MS II 11 wrist
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MS II 11 wrist
MS II 11 wrist
pivko and rosen spring 2013
how many degrees of freedom in wrist?
what kind of joint is the radiocarpal joint?
ellipsoidal - 2 degrees of freedom - it can do circumduction bc so round
ellipsoidal joint - aliases and def
condyloid, condylar, bicondylar
a condyle that is received into an elliptical cavity
permits movement in two planes, allowing flexion, extension, adduction, abduction, and circumduction
ex: wrist, MCPs, MTPs
tell me about the mid carpal joint
it's S shaped
lat part is plane
medial part is condylar
joint surface of radius on carpals?
bi-concave - radius is concave med/lat and ant/post
also, the articular disc there is concave
so, the prox row of carpals is convex
how to move carpals to increase ext, flex, rad dev, unlar dev?
how many mobilization techniques do we have for the carpals?
5 - flex ext rad ulnar distraction
the thing about the midcarpal joint
it's not a normal joint, it's a
- no muslces make mvmnt here directly, rather it moves passively bc of attachments on either side of it
no synovial jt btwn rows of carpals
how do you do med/lat glide at mid-carpal joint?
you can't due to the S shape of the joint
in wrist flex to ext, what moves first?
distal row of carpals moves until it close-packs the prox row, then they move as a unit
when each part moves into ext, its distal part goes dorsal while its prox part goes ventral
zero starting pos of the wrist?
longitudinal axes thru the radius and 3rd metacarpal are in a straight line
close packed for midcarpal jt?
ext w ulnar dev
45 ext - carpals acta as a functional unit as you go further into ext
how do carpals move in ulnar dev?
the two rows move as a unit, sooo
prox part of prox row moves radially
distal part of distal row moves ulnarly
(reverse this for radial dev)
ulnar/rad dev - which more, why?
ulnar > radial bc of big radial styloid process
radiocarpal resting pos
neutral btwn flex/ext w a bit of ulnar dev
(axis thru radius an 3rd metacarpal are straight but with a bit of ulnar dev)
radiocarpal close-packed pos?
midcarpal jt resting pos
neutral or slight flexion w ulnar dev
capsular pattern for midcarpal joint?
flex = ext
"works w RC jt"
capsular pattern for radiocarpal joint
restricted equally in all dir
the take-away about movement at radiocarpal and midcarpal joints in flex & ext
: radiocarpal > midcarpal mvmnt
: radiocarpal < midcarpal mvmnt
flexion to 85 degrees - midcarpal does 35, radiocarpal does 50
ext to 85 degrees - midcarpal does 50, radiocarpal does 35
but these numbers vary. But basically for flex/ext you want symmetry (85:85 is nice)
pos of pt's hand in radiocarpal distraction -- and list of for others
pronated -- supinate for dorsal glide, pronate for volar, go to side for ulnar glide (can for radial, but can also do it prone)
(I'm not detailing how to do a lot of these bc I think you know... so be sure to double check)
a movement to remember in wrist glides?
Tinel's sign in wrist
tap median nerve, see if you get tingle
I think the only times it's superficial enough to tap is a bit prox to the wrist, and then again in the cubital fossa
put a sphigmometer on prox to elbow, inflate, see if there's tingling within 60 sec - tests the median N.
Finglkestein's test / DeQuervain's Disease test - looks for what? tests how?
looks for tenosynovitis of the snuff box
pt puts thumb in palm, makes a fist, does ulnar dev ... look for pain
inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon
Watson's test - how?
stabilize radius, put thumb on scaphoid, glide in ulnar & radial dev, looking for pain, crepitus, clicking
Watson test - what for?
Murphy's sign -- how?
look into a fist and see if the knuckles make a straight line, checking out alignment of MCP joints -- the 3rd one should be higher
Murphy's sign - tests for what?
lunate dislocation (or at least, if the MCPs are in a straight line that's one explanation)