3. Grip Kin

bilateral function and hand grasps needed for: Carrying a lunch tray:

Bilateral symmetry pattern; both hands using a pad-to-pad grip ?

bilateral function and hand grasps needed for: Tying laces on a shoe

Bilateral symmetry; tip to tip prehension

When measuring joint ROM of wrist radial or ulnar deviation using a goniometer, which carpal bone is used as the landmark for the axis of the goniometer?

Capitate

Hook grasp: A functional activity that involves this grasp pattern.

Carrying a suitcase or briefcase. Weight lifters may use a hook grip to lift a barbell off the floor.

The prime movers for wrist extension are:

ECRL, ECRB, ECU

What are the primary movers of release of grip in the hand?

EDC & extensor mechanism, EPL, EPB

Which muscles of the thumb are affected in De Quervain's tenosynovitis?

Extensor Pollicus Longus, Extensor Pollicus Brevis, Abductor Pollicus Longus

The prime movers for wrist radial deviation are:

FCR, ECRL, ECRB

Spherical Grasp:orientation of fingers and thumb, is object in contact with the palm?

Finger: MCP joints are abducted and partially flexed. The abductor and adductor interossei co-contract to stabilize the MCP joints. Both extrinsic flexor muscles work to flex the fingers. The extensor digitorum contracts to counteract the flexor force and control release of the object. Thumb: position varies according to the size and weight of the object. The thumb opposes the other fingers and is flexed at the MCP joint and may be flexed at the IP joint. The adductor pollicis and other thenar muscles are active.

Cylindrical Grasp:orientation of fingers and thumb, is object in contact with the palm?

Finger: Primarily flexion of the IP and MCP joints with activity from FDP. The FDS assists when increased forces are required. Interossei muscles flex the MCP joints and move the MCP joints in an ulnar direction. This ulnar deviation is counteracted by radial collateral ligaments of the MCP joints. The fingers usually lie adjacent and parallel to each other. Thumb: position varies. Most often, it flexes and adducts, acting as a vice to secure the object to the fingers and palm. Rotation to provide opposition at the CMC joint occurs but depends on the width of the grip.

Pap to side prehension: orientation of fingers and thumb, is object in contact with the palm?

Finger: the index finger is abducted at the MCP joint and partially flexed at the MCP and IP joints. Muscles used include the FDP, FDS, and first dorsal interossei. Thumb: is adducted and the IP joint is flexed. Muscles performing these tasks include FPL, FPB, and adductor pollicis.

Hook Grasp:

The finger digits provide this grip. Used primarily to support or carry an object.

Pad-to-side prehension (key grip or lateral pinch grip):

The least precise of the precision grips. A small object is placed between the index finger and thumb so it may be manipulated or used.

Pap to pad prehension (three prong chuck grip) (palmar prehension grip)

The pads of distal #2-3 digits contact the pad of the distal thumb for the purpose of picking up or grasping objects.

Tip-to-tip prehension (tip prehension grip):

The thumb faces one of the fingers. Most often, the index finger is used in this grip. This grip is used to pick up or manipulate small objects.

Power Grip

Used when object must be held forcefully, palm in contact with object, forceful flexion of all fingers

Precision

Used when object must be manipulated finely, skillful positioning of thumb & fingers around object, palm not involved

What is the difference in mobility of the 2nd and 3rd CMC joints as compared to the 4th and 5th CMC joints and why does this difference impact function?

Very little motion occurs at the 2nd and 3rd CMC joints as compared to the 4th and 5th CMC joints. The limited ROM of the 2nd & 3rd CMC joints provides stability for grasp functions of the muscles of the hand

For optimal length-tension relationships of muscles during active use of the hand, the functional position of the wrist and hand is:

Wrist in slight extension to 20 degrees and slight ulnar deviation to 10 degrees; fingers flexed with MCP at 45 degrees, PIP at 30 degrees with slight DIP flexion; thumb beneath index finger in palmar abduction

What is the normal end feel for radial deviation and why?

firm and hard, action stopped by ligaments and boney contact of radius and scaphoid

What is the major difference in movement control at the elbow and shoulder when using a power grip to manipulate an object?

movement occurs at elbow and shoulder to move transport object in space.

What is the major difference in movement control at the elbow and shoulder when using a precision handling to manipulate an object?

movement occurs at finger joints, with elbow and shoulder in a stable position when object is moved.

Why can someone with a spinal cord injury above C-7 (has active wrist extension) do this grip without the use of hand extrinsic & intrinsic muscles?

tenodesis

What roles do the interossei muscles play in precision handling?

· Allows for precise adjustments of finger position when handling small objects · Digit rotation to allow fingers to wrap around objects · Help to strengthen grip · Stabilize MCP joints

the primary muscles of release of grip in the wrist and hand?

· Extensor digitorum · Extensor mechanism · Extensor pollicis longus (EPL) · Extensor pollicis brevis (EPB) - Lumbricals and interossei to get fingers fully straight.

bilateral function and hand grasps needed for: Pull apart Velcro

-Bilateral symmetrical pattern; both hands using lateral pinch grip or pad to pad?

Tip-to-tip prehension:orientation of fingers and thumb, is object in contact with the palm?

-Finger used is position in flexion at all three of its joints. Some lateral movement of the MCP joint towards the ulnar side occurs to allow the finger to meet the thumb with the finger tip facing a radial direction. -FDP plays a greater role since DIP flexion is consistent with this grip although it is not in the three prong chuck grip. -Thumb is in opposition with flexion at the MCP and IP joints and adducted so its tip is in alignment with the opposing finger's tip. Muscles used in the three prong chuck, the FPL plays a more important role in this grip.

Hook Grasp:orientation of fingers and thumb, is object in contact with the palm?

-Fingers & palm are primary contributors. -Primary function occurs from the flexor digitorum superficialis primarily and profundus secondarily with the IP joints in flexion, especially the PIP joints. -Thumb doesn't contribute to this grip, it's usually held in extension, away from the hand.

bilateral function and hand grasps needed for: Putting a paper clip on a piece of paper:

-One hand lumbrical grip to stabilize; other hand pad to pad -Bilateral asymmetrical

Describe how an OT would position the client's arm when testing hand and grip strength using a dynamometer

-Shoulder adducted toward side, elbow flexed at 90, forearm at mid position -Arm should be positioned with shoulder adducted and next to body and with elbow at 90 degrees. Have patient squeeze dynamometer 3 times and record the average score.

How many times would an OT ask his/her client to squeeze the dynamometer and how would the OT decide which score to use?

-Take measurement 3 times and use average -Arm should be positioned with shoulder ADducted and next to body and with elbow at 90 degrees

Spherical grasp: a power grip or a precision grip?

Power

In general, the functional ROM of the wrist that is required for most ADLs is?

5° of flexion, 30° extension, 15° ulnar deviation, 10° radial deviation

The intrinsic muscles of the thumb include which of the following muscles:

Abductor Pollicus Brevis, Flexor Pollicus Brevis, Adductor Pollicus, Opponens Pollicus

When the elbow is in a position of full flexion, and wrist is in a position of full flexion, and the client attempts to grasp a ball, grasp is difficult because the FDS and FDP become

Actively insufficient

What is the major functional role of the interossei muscles?

Allows for precise adjustments of finger position when handling small objects.

How would an OT position the arm when testing hand strength using a dynamometer? How many times would an OT ask the client to squeeze the dynamometer and how would the score be recorded?

Arm should be positioned with shoulder adducted and next to body and with elbow at 90 degrees. Have patient squeeze dynamometer 3 times and record the average score.

Pap to pad prehension: orientation of fingers and thumb, is object in contact with the palm?

Fingers: are in flexion at MCP and PIP joints. There may be some flexion of DIP joints. The FDS performs the task if the DIP is in extension, but if the DIP is partially flexed, the FDP is also activated. During manipulation of the object, the interossei work to provide MCP joint abduction and adduction. Other fingers not involved in the grip are usually held in variable degrees of flexion so as to not obstruct the desired activity Thumb: is positioned in opposition, flexion at the MCP and IP joints and adduction at the CMC joint. Muscles providing these positions include the adductor pollicis working with the FPB to stabilize the first metacarpal while the FPL flexes the thumb joints.

Cylindrical Grasp:

Grasp objects that are cylindrical in shape and large enough that the thumb does not touch the fingers. The fingers and palm are on one side of the object and the thumb is placed on the opposite side to secure the object to the palm.

Spherical Grasp:

Grasp round objects; consciously engage finger flexors. Fingers are spread apart more than in cylinder grip, so interossei muscles work more in this grip. The grasp is adjusted to the size and shape of the spherical object. Allows for cupping of palm.

Pap to pad prehension: A functional activity that involves this grasp pattern.

Grasping a coin, using a writing utensil such as a pen or pencil.

Spherical grasp: A functional activity that involves this grasp pattern.

Holding a ball or an apple.

Cylindrical grasp: A functional activity that involves this grasp pattern.

Holding a beverage container or a telephone receiver

Pap to pad prehension: a power grip or a precision grip?

Precision

Pap to side prehension: a power grip or a precision grip?

Precision

Tip-to-tip prehension:a power grip or a precision grip?

Precision

In wrist injury, which carpal bone is the most frequently fractured?

Scaphoid

How does ROM in the MCP joints change from the 2nd finger to the 5th finger and why does this difference impact function?

Joint ROM of MCP joint increases from radial side of hand to ulnar side of the hand. This increase in ROM helps the ulnar side of the hand to shape itself around objects during grasp and adds power to grasp.

bilateral function and hand grasps needed for: Peeling up a sticker:

Lateral pinch and tip to tip; bilateral asymmetrical

What is the finest (most precise) form of prehension that can be accomplished by someone without intact hand musculature, but who has active wrist extension (spinal cord injury above C-7)?

Lateral pinch grip due to tenodesis.

bilateral function and hand grasps needed for: Open a lid of a jar

One hand stabilizes jar using cylindrical grasp; other hand manipulates lid with pad-to-pad prehension? (bilateral asymmetrical)

Tip-to-tip prehension: A functional activity that involves this grasp pattern.

Picking up a small object such as a pin, bead, or strand of hair

Pad to side prehension: A functional activity that involves this grasp pattern.

Placing a key in the ignition, grasping papers.

Cylindrical grasp: Is this grasp a power grip or a precision grip?

Power

Hook grasp: Is this grasp a power grip or a precision grip?

Power