Hand

Question 1

When you talk about the (elbow/hand), we know that its’ importance for fine motor tasks is what defines it.

Answer 1

hand

Question 2

The (shoulder/hand) is a sensory organ and an effector organ.

Answer 2

hand

Question 3

As a (motor/sensory) organ, the hand allows us to have an intricate perception of our environment right, we can touch and feel things and recognize what that object is without even looking at it.

Answer 3

sensory

Question 4

There’s (a lot/not a lot) of nervous system inputs both back and forth between the brain and the hand.

Answer 4

a lot

Question 5

The hand is also an (sensory/effector) Organ because you’re able to complete complex tasks with your hands. Think of Kodali’s anatomy professor lab practical he had to do when he had to reach inside the bone box and identify the bone without looking. What was happening there is that his hand was reaching in and his brain knows all the anatomy information and he has to now make sense of the input he was getting from his hand . So that’s how some of those very routine tasks that we take for granted, are happening, there’s like a big connection between the hand in the brain.

Answer 5

effector

Question 6

The CMC joint at the thumb is (the same as/different than) the CMC joints from digits 2-5.

Answer 6

different than

Question 7

The CMC joint at (the thumb/digits 2-5) gets its’ stability from the joint capsule and the supporting ligaments

Answer 7

the thumb

Question 8

The ligaments can guide the motion of the thumb. So if they’re appropriately tight in their position they will help guide some motion. So medial rotation at the cmc joint is coupled with either ___ or ____ . A lateral rotation couples with ___ or ____.

Answer 8

flexion or abduction; extension or adduction

Question 9

The thumb is rotated almost 90 degrees from the other CMC joints which is why flexion/extension occurs in the ___ plane and abduction and adduction occurs in the _____ plane for these movements at the thumb.

Answer 9

frontal; sagittal

Question 10

CMC joints 1, 4, & 5 is (less/more) mobile than the CMC joints 2 and 3.

Answer 10

more

Question 11

The ____ pillar is a mechanism that we have that enhances grip strength and also provides a very firm attachment to the ECRL, ECRB, and the FCR. Because this is a very sturdy area, the attachment of the muscle to a very sturdy area allows those muscles to operate very efficiently and with strong force. When you squeeze an object you do not feel as much movement in the CMC joints 2 and 3 compared to CMC joints 4 and 5 and that sturdy joint is where a lot of those major wrist extensors and flexors attach and that allows them to operate efficiently.

Answer 11

central

Question 12

Stability for the __& __ joints comes from the bone, capsule & ligaments, & the volar plate. The stability of these joints is critical to the biomechanics of the hand overall.

Answer 12

MCP & IP

Question 13

As you flex the (IP/MCP) joints those ligaments start to get stretched out and more taught. So increased tension in flexion leads to increased (mobility/stability) because of the ligaments. One way of visualizing this is if you take your finger and you abduct them. Now take your MCPS and flex them and you’ll see that it is much harder and that is because that joint is more stable because of the ligamentous tension.

Answer 13

MCP; stability

Question 14

For the (MPS/IPS), the collateral ligaments is taught throughout the range of motion and that makes sense if you look at your finger. Can you ever abduct at that joint? No matter where you are you can’t really abduct, so the ligaments are (mobile/stable) throughout the range of motion, they’re just tight all the time. You’re not going to have that wiggle room where you can abduct at the IP joints. If you abduct too far you’re actually going to tear the ligament.

Answer 14

IPS; stable

Question 15

All of the collateral ligaments are important to maintain (mobility/stability) in order to grasp things.

Answer 15

stability

Question 16

Metacarpals _ and _ makeup the central pillar.

Answer 16

2 and 3

Question 17

At the thumb MCP joint there is virtually no (flexion/abduction) and it is very stable. If you stabilize the first metacarpal and you try to wiggle it sideways you will see it is very stable.

Answer 17

abduction

Question 18

From the thumb going to the 5th MCP joint there is more and more (mobility/stability) available and it provides additional range for opposition in order to grasp objects. I am able to manipulate the grasp around a lot of different sized objects because of the mobility that (increases/decreases) through the MCP joints as I move from the thumb to the 5th finger.

Answer 18

mobility; increases

Question 19

The volar plate enhances joint (mobility/stability) by limiting (hyperflexion/hyperextension).

Answer 19

stability; hyperextension

Question 20

The MCPS are taught in (flexion/extension) and slacking in (flexion/extension).

Answer 20

flexion; extension

Question 21

The volar plate is more responsible in (flexion/extension) for stability, so it is going to prevent hyperextension

Answer 21

extension

Question 22

The volar plate gets more taught during (flexion/extension).

Answer 22

extension

Question 23

The volar plate buckles in (flexion/extension) and the different layers fold on over themselves and become redundant tissue.

Answer 23

flexion

Question 24

If the volar plate stays in fixed flexion (the finger stays fixed) you’re going to get a contracture and those fibrous ends tend to stick together and when that happens the flexor tendons can tend to stick to the volar plate as well so you lose even more function because now the flexor tendons can’t glide normally like they would. As a result you will have very limited ability to (flex/extend).

Answer 24

extend

Question 25

Just because muscles are finger flexors as their primary goal does not mean that they do not have the ability to also flex the wrist.

Answer 25

Got it

Question 26

In order to isolate the muscle force for the finger flexors, the (flexors/extensors) of the wrist have to turn on in order to negate the flexion that is generated from the finger flexors of the wrist in order to generate the most force to have good grip strength. So if I am flexing my fingers my wrist has the potential to go into flexion. So in order for those finger flexors to work efficiently the (flexors/extensors) of the wrist have to turn on.

Answer 26

extensors; extensors

Question 27

The (intrinsics/extrinsics) of the thumb allow us to kind of place our thumb in order to put different pressure on different objects. Prehension is the act of holding on to something. Those (intrinsics/extrinsics) of the thumb are what allow you to place your thumb in more specific grasps.

Answer 27

extrinsics; extrinsics

Question 28

The lumbricals (flex/extend) at the (MCP/IP) and keep it straight.

Answer 28

flex ; MCP

Question 29

For class all we need to know is that we have flexor tendon sheaths and they’re made up of these pulleys. When a pulley is ruptured and you try and flex the distal IP joint and there’s nothing tethering this down here, so you can have this bowstring tendon and with that you are going to get (increased/reduced) grip strength and (increased/reduced) flexion ROM because now the tendon does not have a great leverage in order to move the distal segment.

Answer 29

reduced; reduced

Question 30

Remember the example in the second week of class when the surgeon moves the tendon further away and it increases its’ moment arm? We said the potential consequences of that would be decrease in strength and decreased ROM overall and the reason why was because the joint is set up in a particular way where now it doesn’t have the capability of contracting as well, and so, even though it has a bigger internal moment arm, it is not as efficient. You’ll lose ROM in that situation and that is kind of what is going on with the flexor tendon sheaths with the ruptured pulleys.

Answer 30

Got it

Question 31

The extensor indicis and extensor digiti minimi work to provide a little extra independent function. Instead of just a common extensor tendon for all of my digits, I also have the ability to extend at the _ ray and the _ ray. You can extend those individually so it allows for more function and dexterity, not necessarily more strength.

Answer 31

2nd; 5th

Question 32

If the extensor digitorum is cut, the biggest deficit you will see is extension in what joint?

Answer 32

The MCP joint

Question 33

The anatomy of the extensor mechanism is that we have this dorsal hood that also blends in with the extensor digitorum tendon over the dorsum of the __ joint.

Answer 33

MCP

Question 34

There are some fibers that continue along the way of the extensor digitorum and those fibers continue to what two bands?

Answer 34

The central band and the lateral band

Question 35

As far as the central band goes, it transmits extensor force from the extensor digitorum across the __ joint

Answer 35

PIP

Question 36

The lateral bands transmit extensor force from the extensor digitorum, lumbricals, and the interossei across what two joints?

Answer 36

PIP & DIP joint

Question 37

The interossei help function in (flexion/extension) of the PIP and DIP joints.

Answer 37

extension

Question 38

If fibers come down anterior to the axis of rotation at the MCP joint, they will pull it into (flexion/extension).

Answer 38

flexion

Question 39

Remember that in the extensor mechanism there will be MCP (flexion/extension) and IP (flexion/extension).

Answer 39

flexion; extension

Question 40

We have these oblique retinacular ligaments that are noncontractile. It gets slacked and it gets tensioned and it helps (drive/prevent) some of that movement depending on that position.

Answer 40

drive

Question 41

The oblique retinacular ligament is attached to the (central/lateral) bands and the (proximal/distal) phalanx.

Answer 41

lateral; proximal

Question 42

The oblique retinacular ligament helps coordinate movement between the __ and _ joints, meaning that it wants to go into flexion together and in extension together.

Answer 42

PIP & DIP

Question 43

When the PIP joint extends it transmits a force across the dorsal side of the DIP, leading to DIP (flexion/extension).

Answer 43

extension

Question 44

So when the phalanx extends it is going to tug on the oblique retinacular ligament and (flex/extend) it.

Answer 44

extend

Question 45

When the DIP joint flexes it transmits a force on the palmar side of the PIP joint and will help with flexion of the PIP and DIP (separately/together).

Answer 45

together

Question 46

If you do not have oblique retinacular ligaments if you flex your DIP, the PIP will go into (flexion/extension). The DIP can flex by itself because the ORL is not guiding and coordinating movement of the PIP. Most of us will have it where when you flex that the DIP and PIP move together.

Answer 46

extension

Question 47

The (intrinsics/extrinsics) of the digits and thumb support the arches of the hand.

Answer 47

intrinsics

Question 48

When we are talking about the hand and partially the wrist there is this idea of arches of our hand. Lots of people think of the arches of the feet, but we also have arches of our hand from the wrist. If I look at my knuckles they kind of go in a curve and that is the (longitudinal/transverse) arch through the hand. If you feel your palm, all of these metacarpals are not right next to each other, they form a curve and an arch through your hand and that is the (longitudinal/transverse) arch.

Answer 48

transverse; transverse

Question 49

We have a proximal (longitudinal/transverse) arch and a distal (longitudinal/transverse) arch.

Answer 49

transverse; transverse

Question 50

The (distal/proximal) transverse arch is the distal row of carpal bones. The keystone (the thing that holds it all together) is what carpal bone?

Answer 50

proximal; The capitate

Question 51

The proximal transverse arch is a very (flimsy/rigid) arch.

Answer 51

rigid

Question 52

The distal transverse arch is your __ joints.

Answer 52

MCP

Question 53

The keystone for the distal transverse arch is the __ and __ metacarpals (the central pillar).

Answer 53

2nd & 3rd

Question 54

The _, _, & _metacarpals are flexible. If you ball up your fist, watch the 4th and 5th knuckles if you really squeeze. Do you see how they move kind of in a downward position? That is the metacarpals being able to be mobile, they move a little bit more.

Answer 54

1st, 4th, & 5th

Question 55

There is a longitudinal arch that follows the shape of the _ and _ rays.

Answer 55

2nd & 3rd

Question 56

In the longitudinal arch, the keystone is the _ and _ metacarpals.

Answer 56

2nd & 3rd

Question 57

The control of these natural palmar concavities allows the hand to securely hold and manipulate objects. If everything was perfectly flat and in one plane you would not be able to hold a diverse group of objects. You need those metacarpals to be able to rearrange around different shaped objects.

Answer 57

Got it

Question 58

Opposition, broken down into steps is (abduction/flexion) first, followed by (abduction/flexion) which also has medial rotation that occurs passively.

Answer 58

abduction; flexion

Question 59

In flexion/extension of the thumb, we have a (concave/convex) metacarpal that is moving on a (concave/convex) trapezium.

Answer 59

concave; convex

Question 60

In abduction/adduction of the thumb, we have a (concave/convex) metacarpal that is moving on a (concave/convex) trapezium.

Answer 60

convex; concave

Question 61

In the CMC Joints digits 2-5, motion in flexion/extension from the radial to the ulnar side (increases/decreases).

Answer 61

increases

Question 62

We are going to say that the arthrokinematics that occurs at the CMC Joints in digits 2-5 is __ and ___ , it is not true flexion as we would see in other joints.

Answer 62

sliding and gliding

Question 63

The joint motion for the osteokinematics at the MCP joint can vary a lot in people and individuals. What movements can you perform at the MCP joint?

Answer 63

Flexion and extension and abduction and adduction

Question 64

At the MCP joint of the (2-5 digits/thumb) we have no abduction or adduction because of the nice strong collateral ligaments that we have around the joint.

Answer 64

thumb

Question 65

We have a little bit of extra motion in the __ and digit number __ at the MCP Joints. When we are talking about flexion/extension we have a little bit of additional range in those joints in order to allow for opposition. That is all an ability to enhance your grip.

Answer 65

thumb; 5

Question 66

Some of these dorsal capsular ligaments on the back side of the hand at the MCP joint will go into tension as you (flex/extend). If you have tension that runs through these capsules that helps to maintain the joint surface contact. As the roll is happening it keeps the slide from being too much so that you keep that good articular surface contact.

Answer 66

flex

Question 67

The arthrokinematics at the MCP joint have rolls and slides in the (same/opposite) direction.

Answer 67

same

Question 68

At the MCP joint there is the (concave/convex) surface of the proximal phalanx moving on the (concave/convex) surface of the metacarpal.

Answer 68

concave; convex

Question 69

There is natural joint (stability/mobility) at the MCP joint by the capsular ligaments and that helps maintain articular surface contact and if you have tight ligaments in that area, it helps really give your muscles a sturdy base off of which to provide strong grip from your FDP and FDS tendons.

Answer 69

stability

Question 70

At the MCP joint in the AP plane and sagittal plane you have a (concave/convex) surface rolling and sliding on a (concave/convex) surface.

Answer 70

concave; convex

Question 71

At the MCP joint for digits 2-5 you have abduction and adduction which is pretty plentiful, but as you (flex/extend) you have less ability to abduct and adduct and that is due to the collateral ligaments being on tension.

Answer 71

flex

Question 72

When we are talking about (flexion/axial rotation) at the MCP joint, it is just passive, you can’t actively do that at the joint. The ability to medially rotate passively is what gives us dexterity and control while we are working to hold objects of various surface areas, shapes, and sizes.

Answer 72

axial rotation

Question 73

The IP joints are (saddle/hinge) joints.

Answer 73

hinge

Question 74

What motion(s) do we have at the IP joints?

Answer 74

Flexion/extension

Question 75

At the IP joint there is a (concave/convex) surface moving on a (concave/convex) surface. So the roll and slide will be in the (same/opposite) direction.

Answer 75

concave ;convex; same

Question 76

The hinge joints at the IP joints are formed because of the (weak/strong) collateral ligaments and the joint capsules in those areas.

Answer 76

strong

Question 77

When we talk about prehension or grasp and pinch, we have a lot of different ways that we can manipulate our hands for different types of function.

Answer 77

Got it

Question 78

We have _ different types of grasps, name them.

Answer 78

3; Hook, spherical, and cylindrical

Question 79

The hook grasp does not require what finger? It is usually in a (static/dynamic) position which you aren’t manipulating back and forth with. So an example would be that you hold on to a briefcase handle and you’re just in that position as you move along. You’re not changing that grasp a whole lot.

Answer 79

The thumb; static

Question 80

The type of grasp you use is determined by the __ of the object that you’re trying to grasp and also how you’re trying to hold on to them. Remember that we said there is more ulnar flexion on the ulnar side so as you need to grasp harder and harder you’re going to get more movement on that side of the hand which changes the type of grasp that you would use.

Answer 80

size

Question 81

Once you start including the thumb you are increasing into what we call the (soft/power) type of grasp which are the spherical and cylindrical grasps.

Answer 81

power

Question 82

The (spherical/cylindrical) grasp is like grasping a ball very firmly right before you are about to throw it.

Answer 82

spherical

Question 83

The (spherical/cylindrical) grasp is like holding on to a baseball bat using your thumb

Answer 83

cylindrical

Question 84

When we talk about the types of (grasp/pinch) we are going to vary different positions. Any of these pinches can involve the thumb, the index, and in some cases the middle finger.

Answer 84

pinch

Question 85

The tip to tip pinch is what is called a (precision/power) type of pinch. For this pinch, think of sewing, or a surgeon that is suturing.

Answer 85

precision

Question 86

A pulp to pulp pinch is a (precision/power) type of pinch, however it has more surface contact area. You’re using the pulp of your fingertips on each of those in order to grasp a small object.

Answer 86

precision

Question 87

The lateral or key pinch. Imagine holding a key like you are going to insert it into a lock and the lock really needs some kind of lubrication and you’re really working it in order to try and get that key to work. You need to be able to generate a little more power so we would call this a (precision/power) type of pinch.

Answer 87

power

Question 88

The three-point chuck pinch is between the thumb, the index finger, middle finger, and fourth finger. Remember we can sometimes use that middle finger for pinching and this is also another example of a (precision/power) type of pinch.

Answer 88

power

Question 89

When doing assessments of these pinches discussed, these are the type of pinches in which you are able to determine important things like what type of nerve injury may be present. If someone has pinch strength in one position versus another you know now the anatomy and the nervous system influence over those muscles and the innervation. And you should be able to determine where the deficit is occurring.

Answer 89

Got it

Question 90

Boutonniere’s deformity is an extensor mechanism pathology characterized by extension of the (DIP/PIP) joints with flexion of the (DIP/PIP) joints.

Answer 90

DIP; PIP

Question 91

Boutonniere’s Deformity happens when the central band tears causing a loss of extension at the __joint. When this happens you can get a subsequent lateral band tear and that causes the lateral band to fall volar (anterior) to the palm of the PIP joint. Remember that the lateral bands allow you to extend at the PIP and DIP joint but now because they fall volar to the axis of rotation, it causes (flexion/extension) of the PIP joint. Due to this loss and the balance of the system it leads to increased tension on the lateral bands. Now because you have unopposed tension on the lateral band you will get a pole into further extension of the DIP joint which is why you end up extension of the DIP joint and flexion of the PIP joint.

Answer 91

PIP; flexion

Question 92

When we talk about a Swan Neck deformity it is characterized by hyperextension of the (DIP/PIP) joint and flexion of the (DIP/PIP) joint.

Answer 92

PIP; DIP

Question 93

Swan Neck deformity is secondary to a weakening of the volar plate at the tip of the joint from diseases like RA or it could be from tearing of the volar plate due to injury. Because of that tension that would be present from these intrinsic muscles if you had a volar plate injury, these muscles are now going to pull you into extension a little bit more and will eventually hyperextend the PIP joint because they’re running unopposed, there’s no volar plate to oppose them. If you do that for a long time it is going to cause bowstringing of the lateral bands dorsally. So the lateral band is going to get pulled more dorsally and that is going to cause the PIP to be pulled into hyperextension and the continued tension of the FDP pulls the DIP joint into (flexion/extension).

Answer 93

flexion

Question 94

The protected position of the hand is the position in which you want to immobilize somebody. This position is characterized by the MPs in _ degrees of flexion, the IPs at _ degrees of extension, the wrist at _ degrees of extension, and we are going to have an open _ web space. The web space is going to be completely open because we do not want to limit that motion.

Answer 94

70; 0; 0; 1st

Question 95

Protected Position of the Hand: When you have an the MP joints in 70 degrees you're maintaining the length of the collateral ligaments remember, we talked about how, when you go into flexion the collateral ligament, those joints are under tension. So if you put them in an immobilized position under tension it'll keep them from getting pathologically shortened if you were to keep your hand in an (flexed/extended) position of the MP & IP joints when immobilizing the person, that person would have a really hard time flexing if the collaterals got too tight in this position. That would ultimately leave the person with no function or less function at the hand.

Answer 95

extended

Question 96

Protected Position of the Hand: When you have IPs extended at 0 degrees.. Remember how we talked about how during (flexion/extension) those volar plates have redundancy and if they’re in that position for a long time they can get adhesion and they can stick together and prevent extension from happening later on because you’re in a flexion contracture.

Answer 96

flexion

Question 97

Protected Position of the Hand: The wrist being neutral at 0 degrees is what allows there to be no pressure on that carpal tunnel. Being in flexion or extension can (increase/decrease) the carpal tunnel pressure.

Answer 97

increase

Question 98

Protected Position of the Hand: The open 1st Web Space is to allow freedom of movement of your thumb and that is going to prevent an ___ pollicis contracture because you don’t want to limit that motion and have that muscle become contracted. You would lose a lot of thumb function and the ability to grasp.

Answer 98

adductor