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Semester 4 FS Exam 3 > Biomechanics Wrist and Hand > Flashcards

Biomechanics Wrist and Hand Flashcards

(190 cards)

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1
Q

Wrist - elbow - shoulder relationship

A

Wrist works in conjunction with elbow and shoulder to allow optimal placement of hand in surrounding space

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2
Q

Wrist - in relation to length tension

A

The wrist optimizes the length tension relationships of the mm of the hand to allow for higher accuracy and effective functional use

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3
Q

What is responsible for carrying the work of the UE

A

hand

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4
Q

Diversity in tasks require

A

ROM, force, sensitivity

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5
Q

What allows for efficiency

A

Synergy among the wrist/hand structures

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6
Q

Forearm bones

A

Radius

Ulna

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7
Q

Hand bones

A

Carpals (wrist)
Metacarpals (palm)
Phalanges (fingers)

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8
Q

How many bones of the hand and the breakdown

A

27 bones
8 carpals
5 metacarpals
14 phalaneges

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9
Q

Proximal row of carpals from radial to ulnar side

A

Scaphoid, lunate, triquetral, pisiform

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10
Q

Distal row of carpals from radial to ulnar side

A

Trapezium, trapezoid, capitate, hamate

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11
Q

Anteriorly (palmar) what shape is the hand

A

Concave

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12
Q

What does the proximal row of carpals make

A

condyle type structure

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13
Q

Base of all the carpals is the

A

capitate

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14
Q

Metacarpals - parts

A

Proximal (base)
Body
Distal (head)

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15
Q

Phalanges - parts

A

Proximal
Middle
Distal

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16
Q

Phalanges - thumb

A

Only has 2 phalanges

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17
Q

Radiocarpal joint - why is it called that

A

Connects the radius to the carpal bones

Dropped the ulna because ulna doesnt directly contact the carpal bones (disc does)

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18
Q

What type of joint is the radiocarpal joint and how many DOF

A

Condyloid

2 DOF

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19
Q

Movements of the Radiocarpal joint and what plane they are on

A

Flex/Ext = sagittal
Rad/Uln Dev = frontal
Some degree of circumduction

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20
Q

Circumduction of the radiocarpal joint is facilitated by

A

pronation and supination

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21
Q

radiocarpal joint - rotation

A

NOT possible due to oblong shape of radius

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22
Q

Joint surfaces of the radiocarpal joint- proximal

A

Distal radius and the radioulnar disc = biconcave

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23
Q

Joint surfaces of the radiocarpal joint - distal

A

Convex

Scaphoid, lunate, triquetrum

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24
Q

Joint surfaces of the radiocarpal joint - lateral facet

A

Scaphoid

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25
Joint surfaces of the radiocarpal joint - medial
Lunate
26
Joint surfaces of the radiocarpal joint - disc
triquetrum
27
What encloses the radiocarpal joint
fibrous capsule | From the distal radius and ulna to the proximal row of carpals
28
Arthrokinematics of the radiocarpal joint - open chain
Carpals on the radius/disc | Convex on concave
29
Arthrokinematics of the radiocarpal joint - closed chain
Radius/disc on the carpals | Concave on convex
30
Ulnar tilt
The articular surface of the radius (anteriorly) faces in the ular direction MEDIALLY about 25 degrees
31
Radial tilt
The radial surface shows a palmar tilt - facing a little ANT
32
Distal articular surface of the radius to the carpals faces what directions
Slightly med and ant
33
Midcarpal joint - describe it
distal row of carpals moving on the proximal row of carpals
34
Midcarpal joint - which is convex and which is concave
Convex distal row of carpals moving on the Concave proximal row of carpals
35
What type of joint is the midcarpal joint and how many DOF
Condyloid | 2 DOF
36
Midcarpal joint - movements
Flex/Ext | Radial/Ulnar deviation
37
Plane for Flex/Ext of the midcarpal joint
Sagittal plane
38
Plane for Rad/Uln deviation of the midcarpal joint
Frontal plane
39
Joint surfaces of the midcarpal joint - Proximal
Scaphiod, lunate, triquetrum
40
Joint surfaces of the midcarpal joint - Distal
Trapezium, trapezoid, capitate, hamate
41
Intercarpal joints
Located between the individual carpal bones | Gliding movement btw them allows for inc ROM at the wrist
42
Volar (palmar) radiocarpal ligaments
Radiocapitate Radiotriquetral Radioscaphoid Radiolunate
43
Function of the radiocapitate ligament
Stabilize the lunate and scaphoid
44
Function of the radiotriquetral
Stabilize the lunate
45
Volar (palmar) ulnocarpal ligaments
Ulnocapitate Ulnolunate Ulnotriquetral
46
Volar radiocarpal AND Volar ulnocarpal ligaments - what do they do
Limit extension | Prevent separation of the carpals - creates stability among the carpal bones
47
Wrist joint ligaments
Dorsal radiocarpal Ulnar collateral Radial collateral
48
Dorsal radiocarpal ligament goes where
from the radial styloid to the lunate and triquetrum
49
Dorsal radiocarpal ligament limits what
Limits flexion | Prevents separation of the carpals
50
Ulnar collateral ligament goes from where
From ulna to pisiform and triquetrum
51
Ulnar collateral ligament limits what
limits radial deviation
52
Radial collateral ligament goes from where
From radius to scaphoid, trapezium, and 1st metacarpal
53
Radial collateral ligament limits what
ulnar deviation
54
Arthrokinematics - wrist - Flexion vs. Extension ROM - which do we have more of
``` More flexion (80-85 degrees) Extension (70-80) ```
55
Arthrokinematics - wrist - Radial vs. Ulnar Deviation ROM - which do we have more of
Moe ulnar deviation (30-45) | radial (15-25)
56
Arthrokinematics - wrist - ROM - why do we have more ulnar deviation than radial
The distal radius faces medially (ulnar tilt)
57
Close packed position of the radiocarpal joint
Full extension and radial deviation (the motions we have less of)
58
Close packed position of the midcarpal joint
Full extension
59
Open packed position of the radiocarpal joint
Neutral with slight ulnar deviation
60
Open packed position of the midcarpal joint
Slight flexion and ulnar deviation
61
Axis of motion in for the wrist joints
With ext = is more distal With flex = is more proximal Deviates because of the motion in the carpal bones
62
Wrist - sequence from flexion into extension
1. movement initiated from distal carpal row (capitate) 2. distal carpals glide on prox carpals in same direction as hand 3. At neutral, volar radioscaphoid and radiocapitate ligaments tighten and pull distal row of carpals into close packed 4. At 45 degrees of ext, the volar radioscaphoid and radiolunate ligaments tighten and pull lunate into close packed on scaphoid 5. Remaining motion in ext is via both rows of carpals moving together as a solid unit on radius and disc
63
Wrist - sequence from extension into flexion
MAKE CARD ONCE UNDERSTAND :(
64
Wrist - sequence for radial deviation
1. Mvmnt initiated at distal carpal row 2. Distal carpal row moves back towards the radius 3. Ligaments on ulnar side tighten 4. Prox carpal row moves in ulnar direction 5. Scaphoid and Zium approach radial styloid 6. Scaph forced into flex (ant) 7. Ligament between scaph and lunate pulls lunate into flex 8. Radial deviation continues with proximal row ulnar glide
65
Wrist - sequence for ulnar deviation
1. Mvmnt initiated at distal carpal row 2. Distal carpal row moves towards the ulna 3. Ligaments on radial side tighten 4. Prox row moves in radial direction 5. Triquetrum forced into hamate 6. Hamate pulled prox by ligament tension 7. Ligament tenstion pulls scaphoid and lunate into ext 8. Ulnar deviation continues until stopped by ligaments
66
Flexor carpi radialis - action and location
Flexion of the wrist and radial deviation | On ant side predominantly - the distal aspect is on the radial side
67
Flexor carpi ulnaris - action and location
Flexion of the wrist and ulnar deviation | Starts on medial epicondyle and stays on medial side of the forearm
68
Plamaris longus - action
flex the wrist
69
Flexor digitorum superficialis - action
flex the wrist and fingers to the PIP
70
Flexor digitorum profundus - where does it start and attach
proximal shaft of the ulna to the distal phalanges 2-5
71
Flexor digitorum profundus - actions
Will flex the wrist, flex the fingers all the way and can contribute into ulnar deviation too
72
How does the flexor digitorum profundus contribute into ulnar deviation
Because the radiocarpal joint is oriented medially so when it pulls, it pulls into ulnar deviation
73
Extensor digitorum - where do the tendons connect
To the aponeurotic hood
74
Action of the extensor digitorum
Ext wrist and fingers all the way (2-5)
75
Function of the aponeurotic hood
Make sure that the force of the tendons gets pulled into only extension
76
Extensor carpi radialis longus - action
Radial deviation and extension
77
Extensor carpi radialis brevis - action
Radial deviation and extension
78
Location difference of extensor carpi radialis brevis and longus
Longus starts more proximal on the humerus and the brevis starts on the condyle
79
Extensor carpi ulnaris - action
Extension and ulnar deviation
80
The carpal tunnel contains
``` Flexor digitorum superficialis Flexor digitorum profundus Flexor pollicis longus Flexor carpi radialis Median nerve ```
81
Flexor retinaculum - distally - from where to where
Trapezium to hook of hamate
82
Flexor retinaculum - proximally - from where to where
Scaphoid with triquetrum
83
Which end (prox or distal) is the flexor retinaculum tighter
Tighter at proximal end
84
The carpal arch is maintained by the
flexor retinaculum (transverse carpal ligament) and the transverse intercarpal ligament
85
Arches of the wrist and hand - name them
Longitudinal Transverse Oblique
86
Longitudinal arches of the hand from where? centered where?
From carpal bones to tip of phalanges | Centered around 3rd digit
87
``` Transverse arches of the hand Proximal? Distal? Serve for: Keyston ```
Proximal - distal row of carpal bones Distal - through heads of metacarpals Serve for mobility of the hand - wrist and finger flexion Keystone = capitate
88
Oblique arches of the hand
Digits move in an oblique fashion to thumb/carpals | Thumb opposition to fingers
89
Joints of the hand include
Carpometacarpal Metacarpophalangeal Interphalangeal (proximal and distal)
90
2nd CMC joint - type of joint and DF
Plane, 1 DF (FLEX/EXT)
91
2nd CMC joint is made of what
Trapezium Trapezoid Capitate 3rd MC
92
3rd CMC joint - type of joint and DF
Plane, 1 DF (FLEX/EXT)
93
3rd CMC joint is made of what
Capitate | 2nd and 4th MC
94
4th CMC joint is what type and DF
Plane, 1 DF (FLEX/EXT)
95
4th CMC joint is made of what
Hamate Capitate 3rd and 5th MC
96
5th CMC joint is what type and DF
Saddle, 2 DF (FLEX/EXT and ABD/ADD)
97
5th CMC joint is made of what
Hamate | 4th MC
98
All CMC joints are supported by
Strong transverse ligaments and weaker longitudinal ligaments volarly and dorsally
99
CMC joint 2-5 motion - pattern
Motion increases from radial to ulnar (2-5) | 2 and 3 are immobile
100
CMC of the thumb - bones
Trapezium, first metacarpal
101
CMC of the thumb - type of joint
Sellar - Saddle shaped | Concave and convex at the same time
102
Ligaments of the CMC of the thumb
Capulse Radial CMC (lateral) Ant and Post oblique
103
Stabilizing factors of the CMC of the thumb
Surface shape Muscles Ligaments
104
Type of motion of the CMC of the thumb - how many DF
3 DF Flex/Ext Abd/Add Limited axial rotation, but there is circumduction
105
Trapezium is __ in the ___ plane and ___ in the ___ plane
Concave in the sagittal plane | Convex in the frontal plane
106
Movements of the CMC joint of the thumb - what makes up opposition
Flexion + abduction + internal rotation
107
1st MCP joint (thumb) - what is it
The head of the 1st MC bone with the base of the proximal phalanx
108
What type of joint is the 1st MCP and how many DF
Condyloid - 2 DF FLEX/EXT and ABD/ADD Motion is significantly restricted though
109
1st MCP joint motion Ext = Flex = Ab/Ad =
0 Ext 50-60 Flex 5-10 of total ab/ad
110
1st MCP - supported by
collateral and intersesmoid ligaments
111
2nd to 5th MCP joints - what are they
Head of the MC bones to the base of the proximal phalanx
112
2nd to 5th MCP joints - what type of joint and DF
Condyloid - 2 DF | FLEX/EXT and ABD/ADD
113
2nd to 5th MCP joints - articulating surfaces
Concave phalanx (20 degrees of articulating surface) Convex MC bone (180 degrees of articulating surface) Difference contributes to hyperextension and axial rotation
114
2nd to 5th MCP joints - motion increases from
radial to ulnar side
115
2nd to 5th MCP joints Ex: Flex: Ab/Add:
40 of ext 90-110 of flex 20 total of ab/add
116
Close packed position of the 2nd to 5th MCP joints
Full flexion
117
2nd to 5th MCP joints - volar ligament does what
Enhances joint stability and prevents hyperextension
118
2nd to 5th MCP joints - collateral ligaments do what
Limit radial and ulnar deviations as well as flexion
119
2nd to 5th MCP joints - axial rotation requires what
Is a passive movement
120
IP joints - type
Synovial hinge - FLEX/EXT
121
IP joints - what on what
Concave base on convex head
122
IP - joints - Proximal (convex) articulating surface faced ____ this results in what?
Faced volarly | Results in higher flexion and decreased extension
123
PIPs: Flex and Ext
``` Ext = 0 Flex = 100-135 ```
124
DIPs: Flex and Ext
``` Ext = 10 Flex = 80-90 ```
125
IP joints - increase movement in which direction (radially or ulnarly) What does it facilitate
Inc ulnarly - which facilitates opposition and convergence
126
Close packed position of the IP joints
Full extension
127
Ligaments of the IP joints
Volar ligament | Collateral ligaments
128
Function of the ligaments of the IP joint
Volar - enhances joint stability, prevents hyperextension | Collateral - tight through range
129
Arthrokinematics of active Ext, Flex, Abd
Concave on convex - Roll and glide in the same direction
130
Intrinsic muscles of the hand
``` Thenar Hypothenar Lumbricals Dorsal interossei Palmar interossei ```
131
Thenar muscles
Abductor pollicis brevis Opponens pollicis Flexor pollicis brevis Adductor pollicis
132
Hypothenar muscles
Abductor digiti minimi Opponens digiti minimi Flexor digiti minimi
133
Lumbricals - how many and action
4 of them Flex MCP Ex IP Radial deviation of the MCP
134
Weakness of the lumbricals contributes to
claw hand (in conjunction with the dorsal interossei)
135
Dorsal interossei - how many and action
4 of them | Abd
136
Weakness of the dorsal interossei
Weakness in abd of index, long and ring fingers | Loss of muscle balance and grip strength
137
Palmar interossei - how many and action
3-4 of them | Add
138
Palmar interossei - weakness
Weakness in Add/convergence of fingers | Loss of muscle balance and grip strength
139
Prehension - define
The act of gripping something with the hand
140
Precision grip - when used
Use when fine movements are needed | Great strength is not available
141
Precision grip - mainly involves what
index finger and thumb | Only radial side is involved
142
Precision grip - different types
Tip to tip Pad to pad Pad to side Three point
143
Power grip - when used
Used where strength is needed | Fine movements are not available
144
Power grip - mainly involves what
Flexion of all fingers | All digits and palm are involved
145
Power grip - different types
Palmar grip | Hook grip
146
Distinguishing factors between power and precision grips
``` Area of contact within the hand Number of fingers involved in the activity Amount of finger flexion Position of the thumb Position of the wrist ```
147
Muscles involved in tip to tip
Thumb - opposition | MCP, PIP and DIP flexed
148
Muscles involved in pad to pad
Thumb - opposition MCP, PIP flexed DIP extended
149
Muscles involved in pad to side
Thumb - approaches 2nd and 3rd fingers | Stronger pinch when more power is required
150
Types of power grip/grasp - joint positions vary with type of grasp - what impacts grasp pattern
Size of the object
151
Types of power grip/grasp - joint positions vary with type of grasp - Fingers more flexed on which side
Ulnar side
152
Types of power grip/grasp - joint positions vary with type of grasp - what acts as a stabilizer and how
Thumb - it tends to flex over the other fingers
153
Types of power grip/grasp - joint positions vary with type of grasp - What pulls the thumb onto the fingers and/or object
Adductor pollicis brevis
154
What is often associated with a palmar or cylindrical grip
Ulnar deviation
155
Extensor assembly provides what
Optimal alignment of the ED tendon Assists in producing proper moment arms during extension Allows for smooth coordinated finger flexion
156
Extensor assembly - Ext digitorum tendon attaches to what
Aponeurotic hood
157
Extensor assembly - dorsal and palmar interossei attach where
aponeurosis
158
Extensor assembly - lumbricals attach where
aponeurosis
159
Extensor assembly - hood distal structure - how many segments
3 Central tendon 2 lateral bands separate and reunite to the central tendon
160
Flexor tendon, sheaths, and pulleys - FDS attaches where
to the middle phalanx | and splits into two bands forming a tunnel for the FDP
161
Flexor tendon, sheaths, and pulleys - FDP attaches where
to the distal phalanx
162
Flexor tendon, sheaths, and pulleys - how many pulleys
5 annular and 3 cruciform
163
Flexor tendon, sheaths, and pulleys - function of the pulleys
Maintain a constant moment arm of the tendon
164
Flexor tendon, sheaths, and pulleys - damage of the pulleys contributes into what
Bowstringing - amplification of torque produced - reduction of angular motion of the joint
165
Wrist extensor role in grip strength - with the wrist flexed -->
Flexors cant generate adequate force (they are too short) | Overstretch extensors create a passive extensor torque
166
Wrist extensor role in grip strength - with the wrist extended
flexors cant generate adequate force (too long)
167
Wrist extensor role in grip strength - where is the optimal position for best grip strength
about 35 degrees extension optimizes the length-tension curve of the extrinsic finger flexors
168
Paralyzed wrist extensors results in
ineffective grip strength
169
Hand: stability/control mechanisms
Ligamentus system Extensor assembly Flexor tendon sheaths and pulleys
170
Hand: stability/control mechanisms - ligamentus system
``` Collateral ligaments (radial and ulnar) Volar plate Thick volar joint capsules (IP joints) Arches of the hand Thick volar skin Thin dorsal capsules (MCP and IP joints) ```
171
Hand: stability/control mechanisms - Extensor assembly
Tendinous structures of the ED and the intrinsic muscle insertions
172
Hand: stability/control mechanisms - Flexor tendon sheaths and pulleys
Attachments of the FDS and FDP surrounding retinacula, tendon sheaths and pulleys
173
Balance of muscle forces in the hand - tendon excursions occur
simultaneously and in opposite directions
174
Balance of muscle forces in the hand - Tendon moment arms and excursions decrease from
Proximal to distal joints FDS - FDP FL - EXT Extrinsic - Intrinsic
175
Balance of muscle forces in the hand - During flex/ext what acts as moderators
Intrinsic muscles | They stabilize the middle phalange
176
Balance of muscle forces in the hand - use of FDP versus FDS
FDP used more frequently | FDS used as more power is needed
177
Balance of muscle forces in the hand - only muscle that produces MCP ext is what
ED | If intrinsic muscles are inactive, ED produces clawing
178
Balance of muscle forces in the hand - DIP movement is tied to what
PIP movement | Full flexion of PIP prevents DIP active extension
179
Tenodesis - define
an action that is used as a substitute to a proper, finger flexing grasp
180
Tenodesis - when the wrist is extended...
the fingers naturally fall into position of flexion and the thumb into opposition with the index finger
181
Tenodesis - process used
1. Wrist placed in flexion using gravity 2. Object placed between thumb and finger 3. Active wrist extension to pick up object 4. Wrist extension maintained to transfer object 5. Object released by relaxing extension and allowing hand to open
182
Opening the hand sequence - Early phase
ED
183
Opening the hand sequence - Middle phase
Lumbricals | Interossei
184
Opening the hand sequence - Late phase
ED and intrinsic | Flexor carpi radialis
185
Opening the hand sequence - pattern is
Proximal to distal
186
Opening the hand sequence - hood migration
Dorsal hood migrates proximally
187
Closing the hand sequence - early phase
FDP FDS Interossei
188
Closing the hand sequence - late phase
FDP FDS Interossei Lumbricals remain inactive (stretched)
189
Closing the hand sequence - pattern is
Distal to proximal
190
DON'T FORGET TO SMILE
:D

Semester 4 FS Exam 3 (1 decks)

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