WRIST FLEXION EXERCISE CONTINUED

Wrist Extension

          Normal and Good

ü   Forearm in pronation, muscles of thumb and fingers relaxed.

ü   Patient extends wrist.

ü   To test Extensor carpi radialis longus and bravis, resistance is given on dorsal surface of second and third metacarpal bones in direction of flexion and ulnar deviation.

ü   To test Extensor carpi ulnaris, resistance is given on dorsal surface of fifth metacarpal bone in direction of flexion and radial; deviation.

Note: Do not allow extension of fingers during the movement of resistance to prevent substance to prevent substitution by the finger extensors.

 

 


 

 

FLEXION OF METACARPOHALANGEAL JOINTS OF FINGERS

NORMAL AND GOOD

ü Forearm supinated

ü Stylize metacarpals

ü Patient fixes fingers metacarpo phalangeal joints, keeping inter-malangeal joints extended.

ü Resistance is given on palmer surface of proximal row of phalanges.

ü Extension of the middle and distal inter-phalangeal joints with metacarpophalangeal joint in flexion should be tested concurrently, extension of these joint is part of the primary action of the lumbricales.

NOTE: Resistance should be given to each finger separately as lumbricales are uneven in strength and have divided innervations.

The flexor digitorum superficalist and flexor digitorum prefundins should not be allowed to subsititute for umbricales with flexion of fingers. These muscles should be kept relaxed as much as possible with motion limited to metacarpophalangeal joint.

FLEXION OF PROXIMAL AND DISTAL INTERPHALANGEAL JOINTS OF FINGERS

NORMAL AND GOOD

ü Forearm supinted, wrist in mid-position and fingers extended.

ü Stabilize proximal phalanx of finger.

ü Patient flexes middle phalanx and resistance is given on palmar surface.

 

EXTENSION OF METACARPOPHALANGEAL JOINTS OF FINGERS

NORMAL AND GOOD

ü Forearm pronated wrist in mid-positon ,fingers flexed.

ü Patient extends metacarpophalengeal joints with inter phalangeal joints partially fixed. Resistance is given on dorsal surface of proximal row of phalanges of fingers

Note:  Resistance should be given to each finger separately. Extensor indices assists in extension of index finger, and extensor digits minimi assists in extension of fifth finger.

Extension of the wrist beyond the midline allows “slacks” in the long finger flexors that inhibit completion of range of motion in extension.

Flexion of the wrist causes tension in the long finger extensors that result in passive extension at the metacarpophalangeal joint.


FINGER ABDUCTION

NORMAL AND GOOD

ü Forearm pronated , hand resting on table, fingers in extension and addiction.

ü Stabilize metacarpals.

ü Patients abdults fingers.

ü Resistance is given on radial side of second and ulnar side of third finger.

ü To test individual fingers, resistance is given on proximal phalanx.



FINGER ABDUCTION

NORMAL AND GOOD

ü Forearm pronated fingers in extension and abduction.

ü Patient adducts fingers.

ü Resistance is given in radial direction on.

ü Proximal phalanx of second finger and in ulnar direction on fourth and fifth fingers.

Test fingers individually.

 

FLEXION OF METACARPOPHALANGEAL AND INTERPHALANGEAL JOINTS OF THUMB

NORMAL AND GOOD

ü Forearm in supinated, wrist in mid-position.

ü Stabilize first metacarpal.

ü Patient flexes proximal phalanx of thumb.

ü Distal phalanx remains relaxed.

ü Resistance is given on palmar surface of proximal phalanx.

 

EXTENSION OF METACARPOPHALANGEAL AND INTERPHALANGEAL JOINTS OF THUMBS

          NORMAL AND GOOD

ü Forearm and wrist in mid-position.

ü Stabilize first metacarpal.

ü Patient extends proximal phalanx of thumbs.

ü Resistance is given on dorsal surface of proximal phalanx.

 

THUMBS ABDUCTION

NORMAL AND GOOD

ü Forearm supinated, wrist in mid-position.

ü Stabilize medial four metacarpals and wrist.

ü Patient raises thumb vertically through range of abduction.

ü Resistance is given on lateral border of proximal phalanx of the thumbs for the abductor pollics  longus and the distal and of the metacarpal of the abductor policis brevis.

ü If the abductor policies longus is stronger than the bravis, thumbs will deviate toward radial side of hands.

ü If the abductor policies longer are stronger than the brevis, thumb will deviate toward radial side of hand.

ü If the abductor policies brevis is stronger deviation will be toward ulna side

THUMBS ABDUCTION

NORMAL AND GOOD

ü Forearm pronated, wrist in mid-position

ü Stabilize medical four metacarpals

ü Resistance is given on medical border of proximal phalanx

 


OPPOSITION OF THUMB AND FIFTH FINGER

NORMAL AND GOOD

ü Forearm supinated, wrist in mid-position

ü Patient brings palmer surfaces of distal phalanges of thumb and fifth finger together.

ü The first fifth metacarpals rotate toward the mid-line of the hand. The movement cannot be carried out by muscles other than the two opponents

ü Resistance is given on distal and of first and fifth metacarpals on palmar surface with derotating pressure. The two muscles are graded separately.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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