Wrist Flashcards by Dani W

Midcarpal Joint

medial: condyloid
lateral: planar

functional unit and not synovial because between rows of carpals

scaphoid convex on concave trapezium and trapezoid

lunate concave on convex capitate

triquitrium concave on convex hamate

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Radiocarpal Joint

Type

convex/concave

ellipsoidal

Convex on concave (for both AP and mediolateral)

btwn concave radius and convex carpals
ARTICULAR DISC: triangular fibrocartilage

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TFCC

triangular fibrocartilage complex: ulnar support for carpal bones, between ulna and carpals

often injure: pain with forearm pronation and supination and painful wrist ulnar deviation. history of clicking in the wrist at ulna side

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Boundary for articular disc formed by what complex

ECU tendon sheat

ulnotriquitrial ligament
ulnolunate ligament
palmar radioulnar ligament
dorsal radioulnar ligament

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meniscus homologue

not a meniscus or a ligament

has a cushioning effect
if it is ruptured and gets into the joint it would mess up the mechanics

need to be intact for TFCC complex

manage: support distal wrist (distal ulna)

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Flexion to Extension: midcarpal jt/radiocarpal joint

what moves first and next

radioscaphoid vs radiolunate

distal row moves first (convex on concave, except scaphoid on trapezium/trapezoid)

proximal row moves next (convex on concave)

FLEXION: 75% radioscaphoid/ 50% radiolunate

EXTENSION: 92% radioscaphoid / 52% radiolunate

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Radial and Ulnar Deviation

midcarpal/radiocarpal

the distal row of carpals follow the metacarpals

Midcarpal Joint: convex on concave

then the proximal row of carpals move: convex on concave: they move radiallly in ulnar deviation: radial glide plus extension

(most of radial deviation is at the midcarpal joints)

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Dart Throwers Arc

–what is the motion

Radial Deviation and Extension–>Ulnar Deviation and Flexion

-scaphoid and lunate are stable in this motin
-see if pick up anything in TFCC area

Need this motion in ADL: do it gently for carpal ligament repair to SCAPHOID or LUNATE to protect this repair

if issue at TFCC do it gently not ballistic

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Radiocarpal Joint

positions:

zero
rest position
closed packed position
capsular pattern

zero: longitudinal axes through radius and 3rd metacarpal

rest position: slight ulnar dev/wrist flexion –longitudinal axis through radius and 3rd metacarpal are straight

closed packed: full extension

capsular pattern: restricted equally in all directions

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Midcarpal Joint Positions

rest

closed packed

capsular pattern

rest: neutral or slight flexion with ulnar deviation

closed packed: full extension with ulnar deviation

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Midcarpal and Radiocarpal Flexion and Extension

ROM: where most?

85 degrees:
Flexion: 50 radiocarpal, 35 midcarpal

Extension: 35 radiocarpal, 50 midcarpal

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goniometer

wrist flexion/extension

radial/ulnar deviation

flexion/extension

pivot: distal to ulnar styloid
static: in line with ulna
moving: 5th metacarpal

radial/ulnar deviation

pivot: capitate
static: midline of forearm
moving: 3rd metacarpal

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Radiocarpal Joint

-distraction

patient position: seated, forearm pronated, wrist in resting position (slight ulnar and flexion)

stabilize: forearm just proximal to wrist on table (radius and ulna close to joint as possible)
mobilize: mobilize just distal to wrist arond row of carpals (encircle scaphoid and triquitrium)
direction: distal

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Radiocarpal

palmar glide

*do picolo first

patient position: patient seated, forearm pronated, longitudinal axis straight through radius and 3rd metacarpal, wrist in slight ulnar flexion

stabilize: distal forearm just proximal to wrist
mobilize: proximal carpal bones
direction: mobilizing hand moves in volar direction to the floor

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Radiocarpal: dorsal glide

*start with picolo

patient position: sit, forearm supinated, longitudinal line between radius and 3rd metacarpal, slight ulnarflex

stabilize: distal forearm
mobilize: just distal to wrist around carpal bones
direction: dorsal to floor

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Radiocarpal Joint

radial glide

*start with picolo

patient position: seated, forearm resting on radial aspect, wrist in resting position
***for ulnar deviation

start with picolo
stabilize: distal forearm
mobilize: just distal to wrist around proximal carpals
direction: radial glide to floor

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Radiocarpal Joint

Ulnar Glide

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for radial deviation

patient position: patient seated, forearm resting on ulnar aspect, wrist in resting position

stabilize: forearm proximal to wrist on radial side
mobilize: just distal to wrist around carpals
direction: ulnar direction to floor

Which radiocarpal glide for wrist flexion?

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DORSAL GLIDE

Which radiocarpal glide for wrist extension?

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Palmar Glide

Midcarpal Joint Distraction

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position: seated, foreram pronated, wrist in resting position
stabilize: distal to wrist on proximal carpals
mobilize: distal row of carpals (support as needed)
direction: distal distraction

Midcarpal Joint

dorsal glide

volar glide

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position: seated, forearm supinated (in dorsal) or pronated (in volar), wrist in resting position (prox carpals on wedge or edge of table)
stabilize: distal to wrist on proximal carpals
mobilize: distal row of carpals
mobilize: dorsal

Carpal Tunnel Syndrome

3 tests

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Tinel’s Sign: gentle tap anterior wrist where median nerve emerges from under the flexor retinaculum to the hand before it goes deep: median nerve distribution pain or parasthesia
Phalens Test: mechanically compress both median nerves by brining dorsal hands together with maximal wrist flexion for 1 minute. median nerve needs time to conduct so hold for about 1 minute : pain or parasthesia in median nerve distribution
tourniquet tets: 200mmHg inflate and see if pain or parasthesia in median nerve distribution
Tourniquet Test

Finklestein Test

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for de-quevarian disease: you will be suspicious because it will be hot and painful

AbPL or EPB

–put muscle on stretch: thumb into hand (MCP flexion) and then do ulnar deviation

+pain on AbPL or EPB

isolate tendons by their specific function

Watson Test:

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scaphoid/lunate instability

HOLD THE SCAPHOID

ULNAR DEVIATE THE WRIST

+ click or pop

tx: mobilization of scaphoid and lunate

Murphy Sign

for scaphoid lunate dislocation patient makes a fist see if third metacarpal is level with second and fourth instead of being highest indicate lunate dislocation

2 tests for scaphoid-lunate dislocation

1. Watson Test (stabilize scaphoid and ulnar deviate-pain, click, clunk) 2. Murphy sign: (fist, is 3rd metacarpal not the tallest: dislocated lunate)

TFCC Test

1. TFCC load test: ULNAR DEVIATE WRIST PUSH THROUGH 5th Metacarpal (into triquitrium/ulna) (+) pain, crepitus, clicking if not positive can stress tissue further in flexion/extension/supination/pronation 2. also we have the supination lift test: patient tries to lift examination table with palm flat on undersurface of table (+) pain or weakness tx: grade 1 in surrounding area ie capitate lunate joint protection and splinting modality for inflammation, paraffin

MP Joint

condyloid, 2DF

IP Joint

hinge, 1DF

1st CMC jt

saddle joint, 2DF flex extend: concave on convex ab/adduct: convex on concave

CMC Positions thumb vs fingers

Fingers: Rest: midway flex/extend Closed Packed: full flexion Capsular Pattern: equal in all directions THUMB Rest: midway btwn all Closed Packed: full opposition Capsular pattern: ABDUCTION then EXTENSION

MCP Positions thumb vs fingers

FINGERs: Rest: slight flexion Closed Packed: full flexion capsular pattern: FLEXION-->EXTENSION THUMB rest: slight flexion Closed Packed: full opposition Capsular pattern: FLEXION --> EXTENSION

DIP and IP Positions thumb vs fingers

Rest: slight flexion closed packed: full extension capsular pattern: FLEXION --> EXTENSION

What degrees MCP, PIP, DIP in mass grasp

MCP: 90 PIP: 120 DIP: 90

Types of Glides MCP, PIP, DIP and why

Distraction Volar Glide/Dorsal GLide Radial Glide/Ulnar Glide: MCP for ab/adduction, PIP/DIP to help stretch collateral ligaments that are bound down

Types of Glides 1st CMC and why

Palmar: to increase adduction Dorsal: to increase abduction Radial: to increase extension Ulnar: to increase flexion

CMC glides

patient position: patient seated, (ulnar border, or palm on the table), thumb in resting position (midway between flex/extend/adduct/abduct) stabilize: trapezium and trapezoid mobilize: metacarpal just distal to the joint direction: glide (start picolo and then distract, volar, dorsal, ulnar, radial glide)

General Hand Mobility metacarpals 1. arch 2. volar/dorsal

1. patient hand rests on table, grab palmar surface with fingers, and thumbs on dorsal surface: push palmar to flatten or switch fingers and push with fingers underneath to exagerate the arch: spread metacarpals to reverse the arch 2. patient hand rest on table, hold metacarpal with your thumb and index finger along the length of the bone. Mobilize the metacarpals around the 3rd metacarpal which is always held stable. Move from one metacarpal to the next and do a dorsal glide, back to neutral, palmar glide, back to neutral. My thumb is along the metacarpal and my fingers are dancing on the bone in order to stabilize on the palmar aspect/ can be facing the subject or next to.

Carpal Bone Mobility:

Dorsal back to neutral, palmar back to neutral stabilize capitate: trapezei, scaphoid, hamate, lunate Radial side: stabilize scaphoid and mobilize trapezeii Ulnar Side: stabilize triquitrium and mobilize hamate or pisiform (pisiform in radial and ulnar directions with a pincer grip)

Wartenberg Sign

for ULNAR NEUROPATHY Start: fingers abducted, palm on the table Say adduct your fingers + cannot adduct 5th digit substitutions: extend finger and drop it where we said to put it observe: hypertrophy of hypothenar eminance note sensation loss to part of 4th and 5th MMT failed: interossei, digiti minimi, lumbricals NOTE: EDM can abduct the 5th digit

Wrist Flashcards

(40 cards)