Hand Flashcards
(128 cards)
0
Q
_____ is the principle vehicle of complex and precise motor activity
A
The hand
1
Q
The _____ has a strong functional relationship with the eyes
A
Hand
2
Q
What is the function of the upper extremity
A
Position the hand for optimal function
3
Q
The proximal transverse arch is made by the ____
A
Distal row of carpal bones
4
Q
What arch passes through the mcp joints
A
Distal transverse arch
5
Q
What arch follows the shape of the 2nd and third rays
A
Longitudinal arch
6
Q
_____ is the “rigid tie beam”
A
Longitudinal arch
7
Q
_____ creates a concavity of the palmar surface of the hand
A
Longitudinal arch
8
Q
______ allows the hand to hold and manipulate objects of various shapes ans sizes
A
Longitudinal arch
9
Q
_____ articulation between the distal row of carpal bones and the base of the 5 metacarpal bones
A
Carpometacarpal joints
10
Q
How many degrees of freedom do the Cmc joints have
A
2 degrees of freedom
Flexion/extension
Abduction/adduction
11
Q
_______ Cmc joints are rigid stable central pillars
And what ones are mobile
A
2 and 3
1 4 and 5
12
Q
All Cmc joints are surrounded by _____ and strengthened by ____
A
Articular capsules
Ligaments
13
Q
What ligaments strengthen the Cmc joints
A
Dorsal
Palmar
Interosseous
14
Q
_____ cmc joint has jagged interlocking surfaces, strong ligamentous support, and permit very little movement
A
2 and 3
15
Q
What is the joint structure of 4 and 5 Cmc joints
A
Convex metacarpal base, concave hamate
16
Q
What is functional about the 4 and 5 Cmc joints
A
It improves effectiveness of grasp
Enhances the functional interaction with opposable thumb
17
Q
______ is the articulation formed between the convex metacarpal and concave proximal phalanx (P1)
A
Metacarpophalangeal joints or mcp
18
Q
What are the degrees of freedom at the mcp joints of the digits
A
2 degrees of freedom
Flexion extension
Abduction
Adduction
19
Q
What is the axis of rotation in the mcp finger joints
A
Passes through the metacarpal head.
20
Q
What is in the capsule of each mcp joint
A
Pair of radial and ulnar collateral ligaments
Volar plate
21
Q
_____ is oblique palmar direction from metacarpal to proximal phalanx (2 distinct parts)
A
Collateral ligaments
22
Q
The collateral ligaments are more taut in _______
A
Flexion than extension
23
Q
What is the function of the Volar plate ligament
A
Strengthens the mcp joint
Prevents hyperextension
24
The Volar plate is a dense _____ structure found in every mcp Joint
Fibrocartilage
25
How would an mcp joint dislocate
Rupture of the Volar plate at its proximal attachment
26
Simple vs complex mcp joint dislocation
Cannot be reduced because Volar plate or other structures become entrapped within the joint.
27
_____ is the attachment between Volar plates and the mcp joint
Deep transverse metacarpal ligaments
28
What ligament binds the fourth and fifth metacarpals
Deep transverse metacarpal ligaments
29
what limits the distance by which metacarpal heads may separate
Deep transverse metacarpal ligaments
30
There is substantial accessory motion in _____ joints
Mcp
31
What is good about substantial accessory motion in the mcp joints
Permits fingers to conform to the shapes of objects
Increases grasp control
32
Mcp rom increases gradually from digits 2-5 from _____ to _____ mcp joint flexion
90-115
33
Where is the greatest rom flexion of the mcp joints
Ring finger and small finger
34
Describe the arthrokinematics of the mcp joint of the fingers
Concave phalanx moving against convex metacarpal
35
Explain the arthrokinematics of active mcp finger joint flexion (FDP)
Proximal phalanx rolls and slides volarly
Passive tension increases in the dorsal capsule and the collateral ligaments are taut
36
______ of the mcp finger joints are stabilizing the joints during flexion and useful during grasp
Active mcp joint flexion (FDP)
37
Explain the arthrokinematics of active mcp finger joint extension (co-activation of ED and intrinsic muscles of the finger)
Proximal phalanx rolls and slides Dorsally
38
During ______ the Volar plate elongates to support the head of the metacarpal
Active mcp finger joint extension
39
_______ creates slack in the radial collateral ligament of the mcp finger joints
Active mcp joint extension
40
How is the mcp finger joint positioned to heal after trauma
70 degrees of flexion to place a stretch on the collateral ligaments to prevent mcp joint contracture
41
Explain the arthrokinematics of active mcp finger joint adduction
Proximal phalanx rolls and slides radially
42
_____ muscle directs abduction at mcp finger
First interossei
43
What are the collateral ligaments doing when mcp finger joints are abductiing. How does this stabilize the joint
Ucl is taut
Rcl is on slack
This stabilizes the joint radially
44
How do the pip joints articulate
Articulation between the concave middle phalanx surface and the convex proximal phalanx
45
_____ joint articular surface appears as a tongue in groove articulation. It guides flexion and extension as it restricts axial rotation
Pip joint
46
Within the capsule each pip joint is reinforced by _____.
Radial collateral ligament
Ulnar collateral ligament
47
Accessory motion of the collateral ligament in pip joints reinforces ____
The Volar plate
48
______ limits pip joint hyperextension via check rein ligaments
Collateral ligaments
49
How will the pip joints be placed if they need to heal after dis location
15-20 degrees of flexion for the Volar plate to heal
50
Pip joint dislocation can cause...
Partial or complete damage to the collateral ligaments and central slip or Volar plate
51
_____ articulation between the bases of the concave distal phalanx and convex middle phalanx.
Dip
52
How do the pips and dips differ
Dips don't have the check rein ligaments
53
Describe active pip joint flexion
Concave middle phalanx rolls and slides volarly by the extrinsic finger flexors (FDS and FDP)
54
Axis of rotation for pip joint flexion
Medial lateral direction through the convex joints
55
How is the thumb oriented in anatomical position
Medially and anteriorly. It is almost rotated 90 degrees in relation to the fingers for optimal prehension
56
What is the Cmc thumb joint arthrology
Articulation between the trapezium and the base of the first metacarpal. It's saddle shaped
57
Explain the saddle shape
Articular surface is convex in one direction and concave in the other.
58
Shape of the trapezium and 1st metacarpal (convex/concave)
Trapezium: Concave longitudinally and convex transversely
Base of the 1st metacarpal is convex longitudinally and concave transversely
59
What are the degrees of freedom for the Cmc thumb joint
2
Flexion extension
Abduction adduction
Opposition reposition
60
What are the ligaments of the Cmc thumb joint
```
Rcl
Ucl
Anterior oblique ligament
Posterior oblique ligament
1st inter metacarpal
```
61
_____ is the most important ligament for thumb stability and resists dorsal translation of Cmc on the trapezium
Anterior oblique ligament
62
Arthrokinematics of thumb Cmc joint flexion
Concave metacarpal rolls and slides medially on the convex trapezium.
63
Cmc thumb joint flexion does what to the Rcl
Elongates
64
Arthrokinematics of thumb Cmc joint extension
Concave metacarpal rolls and slides laterally on the convex trapezium. This stretches the Ucl and anterior oblique ligament. There is also slight metacarpal lateral rotation on the groove on the trapezium
65
What is the axis of rotation of the Cmc joint of the thumb
Passes thorough the head of the metacarpal bone
66
Arthrokinematics of Cmc thumb joint abduction
Convex metacarpal surface rolls volarly and slides Dorsally on the concave trapezium. Stretching the adductor pollicis and most ligaments
67
Arthrokinematics of Cmc thumb joint adduction
Convex metacarpal rolls Dorsally and slides volarly on the concave trapezium
68
What are the two phases of opposition
Thumb metacarpal abducts
| Metacarpal flexes and medially rotates across the palm and towards the small finger.
69
______ guides and rotates the thumb metacarpal
Opponens pollicis
70
_____ is the articulation between concave proximal phalanx and convex metacarpal
Thumb mcp
71
What are the Osteokinematic differences between thumb and finger mcp joints
One degree of freedom--flexion extension
Arom and prom at mcp joint significantly less
Active abduction adduction are limited due to collateral ligament structure and bone congruity
72
What is the axis of rotation for the thumb ip joint
Anterior posterior direction, through the convex joints
73
Flexion of the thumb is powered by ___ and ____
FPL and fpb
74
Hand movements cannot be achieved without _____. It requires _____ contraction of the muscles that cross the wrist.
Wrist stabilization
Isometric contraction
75
______ supplies all the extensors of the wrist and digits with proximal attachments in the forearm and the lateral epicondyle
Radial nerve
76
_____ supplies most of the flexors of the wrist and digits with proximal attachments on the forearm and the medial epicondyle
Median nerve
77
_____ supplies most of the small muscles in the hand.
Ulnar nerve
78
What are the exceptions to the innervations
Half of FDP and lumbricals supplied by the median and ulnar nerves
Ulnar nerve supply to FCU
Median nerve supply to the thenar muscles
79
_____ flexes the ip joint of the thumb
FPL
80
_____ exerts flexion torque at mcp and Cmc joints
FPL
81
Extrinsic flexor tendons travel to their distal attachment via ____
Fibrous sheath tunnels
82
Embedded within each digital sheath there are bands of tissues called ____
Pulleys
83
______ is inflammation of flexor tendons and surrounding synovial membranes
Stenosing tenosynovitis
84
Stenosing tenosynovitis is also known as
Trigger finger
85
_____ stabilize tendons relative to underlying joints
Flexor pullys
86
What are the flexor pulleys
5 annular pulleys (A1-A5)-- A2 and A4 are the main ones
3 cruciate pulleys (C1-C3)
87
What is the tenodesis action
As the wrist actively extends, digits automatically flex due to the increased passive tension of the extrinsic flexor muscles.
88
_____ are the interconnections between ED tendons
Juncturae tendinae
89
______ do isolated finger extension of digit 4 and 5
Juncturae tendinae
90
____ works independently in wrist extension if you do extension with a fist
Extensor indicis
91
ED is firmly anchored to the dorsal aspect of the mcp joint by the ____
Sagittal bands
92
_____ travel from the ED tendon Dorsally to the Volar plate volarly
Sagittal bands
93
___ transmit extension power of the ED to the mcp joint
Sagittal bands
94
_____ stabilize the ED over the dorsum of the hand
Sagittal bands
95
What is the central feature of the extensor mechanism
Dorsal hood
96
_____ consists of a triangular sheet of thin aponeurosis
Dorsal hood of extensor mechanism
97
Multiple attachments of the extensor mechanism into the phalanges allow the _____ to transfer extensor force distally throughout the entire finger.
Extensor digitorum
98
_____ flexes the ip and mcp joint
FPL
99
_____ is the only muscle that flexes the thumb ip joint
FPL
100
What generates a firm grip
FDS and FDP
101
_____ extends the ip, mcp, and Cmc joint
EPL
102
_____ extends the mcp and cmc joints
EPB
103
_____ abducts the Cmc joint
APL
104
____ flexes the mcp and Cmc joint of the thumb
Flexor pollicis brevis
105
_____ opposes the thumb for pinch and grasp against fingers
Abductor pollicis brevis
106
_____ opposes and rotates the thumb medially towards the fingers. It flexes and abducts the Cmc joint
Opponens pollicis
107
What is the dominant muscle at the Cmc joint
Adductor pollicis
108
_____ pass volarly to the deep transverse carpal ligament
Lumbricals
109
______ pass dorsal to the deep transverse carpal ligament
Interossei
110
Explain the early phase of finger extension
ED extends the mcp joint
| ED and intrinsics are primary finger extensors
111
Explain the middle phase of finger extension
Intrinsic muscles effect in ip joint extension
Direct: proximal pull of the extensor mechanism
Indirect: flexion torque at the mcp joint
112
Explain the late phase of finger extension
Muscle activation continues through full finger extension
113
Explain the phases of finger flexion
Early phase: FDP, FDS, and interossei actively flex ip joints pulling the extensor mechanism distally
Late phase: muscle activation continues through full flexion. Lumbricals remain inactive but passively assist. ED decelerates mcp flexion with consistent EMG activity when the hand is closing. The ECRB stabilizes the wrist in slight extension.
114
Where is the oblique retinacular ligament
Palmar side of the pip joint to the dorsal side of the dip joint
115
What happens to the oblique retinacular ligament when ED and intrinsics initiate extension of the pip joint
It stretches, and passive tension is transferred distally to extend the dip joint
116
What is rheumatoid arthritis
Autoimmune disease
Chronic systemic inflammatory disorder
Primarily attacks the synovial joints--> chronic synovitis
117
_____ reduces tensile strength of the connective tissue s
Synovitis
118
What happens in rheumatoid arthritis
Mechanical integrity of the joint is destroyed --> joints become misaligned, unstable and frequently deformed.
119
_____ is the collapse of multiple interconnected joints in alternating directions
Zigzag deformity thumb
120
What does zigzag deformity involve
Cmc flexion and adduction
Mcp hyperextension
Ip flexion
121
How can you tell you have volar dislocation
When the fingers flex during grip, FDP transmits force palmarly away from the mcp joint. Proximal phalanx translates palmarly causing mcp dislocation
122
_____ is excessive ulnar deviation and translation of the proximal phalanx, ulnar directed forces generated by the thumb. Flexion torque causes Volar dislocation, in addition to this
Ulnar drift
123
_____ is a huge trauma to Volar plates of he digits. There is a weakened or attenuated Volar late at the pip joint. Lateral bands bowstring Dorsally away from the joint axis of rotation.
Swan neck deformity
124
What does swan neck deformity look like
Increasing moment arm of the pip joint extension causing hyperextension and dip joint flexes because of increased FDP passive tension placed across the pip joint
125
What is the primary cause of boutonnière deformity
And normal displacement of the bands of the extensor mechanism at the pip joint.
126
What causes boutonnière deformity
Chronic synovitis which causes a rupture of the central slip. Lateral bands slip volarly to the axis of rotation.
127
What does the boutonnière deformity look like
Forces cause flexion at the pip joint
| Dip joint hyper extends due to the increased tension of the stretched lateral bands.
