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wrist Flashcards

(115 cards)

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1
Q

The main functions of the wrist complex are to

A

Position the hand in space for prehension

Control the length-tension relationships in multiarticular hand muscles

Control fine adjustments of grip

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2
Q

what are the joints of the wrist

A

Distal RU Joint

Radiocarpal Joint – Wrist Joint

Intercarpal Joints(Midcarpal)

Carpometacarpal Joints
Intermetacarpal Joints

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3
Q

Radiocarpal Joint is between what

A

This is the joint between the distal aspect of the radius and articular disk proximally and the proximal row of carpal bones distally

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4
Q

Radiocarpal Joint - what kind of joint

A

synovial - ellipsoid (condyloid

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5
Q

proximal part of the radiocarpal joint

A

Radius & Articular Disk

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6
Q

distal part of the radio ulnar joint

A

Scaphoid, Lunate, Triquetrum

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7
Q

distal part of the radiocarpal joint

A

Scaphoid, Lunate, Triquetrum

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8
Q

movement allowed at the distal radiocarpal

A

Flexion/ext, add/abd, & circumduction

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9
Q

Ulnar deviation

A

pinky side
at the radiocarpal joint

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10
Q

radial deviation

A

thumb side
at the radiocarpal joint

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11
Q

radial inclination

A

Distal radial surface is approximately 23° inclined off the perpendicular to the radial shaft

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12
Q

Difference in length between the ulnar head and the tip of the radial styloid is an average of what

A

12 mm (limits radial deviation)

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13
Q

ulnar variance

A

The difference in length between the ulnar head and the distal radius

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14
Q

Ulna positive

A

ulna extends further toward the carpals
ulnar variance

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15
Q

Ulna neutral

A

ulnar variance
when they are approximately even

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16
Q

ulna negative

A

ulnar variance
when the radius extends further toward the carpals

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17
Q

Colles Fracture

A

The most common wrist fracture-
distal radius fracture - distal radial metaphysis
Closed fracture
Usually occurs within 2 cm of the articular surface

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18
Q

what happens in Colles Fracture

A

the apex of the distal fragment points in the palmar direction and the hand and wrist are dorsally displaced.

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19
Q

what population do we see colles fracture​ in

A

adults
rare in children

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20
Q

Distal radiocarpal joint vex or cave

A

vex
Scaphoid, lunate, triquetrum

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21
Q

proximal radiocarpal joint - vex or cave

A

cave
radius and the articular disc

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22
Q

Triangular fibrocartilage complex (TFCC) is made out of

A

Consists of articular disk, distal radio-ulnar ligaments, meniscus homolog, ulnolunate and ulnotriquetral ligaments, extensor carpi ulnaris sheath, and ulnar capsule

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23
Q

Triangular fibrocartilage complex (TFCC) function

A

interposes between the distal ulna and carpus (force-transmitting and stability)

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24
Q

axial loading in the radius and the ulna

A

TFC and ulnar side - carries 20% of axial loading across the wrist

Radial side carries 80% of axial load

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25
TFCC variation
varies inversely with ulnar variance, EX: ulnar negative wrists have a thicker disk
26
Compressive forces go through:
Capitate Scapholunate junction Distal radius TFCC
27
Removal of TFCC reduces load on what and by how much
ulna by 12%
28
Increase in ulnar negative variance may cause what issue in the carpals
avascular necrosis of Lunate (Keinbocks Disease)
29
Avascular necrosis of the lunate is called what
Kienbock’s disease
30
Kienbock’s disease characteristics
Affect young adults men Related to repetitive trauma (martial arts, handball, volleyball) Ulnar negative variance is a risk factor
31
Radiocarpal - fiborus Capsule
Fibrous capsule from distal radius and ulna to proximal row of carpal bones, lined by synovial membrane
32
Radiocarpal - fibrous Capsule Strengthen by what
Rad/uln carpal ligs. (palmar) Collateral ligs (dorsal)
33
Radiocarpal Ligaments
Dorsal RC Dorsal UC Ulnar Collateral- Radial Collateral- Volar RC Volar Ulnocarpal
34
Radiocarpal - Blood
articular arteries from dorsal and palmar carpal arterial arches.
35
Radiocarpal - Blood and Nerve Supply
from anterior interosseous branch of median n., posterior interosseous branch of radial n., and dorsal and deep branches of ulnar nerve
36
Intercarpal Joints
In between each neighboring carpals Midcarpal Joint Pisotriquetral Joint
37
Intercarpal Joints what kind of jts
Plane synovial; sliding movements Sliding movements help wrist flexion and radial dev.
38
Scaphoid details
Transmit majority of forces; at risk for fracture at the wrist – Radial collateral ligament attaches and provides vascular supply Scaphoid is over 80% covered with articular cartilage
39
Lunate details
Most frequent dislocated; vasculature supplied by dorsal and volar lig.
40
Triquetrum details
Attach UCL
41
Pisiform
attachment for retinacula, ligaments (UCL), and tendons (flexor carpi ulnaris & AbDM)
42
Blood supply of the scaphoid
Dorsal scaphoid branch: proximal 70% to 80% of bone Volar scaphoid branch: distal 20% to 30% of bone Tenuous blood supply to proximal pole explains the delayed union of fractures
43
Scaphoid fracture
Common in young (15 to 30 yo), rare underage of 10; however, accounts for over 70% of carpal fracture in children FOOSH - common mechanism of injury Tenderness over the anatomic snuff box, scaphoid tuberosity (palm), and distal to Lister’s tubercle (dorsal)
44
Trapezium details
– attachment of transverse carpal lig. and RCL
45
Capitate details
keystone of the wrist
46
Hamate
hook offers protection to ulnar artery & n.
47
what makes up the midcarpal joint
is the joint between the proximal and distal rows of carpals, shown here in this radiograph.
48
Fibrous capsule in the intercarpal
common articular capsule with a fibrous and synovial layer that covers all of the intercarpal joints together The only exception is that the joint between the triquetrum and pisiform has its own joint capsule.
49
Interosseous (intercarpal) ligaments
connecting proximal row carpals connecting distal row carpals
50
Palmar intercarpal ligaments Dorsal intercarpal ligaments
on the palmar and the dorsal side and connect the carpals together
51
Intercarpal - Blood
articular arteries from dorsal and palmar carpal arches
52
Intercarpal - Nerve
from anterior interosseous branch of median n., posterior interosseous branch of radial n., and dorsal and deep branches of ulnar nerve
53
Closed Packed for​ the midcarpals and the radiocarpal
full extension
54
open packed for the midcarpals and the radiocarpal
slight flexion
55
Flex/ext what axis and plane
coronal axis between lunate and capitate; sagittal plane movement
56
Rad/ulnar dev what axis and pane
sagittal or A-P axis between lunate & capitate; frontal plane movement
57
Circumduction axis
polyaxial
58
Flexion artho
anterior (volar) roll, posterior glide: + midcarpal Limited by dorsal radiocarpal lig
59
Extension artho
posterior (dorsal) roll, anterior glide: + radiocarpal Limited by volar radiocarpal and ulnocarpal lig.
60
Distal carpals glide in the same direction as
the hand rolls
61
Radial Deviation carpal movement
Distal carpal row moves radially Proximal row moves toward ulna
62
Radial Deviation limited by
Bony contact of radius and carpal bones Stress on the UCL
63
Radial and ulnar deviation wrist flexed or extended
both limited in extremes of wrist flex and ext due to ligamentous constraints
64
what has a greater ROM flexion and extension or deviation
flexion and extension
65
Digits II-V what kind of joint
Plane synovial sliding movements - cavity is continuous with intercarpal
66
Digit I what kind of joint
thumb saddle joint
67
Ligaments of CMC & IMC 2nd to 5th fingers
Metacarpal Interosseous ligaments CMC ligaments (trapezium to base of 2nd meta; hamate to 5th meta)
68
motion in the metacarpals increase in which direction
Motion increases ulnarly 2nd & 3rd: immobile 4th: glide into flex/ext 5th: 10 to 20 degrees flex/add
69
closed packed for the CMC & IMC ii-v
Closed Pack: full fist
70
open pack for CMC and IMC ii-v
Open Pack: neutral
71
CMC of Thumb - Joint Classification
Saddle/synovial; angular movements in any plane
72
CMC of Thumb - movement
Flex/ext, abd/add, opposition (this is very important)
73
CMC of the thumb - vex and cave
Concave – flex and ext Convex – abd and add
74
injury seen at the CMC of the thumb
High prevalence of osteoarthritis
75
does the thumb have a seperate​ joint capsule
yes it is seperate from the rest of the other joint capsules​
76
Fibrous capsule of the CMC of the thumb
Fibrous capsule, loose to allow movement
77
CMC of Thumb - Movement flexion​
53 degrees
78
CMC of Thumb closed packed
opposttion (pinky to the thumb)
79
CMC of Thumb - open packed
neutral
80
CMC of Thumb - Movement ext
42 degrees
81
CMC & IMC - Blood
Blood – articular arteries from dorsal and palmar metacarpal arteries & dorsal carpal and deep palmar arterial arches
82
CMC & IMC - Nerve
from anterior interosseous branch of median n., posterior interosseous branch of radial n., and dorsal and deep branches of ulnar nerve “SAME AS RADIOCARPAL, INTERCARPAL
83
how many tendosn cross the dorsum of the wrist
9
84
how many tendons that cross the dorsum of the wrist contribute to wrist extesnion
7
85
7 tendons that contribute to wrist extension
3 primary: ECU, ECRL, ECRB 4 secondary: EDM, EI, ED, EPL
86
whar two tendons that cross the wrist do not contribute to wrist extension
EPB and APL
87
Extensor Retinaculum runs from
From distal end of radius to styloid process of ulna, triquetral and pisiform bones
88
what does the extensor ret form
osseofibrous extensor tunnels
89
what does the extensor ret prevent
Prevents bowstringing of long tendons during hyperextension
90
Extensor Tendon Synovial Sheaths
Located in osseofibrous canals Reduces friction between tendons and walls of canals
91
Extensor Tunnels at the Wrist: lat to med (Dorsal Compart)
T1- Abductor pollicis longus & extensor pollicis brevis T2 - Extensor carpi radialis longus & brevis T3- Extensor pollicis longus T4- Extensor digitorum & Extensor indicis T5- Extensor digiti minimi T6- Extensor carpi ulnaris
92
APL, EPB (T1) issue
De Quervain’s tenosynovitis
93
EPL (T3) issue
Rupture at Lister’s tubercle (after wrist fracture)
94
APL/EPB and ECRL/ECRB (T1 T2) issue
Intersection syndrome
95
ED, EI (T4)– issue
Extensor tenosynovitis
96
EDM (T5) issue
Rupture (rheumatoid)
97
ECU (T6) issue
Snapping at ulnar styloid or tendonopathy
98
De Quervain’s tenosynovitis
Most common tendonopathy of the wrist in athletes Inflammation of the tenosynovium of the first dorsal compartment tendons, the APL and EPB Repetitive wrist motion causes shear stress on the tendons in their small compartment Common in racquet sports, fishing, and golf
99
Intersection Syndrome
T1 and T2 Site is tender, swollen, often crepitus during wrist flexion/extension “squeakers syndrome” Seen in sports requiring forceful repetition of flex/ext
100
Anatomical Snuff Box ant/rad border
abductor pollicis longus and extensor pollicis brevis (t1)
101
Posterior/Ulnar border: snuff box
extensor pollicis longus(t3)
102
Floor: snuff box
scaphoid & trapezium
103
how many muscles​ cross the palmer side of the wrist
6 muscles - produce wrist flexion
104
primary wrist flexor
FCU and FCR
105
secondary wrist flexors
FDS FDP PL FPL
106
Flexor Retinaculum
Thickening of the deep fascia of the forearm Prevent bowstringing of flexor tendons during flexion Under constant tension Aids maintaining the contour of the carpal arch
107
vincula
The connective tissue that helps hold a tendon down to the bone
108
Flexor Tendon Synovial Sheaths provide what to the tendons
Protects and nourishes the tendons
109
Carpal Tunnel Roof
Transverse Carpal Ligament: from trapezium/scaphoid to hamate/pisiform
110
Floor of carpal tunnel
Palmar Carpal Arch
111
Contents of carpal tunnel
Median nerve FDS III & IV FDS II & V FPL FDP
112
Carpal Tunnel Syndrome
Decrease in size of carpal tunnel (inflammation of retinaculum, bone dislocation, arthritis, tenosynovitis) may compress Medial n.
113
medial nerve innervate what part of the palm
palmar aspect of the thumb, the 2nd finger, the 3rd finger, and the radial half of the 4th finger
114
what runs through Guyon’s Tunnel
ulnar nerve and art
115
Guyon’s Tunnel- roof, floor, and walls
Roof: Volar carpal lig. Floor: Transv. Carpal and pisohamate ligs. Walls: Pisiform and hook of hamate

Anatomy UE (11 decks)

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