Wrist Flashcards
(139 cards)
1
Q
Listers tubercle acts as a pulley for
A
EPL
2
Q
Radial styloid process
A
Distal radius. Insertion of Brachioradialis
Fall into joint gap on lateral side, ulnar deviate to feel it pop into thumb.
3
Q
Ulnar styloid process
A
Distal ulna.
Posterior and proximal to radial styloid process.
No muscle attachment, but TFCC
Radially deviate to find it, flex/extend to rule out carpals
4
Q
Palpate scaphoid
A
Most lateral of the proximal carpals
Can Palpate dorsally in floor of anatomical snuff box
On palmar side it is at the base of the thenar eminence, at the intersection of the four digits when fingers flexed.
If palpated when fingers flexed will slide forward during radial deviation and flexion
5
Q
Palpate lunate
A
Proximal carpal, in between scaphoid and triquetrum
Dorsal: roll medially off Listers Tubercle, then distal into joint space.
Flex wrist and lunate should pop into contact.
6
Q
Palpate triquetrum
A
Medial proximal carpal.
“Under” pisiform; articulates with ulna and hamate.
Move distal from ulnar styloid process into joint space. Radially deviate and it should pop into contact.
Can also roll off pisiform
7
Q
Palpate pisiform
A
Palpate medial aspect of most distal crease in wrist
8
Q
Palpate trapezium
A
Most lateral distal carpal
Articulates with 1st MC and scaphoid.
Come proximal to MC 1, flex/extend to confirm. Or “top” of floor of anatomical snuff box.
9
Q
Palpate trapezoid
A
Articulates with MC #2 and scaphoid
Palpate proximal to base of MC 2.
10
Q
Palpate capitate
A
Articulates with MC #3 and lunate
11
Q
Lister’s tubercle
A
Distal dorsal radius
Extend thumb to verify palpation
12
Q
Palpate hamate
A
Dorsally, drop proximally off the end of 5th MC
Hook of hamate: 1cm distal and slightly lateral to pisiform.
13
Q
What tendon attaches to the proximal pisiform?
A
FCU
14
Q
Anatomical snuff box
A
Lateral: APL and EPB Medial: EPL Posterior: radial styloid process Floor: Scaphoid (and trapezium) Radial artery
15
Q
Tendons associated with DeQuervain’s
A
APL
EPB
(Another Long Exam Blows)
16
Q
Transverse carpal ligament
A
AKA flexor retinaculum
Attaches to pisiform, Hook of Hamate, scaphoid, and the tubercle of the trapezium
Covers carpal tunnel
17
Q
Palpate EDMinimi tendon
A
Compartment 5
Just lateral to ulnar styloid process
18
Q
Carpal tunnel
A
Under flexor retinaculum
Deep to palmar flexor
Lateral border: scaphoid and tubercle of trapezium
Medial border: pisiform and hook of hamate
Contain: median nerve, FDS, FDP, FPL
19
Q
Tunnel of Guyon
A
AKA ulnar tunnel
Ulnar artery and nerve pass in between pisiform and the Hook of Hamate
Floor: pisohamate ligament and flexor retinaculum
Roof: palmar carpal ligament and palmaris brevis ligament
20
Q
Thenar eminence (superficial to deep)
A
AbPB
FPB
OppPolBrev
21
Q
Hypothenar eminence (superficial to deep)
A
AbDigMin
Flex Dig Min B
OpDigMin
22
Q
Distal Radioulnar joint
A
Synovial pivot
Head of ulna (convex) on Ulnar notch of radius (concave)
1 degree of freedom (sup/pro)
Resting: 10° sup
Closed pack: 5° sup
Capsular pattern: pain at extreme pronation or supination
23
Q
Distal RU: ROM and end feel
A
Supination 90° firm
Probation 70-90° firm/hard
24
Q
Radiocarpal joint
A
Synovial ellipsoid
Scaphoid and lunate (convex)’on distal radius (concave)
2 degrees of freedom (flex/ext, rad/uln dev)
Resting: neutral, slight ulnar deviation
Closed pack: full extension
Capsular pattern: equal all around
25
Ulnomeniscotriquetral joint
Synovial ellipsoidal
Triquetrum (convex) on disc (concave)
2 degrees of freedom (flex/extend and uln/rad dev
Resting: neutral, slight ulnar dev
Closed pack: full extension
Capsular pattern: equal all around
26
Midcarpal joints
Between proximal and distal rows of carpal (except pisiform)
Resting: neutral or slight flexion, with slight ulnar deviation
Closed pack: extension with ulnar deviation
Capsular pattern: flexion=extension
27
RadCarp, UMT and MidCarp: ROM and end feel
Flexion: 80° firm
Extension: 70° firm
Radial Dev: 20° firm
Ulnar Dev: 30° firm
28
Radial collateral ligament
Radial styloid process to tubercle of scaphoid and trapezium
Limits ulnar deviation
29
Palmar radiocarpal ligament
Limits extension
| stronger then dorsal
30
Dorsal radiocarpal ligament
Limits flexion
Weaker than palmar
31
Ulnar collateral ligament
Ulnar styloid process to triquetrum and hamate
Limits radial deviation
32
Ulnocarpal ligaments
Palmar and dorsal.
Limit extension and flexion respectively
33
UMT joint primarily involved in what movement
Supination/pronation.
34
Triangular fibrocartilage complex (TFCC)
The meniscus and disc in the UMT
Disc Extends from medial distal radius to ulnar styloid process, prevents direct articulates of ulna with triquetrum (and maybe lunate)
Cushion and stabilizer for distal RadUln jt
35
With supination/pronation the TFCC:
Disc moves with radius and carpals, sweeps around ulna
36
With flexion/extension the TFCC:
Disc stays with radius and ulna; movement occurs between disc and carpals.
37
Intercarpal joints
Between carpals of the same row
Only slight gliding movement
Dorsal, palmar and interosseus ligaments
Resting: neutral or slight flexion
Closed pack: extension
No capsular pattern.
38
Palmar ligaments are _______ than dorsal.
Stronger.
39
Carpometacarpal Joint #1
Trapeziometacarpal
Saddle joint
3 degrees of freedom (flex/ext, ad/abduction, rotation)
Dorsal and palmar ligaments
Resting: midway
Closed pack: full opposition
Capsular pattern: abd then extension
40
Carpometacarpal joints 2-5
Plane joints (slight gliding only)
Dorsal, palmar and interosseus ligaments
4&5 more mobile
Resting: midway between flex/ext
Closed pack: full flex
Capsular pattern: equal in all directions
41
Intermetacarpal joints
2-5 only
Slight gliding
Palmar, dorsal and interosseus ligaments
42
Metacarpophalangeal joint # 1
Semicondyloid joint
3 degrees of freedom: flex/ext, ab/adduction, rotation
Resting: slight flexion
Closed pack: full opposition
Capsular pattern: flexion more than extension
43
Sesamoid bones (thumb)
On palmar surface of MC 1. With tendons of Add Pol and FPB
Attach to volar plate and to medial and ulnar collateral ligament
44
Metacarpophalangeal joints 2-5
Condyloid joints
2 degrees of freedom (flex/ext, ab/adduction)
Collateral, palmar and deep transverse ligaments.
Resting position: slight flexion
Closed pack: full flexion
Capsular pattern: flexion more than extension
45
Volar plates
Thick ligament that span MCP and IP joints
Anterior/palmar
Reinforce capsule, limit hyperextension
46
Interphalangeal Joints
Hinge
Flex/ext
Some rotation during flexion
Fibrous capsule, palmar and collateral ligaments
Resting: slight flexion
Closed pack: full extension
Capsular pattern: flexion > extension
47
Lumbricals manus
Digits 2-5
Origin: tendon of FDP to proximal tendons go ExtDig of same finger. Lateral side of finger MC->Prox phalanx
#3 and 4 bipennate: also insert at Prox phalanx of digits 3&4
Flexion MCP 2-5
Extension PIPs and DIPs 2-5
Median and/or ulnar nerve
Ulnar and radial artery
48
Palmar interossei
Unipennate. Three.
Base of MC 2, 4, 5 --> base of prox phalanx 2,4,5
ADduction of 2,4,5
Ulnar nerve
Radial and ulnar artery
49
Dorsal interossei
Bipennate. Four.
Bodies of MC 1-5 --> base of prox phalanx 2,3,4
Abduction of 2,3,4
Ulnar nerve
Radial and ulnar artery
50
MMT: ECRL
Seated. Elbow 90°. Forearm pronated, resting on table. Wrist extended and radially deviated.
Pressure against wrist flexion and ulnar deviation
51
MMT: ECRB
Seated. Leaning forward so elbow fully flexed. Forearm pronated and resting on table. Wrist extended and radial deviated
Apply pressure towards flexion and ulnar deviation.
52
MMT extensor digitorum
Seated. Elbow flexed. Elbow stabilized. MCP extended PIPs and DIPs flexed
Apply pressure towards MCP flexion
53
MMT ECU
Seated. Elbow at 90°. Wrist extend and ulnar deviated
Apply pressure towards wrist flexion and radial deviation.
54
MMT Palmaris Longus
Elbow 90°. Forearm up. Wrist flexed. Fingers making beak hand.
Attempt to open beak and extend wrist
55
MMT FDS
Seated. Sublimated forearm on table. Flex at PIPs. Stabilize DIPs, MCP
Apply pressure towards PIP extension
56
MMT FDP
Supinated forearm resting on table. Flex at DIPs. Stabilize PIPs
Apply pressure towards DIP extension.
57
Primary axis for flexion-extension is through the __________ (carpal).
Capitate
58
Wrist flexion is primarily at what joint,
Midcarpal
59
Wrist extension is primarily at what joint?
Radiocarpal
60
Close pack position of the wrist
Slight supination with extension
61
"Screw Home" mechanism (wrist)
As wrist extends, the distal carpals become close-packed with the scaphoid.
Lunate and triquetrum then move independent of scaphoid
Resulting supination twists capsules and ligaments --> close packed
62
Most commonly fractured carpal
Scaphoid
63
Most commonly dislocated carpal
Lunate
| Dislocates anteriorly/palmarly
64
During ulnar and radial deviation the axis of movement is through the
Capitate
65
What happens to the proximal carpals during radial deviation?
PPUF
Pronation
Ulnar glide
Flexion
66
What happens to the distal carpals during radial deviation?
DSUE
Supination
Ulnar glide
Flexion
67
During extension what direction do the carpals glide?
Anterior
68
Carpal Tunnel Syndrome
Compression of the median nerve through the carpal tunnel.
69
CTS compression occurs because of
1 decreased tunnel size
2 increased component size
3 combination of the above
70
CTS: Hallmark sign
Nocturnal neuro Sx
Also: "tearing" sensation at palmar fascia
HT forearm flexors
Atrophied thenars
Decreased dexterity
71
CTS: thumb sensation
Unaffected because palmar cutaneous branch of median nerve doesn't pass through carpal tunnel.
72
CTS: special tests
```
Phalens
Flexion ligamentous stress test
Reverse Phalens
Extension ligamentous stress test
Tinel's
```
73
CTS: DDx
Pronator teres syndrome (Rule out with pronator teres syndrome test. No nocturnal Sx)
C6-7 Radiculopathy (increased Sx with neck movement)
TOS (Sx more ulnar)
Double crush. ULTT if positive decrease tension on that site and test other sites
74
Dupuytren's Contracture
Flexion deformity due to contraction of palmar fascia. Non inflammatory. No pain
Usually HT of palmaris longus; it that's absent then FCU
Idiopathic
75
Dupuytren's: Sx
Bilateral
Thick, puckered, noduled palmar fascia
MCP and IP flexion, usually D4&5
HT wrist flexors
Decreased IP AROM
76
Dupuytren's; Tx
MFR: flexors, palmar fascia
NMT: flexors (palmaris longus, FCU)
JM: tractions; ant glide MCP DIP PIP
PStretch: flexors
Remex: DMH, SFMR fascia, stretch flexors, selfPROM finger extensor a
77
How many functional arches of the hand?
4 (1 longitudinal, 3 transverse)
78
What do the functional arches of the hand allow for?
Gripping, cupping
79
Longitudinal arch of the hand
Each finger and its corresponding carpal
| Arches centered around their MCP joints
80
Focal point of the longitudinal arch
Capitate + long finger
81
Transverse arches of the hand
2 transverse carpal + 1 transverse metacarpal
82
Transverse carpal arch
Made of the proximal and distal rows of carpals
| Distal row centres around the capitate and is less mobile.
83
Transverse metacarpal arch
Formed by heads of metacarpals
Centre point: MC 3, lunate, capitate
84
Cascade sign
In finger flexion, the index finger flexes in the sagittal plane (straight down) and the other fingers flex toward the scaphoid tubercle.
85
Cupping of the hand involves ____________; flattening involves _______________.
finger flexion
| finger extension
86
Muscles of the wrist perform what two functions?
1. provide fine adjustment of the hand into its functioning position
2. once in position, stabilize the wrist to provide a stable base
87
As grip strength increases, wrist extensors ....
Slacken
| This allows for flexors to shorten
88
Greatest IP flexion force is during
ulnar deviation and neutral flexion/extension (power grip)
89
Dorsal digital expansion is composed of
Extrinsic extensor tendon and sheath (posteriorly)
| Intrinsic tendons of interosseous muscles and lumbricals (anteriorly)
90
DDE: Origin and insertion
O: posterior, medial and lateral proximal phalanges 1-5
I: posterior distal phalanges 1-5
91
Extrinsic extensor tendon
Extensor digitorum and Extensor pollicis longus
Attach posteriorly to the DDE
Exert force at the MCP
92
Intrinsic extensor tendon
Lumbricals and interossei
Attach anteriorly to the DDE
Extend IP 2-5 only
93
4 types of prehension
Pinch
Encircle
Push
Adhere
94
2 groups of prehension
Power and precision
95
Power grip
Forceful act with isometric flexion at all fingers
Cylindrical
Spherical
Hook
Fist/Lateral
96
In power grip, movements are produced by
Radial or ulnar deviation at the wrist (think hammering), supination and pronation of the wrist, and/or elbow extension
97
Precision grip
No contact with palm. No static phase
Isotonic contraction of D1-3
Palmar pinch
Lateral pinch (opposition)
Tip prehension
98
Nerve(s) involved in power grip
Median and ulnar
99
Nerve(s) involved in precision grip
median
100
Primary muscles in power grip
extrinsic
101
Primary muscles in precision grip
intrinsic
102
Swan Neck deformity
Flexion in MCP and DIP
(hyper)Extension in PIP
Caused by contracture of intrinsic muscles or tearing of the volar plate
RA, trauma
103
Boutonniere deformity
Extension of MCP an dDIP
Flexion of PIP
Rupture of central slip of DDE
RA, trauma
104
Dupuytren's contracture
Contracture of the palmar fascia
Fixed flexion deformity of MCP and PIP joints
Idiopathic
105
Heberden's Nodes
Dorsal DIP
| Associated with OA
106
Bouchard Nodes
Dorsal PIP
| Associated with OA
107
Ulnar Drift
Seen in RA
| Due to weakening of MCP capsuloligamentous structures and pull of long tendons
108
Zigzag deformity
Thumb
CMC flexion
Hyperextended MCP
RA
109
Z deformity
Thumb
hyperextension of IP
Familial
110
Mallet Finger
Permanent flexion of the DIP because of rupture/avulsion of extensor tendon at distal insertion
111
Ape hand
Median nerve palsy.
Thumb in line with fingers because of unchecked extensors
Inability to flex or oppose thumb
Muscle wasting at thenar eminence
112
Benediction Hand/Ulnar Claw
Ulnar nerve palsy
MCP hyperextension, DIP/PIP flexion in D4&5
Can't extend 4&5
Wasting of hypothenars, interossei, 2 medial lumbricals
113
Oath Hand
Median nerve palsy
Can't flex 1-3
MCPs flexed
114
Claw fingers
Combined ulnar and median nerve palsy
MCP hyperextended and PIPs/DIPs flexed
Loss of intrinsic muscle function and loss of functional arches of the hand
115
Wrist drop
Radial nerve palsy
Inability to extend fingers and wrist
116
What movements primarily happen at the midcarpal joint?
Flexion and radial deviatioin
117
What movements primarily happen at the RC joint?
Extension and ulnar deviation
118
Which muscle's referral pattern is similar to the pain felt in lunate dislocation?
FCR
119
Abductor digiti minimi manus
O: pisiform and tendon of FCU
I: proximal phalanx of D5
Abduction of D5
Ulnar nerve
Ulnar artery
120
Flexor digiti minimi manus
O: flexor retinaculum and hook of hamate
I: proximal phalanx of D5
Flexion of D5
Ulnar nerve
Ulnar artery
121
Opponens digiti minimi
O: flexor retinaculum and hook of hamate
I: MC#5
opposition of D5 at CMC joint
Ulnar nerve
Ulnar artery
122
Adductor pollicis
Oblique head: bases of MC 2 & 3, capitate (travels through medial sesamoid)
Transverse head: distal MC 3
Insertion: medial proximal phalanx thumb
Adduction of thumb at CMC
Ulnar nerve
Radial artery
123
Carpal Tunnel
| Syndrome
Compression of the
Median nerve as it passes through carpal tunnel.
Due to small tunnel and/or big contents.
124
CTS: Sx
Hallmark: nocturnal neurological Sx
Unilateral
Also:
Tearing sensation in palmar fascia
HT flexors
Atrophied thenars
125
CTS and Thumb
Unaffected because palmar cutaneous branch passes over carpal tunnel.
126
CTS: special tests
Phalens, Flexion Ligamentous
Reverse Phalens, Extension Ligamentous
Tinels
127
CTS: DDx
C6-7
Pronator Teres syndrome
TOS
Double Crush
128
CTS vs C6-7 Radiculopathy
C6-7 Radiculopathy: Sx increase with neck movement
CTS: Sx increase with wrist movement
129
TOS vs CTS
TOS: Sx prox to wrist. Thumb involvement. Tends to be more ulnar
130
Pronator Teres Syndrome vs CTS
Pronator Teres; no nocturnal pain, Sx increase with elbow flexion; thumb involvement; Sx proximal to wrist
CTS: nocturnal pain; Sx worse with wrist movement; no thumb involvement
=> pronator Teres syndrome test
131
Double Crush Syndrome vs CTS
ULTT. When one site tests positive, relax it but continue testing remaining sites.
132
CTS: Tx
MFR: flexor retinaculum
NMT: FDS, FDP, FPL
JM: wrist
MLD
PStretch: palmar fascia, flexors
ReMex: stretch flexors;
133
Gamekeeper's thumb
UCL sprain of MCP 1
AKA skiers thumb
Pain in webspace
Weakness and pain in punch
134
Trigger Finger
Digital tenovaginitis/tenosynovitis
Thickening of flexor tendon sheath, development of nodules
Sticking when going from Flexion to extension
Idiopathic
135
Lunate Dislocation
Most common carpal dislocation
MOI FOOSH with hyperextension
Sx: swollen wrist, pain with extension, possible median nerve Sx
Extension ligament stress test
136
Lunate dislocation: ROM
Pain with extension - A,P,R
Bony end feel
Weak extension
137
Scaphoid Fracture
Most commonly fractures carpal
MOI: FOOSH with radial deviation
Sx: radial side pain, especially with radial deviation and extension
Tender anatomical snuffbox
138
Complication of galeazzi fracture
Ulnar nerve lesion
139
Complication of Colles fracture
Median nerve lesion
