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Human Movement > Hand > Flashcards

Hand Flashcards

1
Q

Purpose of the hand

A

Opposition of thumb to digits
- Manipulation and precision greater than any other animal
* Grasp
* Pinch
* Writing, sewing, surgery
Intake of sensory information-greatest connection to the brain
Vital for functional performance
Key for development
Emotional and Social Connections
- Communication
- Aesthetics

Haptic perception: knowing what something feels like without actually touching it
Excessive hand decorations are a sign of personality disorder, bipolar disorder, psychopaths, narcissists

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2
Q

Types of grasps

A

Grasps (involve manipulation)
- Power
* Hook (FDP and FDS)
* Disc
* Cylindrical
* Spherical
- Precision (pinch)
* Tip to tip/pincer/Two point
* Lateral/Key
* 3 jaw-chuck/3 pt/tri-tip

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3
Q

Types of fists

A

Flat
Composite
Claw

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4
Q

Arches of the hand

A

Balance stability and mobility in the hand
Flat hands =paddles

Distal (metacarpal) transverse arch
- Runs along the metacarpal head
- Controls thumb opposition
* 2 & 3 are stable, 4 & 5 are mobile
- Strength, precision (mobility of digits, superimposed on stability-arch)
* writing

Longitudinal (runs length wise the hand)
- Digits mobilize around it
- The middle finger is the center pole of the hand (with lunate & capitate)
- Grasp

Proximal transverse
- Most rigid
- Bone arch that is the posterior boarder of the carpal tunnel
- Runs along the neck of the metacarpal
- Forms the fulcrum (mechanical advantage) for the flexor tendons
* Supported by the flexor retinaculum (scaphoid to hamate)

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5
Q

Creases of the hand

A
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6
Q

Functional position of the hand

A

Wrist in 20 - 30º of extension and slight ulnar deviation
Fingers in 45º of MCP flexion, 15º of PIP and DIP flexion
Thumb is in 45º of abduction

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7
Q

Position for long term immobilization

A

Also known as antideformity position or intrinsic plus position
MCP joint in 60-70º of flexion
Thumb in 45º abduction
PIP and DIP joints extended
10-20º wrist extension

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8
Q

Anatomical snuffbox

A

Radial border-abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons
Ulnar border-extensor pollicis longus (EPL) tendon
Radial artery and nerve run through the middle

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9
Q

tunnel of Guyon

A

Holds the ulnar nerve
Hook of hamate is the lateral or radial border
The pisiform is the medial or ulnar border

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10
Q

Joints of the hand

A

CMC joint of the thumb (fingers too, but slide)
- Saddle joint: highly mobile, which means it is not very stable
- Flex/ext, abd/add
- Opposition
- Circumduction
- Volar plate: fibrocartilaginous plate that is lined with hyaline cartilage; increases the articular surface of the MP joint

MP or MCP (metacarpophalangeal joint): condyloid joint
- Biaxial: flex/ext, abd/add

IP/PIP or DIP
- Uniaxial hinge
- flex/ext

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11
Q

Biomechanical failure of CMC joint

A

The mechanics seriously change
- Shortening of adductor
- Hyperextension of MP
- Flexion deformity of IP

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12
Q

Radiocarpal joint

A

Radius to the scaphoid and lunate (central column)
Connection between lunate and capitate (midcarpal joint)
During wrist extension
- Lunate rolls dorsally (on the radius) (convex on concave) and slides palmarly
- The head of the capitate rolls dorsally (on the lunate) and slides palmarly
During wrist flexion it does the opposite.

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13
Q

Wrist joint in ulnar deviation

A

Scaphoid, lunate, and triquetrum roll ulnarly and slide radially
- Capitate follows same
- Triquetrum smacks the articular disc (TFCC)
- Scaphoid and lunate compress against the radial styloid
* Stability for grasp
The proximal row of carpal bones extend or flatten out

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14
Q

Wrist joint in radial deviation

A

Opposite of ulnar deviation
The radial styloid impinges the scaphoid and trapezium
The capitate (midcarpal joint) moves more
- Less motion overall
The proximal row of carpal bones flex or cup

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15
Q

Other parts of the wrist

A

Ulna to the articular disc of the TFCC
- Slack in extension
- Taut in flexion

Distal radioulnar joint
- Stabilized by the TFCC
- Piano key test
- DRUJ stability test

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16
Q

Biomechanical failures of the carpal bones

A

Carpal collapse or zig zag deformity (windswept hand)
- The connection between the radius, lunate, and capitate fail, usually ligamental damage or Keinbock’s disease
- MP ulnar deviation, IP radial deviation
- result of osteoarthritis or rheumatoid arthritis

Ulnar translocation (impaction)
- Too short: chronic tears and sprains
- Too long: early arthritis and tears
- ANY abnormal length

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17
Q

Hand ligaments

A

Ulnar and radial collateral ligaments
- MPs: taught in flexion
- PIPs: taught in extension

Annular Pulleys - A1-A5
- Trigger finger A1
- Bow stringing (A2-A5, C1-C3)
* multiple pulleys affected
* can’t make composite fist

Cruciate ligaments (actually pulleys) C1-C3

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18
Q

Intrinsic muscles

A

Key to extension and abduction
4 Lumbricals
- Always on the radial side of the digits (not the thumb)
- Come from palmar surface and attach to dorsal hood to cause extension of PIP and DIP
4 dorsal and 3 palmar interossei
- Help the lumbricals and abduct/adduct
Opponens digiti minimi
Opponens pollicis
Abductor pollicis brevis
Adductor pollicis - two heads

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19
Q

Biomechanical failures of intrinsic muscles

A

Boutonniere deformity
- Central slip of extensor hood disruption
- Lateral bands palmer
- DIP extension, PIP flexion

Swan neck deformity
- Often starts as unresolved mallet
- Lateral bands displace dorsally
- Tears terminal tendon
- PIP extension, DIP flexion

20
Q

Extrinsic muscles

A

Key to wrist motion and digit flexion
Supinator and biceps brachii
Pronator teres and pronator quadratus
Flexor digitorum superficialis (FDS): make a fist
Extensor & Flexor carpi radialis (ECR)(FCR)
Extensor & Flexor carpi ilnaris (ECU) (FCU)-to get the ECU-move thumb
Extensor carpi radialis brevis (ECRB)
Extensor digitorum (communis) ED or EDC
Flexor digitorum profundus (FDP)
Flexor digiti minimi (FDM)
Flexor pollicis brevis (FPB)
Flexor pollicis longus (FPL)
Extensor pollicis brevis (EPB)
Extensor pollicis longus (EPL)-top of snuff box
Abductor pollicis longus (APL)

21
Q

How to determine if it’s intrinsic or extrinsic muscles that are affected

A

The MP joint is the KEY!!

Intrinsic tightness (Bunnell Test)
- Flex the pip joint twice (passive)
- Once with MP extended, once with it flexed
- Intrinsics are tight If the PIP flexes when MP is flexed but not when extended

Extrinsic tightness
- Same as Bunnell but PIP flexes when MP is extended but not when flexed (claw/hook)

Capsular tightness
- Restricted PIP with both

Extensor hood (retinacular ligament)
- DIP flexion is restricted when PIP is extended

22
Q

Radial nerve

A

Supplies sensory only to the hand
Controls extrinsic wrist extensors
- Wrist drop
- MP drop
- Thumb drop
Extensor wad is the last muscle innervated
Branch: PIN

23
Q

Median nerve

A

Sensory and motor to the hand
FDS, FDP 2 and 3, 1 and 2 lumbricals
All of thumb flexors except deep head of APB
- Carpal tunnel (sensory effect), ape hand, Benedict hand (no thumb, index, or middle finger; kinda claw)

24
Q

Ulnar nerve

A

Sensory and motor
FDP 4 and 5, 3 and 4 lumbricals
All interossi
Claw hand

25
Q

Active insufficiency

A

Muscles can only contract ½ the length of the muscle body. This never increases so if the tendon has been stretched, the muscle will contract and there will be “slack” in the over stretched tendon, so we feel trace but there is no movement.
No amount of strengthening will help.
Splinting in neutral or slight extension for 3-4 weeks (maybe longer) with active extension and slight flexion (10-15 degrees)
ONE day out of the splint, you start ALL OVER!!
Prime mover
Insufficiency in concentric contraction

26
Q

Passive insufficiency

A

If the client stays in this position, or is unable to actively extend, the flexors will shrink and then prevent extension.
If you can’t get full passive extension, they most likely have passive insufficiency of the flexors.
Insufficiency in eccentric contraction.
Antagonist muscle

27
Q

When is active/passive insufficiency a good thing?

A

Tenodesis action

C6 spinal cord injury
- Extension of wrist actively
* Natural passive insufficiency of the finger flexors
- Flexion by way of gravity
* Natural passive insufficiency of the finger extenders
- We want it to get worse (slight contracture)
* Never stretch wrist extensors and digit extensors together
or finger and wrist flexors together

28
Q

Wrist flexion ROM

A

Expected = 60-80º
End feel = firm

Position
1. Ulnar side
- Seated with arm hanging off table
- Stationary arm: midline of ulnar
- Axis: over the triquetrum
- Movable arm: midline of fifth metacarpal
2. Radial side
- Seated with arm resting on ulnar boarder
- Stationary arm: midline of the radius
- Axis: over the radial styloid
- Movable arm: midline of 2nd metacarpal
3. Over the top
- Stationary arm: midshaft of forearm
- Axis: over the capitate
- Moveable arm: third metacarpal

29
Q

Wrist extension ROM

A

Expected = 60-70º
End feel = firm

Position
1. Ulnar side, exactly the same, flip goniometer over
2. Radial Side, exactly the same, flip goniometer over
3. Up from the bottom
Stationary arm: on the palmer surface, mid line
Axis: palmer surface under the capitate
Moveable arm: on the palm with third metacarpal

30
Q

Radial and ulnar deviation ROM

A

Expected = Radial - 20º, Ulnar - 30º
End feel = hard for radial, firm for ulnar

Position (same, just flip it)
- Hand flat on table
- Stationary arm: midline of forearm
- Axis: dorsal wrist over the capitate
- Moveable arm: midline of third metacarpal (NOT phalanx!!)

Possible substitution
- Flex wrist

31
Q

Metacarpophalangeal (MCP or MP) flexion ROM

A

Expected = 90-100º (90º is most common)
End feel = hard

Position
- Stabilize the wrist, can do it in sidelying or on elbow (“aim for the imaginary line”)
- Stationary Arm: dorsal midline of corresponding metacarpal
- Axis: dorsal aspect of MCP joint
- Moveable arm: midline of proximal phalanx

32
Q

Metacarpophalangeal (MCP or MP) extension ROM

A

Expected = 0 is the neutral position with 20-45º of extension or hyperextension (20 is most common)
End feel = firm

Position
- Same as flexion except you have to use a full circle goniometer or measure from the palmer surface
- Stabilize the wrist, can do it in sidelying or on elbow (“aim for the imaginary line”)
- Stationary Arm: dorsal midline of corresponding metacarpal
- Axis: dorsal aspect of MCP joint
- Moveable arm: midline of proximal phalanx

33
Q

Metacarpophalangeal abduction ROM

A

No norm with this one, typically 10-20º, compare to adjacent digits and other hand
End feel = loose in extension, firm in flexion

Position
- Hand flat on table
- Stationary arm: midline of metacarpal
- Axis: over the MCP joint
- Moveable arm: over the proximal phalanx

34
Q

Proximal interphalangeal joint (PIP) flexion ROM

A

Expected = 100-110º
End feel = firm

Position
- Joint blocking is often required
- Cut off goniometer works well
- Sidelying or up on elbow
- Block MP and ask them to flex (aim for the “fat pads”)
- Stationary arm: midline of proximal phalanx
- Axis: over the PIP joint
- Moveable arm: midline of middle phalanx

35
Q

Proximal interphalangeal joint (PIP) extension ROM

A

Expected = 0º, however, 10º hyperextension is normal if all are like that
End feel = firm

Position: same as flexion, but from the palmer surface
- Stationary arm: midline of proximal phalanx
- Axis: over the PIP joint
- Moveable arm: midline of middle phalanx

36
Q

Distal interphalangeal joint (DIP) flexion ROM

A

Expected = 70-90º
End feel = firm

Position: same as PIP, but move a phalanx
- Will need to joint block
- Can measure with PIP if they can isolate
- “Touch the fat pad”
- Stationary arm: midline of proximal phalanx
- Axis: over the PIP joint
- Moveable arm: midline of middle phalanx

37
Q

Distal interphalangeal joint (DIP) extension ROM

A

Expected = 0º - up to 10º hyperextension is expectable if all others have it

Position: same as PIP, but move a phalanx
- Will need to joint block
- Can measure with PIP if they can isolate
- “Touch the fat pad”
- Stationary arm: midline of proximal phalanx
- Axis: over the PIP joint
- Moveable arm: midline of middle phalanx

38
Q

Thumb carpometacarpal (CMC) joint flexion ROM

A

Flexion (across the palm)
Expected = 15º
End feel = soft

Position
- Hand is positioned FLAT with the thumb aligned with index finger
- This means you may not start at 0
- Stationary arm: palmer surface, along the radial shaft
- Axis: over CMC joint
- Moving Arm: along the shaft of the first metacarpal (don’t follow the IP!!)

39
Q

Thumb carpometacarpal (CMC) joint extension ROM

A

Expected = 0-20º of motion (you may see larger numbers, up to 70º)

Position
- Hand is positioned FLAT with the thumb aligned with index finger
- This means you may not start at 0
- Stationary arm: palmer surface, along the radial shaft
- Axis: over CMC joint
- Moving Arm: along the shaft of the first metacarpal (don’t follow the IP!!)

40
Q

Thumb carpometacarpal (CMC) joint abduction ROM

A

Expected = 30-70º
Also called palmer abduction

Position:
- Hand in sidelying with radial side up
- Axis: lateral aspect of radial styloid
- Stationary arm: midline of 2nd metacarpal
- Moveable arm: midline of 1st metacarpal

NOTE START POSITION!!!!!!!!!!

41
Q

Thumb carpometacarpal (CMC) joint adduction ROM

A

Only measured if unable to do it
Common with CMC replacements
Should be able to come in to 0º, if not record the lack of motion in negative
-10º adduction

42
Q

Thumb opposition

A

Occurs due to the CMC, MP and IP joint
Primarily the CMC
Several ways to measure
To tip of small or 5th digit
To base of small or 5th digit
Can use a tape or ruler to measure distance off palm

43
Q

Thumb metacarpophalangeal joint (MP) flexion and extension ROM

A

Expected= 50-60º (flexion), 0-10º hyperextension (extension)
Position:
- Hand in sidelying
- Axis: dorsal aspect of MP
- Stationary arm: dorsal midline of metacarpal
- Moveable arm: dorsal midline of proximal phalanx

Extension is measured in negative

44
Q

Thumb interphalangeal joint (IP) flexion and extension ROM

A

Expected = 80º flexion

Position
- In sidelying
- Axis: over the dorsal IP joint
- Stationary arm: over midline of dorsal proximal phalanx
- Moveable arm: over midline of dorsal distal phalanx

Expected = 0º extension
- Measured just like MP

45
Q

MMT

A

Typically when looking at the wrist and digits, we do not do full MMT.
MMT are commonly done on the wrist
Typically use a dynamometer to get grip strength for digits

46
Q

MMT for wrist flexion

A

Position
- Forearm in supination AG or sidelying GM

Palpation: flexor wad or over tendon at the wrist

Resistance: into palm of hand
Check each flexor

47
Q

MMT for wrist extension

A

Position:
- Hand in prone AG and sidelying for GM

Palpation: at extensor wad or over the wrist

Resistance: over dorsal metacarpals

Human Movement (13 decks)

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