4.0) Inferior Radioulnar Joint + Wrist

Question 1

Inferior radioulnar joint

Answer 1

Pivot,complex,synovial,uniaxail

Question 2

Inferior radioulnar joint

Articular surface

Answer 2

See file

Question 3

Inferior radioulnar joint

Joint capsule

Answer 3

See file

Question 4

Inferior radioulnar joint

Synovial membrane

Answer 4

Large compared to size of joint

Extends upwards above joint margins of radius and ulna in front of Interosseous membrane as recessus sacciformis

Question 5

Interosseous membrane

Answer 5

Continuous fascia strong fibrous sheet between Interosseous boarders of radius and ulna

Fibres pass obliquely and inferomedially

Deficient superiorly continuous fascia posteriorly of pronator quadratas

Question 6

Interosseous membrane functions

Answer 6

1. Static stabiliser of both radioulnar joints maintaining contact of articulating surfaces
2. Minimising torsional stresses on the bones very strong bond acts as an internal brace
3. Provides an increased surface area for muscle attachments in the forearm helping to compartmentalise these muscles into an anterior (flexor muscle compartment) and posterior (extensor muscle compartment)
4. Tension during pronation and supination *midpronation
5. Due to fibres passing obliquely medially and downwards it Facilitate great transmission through upper limb its able to transmit force from radius onto ulna then humeroulna articulation then axail skeleton
6. Increased surface area muscle attachment in forearm fills gap between radius and ulna

Question 7

Stability

Answer 7

Extremely stable

Articular disc
Interosseous membrane
Pronator quadratus

Question 8

Movements

Answer 8

Rotation distal end radius around head do ulna during pronation and supination

Axis of pronation and supination coincide axis hand= middle finger
Radial rotation therefore accompanied by movement of head of ulna

As the radius rotates about the ulna the ulna is displaced. Displacement is a result of slight extension and medial displacement of ulna at elbow.

Side-to-side movement between trochlear humerus and trochlear notch is mechanically amplified at distal ulna

Extension+lateral displacement of ulna= aconeus= occur simultaneously during pronation

Question 9

Pronation

Answer 9

Radius crosses ulna and is anterior

Question 10

Supination

Answer 10

Radius and ulna are parallel to each other

When elbow is fully extended biceps is unable to produce supination as its tendon runs parallel to shaft of radius so cannot produce radial rotation

Question 11

Wrist

Answer 11

Not a single joint

Articulations between:

Forearm- radiocarpal joint
Carpal bones- intercarpal, midcarpal

Question 12

Carpus

Answer 12

8 individual small bones arranged around the carpitate

X2 rows : proximal and distal

1. Proximal articulate with inferior radioulnar joint ( except pisiform)
2. Proximal and distal articulate each other= midcarpal joint
3. Distal and metacarpal= carpometacarpal joint

Question 13

What are the proximal bones of carpus

Lateral to medial

Answer 13

Scaphoid
Lunate
Triquetral
Pisiform

All except pisiform articulate with the distal radius and articular disc at inferior radioulnar joint

Question 14

What are the distal bones of carpus

Lateral to medial

Answer 14

Trapezium
Trapezoid
Capitate
Hamate

Question 15

Radiocarpal joint classification

Answer 15

ellipsoid, complex, synovial, bi-axial joint

Question 16

Radiocarpal joint

Articular surface

Answer 16

See file

Question 17

Radiocarpal joint

Joint capsule

Answer 17

See file

Question 18

Radiocarpal joint

Synovial membrane

Answer 18

Locks synovial membrane lines joint capsule attaching to margins of all articular surfaces

Manifolds – particularly posteriorly

Due to disc + completeness of interosseous ligaments uniting proximal surface of proximal carpal row synovial cavity is limited to radiocarpal space

Periforation = communication inferior radioulnar joint

Question 19

Radiocarpal joint

Caspular ligaments

Answer 19

Dorsal radiocarpal ligament
Palmer radiocarpal ligament
Palmer ulnocarpal ligament

Question 20

Dorsal radiocarpal ligament

Answer 20

Posterior lower end of radius ——— posterior surface of scaphoid lunate triquetral

Inferomedially

Question 21

Palmer radiocarpal ligament

Answer 21

Anterior lower radius and styloid process ——anterior surface of proximal row of carpal bones

Broad band passing downwards and medially

Question 22

Palmer ulnocarpal ligament

Answer 22

Anterior articular disk and base of ulnar styloid process ————- anterior surfaces of proximal carpal bones

Fibres extending inferolaterally

Question 23

What happens to anterior and posterior Caspular ligaments

Answer 23

Become taut in extension and flexion of radiocarpal joint

Question 24

Radiocarpal joint

Ligaments

Answer 24

Radial collateral carpal ligament

Ulnar collateral carpal ligament

Question 25

Radial collateral carpal ligament

Answer 25

Tip radial styloid process to lateral side of the scaphoid

Question 26

Ulnar collateral carpal ligament

Answer 26

Rounded cord Ulnar styloid process base of pisiforms and medial posterior non-articular surfaces off triquetral ( blends middle part of flexor retinaculum)

Question 27

Movement off radiocarpal joint

Answer 27

Flexion Extension Abduction Adduction

Question 28

Flexion radiocarpal + Midcarpal joint NROM+ limiting factors

Answer 28

0 to 90° Midcarpal contributes the most Dorsal radiocarpal ligament Tension in extensor tendons

Question 29

Extension radiocarpal and midcarpal joint

Answer 29

0 to 85° Radiocarpal joint makes greatest contribution Palmar radiocarpal ligament Palmer ulnocarpal ligament Tension flexor tendons

Question 30

Abduction radiocarpal and midcarpal joint Radial deviation

Answer 30

0–15° Ulnar collateral ligament Impact scaphoid tubercle on radial styloid

Question 31

Adduction radiocarpal and midcarpal joint Ulnar deviation

Answer 31

0-45° Radial collateral ligament

Question 32

Intercarpal joints Classification

Answer 32

Between x2 rows of carpals Completed joint x2 rows = midcarpal joint Plane, compound, synovial, multiaxail

Question 33

Intercarpal proximal row joint

Answer 33

Plane synovial distal scaphoid lunate and triquetral Bones are bound together by interosseous dorsal+Palmer ligaments = minimal movement

Question 34

Intercarpal proximal row joint Ligaments

Answer 34

1. Interosseous intercarpal ligaments •short bands attaching to margins of the joint surfaces radiocarpal articulation Whole anteroposterior length 2. palmar+dorsal intercarpal ligaments * transverse bands grim scaphoid to lunate * lunate to triquetral anteroposterior aspects

Question 35

Pisiform

Answer 35

? Pg140

Question 36

Joints of intercarpal distal row

Answer 36

Intercarpal interosseous ligament palmar and dorsal same as proximal joint Arrangements allows gliding movement between bones is minimal but increases movement at radiocarpal and mid carpal joints

Question 37

Difference in interosseous ligament in proximal and distal row

Answer 37

Distal row ligament is less extensive Leaving clefts between bones Runs transversely uniting trapezium to trapezoid to capitate to hamate

Question 38

Midcarpal joint

Answer 38

Completed joint x2 rows = midcarpal joint

Question 39

Midcarpal joint Articulating surfaces

Answer 39

See file

Question 40

Midcarpal joint Joint capsule

Answer 40

See file

Question 41

Midcarpal joint Intercarpal synovial cavity

Answer 41

Lines the capsule and all non articular surfaces attaching to margins of all joint surfaces Large complex

Question 42

Midcarpal joint Ligaments

Answer 42

Palmar intercarpal (radiate capitate lig) Dorsal intercarpal Radial collateral Ulnar collateral Interosseous ligament

Question 43

Palmar intercarpal (radiate capitate lig)

Answer 43

Runs from bones of proximal row to head of capitate

Question 44

Dorsal intercarpal

Answer 44

Runs from bones of one row to the other

Question 45

Radial collateral

Answer 45

Strong, continuation radiocarpal collateral ligament Runs from scaphoid to trapezium

Question 46

Ulnar collateral

Answer 46

Runs from triquetral and hamate Continuation ulnar collateral carpal lig

Question 47

Interosseous ligament

Answer 47

Slender Lateral side capitate to scaphoid

Question 48

Movements midcarpal joints

Answer 48

Flexion Extension Abduction Adduction Transverse anteroposterior axis through head of capitate **Movements occur in combination with radiocarpal joints

Question 49

Flexors of the wrist

Answer 49

``` flexor carpi ulnaris flexor carpi radialis palmaris longus Flexor digitorum superficialis Flexor digitorum profundus Flexor pollicis longus ``` Flexor pollicis longus

Question 50

Extensors of the wrist

Answer 50

``` extensor carpi ulnaris extensor carpi radialis longus extensor carpi radialis brevis Extensor digitorum Extensor indicis Extensor digiti minimi Extensor pollicis longus Extensor pollicis brevis ```

Question 51

Flexor carpi ulnaris

Answer 51

S: most medial superficial flexors O: 1) humeral head: common flexor origin- medial epicondyle humerus+ fascia 2) Ulnar head: medial boarder olecranon, aponeurosis upper 2/3 posterior ulna I: long tendon into pisiform, hook hamate D: inferiorly A:flexes hand at wrist, ulnar deviation. Stabilising pisiform during abduction of pinky *synergist prevents unwanted extension F: NS: ulnar nerve C7,8

Question 52

Flexor carpi radialis

Answer 52

S: fusiform, most lateral O: medial epicondyle of humerus + fascia I: long tendon passes beneath flexor retinaculum Distally: palmar surface bases 2nd,3rd metacarpals D: oblique lateral A: flexion, oblique nature= pronation, help flex elbow, radial deviation F: NS: median nerve C6,7

Question 53

Palmaris longus

Answer 53

S: small a scent 10% population between ulnar is and radialis O: medial epicondyle I: via flexor retinaculum to apex of palmar aponeurosis D: inferiorly A: flexion of wrist flexion metacarpalphalangeal F: NS: median nerve C8

Question 54

extensor carpi ulnaris

Answer 54

S: O: lat epicondyle + fascia+ aponeurosis posterior boarder of ulna I: medial side base 5th metacarpal D: inferomedially A: extends wrist, works with other muscles=ulnar deviation F: NS: posterior Interosseous radial nerve C7,8

Question 55

extensor carpi radialis longus

Answer 55

S: posterior compartment O: anterior lower 1/3 lat supercondylar ridge, lat epicondyle common extensor tendon I: posterior base 2nd metacarpal D: distally A: extend wrist F: NS: radial nerve C6,7

Question 56

extensor carpi radialis brevis

Answer 56

S: O: lateral epicondyle common extensor tendon I: posterior base 3rd metacarpal D: A: extension radial deviation F: NS: posterior Interosseous radial C6,7

Question 57

Flexor retinacula

Answer 57

Anterior to carpus Strong band for retention of long flexor tendons Converts the carpal sulcus into a tunnel Attachments: Laterally: Tubercle of scaphoid lips of trapezium Medially: pisiform hook of hamate

Question 58

Extensor retinacula

Answer 58

Thickening of the deep fascia Attachments: Laterally: distal part of the anterior surface of radius Medially: distal end ulna pisiform triquetral UCL Septa run from its deep surface to the distal ends of the radius and ulna converting the grooves on the dorsum of the wrist into 6 separate tunnels each lined by synovial sheath

Question 59

Muscles in the Superficial,intermediate, Deep anterior compartment of the arm

Answer 59

Superficial: 1. flexor carpi ulnaris 2. flexor carpi radialis 3. palmaris longus 4. pronator teres. Intermediated: 1. Flexor digitorum superficialis Deep: 1. flexor digitorum profundus 2. flexor pollicis longus 3. pronator quadratus.

Question 60

Muscles in the Superficial and Deep posterior compartment of them arm

Answer 60

Superficial: 1. extensor carpi radialis brevis 2. extensor carpi ulnaris 3. extensor digitorum 4. extensor digiti minimi Deep: 1. supinator 2. abductor pollicis longus 3. extensor pollicis brevis 4. extensor pollicis longus 5. extensor indicis.