wrist hand presentation
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Wrist, Forearm and Finger Mobilization-Case Studies
W. Smith DPT. ATC , SCS , CMT
Wrist Colles’ Fracture
Colles’ fracture 1. Classified as an extra-articular fracture of the distal
radius with dorsal (posterior) displacement of the distal radius and a radial shift of the wrist carpals and hand.
2. Complications from a Colles’ fracture can include injury to the distal radioulnar joint and the distal radiocarpal joint.
Colles’ Fracture- Case I
History 18 year old skateboarder sustained a colles’ fracture of the right wrist.
Clinical Findings Functional losses to the patient include limited range of
motion in all planes of wrist movement: a. Flexion/extension. b. Radial/ulnar deviation. c. Pronation/supination.
Pain is intermittent rated 4/10
Arthokinematic of the Wrist
It believed that most wrist motion occurs between the radiocarpal, ulnacarpal and midcarpal rows.
Proximal articulation of the convex scaphoid, lunate and triquetrium move on concave radius.
Dorsal glides of the scaphoid, lunate and triquetrium will enhance flexion of the wrist.
Arthokinematic of the Wrist
Volar glide of scaphoid, lunate and triquetrium will help to restore extension.
Radial deviation occurs in conjunction with wrist extension.
Ulnar deviation occurs in conjunction with wrist flexion.
Wrist Bone Anatomy
QuickTime™ and aPlanar RGB decompressor
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Mobilization Techniques for the Wrist
Wrist distractionWrist dorsal and volar glidesDorsal and volar glides of selected carpal
bones.Radial and ulnar glides of the wrist.
Wrist Distraction
To increase joint play in the radiocarpal and ulnocarpal joints
To decrease pain Generally first
mobilization treatment
Wrist Dorsal Glide
Purposes are the same as for distraction, with emphasis on restoring wrist flexion.
Dorsal Glide of the Capitae on Lunate
Helps restore wrist flexion.
Wrist Ventral (Volar) Glide
To increase overall movement of the proximal row of carpal bones on the radius and ulna.
To improve overall wrist extension.
Volar Glide of Scaphoid on Radius
To Improve Extension of the wrist.
Triquetrium-Ulna Glide
To restore wrist extension
To release a fixated triquetal-ulnar disc.
Wrist Ulnar Glide
General Mobilization to restore radial deviation and wrist flexion.
Wrist Radial glide
General Mobilization to restore ulna deviation and wrist extension
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Volar and Dorsal Glide of the Radio-Ulnar Joint
Volar Glide restores PronationDorsal Glide restores Supination
Metacarophalangel Mobilization Techniques
Selected Conditions
Finger Injuries
Treating joint restriction can be a challenge due to: Effects of swelling on the small joints
(fibrosis) Small lever arm
Finger Injuries
Distal phalanx Avulsions
Terminal extensor with tight repair
Treatment: MP distraction and dorsal glide
MP,PIP DIP Volar Glides
To improve flexion of the digits
Finger Fractures
Finger Fractures adhesion due to splintered fracture and division
of extensor hood for visualization of the fracture
Treatment: Dorsal/palmar glides Middle phalanx Very rare due to thick cortex of shaft
Proximal Phalanx Many are spiral fractures that require fixation Joint fibrosis due to swelling/immobilization Tendon
End