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Kinesiology > Chapter 8 - The Hand > Flashcards

Chapter 8 - The Hand Flashcards

1
Q

make-up of the hand

A

19 bones
29 muscles
- takes up a large part of the motor/sensory cortex of brain

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2
Q

palmar creases

A
  • distal and middle digital creases
  • proximal digital crease
  • proximal and distal palmar creases
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3
Q

concavity of the palm

A

supported by three integrated arch systems:

1) longitudinal arch(follows 3rd phalanx)
2) distal transverse arch(knuckles or MCP joints)
3) proximal transverse arch(CMC joints)

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4
Q

Which metacarpals are the most mobile?

A

1st, 4th, and 5th

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5
Q

Thumb CMC

A
  • classic saddle joint
  • Trapezium/1st metacarpal
  • trapezium = concave (palmar to dorsal)
  • trapezium = convex (medial to lateral)
  • 2 degrees of freedom(flex/ext & abd/add)
  • opposition = combination of all
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6
Q

ROM of thumb CMC

A 
abduction = 50 degrees
Flexion = 45-50
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7
Q

abduction of the thumb

A

convex-on-concave

  • caused by abductor pollicis longus
  • roll anterior/slide posterior
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8
Q

flexion of thumb

A

concave-on-convex

  • roll medially/slide medially
  • stretches medial collateral ligament
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9
Q

extension of the thumb

A

concave-on-convex

  • roll laterally/slide laterally
  • stretches the anterior oblique ligament
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10
Q

opposition

A

2 phases:

1) abduction
2) flexion with medial rotation
- posterior oblique ligament is taut
- muscle = opponens pollicis

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11
Q

CMC joints of fingers

A

2nd and 3rd are more rigid for stability

  • 4th and 5th are mobile
  • intermetacarpal joints at bases of 2nd through 5th
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12
Q

ROM CMC joints

A
  • 2nd and 3rd relatively stable
  • 4th flexes = 10 degrees(hamate bone)
  • 5th flexes = 20-25 degrees(hamate bone)
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13
Q

MCP of fingers

A

2 degrees of motion = flex/ext & abd/add

  • rotation as an accessory motion
  • convex head of MC’s to concave proximal phalanges
  • close packed position = 70 degrees of flexion
    • collateral ligaments are tightest and most stable
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14
Q

limiting extension of MCP

A

prevented by palmar plates

- MCP can be hyper extended(unlike IP joints)

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15
Q

ROM of MCP

A

increases from 2nd digit to 5th digit

  • flexion = 90 - 115
  • passive hypertension = 30-45
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16
Q

abduction and adduction of fingers during flexion

A

limited because radial and ulnar collateral ligaments are stretched
- dorsal capsule is also stretched

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17
Q

abduction of fingers

A

concave on convex

  • roll and slide in same direction
  • muscles = dorsal interossei
  • ulnar collateral ligament
  • axis through head of MC
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18
Q

flexion of MCP joint

A

head of the MC is cam-shaped

  • flexion increases the distance between attachment points of the collateral ligaments
  • in contrast to PIP where distance remains constant
19
Q

thumb MCP

A

1 degree of freedom(flex/ext)

  • flexion = 60 degrees
  • concave-on-convex(roll and slide same direction)
  • limited hyperextension
  • muscle = flexor pollicis brevis, some flexor pollicis longus
  • dorsal capsule being stretched during flexion
20
Q

finger IP joints

A

1 degree of freedom(flexion/extension)

  • tongue in groove articulation
  • closed packed near full extension
  • PIP flex = 100-129
  • DIP flex = 70-90
  • palmar plate limits extension
  • collateral ligament stretched during flexion
21
Q

Thumb IP joint

A

1 degree of freedom(flex/ext)

  • similar to fingers
  • flex = 70 degrees
  • passive hyperextension to 20 degrees
22
Q

“position of function”

A

wrist = 20-30 degrees of extension with slight ulnar deviation
fingers = 35-45 degrees of MCP flex
- 15-30 degrees of PIP and DIP flexion
thumb = 35-45 degrees of CMC joint abduction

23
Q

intrinsic hand muscles

A

interossei, lumbricals, adductor pollicis, opponens pollicis

24
Q

extrinsic hand muscles

A

muscles that cross wrist joint

25
Q

flexor digitorum superficialis

A

medial epicondyle to middle phalanx

- median nerve

26
Q

flexor digitorum profundus

A

to distal phalanx

- median and ulnar nerve

27
Q

lumbricals

A

attach on the tendon of flexor digitorum profundus

  • flexion of MCP and extension of IP’s
  • insert on the dorsal hood
  • 1&2 = median nerve
  • 3&4 = ulnar nerve
28
Q

through the carpal tunnel

A 
through the tunnel:
- flexor digitorum superficialis and profundus
- flexor pollicis longus
- flexor carpi radialis
- median nerve
- ulnar(flexor digitorums) and radial(flexor pollicis longus) synovial sheath
outside of tunnel:
- ulnar nerve
29
Q

make up of carpal tunnel

A 
top = transverse carpal ligament
bottom = pisiform, triquetrum, lunate, scaphoid
30
Q

during PIP flexion

A

flexor digitorum superficialis flexes

- extensor digitorum and extensor carpi radialis brevis isometrically contract to prevent wrist flexion and MCP flexion

31
Q

tendodesis action

A

as the wrist is extended, thumb and fingers automatically flex because of stretch placed on the extrinsic digital flexors(passively)

32
Q

finger abduction

A

dorsal interossei and abductor digiti minimi

33
Q

finger adduction

A

palmar interossei

- also thumb flexion

34
Q

intrinsic-plus position

A

MCP’s flexed
DIP’s and PIP’s extended
- lumbricals and interossei

35
Q

extrinsic-plus position

A

MCP’s extended

DIP’s and PIP’s flexed

36
Q

“claw” position

A

ulnar nerve lesion(3&4 lumbricals paralyzed)

  • 4&5 MCP’s hyperextended
  • DIP’s and PIP’s partially flexed
  • manually holding MCP’s in flexion, extensor digitorum extends DIP and PIP joints
37
Q

active finger extension progression

A

1) intrinsic muscles activate(lumbricals and interossei)
2) PIP joints extend
3) oblique retinacular ligament is stretched
4) DIP joint extends

38
Q

Finger flexion progression

A

Early Phase:
- flexor digitorum profundus and superficialis, and interosseus muscles flex joints of finger
Late Phase:
- flexing continues, extensor carpi radialis brevis extends wrist slightly, extensor digitorum decelerates flexion of MCP joint

39
Q

finger extension progression

A

Early phase:
- extensor digitorum extends MCP joint
Middle phase:
- intrinsic muscles(lumbricals and interossei) assist in extension of PIP and DIP
- also they produce flexion at MCP to prevent hyperextension
Late phase:
- muscle activation continues
- flexor carpi radialis slightly flexes wrist

40
Q

zigzag deformity of the thumb

A

radially directed dislocation of CMC joint

  • hyperextension of MCP joint(from extensor pollicis longus)
  • IP joints remain partially flexed(flexor pollicis longus)
  • caused by rheumatoid arthritis
41
Q

palmar dislocation of the MCP joint

A

palmar directed bowstring force of flexor tendons(FDP & FDS) against the palmar plate

  • rupture of the weakened collateral ligaments
  • caused by rheumatoid arthritis
42
Q

ulnar drift MCP joint

A

ruptured radial collateral ligament

- extensor digitorum pulls in ulnar direction at MCP joint

43
Q

Swan-neck deformity

A

1) hyperextension of PIP
- palmar plate damaged(over stretch)
2) flexion of DIP
- flexor digitorum profundus

44
Q

Boutonniere deformity

A

1) flexion of PIP
- ruptured central band
- slipped lateral band
2) hyperextension of DIP

Kinesiology (8 decks)

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