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Radial Deviation ROM. Each of the IP joints of the hand is classified as a hinge joint and is thus able to perform the motions of flexion and extension.5,13 There appears to be no significant difference in the amount of flexion and extension available at the PIP and DIP joints as one progresses across the hand.19,33 Normal ROM: 60-80 degrees. 5-5, A and B), whereas abduction and adduction occur in a plane positioned perpendicular to the palm (sagittal plane) (see Fig. Conversely, because abduction and adduction at the first CMC joint involve movement of the convex arch of the first metacarpal on the concave arch of the trapezium, the first metacarpal rolls volarly and slides dorsally during abduction and moves in the reverse direction during adduction.11,25. Effective For. In each of these joints, the capsule should be suspected if flexion is more limited than extension. Limitation of MCP joint extension is produced by tension in the anterior joint capsule and volar plate. Conversely, when radial and ulnar deviation is measured, a neutral wrist position in terms of flexion and extension should be maintained. Conversely, extension of the more proximal joints causes tension on the extrinsic finger flexors, which, in turn, restricts the amount of extension that can be obtained at more distal joints. Both opposition and adduction of the first CMC joint are limited by soft tissue approximation, the former between the pad of the thumb and the base of the fifth digit, and the latter between the side of the thumb and the tissue overlying the second metacarpal. Fig. Each MCP joint is reinforced along its sides by a pair of collateral ligaments and along its volar surface by a volar plate. Fig. The end-feel for adduction and opposition of the first CMC joint is also soft as the result of soft tissue approximation. 5-11). 15-20 degrees. Similar to the MCP joints, each IP joint is reinforced by a pair of collateral ligaments attached along the sides of the joint and by a volar plate on the volar surface (see Fig. The average DASH value for all male subjects was significantly less than that of female subjects. Measurement of first CMC joint opposition involves the measurement of motions occurring at the first and fifth CMC joints, as well as motion occurring in at least one other joint of the first or fifth digit. These movements occur around an axis that passes through the head of the capitate.37 The amounts of flexion and ulnar deviation exceed the amounts of extension and radial deviation available at the wrist.9,28,30, Motions of the bony surfaces making up the radiocarpal and midcarpal joints during motions of the wrist are fairly complex. Performing passive movement provides an estimate of ROM and demonstrates to patient exact motion desired (see Fig. 5-4). 5-4 Bony anatomy of the carpometacarpal, metacarpophalangeal, and interphalangeal joints. Do not use soft tissue of the hypothenar eminence for reference. Over dorsal surface of forearm (Fig. Align proximal arm parallel to the anterior mid-line of the humerus. MEASUREMENT of RANGE of MOTION of the ANKLE and FOOT, MEASUREMENT of RANGE of MOTION of the ELBOW and FOREARM, MEASUREMENT of RANGE of MOTION of the HIP, MEASUREMENT of RANGE of MOTION of the KNEE, MEASUREMENT of RANGE of MOTION of the CERVICAL SPINE and TEMPOROMANDIBULAR JOINT, RELIABILITY and VALIDITY of MEASUREMENTS of RANGE of MOTION and MUSCLE LENGTH TESTING of the LOWER EXTREMITY, MEASUREMENT of RANGE of MOTION of the THORACIC and LUMBAR SPINE, RELIABILITY and VALIDITY of MEASUREMENT of RANGE of MOTION for the SPINE and TEMPOROMANDIBULAR JOINT, Joint Range of Motion and Muscle Length Testing. CDS Elbow Brace Flexion; Wrist. cSCI par-ticipants produced significantly less isometric flexion and extension force than control participants, consistent with previous studies (Fig. Nine interphalangeal (IP) joints are present in the digits of the hand. Fig. (D) Abduction. Wrist Flexion: Dorsal Alignment Fig. Adduction at the MCP joints and flexion at the PIP joints normally produce a soft end-feel as the result of soft tissue approximation. 5-1). 5-3), and the radial and ulnar collateral ligaments, located on the radial and ulnar aspects of the wrist, respectively (see Figs. Much of the variation in technique appears to be due, at least in part, to inconsistent terminology regarding motion of this joint. METACARPOPHALANGEAL AND INTERPHALANGEAL JOINTS. Most of the techniques used in this text are based on motions of the CMC joint as defined in Gray’s Anatomy.5. (A) Extension. 5-5, C and D).5,25 Rotation occurs as a result of rotation of the metacarpal around its longitudinal axis during flexion and extension of the first CMC joint and normally is not measured clinically. For example, when wrist flexion-extension is measured, the subject’s wrist should not be deviated in a radial or ulnar direction. Several ligaments reinforce the wrist joint complex and guide the motions that occur at the radiocarpal and midcarpal joints. 5-12 End of wrist flexion ROM, showing proper hand placement for stabilizing forearm and flexing wrist. A more limited ROM of the wrist was required for diet and food preparation. Injuries, repetitive movements, arthritis and neurological disorders all can affect wrist range of motion. Several ligaments reinforce the wrist joint complex and guide the motions that occur at the radiocarpal and midcarpal joints. 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