손과 손목 주변 근육 정리(수정중)

[이영호]

1. 손과 손목의 구조

http://cafe.daum.net/panicbird/RUll/24  하단부

전체 동영상  https://www.youtube.com/watch?v=zyl6eoU-3Rg&feature=player_embedded

손바닥 동영상 https://www.youtube.com/watch?v=Q3fyqEr5F1g&feature=player_embedded

손등 동영상 https://www.youtube.com/watch?v=DpQ7do2TF0c&feature=player_embedded

2. 손과 손목의 운동

- 손목 radial 움직임 20도,  ulnar 움직임 30도

- 손목 굴곡신전 60도

3. 손목의 주요 근육

1) 손목 굴곡/ 신전 주요 근육은 주관절에서 소개

2) thenar

Opponens pollicis muscle
The muscles of the thumb
The muscles of the left hand. Palmar surface.
Details
Latin	musculus opponens pollicis
Origin	trapezium and transverse carpal ligament
Insertion	metacarpal bone of the thumb on its radial side
Artery	Superficial palmar arch
Nerve	Recurrent branch of the median nerve
Actions	Flexion of the thumb's metacarpal at the first carpometacarpal joint, which aids in opposition of the thumb

Flexor pollicis brevis muscle
The muscles of the left hand. Palmar surface. (Flexor pollicis brevis visible at center right, near thumb.)
Details
Latin	musculus flexor pollicis brevis
Origin	trapezium, flexor retinaculum
Insertion	thumb, proximal phalanx
Artery	Superficial palmar arch
Nerve	Recurrent branch of the median nerve, deep branch of ulnar nerve (medial head)
Actions	Flexes the thumb at the firstmetacarpophalangeal joint
Antagonist	Extensor pollicis longus andbrevis

Abductor pollicis brevis muscle
Abductor pollicis brevis visible at center right.
Details
Latin	musculus abductor pollicis brevis
Origin	Transverse carpal ligament, thescaphoid and trapezium[1]
Insertion	Radial base of proximal phalanxof thumb and the thumb extensors[1]
Artery	Superficial palmar arch
Nerve	Recurrent branch of the median nerve
Actions	Abduction of the thumb by acting across thecarpometacarpal joint and themetacarpophalangeal joint. It also assists in opposition and extension of the thumb.
Antagonist	Adductor pollicis muscle

3) Adductor pollicis muscle

Adductor pollicis muscle
The muscles of the thumb. (Adductor pollicis transversus is red band at bottom, and adductor pollicis obliquus is red band immediately above it.)
Details
Latin	musculus adductor pollicis
Origin	Transverse head: anterior body of the third metacarpal Oblique head: bases of thesecond and the third metacarpals and the adjacenttrapezoid and capitate bones
Insertion	medial side of the base of theproximal phalanx of the thumband the ulnar sesamoid
Artery	deep palmar arch
Nerve	deep branch of the ulnar nerve(T1)
Actions	adducts the thumb at thecarpometacarpal joint
Antagonist	Abductor pollicis longus muscle,Abductor pollicis brevis muscle

4) hypothenar

Opponens digiti minimi muscle
The muscles of the thumb. (Opponens quinti digiti visible at center right.)
Front of the left forearm. Deep muscles. (Opponens digiti quinti visible at bottom left.)
Details
Latin	musculus opponens digiti minimi
Origin	Hook of hamate and flexor retinaculum
Insertion	Medial border of 5th metacarpal
Artery	ulnar artery
Nerve	deep branch of ulnar nerve (C8 and T1)
Actions	Draws 5th metacarpal anteriorly and rotates it, bringing little finger (5th digit) into opposition with thumb

Flexor digiti minimi brevis
The muscles of the left hand. Palmar surface
Details
Latin	musculus flexor digiti minimi brevis manus
Origin	hamate bone
Insertion	ulnar side of the base of the proximal phalanx of minimi
Artery	ulnar artery
Nerve	deep branch of ulnar nerve
Actions	flexes little finger
Antagonist	Extensor digiti minimi muscle

Abductor digiti minimi muscle of hand
The muscles of the left hand seen frompalmar surface (abductor digiti quinti visible at center left)
Details
Latin	Musculus abductor digiti minimi manus
Origin	Pisiform bone, the pisohamate ligament, and the flexor retinaculum
Insertion	Base of the proximal phalanx of the 5th digit on the ulnar ormedial side
Artery	Ulnar artery
Nerve	Deep branch of ulnar nerve
Actions	Abducts little finger

4) Palmaris brevis muscle

Palmaris brevis muscle
The muscles of the left hand. Palmar surface (palmaris brevis visible at center left).
Details
Latin	Musculus palmaris brevis
Origin	Flexor retinaculum (medial) andpalmar aponeurosis
Insertion	Palm
Nerve	Superficial branch of ulnar nerve
Actions	Pulls on skin over hypothenar eminence, deepening the cup of the palm and so improving grip

5) Lumbricals of the hand

Lumbricals of the hand
The muscles of the left hand. Palmar surface. (1st lumbricalis labeled at bottom right of muscular group.)
Details
Latin	musculi lumbricales manus
Origin	flexor digitorum profundus
Insertion	extensor expansion
Artery	superficial palmar arch, common palmar digital arteries, deep palmar arch, dorsal digital artery
Nerve	3rd and 4th deep branch of ulnar nerve, 1st and 2nd median nerve
Actions	flex metacarpophalangeal joints,extend interphalangeal joints

6)Dorsal interossei of the hand

Dorsal interossei of the hand
Interossei dorsales of left hand.
Details
Latin	Musculi interossei dorsales manus
Origin	Metacarpals
Insertion	Proximal phalanges andextensor expansions
Artery	Dorsal and palmar metacarpal artery
Nerve	Deep branch of ulnar nerve
Actions	Abduct finger
Antagonist	Palmar interossei

7)Palmar interossei muscles

Palmar interossei muscles
Three of the palmar interossei of the left hand
Details
Latin	Musculi interossei palmares
Origin	Sides of metacarpals facing midline
Insertion	Bases of proximal phalanges, extensor expansions
Artery	Palmar metacarpal artery of deep palmar arch
Nerve	Deep branch of ulnar nerve
Actions	Adduction, flexion and extension of fingers
Antagonist	Dorsal interossei

4. 손과 손목의 흔한 질환

http://cafe.naver.com/panicbird/141

손목 통증질환 https://www.youtube.com/watch?v=vTcgJuwoPis&feature=player_embedded

                    https://www.youtube.com/watch?v=tJhfKBhzRRM&feature=player_embedded

5. 근막이완

 1) 롤핑

     http://cafe.daum.net/panicbird/OJs0/281

 2) CMP건

    - http://cafe.daum.net/panicbird/Qibc/88

    - http://cafe.daum.net/panicbird/Qibc/89

 3) 단단한 공 이용

6. 주요 근육 스트레칭 

1) 스트레칭 기본개념

*** 각 동작은 5초씩 3회가 기본(7초가 넘어가면 보상기전이 발생하므로)

*** 모든 동작은 다음 동작을 위한 예비동작 임, 건너 뛰지 말 것

 http://cafe.daum.net/panicbird/QtNi/299

2) thenar

3) hypothenar

4) lumbrical, interossei

https://youtu.be/yJsU2bed6FM

7. 관절가동  

1) 총괄

 http://cafe.daum.net/panicbird/OUdz/3

2) distal radioulnar joint mobilization 

https://www.youtube.com/watch?feature=player_embedded&v=Fn3JSdqaZFE

3) wrist complex joint mobilization

https://youtu.be/ulwvV-COBUw

4) Metacarpal Mobilization

https://www.youtube.com/watch?feature=player_embedded&v=jq4qscIUhm0

5) mcp and ip joint mobilization

https://youtu.be/q8C0N_Fa9E0

8. 인대 약침, 가열식 화침

 http://cafe.daum.net/panicbird/RNu8/21

9. stabilizing ex.

10. 근력 불균형 검사

1)근력 검사의 고려사항

http://cafe.daum.net/panicbird/QzZ4/15

2) https://youtu.be/OtR35RCNc9k

3) finger extension, finger flexion, finger abduction , thumb abduction, thumb opposition

11. isolation ex.

이미지 출처 : http://blog.codinghorror.com/content/images/uploads/2006/06/6a0120a85dcdae970b0176158540eb970c-800wi.png

12. functional ex.

 1) 수건이나 신문 구기기

 치료대 위에 수건을 펼쳐 놓는다. 수건의 한쪽 끝에 손바닥이 아래로 가게 환자의 손을놓게 한다. 팔꿈치가 닿도록 유지하는 동안 손으로 수건을 구긴다 . 이 같은 운동은 손아래에 신문을 놓음 으로써 수행되어질 수 있다. 환자는 맨위에 있는 신문을 동그랗게 구겨서 바구니 안에 던져 넣는다.

2) 다양한 크기의 작은 물건을 집어올리기

3) 나사를 돌리고 볼트를 빼내기

4) 매듭을 묶고 풀기, 작은 병 열고 닫기

출처 : 키스너 콜비 '운동치료 총론' p744

13. 정렬운동

14. 행동수정

 손목쪽에는 ganglion이 많이 발생하는데 compression 후 움직임을 주도록 티칭.

 스트레칭과 아이스팩.