Wrist Hand Presentation

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Wrist Hand Presentation

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

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