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60 Cards in this Set
- Front
- Back
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What 2 compound joints make up the wrist complex?
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radiocarpal jt
midcarpal jt |
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The wrist joint complex is Biaxial because it moves in which two planes of motion?
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Flex/Ext in sagittal plane
Radio/Ulnar deviation in the coronal plane |
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How does the wrist joint complex allow for fine adjustment of the extrinsic musculature for optimal grasp?
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By controlling the length-tension relationships of the extrinsic musculature.
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What type of joint is the Radiocarpal joint?
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Biconcave-ellipsoidal
synovial/ arthrodial 2 DOF |
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What articulates in the radiocarpal joint Proximally?
Concave or Convex? |
Radius
Radioulnar disc (TFCC) Concave |
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What articulates in the radiocarpal joint distally?
Convex or Concave? |
Scaphoid
Lunate Triquetrum Convex |
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What does the lat. radial facet articulate with?
the medial radial facet? the TFCC? |
lat. radial facet articulates with the scaphoid (46%)
med. radial facet articulates with the lunate (43%) TFCC articulates with the triquetrum (11%) |
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What does TFCC stand for?
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Triangular Fibrocartilage Complex
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For the Radiocarpal joint:
what is the closed packed position? what is the capsular pattern? |
closed packed = extension
capsular pattern = flexion and extension are equally limited. |
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What type of joint is the Midcarpal joint?
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Biconcave ellipsoidal?
Synovial/ Diarthrodial 2 DOF |
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What articulates proximally in the midcarpal joint?
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scaphoid
lunate triquetrum (and pisiform) |
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What articulates distally in the midcarpal joint?
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Trapexium
Trapezoid Capitate Hamate |
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What is the AOR for the midcarpal joint?
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The Capitate
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What joint does the midcarpal joint share a capsule with?
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carpometacarpal joint
-it is anatomically separate from the radiocarpal joint |
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Why does the distal carpal row move as a fixed "functional unit"
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the capitate and hamate are strongly bound together
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what does "some lovers try positions that they can't handle" stand for
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thumb to pinky proximally:
scaphoid, lunate, triquetrum, pisiform thumb to pinky distally: trapezium, trapezoid, capitate, hamate. |
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What are the 3 parts of the Dorsal Radial Collateral Ligament?
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radiotriquetrum
radiolunate radioscaphoid |
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What is the only extrinsic muscle that attaches to a carpal bone?
What is it's function? |
FCU : pisiforma and hamate
to stabilize the pisiform when you abduct your 5th digit using Abd digiti minimi. |
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Radial Collateral Lig (LCL):
attachments? function? |
from the radius to the trapezium
prevents carpal bones from moving radially(laterally) |
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Ulnar Collateral Lig (MCL):
attachments? function? |
from ulna to hamate and pisiform
prvents carpal bones from moving ulnarly (medially) |
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what are the 3 parts of the Palmar Radiocarpal Ligaments:
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radiocapitate
radioulnate radioscaphoidlunate |
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what are the 3 parts of the ulnarcarpal complex?
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ulnar collateral lig
palmar ulnocarpal lig articular disc |
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Snuff Box:
tendons? Floor? |
Abd Pollicis longus, Extensor Pollicis brevis, extensor pollicis longus
scaphoid- pops into the snuff box with ulnar deviation |
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What tendons are in the 2 Ant synovial compartments of the wrist
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1) FPL
2) FDS and FDP - so both get inflammed in carpal tunnel |
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what tendons are in the 6 Post synovial compartments of the wrist?
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1) Lat border of the snuff box (abd PL and EPB)
2) ECRL and ECRB 3) med border of the snuff box (Ext PL) 4) ED and EI 5)EDmimimi 6) ECU |
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What is DeQuervain's?
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Tinosynovitis of Compartment #3
ie. overuse of EPL |
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What compartment to Piano players get inflammation in?
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compartment #4
ED and EI have trouble extending their fingers. |
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How to treat tinosynovitis?
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immobilize for a short time
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Carpal Tunnel:
9 tendons? what nerve? |
4 FDS tendons 4FDP tendons
1 FPL tendon Median nerve |
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Pronator Teres Syndrome:
where? what nerve? what muscles affected? |
between to heads of Pronator Teres (humeral and ulnar head)
AIN FPL, lat 1/2 FDP, PQ |
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How can you test for AIN compression?
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can you pinch a piece of paper with tips of index and thumb?
can you make an OK sign tip to tip (not pad to pad) -b/c FDP does DIP flexion |
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Symptoms of Superficial Radial Nerve compression?
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sensory problems on radial dorsum side of hand, excluding the tips of fingers (that's median)
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Symptoms of PIN syndrome?
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1)pain over post forearm
2)weak extension: wrist, finger and thumb 3)decreased grip strength because they can't stabilize their wrist |
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what are 4 sites of ulnar nerve compression?
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1) arcate of struthers
2) medial epicondyle 3) compression from FCR muscle 4) Guyon's tunnel |
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Guyon's Tunnel:
1) what muscle and nerve travel here 2) how do cyclists impinge this nerve? |
FCU and ulnar nerve
ulnar nerve gets squished between the pisiform and the hamate. |
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Symptoms of ulnar nerve compression?
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sensory problems on both sides of med 1 1/2 fingers
atrophe of hypothenar muscles |
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what is the thumbs CMC joint?
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CMC joint
trapezium and 1st MC diarthrodial saddle 2 DOF |
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CMC jt ligaments
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ulnar and radial collaterals
volar and dorsal ligaments (same as radiocarpal joint) |
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what is the thumbs MCP joint
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head of 1st MC and base of proximal phalanx
diarthrodial condyloid 2 DOF |
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What is the thumbs IP joint
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diarthrodial
hinge |
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4 extrinsic muscles of the thumb
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flexor pollicis longus
extensor pollicis longus and brevis abductor pollicis longus |
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4 intrinsic muscles of the thumb
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flexor pollicis brevis (sup and deep heads)
abductor pollicis (transverse and oblique heads) abductor pollicis brevis opponens pollicis |
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"Position of rest" for the hand
- where optimal function is |
20 extension
10 ulnar deviation 45 MCP flexion 30 PIP flexion 20 DIP flexion |
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prehension
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grasping objects between two hand surfaces (with or without thumb)
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power grip
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used when strength or force is required
digits maintain the object against the palm |
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Hook Grasp
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PIP, DIP and sometimes MCP flexion
NO thumb eg. suitcase |
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Cylinder Grasp
(palmar prehension) |
Thumb and entire hand wraps around object
FDP, FDS, FPL, thenar mm hypothenar eminance (ODM, ADM, FDM) ulnar deviation common eg. Baton |
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Spherical Grasp
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like cylindrical grasp but more abduction of MCP joints
interosseous and flexor activity eg. baseball |
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Lateral Prehension
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contact between 2 fingers occurs
eg. cigarrette |
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Precision Handling
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skillful placement of object between fingers and thumb (no palm involvement)
requires sensation |
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Tip to Tip
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MCP, PIP, DIP flexion
FDL and FDP activity AIN nerve |
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Pad to Pad
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MCP and PIP flexion
DIP may be slightly flexed or extended usually thumb and index or middle finger interosseous and thumb mm |
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Pad to Side
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least precise form of precision handling
thumb adduction (Add P and FPB) can be performed without any hand mm |
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Tenodesis
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hand closure with wrist extension (need ECRL and ECRB)
* don't stretch out fingers |
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Mallet finger
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extensor expansion mechanism:
permanent flexion of DIP caused by evulsed Terminal Tendon from Distal Phalanx |
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Swan Neck Deformity
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extensor expansion mechanism:
permanent flexed DIP and PIP hyperextended PIP and short FDP muscle |
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Boutoneire
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exgtensor expansion mechanism:
rupture of central band lat bands slide anteriorly but terminal tendons still intact so get hyperextended DIP |
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Parts of Extensor Expansion Mechanism
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Lumbricals and Interossei
Lateral Bands Terminal Bands |
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Extensor Expansion Mechanism
- how it works |
L and I mm cross palmar MP joints causing MP flexion. Then L and I mm join the Lat Bands of ext exp mech on dorsal IP joint casuing IP extension.
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So extensor expansion mechanism causes...
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MP flexion and
IP extension |
