PERGELANGAN TANGAN

(FOREARM, WRIST, AND HAND)

Oleh
Drs. Soeparman SSt,FT
WRIST BONES
APPLIED ANATOMY
1. Distal radioulnair joint.
a. Uniaxial pivot joint.
b. Radius (concave) moves over the ulna (convex),
pronation and supination.
c. Resting position 10 of supination
d. CLPP 5 of supination
e. Capsular pattern, pain at extreme of rotation
2. Radiocarpal Joint (wrist ).
a. Biaxial ellipsoid joint, flexion-extension, radial
deviation-ulnar deviation (Abd).
b. Formed : radius, scapoid, lunatum.
Radius concave, carpal convex.
c. Distal radius is not straight but its posterior margin
more distally, and more dIstally then ulna.
d. Resting position, neutral with sligh ulna deviation.
e. CLPP, full extention
f. Capsular pattern, equally limited on ext – flex.
3. Midcarpal joint.
a. Formed : proximal carpal (SLTP) – distal
carpal (TRAP2CAH).
b. Resting position, neutral and slight flexion
with ulna deviation..
c. CLPP, extension with ulnar deviation.
d. Capsular pattern, equal limitation of flexion
and extension.
FLEXION AND EXTENSION
4. Intercarpal joint.
a. Glidding movement between the bones.
b. Resting position, neutral or slight flexion
c. CLPP, extension
d. Capsular pattern, none.
5. Carpometacarpal joint.
a. A sellar joint (sadle jt), whereas the second to fifth
carpometacarpal joint are plane joints.
b. Resting position, thumb midway between abd-add,
and midway between flex-ext. Fingers, midway
between flex-ext.
c. CLPP, thumb full oposition, fingers full flexion.
d. Capsular pattern, thumb abd then extension.
Fingers, equal limitation I all direction.
6. Metacarpophalangeal joint.
a. Condyloid joint
b. Resting position, slight flexion
c. CLPP, thumb full oposition, fingers full flexion.
d. Capsular pattern, flexion, then extension.
7. Interphalangeal joint.
a. Uniaxial hinge joint
b. Resting position, slight flexion
c. CLPP, full extension
d. Capsular pattern, Flexion, extension.
GUYON CANAL/TUNEL
CARPAL TUNEL
SELANJUTNYA BACA BUKU INI HAL 101-161
TRACTION & TRANSLATION
1. Radiocarpal joint.
a. Traction, pull in distal direction slight flexion-slight
ulnar deviation.
b. Dorsal glide slight distally, for flexion problem.
c. Palmar glide slight proximal, for extesion problem.
d. Radial glide slight distal, for ulnar deviation problem.
e. Ulnar glide slight proximal, for radial deviation
problem.
SELANJUTNYA BACA BUKU INI HAL 137-143
2. Distal Radio-ulnar joint
a. Radius ventral, for pronation problem.
b. Radius dorsal, for supination problem.

3. Carpometacarpal I joint .
a. metacarpalia traction, distally direction of metacarpal.
b. metacarpalia palmar slight radial, for add problem.
c. metacarpalia dorsal slight ulnair, for abd problem
d. metacarpalia ulnair slight palmar, for flexion problem
d. metacarpalia radial slight dorsal, for extension problem.
ASSESSMENT
1. Observation
Dupuytren’s contracture, skin creases(kusut), muscle
wasting (thenar, hypothenar, dorsal interoseus),
swelling (ganglion), ROM normal, sympathetic
changes (vasomotor, sudomotor, pilomotor, trophic).
Heberden’s node or Bouchard’s node, wound or scar,
nail, deformity (swan-neck, Boutonniere, Claw finger,
triger finger, drop hand etc.)
SYMPHATETIC CHANGES
Symp.Function Feature Early changes Late changes

Vasomotor Skin color Rosy Cyanotic

Skin temperature Warm Cool

Sudomotor Sweating Dry skin Dry or overly moist

Pilomotor Gooseflesh Absent Absent

response(tegak bulu
roma)
Trophic Skin texture Soft, smooth Nonelastic
Soft tissue atrophy Slight Pronounced
Nail change Blemishes (rusak, Talonlike (cakar)
cacat).
Hair growth Fall out/finer Fall out, longer, and
finer.
Rate of healing Slowed Slowed
2 Active Movement
.

• Pronation 85-90
• Supination 85-90
• Radial deviation / abd 15
• Ulnar deviation / add 30-45
• Flexion 80-90
• Extension 70-90
2. CONTINUOS…
• Figner flexion, MCP 85-90, PIP 100-115, DIP 80-90.
• Finger extention, MCP 30-45, PIP 0, DIP 0-20
• Finger abd, 20-30
• Finger add, 0
• Thumb flexion, CMC 45-50, MCP 50-55
• Thumb extension, MCP 0, IP 0-5
• Thumb abd 60-70
• Thumb add 30
• Oposition, little finger and thumb tip to tip
3. Passive Movement
• Pronation
• Supination
• Radial devition
• Ulnar deviation
• Wrist flexion
• Wrist extension
3. CONTINUOS..
• Finger flexion
• Finger extension
• Finger abd
• Thumb flexion
• Thumb extension
• Thumb abd
• Thumb add.
• Oppositiopn
4. Resisted Isometrik.
• Pronation of forearm
• Supination of forearm
• Radial deviation
• Ulnar deviation
• Flexion
• Extension
4. CONTINUOS..
• Finger flexion
• Finger extension
• Finger add
• Finger abd
• Thumb flexion
• Thumb extension
• Thumb abd
• Thumb add
• Opposition
SPECIAL TEST
1. Test for tendon and muscles
* Finkelstein Test, is used to determine the
precence of De Quervain’s or Hoffmann’s
disease, a tenosynovitis in the thumb.
* Bunnel –Littler test, is test for the structure
of the metacarpophalangeal joint.
FINKELSTEIN TEST
BUNNEL LITLE TEST
* Sweater Finger Sign, patient is asked
to make fist. If the distal phalanx of one
of the fingers does not flex, the sign is
positive for a ruptured flexor digitorum
profundus tendon. It occurs most often
to the ring finger.
SWEATER FINGER SIGN
2. Test for neurological dysfunction
* Phalen’s test, The examiner flexes thr
patien’s wrist maximally and hold this
position for 1 minut by pushing the patien’s
wrist together. A positive test is indicated
by tingling in the thumb, index finger, and
middle and lateral half of the ring finger
and is indicated of carpal tunnel syndrom.
PHALEN’S TEST
 WRINKLE TEST
* Wrinkle test, The patien’s finger are placed
in warm water for 5-20 minutes, and then
remove from water and observes the skin,
normal is wrinkling, but denervated ones is
does not. Tes is valid only within the first few
months after injury.
TINEL SIGN TEST
* Tinel sign test, examiner taps over the
carpal tunnel at the wrist. Positive * test
causes tingling or paresthesia the thumb,
index, middle, and lateral half ring finger
(median nerve distribution).
TINNEL TEST
WEBER’S TWO POINT DISCRIMINATION
(TPD)

The examiner uses a paperr clip, two point

discriminator, to simultaneously apply
pressure on to adjacent point in a
longitudinal direction of the finger.Normal
discrimination distance is less than 6 mm,
but this varies from person to person.
TPD USES CLIP PAPER
TPD USES CALIPER
DIFFERENT ZONES VALUE TPD IN MM
SPECIAL TEST
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• Halaman 114 sampai 147.
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