FOREARM & WRIST REGION
PTHY 6401 Kinesiology I Lab - 2015
I.
Palpation
Styloid Processes (review)
Scaphoid
Head of the ulna (review)
Trapezium
Dorsal Radial “Lister’s” Tubercle
Lunate
Bases & shafts of metacarpals 1-5
Capitate
Anatomic Snuffbox (contents &
Triquetrium
Wrist & finger flexor muscles &
tendons (detailed), including Palmaris
Longus
Wrist & finger extensor muscles &
tendons (detailed)
Ulnar Artery
Radial Artery pulse & pulse count
boundaries)
Pisiform
Distal Radioulnar Joint
II.
(2 places- wrist & snuffbox)
AROM Measurement
Reese &
Bandy
Movement
Body Position
Axis
Stationary Arm
Moving Arm
Normal
ROM
NOTE on Flex/Ext: fingers relaxed; also, alternatives exist for positioning shoulder & forearm (see text)
110
112
114
Wrist Flexion (dorsal align)
Wrist Flexion
(medial align)
same as below
Seated, shoulder & elbow
at 90°, neutral forearm
(supported); hand off table
Wrist Extension
(ventral align)
same as above
Lunate
Lat. Epicondyle
(forearm midline)
3rd metacarpal
0-80
Triquetrum
Olecranon
(ulnar border)
5th metacarpal
0-80
Lunate
Biceps tendon
(forearm midline)
3rd metacarpal
0-70
116
Wrist Extension
(medial align)
Seated, shoulder & elbow
at 90°, neutral forearm
(supported); hand off table
Triquetrum
Olecranon
(ulnar border)
5th metacarpal
0-70
118
Ulnar Deviation
(dorsal align)
Seated, shoulder & elbow
at 90°, neutral forearm
(supported);
Capitate
Lat. Epicondyle
(forearm midline)
3rd metacarpal
0-30
120
Radial Deviation
(dorsal align)
same as above
Capitate
Lat. Epicondyle
(forearm midline)
3rd metacarpal
0-20
MUSCLE LENGTH TESTING
Muscle Tested
Reese
& Bandy
Body Position
Movement
Measurement
158
Extrinsic Finger
Flexors
(FDS, FDP, FPL)
Supine, shoulder abd 70-90°*, elbow
extended, forearm supinated, fingers
extended
Passive OR Active
wrist extension
Goniometry of wrist extension
using medial alignment
160
Extrinsic Finger
Extensors
(ED, EPL)
Supine, shoulder abd 70-90°*, elbow
extended, forearm pronated, fingers
flexed
Passive OR Active
wrist flexion
Goniometry of wrist flexion
using medial alignment
* shoulder abducted just enough to get access to medial wrist for goniometer alignment
Plain Film Radiology of the Forearm-Wrist-Hand Regions:
Forearm: AP and Lateral view (elbow at 90°
Wrist and Hand: PA, Lateral, and Oblique; Viewed with fingers pointing up
III.
Manual Muscle Testing (GR tests are combined movements to place emphasis on muscles)
Reese
Movement
Muscle(s) Tested
Gravity Resisted
Position
Gravity Elim
Position (straight plane
movements)
115
Wrist flexion & Radial
Deviation
Flexor Carpi Radialis
Seated, forearm
supinated; supported
Seated, forearm
neutral; supported
119
Wrist flexion & Ulnar
Deviation
Flexor Carpi Ulnaris
Seated, forearm
supinated; supported
Seated, forearm
neutral; supported
123
Wrist Extension &
Radial Deviation
Extensor Carpi Radialis
Longus & Brevis
Seated, forearm
pronated; supported
Seated, forearm
neutral; supported
127
Wrist Extension & Ulnar
Deviation
Extensor Carpi Ulnaris
Seated, forearm
pronated; supported
Seated, forearm
neutral; supported
NOTE: fingers should remain relaxed during all MMTs of the wrist
HANDHELD DYNAMOMETRY (Straight-plane movements, multiple muscles)
Reese
Movement
Body Position
Placement
Stabilization
468
Wrist Flexion
Seated, wrist flexed in GE
position, supported
Ventral surface of
hand
Radial side of forearm
469
Wrist Extension
Seated, wrist extended in GE
position, supported
Dorsal surface of hand
Radial side of forearm
Kinesiology Wrist and Hand Palpation
1. The dorsal radiocarpal (RC) joint line should be palpated and drawn as shown in figure 1. You
should palpate in a proximal to distal direction and feel for the drop-off. Features to palpate and
draw include the radial and ulnar styloid processes as shown in figure 3.
2. Two additional features on the dorsal aspect of the distal forarm include the dorsal radial
tubercle (Lister’s tubercle) and the distal radioulnar joint line (DRUJ). The DRUJ can not be
directly palpated but its location can be determined by active contraction of EDM. The joint is
located just below the palpable tendon. Joint play (AP) can also confirm the location. Lister’s
tubercle is palpated as a sharp edge that runs prox-distal up to the RC joint line. The EPL tendon
uses the tubercle as a pulley, changing the line of pull.
3. The metacarpal shafts (1-5) should be palpated and drawn as shown in figures 1-3. Palpated and
draw the medial and lateral borders of each shaft. Adjacent shafts will flare proximally to form
tight articulations at the bases. The carpometacarpal (CMC) joint line will be formed by adjacent
bases. This should be carefully palpated and drawn as in figure 1. The resulting space between
the CMC and RC joint lines demarcates the area for the carpal bones. This space will be divided
into 3 equal parts by a dotted “helpers line” as seen in figure 2.
4. We will proceed to locate each of the carpals by using a set of approximations as outlined below.
With these, you can have a high degree of confidence that the respective carpal bone is within the
designated space. Note: “Row” corresponds to the rows created by the helper’s lines rather than
the anatomical proximal and distal rows.
a. Capitate: Extends from (articulated with) the base of the 3rd MC. It will fill the distal and
middle rows and is slightly wider than the base of the 3rd MC.
b. Lunate: Located in the ulnar half of the distance between the DRUJ and LT in the
proximal row. Articulates with radius proximally and capitate distally.
c. Trapezoid: Located in the distal row at the base of the 2nd MC
d. Scaphoid: Fill in the space from the lunate to the radial styloid in both the prox. and
middle rows. Keep in mind the 3-D nature of the carpals and that the Scaphoid will extend
palmarly as well. It is easily palpated in the snuff box during ulnar deviation.
e. Trapezium: Located in the distal row (in the snuff box) at the base of the 1st MC. This
CMC joint is much more mobile than the others and movement can be easily felt at the
joint line during thumb movement.
f. Hamate: Located at the base of the 4th and 5th MC’s. A diagonal line should be drawn
from the base of the 5th to the corner of the lunate crossing the distal and middle rows.
g. Triquetrum: The “left-over” space in the proximal and middle rows belongs to the
triquetrum. It is easily palpable on it’s ulnar border during radial deviation.
5. The borders of the carpal tunnel can be defined by four palpable boney structures (figure 5). The
ulnar borders are defined by the pisiform proximally and the hook of the hamate distally. The
HH can be found by placing the IP joint of your thumb over the pisiform and then pointing the
thumb toward the 2nd MCP. The tip of your thumb should fall on the HH. The radial border
extends to the scaphoid and trapezium tubercles. To confirm the location of the scaphoid
tubercle, radially deviate the wrist and it should become more prominent. The converse is true of
the trapezium tubercle (it is more prominent in UD).
6. The extensor tendons are shown drawn in figure 7-8. Each of these can be palpated by isolated
action of the respective muscles. You should locate and draw (ulnar to radial) the ECU, EDM,
ED, ECRB, ECRL, EPL, EPB, APL. Knowledge of muscle insertions is helpful. Lister’s
tubercle and the ulnar head are useful landmarks.
Figure 1
Figure 2
Figure 3
Figure 5
Figure 4
Figure 6
Figure 7
Figure 8