Sporting Hand and Wrist - What to Consider When Measuring Range of Motion: Difference between revisions

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* Proximal region of the hand is the carpus (wrist)
* Proximal region of the hand is the carpus (wrist)
* The middle region the metacarpus (palm)
* The middle region the metacarpus (palm)
* The distal region the phalanges (fingers)
* The distal region the phalanges (fingers)[[File:Bigstock-Skeletal-System-Phalanges-89698643.jpg|center|Skeletal System Phalanges - 89698643|1000x1000px]]


== Joints in the wrist and hand ==
== Joints in the wrist and hand ==
Line 67: Line 67:
|Flexion (lots) Extension (minimal)
|Flexion (lots) Extension (minimal)
|}
|}
Table summarises from - Kapandji I.A. The Physiology of the Joints: Volume 1, The Upper Limb. 5th Ed. London: Churchill Livingstone, 1982[[File:Bigstock-Skeletal-System-Phalanges-89698643.jpg|center|Skeletal System Phalanges - 89698643|1000x1000px]]
Table summarises from - Kapandji I.A. The Physiology of the Joints: Volume 1, The Upper Limb. 5th Ed. London: Churchill Livingstone, 1982


60% of it is coming from that midcarpal joint that we discussed, the more distal joint versus 40% coming from the radiocarpal joint.
== Range of motion in the wrist and hand ==
== Range of motion in the wrist and hand ==
# Flexion
{| class="wikitable"
When looking at flexion, roughly about 90 degrees. 60% of it is coming from that midcarpal joint that we discussed, the more distal joint versus 40% coming from the radiocarpal joint. So you can see if there's more movement happening from the midcarpal joint, or even not to get confused, that there's a big percentage, you know, almost half, but more than half happening from that midcarpal joint, we need to know how to measure it. And so that's where it comes when we talk about the how, to try and make sure we incorporate that.
|Movement
 
|Muscles
2. Extension
|Range
 
|Origin
Extension tends to be a bit less. Depends obviously, what type of sport you do? You always have these exceptions, but tends to be a bit less, 80 degrees. But now it's reversed. So you have more movement that tends to occur at your radiocarpal joint than your midcarpal joint. And that's really is occurring because of the mechanics of the scaphoid, which I'm not going to dwell into detail over here because we're trying to keep it uncomplicated rather than complicated, but just an understanding that obviously, if you're doing flexion and extension, you have a component of radiocarpal and midcarpal joint.
|Insertion
 
|Innervation
3. Radial deviation
|Joint
 
|-
The same can be said then for your radial deviation and also your ulnar deviation. So to go back to radial deviation, you can see like flexion, you have a bit more of that midcarpal joint occurring versus radial and the movements are about up to 20 degrees. Ulnar deviation tends to be more. It tends to be double. So almost a ratio of twos to one, ulnar deviation versus radial deviation. But again, that's if it's from a normative population, you have to see the type of athletes they are, what are they doing? You tend to have compensations, but obviously, it's good understanding of knowing you're left to right. So again, you can see like flexion and radial deviation, a bit more midcarpal joint. So really what we need to take away from here to try to keep it simple, movements are happening from both the midcarpal joint and the radiocarpal joint. So it's an understanding that when we're measuring, we need to measure that.
|'''Flexion'''
 
|Flexor carpi radialis
4. Ulnar deviation
|0-80
 
|Medial Epicondyle of humerus
5. Distal interphalangeal
|2nd and 3rd metacarpals
 
|Median nerve (C6,7)
6. Proximal Interphalangeal
|Radiocarpal Jt
 
|-
7. Pronation
|
 
|Flexor carpi ulnaris
not directly because it's pertained to the wrist, although you can see with external forces, you are going to get that additional 10% or additional movement and torsion happening over there. But it is important because pathology is like, your TFCCs. Pathologies, which involve these sort of pronation supination movements, which is very big in sports, you know, think about golf. Think about, you know, your rugby's, your movements. Think about your tennis. So what other movements you're doing and whether they have obviously that external force or not, you need that movement and if that is obviously limited, it can require more movements to occur, more distally
|
|Medial epicondyle of humerus and sup.post. border of ulna
|Pisiform, hamate and base 5th metacarpal
|Ulnar nerve (C7,8)
|
|-
|
|Palmaris longus
|
|Medial epicondyle of humerus
|Flexor reinaculum and palmar aponeurosis
|Median nerve (C8)
|
|-
|
|Flexor digitorum superficialis
|
|Medial epicondyle of humerus, coronoid process of
ulna, and a ridge along lateral margin of anterior surface of radius
|Middle phalanges of each finger
|Median nerve (C7,8 T1)
|
|-
|
|Flexor digitorum profundus
|
|Anterior medial surface of body of ulna
|Base of distal phalanx of thumb
|Median nerve (C7,8, T1)
Ulnar nerve (C8, T1)
|
|-
|
|Flexor pollicis longus
|
|Anterior surface of radius and interosseous membrane
|Base of distal phalanx of thumb
|Median nerve (C8, T1)
|
|-
|'''Extension'''
|Extensor carpi radialis longus
|0-70
|Lateral supracondylar ridge of humerus
|2nd metacarpal
|Radial nerve (C6,7)
|Radiocarpal Jt
|-
|
|Extensor carpi radialis brevis
|
|Lateral epicondyle of humerus
|Distal and middle phalanges of each finger
|Radial nerve (C6,7)
|
|-
|
|Extensor carpi ulnaris
|
|Lateral epicondyle of humerus and posterior border of ulna
|5th metacarpal
|Radial nerve (C7,8)
|
|-
|
|Extensor digitorum
|
|Lateral epicondyle of humerus
|Distal and middle phalanges of each finger
|Radial nerve (C7,8)
|
|-
|
|Extensor indicis
|
|Posterior surface of ulna
|Tendon of extensor digitorum of index finger
|Radial nerve (C7, 8)
|
|-
|
|Extensor digiti minimi
|
|Lateral epicondyle of humerus
|Tendon of extensor digitorum on 5th phalanx
|Radial nerve (C7,8)
|
|-
|
|Extensor pollicis longus
|
|Posterior surface of middle of radius and ulna and interosseous membrane
|1st metacarpal
|Radial nerve (C7,8)
|
|-
|
|Extensor pollicis brevis
|
|Posterior surface of middle of radius
|Base of proximal phalanx of thumb
|Radial nerve (C7,8)
|
|-
|'''Radial deviation'''
|Flexor carpi radialias
|30
|Medial Epicondyle of humerus
|2nd and 3rd metacarpals
|Median nerve (C6,7)
|Radiocarpal Jt
|-
|'''Ulnar deviation'''
|Flexor carpi ulnaris
|20
|Medial epicondyle of humerus and sup.post. border of ulna
|Pisiform, hamate and base 5th metacarpal
|Ulnar nerve (C7,8)
|Radiocarpal Jt
|-
|'''Supination'''
(of forearm)
|Supinator
|60
|Lateral epicondyle of humerus and ridge near radial notch of ulna
|Lateral surface of proximal one-third of radius
|Radial nerve (C5,6)
|Sup. and inf.radioulnar jt
|-
|
|Biceps brachii
|
|Long head - supraglenoid tubercle; Short head - coracoid process of scapula
|Radial tuberosity and bicipital aponeurosis
|Musculocutaneous nerve (C5,6)
|
|-
|
|Brachioradialis
|
|Medial and lateral borders of distal end of humerus
|Superior to styloid process of radius
|Radial Nerve (C5,6)
|
|-
|'''Pronation'''
(of forearm)
|Pronator teres
|40
|Medial epicondyle of humerus and coronoid process of ulna
|Midlateral surface of radius
|Median nerve (C6,7)
|Sup.and inf.radioulnar jt
|-
|
|Pronator quadratus
|
|Distal portion of shaft of ulna
|Distal portion of shaft of radius
|Median nerve (C8, T1)
|
|-
|
|Brachioradialis
|
|Medial and lateral borders of distal end of humerus
|Superior to styloid process of radius
|Radial nerve (C5,6)
|-
|Distal Interphalangeal
|
|
|
|
|
|-
|Proximal Interphalangeal
|
|
|
|
|
|}
Table summarised from {Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th Ed. London: Churchill Livingstone, 2012}


8. Supination
== Tools used to measure range of motion in the wrist and hand ==
== Tools used to measure range of motion in the wrist and hand ==
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Revision as of 19:35, 21 March 2021

Bony Anatomy[edit | edit source]

The hand and wrist have a total of 27 bones arranged to roll, spin and slide[Maitland, G.D. Maitland's Peripheral Manipulations. 3rd Edition Edinburg: Elsevier Butterworth-Heinemann, 1999]; allowing the hand to explore and control the environment and objects.

The carpus is formed from eight small bones collectively referred to as the carpal bones. The carpal bones are bound in two groups of four bones:

  • the pisiform, triquetrum, lunate and scaphoid on the upper end of the wrist
  • the hamate, capitate, trapezoid and trapezium on the lower side of the hand.

Other bones of the hand are:

  • the metacarpals – the five bones that comprise the middle part of the hand
  • the phalanges (singular phalanx) – the 14 narrow bones that make up the fingers of each hand. Each finger has three phalanges (the distal, middle, and proximal); the thumb has two.

The hand is divided into three regions[Physical Examination of the Spine and Extremities. Hoppenfield, S. New York: Appleton-Century-Crofts, 1976.]

  • Proximal region of the hand is the carpus (wrist)
  • The middle region the metacarpus (palm)
  • The distal region the phalanges (fingers)
    Skeletal System Phalanges - 89698643

Joints in the wrist and hand[edit | edit source]

Joint Proximal articulation Distal Articulation Type Movement
Radiocarpal joint Radius and articular disc/ concave Scaphoid, lunate, triquetrum / – convex Ellipsoid Flexion-extension; Abduction-adduction
Midcarpal joint Scaphoid. Lunate, Triquetrum Trapezium, Trapezoid, Capitate, Hamate Gliding Flexion-extension; Abduction-adduction
Carpometacarpal joint (thumb) 1st metacarpal trapezium Saddle Flexion-extension; Abduction-adduction; circumduction; opposition
Carpometacarpal joint (fingers) 2nd metacarpal

3rd metacarpal

4th metacarpal

5th metacarpal

trapezoid, trapezium

capitate

capitate, hamate

hamate

Ellipsoidal Flexion-extension
Metacarpophalangeal joints Metacarpals phalangeal Ellipsoidal Flexion, extension, abduction, adduction, circumduction
Interphalangeal Distal phlangeal Proximal phalangeal Hinge Flexion (lots) Extension (minimal)

Table summarises from - Kapandji I.A. The Physiology of the Joints: Volume 1, The Upper Limb. 5th Ed. London: Churchill Livingstone, 1982

60% of it is coming from that midcarpal joint that we discussed, the more distal joint versus 40% coming from the radiocarpal joint.

Range of motion in the wrist and hand[edit | edit source]

Movement Muscles Range Origin Insertion Innervation Joint
Flexion Flexor carpi radialis 0-80 Medial Epicondyle of humerus 2nd and 3rd metacarpals Median nerve (C6,7) Radiocarpal Jt
Flexor carpi ulnaris Medial epicondyle of humerus and sup.post. border of ulna Pisiform, hamate and base 5th metacarpal Ulnar nerve (C7,8)
Palmaris longus Medial epicondyle of humerus Flexor reinaculum and palmar aponeurosis Median nerve (C8)
Flexor digitorum superficialis Medial epicondyle of humerus, coronoid process of

ulna, and a ridge along lateral margin of anterior surface of radius

Middle phalanges of each finger Median nerve (C7,8 T1)
Flexor digitorum profundus Anterior medial surface of body of ulna Base of distal phalanx of thumb Median nerve (C7,8, T1)

Ulnar nerve (C8, T1)

Flexor pollicis longus Anterior surface of radius and interosseous membrane Base of distal phalanx of thumb Median nerve (C8, T1)
Extension Extensor carpi radialis longus 0-70 Lateral supracondylar ridge of humerus 2nd metacarpal Radial nerve (C6,7) Radiocarpal Jt
Extensor carpi radialis brevis Lateral epicondyle of humerus Distal and middle phalanges of each finger Radial nerve (C6,7)
Extensor carpi ulnaris Lateral epicondyle of humerus and posterior border of ulna 5th metacarpal Radial nerve (C7,8)
Extensor digitorum Lateral epicondyle of humerus Distal and middle phalanges of each finger Radial nerve (C7,8)
Extensor indicis Posterior surface of ulna Tendon of extensor digitorum of index finger Radial nerve (C7, 8)
Extensor digiti minimi Lateral epicondyle of humerus Tendon of extensor digitorum on 5th phalanx Radial nerve (C7,8)
Extensor pollicis longus Posterior surface of middle of radius and ulna and interosseous membrane 1st metacarpal Radial nerve (C7,8)
Extensor pollicis brevis Posterior surface of middle of radius Base of proximal phalanx of thumb Radial nerve (C7,8)
Radial deviation Flexor carpi radialias 30 Medial Epicondyle of humerus 2nd and 3rd metacarpals Median nerve (C6,7) Radiocarpal Jt
Ulnar deviation Flexor carpi ulnaris 20 Medial epicondyle of humerus and sup.post. border of ulna Pisiform, hamate and base 5th metacarpal Ulnar nerve (C7,8) Radiocarpal Jt
Supination

(of forearm)

Supinator 60 Lateral epicondyle of humerus and ridge near radial notch of ulna Lateral surface of proximal one-third of radius Radial nerve (C5,6) Sup. and inf.radioulnar jt
Biceps brachii Long head - supraglenoid tubercle; Short head - coracoid process of scapula Radial tuberosity and bicipital aponeurosis Musculocutaneous nerve (C5,6)
Brachioradialis Medial and lateral borders of distal end of humerus Superior to styloid process of radius Radial Nerve (C5,6)
Pronation

(of forearm)

Pronator teres 40 Medial epicondyle of humerus and coronoid process of ulna Midlateral surface of radius Median nerve (C6,7) Sup.and inf.radioulnar jt
Pronator quadratus Distal portion of shaft of ulna Distal portion of shaft of radius Median nerve (C8, T1)
Brachioradialis Medial and lateral borders of distal end of humerus Superior to styloid process of radius Radial nerve (C5,6)
Distal Interphalangeal
Proximal Interphalangeal

Table summarised from {Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th Ed. London: Churchill Livingstone, 2012}

Tools used to measure range of motion in the wrist and hand[edit | edit source]

  • Goniometer position for wrist flexion and extension

    Goniometer position for wrist flexion and extension

  • Inclinometer

    Inclinometer

  • Cellphone Inclinometer

    Cellphone Inclinometer

Goniometer Inclinometer Cellphone Inclinometer
Pros Compact, easy to use and portable Accurate and measures multiple planes Accurate, measures multiple planes, free downloadable appconvenient
Limitations Only one plane of movement Bulky and expensive

Considerations when measuring wrist flexion and extension[edit | edit source]

  • Extension/radial deviation

    Extension/radial deviation

  • Neutral

    Neutral

  • Flexion/Ulnar deviation

    Flexion/Ulnar deviation

Coupling

Open versus closed hand

Open vs closed hand

Flexion

  • Open hand = joint
  • Closed hand = soft tissue

Extension

  • Open hand = soft tissue
  • Closed hand = joint

Reason to measure[edit | edit source]

Baseline

Gupta and Moosawy 2005, talking about that free movement and external forces and the difference about those, how the impact on the radiocarpal joint

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