ASSIGNMENT

Submitted By
Monicca Priya E
Aparna Preman
Jojo Jose
 DISTAL RADIOULNAR JOINT
• Articulating bone:
 Radius : Ulnar notch of radius
 Ulna: Distal head of ulna
• Concave convex moving part:
 Radius : Concave
Ulna: Convex
• Type of joint: Synovial pivot joint
• Degree of freedom: Supination ,Pronation
• ROM : Supination :90
Pronation : 80-90
Goniometry :
1. Supination
Axis : Just medial and posterior to the ulnar styloid process
Stationary arm : Parallel to the long axis of the humerus
Moving arm: parallel to the dorsal forearm surface in pronation

2 Pronation
Axis :Just lateral and posterior to the ulnar styloid process
Stationary arm: Parallel to the axis of the humerus
Moving arm: Parallel to the volar surface in supination

OPEN AND CLOSE PACK POSITION

Open pack position : 10 supination
Close pack position : 5 pronation
Capsular pattern : Pain at extremes of rotation
• Normal end feel : Forearm supination (Tension in the
palmar radioulnar ligament of the inferior radioulnar joint,
interosseous membrane ,oblique cord)
• Muscles acting in and around the joint : Pronator quadratus
 (O) Oblique ridge on the anterior surface of the distal
fourth of the ulna
 (I) Lateral border and anterior surface of the distal fourth
of the radius
 (N) Anterior interosseous nerve ,a branch of median
nerve (c8-t1) (A) anterior interosseous artery
 (F) Pronation of the radioulnar joint
• Pronator teres (o) humeral head : Medial epicondyle of the
humerus, common flexor tendon and deep antebrachial
fascia
• (I) Middle of the lateral surface of the radius
• (N) Median nerve ,C6and C7
• (A) Ulnar artery ,anterior recurrent ulnar artery
• (F) Pronates the forearm
Supinator
• (O) Supinator crest of the ulna ,lateral epicondyle of the
humerus
• (I) Proximal 3rd of the radius
• (N) Radial nerve (c5-c6)
• (A) Radial artery ,ulnar artery ,posterior interosseous and
posterior interosseous recurrent arteries
• (F) Supination of forearm
Stretching of muscles

• With the patient’s humerus supported on the table and the

elbow flexed 90degree ,grasp the distal forearm.
• Stabilize the humerus
• Supinate or pronate the forearm just beyond the point of
tissue resistance.
• Be sure the stretch force is applied to the radius rotating
around the ulna .
• Do not twist the hand ,thereby avoiding stress to the wrist
articulations
• Repeat the procedure with the elbow extended. Be sure
to stabilize the humerus to prevent internal or external
rotation of the shoulder .
• Direction of glide : anteroposterior glide and medial and
lateral rotary joint play moments of the distal ulna
Radiocarpal joint
Articulating bones:
• Proximal: Radius and articulating disc
• Distal: Scaphoid, Lunate, triquetrum
• Type of joint: Ellipsoid
• Degrees of freedom: Flexion, Extension, Ulnar deviation,
Radial deviation
 ROM:Flexion-80-90
 Extention-70-90
 Radial deviation-15
 Ulnar deviation-30-45
Goniometry:
1. Flexion
• Axis: Lat. Aspect of the wrist over the triquetrum
• Stationary arm:Lat. Midline of the ulna using the olecranon
and ulnar styloid process for ref.
• Movable arm:Lat. Midline of the fifth metacarpal
2. Extension
• Axis: Lat. Aspect of the wrist over the triquetrum
• Stationary arm: Lat. Midline of the ulna using the olecranon
and ulnar styloid process for ref.
• Movable arm: Lat. Midline of the fifth metacarpal
3. Radial deviation
• Axis: Over the middle of the dorsal aspect of the wrist over the
capitate.
• Stationary arm: Dorsal midline of the forearm using the lat.
Epicondyle of the humerus for ref.
• Movable arm: Dorsal midline of the 3rd metacarpal
4. Ulnar deviation
• Axis: Over the middle of the dorsal aspect of the wrist over the
capitate.
• Stationary arm: Dorsal midline of the forearm using the lat.
Epicondyle of the humerus for ref.
• Movable arm: Dorsal midline of the third metacarpal.
Open and close pack position:
• Open pack position : Nutral with slight ulnar deviation.
• Close pack position: Extention with radial deviation.

• Capsular pattern: Flexion Extension equally limited.

• Normal end feel:
 Flexion:0-80 firm end feel
 Extention:0-80 firm end feel
 Ulnar deviation:0-30 firm end feel
 Radial deviation:0-20 firm end feel
Muscle acting in and around the joint
Flexion
1. Flexor carpi ulnaris:
• Origin: Medial epicondyle of Humerus
• Insertion: Pisiform, Hamate, 5th metacarpal
• Nerve: Ulnar nerve

2. Flexor carpi radialis:

• Origin:Medial epicondyle of Humerus
• Insrtion:2nd and 3rd metacarpal
• Nerve:Median nerve

3. Flexor digitorum superficialis

• Origin: Medial epicondyle, Radius, Ulna
• Insertion: Medial 4 digits
• Nerve: Median nerve
Extention
1. Extensor carpi radialis longus
• Origin: Lateral condyle and supracondylar ridge
• Insertion: 2nd metacarpal
• Nerve: Radial nerve

2. Extensor carpi radialis brevis

• Origin: Lateral epicondyle of humerus
• Insertion: 3rd metacarpal
• Nerve: Posterior inter-deep radial nerve

3. Extensor carpi ulnaris

• Origin: Lateral epicondyle of humerus
• Insertion: 5th metacarpal
• Nerve: Posterior inter-deep radial nerve
4. Extensor digitorum
• Origin: Lat.epicondyle of humerus
• Insertion: Extention expansion hood of medial 4 digits
• Nerve: Posterior inter-deep radial
Ulnar deviation
1. Extensor carpi ulnaris
• Origin: Lateral epicondyle of humerus
• Insertion: 5th metacarpal
• Nerve: Posterior inter-deep radial

2. Flexor carpi ulnaris

• Origin: Medial epicondyle of humerus
• Insertion: Pisiform, Hamate, 5th metacarpal
• Nerve: Ulnar nerve
Radial deviation
1. Abductor pollicis longus
• Origin:Posterior Radius and Ulna
• Insertion:Radial side of 1 st metacarpal
• Nerve:Posterior inter-deep radial nerve

2. Flexor carpi radialis

• Origin:Medial epicondyle of humerus
• Insertion:2nd and 3rd metacarpal
• Nerve:Median nerve

3. Extensor carpi radialis longus

• Origin:Lateral condyle and supra condylar ridge
• Insertion:2nd metacarpal
• Nerve:Radial nerve
4. Extensor carpi radialis brevis
• Origin: Lat.epicondyle of humerus
• Insertion: 3rd metacarpal
• Nerve: Posterior inter-deep Radial nerve
 Metacarpophalangeal joint (MCP)
• Articulating bones : Metacarpal head and proximal phalanx
• Concave convex moving part :
convex :Metacarpal head
concave : Phalanges
• Types of joints : Synovial , condyloid joint
• Degree of freedom : Flexion/ extension
Ulnar /radial deviation
• ROM : (2-5 MCP) flexion : 85-90
Extension: 30-45
(1MCP) flexion : 50-55
extension : 0
• Goniometry : MCP flexion
axis : Over the dorsal aspect of the MCP joint
stable arm : Over the dorsal midline of the metacarpal
moving arm: Over the dorsal midline of the proximal phalanx
• MCP extension
axis: Over the dorsal aspect of the MCP joint
moving arm: Over the dorsal midline of the proximal phalanx
stable arm : Over the dorsal midline of the metacarpal
OPEN PACK CLOSE PACK
1 MCP : Open pack :slight flexion
: Close pack : full extension
2-5 MCP : Open pack :slight flexion with ulnar deviation
: Full flexion
Capsular pattern : Equally restricted all direction
Normal end feel : Capsular stretch – extension of MCP joint of finger
Muscle acting in and around the joint :
• Extensor pollicis brevis
 (O) Lower 3rd of the posterior surface of the radius and the
interosseous membrane
 (I) Base of proximal phalanx of the thumb
 (N) Posterior interosseous nerve (C7-C8)
 (A) Posterior interosseous artery
 (F) Extend the thumb
• Extensor indicis proprius
 (O) Posterior surface of ulna
 (I) Base of the 2nd proximal phalange and into the tendon of
extensor digitorum
 (N) Posterior interosseous nerve which is a deep branch of
radial nerve (C7-C8)
 (A) Ulnar artery ,anterior interosseous artery
 (F) Extension of 2nd digit at MCP&IP joint
• Extensor digitorum communis
 (O) Lateral epicondyle of the humerus at the common extens or
origin
 (I) Extensor expansion of the medial 4 digits .
 (N) Radial nerve
 (A) Posterior interosseous artery &radial recurrent artery
 (F) Extends medial 4digits
• Extensor digitorum minimi
 (O) Lateral epicondyle of the humerus
 (I) Base of the 5th proximal phalange on the dorsal side
 (N) Posterior interosseous nerve (C7-C8)
 (A) Radial artery ,ulnar artery
 (F) Extending the 5th finger
• Flexor pollicis brevis
 (O) Crest of the trapezium &flex or retinaculum
 (I) Base of the proximal phalanx of the thumb
 (N) Median nerve
 (A) Radial artery
 (F) Flex the MCP
• Lumbricals
 (O) Flexor digitorum profunds
 (I) Extensor expansion
 (N) 3rd &4th deep branch of ulnar nerve ,1st &2nd median
nerve
 (A) Superficial palmar arch –common palmar digital
arteries
 deep palmar arch – dorsal digital artery
 (F) Flex mcp joint
• Interossei
 (O) Sides of mc facing midline
 (I) Base of proximal phalanges ,extensor expansions
 (N) Deep branch of ulnar
 (A) Palmar metacarpal artery
 ( F) Adduction, flexion , extension
• Flexor digiti minimi brevis
 (O) Hamate bone
 (I) Palmar side of the base of the proximal phalanx of 5th digit
 (N) Deep branch of ulnar nerve
 (A) Ulnar artery
 (F) Flexes little finger
• Interphalangeal joint
• Articulating bones
• Proximal interphalngeal joint: Head of proximal phalanx,
Base of middle phalanx.
• Distal interphangeal joint:Head of middle phalanx, Base of
distal phalanx
• Type of joint: Hinge joint, Uniaxial
Degrees of freedom: Flexion and Extension
ROM:
• Proximal interphangeal joint
• Flexion:100-115
• Extention :0
• Distal interpgalangeal joint
• Flexion:80-90
• Extention :20
First IP
• Flexion:85-90
• Extention :0-5
Goniometry :
• Proximal Interphalangeal joint
• Flexion
• Axis: Over the dorsal aspect of the proximal interphalangeal
joint
• Stationary arm: Over the dorsal midline of the proximal
phalanx
• Movable arm: Over the dorsal midline of the middle phalanx

Extention
• Axis: Over the dorsal aspect of the proximal interphalangeal
joint
• Stationary arm: Over the dorsal midline of the proximal
interphalangeal joint
• Movable arm: Over the dorsal midline of the middle phalanx
Distal interphalangeal joint
• Flexion
• Axis: Over the dorsal aspect of the proximal interphalangeal
joint.
• Stationary arm: Over the dorsal midline of the middle phalanx.
• Movable arm: Over the dorsal midline of the distal phalanx

• Extention
• Axis: Over the dorsal aspect of the proximal interphalangeal
joint
• Stationary arm:Over the dorsal midline of the middle phalanx
• Movable arm:Over the dorsal midline of the distal phalanx
• Open pack and close packed position
• Open packed position: Slight flexion
• Close packed position: Full extension
• Capsular pattern: Flexion, Extension, Side flexion and rotation
equally limited

• Normal end feel:

• Flexion:
• Extention :
Muscles acting in and around the joint
Flexion
IP joint of thumb

1. Flexor pollicis longus

• Origin: Radius
• Insrtion: Distal phalanx thumb
• Nerve supply: Ant. Inter-deep Median
PIP joints of digits 2 to 5

1. Flexor digitorum superficialis

• Origin:Medial epicondyle, Radius, Ulna
• Insertion:Medial 4 digits
• Nerve:Median

2. Flexor digitorum Profundus

• Origin:Ulna, Interosseious membrane
• Insertion:Medial 4 digit distal part
• Nerve:Median(lat. 2 digits), Ulnar medial 2 digits
DIP joints of digits 2 to 5

1. Flexor digitorum profundus

• Origin:Ulna, Interosseious membrane
• Insertion:Medial 4 digit distal part
• Nerve:Median, Ulnar

Extention
IP joints of thumb
1. Extensor pollicis longus:
• Origin:Ulna and Interosseious membrane
• Insertion:Distal phalanx thumb
• Nerve:Post. Inter-deep Radial
PIP joints of digits 2 to 5

1. Extensor digitorum
• Origin:Lateral epicondyle of humerus
• Insertion:Extention expansion hood of medial 4 digits
• Nerve:Post. Inter-deep Radial

2. Lumbricals
• Origin:Tendons of flexor digitorum profundus
• Insertion:Extention expansion hood of medial 4 digits
• Nerve:Deep branch ulnar, median Nerve:Deep branch ulnar,
median
3. Dorsal inrerossei:
• Origin:Sides of metacarpals
• Insertion:Ectension expansion hood of digit 2-4
• Nerve:Deep branch ulnar

4. Extensor indicis
• Origin:Ulna and Interosseious membrane
• Insertion:Extention expansion hood of index finger
• Nerve:Post. Inter-deep Radial

5. Palmar interossei
• Origin:Sides of metacarpal
• Insertion:Extention expansion hood of digit 2,4,5
• Nerve:Deep branch ulnar
DIP joints of digits 2 to 5
1. Extensor digitorum
2. Lumbrical
3. Dorsal interossei
4. Extensor indicis
5. Palmar interossei
Stretching exercise
Lumbricals

Dorsal intreossei
Palmar interossei