Wrist and Hand Flashcards
(124 cards)
0
Q
What is the purpose of more bones in a joint?
A
Allows for more mobility
1
Q
What are the two types of joints that comprise the wrist joint?
A
Radiocarpal joint and midcarpal joint
2
Q
What are the motions of the wrist?
A
Flexion, extension, radial deviation, ulnar deviation, and circumduction
3
Q
What is the normal ROM of wrist flexion?
A
65-85*
4
Q
What is the normal ROM of wrist extension?
A
60-85*
5
Q
What is the normal ROM of radial deviation?
A
15-21*
6
Q
What is the normal ROM of ulnar deviation?
A
20-45*
7
Q
What is the purpose of having two joint in the wrist joint?
A
Permits larger ROM with less articular surface exposed and allows for flatter joint surfaces that can tolerate more pressure
8
Q
What is the structure of the proximal segment of the radiocarpal joint?
A
Concave
9
Q
What is the structure of the distal segment of the radiocarpal joint?
A
Convex
10
Q
What comprises the proximal radiocarpal joint?
A
Radius and radioulnar disc
11
Q
What comprises the distal segment of the radiocarpal joint?
A
Scaphoid, lunate, and triquetrium
12
Q
Does the ulna connect with the carpal bones?
A
No - reason is because of the triangular fibrocartilage complex
13
Q
What is important about the position of the proximal radiocarpal joint?
A
Angled slightly: reason why you can get more ulnar deviation
Volarly - 11*
Ulnarly - 23*
14
Q
What is the % of contact between the proximal radiocarpal joint surfaces?
A
20-40%
15
Q
Which ROM is greater, flexion or extension?
A
Flexion
16
Q
Which ROM is greater, ulnar deviation or radial deviation?
A
Ulnar deviation
17
Q
What % of compression is sustained by the scaphoid?
A
80%
18
Q
What % of compression is sustained by the triangular fibrocartilage complex?
A
20%
19
Q
What is positive ulnar variance?
A
Ulna is almost at the same height as the radius
20
Q
What is negative ulnar variance?
A
Ulna is shorter than the radius
21
Q
What is FOOSH?
A
Falling on an outstretched hand
22
Q
Which carpal bones are proximal?
A
Scaphoid, lunate, and triquetrium
23
Q
What carpal bones are distal?
A
Trapezium, trapezoid, capitate, and hamate
24
What are extrinsic ligaments?
Connect the carpals to the radius and ulna
25
What are intrinsic ligaments?
Interconnect the carpals
26
Which type of ligament is weaker?
Extrinsic
27
What type of ligament has a better potential for healing?
Extrinsic
28
What is the closed pack position for the wrist joint?
Extension
29
What is important about the wrist joint?
Very complex!
30
What is the closed pack position for the radiocarpal and midcarpal joints?
Radial deviation
31
What is the minimum wrist ROM for function/ADL's?
Flexion - 10*
Extension - 35*
or
Flexion - 54*
Extension - 60*
UD - 40*
RD - 17*
32
What two positions are most important for function?
Extension and ulnar deviation
33
What are the ROM values for fusion?
20* of extension and 10* of UD
34
What is the primary role of wrist muscles?
Provide stable base for hand and adjust position to achieve optimal length-tension relationship
35
What are the primary wrist flexors?
PL, FCR, and FCU
36
What two muscles do flexion and avoid deviation?
FCU and FCR
37
What percentage of people are missing their PL?
14%
38
What is the importance of the pisiform?
Allows for a longer moment arm for the flexor carpi ulnaris
39
What is Carpal tunnel?
Compression on the median nerve - surgery done to cut flexor retinaculum
40
What are the primary wrist extensors?
ECU, ECRL, and ECRB
41
What muscles work together to produce extension and avoid deviation?
ECU, ECRB, and ECRL
42
What extensor muscle is affected in forearm pronation?
ECU - decreased moment arm
43
What are the hand compartments?
```
1 -
2 -
3 -
4 -
5 -
6-
```
44
What two muscles cause flexion?
FCR and FCU
45
What three muscles cause extension?
ECRL, ECRB, and ECU
46
What three muscles cause RD?
FCR, ECRL, and ECRB
47
What two muscles cause UD?
ECU and FCU
48
Where does the transverse carpal ligament lie?
Between the hook of hamate/pisiform and the scaphoid/trapezium
49
What is an "ape hand"?
Atrophy of the thenar eminence muscles due to median nerve injury
50
How many bones and joints comprise the hand?
19 bones and 19 joint distal to the carpals
51
Which CMC joints have the least mobility?
2nd and 3rd
52
Which CMC joint has the most flexion and extension?
4th
53
How many degrees of freedom does the 5th CMC have regarding flexion/extension and ADD/ABD?
2
54
Regarding the MCP joint, what is convex and what is concave?
Metacarpal - convex
| Base of phalange - concave
55
How many degrees of freedom does the MCP joint have regarding flexion/extension and ABD/ADD?
2
56
What type of joint is the MCP?
Condyloid joint
57
How many degrees does the surface of the metacarpal head have?
180* mainly volarly
58
How many degrees does the surface of the phalanx have?
20*
59
What is the open pack position for the MCP joint?
Extension
60
What structures enforce the MCP joint?
2 collateral ligaments and volar plate
61
What is the function of the volar plate?
Protects articulating surface and blends with deep transverse metacarpal ligaments
62
What is the function of the annular pulleys?
Keep the tendon outside of the joint but close to the bone
63
What is the closed pack position for the MCP joint?
Flexion
64
When are the collateral ligaments taught?
Full MCP flexion
65
What finger has the greatest and least amount of MCP flexion?
```
Greatest = 5th (110*)
Least = 2nd (90*)
```
66
When is ABD and ADD maximum at the MCP joint?
Full extension
67
What type of joint is the IP joint?
Synovial hinge
68
How many degrees of freedom are in the IP joints?
1
69
What type of surface is the proximal end of the IP joint?
Concave
70
Which has greater flexion, PIP or DIP?
PIP
71
Which PIP and DIP has the greatest flexion?
5th finger
72
What is the reason for the fingers being angled toward the scaphoid?
Facilitates opposition of fingers with thumb
73
How do you immobilize a joint?
Position that will minimize contractures
74
How is the MCP joint immobilized?
Flexion
75
How are the IP joints immobilized?
Extension
76
How is the thumb CMC immobilized?
ABD
77
Where does the FDS attach?
DIP
78
What is the action of the FDS?
Flex PIP and MCP
79
When does the FDS have the greatest and lesser moment arm?
```
Greatest = MCP
Lesser = PIP
```
80
What does the FDP do?
Flexes DIP, PIP, and MCP - primary muscle with gentle pinch
81
What does the FDS and FDP depend on regarding optimal length-tension?
Wrist position
82
Which muscle, FDP or FDS, is not able to flex both IP joints at the same time?
FDP
83
Which muscle has to be absent in order for the DIP to flex and the PIP to flex during forceful pressure?
FDS
84
What is the pistol grip?
Finger flexion grasp that is wider ulnarly - digits 4-5 will not have to flex as much minimizing loss of tension (holding a hammer)
85
What are structures that aid in smooth gliding and close contact of the tendons of finger flexors to bone?
Flexor retinacula, bursae, and digital tendon sheet (synovial sheaths)
86
What is the function of the synovial sheaths?
Cover tendons and allow for nutrition
87
Which muscles perform MCP extension?
ED, EDM, EI - also perform wrist extension
88
What does the ED tendons split into?
Central tendon and lateral bands distal to the PIP joint
89
What tendon crosses the PIP joint?
Central tendon
90
What tendon crosses the DIP joint?
Lateral tendons
91
What are the functions of the ED?
MCP joint extension and PIP and DIP flexion
92
What is needed in order to achieve PIP and DIP extension?
Intrinsic muscles
93
What are the intrinsic muscles?
Dorsal and volar (palmar) interossei - arise between the metacarpals and does not cross the wrist joint
94
Where do the interossei attach?
Extensor hood, central tendon, and lateral bands
95
What is the function of the interossei?
1. Compress MCP when in extension
2. MCP and finger ADD/ABD in extension
3. Simultaneous DIP and PIP extension
96
When do the interossei have the greatest moment arm?
MCP joint flexion - can produce greater flexion torque at MCP
97
What is the function of the interossei and lumbricals?
MCP flexion and DIP and PIP extension
98
Where do the lumbricals attach?
FDP tendon and lateral bands of the extensor mechanism
99
What hand position is the result of loss of intrinsic muscles?
Clawing - splint is consequently used to keep MCP in flexion so that the ED can cause PIP and DIP extension without the intrinsic muscles
100
What is important about having a EDM and EI?
Can put up "rock" sign
101
What is needed in order to hyperextend the PIP and flex the DIP?
Hypermobility
102
What does "intrinsic plus" position mean?
Have to use the intrinsic muscles (lumbricals) in order to achieve the position
103
What is Boutonniere deformity?
Rupture of the central tendon - hyperextension of the DIP
104
What type of joint is the thumb MCP?
Condyloid
105
How many degrees does the thumb MCP have?
2
106
Does the thumb MCP have more or less ROM than the other fingers?
Less ROM
107
What is the function of the sesamoid bone?
???
108
What are the extrinsic thumb muscles?
FPL, EPB, EPL, and APL
109
Where does the EPL attach?
Distal phalanx
110
Where does the EPB attach?
Proximal phalanx
111
Where does the APL attach?
Base of metacarpal
112
What are the extrinsic thumb muscles affected by?
Wrist position
113
What are the five intrinsic thumb muscles?
Thenar eminence - OP, APB, FPB, AP, and first volar (palmar) interossei
114
What shape is the first dorsal interossei muscle?
Bipennate - arises from 1st and 2nd metacarpal
115
What is the power grip?
Full hand prehension - baseball grip
116
What is the precision handling grip?
Finger-thumb prehension - buttoning a shirt
117
What is the cylindrical grip?
Holding a phone
118
What is a spherical grip?
Holding a small ball
119
What is a hook grip?
Holding a briefcase
120
What is lateral prehension?
Holding an object between two adjacent extended fingers
121
What are the three types of pinch grip?
1. Pad to pad prehension
2. Tip to tip prehension
3. Pad to side prehension (lateral pinch) - holding a key
122
Which type of grip does not have DIP flexion?
Pad to pad
123
What type of grip has to have DIP flexion?
Tip to tip
