the wrist and hand

Question 1

what are the 8 carpel bones

Answer 1

scaphoid, lunate, triquetium, pisiform, trapezium, trapezoid, capitate, hamate

Question 2

physiologic motion of the wrist

Answer 2

flexion and extension; radial and ulnar deviation

Question 3

what kind of lever is the brachioradialis

Answer 3

type 2; elbow is the fucrum, load is the hand or the weight in the hand.

Question 4

anconeus is not working properly what should you work on

Answer 4

quick motions of flexion and extension

Question 5

why does radial deviation go less then ulnar deviation and why does ulnar deviation have a soft end feel

Answer 5

radial styloid process extends further then the ulnar styloid process and their is a menisci on the ulnar side that gives a softer end feel

Question 6

medial mass muscles

Answer 6

pronator teres and the wrist flexors

Question 7

lateral mass muscles

Answer 7

supinator and the wrist extensors

Question 8

what position is the ulnar nerve stretched (tension)

Answer 8

in elbow flexion

Question 9

what position is the radial and median nerve stretched (tension)

Answer 9

in extension

Question 10

when do most neuro problems start to happen?

Answer 10

once the plexus leaves the axilla

Question 11

common sites of nerve entrapments

Answer 11

ulnar at the cubital tunnel (funny bone)
medial at the pronator and supinator (anterior portion of the forearm)
radial at the superior and supracondylar ridge extensor carpi radialis and brachioradialis

Question 12

what is a sign of a medial nerve entrapment?

Answer 12

a dip in the palm of the hand

Question 13

what causes throwers elbow

Answer 13

repetitive valgus stress

Question 14

little league elbow

Answer 14

stress on the growth plate of the medial humeral epicondyle

Question 15

nursemaids elbow

Answer 15

a slip of the annular ligament caused by distraction elbow extension and pronation (can be fixed my quickly moving the arm in flexion and supination)

Question 16

the “cock up muscles” for hand function

Answer 16

wirst extensors and finger flexors

Question 17

what should PTs bias when working with elbows

Answer 17

flexion and supination

Question 18

what is a sign of a radial nerve injury

Answer 18

wrist drop

Question 19

what does ulnar deviation have more of when compared to radial deviation?

Answer 19

more mobility, less stability
more ROM
-this can leas to ulnar drift and chronic conditions of instability

Question 20

the hand rule of 1/2

Answer 20

the thumb is 1/2 of hand function
sensation is 1/2 of hand function

Question 21

how to stretch the triceps

Answer 21

arm by the ear with a flexed elbow

Question 22

how to stretch the biceps

Answer 22

elbow extension and pronation behind the back

Question 23

rheumatoid arthritis

Answer 23

eats away at the tendons and tendon shafts that lead to joint instability and ulnar drift

Question 24

the articulations of the carpal bones compared to the elbow

Answer 24

week articulation

Question 25

why are you unable to make a strong fist in wrist flexion

Answer 25

due to active insufficiency: the wrist flexors are too shortened and the myofiliments have nowhere to go

Question 26

radial nerve palsy

Answer 26

paralysis of the wrist extensors from the lateral epicondyle; will need a splint to hold the hand in extension and hold a grasp

Question 27

function of the hand

Answer 27

control and sensation

Question 28

MP joint in the hand motions

Answer 28

flexion and extension abduction and adduction

Question 29

DIP joint motions

Answer 29

flexion and extension

Question 30

digit alignment

Answer 30

when the fingers flex all together they will all point to the lunate without overlapping eachother

Question 31

carpal metacarpal motions (opposible thumb)

Answer 31

abduction/adduction flexion/extension circumlocution

Question 32

ligaments at the hand

Answer 32

collateral ligaments and transverse ligament across the hands of the finger metacarpals

Question 33

CAM configerations

Answer 33

-loose pack postion allows for distraction and joint play with MP joint in extension -mobility in extension due to axis of rotation being close to the proximal pharynx -stability in flexion due to the axis of rotation being further away from the proximal pharynx

Question 34

saddle joint (carpel/metacarpal)

Answer 34

flexion/extension: distal concave on convex abduction and adduction: distal convex on concave

Question 35

thenar crease

Answer 35

crease for thumb opposition allows for us to easily find the CMC need to split around the thenar crease to allow for thumb motion

Question 36

distal and proximal palmer crease

Answer 36

allows for freedom the the MP joints

Question 37

static split

Answer 37

split at distal palmer crease, allows for MP flexion

Question 38

resting hand position splint (pismo clam)

Answer 38

-30 degrees of wrist extension -80 degrees of MP flexion and full IP extension -allows for cam ligaments to stay lengthened -maintain the transverse arches -thumb is opposed

Question 39

intrinsic muscles of the hand

Answer 39

lumbricals and interossei

Question 40

lumbricals

Answer 40

innervated by the median and ulnar nerve. action MP flexion and IP extension

Question 41

Extrinsic thumb muscles

Answer 41

flexor pollicis longus, abductor pollicis longus, extensor pollicis longus and brevis

Question 42

intrinsic thumb muscles

Answer 42

thenar eminence

Question 43

muscles that help with grip

Answer 43

extrinsic- long finger flexors intrinsic - abductions and opposable thumb

Question 44

what goes through the carpal tunnel

Answer 44

median n, flexor tendons, transverse ligament

Question 45

what goes through the dorsal tunnel

Answer 45

extensors and radial nerve

Question 46

carpal tunnel syndrome

Answer 46

median nerve entrapment can be detected by pressing down in the flexor (palmer) retinaculum (positive tinel sign)

Question 47

entrapment of the ulnar nerve

Answer 47

in the tunnel of guyon (between the hook of hamate and pisiform)

Question 48

circulation at the hand

Answer 48

the radial artery is bigger then the ulnar and goes to the digits

Question 49

what is required for normal movement

Answer 49

P1 at or after R2; accessory and joint play