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Wrist Hand Presentation
 

Wrist Hand Presentation

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    Wrist Hand Presentation Wrist Hand Presentation Presentation Transcript

    • 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
    • Mobilization Techniques for the Wrist
      • Wrist distraction
      • Wrist dorsal and volar glides
      • Dorsal 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
    • Volar and Dorsal Glide of the Radio-Ulnar Joint
      • Volar Glide restores Pronation
      • Dorsal 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