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Human Locomotor Systems > 4.2 Wrist and hand joints > Flashcards

4.2 Wrist and hand joints Flashcards

0
Q

What are the joints of the hand?

A

*Carpometacarpal - b/w carpals and metacarpals
*Intermetacarpal - b/w metacarpals themselves
Metacarpophalangeal - metacarpals and phalanges
Interphalangeal - b/w phalanges themselves

**synovial joints

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1
Q

What are the joints of the wrist?

A

Radiocarpal*
Intercarpal* - between carpal bones
Midcarpal - between the distal and proximal rows of carpal bones, physiological/functional

*synovial joints

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2
Q

Describe the wrist complex.

A

Radiocarpal joint
-b/w distal radius and scaphoid, lunate, triquetrum

Intercarpal joint
-b/w proximal and distal carpals

Midcarpal
-b/w proximal and distal carpal rows

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3
Q

What are the features of the wrist joint? (ie. ligaments, type of joint, presence of disc)

A
  • Radiocarpal joint is a condyloid joint (concave/convex surface)
  • *biaxial joint, slight amount of F/E, condyloid joint due to concave/convex shapes of carpal bones

Ligaments:

  • medial collateral
  • lateral collateral
  • palmar and dorsal radiocarpal
  • palmar and dorsal radioulnar

-Triangular fibrocartilaginous disc

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4
Q

What is the blood and nerve supply to the wrist joint?

A

Blood: branches of palmar and dorsal carpal arches

Nerve: anterior/posterior interosseous, deep branch of ulnar

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5
Q

What are the movements at the wrist joint?

A

Flexion:
FCR, FCU, FDS, FDP, FPL, PL, APL

Extension:
ECRL, ECRB, ECU, ED, EI, ECM, EPL, EPB

Radial deviation (abduction)
APL, FCR, ECRL
Ulnar deviation (adduction)
ECU, FCU
*more ulnar deviation than radial deviation due to condyloid nature of joint, and orientation of carpals
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6
Q

Intercarpal joints

A
  • B/w carpal bones in proximal and distal row
  • Joint capsule same as carpometacarpal (CMC) joints
  • Ligaments: anterior, posterior, IO
  • Movement: gliding between carpals (plane type of joints, ie. making a fist, or extension of wrist where carpal bones rub together)
  • Fall on outstretched hand
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7
Q

Blood and nerve supply of intercarpal joints?

A

BS: palmar and dorsal carpal arches (radial and ulnar arteries)

NS: anterior interosseous, deep branch of ulna

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8
Q

Midcarpal joint features

A
  • functional joint
  • convex-concave
  • condyloid type
  • movement: F/E, radial deviation > ulnar deviation
  • *flexion = scrunching up hand, extension is returning to non scrunched position
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9
Q

What type of joint is it between capitate and index/middle fingers in CMC joint?

A

Capitate projects into and holds the joint with the 2nd and 3rd metacarpals in place. Fairly tight joint, immobile, stable, limiting the movement in this joint, which is a plane joint with slight gliding.

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10
Q

What type of joint is CMC of the 4th and 5th metacarpals?

A

Here the hamate meets up with capitate, 4th and 5th metacarpals are much more mobile, allows F/E.

Hinge joint

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11
Q

Type of joint of CMC 1st metacarpal?

A

Saddle joint:

  • Trapezium itself has that concave/convex shape, has 2 curvatures in sagittal and coronal plane that sits against the 1st metacarpal
  • Allows movements of F/E, Ab/Ad, rotation, opposition
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12
Q

What connects the CMC and IMC?

A

Ligaments

  • interosseous
  • collateral ligaments
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13
Q

Blood and n’ supply of CMC & IMC joints

A

BS: palmar arterial arches, dorsal & palmar metacarpal arteries

NS: anterior and posterior IO, deep ulnar

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14
Q

Features of MCP

A

Fibrous capsule surround joints

  • b/w head of metacarpal (distal; proximal = base, mid = body of metacarpal), base of proximal phalanx
  • condyloid
  • F/E, Ab/Ad

-connected with each other

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15
Q

Features of IP

A
  • b/w head of proximally placed phalanx and base of distal

- hinge: F/E

16
Q

What are the ligaments of the MCP and IP?

A
  • Collateral ligaments (med/lat)
  • Transverse metacarpal ligaments (fibrous ligament that connects heads of metacarpals together and in place)
  • Palmar (volar) plate (fibrous and ligamentous plate: deep to extensor expansions, increase SA of ligaments going through that area)
  • Dorsal plate
  • Modified hinge (movement is restricted by deep transverse ligaments, but are able to do a little bit of F/E, Ab/Ad)
17
Q

What are the BS & NS of MCP & IP?

A

BS: palmar arterial arch
NS: median and ulnar nerves

18
Q

What is the Skier’s thumb?

A

Rupture of medial collateral ligament from forced abduction and extension.

19
Q

Finger injuries: Swan-neck deformity

A

Ventral IP injury

  • palmar plate breaks off and subsequent dislocation posteriorly, ventral tendons have broken away, but dorsal expansion tendons are working
  • hyperextension at proximal IP joint
  • compensatory flexion at distal IP joint (profunda tendons are working)
20
Q

Finger injuries: Boutonniere deformity

A

Dorsal IP injury: extensor expansion ruptures off

  • flexion at proximal IP
  • compensatory hyperextension at distal IP

*lumbricals responsible for flexion/comp. hyperext above

21
Q

‘Mallet finger’ injury

A

Distal IP injury

ie. ball hits end of finger

22
Q

What movements are the digits capable of?

A

Ab/Ad, F/E, Opposition/reposition

Wrist: F/E

23
Q

Features of synovial sheaths

A
  • Common flexor sheath: tendons of FDS (2 rows), FDP (1 row), FPL
    *tendons travel through confined spaces to work on distal end of digits, require lubrication to work, therefore synovial membrane envelopes all flexor tendons of hand
    *FDS & FDP synovial enclosure of ulnar bursa (medial side)
    FPL - radial bursa
  • Digital synovial sheaths
  • Fibrous digital sheaths

*Note: sheath for little finger is continuous with ulnar and radial bursa, absence of sheath where lumbrical muscles attach

24
Q

What are the origin and insertion of the lumbricals?

A

Origin: tendon of FDP

Insertion: extensor expansion on either side

25
Q

Fibrous flexor sheaths

A

Fibrous covering that holds the synovial sheaths in place:

  • Annular (A) fibres
  • Cruciform (C) fibres: during flexion, produces continuous tunnel for tendon with lubrication
  • connect volar plates

Clinical implications:

  • spread of infection in synovial sheath (ie. little finger and ulna bursa)
  • De Quervain’s tenosynovitis (tendon sheaths get inflammed, particularly laterally - in thumb EPL & AbPL tendons)
  • digital tenovaginitis stenosans (tendons inflammed, flexion produces snapping sound)
26
Q

Median nerve (C5-T1)

A

Muscle: supplies most muscles of anterior compartment of forearm and most muscles of thumb
-passes through carpal tunnel

Skin: lateral 3.5 digits and nail beds

*susceptible to compression injury (or to associated blood supply) in carpal tunnel

Potential motor & sensory loss if to skin if injured - Tinel’s test

27
Q

Consequences of a cut median nerve?

A

‘Hand of Benediction’

  • opponens wasting/wasting of thenar elements
  • pins and needles
  • won’t be able to form fist due to intrinsic muscles on lateral side are affected
28
Q

Ulnar nerve (C8, T1)

A

Muscles: supplies remaining muscles in anterior compartment of forearm and hand, except for thumb

Skin: medial 1.5 digits (both palmar & dorsal)

  • susc. to compressino and/or stretch across back of medial epicondyle
  • passes superficial to flexor retinaculum
  • at wrist, susc. to compression against bike handlebars
29
Q

Radial nerve (C5-T1)

A

Muscles: extrinsic muscles of arm & forearm

Skin: skin of arm, forearm, back of hand
-Runs across shaft of humerus (between med/lat heads of triceps)

*Susc to damage in humeral shaft fracture, compression (Saturday night palsy)

Human Locomotor Systems (18 decks)

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