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PT9111 - TEST 3 > Lecture 36- Elbow, wrist and hand > Flashcards

Lecture 36- Elbow, wrist and hand Flashcards

1
Q

Summary of anatomical landmarks of the humerus, radius, ulnar and the processes

A
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2
Q

Where are the anterior and posterior connections of the humerus

A

Anterior: Glenohumeral Joint

Posterior: Flares into 2 supracondylar ridges (medial and lateral epicondyles)

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3
Q

Medial Epicondyle

A

More prominent than lateral and is an attachment site for the pronator teres, common flexor tendon and ulnar collateral ligament

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4
Q

Lateral Epicondyle

A

Attachment site for the supinator, radial collateral ligament, and extensor muscles

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5
Q

Trochlea

A

Distal medial aspect of humerus that articulates with sigmoid notch of ulna (edge extends distally more than laterally giving carrying angle of elbow)

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6
Q

Capitellum

A

Distal lateral aspect of humerus that articulates with the head of the radius

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7
Q

Radius

A

Cylindrical bone that articulates with the capitellum of the humerus

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8
Q

What 2 ligaments secure the radius

A

Annular ligament (surrounds the head) and quadrate ligament

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9
Q

T or F: 360 degrees of the radial head articulates with the ulna

A

F, 240 degrees

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10
Q

Ulna

A

Primary source of bony stabilization at the elbow

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11
Q

Trochlear notch

A

Part of ulna that articulates with trochlea of humerus

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12
Q

Coronoid Process

A

Inferior-anterior medial lip of the trochlear notch of the ulna that is the attachment site for the brachialis and anterior portion of ulnar collateral ligament

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13
Q

Olecranon Process

A

Attachment site for triceps, anconeus and flexor carpi ulnaris

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14
Q

Radial Notch

A

Concave, articular depression where the radius articulates with the ulna

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15
Q

What are the 4 joints that make up the elbow

A
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16
Q

Humeroulnar Joint

A

Medial aspect of elbow that contributes to flexion/extension

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17
Q

Humeroradial Joint

A

Lateral aspect of elbow which contains a concave radial head and convex capitellum that is essential for elbow stability (mainly valgus stress)

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18
Q

Proximal Radioulnar Joint

A

Composed of radial head, AL ring, radial fossa of ulna that is used for pronation (70 degrees) and supination (80 degrees)

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19
Q

Distal Radioulnar Joint

A

Distal end of radius, ulna, joint capsule and triangular fibrocartilage complex that is mostly pronation (70 degrees) and supination (80 degrees)

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20
Q

3 characteristics that make up the elbow capsule

A

1) Surrounds all three articulations
2) Thin/loss anteriorly/posteriorly but thicker medially/laterally forming the collateral ligaments
3) Anterior capsule is taught in extension and posterior capsule is tight in flexion

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21
Q

The ulnar (medial) collateral ligament is made up of what 3 ligaments

A

1) Anterior (strongest = most stable)
2) Posterior
3) Transverse (weakest = least stable)

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22
Q

The transverse ulnar collateral ligament is also called

A

Coopers ligament

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23
Q

Function of the ulnar (medial) collateral ligament

A

Taught with flexion, and resists valgus stress

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24
Q

What are the 4 parts of the radial (lateral) collateral ligament

A
  1. Annular ligament
  2. Radial Portion
  3. Ulnar portion
  4. Accessory portion
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25
Q

3 functions of the radial (lateral) collateral ligament

A
  1. Annular ligament encircles radial head from anterior to posterior attaching radius to ulna
  2. Stabilizing complex of posterior radioulnar joint
  3. Resist varus stress
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26
Q

T or F: The radial collateral ligament is stronger than the ulnar collateral ligament

A

F, it is weaker

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27
Q

What are the 3 anterior flexor muscle groups of the elbow

A
  1. Biceps brachii
  2. Brachialis
  3. Brachioradialis
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28
Q

Biceps brachii

A

strongest supinator

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29
Q

Brachialis

A

Elbow flexor

30
Q

Brachioradialis

A

Strongest elbow flexor

31
Q

What are the 2 posterior extensor muscles of the elbow

A
  1. Triceps brachii
  2. Anconeus
32
Q

Triceps Brachii

A

Elbow extensor

33
Q

Anconeus

A

Joint stabilizer

34
Q

What are the 6 lateral forearm extensor/supinator muscles of the elbow

A
  1. Extensor carpi radialis longus
  2. Extensor carpi radialis brevis
  3. Extensor digitorum communis
  4. Extensor digiti minimi
  5. Extensor carpi ulnaris
  6. Supinator
35
Q

What are the 7 medial forearm flexor/pronator muscles of the elbow

A
  1. Pronator teres
  2. Pronator Quadratus
  3. Flexor carpi radialis
  4. Flexor carpi ulnaris
  5. Flexor digitorum superficialis
  6. Flexor digitorum profundus
  7. Palmaris longus
36
Q

Pronator Teres

A

strong pronator and weak elbow flexor which resists valgus stress at elbow

37
Q

Flexor carpi ulnaris

A

Wrist flexion and ulnar deviator and weak elbow extensor

38
Q

Flexor digitorum superficialis

A

Flex PIP 2-5 digits

39
Q

Flexor digitorum profundus

A

Flex DIP

40
Q

Valgus Stress

A

Inward stress pushing out away from midline

41
Q

Varus

A

Outward Stress pushing in towards midline

42
Q

What 2 medial forearm flexor muscles may have a role in dynamic stability

A
  1. Flexor digitorum superficialis
  2. Flexor carpi ulnaris
43
Q

What are the 4 nerves of the elbow and location

A
  1. Radial Nerve: C5-C8; deep branch is the posterior interosseous nerve beneath supinator
  2. Ulnar Nerve: C8-T1 and passes posterior to medial epicondyle through cubital tunnel
  3. Median Neve: C5-C6 and C8-T1 that turns into AIN (anterior interosseous nerve) through pronator teres
  4. Musculocutaneous Nerve: C5-C7 that provides no motor innervation distal to elbow
44
Q

What are the 3 primary arterial structures at the elbow and location

A
  1. Brachial Artery: Follows path of median nerve and is palpable in antecubital fossa

Distal to antecubital fossa:
2. Radial Artery: Radial collateral and middle collateral branches
3. Ulnar artery: Superior/inferior collateral

45
Q

Summary of structures that contribute to stability of elbow and resist stressors (KNOW THIS)

A
46
Q

5 characteristics in regards to biomechanics of the muscles at the elbow

A
  1. Muscular activity across elbow lends to compressive forcing to increase stability
  2. Flexor pronator group helps the ulnar collateral ligament contribute to valgus stability
  3. FDS is the greatest amount of individual stability muscularly
  4. Lateral extensors contribute to varus stress (pronation)
  5. Medial flexors contribute to valgus stress (supination)
47
Q

3 characteristics of the hand osteology

A
  1. 5 metacarpals
  2. 14 phalanges
  3. Base of each long bone is concave and the head is convex
48
Q

3 characteristics of the the wrist

A
  1. Made of 8 carpal bones, distal radius and ulna
  2. Distal row of carpals: Trapezium, trapezoid, capitate, hamate (stable row and forms carpometacarpal joint)
  3. Proximal Row: Scaphoid, Lunate, Pisiform, and Triquetrum (Unstable row)
49
Q

Summary of bone anatomy of hand

A
50
Q

What are the 4 types of joints of the wrist

A
  1. Distal radio-ulnar joint
  2. Radio-carpal joints
  3. Mid-carpal joints
  4. Carpo-metacarpal joints
51
Q

The distal radio-ulnar joint is tilted in what 2 planes

A
  1. Sagittal Plane -> 10-15 degree palmar tilt
  2. Frontal Plane-> 24 degree ulnar inclination
52
Q

Ulnar variance

A

Radial border of ulna should be level with ulnar border of radius

53
Q

Positive Ulna Variance

A

Lead to degenerative changes to the Triangular fibrocartilage complex (TFCC)

54
Q

Negative Ulna Variance

A

Kienbocks disease (avascular necrosis of the lunate

55
Q

3 characteristics of the radio-carpal joint

A
  1. Modified ovoid
  2. Compound/Complex
  3. 2 degrees of freedom (flexion/extension; radial/ulnar deviation)
56
Q

Characteristics of the mid carpal joint

A
  1. Between proximal and distal rows of the carpal bones (except pisiform)
  2. Synovial
  3. 1 degree of freedom (flexion/extension) -> more flexion than radiocarpal joint (60 vs 40%)
  4. Compound
57
Q

The majority of the blood supply comes from

A

dorsal scaphoid branch of radial artery near bone’s distal pole

58
Q

What blood supply can be easily interrupted by a fracture in the hand

A

Blood supply to proximal pole in retrograde manner

59
Q

2 characteristics of distal and proximal interphalangeal joints

A
  1. Hinge joints
  2. 1 DF (flex/ext)
60
Q

2 characteristics of metacarpal phalangeal joints

A
  1. Bi-axial
  2. 2 DF (Flex/ext; abd/add)
61
Q

2 characteristics of metacarpal phalangeal joints of thumb

A
  1. Hinge joint with 2 CMC
  2. 2 DF (flex ext; abd/add)
62
Q

Joint Capsule of the wrist

A

Extensive and irregular thickenings forming the extrinsic ligamentous system of the wrist

63
Q

Ligaments of the wrist can be classified as (2):

A
  1. Intrinsic
  2. Extrinsic
64
Q

Intrinsic ligament of wrist

A

Inside joint capsule that is an interosseous ligament (ex. scapholunate or dorsal intercarpal ligament)

65
Q

Extrinsic ligament of wrist

A

Originate from radius and ulna and run into carpus or form carpus to metacarpals

66
Q

Triangular Fibrocartilage Complex (KNOW THIS)

A

Cartilaginous load bearing structure found between the lunate, triquetrum and ulnar head that is made of articular disc, ulnar collateral ligaments, sheath of extensor carpi ulnaris and dorsal and volar radio ulnar ligaments

67
Q

What are 3 characteristics of the 1st CMC (carpometacarpal) joint of the thumb

A
  1. Unmodified synovial joint
  2. Unmodified sellar
  3. 2 degrees of freedom (flex/ext;abd/add)
68
Q

What are the 3 ligaments of the CMC joint (thumb)

A
  1. Posterior oblique ligament
  2. Anterior oblique ligament
  3. Dorsoradial ligament
69
Q

What is the strongest ligament and major stabilizer of the CMC

A

Dorsoradial ligament

70
Q

Describe the 2 biomechanical properties for 1st carpometacarpal

A
  1. Concave for flexion/extension
  2. Convex abduction/adduction
    **these movements cause breakdown in ligaments found here
71
Q

Summary of muscles of the 1st CMC of the thumb

A
72
Q

What joint is commonly affected by osteoarthritis

A

1st carpometacapral joint of thumb

PT9111 - TEST 3 (16 decks)

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