The Hand (Unit 4) - Kinesitherapy Principles - PDF

Unit 4. The hand Principles of kinesitherapy Prof. Olga Hoyos López MSc PT The hand Carpometacarpal (CMC) Intermetacarpal Metacarpal-phalangeal Interphalangeal 2 ...

Unit 4. The hand Principles of kinesitherapy Prof. Olga Hoyos López MSc PT The hand Carpometacarpal (CMC) Intermetacarpal Metacarpal-phalangeal Interphalangeal 2  1.Carpometacarpal joints Distal row of carpal bones and the proximal bases of the five metacarpal bones Allows the concavity of the palm to fit around many objects Capsule and ligaments (Dorsal, palmar, interosseus) Plane joints: slight gliding, except: – First metacarpal joint: Trapeziometacarpal joint 3 4  Trapeziometacarpal joint (1st CMC) Saddle joint: 2 main axis (flex/ext, ABD/ADD, + opposition. Between: Trapezium and Metacarpal 1 Important function. Large functional demand: – Grasp, grip, hold, manipulate… CMC flexión + ABD= opposition Close packed position: full opposition (no passive rotation allowed) 5 Trapeziometacarpal joint osteokinematics MOVEMENT AXIS PLANE PROM FLEXION TRANSVERSAL SAGITTAL 25-35º EXTENSION TRANSVERSAL SAGITTAL 15-25º ABD ANT-POST FRONTAL 20-25ºº ADD ANT-POST FRONTAL 30-45º 6  Trapeziometacarpal joint arthrokinematics Abduction/Adduction: convex rule (1MC is CONVEX, Trapezium is CONCAVE) Flexion/Extension: concave rule (1MC is CONCAVE, Trapezium is CONVEX) 7 Trapeziometacarpal joint arthrokinematics 8  Trapeziometacarpal joint stability High stress loads, particularly during pinch / grasp maneuvers Capsule laxity: wide ROM Ligaments / Tendons stability Complex ligamentous anatomy 9 Trapeziometacarpal joint kinetics 10  2.Intermetacarpal joints Between the bases of second to fifth metacarpal bones. Plane joints. Connected by: The dorsal and volar ligaments pass transversely from one metacarpal to another, on the dorsal and volar surfaces. The interosseous ligaments connect their contiguous surfaces. Reinforcement of the carpometacarpal joints Transverse intermetacarpal ligament: heads of the second, third, fourth and fifth metacarpals 11  3.Metacarpophalangeal joints Between the metacarpal bones and the proximal phalanges of the fingers Ellipsoid/condyloid joints Convex metacarpal head - concave base of the first phalanx Arthrokinematics: Concave rule Stability: – Palmar and collateral ligaments – Flexors and extensors muscles 12 Metacarpophalangeal osteokinematics MOVEMENT AXIS PLANE PROM FLEXION TRANSVERSAL SAGITTAL 100º EXTENSION TRANSVERSAL SAGITTAL 30-90º ABD ANT-POST FRONTAL 30-40º ADD ANT-POST FRONTAL 30-40º 13 Metacarpophalangeal arthrokinematics ARTHROKINEMATIC ATHROKINEMATIC OSTEOKINEMATIC (GLIDE) (ROLL) FLEXION PALMAR PALMAR EXTENSION DORSAL DORSAL ABD (2ND FINGER) RADIAL RADIAL ADD (2ND FINGER) ULNAR ULNAR 14 Metacarpophalangeal kinetics 15  4.Interphalangeal joints Between the phalanges of the fingers. They provide flexion towards the palm of the hand. Hinge joints (uniaxial). Flexion/extension Stability: – Palmar and collateral ligaments – Flexors and extensors muscles Head of proximal phalanx is convex. Concave rule 16 Interphalangeal osteokinematics MOVEMENT AXIS PLANE PROM FLEXION TRANSVERSAL SAGITTAL 90-135º (Proximal) EXTENSION TRANSVERSAL SAGITTAL 0º (Proximal) FLEXION TRANSVERSAL SAGITTAL 70-90º (Distal) EXTENSION TRANSVERSAL SAGITTAL 5-30º (Distal) 17 Interphalangeal arthrokinematics ARTHROKINEM ATHROKINEM MOVEMENT ATIC (GLIDE) ATIC (ROLL) FLEXION PALMAR PALMAR (Proximal) EXTENSION DORSAL DORSAL (Proximal) FLEXION PALMAR PALMAR (Distal) EXTENSION DORSAL DORSAL (Distal) 18 Interphalangeal ¡ kinetics 19