Elbow, Wrist and Hand Flashcards
describe the makeup of the elbow’s joint capsule
- large loose and weak (A/P)
- reinforced laterally by collateral ligaments
what is the normal carrying angle of the elbow?
8-15 degrees
what is the purpose of the carrying angle at the elbow?
allows for a person to carry an object away from side of the thigh
list the passive structures that reinforce the elbow joint
- medial (ulnar) collateral ligaments
- A/P Transverse
- Lateral (radial) collateral ligaments
- lateral ulnar collateral ligament
- annular ligament
what does the A/P transverse ligament do at the elbow?
stabilizes against valgus torque at the elbow and limits elbow extension at end ROM
what is the role of the annular ligament?
stabilizes against varus torque at the elbow and combined varus and supination torques
what osteokinematic motions are available at the humeroulnar and humeroradial joint?
flexion/extension
describe the arthrokinematics at the humeroulnar and humeroradial joint
concave on convex
roll and slide in same direction
At the humeroulnar joint, what is the:
closed pack position
open pack position
capsular pattern
closed = full extension and supination
open = flexed 70 degrees, supinated 10 degrees
capsular pattern = flexion > extension
at the humeroradial joint, what is the following:
closed pack position
open pack position
capsular pattern
closed = 90 degrees of elbow flexion and 5 degrees of supination
open = full extension and supination
capsular pattern = flexion > extension
what types of joints are the proximal and distal radioulnar?
synovial pivot
how is the arthrokinematics different at the proximal and distal radioulnar?
proximal = convex on concave
distal = concave on convex
describe the following for the proximal radioulnar joint:
closed pack position
open pack position
capsular pattern
closed pack = 5 degrees supination
open = 70 degrees flexion and 35 degrees supination
capsular pattern: supination = pronation
describe the following for the distal radioulnar joint:
closed pack position
open pack position
capsular pattern
closed = 5 degrees supination
open = 10 degrees supination
capsular pattern: supination = pronation
how do we produce the most torque for elbow flexion at the elbow?
supinated position
increased flexor moment arm of biceps and brachioradialis when forearm is supinated
what is the workhorse of the elbow?
brachialis
can produce equal force regardless of position
describe the synergy between the triceps and anterior deltoid
ant deltoid synergizes with triceps during elbow extension
this will counter shoulder extension potential of triceps
what muscle is primarily activated with low level supination?
supinator
what role does the triceps play during forceful supination?
must co-contract to prevent the biceps from actually flexing the elbow and shoulder during supination effort
what muscle is primarily activated during low level pronation?
pronator quadratus
what role does the triceps play during forceful supination?
acts as a synergist to counter tendency of biceps brachii to flex elbow
what are 2 points of consensus with regards to the wrist complex?
- structure and biomechanics of wrist and hand vary tremondously from person to person
- even subtle variations can produce differences in the way a given function occurs
what bones make up the radiocarpal joint?
radius with schapoid, lunate, and triquetrum
what makes up the 2-joint system in the wrist?
radiocarpal joint
midcarpal joint
what is the benefit of the 2 joint system in the wrist?
permits large ROM w/less exposed articular surface and tighter joint capsules
less tendency for structural pinch at extremes of motion
allows for flatter multi-joint surfaces that are more capable of withstanding imposed pressures
what is the function of the TFCC (triangular fibrocartilage complex)?
binds distal ends of ulna and radius while allowing radius to rotate around fixed ulna
what is beneath the extensor retinaculum?
6 fibro-osseus compartments
what are the factors that contribute to carpal tunnel syndrome?
- overcrowding (9 extrinisic flexor tendons + median nerve)
- excessive mechanical stress
- fibrotic changes of CT
what osteokinematic motions are available at the radiocarpal and midcarpal joints?
flexion/extension
radial/ulnar deviation
describe the arthrokinematics that occur at the radiocarpal and midcarpal joints
convex on concave = roll is opposite of slide
what is the closed/open pack position and capsular pattern for the radiocarpal joint?
closed pack = full extension w/radial deviation
open pack = neutral flexion/extension w/slight ulnar deviation
capsular pattern: flexion = extension , slight radial and ulnar deviation
what is the main function of the wrist extensors?
- position and stabilize wrist in activities that require active flexion of digits (making a fist)
- act to counterbalance wrist flexor torque
List the joints in the hand
- CMC
- MCP
- IP
- DIP
what osteokinematic motions are available at the 1st CMC joint?
flexion/extension
abduction/adduction
opposition/reposition
describe the arthrokinematics at the 1st CMC joint
flexion/extension = concave on convex (M/L roll with glide)
ADB/ADD = convex on concave
what is the open/closed pack position and capsular pattern for the 1st CMC joint?
closed pack = full opposition
open pack = midway between flx/ext and abd/add
capsular pattern = abduction
what is the open/closed pack position and capsular pattern for 2-5 CMC joints?
closed = full flexion
open = midway between flx/ext
capsular pattern = not really defined
describe the arthrokinematics at the MCP joints
concave on convex
roll and glide same direction
describe the arthrokinematics at the IP joints
concave on convex
palmar/dorsal roll with anterior/posterior glide
(in same direction)
what is the open/closed pack position and capsular pattern for the MCP joints?
closed = full flexion
open = slight flexion
capsular pattern: flexion = extension
what is the open/closed pack position and capsular pattern for IP joints?
closed = full extension
open = slight flexion
capsular pattern: equal loss of flexion and extension
what is the function of the flexor mechanism?
prevent bowstringing the tendons w/contraction of extrinsic finger flexors
(these refer to the flexor pulleys embedded within fibrous digital sheaths)
describe the anatomy of the extensor mechanism
- Distal to wrist they lack digital sheath or pulley system. Tendons become integrated into fibrous extensor expansion