Test Your Knowledge of Positional Release Therapy Techniques for Wrist and Hand...

Palpation and Treatment of Anterior Structures of the Wrist and Hand using Positional Release Therapy

• The wrist flexor tendons may exhibit osteopathic lesions and become entrapped within the carpal tunnel causing pain and numbness in the hand.

• The wrist flexor tendons palpation procedure involves strumming across the flexor tendons and noting the location of any tender points or fasciculatory response.

• The PRT clinician procedure for the wrist flexor tendons involves applying marked wrist flexion, wrist deviation, rotation, and light compression at the wrist toward the elbow.

• The metacarpophalangeal (MCP) joints are synovial ellipsoid joints formed by the articulation of each metacarpal and the proximal end of the associated proximal phalange.

• The MCP joint palpation procedure involves grasping the MCP between the thumb and forefinger, rolling over the dorsal and palmar aspects of the joint, and noting the location of any tender points or fasciculatory response.

• The PRT clinician procedure for the MCP joints involves applying long axis compression, phalange flexion, and extension, as well as rotation of the proximal phalange and metacarpal.

• The proximal and distal interphalangeal joints of the fingers often present with acute and chronic injury or conditions such as a jammed finger, pulley rupture, and osteoarthritis.

• The palpation procedure for the proximal and distal interphalangeal joints involves strumming deeply between the metacarpals and along their shafts, noting the location of any tender points or fasciculatory response.

• The PRT clinician procedure for the interphalangeal joints involves applying compression to the joint, extending the joint for dorsal lesions, and flexing for palmar lesions, as well as applying a valgus force for medial lesions and a varus force for lateral lesions.

• The lumbricals of the hand join both the flexor and extensor tendon systems of the hand and fingers and assist with both actions at the fingers.

• The lumbricals of the hand palpation procedure involves strumming deeply between the metacarpals and along their shafts, noting the location of any tender points or fasciculatory response.

• The PRT clinician procedure for the lumbricals of the hand involves applying flexion as well as adduction to the metacarpals and fingers, adducting the metacarpals by squeezing the patient’s hand together, and rotating the metacarpals for fine-tuning.

• The opponens and adductor pollicis share a common deep location within the thenar eminence of the thumb and also a similar function, which is why they are grouped for palpation and treatment.Positional Release Therapy for Wrist and Hand Muscles

• The abductor and flexor pollicis brevis are superficial and intermediate muscles that form the thenar eminence of the thumb.

• These muscles abduct and flex the thumb, and are treated as a group.

• Palpation of these muscles involves starting at the MCP joint of the thumb and strumming towards it.

• The dorsal interossei of the hand are four bipennate muscles that arise from the sides of each of the metacarpals and function in finger abduction.

• Palpation of these muscles involves stroking up and down each side of the metacarpals and the overlying interossei.

• The extensor tendons crossing at the wrist may exhibit osteopathic lesions, often due to repetitive eccentric wrist flexion or acute injury.

• Palpation of wrist extensor tendons involves starting at about 1 cm medial to the radial styloid and strumming across the tendons.

• The tendons of the extensor pollicis longus and brevis form the borders of the anatomic snuff box at the posterior thumb.

• These tendons are not accessible to palpation because they course upward to the middle of the posterior forearm, deep to the forearm extensors.

• Lesions of these tendons are often present with conditions such as osteoarthritis of the CMC joint of the thumb and de Quervain syndrome.

• Palpation of the extensor pollicis longus and brevis tendons involves visually identifying both tendons by asking the patient to pull the thumb upward and back.

• Treatment for these tendons involves applying marked thumb extension, compression of the thumb towards the wrist, and rotation to the thumb.