wrist & hand function

1. TRICK MOVEMENTS OF WRIST &
HAND
Dr.Chhavi SinghTomar
Asst. Prof./Vice – Principal
Nims College of Physiotherapy &
OccupationalTherapy
NIMS University.

2. Outline:
 Introduction of hand
 Types of grasp
 Arches of the hand
 Functional position of the hand
 Joints of the hand
 Mechanism for finger flexion Mechanism for finger
extension; the extensor mechanism
 Muscles that transmit force to the extensor
mechanism
 How does the extensor mechanism work?
 Clinical appearance of peripheral nerve injuries in
the hand
 Internet links related to the hand

3. Movements of the Wrist:
 Sagittal and frontal plane movements
 Rotary motion
 Flexion
 Extension and Hyperextension
 Radial Deviation
 Ulnar Deviation

4. Joint Structure of the Hand:
 Carpometacarpal (CM)
 Metacarpophalangeal (MP)
 Interphalangeal (IP)

5. Common Injuries of the Wrist
and Hand:
 Sprains and strains fairly common
 Metacarpal fractures and football
 Ulnar collateral ligament and hockey
 Wrist fracture and skate/snowboarding
 Wrist in non-dominant hand for golfers
 Carpal tunnel syndrome

6. Types of grasp:
Two types of grasp are differentiated according
to the position and mobility of the thumb's
CMC and MP joints.
1. Power grasp
2. Precision grasp

7. POWER GRASP :
The adductor pollicis stabilizes an object against
the palm; the hand's position is static.
• cylindrical grip (fist grasp is a small diameter
cylindrical grasp)
• spherical grip
• hook grip (MP extended with flattening of
transverse arch; the person may or may include
the thumb in this grasp)
• lateral prehension (this can be a power grip if the
thumb is adducted, a precision grip if the thumb is
abducted).

8. Prehension of Hand :

9. PRECISION :
 Muscles are active that abduct or oppose the
thumb; the hand's position is dynamic.
 Palmar prehension (pulp to pulp), includes
'chuck' or tripod grips.
 Tip-to-tip (with FDP active to maintain DIP
flex)
 lateral prehension (pad-to-side; key grip)

10. Arches of Hand :
 Three arches balance
stability and mobility in the
hand.
 The proximal transverse
arch is rigid, but the other
two arches are flexible, and
are maintained by activity
in the hand's intrinsic
muscles.

11. 1.PROXIMAL TRANSVERSE ARCH :
 A stable bony arch that forms the posterior
border of the carpal tunnel.
 The arch's integrity is maintained by a soft
tissue "strut" formed by the flexor
retinaculum or transverse carpal ligament
(also called the volar carpal ligament).
 This ligamentous strut connects the scaphoid
and trapezium on the arch's radial side with
the hamate on its ulnar side, and forms the
anterior border of the carpal tunnel.

12. 2. DISTAL TRANSVERSE ARCH :
It is also call metacarpal arch, because it is formed by
the metacarpal heads; metacarpals 2 and 3 are stable
while 4 and 5 are relatively mobile.
You can observe the arch's combination of "radial"
stability and "ulnar" mobility by loosely closing your
fist, then squeezing more tightly, when you will
observe movement in the more mobile fourth and
fifth metacarpals.

13. 3. LONGITUDINAL ARCH
 3. Observe this arch's behavior as you loosely close your fist.
 The arches provide a balance between stability and mobility
for grasping.
 For instance, we produce the so-called "chuck grasp" by
using the more stable second and third metacarpals, instead
of the more mobile fourth and fifth metacarpals.
 Therapeutic splints must support these three arches.

14. Functional position of the
hand :
Wrist :
• extended - 20 degrees
• ulnarly deviated 10 degrees
Digits 2 through 5 :
• MP joints flexed - 45degrees
• PIP joints flexed 30-45 degrees
• DIP joints flexed 10-20 degrees
Thumb:
• first CMC joint partially abducted and opposed
• MP joint flexed 10 degrees
• IP joint flexed 5 degrees

15.  When therapists immobilize a patient's hand,
they often position it this way.
 During a period of immobilization, the resting
lengths of the hand's ligaments and muscles
change.
 This hand position provides the best balance
of resting length and force production so the
hand can function when the patient mobilizes
it again.

17. Mechanism for finger flexion:
 FDP: flexor digitorum profundus (the deeper of the
two)
 FDS: flexor digitorum superficialis (the more
superficial muscle)
Although the FDP is deep to the FDS over most of its
course, it attaches to the skeleton more distally,
because it passes through a 'split' in the FDS tendon.

18. Mechanism for finger extension :
 We can extend the PIP and DIP joints without
also extending the MP joints.
 But we can't extend the PIP joint without
extending the DIP joint at the same time.
 Flexing only the DIP joint without also flexing
the PIP joint is difficult.
 Full (active or passive) flexion of the PIP joint
prevents active extension of the DIP joint.

19. Force Transmission :
• 80-90% through Radius & 10-20% - Ulna
• Peak pressures are higher through Scaphoid
fossa than lunate fossa
• 50% of load applied through distal Carpus is
transmitted through the Capitate to the
scaphoid & lunate.
 Pattern of force transmittal depends on:
•Wrist position
• Capsuloligamentous integrity
• Articular surface
• Congruity

20. PERIPHERAL NERVE INJURIES IN
THE HAND :
Median nerve:
Often due to carpal tunnel syndrome.
Wasting of thenar eminence
Decreased thumb function, especially
opposition.
Thumb moves into plane of palm.

21. Ulnar nerve :
 Damage to ulnar nerve can occur with trauma to
elbow region.
 Ulnar neuropathy is a frequent complication of
diabetes mellitus .
 Wasting of web space and interosseous spaces.
 Affects strength of intrinsic muscles of hand, so
person can't hold a piece of paper between
extended but adducted fingers.
 Affects adductor pollicis and ulnar head of FPB.
 A person who lacks strength in these muscles
cannot grasp with the thumb unless he or she
flexes the IP joint by substituting with the flexor
pollicis longus.

22. Radial nerve injury :
 Associated with gunshot or stab wounds,
fracture of humerus, "Saturday night palsy."
 Person demonstrates a "dropped wrist," and
cannot reposition thumb.
 lack of wrist extension may cause hand grip to
be weak.

24. Thank You