Clinical Chiropractic: The Wrist and Hand
We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.
This is Chapter 9 from RC’s best-selling book:
“Clinical Chiropractic: Upper Body Complaints”
These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.
Chapter 9: The Wrist and HandCLINICAL BRIEFING
Clinically, the most important articulation in the elbow is formed by the proximal ulna and the distal radius forms the most important articulation in the wrist. The carpals articulate with the ulna only during extreme wrist adduction.
The distal row of carpals forms a complex joint with the proximal row. Because they are loosely connected, the navicular and trapezium spread during wrist abduction and approximate during adduction. The proximal carpals rock and glide toward the ulna during wrist abduction and toward the radius during adduction. Adduction is slightly greater in pronation because the styloid process of the ulna restricts motion when the hand is supinated. During adduction, the styloid swings backward out of the way. As the A-P curve of the proximal carpals is more acute than the transverse curve, greater excursion is allowed in wrist flexion and extension than in lateral motion. The more delicate the patient’s bone structure, the greater the mobility.
The intricate anatomical architecture of the wrist allows flexion (80°), extension (70°), radial deviation (30°), ulnar deviation (20°), supination and pronation of the forearm.
Basic Wrist and Finger Biomechanics
The muscles of the wrist course obliquely to the parts to be moved. This requires coordination with other muscles whenever the wrist is moved. Wrist strength in flexion is nearly double that in extension, and the power of extension is greatly lessened when the wrist is fully flexed. During extreme flexion of the wrist, it is impossible to strongly curl the fingers in full flexion because the flexor tendons are slack. When the wrist is hyperextended, the extensors relax and the fingers cannot hyperextend fully. These are two important considerations during examination. (more…)