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Clinical Anatomy > 3.5 Arm, FA, Wrist > Flashcards

3.5 Arm, FA, Wrist Flashcards

1
Q

proximal radius & ulna

A
  • radioulnar joint
    • synovial- pivot
    • diarthrois- unixial (y-axis)
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2
Q

middle radius & ulna

A
  • radioulnar joint
    - syndesmosis structural joint
    - amphiarthrosis functional joint
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3
Q

distal radius & ulna

A
  • radioulnar joint
    • synovial- pivot
    • diarthrosis- uniaxial (y-axis)
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4
Q

Wrist and Hand complex includes

A
  • distal radius (&ulna)
    • ulna does not articulate with carpal bones
      - too short
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5
Q

how many carpal bones?

A

8

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6
Q

how many metacarpals?

A

5

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7
Q

digits & pollex

A
  • proximal phalanges (5)
  • middle phalanges (4)
  • distal phalanges (5)
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8
Q

Metacarpophalangeal joint

-type?

A
  • head of MC articulates w/base of phalanx
  • synovial condyloid joint
  • biaxial
  • except thumb!
    - uniaxial hinge
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9
Q

Interphalangeal Joint

A
  • head of prox. phalanx articulates w/ base of distal phalanx
  • synovial hinge joint
  • uniaxial
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10
Q

which rotates which is passive?

A

-radius rotates around relatively passive ulna!

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11
Q

radioulnar joints: Proximal

A

-Radial Head- Radial notchof ulna

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12
Q

radioulnar joints: distal

A

-ulnar head-ulnar notch of radius

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13
Q

pronation accomplished by

A

pronator teres mm.

pronator quadratus mm.

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14
Q

pronator teres mm. innervated by…

A

median n.

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15
Q

pronator quadratus innervated by…

A

anterior interosseous n. ( of median n.)

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16
Q

supination accomplished by

A

supinator mm. (extensor side)

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17
Q

supinator mm. innervated by

A

radial n.

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18
Q

biceps brachii mm.

innervated by

A

(during flexion)

-innervated by musculocutaneous n.

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19
Q

ARTICULAR SURFACE:

distal end of ulna (head)

A
  • articular fossa for triangular ligament (TFCC)

- styloid process projects posterrior (cone shaped, easily palpated)

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20
Q

ARTIC SURF:

distal end of radius

A
  • articular fossa for :
    • lunate (medial)
    • scaphoid (lateral)
  • greater distal projection
  • styloid is lateral with lateral projection
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21
Q

angle of inclination is…

A

23 deg.

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22
Q

only distal articulation with carpals is

A

radius (wrist is radiocarpal joint)

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23
Q

distal radioulnar joint neurovascular supply

A
  • ant/post interosseous a/v

- ant (median)/post (radial) interosseous n.

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24
Q

Radioulnar joint cavity shape…

accommodates…

A
  • “L-shaped cavity”
  • Accommodates:
    • ulnar notch articulating surface with (TFCC)
  • RU Sacciform Recess for movement
  • Triangular Radioulnar Disc
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25
Q

TFCC

A

triangular fibrocartilaginous complex

26
Q

Triangular fibrocartilaginous complex

A
  • triangular-shaped radioulnar disc (“triangular ligament”)
  • ligamentous bands frames disc
    - dorsal radioulnar ligament
    - palmar radioulnar lig
27
Q

TFCC attach from

A
  • ulnar styloid process to ulnar notch of radius
    - fills space of shorter distal ulna
    - ligaments stabilizes & suspends ulna to the triquetrum & lunate!!
28
Q

TFCC allows for

A

greater ROM at wrist

29
Q

TFCC: triangular-shaped radioulnar disc (“triangular ligament”)

A
  • ligamentous bands frames disc
    - palmar radioulnar lig
    - dorsal radioulnar lig
30
Q

ulna variance

A
  • neutral
  • positive
  • negative
31
Q

neutral (normal) ulnar variance

A

0.9mm
~80% of load is born by radius
~20% by ulna

32
Q

positive ulnar variance

A
  • long ulna (in relation to radius)
  • distal end
  • increase load born by ulno-carpal joint from 18% to 42%
33
Q

negative ulnar variance

A
  • short ulna (in relation to radius)
  • distal end
  • decrease load borne by the ulno-carpal joint to 4.3%
34
Q

positive ulnar variance leads to…

A

-pressure of carpals on TFCC may reduce space, thinning and damage of TFCC

35
Q

negative ulnar variance leads to…

A
  • more P on radiocarpal joint

- possible necrosis of lunate (indirectly)

36
Q

TFCC injuries

A

-tear, stretch, compression of TFCC
-mechanism of injury
=T1 or T2

37
Q

T1 TFCC

A

T1- Traumatic Injury(???)

 - fall on extended wrist usually while pronated
- traction injury on ulnar side
38
Q

T2 TFCC

A

T2- degenerative

 - over 50 years
 - positive ulnar variance 
         - "ulnar impaction syndrome"
        - "Ulnocarpal abutment syndrome" - arthritis  - gout
39
Q

a third mechanism of injury of TFCC

A
  • repetitive motion injury

- bowing, tennis, hammering, power drill, etc.

40
Q

Sx of TFCC

A
  • wrist pain at ulnar side
    • sometimes overall, diffuse pain
    • made worst woth pronation-supination, or abd, add
      • swelling
      • weakness & instab. (esp. with styloid fx)
      • crepitus; “catching”
41
Q

Tx of TFCC

A
  • rest (splint/cast)
  • NSAIDS
  • Steroid injection
  • PT (strengthening exercises and ROM)
  • Surgery (arthroscopic)
    • debride
    • suture-repair
    • ulnar length reduction
42
Q

Colles’ Fracture mechanism

A
  • mechanism
    • fall on outstretched hand (foosh)
      • force + hyperextension (forearm forced dorsally)
43
Q

Colles’ fx results in:

A
  • distal fx to radius
  • broken distal end projects dorsal
  • proximal end may project ventral/volar (overriding fractured end)
44
Q

an avulsed what in a colles’ fx may be present?

A

-styloid process of ulna and radius

45
Q

X-rays of colles’ fx may reveal what?

A
  • reduced radial angle of inclination
  • displays “dinner force deformity”
    • broken distal end projects posterior, while proximal end my project anterior (overriding fractured end)
46
Q

Radiocarpal Joint

A

SLTQ

  • capsule envelops distal radius & ulna, and proximal carpals (scaphoid, lunate, triq.)
    • numerous synovial membrane folds
47
Q

Intercarpal joint

A
  • continous capsule for intercarpal joint cavities & carpometacarpal joint
    • EXCEPT: carpometacarpal joint of thumb
    • fibrous capsule helps unite bones
48
Q

Wrist joint (radiocarpal ligaments)- how many?

A

-four main ligaments

49
Q

What are the four main ligaments of the wrist joint called?

A
  • palmar radiocarpal ligaments
  • dorsal radiocarpal lig
  • ulnar (or medial) collateral ligaments
  • radial (or lateral) collateral ligaments
50
Q

ligaments provide support to pull hand along for ______ and ________.

A

-supination and pronation

51
Q

Kienbock’s Disease

A
  • avascular necrosis of LUNATE BONE

- most commonly dislocated carpal bone!

52
Q

causes of keinbock’s disease

A
  • injury (although not a direct cause)
  • negative ulnar variance
    • increased compression from radius (b/c lunate articulates with rad)
53
Q

symp. of keinbock’s

A
  • pain and swelling in MEDIAL wrist
  • reduced ROM and weakness
  • pain with SUPINATION or ADDUCTION
54
Q

dx OF KEINBOCK’S

A
  • xray shows:
    • fibrosis of bone (bright lunate on xrays)
    • fx
    • collapse of lunate
55
Q

Radiocarpal joint (radius + scaphoid/ lunate)

A
  • synovial condyloid (ellipsoidal) joint

- biaxial (x and y axes)

56
Q

Intercarpal joints include-

A
  • joints b/w adjacent carpal bones w/in rows
    - midcarpal joint
    - pisotriquetral joint
57
Q

Midcarpal joint

A
  • between proximal and distal rows
  • lateral and medial midcarpal joint
    - acts as saddle joint
58
Q

Pisotriquetral joint

A
  • b/w pisiform and triquetrum
  • synovial gliding joint
  • nonaxial
59
Q

Intercapral ligaments consist of:

A
  • palmar ligaments
  • dorsal intercarpal ligaments
  • interosseous ligaments
  • ligaments specifically names for bones that articulate
60
Q

Carpometacarpal joint (CMC)

A

-b/w distal rows and metacarpals

61
Q

Intermetacarpal joint (IMC)

A
  • synovial gliding joint
  • nonaxial
  • except thumb (own capsule)
    - synovial saddle and biaxial

Clinical Anatomy (8 decks)

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