstretching of the ligaments, without joint instability. 2. A partial rupture of the ligaments, with no or mild joint instability. 3. A complete rupture of a ligament with severe joint instability. DR NEETI CHRISTIAN (PT) 91
  • 92. HAND AND WRIST OSTEOARTHRITIS:  Hand osteoarthritis(OA) is a common chronic condition involving one or more joints of the thumb and fingers. It is associated with pain, reduced grip strength, loss of range of motion (ROM), and joint stiffness, leading to impaired hand function and difficulty with daily activities.  Estimates of the prevalence of symptomatic hand OA range from 13% to 26% and are greater in women. DR NEETI CHRISTIAN (PT) 92
  • 93. Rheumatoid arthritis (RA) :  It is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement.  C/F : Polyarthritis of small joints of hands: proximal interphalangeal (PIP), metacarpophalangeal (MCP) joints and wrist.  Stiffness in the joints in the morning may last up to several hours, usually greater than an hour. The patient may have a "trigger finger" due to flexor tenosynovitis. DR NEETI CHRISTIAN (PT) 93
  • 94.  Complex regional pain syndrome (CRPS) is a term for a variety of clinical conditions characterized by chronic persistent pain and are subdivided into Type I and Type II CRPS.  It is a condition that can develop after a limb trauma and appears mostly in one or more limbs. DR NEETI CHRISTIAN (PT) 94
  • 95.  Colles fracture  Smith s fracture  Scaphoid fracture  Lunate Instability  Hamate frcture  Metacarpal fracture DR NEETI CHRISTIAN (PT) 95
  • 96.  Ape thumb :Paralysis of thenar muscles due to Median nerve injury or polio or leprosy.  Claw hand : Inability to extend fingers from IP joints due to ulnar nerve injury.  Deformities of RA DR NEETI CHRISTIAN (PT) 96
  • 97.  Dupuytren contracture is a progressive disease of the palmar fascia which results in shortening, thickening and fibrosis of the fascia and aponeurosis of the palm.  The most commonly affected digits are the third and fourth digits.  The disease begins in the palm as painless nodules that form along longitudinal lines of tension.  The nodules form cords that produce contracture deformities within fascial bands and tissues of the hand. DR NEETI CHRISTIAN (PT) 97
  • 98.  A crush injury is defined as compression of the extremities causing muscular and neurological disturbance and in the upper limb is sustained when the fingers, hand or wrist are caught between two surfaces (sharp, blunt, smooth or irregular) forcibly producing damage to the skin. DR NEETI CHRISTIAN (PT) 98