ana of elbow, forearm, wrist and hand Flashcards
primary role of the elbow
position hand in appropriate location to perform fine motor abilities, gripping, grasping
what are the 3 joints of the elbow complex
ulnohumeral
radiohumeral
superior radioulnar
what motions are present in the elbow complex
1 deg of freedom - flex-ext
but some rotation in sup RU joint
discuss the stability of the elbow
1° stabilized by ligaments hence it does respond well to trauma
most common type of dislocation in the elbow
posterolateral dislocation d/t empty back part in RH joint
discuss the congruency of joints in the elbow
mostly superficial yung sa trochlea, olecranon and cornoid of UH lng yung deep
and sa RH meron empty back part
what inert structures can be found on the medial elbow
MUCL or UCL - on medial side; restricts valgus motion and fan shaped
what ligament is most commonly injured in the elbow
MUCL
what can be found in the posterior portion of UCL
houses ulnar nerve as it passes by cubital fossa
what inert structures can be found on the lateral elbow
radial collateral lig and lateral ulnar collateral lig
what does the LUCL do
has to restrict more - d/t to empty space in lateral elbow
stronger than medial ligaments
fan shaped
second most commonly injured ligament in the elbow
LUCL
proximal row of carpals
scaphoid
lunate
triquetrum
pisiform
distal row of carpals
trapezium
trapezoids
capitate
hamate
movements in the DRUJ
uniaxial pivot - pronation and supination
and some radial/ulnar dev
rc joint movements
biaxial ellipsoid - flex/ext and radial/ulnar deviation
keeps the stability of proximal carpals to radiocarpal bones
radioscapholunate ligament
most common injured lig of the wrist
radioscapholunate ligament
how is radioscapholunate ligament usually injured
pronated FOOSH per pwede din FOOSH tas either ext, ulnar dev and intercarpal supination
second most common injured lig of the wrist
Lunotriquetral Ligament
MOI for Lunotriquetral Ligament
wrist ext, radial dev and intercarpal sup
what is the TFCC
cushion for the triquetrum as it articulates with the ulna
bears the weight of the triquetrum at the proximal carpal bones
weight distrib on wrist
60% borne on the radius and 40% on the ulna but mostly on the TFCC
relate tendons to resting pos of hand
tendons are in the most ready or most efficient position to contract and to perform its action
no active or passive insufficiencies present in the tendon
relate resting pos of hand and immob
immobilize using cast or orthosis, this is our preferred position to avoid contractures and tightening of the muscular tissue of the hand
which is mobile and stable betw proximal and distal transverse arch
proximal arch has to be more stable than your distal transverse arch
components of proximal transverse arch
carpal tunnel
distal row of carpals
CMC of thumb
Keystone of the proximal transverse arch
Capitate
Keystone of the distal transverse arch and longitudinal arch
2nd and 3rd MCP
compare stab and mob of proximal and distal carpal bones
Wrist and proximal carpal bones (RC joint) is geared towards mobility (2o of freedom), whereas the distal carpal bones requires stability
compare stab and mob of 2nd and 3rd MTC and distal carpal bones
2nd and 3rd metacarpals as well as distal carpal bones are geared towards stability
hypermobility in 2nd or 3rd metacarpal, there is compromise in the hand present
hamate/trapezium (basta distal row) is unstable there will be instability in the hand
MOI for posterior elbow disloc
FOOSH c extended shoulder, elbow, and wrist + ulnar dev
usual presentation of lateral epicondylitis
35 yo or older
inflammation of tendons at common extensor origin at elbow d/t overuse or repetitive stress/strain in wrist flexion and extension
pain present in motion or even at rest
usual presentation of nursemaid’s elbow
young children
elbow lacks supination and head of radius is dislocated d/t tug on arm the radial head is distracted from anullar ligament
discuss effect of repetitive throwing in sports
throwing can create severe valgus force
medial side traction = sprain of MCU
lateral side compression
usual presentation of little leaguer’s elnow
concomitant valgus sprain on the medial side of elbow
excessive concomitant compression on the lateral side
Younger population is more predisposed due to the not fully developed inert stabilizers
usual effect if MOI is FOOSH
elbow disloc or wrist fractures
consider also clavicle, AC and labrum
usual effect if MOI is fall on tip of elbow
Contusions or Displacemens of the Radius
and Ulna on the olecranon or on to the humerus
common MOI and presentation for MCL or MUCL sprain/tear
audible pop followed by pain and swelling one medial elbow
common in throwers, pitchers and racket sports
also consider ulnar nerve affectation
usual presentation of distal bicep rupture
centralized pop c weakness of elbow flexion
normal carrying angle
5-10° for males and 10-15° for females
what to consider if swelling is extra-acrticular
bursitis or student’s elbow or repetitive strains
what to consider if swelling is intra-acrticular
in triangular space in lat elbow - radial head, olecranon, lat epicondyle
usual presentation of gunstock
Decrease in carrying angle
sheer stresses on lateral portions of the elbow = lateral sprain and compression on medial
usually secondary to severe disloc or trauma
usual presentation of cubito valgus
Increase in carrying angle
Sprain on medial structures, compression on lateral structures
compare loc of heberdens and bochards
usually late stage RA
bouchards - DIP
heberdens - PIP
usual presentation of ulnar drift
Severe ulnar deviation of the MCP, PIP, and DIP = Concomitant zigzag of the metacarpals to radial
deviate
insufficiency’s of the grip
late stage RA
usual presentation of dupuytrens
tightness of the anterior fascia of the MCP and DIP
fixed flexion in MCP and DIP usually ring and little
may cordlike structure na kita
genetic and progressive
what to consider if pt has spoon shaped nails
Entail fungal, anemic, local injuries,
or diabetes
what to consider if pt has clubbing of DIP
Entail respiratory compromise and other infection
usual presentation of Boutonniere deformity
rupture of the central slip of the extensor hood
could be present in RA and due to trauma
ext of MCP and DIP but PIP is flexed
usual presentation of swan neck
contracture of intrinsic muscles or torn volar plate due to trauma or RA
ext PIP but flexed MCP and DIP
usually one finger lang
usual pres of Benediction’s hand deformity
wasting of the interossei muscles and 2 medial lumbricals d/t ulnar nerve palsy
inability to raise the fingers and there is contraction in structures below
tightening and they cannot properly extend the fingers because of the weakness and the contractures of the structures of the volar surface
usual pres of ape hand
median nerve compromise (neck, shoulder, forearm or anterior interosseous nerve)
wasting of thenar eminence - thumb pulled or ext in line na with other fingers = unable to oppose or flex thumb
usual pres of Claw hand or Intrinsic minus hand
MCP hyperextension, IP flexion
median and ulnar nerve palsy
Weak long flexors of the wrist and hand leading to overriding of the radial nerve subserved structures tas strong extensors
what to consider in drop wrist
inability to actively extend = radial nerve palsy or saturday night
paralyzed extensor muscles
usual pres of Zigzag deformity of the thumb
in RA
seen in ulnar drift
Bowstringing effect with the
dislocated CMC, hyperextended
MCP and flexed DIP
Volar plate avulsion and rupture of
the ligaments
usual pres of mallet finger
common in sports
rupture or avulsion of extensor tendon sa distal phalanx = flexed DIP
