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77 Cards in this Set
- Front
- Back
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What percent does the hand contribute to upper extremity function? |
90%
shoulder and elbow serve the hand
"climbing el capitan" - amazing power in hands - small muscles but impressive strength |
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What are the bones in the hand? |
Scaphoid, lunate, triquetral, trapezium, trapezoid, capitate, hamate |
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Is the radial or ulnar styoid process more distal? |
radial styloid is more distal |
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What line is the articulation of the radial and ulnar with carpal area? |
obliquely oriented
23 deg |
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What is the carpal arch? |
formed by shape of carpals and ligaments that help maintain the arch |
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What are the boundaries of the carpal arch? |
lateral border: scaphoid and trapezium
medial border: triquetral and hamate
roof: flexor retinaculum |
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How many metacarpals are present? |
5 in each hand |
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How many phalanges are present? |
14 in each hand |
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Metacarpal 1 articulates with... |
trapezium |
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metacarpal 2 articulates with... |
trapezoid |
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metacarpal 3 articulates with... |
capitate |
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metacarpal 4 articulates with... |
capitate and hamate |
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metacarpal 5 articulates with... |
hamate |
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What are the functions of the arches within the hand? |
allow hand to conform to objects
increases sensory feedback
created by the intrinsics |
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What are the arches within the hand and what are their functions? |
transverse arch - distal - mobility around stable 2 and 3 MCs
transverse arch - proximal - stability
long arch - longitudinal
*want to maintain curved bowl when splinting |
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What is a Colle's fracture? |
Most common fracture in ppl of all ages
Fractured radius
FOOSH |
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What is a scaphoid fracture? |
most common carpal bone fracture
often missed
-poorly vascularity (radial artery) - open for infection - surgery may be needed -variable healing - 5 to 20 wks -radial dev can't see - neutral/ulnar dev can see |
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What is a lunate dislocation? |
most dislocated bone |
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What type of joint is the distal radioulnar articulation? |
synovial joint
allows pronation/supination |
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What is found between the distal ulna and triquetrium? |
triangular fibrocartilage
ulna does not articulate with carpal bones |
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What bones articulate at the radio carpal joint? |
radius articulates with scaphoid and lunate (lateral and medial facets - 2 concave facets) |
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How many carpals does the scaphoid articulate with and why is this functional? |
4 carpals
provides important stability during complex motions |
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radial collateral ligament |
checks ulnar deviation |
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ulnar collateral ligament |
checks radial deviation |
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dorsal radiocarpal ligament |
checks wrist flexion |
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volar radiocarpal/ulnocarpal ligaments |
checks wrist extension |
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intercarpal/interosseous ligaments |
bind carpals, restrain motion, very important to stability during motion |
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dorsal/volar carpometacarpal ligaments |
binds distal carpals to metacarpals |
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dorsal/volar intermetacarpal ligaments |
bind bases of metacarpals together |
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What are the muscular attachments of the proximal carpal row? |
no muscular attachments except FCU on pisiform |
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Determine the roll and glide from full flexion of wrist toward extension or neutral position. |
capitate and hamate roll dorsally and glide anteriorly on proximal carpal row
like convex on concave surface |
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Determine the roll and glide from neutral to extension of the wrist. |
wrist extensors have attachments on the metacarpals (ECRL: MC 2 + ECRB: MC3)
scaphoid and lunate roll dorsally and glide anteriorly on the radius
like convex on concave surface |
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During radial and ulnar deviation, how do the proximal carpal rows glide? |
in the opposite direction
means more adaptable than distal carpal row |
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Joints of the fingers (MCP, PIP, DIP) and thumb have what type of motion in relation to concave and convex? |
concave on convex |
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What are the surfaces (convex/concave) of the thumb in the first CMC, MCP and IP? |
first CMC: sellar (both concave and convex components) MCP: concave on convex IP: concave on convex *allows thumb to have variable motion
thumb > index finger w/o thumb dec hand function |
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MCP collaerals are taut with.... |
flexion (CPP with MCP joint) |
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volar plate taut with.... |
extension |
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collateral ligaments of PIP and DIP taut with... |
extension |
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Describe the PIP and DIP in swan neck deformity with Rheumatoid arthritis. |
PIP - hyperextension
DIP - flexion
lower stability and higher deformity
may be due to extensor (damage) tendon lateral tendons dislocating anteriorly |
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Describe the PIP and DIP in Boutinniere deformity. |
DIP: hyper extension
PIP: flexion
*related to damage of stability |
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Rheumatoid arthritis |
subluxation of MCP
ulnar deviation of phalanges
musculotendionous junctions poorly aligned and lower stability
surgeon can realign |
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What are the extrinsic wrist extensors? |
ECRL (attaches on MC2) ECRB (MC3) ECU (MC5) ED |
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What are the extrinsic specific finger extensors? |
EI
EDM
ED |
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What are the extrinsic thumb extensors/abductors? |
EPL (snuffbox)
EPB
APL |
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What are the extrinsic wrist flexors? |
FCU (pisiform and by ligaments into MC5 - greatest tension of all)
FCR (MC2 and MC3)
PL if you have it.... |
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What muscles are used for radial deviation? |
synergy of FCR and ECRL |
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What muscles are used for ulnar deviation? |
synergy of FCU and ECU |
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What are the intrinsic muscles of the fingers? |
lumbricals
DI
VI
PB |
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What are the intrinsic muscles of the thumb? |
ADD. p (strong - ulnar n.) FPB (flex MCP jt) abPB (abd MCP) OP (strong influence CMC jt)
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What action does the dorsal interossei provide? |
abduct MCPs |
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What action does the volar interossei provide? |
adduct MCPs |
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Describe the flexor mechanism. |
*flexor retinaculum *radial bursa (FCR, FPL) lowers friction in tendons *ulnar bursa (FDS, FDP) *anular and cruciate pulleys (fibrous CT tethers tendons to bone; provides fibro-osseous tunnels - efficiency so no bowstringing) *digital tendon sheaths lubricating covers |
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Describe the extensor mechanism |
*extensor hood (dorsal aponeurosis) active: DI, VI: attache to ext hood and lateral bands via "wing tendons" lumbricals: attach to FDP and lateral bands from expansion mechanism passive: ext hood, central tendon, terminal tendon of ED, lateral bands ED and retinacular ligs stabilize elements by binding them together |
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Describe the contraction of the extensor mechanism |
ED contraction mainly PIP/DIP
flex MCP and ext PIP and DIP with lumbricals (lumbrical grip) |
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What if lateral band loss connection to extensor hood? |
lateral band loss connxn to extensor hood
fall anteriorly
ED contract instead of ext, flex at PIP joint
ex. of what happens in boutinnoure deformity |
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How does the dominant and non-dominant hand differ? |
*5-10% difference in strength b/w dom vs non dom (pt same... something is wrong or explanation needed) *injure vs. non injured *male (46kg) vs. female (23kg) *measured with dynamometer *age (peaks in the 20-45 range) *occupation/sport |
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What is the resting position of the hand? |
wrist ext 12-20 deg
MCP slight flex
PIP slight flex
thumb in partial opposition |
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What is the functional position of the hand? |
wrist ext 20-30 deg
MCP flex 45 deg
PIP flex 30-45 deg
thumb in opposition
*want to splint in this position |
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What structure is important when using the cylindrical grasp? |
thumb is critical for this grip ex. can of juice |
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What structure is important when using the spherical grasp? |
FDS and FDP important
interossei making sure not to AD or ABduct |
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What structure is important when using the hook grasp? |
resistance on middle phalange
major FDS function |
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Describe the main structure in the 3 types of precision grasps |
pinch (tip to tip) - FDP
pulp to pulp - FDS
lateral pinch (pad to pad) - key grip - adduct pollicis brevis? - used in pinch dynamometer (squeeze and measure) |
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Boutonniere's deformity |
flex of PIP, hyperext of DIP
injury disrupts extensor mechanism
lateral bands slip over PIP joint |
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Dermatome |
all cutaneous distribution supplied by one nerve root |
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myotomes |
all muscles that reveive innervation from 1 nerve root (ex. pick muscle that has 1 nerve root and test)
ex. C5 impingement - cannot abduct with deltoid |
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Nerve root C6 to T2 general functions |
C4 - shaw area C5 - upper lateral arm C6 - lower lateral arm and thumb C7 - middle finger and back forearm C8 - little finger and lower med arm T1 - med upper arm T2 - axillary area |
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Peripheral nerves |
multiple nerve roots
ex. loss sensation in thumb - could be C6 or median n. ... also test middle and pointer finger |
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How to test cutaneous sensation? |
myofilaments used
sharp vs dull
2 pt distinction |
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Radial nerve |
injuries: fracture humerus, elbow dislocation, compression sup and radial head fx loss: distal to elbow - MCP ext, thumb abd and ext, wrist ext, weakened supination fx loss: prox to elbow - weakened elbow flx, elbow ext (have biceps and brachialis so not as noticeable since will somewhat work with these muscles) **vulnerable to humeral fracture, out of canal in birth stretched**
sensory |
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Median nerve |
injured: humeral fx, elbow dislocation, lunate dislocation, CTS, wrist lacerations
wrist lesion: thumb opp: abPB, OP, FPB (superficial head) (Simian hand) 1 and 2 lumbricals - deformit ape hand
flattening of thenar with inability to oppose
sensory |
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Ulnar nerve |
injured: fx of medial epicondyle or olecranon; wrist lacerations, compression at Guyon's canal
wrist lesion: weakened grip strength (interossei), loss of fine prehension (adP) - holding things - loss of MCP ad and ab - lose fine motor ability - little finger function
sensory
clawing of the fingers due to loss of lumbrical function |
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skin integrity on the back of the hand |
usually lax
damage in wrist/hand - inflammation/edema shows on dorsum of hand
push fluid back up proximally to clear out fluid with compression bandages
do not want static fluid build up |
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Guyon's canal |
floor: pisiform and hamate, flexor ret roof: fascia and palmaris brevis, pisohamat lig
damage to guyon's canal --> laceration but also compression in bikers get numbness and tingling in pinky finger |
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Carpal tunnel |
pisiform, scaphoid, hook of hamate, trapezium
muscles, nerve, transverse lig
FDS/FDP is a tight area
overuse with gripping (clipping shrubs)
tendons not conditioned then inflammation occurs (damage to capillaries too) |
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carpal tunnel nerve issues and symptoms with diagnosis |
*median nerve compression neuropathy at the wrist where the nerve passes beneath the flexor retinaculum (transverse carpal lig) *symptoms include: numbness, tingling and pain of thumb, index, long and ring fingers esp. at night, may be worse with arms raised *usually caused by repetitive motion strain but can also be associated with RA, Colle's fx, pregnancy, DM and thyroid disease *dx made with help of Phalen's, Tinel's signs *pregnant incr. CTS *nerve conduction study performed to dx |
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Anatomic snuffbox |
floor: scaphoid
radial: APL and EPB
ulnar: EPL
contents: radial artery, superficial radial nerve |
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What is the primary wrist stabilizer? |
increased stability at capitate and 3rd MC
wrist occurs around this central column
dec mobility inc stability |
