Wrist And Hand Preclass Flashcards by Brooke Niles

Thumb contributes what percent of hand function

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3 main arches of hand

Longitudinal
Metacarpal phalangeal transverse
Carpal tunnel

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Distal radioulnar joint

Uniaxial pivit joint

Pronation supination occur here-ulna not fixed

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Ulna moves ___ for pronation

Back and lateral

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Ulna moves ___ for supination

Forward and medial

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Distal RU resting

10 deg supination

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distal RU closed pack

5 deg supination

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Distal RU capsular pattern

Pain at extreme of rotation

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DRUJ trauma

Fall on pronated and ulnarly deviated hand

Injury here accompanies forearm fx

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DRUJ trauma symptoms

Ulnar sided wrist pain associated w/ pronation and supination
Tenderness and swelling over joint
Clunks during rotation (possible TFCC tear)

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Forces when you fall

80% up radius
20% up ulna
Load differential based on radial angulation of 10-15 deg volar LT and 20-25 deg toward ulna

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During immobilization for collies Fox

Edema control and retrograde massage of hand
-HEP for mainting ROM of shoulder, elbow, digits (full MP flex)
-full composite digitize flexion and extension
Tendon gliding

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Radiocarpal joint

2 deg freedom
Radius post portion extends distally
Articulate w/ scaphoid and lunate
CONVEX rule

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TFC disc

Attaches at ulnar side of radius
Attaches to ulnar styloid process
Articulates w/ lunate and triquetrum
Acts as stabilizer and shock absorber
Commonly injured w/ FOOSH

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Load bearing ration for TFC disc

Intact 60:40 radius to ulna

Removed is 95:5

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TFCC acute trauma

Peripheral tears

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TFCC degeneration

Central tears

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TFCC injury

Ulnar impaction or positive ulnar variance may contribute to lesion
Local tenderness, pain w/ pronation/sup and forceful gripping
May also hear clicking w/ motion

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Ulnar impaction and positive ulnar variance - radiograph

May show flattening, subchrondral sclerosis or cysts, lyric changes in lunate/triquetrum w/ similar changes seen over distal ulna

pt may have positive ulnar variance
in subtle cases, a pronation grip gradiophragph may demonstrate ulnar variance

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Carpal stability

Ligaments
Scapholunate ligament is commonly injured
Palmar ligaments stronger than dorsal

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Scaphoid Fx

Falling onto radial side of hand w/ supination and ext

Young active people

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Most frequently fractured bone in the wrist

Scaphoid

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Fractures and the waist

70% occur through the waist

Proximal Fx above the waist lead to a vascular necrosis

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Scaphoid Fx symptoms

Snuff box effusion and tenderness
Local tenderness to palpation over scaphoid tubercle w/ wrist extended
Snuff box pain w/ resisted pronation

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Wrist dislocation

Most commonly involve Lunate and scaphoid May or may not spontaneously reduce Can compress median n

Wrist hyperextension dislocation

Volar subluxation of lunate

Dorsal wrist syndrome

Scapholunate snovitis w/ or w/out measurable ligamentous disruption - pain w/ activity - post activity aching - dorsal tenderness over scapholunate joint - provocation w/ resisted finger ext in wrist flexion

Tears of IO ligament

Volar lunate—> dorsal scaphoid | Volar rotary subluxation occurs w/ complete disruption of scapholunate lig

Radiocarpal resting

Neutral w/ slight ulnar deviation

Radiocarpal closed pack

Extension

Radiocarpal capsular pattern

Flexion and extension equally limited

Most common site for restricted motion after immobilization

Intercarpal joints | Minimal amounts of gliding occur here

Intercarpal resting

Neutral or slight flexion

Intercarpal closed pack

Extension

Intercarpal capsular pattern

None

Medial midcarpal joints

Scaphoid, lunate, triquetrum Articulate w/ Capitate and hamate

Lateral medial carpal joints

Scaphoid articulates w/ trapezium and trapezoid

Midcarpal joints bound by

Palmar and dorsal lig | No IO

Midcarpal center of rotation

Base of capitate for wrist flexion/ext, radial/ulnar deviation

Wrist extension and flexion occurs primarily at

Radiocarpal joint | So target here before midcarpal if they’re lacking movement

Midcarpal resting position

Neutral or slight flexion w/ ulnar deviation

Midcarpal closed pack

Extension w/ ulnar deviation

Midcarpal capsular pattern

Equal limitation of flexion and extension

Carpal tunnel roof

Volar | Transverse carpal lig

Carpal tunnel floor

Dorsal | Volar radiocarpal lig, volar intercarpal lig, carpals form concave arch

Carpal tunnel medial wall

Pisiform and hook of hamate

Carpal tunnel lateral wall

Tuberosity of scaphoid and tubercle of trapezium

Carpometacarpal joint

2-4 plane synovial - gliding 5 resembles stellar Thumb is true stellar

First CMC joint arthro

Radial ab/ad concave | Palmar ab/ad convex

MCP movements

2-5 flex/ex, and ab/ad 1 only flex/ext and some rotation Collateral light right in flexion

Wrist power

Extrinsic muscles

Wrist fine control

Interinsic muscles

20-30 deg wrist ext allows

Maintenance and development of required tension

Functional position of the hand

20-25 deg wrist ext | 10-15 deg ulnar devation

Position of hand immobilization

Similar to functional position but MP flexed, IP extended | Decreased potential for contracture

Power grip

Finger flexion, ulnar devation and wrist ext

Median nerve entrapment - wrist

Pronator teres or FDS Carpal tunnel The air eminence

Radial nerve entrapment - wrist

Arcade of froshe B/n tendon os ECRL and brachioradialis Along the radius

Ulnar nerve course

Courses through 2 heads of FCU •  Enters Guyon’s tunnel formed by the pisiform, hook of the hamate and pisohamate ligament

Wrist hyperextension injuries may result in

Capsuloligamentous injury | Lightamentous sprain and/or fx

Long standing wrist/hand problems may have

RSD or CRPS

Wrist drop

Radial nerve palsy

Claw hand

Intrinsic minus hand Combined median and ulnar nerve palsy MP ext PIP and DIP flexion

Ape hand

Median nerve palsy Put unable to oppose or flex thumb Thenar eminence wasting

Bishop’s hand

Ulnar nerve palsy Waisting of hypothenar eminence Loss of interossei and two medial lumbricals

OA hand deformities

Heberden’s nodes | Bouchard’s nodes

RA hand deformities

Ulnar drift | “Z” deformity (flexed MP, ext IP)

Swan neck

Extension at PIP (rupture of ext hood) | Flex at DIP, MCP

Boutonnière

Flexion at PIP (rupture of ext hood) | Ext at DIP, MCP

Hand tendon deformities

Mallet finger Dupuytren’s contracture Trigger finger

Wrist And Hand Preclass Flashcards

(70 cards)