Wrist and Hand

Question 1

Hand Architecture

Answer 1

Central Column/ Pillar effect
Stable at CMC 3
Flanked by mobile segments

Question 2

Keystone Carpal Bone

Answer 2

Capitate

Question 3

flexion ROM

Answer 3

80-90 degrees

Question 4

Extension ROM

Answer 4

70-80 degrees

Question 5

Radial Deviation ROM

Answer 5

20-25 degrees

Question 6

Ulnar deviation ROM

Answer 6

30-35 degrees

Question 7

Radiocarpal Joint

Answer 7

Radius and TFC with scaphoid, lunate, and triquetrum

Question 8

Lateral Radial facet

Answer 8

articulates with scaphoid

46% of RC joint

Question 9

Medial radial facet

Answer 9

articulates with lunate

43% of RC joint

Question 10

inferior radioulnar disc

Answer 10

articulates w/ triquetrum

11% of RC joint

Question 11

RC joint shape

Answer 11

convex carpals on convex radius

Question 12

Midcarpal joint

Answer 12

functional unit
-no isolated capsule
-interrupted multiarticular surface
condyloid

Question 13

Clinical implication of ligament integrity

Answer 13

weaked palmar area near the lunate= palmar dislocation of lunate most common
Ganglion cysts on proximal pole of the scaphoid

Question 14

Dorsal Radiocarpal ligament

Answer 14

Thickening of capsule
Lunate and radius contact
Check rein to end range flexion

Question 15

Radial and Ulnar Collateral ligaments

Answer 15

check rein to frontal plane motions

Question 16

Volar radiocarpal ligament

Answer 16

most important of all ligaments for stability and passive motion contribution
3 bands

Question 17

RC joint flexion

Answer 17

50 degrees

Question 18

MC joint flexion

Answer 18

35 degrees

Question 19

Wrist flexion

Answer 19

85%

Question 20

RC extension

Answer 20

35 degrees

Question 21

MC extension

Answer 21

50 degrees

Question 22

Wrist extension

Answer 22

35 degrees

Question 23

Coupled motions at wrist

Answer 23

Flexion and ulnar deviation

Extension and radial deviation

Question 24

Ulnar tilt

Answer 24

Tilt of radius from styloid to articulation w/ ulna

~25 degrees

Question 25

RC joint arthrokinematics

Answer 25

Flexion: palmar roll dorsal glide Extension: dorsal roll palmar glide Radial deviatoin: radial roll ulnar glide Ulnar deviation: Ulnar roll radial glide

Question 26

Midcarpal ulnar joint arthrokinematics

Answer 26

Convex on Concave in both planes Flexion: palmar roll and dorsal glide Extension: dorsal roll and palmar glide

Question 27

Midcarpal radial joint arthrokinematics

Answer 27

Concave on convex in both planes Flexion: palmar roll and glide Extension: dorsal roll and glide

Question 28

Radial deviation arthrokinematics

Answer 28

Proximal row moves palmarly | Distal row moves dorsally

Question 29

Ulnar deviation arthrokinematics

Answer 29

Proximal row moves dorsally | Distal row moves palmarly

Question 30

Wrist closed pack

Answer 30

45 degrees wrist extension and slight radial deviation

Question 31

Wrist open pack

Answer 31

Slight flexion w/ slight ulnar deviation

Question 32

Wrist muscle synergies

Answer 32

ECR and ED: Substitution if weak ECR FCU and ADM: FCU stabilizes pisiform ECU and EPLB: ECU maintains neutral during thumb ext

Question 33

Tenodesis

Answer 33

Minimal activity wrist extension shortens flexors | Increased passive tension. Gravity flexes wrist to allow positioning, extension flexes fingers to allow gripping

Question 34

CMC joints

Answer 34

Plane synovial 2-4 concave on convex | Condyloid saddle 5 2 DF concave on convex

Question 35

CMC 1 joint

Answer 35

saddle biaxial joint b/w 1 metacarpal and trapezium trapezium concave saggital plane=convex on concave trapezium convex frontal plane=concave on convex

Question 36

CMC ROM

Answer 36

15-20 flexion 20-30 extension 70 abduction

Question 37

CMC 2-5 Arthrokinematics

Answer 37

Concave on convex

Question 38

MCP joints arthrokinematics

Answer 38

2-5 condyloid joint | Concave on convex

Question 39

IP joints

Answer 39

Concave on convex

Question 40

Power grip

Answer 40

Stability Large forces Sphere or cylinder objects

Question 41

Precision Grip

Answer 41

Requires contour delicate action Egg

Question 42

Precision Pinch

Answer 42

Fine control between index and thumb tip-to-tip pulp-to-pulp

Question 43

Power pinch (Key)

Answer 43

larger forces | stability of object occurs b/w thumb and lateral border of index finger

Question 44

Hook grip

Answer 44

No thumb | Requires partial flexion PIP and DIP; static natured for longer periods. FDP primarily

Question 45

Swan-neck deformity

Answer 45

RA implicated Synovitis Flexed MCP, extended PIP, flexed DIP

Question 46

Boutonniere deformity

Answer 46

RA implications | Extended mcp, flexed pip, extended dip

Question 47

Position of rest

Answer 47

``` wrist extension 20 Ulnar deviation 10 MCP flexion 45 PIP flexion 30 DIP slight flexion ```

Question 48

Position of immobilization

Answer 48

Less wrist extension than rest, more MCP flexion, neutral IP | Minimizes potential for contracture