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Anatomy UE > wrist > Flashcards

wrist Flashcards

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
Q

TFCC variation

A

varies inversely with ulnar variance,
EX: ulnar negative wrists have a thicker disk

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26
Q

Compressive forces go through:

A

Capitate
Scapholunate junction
Distal radius
TFCC

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27
Q

Removal of TFCC reduces load on what and by how much

A

ulna by 12%

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28
Q

Increase in ulnar negative variance may cause what issue in the carpals

A

avascular necrosis of Lunate (Keinbocks Disease)

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29
Q

Avascular necrosis of the lunate is called what

A

Kienbock’s disease

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30
Q

Kienbock’s disease characteristics

A

Affect young adults
men
Related to repetitive trauma (martial arts, handball, volleyball)
Ulnar negative variance is a risk factor

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31
Q

Radiocarpal - fiborus Capsule

A

Fibrous capsule from distal radius and ulna to proximal row of carpal bones, lined by synovial membrane

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32
Q

Radiocarpal - fibrous Capsule Strengthen by what

A

Rad/uln carpal ligs. (palmar)
Collateral ligs (dorsal)

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33
Q

Radiocarpal Ligaments

A

Dorsal RC
Dorsal UC
Ulnar Collateral-
Radial Collateral-
Volar RC
Volar
Ulnocarpal

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34
Q

Radiocarpal - Blood

A

articular arteries from dorsal and palmar carpal arterial arches.

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35
Q

Radiocarpal - Blood and Nerve Supply

A

from anterior interosseous branch of median n., posterior interosseous branch of radial n., and dorsal and deep branches of ulnar nerve

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36
Q

Intercarpal Joints

A

In between each neighboring carpals
Midcarpal Joint
Pisotriquetral Joint

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37
Q

Intercarpal Joints what kind of jts

A

Plane synovial; sliding movements
Sliding movements help wrist flexion and radial dev.

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38
Q

Scaphoid details

A

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

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39
Q

Lunate details

A

Most frequent dislocated; vasculature
supplied by dorsal and volar lig.

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40
Q

Triquetrum details

A

Attach UCL

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41
Q

Pisiform

A

attachment for retinacula, ligaments (UCL), and
tendons (flexor carpi ulnaris & AbDM)

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42
Q

Blood supply of the scaphoid

A

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

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43
Q

Scaphoid fracture

A

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)

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44
Q

Trapezium details

A

– attachment of transverse carpal lig. and RCL

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45
Q

Capitate details

A

keystone of the wrist

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46
Q

Hamate

A

hook offers protection to ulnar artery & n.

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47
Q

what makes up the midcarpal joint

A

is the joint between the proximal and distal rows of carpals, shown here in this radiograph.

48
Q

Fibrous capsule in the intercarpal

A

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
Q

Interosseous (intercarpal) ligaments

A

connecting proximal row carpals
connecting distal row carpals

50
Q

Palmar intercarpal ligaments
Dorsal intercarpal ligaments

A

on the palmar and the dorsal side and connect the carpals together

51
Q

Intercarpal - Blood

A

articular arteries from dorsal and palmar carpal arches

52
Q

Intercarpal - Nerve

A

from anterior interosseous branch of median n., posterior interosseous branch of radial n., and dorsal and deep branches of ulnar nerve

53
Q

Closed Packed for​ the midcarpals and the radiocarpal

A

full extension

54
Q

open packed for the midcarpals and the radiocarpal

A

slight flexion

55
Q

Flex/ext what axis and plane

A

coronal axis between lunate and capitate; sagittal plane movement

56
Q

Rad/ulnar dev what axis and pane

A

sagittal or A-P axis between lunate & capitate; frontal plane movement

57
Q

Circumduction axis

A

polyaxial

58
Q

Flexion artho

A

anterior (volar) roll, posterior glide: + midcarpal
Limited by dorsal radiocarpal lig

59
Q

Extension artho

A

posterior (dorsal) roll, anterior glide: + radiocarpal

Limited by volar radiocarpal and ulnocarpal lig.

60
Q

Distal carpals glide in the same direction as

A

the hand rolls

61
Q

Radial Deviation carpal movement

A

Distal carpal row moves radially
Proximal row moves toward ulna

62
Q

Radial Deviation limited by

A

Bony contact of radius and carpal bones
Stress on the UCL

63
Q

Radial and ulnar deviation wrist flexed or extended

A

both limited in extremes of wrist flex and ext due to ligamentous constraints

64
Q

what has a greater ROM flexion and extension or deviation

A

flexion and extension

65
Q

Digits II-V what kind of joint

A

Plane synovial
sliding movements - cavity is continuous with intercarpal

66
Q

Digit I what kind of joint

A

thumb
saddle joint

67
Q

Ligaments of CMC & IMC 2nd to 5th fingers

A

Metacarpal Interosseous ligaments
CMC ligaments (trapezium to base of 2nd meta; hamate to 5th meta)

68
Q

motion in the metacarpals increase in which direction

A

Motion increases ulnarly
2nd & 3rd: immobile
4th: glide into flex/ext
5th: 10 to 20 degrees flex/add

69
Q

closed packed for the CMC & IMC ii-v

A

Closed Pack: full fist

70
Q

open pack for CMC and IMC ii-v

A

Open Pack: neutral

71
Q

CMC of Thumb - Joint Classification

A

Saddle/synovial; angular movements in any plane

72
Q

CMC of Thumb - movement

A

Flex/ext, abd/add, opposition (this is very important)

73
Q

CMC of the thumb - vex and cave

A

Concave – flex and ext
Convex – abd and add

74
Q

injury seen at the CMC of the thumb

A

High prevalence of osteoarthritis

75
Q

does the thumb have a seperate​ joint capsule

A

yes it is seperate from the rest of the other joint capsules​

76
Q

Fibrous capsule of the CMC of the thumb

A

Fibrous capsule, loose to allow movement

77
Q

CMC of Thumb - Movement flexion​

A

53 degrees

78
Q

CMC of Thumb closed packed

A

opposttion (pinky to the thumb)

79
Q

CMC of Thumb - open packed

A

neutral

80
Q

CMC of Thumb - Movement ext

A

42 degrees

81
Q

CMC & IMC - Blood

A

Blood – articular arteries from dorsal and palmar metacarpal arteries & dorsal carpal and deep palmar arterial arches

82
Q

CMC & IMC - Nerve

A

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
Q

how many tendosn cross the dorsum of the wrist

A

9

84
Q

how many tendons that cross the dorsum of the wrist contribute to wrist extesnion

A

7

85
Q

7 tendons that contribute to wrist extension

A

3 primary: ECU, ECRL, ECRB
4 secondary: EDM, EI, ED, EPL

86
Q

whar two tendons that cross the wrist do not contribute to wrist extension

A

EPB and APL

87
Q

Extensor Retinaculum runs from

A

From distal end of radius to styloid process of ulna, triquetral and pisiform bones

88
Q

what does the extensor ret form

A

osseofibrous extensor tunnels

89
Q

what does the extensor ret prevent

A

Prevents bowstringing of long tendons during hyperextension

90
Q

Extensor Tendon Synovial Sheaths

A

Located in osseofibrous canals

Reduces friction between tendons and walls of canals

91
Q

Extensor Tunnels at the Wrist:lat to med (Dorsal Compart)

A

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
Q

APL, EPB (T1) issue

A

De Quervain’s tenosynovitis

93
Q

EPL (T3) issue

A

Rupture at Lister’s tubercle (after wrist fracture)

94
Q

APL/EPB and ECRL/ECRB (T1 T2) issue

A

Intersection syndrome

95
Q

ED, EI (T4)– issue

A

Extensor tenosynovitis

96
Q

EDM (T5) issue

A

Rupture (rheumatoid)

97
Q

ECU (T6) issue

A

Snapping at ulnar styloid or tendonopathy

98
Q

De Quervain’s tenosynovitis

A

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
Q

Intersection Syndrome

A

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
Q

Anatomical Snuff Box ant/rad border

A

abductor pollicis longus and extensor pollicis brevis (t1)

101
Q

Posterior/Ulnar border: snuff box

A

extensor pollicis longus(t3)

102
Q

Floor: snuff box

A

scaphoid & trapezium

103
Q

how many muscles​ cross the palmer side of the wrist

A

6 muscles
- produce wrist flexion

104
Q

primary wrist flexor

A

FCU and FCR

105
Q

secondary wrist flexors

A

FDS FDP PL FPL

106
Q

Flexor Retinaculum

A

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
Q

vincula

A

The connective tissue that helps hold a tendon down to the bone

108
Q

Flexor Tendon Synovial Sheaths provide what to the tendons

A

Protects and nourishes the tendons

109
Q

Carpal Tunnel Roof

A

Transverse Carpal Ligament: from trapezium/scaphoid to hamate/pisiform

110
Q

Floor of carpal tunnel

A

Palmar Carpal Arch

111
Q

Contents of carpal tunnel

A

Median nerve
FDS III & IV
FDS II & V
FPL
FDP

112
Q

Carpal Tunnel Syndrome

A

Decrease in size of carpal tunnel (inflammation of retinaculum, bone dislocation, arthritis, tenosynovitis) may compress Medial n.

113
Q

medial nerve innervate what part of the palm

A

palmar aspect of the thumb, the 2nd finger, the 3rd finger, and the radial half of the 4th finger

114
Q

what runs through Guyon’s Tunnel

A

ulnar nerve and art

115
Q

Guyon’s Tunnel- roof, floor, and walls

A

Roof: Volar carpal lig.
Floor: Transv. Carpal and pisohamate ligs.
Walls: Pisiform and hook of hamate

Anatomy UE (11 decks)

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