Flashcards in Wrist and hand joints Deck (17):
What are the joints of the wrist?
- Midcarpal - physiological joint
What are the joints of the hand?
What joints are within the wrist complex?
- Radiocarpal: Between distal radius and scaphoid, lunate, triquetrum. It is a condyloid joint
-Intercarpal: Between proximal and distal carpals
- Midcarpal (physiological): Between proximal and distal carpal rows
Describe the wrist joint.
- Condyloid radiocarpal joint.
- Ligamentous support: Medial collateral, Lateral Collateral, Palmar and Dorsal radiocarpa, Palmar and dorsal radioulnar
- Triangular fibrocartilaginous disc
- Blood supply: Branches of palmar and dorsal carpal arches
- Innervation: Anterior/posterior interosseous, deep branch of ulnar
What are the movements at the wrist joint and what muscles control them?
- Flexion: FCR, FCU, FDS, FDP, FPL, PL, APL.
- Extension: ECRL, ECRB, ECU, ED, EI, EDM, EPL. EPB
- Abduction: APL, FCR, ECRL
- Adduction: ECU, FCU
Describe the intercarpal joints.
- Between carpal bones in proximal and distal rows
- Joint capsule is the same as CMC joints
- Ligamentous support: Anterior, posterior, interosseous carpal ligaments
- Blood supply: Palmar and dorsal carpal arches
- Innervation: Anterior interosseous, deep branch of ulna
- Movement: gliding b/w carpals
Describe the midcarpal joints.
- Functional joint
- Condyloid tupe
- Movements:Flex/ex and radial deviation to ulnar deviation
What are the joints of the hand?
CMC and IMC joints.
- Between carpals and metacarpals
- All synovial
- CMC: 2nd + 3rd plane = Immobile; 4th + 5th hinge = Flexion/Extension; 1st saddle = F/E, Ab/Ad, Rotation, Opposition
- IMC = Plane joints
- Ligamentous support: CMC, IMC, Interosseous, Collateral
- Blood supply: Palmar arterial arches, dorsal and palmar metacarpal arteries
- Innervation: Anterior and posterior interosseous, deep ulnar
MCP and IP.
- Fibrous capsule surrounding joints
- MCP: Between head of metacrpal and base of proximal phalanx; condyloid, F/E, Ab/Ad
-IP: Between head of proximal phalanx and base of distal; Hinge, F/E
- Ligamentous support: Collateral ligaments, Transverse metacarpal ligaments, Volar plates, Dorsal Plate, Modified hinge
- Blood Supply: Palmar arterial arch
-Innervation: Median and ulnar nerves
What is skiers thumb?
Rupture of medial collateral ligament from forced abduction and extension
What are the different types of finger injuries?
- Swan-neck deformity = Ventral IP injury (compensatory flexion) or Dorsal IP injury (compensatory hyperextension
- Boutonniere deformity = Dorsal ligament rupture
- Mallet finger = Distal extensor ligament rupture - usually caused by direct blow on extended distal phalanx
Describe the synovial sheaths.
- Common flexor sheath includes tendons of FDS, FDP, FPL
- Digital synovial sheaths
- Fibrous digital sheath
- Sheath for little finger is continuous with ulnar sheath
- Fibrous sheaths are absent where lumbrical muscles attach
What are the fibrous flexor sheaths made of?
- Annular fibres and cruciform fibres
Clinical implications: Spread of infection in synovial sheath - De Quervain's tenosynovitis and digital tenovaginitis stensosans.
What does the Median nerve supply?
- Most muscles of anterior compartment of forearm
- Passes through carpal tunnel
- Also supplies muscles of the thumb
- Supplies skin of lateral 3.5 digits and nail beds
- Susceptible to compression injury in carpal tunnel - disruption to skin and potential motor and sensory loss if injured - Hand of benediction
What does the Ulnar nerve supply?
- Supplies remaining muscles in anterior compartment of forearm and hand except for thumb
- Supplies skin of medial 1.5 digits
- Susceptible to compression and/or stretch across back of medial epicondyle
- Passes superficially to flexor retinaculum
- At wrist, susceptible to compression against handlebar of bike