Hand - Session 4: Joints

Front 1

Type of motion for MCP? (3)

Back 1

Flexion - extension

Abduction - adduction

Circumduction - rotation

Front 2

Type of motion for PIP?

Back 2

Flexion - extension

Front 3

ROM for MCP?

Back 3

-15 to 90

RD 10 - 20

UD 20 - 40

Front 4

Tends toward stiffness of for MCP? PIP?

Back 4

MCP = extension

PIP = flexion

Front 5

When are collateral ligaments tight for MCP? PIP?

Back 5

MCP = flexion (+CAM effect)

PIP = All positions (No CAM effect)

Front 6

Is hyperextension possible for MCP? PIP?

Back 6

MCP = yes

PIP = no

Front 7

Dimensions of Volar plate length for MCP and PIP?

Back 7

MCP = 10mm (flexion), 15mm (extension)

PIP = 9mm

Front 8

Dimensions of Deep transverse MC ligament for MCP?

Back 8

10mm

Front 9

Dimensions Collateral ligament for MCP?

Back 9

14-18mm

Front 10

List the volar plate attachments at the MCP (7)

Back 10

Deep Transverse MC ligament
Interosseous fibers
Palmar Aponeurosis
Accessory collateral ligament
Sagittal band
1st dorsal interossei (radial index digit)
Abductor digiti quinti (ulnar small digit)

Front 11

Name the volar plate attachments of the PIP (2)

Back 11

P2 base (firmly)

P1 neck (loose)

Front 12

Volar plate strength of the MCP and PIP?

Back 12

MCP = 6-8 kg

PIP = 16 kg

Front 13

Site of Volar plate rupture for MCP and PIP?

Back 13

MCP = proximal

PIP = distal

Front 14

The PIP has significant __1__ stability secondary to __2__

Back 14

1. Lateral

2. Bony anatomy

Front 15

The __1__ provide a strong attachment to the volar plate at the __2__ aspect of the PIP

Back 15

1. Check ligaments

2. proximal

Front 16

-

Back 16

Front 17

PIP Joint Bony Anatomy - Head of the proximal phalanx:
- 2 condyles separated by the __1__

- Lateral condyle has a __2__ directed apex

- There is a lateral pit __3__ to the mid-axis for attachment of the __4__

Back 17

1. intercondylar cavity

2. Transversely

3. dorsal

4. collateral ligament

Front 18

-

Back 18

-

Front 19

The Base of the Middle Phalanx has a __1__- shaped ridge that articulates with the __2__ of the __3__

Back 19

1. saddle

2. intercondylar cavity

3. Head of the proximal phalanx

Front 20

Name the 3 turburcles of the Base of the Middle phalanx and what inserts there

Back 20

Dorsal = Central slip

Lateral = collateral ligament

Palmar = C2 pulley and capsule

Front 21

On the Base of the Middle Phalanx there are roughenings for...(3)

Back 21

Palmar plate

FDS tendon

A4 fibrous flexor sheath

Front 22

-

Back 22

-

Front 23

The Volar plate of the PIP attaches to the __1__ and __2__ margin of the proximal phalanx, also referred to as __3__

Back 23

1. Middle phalanx

2. volar-lateral

3. triangular check ligaments

Front 24

The PIP volar plate has a free edge centrally over __1__ allowing for greater __2__ and formation of the __3__

Back 24

1. P1

2. flexion

3. "retrocondylar recess"

Front 25

PIP Capsule: The synovial capsusule is stabilized by connecting tissue on all sides

-Dorsal: __1__
-Volar: __2__
-Lateral: Superficial - __3__ / Deep __4__

Back 25

1. Extensor mechanism (central slip, lateral bands)

2. Volar plate, check ligaments, flexor sheath attachment

3. Transverse ligaments, oblique retinacular ligaments

4. capsule, collateral ligaments, accessory collateral ligament

Front 26

__1__ lie on the slopes of the condyles of the proximal phalanx head. They are dorsal in __2__ and slide volarly in __3__

Back 26

1. Lateral bands

2. extension

3. flexion

Front 27

The Collateral ligament lies __1__ to the apex of joint angulation when in __2__

Back 27

1. Dorsal

2. extension

Front 28

The Check Ligament is a normal confluence of __1__. They are reflected fibers of the __2__ and the lateral margin of the __3__

Back 28

1. fascial structures

2. flexor sheath

3. volar plate

Front 29

Pathologic thickening of the Check Ligaments are called?

Back 29

Checkreign Ligament (swallotail extensions of volar plate along volar proximal phalanx which may thicken producing PIP flexion contracture)

Front 30

The Checkrein ligament plays a role in ___1___

Back 30

PIP Flexion Contracture

Front 31

PIP Vascularity
-The Proper Digital Artery gives off the __1__ in the region of C1 just proximal to PIP

-The Proximal Transverse Digital Artery passes between __2__ and __3__ in the __4__ toward midline

-The Proximal Transverse Digital Artery supplies the __5__ and __6__

Back 31

1. Proximal transverse digital artery
2. bone
3. check ligament
4. "fibro-osseous tunnel"
5. VBS & VLP

Front 32

MCP Joint: Bone Anatomy

-The trapezoidal head is wider __1__, thus stabily in __2__ and mobility in __3__
- CAM effect of collaterals is due to __4__ origin of the collateral ligament __5__ to the axis of rotation

Back 32

1. volarly
2. flexion
3. extension
4. eccentric
5. dorsal

Front 33

MCP Joint Bone Anatomy:

-Volar bony prominences on the MC head aid in increasing collateral ligament tension in flexion from __1__

-Radiovolar: less pronounced from __2__

-Ulnovolar: less pronounced from __3__

Back 33

1. 60-90
2. Index to small
3. Small to index

Front 34

MCP Joint Bone Anatomy:

__1__% of thumb MC heads are flat, thus the joint then acts more like a __2__

Back 34

1. 10

2. Hinge

Front 35

MCP Joint: Deep Transverse Metacarpal Ligament (Interpalmar Plate Ligament)
- There are __1__ (#) ligaments
- Interossei pass __2__ (volar/dorsal) to the Interpalmar plate ligament
-Lumbricals and NV bundle pass __3__ (volar/dorsal) to the Interpalmar Plate Ligament

Back 35

1. 3
2. dorsal
3. volar

Front 36

MCP Joint Capsule: The Synovial Capsule is stabilized by connecting tissue on all sides
-Dorsal: __1__ (2)
-Volar: __2__ (2)
-Lateral: Superficial __3__ (2) / Deep __4__ (3)

Back 36

1. Extendor tendon, Sagittal band

2. Volar plate, Deep transverse metacarpal ligament

3. Sagittal bands, Intrinsic muscles

4. Capsule, Collateral Ligament, Accessory Collateral ligament

Front 37

Dorsal Dislocation of MCP:
-Volar incision for reduction is high risk to __1__
-Dorsal incision for reduction: __2__ is felt to be the primary reduction block - it is split __3__ to allow reduction

Back 37

1. digital nerves
2. volar plate
3. longitudinally

Front 38

Irreducible dorsal dislocation of the MCP causes skin "dimpling" secondary to?

Pretendinous bands are?

Back 38

Pretendinous bands and transverse fibers of palmar fascia connecting to skin

Longitudinal bands of palmar fascia

Front 39

Thumb MCP Joint: Bony Anatomy
- Type of joint? (90% _1_, 10% _2_)
- Is there similar joint contact in flexion and extension? __3__
- Sesamoids are located in the __4__.
- Radial Sesamoid characteristics __5__
- Ulnar sesamoid characteristics __6__
- ROM for flexion - extension

Back 39

1. condyloid
2. hinge
3. yes
4. volar plate
5. Flexor pollicis brevis attachment, larger sesamoid
6. Adductor pollicis brevis attachment, "Gillette's scaphoid" - carved facet.
7. 8 - 53 flexion - extension

Front 40

Thumb MCP Joint: Capsule
- Superficial Layer
- Ulnar (2)
- Radial (2)
- Dorsal

-Deep Layer (6)

Back 40

Ulnar - Adductor pollicis, Dorsal aponeurosis of adductor pollicis

Radial - APB, FPB

Dorsal - EPL, EPB

Deep: Ulnar collateral ligament, ulnar accessory collateral ligament, radial collateral ligament, radial accessory collateral ligament, dorsal capsule, FPL

Front 41

Thumb MCP Joint Capsule:
- Superficial and deep layers fuse with the volar plate __1__ (dorsal/palmar)
- The adductor aponeurosis stretches from the ulnar margin of the __2__ and __3__ dorsally to the __4__
-The capsule deep layer attaches to within __5__ mm distal to articular surface
-The volar plate proximal is __6__, and distal __7__

Back 41

1. palmarly
2. volar plate
3. ulnar sesamoid
4. EPL
5. 1.5 - 2 mm
6. thin/pliable
7. Thick/rigid

Front 42

Thumb UCL injury:
- Diagnosis:
- Lack of a firm end-point on stress in extension (__1__) and __2__ degrees flexion (__3__)
- __4__ degrees of absolute __5__ deviation on stress
- __5*__ degrees difference in radial deviation compared to contralateral thumb
- __6__ ligament may tear proximally or distally
-What is Stener Lesion? __7__
- What must be injured to have Stener lesion? __8__
- Injury to the collateral and accessory collateral = __9__% chance of Stener

Back 42

1. accessory collateral lig
2. 30 degrees
3. collateral ligament
4. 30-40 degrees
5. radial
5*. 15 degrees
6. Accessory collateral ligament
7. interposition of adductor aponeurosis between torn ends of collateral ligament
8. Accessory collateral ligament
9. 89%

Front 43

The CMC Joint of the Thumb = ?

Back 43

Trapezio-Metacarpal joint

Front 44

Trapezio-Metacarpal Joint: Bony Anatomy
-2 reciprocally opposed __1__ whose axes are __2__
- There is significant inherent BONY instability (no congruence) -> ligamentous restraint and dynamic __3__ stabilization are primary

Back 44

1. saddles
2. perpendicular
3. APL
*2 reciprocally opposed "Pringle" potato chips

Front 45

Trapezio-Metacarpal Joint Bony Anatomy: Trapezial surface

- __1__ running ridge crossing the greatest diameter
- Two parts: __2__
- The groove crosses the ridge perpendicular connecting the 2 parts

Back 45

1. Obliquely
2. Palmar - Radial :: Slightly concave
Dorsal - Ulnar :: Slightly concave

Front 46

Trapezio-Metacarpal Joint: Metacarpal Base
-__1__ base with a __2__ and __3__ beak
-There is a groove corresponding to the obliquely running ridge on trapezial surface

Back 46

1. Pentagonal
2. volar
3. ulnar

Front 47

Thumb CMC Joint: LIgamentous Restraint:

3 axes of motion

Back 47

Flexion - Extension

Adduction - Abduction

Pronation - Supination

**Motion is coupled = no independent axis of motion**

Front 48

Name the 5 ligaments of the Thumb CMP joint

Back 48

Anterior oblique
Posterior oblique
Dorsoradial
Ulnar collateral
Intermetacarpal

Front 49

What 3 Thumb CMC ligaments are intracapsular and what 2 are extracapsular?

Back 49

Intracapsular = Anterior oblique, Posterior oblique, Dorsoradial

Extracapsular = Ulnar collateral, Intermetacarpal

Front 50

The Anterior Oblique and Ulnar collateral ligaments of the Thumb MCP are taut in what positions?

Back 50

Extension, abduction, pronation

Front 51

The Posterior Oblique and Intermetacarpal Ligaments are taut in what position?

Back 51

Abduction, opposition, supination

Front 52

When is the dorsoradial ligament taut?

Back 52

Supination (extreme)

Front 53

This ligament is the primary stabilizer of the thumb CMC

Back 53

Anterior oblique

Front 54

Anterior Oblique Ligament:
- runs from the thumb __1__ ulnarly to the __2__
- located opposite the __3__
- it is taut in __4__, limiting __5__ translation
-Degeneration and detachment correlates with extent of __6__

Back 54

1. MC beak
2. trapezium
3. APL dorsal expansion
4. pronation
5. dorsal
6. CMC cartilaginous disease

Front 55

3 types of CMC cartilaginous changes?

Back 55

Chondromalacia - dorsal: no correlation with attrition of AOL

Chondromalacia-Palmar: Positive correlation with attrition of AOL

Ebernation: only in palmar joint and always adjacent to AOL

Front 56

This CMC ligament is likely a check-rein to radial subluxation, dislocation

Back 56

Dorsoradial ligament

Front 57

Radial Artery Course:
- distal forearm: -radial to __1__
-Floor of the snuffbox is between __2__
-Runs distally along the __3__ joint toward the thumb and index __4__
-Travels distally between __5__
-Enters the palm to form the __6__ between the 2 heads of the __7__ and is adjacent to the __8__ nerve

Back 57

1. FCR
2. 1st and 3rd extensor compartments (1st = APB, EPB / 3rd = EPL)
3. Scaphotrapezium-Trapezoid joint
4. MC bases
5. 1st dorsal interossei
6. Deep palmar branch
7. adductor
8. deep motor branch of ulnar nerve

Front 58

CMC Joint Reactive Forces:
- Pinch: __1__
- Shear stress: __2__

Back 58

1. 13x

2. 26x