Chapter 3 WRIST.

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1 Chapter 3 WRIST

2 APPROXIMATED DISTAL RADIUS AND ULNA
IND: Wrist pain, trauma to the wrist or hand. PP: Sitting or standing. DP: Side of involvement facing patient. POC: Thumbs are crossed over on the posterior aspect of the distal radius and ulna with fingers supporting the rest of the hand. LOC: Thrust is made to separate the distal ends of the radius and ulna. MOD: A downward thrust is accomplished with emphasis to separate the distal radius and ulna.

3 교정법 APPROXIMATED DISTAL RADIUS AND ULNA

4 SEPARATED DISTAL RADIUS AND ULNA
IND: Carpal tunnel syndrome, wrist pain, trauma to the wrist. PP: Sitting or standing. DP: Side of involvement facing patient. POC: Thumbs are crossed on the distal radius with the fingers interlaced around the distal ulna. LOC: Thrust is made to approximate the distal ends of the radius and ulna. MOD: A downward thrust and squeeze is accomplished with emphasis to approximate the distal radius and ulna. DM: Pronator Quadratus.

5 교정법

6 관련근육 Pronator quadratus O: 척골의 전방 원위부 I:요골체의 측면 원위부 N:정중신경

7 ANTERIOR CARPAL IND: Carpal tunnel syndrome, pain in the wrist, extension trauma,restricted posterior carpal motion (Lunate is the most common). PP: Sitting or standing. DP: Side of involvement facing patient. POC: A double index finger contact is made over the anterior portion of the lunate with the rest of the fingers tabilizing the metacarpals. LOC: Anterior to posterior.

8 ANTERIOR CARPAL MOD: The patient's wrist is in a pronated position (palm down) as the contact is made. The Dr. thrusts the wrist into flexion in a superior direction. DM: Extensor Carpi Radialis Longus 2. Extensor Carpi Radialis Brevis 3. Pronator Quadratus

9 교정법1(ANTERIOR CARPAL )

10 교정법2(ANTERIOR CARPAL )

11 관련근육 Extensor carpi radialis longus
O: 상완골의 측방 supracondylar ridge의 하1/3 I: 제2중수골 base의 후면 A: 수 신전근 N:radial n.

12 관련근육 Extensor carpi radialis brevis O: 상완의 측방 epicondyle
I:제3중수골의 dorsal surface N:radial n. A:손의 신전

13 관련근육 Pronator quadratus O: 척골의 전방 원위부 I:요골체의 측면 원위부 N:정중신경

14 POSTERIOR CARPAL IND: Trauma, wrist pain upon motion, carpal tunnel syndrome, restricted anterior carpal motion. PP: Sitting or standing, wrist is in a pronated position (palm down). DP: Side of involvement facing patient. POC: Double thumb on posterior carpal. LOC: Posterior to anterior. MOD: Traction and thrust downward, the wrist goes into extension.

15 POSTERIOR CARPAL DM: 1. Pronator Quadratus 2. Flexor Carpi Radialis
3. Flexor Carpi Ulnaris

16 교정법(POSTERIOR CARPAL )

17 관련근육 Pronator quadratus O: 척골의 전방 원위부 I:요골체의 측면 원위부 N:정중신경

18 관련근육 Flexor carpi radialis O: 상완의 medial epicondyle
I: 제2-3 중수골 base의 전면 A: 손의 굴곡 N: median nerve

19 관련근육 Flexor carpi ulnaris
O: 상완의 medial epicondyle , 척골의 olecranon process I: pisiform,hook of hamate, 제5중수골 base A:손의 굴곡 N: ulnar n.

20 METACARPAL BASE POSTERIOR
IND: Pain with movement of metacarpals, traumatic flexion injury of the wrist, ganglions at the wrist, restricted anterior motion of metacarpal. PP: Sitting or standing. DP: Side of involvement. CH: The Dr.'s thumb rests on the proximal end of the metacarpal. The rest of the remaining four fingers wrap aroung the patient's thumb and/or fingers for stability.

21 METACARPAL BASE POSTERIOR
IH: Pisiform contact is placed on the distal phalanx of the contact thumb. LOC: Posterior to anterior. MOD: Traction slightly distally. The thrust is applied downward. The patient's wrist goes into extension during the thrust. DM: Muscles of wrist and fingers.

22 교정 법(METACARPAL BASE POSTERIOR )

23 INFERIOR RADIUS IND: Wrist trauma such as a fall on the outstretched hands. PP: Supine. DP: Side of involvement facing patient. POC: Thumbs are crossed at the styloid process of the distal radius with the fingers supporting the rest of the hand. LOC: Inferior to superior. MOD: Traction, thrust toward the elbow joint.

24 INFERIOR RADIUS DM: 1. Brachioradialis 2. Biceps Brachii
3. Pronator Teres

25 교정 법(INFERIOR RADIUS )

26 관련근육 Brachioradialis O:상완의 상 2/3로서 lateral supracondylar ridge
I:요골의 측면과 styloid process의 base N:요골신경 A:전완굴곡

27 관련근육 Biceps Brachii O: 견갑골의 상와결절,견갑골의 오구돌기 I: radius의 tuberosity
N: 근피신경

28 관련근육 Pronator teres O: medial supracondylar ridge , 상완의 epicondyle ,ulna의 coronoid process I:요골의 측면 중간부 N:정중신경 A: 전완회내 , 전완굴곡운동

29 참고