wrist complex, hand and finger 관절가동, 수기저항운동, 자가운동, 기능적 운동법 - 정리중

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1. starting position

2. 관절생체역학적 움직임 방향, 크기, 진폭 등

3. 움직임을 동반한 관절가동의 상상력

4. 기능적 ROM 회복

panic bird..

Wrist Complex (Fig. 5.34)

N O T E : When mobilizing the wrist, begin with general distractions and glides that include the proximal row and distal row of carpals as a group. For full ROM, individual carpal mobilizations/manipulations may be necessary. They are described following the general mobilizations. For a review of the mechanics of the wrist complex, see Chapter 19.

Radiocarpal Joint

The concave distal radius articulates with the convex proximal row of carpals, which is composed of the scaphoid, lunate, and triquetrum.

Resting Position

The resting position is a straight line through the radius and third metacarpal with slight ulnar deviation.

Treatment Plane

The treatment plane is in the articulating surface of the radius perpendicular to the long axis of the radius.

Stabilization

Distal radius and ulna.

1. Radiocarpal Distraction (Fig. 5.35)

Indications

Testing; initial treatment; pain control; general mobility of the wrist.

Patient Position

Sitting, with the forearm supported on the treatment table, wrist over the edge of the table.

Hand Placement

With the hand closest to the patient, grasp around the styloid processes and fixate the radius and ulna against the table.

Grasp around the distal row of carpals with your other hand.

Mobilizing Force

Pull in a distal direction with respect to the arm.

2. Radiocarpal Joint, General Glides, and Progression

Indications

Dorsal glide to increase flexion (Fig. 5.36A); velar glide to increase extension (Fig. 5.36B); radial glide to increase ulnar deviation; ulnar glide to increase radial deviation (Fig. 5.37).

Patient Position and Hand Placement

Sitting with forearm resting on the table in pronation for the dorsal and volar techniques and in mid-range position for the radial and ulnar techniques. Progress by moving the wrist to the end of the available range and glide in the defined direction. Specific carpal gliding techniques described in the next sections are used to increase mobility at isolated articulations.

Mobilizing Force

The mobilizing force comes from the hand around the distal row of carpals.

3. Specific Carpal Gliding (Figs. 5.38, 5.39)

N O T E : Specific techniques to mobilize individual carpal bones may be necessary to gain full ROM of the wrist. Specific biomechanics of the radiocarpal and inter carpal joints are described in Chapter 19. To glide one carpal on another or on the radius, utilize the following guidelines:

Patient and Therapist Positions

The patient sits.

You stand and grasp the patient’s hand so the elbow hangs unsupported.

The weight of the arm provides slight distraction to the joint (grade I), so you then need only to apply the glides.

Hand Placement

Identify the specific articulation to be mobilized and place your index fingers on the volar surface of the bone to be stabilized. Place the overlapping thumbs on the dorsal surface of the bone to be mobilized. The rest of your fingers hold the patient’s hand so it is relaxed.

To increase extension, the stabilizing index fingers are placed under the bone that is concave (on the volar surface), and the mobilizing thumbs are overlapped on the dorsal surface of the bone that is convex. To increase flexion, the stabilizing index fingers are placed under the bone that is convex (on the volar surface), and the mobilizing thumbs are overlapped on the

dorsal surface of the bone that is concave.

Mobilizing Force

In each case, the force comes from the overlapping thumbs on the dorsal surface. 

By mobilizing from the dorsal surface, pressure against the nerves, blood vessels, and tendons in the carpal tunnel and Guyon’s canal is minimized, and a stronger mobilizing force can be used without pain.

Indications

To increase flexion.

Glide the concave radius volarly on the stabilized scaphoid.

Glide the concave radius volarly on the stabilized lunate(see Fig. 5.38).

Glide the concave trapezium-trapezoid unit volubly on the stabilized scaphoid.

Glide the concave lunate volarly on the stabilized capitate.

Glide the concave triquetrum volarly on the stabilized hamate.

To increase extension.

Glide convex scaphoid volarly on the stabilized radius.

Glide convex lunate volarly on the stabilized radius.

Glide convex scaphoid volarly on the stabilized trapezium-trapezoid unit.

Glide convex capitate volarly on the stabilized lunate(see Fig. 5.39).

Glide convex hamate volarly on the stabilized triquetrum.

Ulnar-Meniscal Triquetral Articulation

Indications

To unlock the articular disk, which may block motions of the wrist or forearm; apply a glide of the ulna volarly on a fixed triquetrum (see Fig. 19.7).

Hand and Finger Joints

1. Carpometacarpal and Intermetacarpal Joints of Digits II–V: Distraction (Fig. 5.40)

Indication

To increase mobility of the hand.

Stabilization and Hand Placement

Stabilize the respective carpal with thumb and index finger of one hand. With your other hand, grasp around the proximal

portion of a metacarpal.

Mobilizing Force

Apply long-axis traction to the metacarpal to separate the joint surfaces.

2. Carpometacarpal and Intermetacarpal: Volar Glide

Indication

To increase mobility of the arch of the hand.

Stabilization and Hand Placement

Stabilize the carpals with the thumb and index finger of one hand; place the thenar eminence of your other hand along the dorsal aspect of the metacarpals to provide the mobilization force.

Mobilizing Force

Glide the proximal portion of the metacarpal volar ward.

See also the stretching technique for cupping and flattening the arch of the hand described in Chapter 4.

Carpometacarpal Joint of the Thumb

The CMC of the thumb is a saddle joint. The trapezium is concave, and the proximal metacarpal is convex for abduction/

adduction. The trapezium is convex, and the proximal metacarpal is concave for flexion/extension.

Resting Position

The resting position is midway between flexion and extension and between abduction and adduction.

Stabilization

Fixate the trapezium with the hand that is closer to the patient.

Treatment Plane

The treatment plane is in the trapezium for abductionadduction and in the proximal metacarpal for flexion extension.

1. Carpometacarpal Distraction (Thumb)

Indications

Testing; initial treatment; pain control; general mobility.

Patient Position

The patient is positioned with forearm and hand resting on the treatment table.

Hand Placement

Fixate the trapezium with the hand that is closer to the patient.

Grasp the patient’s metacarpal by wrapping your fingers around it (similar to Fig. 6.41A).

Mobilizing Force

Apply long-axis traction to separate the joint surfaces.

2. Carpometacarpal Glides (Thumb) (Fig. 5.41)

Indications

Ulnar glide to increase flexion; radial glide to increase extension; dorsal glide to increase abduction; velar glide to increase adduction.

Patient Position and Hand Placement

The trapezium is stabilized by grasping it directly or by wrapping your fingers around the distal row of carpals.

Place the thenar eminence of your other hand against the base of the patient’s first metacarpal on the side opposite the desired glide. For example, as pictured in Fig. 5.41A, the surface of the thenar eminence is on the radial side of the metacarpal to cause an ulnar glide.

Mobilizing Force

The force comes from your thenar eminence against the base of the metacarpal. Adjust your body position to line up the force as illustrated in Figure 5.41A–D.

Metacarpophalangeal and Interphalangeal Joints of the Fingers

In all cases, the distal end of the proximal articulating surface is convex, and the proximal end of the distal articulating surface is concave.

N O T E : Because all the articulating surfaces are the same for the digits, all techniques are applied in the same manner

to each joint.

Resting Position

The resting position is in light flexion for all joints.

Treatment Plane

The treatment plane is in the distal articulating surface.

Stabilization

Rest the forearm and hand on the treatment table; fixate the proximal articulating surface with the fingers of one hand.

1. Metacarpophalangeal and Interphalangeal Distraction (Fig. 5.42) 

Indications

Testing; initial treatment; pain control; general mobility.

Hand Placement

Use your proximal hand to stabilize the proximal bone; wrap the fingers and thumb of your other hand around the distal bone close to the joint. 

Mobilizing Force

Apply long-axis traction to separate the joint surface.

2. Metacarpophalangeal and Interphalangeal Glides and Progression

Indications

Volar glide to increase flexion (Fig. 5.43); dorsal glide to increase extension; radial or ulnar glide (depending on finger)

to increase abduction or adduction.

Mobilizing Force

The glide force is applied by the thumb against the proximal end of the bone to be moved. Progress by taking the joint to the end of its available range and applying slight distraction and the glide force. Rotation may be added prior to applying the gliding force.

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