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Chapter 4_Hand and Wrist

Figurę 4-29, cont'd. £, Ali four together. F, Simulated rotational malalignment following a metacarpal fracture.

propcr functioning of the distal radioulnar joint of the wrist. Conditions of the wrist that can lead to reduced forearm rotation include fractures of the distal radius involving the distal radioulnar joint, Galeazzi’s fractures (fractures of the shaft of the distal radius associated with subluxation or dislocation of the distal radioulnar joint), and injuries of the triangular fibrocartilage complex.

Wrist Motion

Wrist motion is a complex process involving coordinated movements at the radiocarpal and intercarpal joints. Loss of wrist motion is a common sequela of fractures or liga-mentous injuries of or near the wrist. For measurement purposes, wrist motion is usually documented in four directions: flexion, extension, radial deviation, and ulnar deviation. During actual function, these motions can be combined in differing proportions, so that complete cir-cumduction is possible. Wrist rangę of motion is usually evaluated with the elbow flcxed to 90° and the forearm pronated. When mcasuring flexion and extension of the wrist, the neutral, or 0°, position is the point at which the dorsum of the wrist forms a straight linę with the dorsum of the distal forearm.

Extension and Flexion. To evaluatc wrist extension (dorsiflexion), ask the patient to puli the hand upward as

Figurę 4-30. Active wrist extension.

Figurę 4-31. Passive wrist extension.