Wrist

Question 0

Analysis of Movement

Answer 0

Fully Flexed to Fully Extended:

a. Full Flexion to Neutral: MidCarpal
b. Neutral to 45 Ext: Distal Carpals & Scaphoid. Fixed Triquetrium & Lunate
c. 45 Ext to Full Ext: Radiocarpal

Radial and Ulnar Deviation:
a. Radial: Scaphoid drops down (flexes), distal carpals move radially, proximal carpals move ulnarly
b. Ulnar: Scaphoid extends, distal carpals move ulnarly, proximal carpals radially
Scaphoid Movement: Sagittal, Carpal Movement: Frontal

Wrist extensors stabilize wrist to prevent active insufficiency of finger flexors.

Question 1

Wrist Joint

~ Overview

Answer 1

Complex and Compound
Radioulnar Disc
2 Components:
1. Radiocarpal: Distal Radius + Proximal Row of Carpals (Scaphoid, Lunate, Triquetrium
2. Midcarpal: proximal carpals with distal carpals

Bi-Axial Joint:
Flexion (80-90) / Extension (70-80) x-axis
Radial Deviation (20-25) / Ulnar Deviation (30-35) z-axis

Question 2

Wrist Ligaments

Answer 2

Dorsal: Radialunate & Radiotriquetrium (Radioscaphoid Joint)

Palmar: Radiotriquetrium, Radiocapitate, Ulnolunate, Ulnocapitate

Collateral: 
Radial Collateral (Scaphoid)
Ulnar Collateral (Triquetrium, Pisiform, 5th Metacarpal)
Transverse Ligaments (Medial, Lateral)

Question 3

Wrist Flexors
Primary (3)
Secondary (4)

Answer 3

Primary:

1. Flexor Carpi Radialis
2. Palmaris Longus
3. Flexor Carpi Ulnaris

Secondary:

1. Flexor Digitorum Profundus
2. Flexor Digitorum Superficialis
3. Flexor Pollicis Longus
4. Abductor Pollicis Longus

Question 4

Flexor Carpi Radialis (FCR)

Answer 4

Palpate: ulnar relative to radial pulse
Medial Epicondyle - base of 2nd/3rd metacarpal
Flexor & Radial Deviator

Question 5

Flexor Carpi Ulnaris

Answer 5

2 Heads: Medial Epicondyle, Proximal part of Ulna
Distal insertion: pisiform, hamate, 5th metacarpal
Flexor and Ulnar Deviator

Question 6

Palmaris Longus

Answer 6

Medial Epicondyle - Palmar Aponeurosis
Flexor
Centrally located therefore does not contribute to radial/ulnar deviation
14% of people do not have PL

Question 7

Flexor Digitorum Profundus

Answer 7

Origin: proximal 1/2 ulna and interosseous membrane
Insertion: Distal Phalanges palmar aspect
Wrist and DIP Flexor

Question 8

Flexor Digitorum Superficialis

Answer 8

Origin: Medial Epicondyle, Coranoid Process, Proximal 1/2 Radius
Insertion: Middle Phalanges
Wrist & PIP Flexor

Question 9

Flexor Pollicis Longus

Answer 9

3 Heads: Medial Epicondyle, Medial Coronoid Process, Middle 1/3 radial shaft.
Insertion: Palmar aspect distal 1st Phalange
Wrist Flexion, Radial Deviation, 1st Phalange distal flexion

Question 10

Abductor Pollicis Longus

Answer 10

Flex and Radially Deviate
Origin: Mid Radius, Mid Ulna, Interosseous Membrane
Insertion: Trapezium and 1st Metacarpal

Question 11

Primary Wrist Extensors (3)

Secondary Wrist Extensors (4)

Answer 11

Primary:

1. Extensor Carpi Radialis Longus
2. Extensor Carpi Radialis Brevis
3. Extensor Carpi Ulnaris

Secondary:

1. Extensor Digitorum
2. Extensor Indices
3. Extensor Digiti Minimi
4. Extensor Pollicis Longus

Question 12

Extensor Carpi Radialis Longus

Answer 12

Origin: Lateral Supracondylar Ridge
Insertion: 2nd Metacarpal
Radial Deviator & Wrist Extensor

Question 13

Extensor Carpi Radialis Brevis

Answer 13

Origin: Lateral Epicondyle
Insertion: 3rd Metacarpal
Extensor, Some Radial Deviation, but not as good as ECRL

Question 14

Extensor Carpi Ulnaris

Answer 14

Origin: Lateral Epicondyle & Dorsal Proximal Ulna
Insertion: 5th Metacarpal
Ulnar Deviation, Wrist Extension

Question 15

Extensor Digitorum

Answer 15

Origin: Lateral Epicondyle
Insertion: Middle & Distal Phalanges, Extensor Hood digits 2-5
Passive insufficiency when full flexion at wrist and phalanges

Question 16

Extensor Indices

Answer 16

Accessory Extensor to 2nd Digit
Origin: dorsal mid-shaft of ulna
Insertion: extensor hood of 2nd digit
Extensor Primarily - maybe some radial deviation

Question 17

Extensor Digiti Minimi

Answer 17

Origin: Lateral epicondyle
Insertion: Extensor Hood of 5th Digit
Accessory
Maybe weak ulnar deviation

Question 18

Extensor Pollicis Longus

Answer 18

Origin: Mid-Shaft of Ulna & interosseous membrane
Insertion: Distal Phalanx dorsal aspect
Radial Deviation

Question 19

Synergies

Answer 19

Extensors prevent wrist flexion when using finger flexors that also cross the wrist joint.
Thumb muscles would pull wrist into radial deviation, FCU & ECU prevent deviation.

Question 20

Primary Deviators:
Radial
Ulnar

Answer 20

Radial Deviators:
FCR, ECRL, ECRB
FPL, EPL, EPB, ABPL

Ulnar Deviators:
FCU, ECU
EDM