Stanbridge - T4 - TMT - W8 - Hand

• The lecture provides an overview of hand therapy measurements and testing.
• The content covers bones, joints, ligaments, musculature of the hand and surrounding regions.
• Range of motion measurements using goniometry for the thumb and fingers are specified.
• Discussion on manual muscle test (MMT) positions for finger and thumb is included.
• There are 3 main pinch types covered along with appropriate strength tests.
• You must review dermatomes in or near the hand.
• Documentation of objective notes from goniometry assessments and strength testing are included.

MCP Flexion ROM (Digits 2-5)

• MCP flexion measures 0-90 degrees.
• When measuring, patients must be seated with forearm and hand on surface in neutral pronation/supination.
• The wrist should be in neutral extension, flexion, and deviation.
• MCP should not be adducted or abducted.
• Extreme PIP and DIP flexion of the digit should be avoided.
• Stabilization is needed through stabilization the MC for that digit only, flex proximal phalanx in neutral adduction and abduction of MCP.
• To measure range of motion, the fulcrum must be on the dorsal aspect of MCP joint.
• Line up stationary are over the dorsal midline of the metacarpal.
• And then line up the movable arm over the dorsal midline over the proximal phalanx.
• A normal end feel should be capsular/firm or bony.

MCP Extension ROM (Digits 2-5)

• MCP extension: measures 0-45 degrees
• The patient must seated, with the forearm and hand on surface, neutral pronation/supination, neutral wrist flex/ext RD/UD.
• Also ensure the MCP isn't adducted/abducted, DIP and PIP some flexion (not full)
• You must stabilize MC of that digit as extend proximal phalanx, avoid adduction/abduction.
• When measuring with a goniometer: Fulcrum must be over dorsal aspect of the MCP joint.
• Stationary is over dorsal midline of the metacarpal.
• Movable arm is dorsal midline of the proximal phalanx.
• A normal end feel is capsular/firm, or bony.

MCP Abduction ROM (Digits 2-5)

• MCP abduction is measured without any specified normal range.
• To ensure proper measure, have the patient sit with the forearm and hand on surface, wrist at 0, forearm full pronation, MCP in 0 flexion/extension.
• Then, stabilize MC and abduct the proximal phalanx.
• When using a goniometer, the Fulcrum must be on the dorsal aspect of the MCP joint.
• Stationary arm is over dorsal midline of the metacarpal, and the movable arm covers the dorsal midline of the proximal phalanx.
• You can expect a capsular/firm or bony end feel.

MCP Adduction ROM (Digits 2-5)

• MCP adduction is measured without any specified normal range.
• Proper form dictates that the patient sit with the forearm and hand on surface, wrist 0, forearm full pronation, MCP in 0 flexion/extension, MCP in abduction.
• Then, stabilize MC and adduct at proximal phalanx (from abducted position).
• When measuring with a gonimeter, the fulcrum must be on the dorsal aspect of the MCP joint.
• The stationary arm is over dorsal midline of the metacarpal, and the movable arm goes over dorsal midline over the proximal phalanx.

Digits 2-5 PIP Flexion ROM

• PIP flexion is measured from 0 to 100 degrees.
• Ensure that the patient is seated with the hand and forearm on the surface, neutral pronation/supination, wrist at 0, and MCP at 0.
• Stabilize the proximal phalanx and move middle phalanx towards flexion.
• The fulcrum must be over the dorsal aspect of the PIP joint.
• The stationary arm goes over dorsal midline of the proximal phalanx.
• The movable arm spans the dorsal midline over the middle phalanx.
• Expect a bony or soft tissue approximation as the end feel.

Digits 2-5 PIP Extension ROM

• PIP extension measures 0 degrees.
• The patient is seated with the forearm and hand on surface, neutral pronation/supination, 0 wrist and 0 MCP.
• The therapist stabilizer proximal phalanx, extend by pushing on middle phalanx.
• The fulcrum for measurement is placed over the dorsal aspect of the PIP join.
• Stationary arm must be placed over dorsal midline of the proximal phalanx.
• Moveable arm goes over dorsal midline of the middle phalanx.
• Expect a capsular/firm end feel.

Flexion ROM (Digits 2-5)

• DIP flexion measures from 0 to 90 degrees.
• The patient must be seated with forearm and hand on surface, neutral pronation/supination, 0 wrist, 0 MCP, PIP in about 70-90 flexion.
• Stabilize middle and proximal phalanx, flex DIP by pushing on distal phalanx into flexion.
• When measuring, the fulcrum goes above and below.
• The fulcrum should be over the dorsal aspect of the DIP joint.
• Stationary arm placement must be over the dorsal midline of the middle phalanx.
• The movable arm should measure midline distally.
• Expect a bony or soft tissue approximation end feel.

DIP Extension ROM (Digits 2-5)

• A normal DIP extension measures 0 degrees.
• Patient needs to be in DIP flexion.
• Apply the Goniometer: Fulcrum should be placed over the dorsal aspect of the DIP joint
• The stationary arm measures above the joint while the movable measure midline distally.
• End Feel with DIP Extension ROM should be Capsular/Firm

Thumb CMC Flexion ROM

• Thumb CMC flexion measures from 0 to 15 degrees.
• Make sure the patient is seated with forearm and hand on the surface, full supination, 0 wrist, CMC of thumb 0 abduction, MCP and IP of thumb relaxed slight flexion
• Stabilize carpals, radius, ulna; flex CMC of thumb by pushing dorsum of MC toward ulnar aspect of hand (CMC still 0 abduction).
• Expect a soft tissue approximation or capsula/firm end feel.

Thumb CMC Extension ROM

• A normal Thumb CMC extension measures 0-20 degrees
• Patient needs to be in seated with forearm and hand on surface, full supination, 0 wrist, CMC of thumb 0 abduction, MCP and IP of thumb relaxed slight flexion.
• Goniometer: Fulcrum must be on the palmar aspect of the first CMC joint.
• Stabilize with ulnar deviations, keep the Radius Stationary (radial Styloid or Head).
• Apply distal measurement and substract: ventral part.
• Moveable Arm: Ventral midline of the 1st metatarsal.
• Normal End Feel: capsular/firm.

Thumb CMC Abduction ROM

• It measures from 0 to 70 degrees.
• Position the patient seated with hand and forearm on surface, neutral pronation/supination; 0 wrist; 0 CMC, MCP, and IP flexion/extension.
• Stabilize carpals and 2nd MC and abduct throught CMC by moving MC away from palm of hand- Goniometer: Lateral Aspect.
• Apply the Goniometer- Place the arm at the Lateral Midline Process of the radial styloid process of Ulna with the radial head still in reference.
• Normal End Feel: capsular/firm

Thumb CMC Opposition

• Thumb CMC opposition involves abd, flex, medial axial rot,add at CMC.
• Position : seated with forearm and hand, full supination with 0 flex/ext and Rd/Ud.
• Stabilize the 5th metacarpal.
• Move 1st MC as it's abducted then move to ulnar direction, to measure,
• Distance between thumb and distal phalanges is required using ruler to measure

Thumb MCP Flexion ROM

• Thumb MCP Flexion range: 0-50 degrees.
• Position the patient seated with forearm and hand on surface full, supination at the wrist, at position 0 (MC of the thumb).
• Flex by Dorsal Proximal Phalanx and towards Ulnar aspect.
• Goniometer: dorsal aspect on head at end/starting number.
• Normal End Feel of this is a Soft tissue approximation or capsular/firm

Thumb MCP Extension ROM

• There should be approximately 0 degrees .
• position patient the same way in flex but this way stabilize first Mc, go proximal and move radial
• Goniometer: dorsal aspect to measure MCP

Thumb IP flexion

• Thumb IP flexion measures between 0 to 80 degrees.
• Stabilize the joint apply: Proximal Phalanx into extension, on surface- IP flex and ext need to be the same to be valid.
• Dorsal Phalnx and go distal toward ulnar aspect
• 0 MC on MCP flex/ext
• 0IP end number- measure again

THUMB IP- THUMB EXT- Normal End Feel

• Capsular/firm- Bony or Soft Tissue

Alternate Goniometer placement if full motion does not occur,

• Clear goniometer place along side, Center the joint
• Stationary measurement: Mid line of proximal bone
• Movable arm: the mid-line of the distal bone: similar to ThumbCMC abduction

Goniometry of the hand for hand placement

• UE movement is a Primary placement on the position at any activity,
• interaction between the thumb / fingers; Opposable thumbs

Cyrax

Here are possible the patterns for fingers:

• DIP/PIP: flex and extension
• MCP: finger 2-5: flex and extension
• 1st digit: retro position

Range of Motion During Functional Task

• By Humes et al.
• ADL's to check for 11 degrees of flexion or a day to day acitivity with 4 fingers-right hands only.
• Flex for the following: Mean is at 61 degree.
• PIP: Flexion needs 60 degree
• DIP: Flexion =39 degree for digits.
• *There was no range of motions that are different for digits because the digits are the same size .

MMT Testing Positions

• Flexor Digitorum Superficialis
• against: Gravity(sitting or supine): Forearm in supination at the wrist jt; stabilized
• Movements IP flexion, tested one by one with each finger (test 2-4)
• Pressure: push Palmer into head towards extensions if Weak a decrease (decreased resistance)
• Gravity will move up , flex in Nuetral if that one was the case previously
• Flexor Digitorum Profundus- test from 2-5 distal head into palm will flex the middle one,
• Test position - wrist into extension- Gravity
• Stabilized
• Movement /pressure - push Palma into extension- week (if week unable to flex this joint)
• if unable gravity to move down- nutrual supination or probations

Palmar Longus muscle testing positions against gravity

• Stabilizing at table when coving hands
• movement cupping hand palm
• testing- gravity, push thenar/ hypo towards flat the joint.

Positions against Gravity-Extensor Digtorum

• Sitting down pronated
• stabilize
• movement 2-5 fingers to lift

Palmar Interossei

• Movement- finger up towards head
• Stabilization- adjacent
• Finger/ testing up towards head
• thumb/index/ fourth
• resistance- pulled away from head toward middle of the palm

Dorsal INterossei

• Testing movement/finger Up position toward head
• Stabilization
• Movements - away finger toward middle of the palm
• testing the following
• index- pull ring finger away towards middle
• middle- fingers towards ring ring- pinky towards digit
• if not at all what occurs means that the hand is weak in that direction.
• all movements must be in abduction from middle of the wrist

Limbriclas with interossei positions

Sitting down against gravity: wrist - slight extensions- movement of that to push up.

• extension position: wrist extnesions

Abductor Digiti minimi

• Sitting, shoulder elevated and elbow in flexion
• stabalize the hand
• pressure (unlar side 5th digit)

Flexor Digiti Minimi

• sitting forearm some pronations
• stabilize hand by arm or table (support)
• movement with IP extention

Oponents DIgiti Minimi

• sitting - suppinate
• stabilize hand through 1st MC / firmly 5th mc towards first- resistance: put the Palma surfaces alone on 5th and resist it from the joint by flattening the area

Flexor Policas Longus

• sitting supping toward the ulna side slight extension
• stabalize the 1st at Metatarsal ( proximal toward exntion)

Ext Tensor Pollica Longus

• Forearm close to mid. Position
• stabalize the head against Palma of the 1st MC through pp
• move head EXTEND JT ,
• to get through flEx with hand

Ext tensor Pollic Brevis

• Testing to have elbow close to nuturaL
• stabilize the whole hand by thereapist
• move extedn head with 0 ext

Testing to have elbow clos •stabalize the whole hand by thereapist -00

###Abductor Pollica Longus

• supinatied position •stabilize the hand by tehrapist •move side by side of both to side ext

•Weakness: wrist RD and decrease - if it occurs then you will need wrist supports

AD Ductor Pollica Brevis

• supinatied position •stabilize the hand by tehrapist 09

•

•Weakness: wrist RD and decrease - A

oppenus Pollica testing

•supping testing to stabilz hand •stabilze wrist- move in medial away abduction

Dynamometers (Device to Measure Head Strenght)

• grip stength

• pinch stength (tip, key, Palma)

• Types: (not digtal) with a dial or lever

• Patterson Medical Jamar: calibrate

###Patterson Medical: Jamar • Adjustable with inche

GRIP Dynamometer

• JAMAR manual by Patterson
• adjust from 1.7-3.38 inches
• Pt. in the seat and 1 in away at angle. elbow to nutral wrist.
• 0- 30 degress and 0 -15 degress deviation
• avergae all scores from 3 trails
• Standard deviation is average limited amount
• account hand movement at function.

dynamotor PINCH from device manual / American society for Hand Thereapsist

• Hold so the weight is on the sptA
• thumb to pinch button
• SHoulder add- nutrtal shoulder
• ELBOW at 90 DEGREE / nutreal wrist and forearm

pinch Styles

• tip: thumb to index - fingetp
• key : thumb head over the top
• Palmar pinch: thumb head , pad head , index with middle

. mathliowatz et. all : 1985

• to obtain 207 yrs
• average the subject that is 66-year-old
• pinch stabalized 20- 60 decline towards -77 years.
• . correlation low from grip and age.
• average hand left and right minimal

sensory of Ue test for body position.

• (UP, Down, Out)
• help hand place movement with minimal movement
• joint is distal to head with movement side to side.

dermatomes of hand

THeraputic measure and

• goniometers- as goniometers

• MMT - strengh tests- manual MMT

• sensory tests- type / perform

• grading: poort, fair, good = absend and the other: intact- N means not to not it all