Wrist Flashcards
(136 cards)
0
Q
Why does the position of the wrist significantly affect the function of the hand
A
Because many of the muscles and tendons which control the digits originate extrinsic to the hand in the forearm
1
Q
What is the most impotent function of the wrist
A
Provide adequate function of the hand as well as stability
2
Q
A weak or painful wrist often assumes a position which will interre with the optimal _____
A
Length tension relationship
3
Q
What are the two primary articulations in the wrist
A
Mid carpal and radiocarpal joints and there are numerous Intercarpal articulations
4
Q
_____ serves as a spacer between the distal radioulnar joint and the hand
A
The wrist
5
Q
_____ separates the extensor Carpi radialis brevis tendon from the extensor pollicis longus
A
Lister’s tubercle or dorsal tubercle
6
Q
Where does the radial collateral ligament attach
A
Radial styloid process that projects from the lateral side of the distal radius
7
Q
The surface of the radius is ______ with an ulnar angulation of _____ and a palmar angulation of ______
A
Concave
25 degrees
10 degrees
8
Q
What is the functional significance of the distal osteology of the radius
A
You has more ulnar deviation and it creates stability because of the way we function
9
Q
_____ styloid is sharper and smaller
A
Ulnar
10
Q
What muscle goes around the styloid process of the ulna
A
Extensor Carpi ulnaris
11
Q
What are the proximal and distal rows of the carpal bones
A
Proximal–scaphoid lunate triquetrum pisiform
Distal– trapezium trapezoid capitate hamate
12
Q
____ has a proximal and distal pole separated by a waist
A
Scaphoid
13
Q
How does the scaphoid articulate with the radius
A
Convex proximal surface
14
Q
Most blood vessels enter the scaphoid through the___
A
Distal pole
15
Q
_____ is vulnerable to fractures
A
Scaphoid
16
Q
_____ fractures to the proximal part of this bone often have long healing times and frequently require surgery
A
Scaphoid
17
Q
How does the lunate articulate with the radius
A
Convex proximally to articulate with the radius
18
Q
What is the most unstable carpal
A
Lunate
19
Q
_____ is the most medial in the proximal row of carpal bones
A
Triquetrum
20
Q
__ is the sesamoid bone
A
Pisiform
21
Q
_____ is embedded in the flexor Carpi ulnaris tendon
A
Pisiform
22
Q
_____ serves as an attachment for the abductor digiti minimi and transverse carpal ligament.
A
Pisiform
23
Q
_____ is concave proximally to articulate with the distal scaphoid
A
Trapezium
24
How does the trapezium articulate with the thumb
The distal end articulates with the base of the first metacarpal and is saddle shaped.
25
_____ articulates with the scaphoid proximally and second metacarpal distally
Trapezoid
26
____ is the largest bone and is located in the center of the wrist
Capitate
27
What does the capitate articulate with
Articulates proximally with the scaphoid and lunate and distally with the third metacarpal
28
What is the attachment for the transverse carpal ligament
Hook of the hamate
29
____ articulates with the 4th and 5th metacarpals distally
Hamate
30
____ proximally projects towards the lunate
Hamate
31
_____ provides the functional mobility of the ulnar side of the hand
Hamate
32
______ is the space on the palmar side of the wrist between the transverse carpal ligament which arches over the concavity formed by the carpal bones
Carpal tunnel
33
_____ serves as an attaché nt for a number of muscles inside the hand
Transverse carpal ligament
34
What does the carpal tunnel contain
The median nerve and extrinsic finger flexor tendons
35
What is carpal tunnel syndrome
Compression of the median nerve within the carpal tunnel
36
Causes of carpal tunnel are
Trauma
Repetitive activity
Systemic illness
37
Carpal tunnel syndrome leads to
Pain
Paresthesias
Numbness
Atrophy of thenar eminance and weakness of median nerve Innervated muscles
38
What are the two primary articulations of the wrist
Radiocarpal joint
| Mid carpal joint
39
_____ row movement depends on ____ row movement for movements of the wrist
Proximal
| Distal
40
Proximal row stability and range depend greatly on ____
Ligament integrity and articular surface anatomy
41
The ____ is the linkage between the distal and proximal rows
Scaphoid
42
How does the radiocarpal joint articulate
The concave surface of the radius articulates with the convex surface of the scaphoid and lunate. There is also an adjacent articular disc known as the triangular Fibrocartilage.
43
Stability of the radiocarpal joint is provided by _____
Radiocarpal ligaments
44
_____ resist palmar and ulnar displacement of the scaphoid and lunate
Radiocarpal ligaments
45
How is force transferred during weight bearing on the radiocarpal joint
80% through the scaphoid and lunate to the radius
20% transferred to the ulna through the articular disc
46
_____ articulation between the proximal and distal rows of carpals
Mid carpal joint
47
What is the medial compartment
Convex head of the capitate articulates with concave surface of the scaphoid, lunate and triquetrum
48
What is the lateral compartment
Concave surface of the trapezium and trapezoid articulates with the convex distal pole of the scaphoid.
49
Which compartment has less movement
Lateral
50
Ligaments are classified into which two types
Intrinsic and extrinsic
51
What are the functions of the ligaments
Maintain alignment of the carpal bones
Transfers forces between carpal bones
Transfers forces across the proximal and distal rows
Provide sensory feedback
52
What are the extrinsic ligaments
Dorsal radiocarpal
Radial collateral
Palmar radiocarpal
53
_____ reinforces the posterior radiocarpal joint, guides motion in the proximal row
Dorsal radiocarpal ligament
54
The dorsal radiocarpal ligament restrains____
Anterior dislocation of the lunate
55
_____ restrains ulnar deviation
Radial collateral ligament
56
_____ made up of three ligaments that are stronger and thicker than the dorsal ligaments
Palmar radiocarpal ligaments
57
______ restrain wrist extension
Palmar radiocarpal ligament
58
_____ bindw the radius and the ulna together while allowing the radius to rotate around the fixed ulna.
Triangular Fibrocartilage complex
59
What does the TFCC stabilize
The distal radioulnar joint
60
What does the TFCC reinforce
The ulnar side of the wrist
61
TFCC is a _____ disc that is in a triangular shape
Biconcave
62
What does the TFCC articulate with
Proximally with the ulna
Distally with the lunate and triquetrum
63
The central portion of the TFCC disc is _____ a vascular
80 percent
64
What are the ligaments in the ulnocarpal space
Palmar ulnocarpal ligament
| Ulnar collateral ligament
65
_____ reinforce the ulnar side of the wrist while allowing pronation and supination
Palmar ulnocarpal ligament
| Ulnar collateral ligament
66
____ fills the gaps in the ulnocarpal space
Meniscus "homologue"
67
_____ link the bones in the sme row
Intrinsic wrist ligaments
68
The intrinsic wrist ligaments are stronger ____ than ____
Volarly
Dorsally
69
What are the ligaments of the intrinsic wrist
Short ligaments
Long ligaments
Intermediate ligaments
70
_____ connects the bones of the distal row and provides stability and allows them to function as a single mechanical row.
Short ligaments
71
What are the intermediate ligaments
Lunatotriquetral
Scapholunate
Scaphotrapezium
72
What are the long ligaments
Dorsal and palmar intrinsics
73
The long ligaments help to ____
Guide motion
74
What are the ranges for flexion and extension
Flexion is 0-85 with normal values around 70-85
Extension is 0-75
75
Ranges for ulnar and radial deviation
Ulnar deviation is 0-40 with 35-40 being normal
Radial deviation is 0-20 with normal being 15-20
76
Where is the axis of rotation for the wrist
Through the capitate
77
Extension combines with
Radial deviation
78
Flexion is combined with
Ulnar deviation
79
Extension and radial deviation can be limited by
Tightness in the palmar radiocarpal ligament
80
What is the closed packed position for the radiocarpal joint
Extension combines with radial deviation
81
What is the functional position of the hand and wrist
Wrist 20-30 extension
10 ulnar deviation
Fingers:
Mp-40
Pip-30
Dip-slight flexion
82
Forces across the ____ reach amounts of ten times greater then the force applied at the _____
Distal carpal row
Fingertips
83
The central column concept is from what plane of motion
Sagittal
84
What is the central column concept
Radiocarpal joint: radius and lunate
Mid carpal: lunate and capitate
Carpometacarpal: capitate and 3rd metacarpal
85
Where does active move to begin in Sagittal plane motion
At the distal carpal row
86
When do the proximal carpal row move in Sagittal plane motion
When the tension is created by the ligaments crossing the midcarpal joints
87
Arthrokinematics of extension at the radiocarpal joint
Convex surface of the lunate rolls Dorsally and slides palmarly on the concave surface of the radius
88
Arthrokinematics of extension at the midcarpal joint
Capitate rolls Dorsally on the lunate and slides palmarly
89
What is the closed packed position of extension
Palmar ligaments and muscles stretch into tension and stabilize the wrist
90
Arthrokinematics of flexion at the radiocarpal joint
Convex surface of the lunate rolls palmarly and slides Dorsally on the concave radius
91
Arthrokinematics of flexion at the midcarpal joint
Convex head of the capitate rolls palmarly and slides Dorsally on the concave lunate
92
Arthrokinematics of flexion at the scaphoid joint
Rolls similarly to the lunate, displacement restrained by the scapulolunate ligament.
93
Arthrokinematics of ulnar deviation at the radiocarpal joint
Scaphoid lunate and triquetrum roll ulnarly and slide radially
94
Arthrokinematics of flexion at the midcarpal joint
Capitate rolls ulnarly and slides radially
95
What happens at full range of ulnar deviation in regards to arthrokinematics
Triquetrum contacts the articular disc
Hamate compressed against the triquetrum
Proximal row pushed against the styloid process of the radius
96
_____ helps stabilize the wrist for gripping
Ulnar deviation
97
Arthrokinematics of radial deviation at the radiocarpal joint
Scaphoid lunate and triquetrum roll radially and slide ulnarly
98
Arthrokinematics of radial deviation at the midcarpal joint
Capitate rolls radially and slides ulnarly
99
What is the closed packed position of radial deviation
Full radial deviation
100
During radial deviation the ____ flexes but the ____ stays neutral due to the extension moment exerted by the triquetrum if all the ligaments are intact
Scaphoid
Lunate
101
_____ attach distally to the carpus and extend only the wrist
Primary wrist extensors
102
_____ cross the carpus and attach to the metacarpals of digits and extend the wrist and the digits
Secondary wrist extensors
103
Where does the axis of rotation pass
Through the capitate bone
104
What are the primary wrist extensors
Ecrl
Ecrb
Ecu
105
What are the secondary wrist extensors
Ed
EI
EDM
EPL
106
All wrist muscles produce torques in what plane(s)
Sagittal and frontal
107
What is the action of ecrl
Wrist extension and radial deviation
108
_____ originates proximally at the lateral epicondyle and attaches distally on the second metacarpal
Ecrl
109
_____ gives a greater moment arm for radial deviation
Ecrl
110
______ originates on the lateral epicondyle and attaches distally to the third metacarpal
Ecrb
111
_____ gives a greater moment arm for extension
Ecrb
112
Injury to_____ will cause decreased grip strength and decreased strength in wrist extension and radial deviation
Ecrl and ecrb
113
Action of the ecu
Extends and ulnarly deviates the wrist with the forearm supinated, less effective as a wrist extensor with the forearm pronated
114
_____ assists the TFCC in providing stability to the ulnar side of the wrist
Ecu
115
What is the main function of wrist extensors
To position and stabilize the wrist during finger activity
116
Making a fist requires synergistic muscle activity between?
Long finger flexors and wrist extensors
117
____ is recruited first in the light grip
Moderate is _____
Strong is _____
Ecrb
Ecrl
Ecu
118
What is the best position for strong grip
In 30-35 degrees of wrist extension and 5 degrees of ulnar deviation. This optimizes the length tension relationship
119
Why is flexion not the best position to have string grip
With the wrist flexed, the fingers cannot generate any torque because they are in a shortened position and are fighting against passive extensor torque.
120
What are the primary wrist flexors
Flexor Carpi radialis
Flexor Carpi ulnaris
Palmaris longus
121
What are the secondary wrist flexors
FDP
FDS
FPL
122
____ originate on the medial epicondyle and work synergistically during wrist flexion
FCU and FCR
123
_____ attaches to the palmar surface of the second and third metacarpal and does flexion and radial deviation
FCR
124
_____ attaches to the pisiform, pisohamate and pisometacarpal ligament, and the 5th metacarpal. Does flexion and ulnar deviation
FCU
125
______grnerates the most torque of the wrist flexors
FCU
126
____ anchors the skin and cassia of the hand
Palmaris longus
127
What are the radial deviatiors
```
ECRB
ECRL
FCR
EPL
EPB
APL
FPL
```
128
______ produce the greatest torque into radial deviation
ECRL and APL
129
_____ provide stability to the radial side of the wrist augument in the radial collateral ligament
APL and EPB
130
____ work synergistically as prime generators of radial deviation
ECRL and FCR
131
_____ is inflammation of degenerative tendinopathy of the APL and EPB (first dorsal compartment).
DeQuervain's synovitis
132
Hoe does dequervain's synovitis occur
Due to then overduse or repetitive strain injury
133
Dequervain's is common in who
Mothers with new babies
134
What is finkelstein's test
Ulnar deviation with the thumb flexed inside of the fist= severe pain
135
What are the secondary ulnar deviatiors
FDP
FDS
Ed
