Brunnstroms Clinical Kinesiology Sixth Edition CHAPTER 7 Wrist

Brunnstrom’s Clinical Kinesiology Sixth Edition Introduction § The wrist and hand are composed of multiple joints. § The wrist fine-tunes hand position. § The hand contains palm and fingers. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Introduction § Fingers are referred to as digits, of which there are five per hand. § The hand is a complex multipurpose organ. § Prehension § Sense organ § Expression and nonverbal communication Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Bones—Wrist § Distal ulna § Not in direct contact with carpal bones (triangular fibrocartilage complex; TFCC) § Three parts: § Ulnar styloid process § Fovea § Pole Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Bones—Wrist § Distal radius § Primary forearm bone of wrist § Features § Dorsal surface tubercle—redirect pull of extensor pollicis longus (EPL) § Radial styloid process § Ulnar notch Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Bones—Wrist § Carpal bones § Categorized into proximal and distal rows § Capitate—occupies central position § Scaphoid—most commonly fractured carpal § Lunate—most frequently dislocated carpal § Pisiform—serves as attachment for flexor carpi ulnaris (FCU) § Hamate—unique hook feature Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Bones—Hand § Metacarpals § Base articulates with carpal bones and adjacent metacarpals. § The shaft is slightly curved with a palmar concavity. § The head articulates with the base of proximal phalanx. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Bones—Hand § Phalanges § Thumb—two: proximal and distal § Digits 2– 5—three: proximal, middle, and distal § Base—biconcave § Distal heads—bicondylar Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Wrist § Radiocarpal joint § Biconcave distal radius and convex proximal row § TFCC § Attaches to distal radius and ulna § Apex attached to triquetrum § Part of flexion/extension; radial and ulnar deviation occur at this joint Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Wrist § Midcarpal joint § Formed by proximal and distal rows § Additional amounts of flexion/extension; radial/ulnar deviation Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Hand § Carpometacarpal joints (2– 5) § Metacarpal bases 2– 5 articulate with one another. § There is minimal motion of the second and third. § Fourth and fifth have significant motion. § Third acts as a stable pillar about which hand rotates. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Hand § Carpometacarpal joints—first § Saddle § Thick but loose capsule § Motions include: § Flexion/extension § Abduction/adduction § Opposition/reposition Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Fingers § Metacarpophalangeal joints § Condyloid with two degrees of freedom § Flexion/extension; abduction/adduction § Convex heads of metacarpals— 3/4 covered with articular cartilage § Concave bases of phalanges—volar plates Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Fingers § Interphalangeal joints § Digits 2– 5—proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints § Thumb—one interphalangeal joint § Hinges—one degree of freedom § Flexion/extension Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Soft Tissue Supporting Structures § Ligaments of the wrist § Complex ligaments—cover all aspects of wrist § Extrinsic—radius, ulna, or metacarpals to carpals § Flexor and extensor retinacula—Carpal Tunnel Syndrome on flexor side § Intrinsic—between carpal bones only § V-shaped ligament § No ligaments between capitate and lunate Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Soft Tissue Supporting Structures § Ligaments of the hand fingers § Medial and lateral collaterals § Taut in flexion—assist with ability to grip § Loose in extension—allow abduction/adduction § Deep transverse carpal ligament § Attaches to heads of metacarpals 2– 5 Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Joints—Soft Tissue Supporting Structures § Ligaments of the hand fingers § Thumb § Two sesamoids attached to volar plate § Several ligaments attached § Sesamoid mechanism facilitates pinch precision Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Muscles § Wrist extensors § Common origin—lateral epicondyle § With elbow >15°— anterior to elbow axis § Primary wrist extensors: § Extensor carpi radialis brevis (ECRB)—extensor carpi radialis longus (ECRL)—extensor carpi ulnaris (ECU) § Extensor digitorum § Wrist extension when fingers extended Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Muscles § Wrist flexors § Common origin—medial epicondyle § With elbow flexed, may aid in elbow flexion § Primary muscles § Flexor carpi radialis (FCR)—FCU—flexor digitorum superficialis (FDS)—flexor digitorum profundus (FDP)— Palmaris Longus (PL)—FPL—APL Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Muscles § Radial/ulnar deviation § Deviation occurs in frontal plane about an A-P axis. § Muscles (either flexors or extensors) that are further from axis will assist with respective deviation. § Wrist extensors and flexors work synergistically. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Muscles—Extensor Mechanism § Tendinous system § Three bands—central (one); lateral (two) § Retinacular system § Extensor hood § Flexor pulleys Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Wrist § Osteokinematics § Radial deviation—bony end feel § Midcarpal and radiocarpal each responsible for 1/2 § A-P axis through capitate § Ulnar deviation—firm end feel § Midcarpal responsible for 1/3 § Radiocarpal responsible for 2/3 Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Wrist § Osteokinematics § Flexion § 50° at radiocarpal joint; 35° at midcarpal § Extension § 50° at midcarpal joint; 35° at radiocarpal § Axis for flexion/extension also passes through capitate Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Wrist § Arthrokinematics § Convex proximal row on concave ulna § Roll and glide in opposite directions § Wrist extension—posterior roll; anterior glide § Arthrokinematics similar at midcarpal joint § Close-packed position—full wrist extension Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Fingers § Osteokinematics—metacarpophalangeal (MCP) joints (2– 5) § ~90° of flexion; extension is variable depending on individual and whether motion is active or passive. § End feels are typically firm for both flexion and extension. § Close-packed position = full flexion. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Fingers § Osteokinematics—MCP joints (digits 2– 5) § ~20° of abduction/adduction can occur when MCP joints are extended. § Little or no abduction/adduction with MCP joints in flexion due to Closed Packed Position. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Fingers § Osteokinematics—MCP joints (thumb) § § Hinge joint Flexion = 45– 60° Extension = 0– 20° Small amount of side-to-side motion with thumb in slight flexion § Allows for fine-tuning grasp Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Fingers § Osteokinematics—proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints § § Hinge joints Flexion = 120° Extension = 0° (unless hyperlax) Resting position (for both MCP and IP joints) § 20° of flexion § Close-packed position § Full extension (thumb); full flexion (2– 5) Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Motions—Fingers § Arthrokinematics—MCP and IP joints § Roll and glide in the same direction § True for both flexion/extension and abduction/adduction motions § In loose-packed position (20°)—large joint play motions are possible Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Functional Movements of Wrist and Hand § Types of grasp § Power grip § Incorporates entire hand § Is used for gross grasping activities § Is involved in holding an object between partially flexed fingers and palm while thumb provides counterpressure § Different types of power grips—see Table 7– 4 Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Functional Movements of Wrist and Hand § Types of grasp § Precision grip § Is used for accuracy and refinement; object manipulation § Thumb abducted—ready to oppose § Different types of precision grips—see Table 7– 5 Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Functional Movements of Wrist and Hand § Strength of grip § Males grip strength (100#) on average 2× greater than females of similar age. § Studies vary, but overall, ~6% stronger grip on dominant side. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Functional Movements of Wrist and Hand § Grasping § Finger flexion occurs with the wrist stabilized in extension. § Grip is significantly weakened if wrist flexion occurs. § Influenced by passive insufficiency of wrist extensors and active insufficiency of wrist flexors § Optimal wrist position during grasp = 20– 35° extension with slight ulnar deviation. Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Functional Movements of Wrist and Hand § Abduction/adduction digits 2– 5 § Away from midline = abduction; toward = adduction § Midline—through middle finger § Occurs at MCP joints when extended § Abduction coupled with extension; adduction with flexion Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Balanced Forces § Thumb § Mobility § Carpometacarpal (CMC) joint = a saddle joint that enhances mobility § Motions: flexion/extension; abduction/adduction; opposition and reposition Copyright © 2012 F. A. Davis Company

Brunnstrom’s Clinical Kinesiology Sixth Edition Summary § Wrist and hand as a complex organ with many responsibilities § Balance of extrinsic and intrinsic muscle activity § Functional position of wrist (20– 35° of extension); ability of injury to affect optimal wrist position Copyright © 2012 F. A. Davis Company