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MSK 1 > Elbow, Wrist and Hand Anatomy + Presentation > Flashcards

Elbow, Wrist and Hand Anatomy + Presentation Flashcards

1
Q

what is cubitus valgus?

A

carrying angle of the elbow

typically 10-15º

greater in females (average = 13, male average = 10)

less in children, increases w/age

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2
Q

what is the functional importance of the carrying angle?

A

compensates for the change of orientation of the radius

allows the axis of the hand to stay in the longitudinal plane

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3
Q

what ligaments stablize both the humero-ulnar and humero-radial joint?

A

anterior capsule

radial and ulnar collateral ligaments

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4
Q

where are the radial collateral ligaments and when are they taut?

A

attaches to the lateral epicondyle and annular ligament

blends with the ulna posteriorly

blends with supinator and ECRB

taut throughout most of flexion range

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5
Q

where is the ulnar collateral ligmanet and when is it taut?

A

triangular band (ant, post, inferior parts)

attaches medial epicondyle, medial coronoid margin, medial margin of olecranon

anterior band taut throughout most of flexion

posterior band taut between 1/2 and full extension

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6
Q

what is the resting position (open pack position) of the humero-ulnar joint? Closed pack?

A

70 degree flexion

10 degrees supination

closed pack = full extension and supination

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7
Q

what is the resting position (open pack) for the humero-raidal joint? Closed pack?

A

full extension and supination

closed pack = 90 degree flexion and 5 degrees supination

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8
Q

describe the vascular supply to the scaphoid, why is this clinically important?

A

no vascular supply to proximal scaphoid,

the scaphoid is commonly fractured, and the lack of vascular supply can result in necrosis to the proximal pole

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9
Q

describe the ulno-carpal joint

A

both the distal ulna and prox triquetrium are convex

TFCC is placed there

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10
Q

what is the roof of the carpal tunnel?

A

Flexor retinactulum of the wrist

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11
Q

what passes through the carpal tunnel?

A
  1. FDS tendons (4) w/synovial sheath
  2. FDP tendons (4) w/synovial sheath
  3. FPL tendon
  4. median nerve
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12
Q

list the columns of the hand and what bones are in each

A
  1. Lateral
    • scaphoid, trapezoid and first 2 metacarpals
  2. Intermediate
    • middle phalanx
  3. Medial
    • triquetrum, pisiform, hamate, 4th and 5th metacarpal
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13
Q

List the joints that make up the finger joints

A
  1. Intermetacarpal
  2. Metacarpophalangeal (MCP)
  3. Interphalangeal (IP)
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14
Q

what are the palmar plates?

A

fibrocartilage attachments off the base of the anterior aspect of the proximal phalanx to the neck of the metacarpal

covers MCPs and IPs

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15
Q

what is the function of the palmar plates?

A
  1. increase the area of the articular surface
  2. resist hyperextension with ligamentous attachment to proximal bony structures
  3. reinforce the joint capsule
  4. prevent impingement of flexor tendons during MCP flexion
  5. protect articular cartilage in extension on impact (high fives!)
  6. has healing capacity
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16
Q

what are finger pulleys?

A

series of arcuate and cruciate pulleys that hold the tendons of the fingers close to the axis of rotation

improves mechanical advantage

prevents bowstringing

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17
Q

what innervates the supinator?

A

deep branch of radial nerve

this muscle is wound around the radial neck (unwind’s the unla)

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18
Q

what innervates the pronator quadratus?

A

anterior interosseous nerve

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19
Q

what makes up the borders of the anatomic snuffbox?

A
  1. extensor pollicis brevis
  2. abductor pollicis longus
  3. extensor pollicis longus

contents → scaphoid and trapezium

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20
Q

what makes up the borders of Guyon’s Canal?

A

lateral border of the pisiform

transverse carpal ligament

pisohamate ligament

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21
Q

list the contents of Guyon’s Canal

A
  1. ulnar nerve
    • bifurcates late in the canal (superfical palmar cutaneous nerve
  2. ulnar artery
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22
Q

list the roots, motor and sensory innervations for the Axillary Nerve

A
  1. Roots → C5, C6
  2. Motor → Deltoid, Teres minor
  3. Sensation → lateral proximal upper arm
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23
Q

list the roots, motor and sensory innervations of the Radial Nerve

A
  1. Roots → C5-T1
  2. Motor → Triceps
  3. Sensation → posterior aspect of digits 1-3 and lateral half of digit 4
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24
Q

list the roots, motor and sensory innervations of the Posterior Interosseous Nerve

A
  1. Roots → C7, C8
  2. Motor → ECRB, ECU, EI, EDM, EPB, EPL, APL, ED
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25
Q

list the roots, motor and sensory innervations for the Musculocutaneous Nerve

A
  1. Roots → C5-C7
  2. Motor → Coracobrachialis, biceps, brachialis
  3. Sensation → lateral cutaneous nerve of forearm
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26
Q

list the roots, motor and sensory innervations of the Median Nerve

A
  1. Roots → C6-T1
  2. Motor → PT, FCR, PL, FDS, APB, FPB, OP, Thenar muscles ( recurrent branch), radial lumbricals
  3. Sensation → palmar lateral hand and digits 1-3 and radial 4th digit
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27
Q

list the roots, motor and sensory innervations of the Anterior Interosseous nerve

A
  1. Roots → C7, C8
  2. Motor → Pronator quadratus, FDP (lateral), FPL
28
Q

list the roots, motor and sensory innervations of the Ulnar nerve

A
  1. Roots → C7-T1
  2. Motor → FCU, FDP (medial half)
  3. Sensation → dorsal cutaneous branch (palmar digit 5 and medial half of digit 4)
29
Q

List the most common clincial presentations of the elbow, wrist, and hand

A
  1. Fractures and other bony abnormalities
  2. inflammatory arthropathies
  3. Finger deformities
  4. Osteoarthropathies
  5. Dupuytren Contracture
  6. Ligament sprain
    1. Wrist
    2. UCL (1st MCP)
    3. Gamekeeper’s Thumb
  7. TFCC Injury
  8. Intercarpal Instability
  9. Tendinopathies
  10. DeQuervain Disease
  11. Ganglia
30
Q

List the types of fractures that can occur at the wrist and hand

A
  1. Distal radius fracture
  2. Carpal fractures
  3. metacarpal fractures
  4. finger fractures
31
Q

List various types of distal radius fractures

A
  1. Colles frx
  2. Smith frx
  3. Barton frx
  4. Buckle Frx
32
Q

what is the difference between Smith and Colle fractures?

A
  1. Colle frx → occur secondary to a FOOSH w/extended wrist
  2. Smith frx → FOOSH w/flexed wrist and volar displacement
33
Q

what is a Barton frx?

A

the fracture line extends through the radius and the articular surface at the distal radius

34
Q

what is a buckle fracture?

A

compressive fracture that occurs at the distal radius and commonly seen in younger folks

35
Q

which carpal is the most common to be fractured?

A

Scaphoid

most common among 15-30 y/o

common at waist and proximal pole

36
Q

what is the most common MOI of scaphoid fractures?

A

FOOSH in a position of radial deviation

37
Q

describe the symptomology of scaphoid fractures

A

deep, dull radial wrist pain

pain w/gripping/squeezing

38
Q

what physical examination findings would found with a scaphoid fracture?

A

tenderness anatomic snuffbox/scaphoid

local swelling/bruising

often not visible on x-rays directly following injury

39
Q

what can a lunate fracture progress into?

A

Kienbock’s Disease

40
Q

what is Kienbock’s disease?

A

osteonecrosis of the lunate

concern for carpal collapse

important to screen for this disease

41
Q

how is Kienbock’s disesae managed?

A

surgically

conservatively → immobilization 6-10 weeks f/b progression of ROM/resistive exercises

42
Q

List types of inflammatory arthropathies

A
  1. RA
    • ulnar drift
    • Boutonniere deformity
    • Swan neck deformity
  2. Septic arthritis
  3. Gouty arthritis
43
Q

what is Boutonneire Deformity?

A

flexion of the PIPJ, hyperextension of the DIPJ

MOI → a rupture of the central band, lateral bands slip to the palmar side of the axis of rotation of the PIPJ

44
Q

what is a Swan neck deofrmity?

A

hyperextension of the PIPJ and flexion of the DIPJ

MOI → disruption of the volar plate at the PIPJ, lateral bands bowstring dorsally, increasing the moment arm of the intrinsics and causing PIPJ extension

45
Q

what is a mallet deformity?

A

flexion of the DIPJ: extensor tendon rupture

more related to trauma

46
Q

describe the clinical presentation of the osteoarthropathy of the CMC

A
  1. Pain at the base of the thumb
  2. Hx prior trauma possibly
  3. Crepitus
  4. Pain ROM at end range (multi-directional)
  5. Pain w/resistance
  6. Women > Men
  7. Age > 45 yrs more commonly
47
Q

list physical examination findings for arthropathies

A
  1. Deformities (more common inflammatory arthropathies)
    • also including nodules
  2. Tenderness to palpation of joint line
  3. Diminished ROM
  4. painful/weak resistance testing
  5. painful/weak grip testing
  6. painful/hypomobile joint mobility testing
48
Q

how is RA managed?

A
  1. Inflammatory management
    • consider period of remission vs/ exacerbation
    • thermal/cryotherapy
  2. Exercises
    • gripping/resistive exercises
    • ROM exercises
  3. Joint protection
    • splinting
    • activity modification
49
Q

what is a Dupuytren Contraction?

A

nodule formation palmar/digital fascia

pitting of skin observed

Natural course:

  • cord structures cause contractures and impaired motion of tendons
    • MCP and PIP commonly affected
    • less commonly affected DIP
  • thickening/shortening of fascia
50
Q

List the risk factors for Dupuytren Contractures

A
  1. Caucasian
  2. Increasing age
  3. Male gender (7-15x > women)
  4. Alcoholism
  5. DM
  6. Smoking
  7. Hand trauma/surgery
  8. 5th digit most commonly affected (70%)
51
Q

what is Gamekeeper’s thumb?

A

sprain to the 1st MCP

ulnar collateral ligament sprain

MOI → valus movement to 1st MCP

local tenderness/swelling

+Ulnar collateral ligmanet test

52
Q

what is a common MOI for TFCC injuries and what most likely shows up during the patient interview?

A

MOI → FOOSH, repetitive pronation/supination w/loading

Pt interview → medial wrist pain, clicking/popping with wrist motions

53
Q

list physical exam findings for TFCC lesions

A
  1. tenderness in area of TFCC
  2. swelling w/more acute trauma
  3. A/PROM painful/limited ulnar deviation
    • supination w/ulnar deviation position to start
  4. pain/tenderness w/mobility testing of radiocarpal joint with ulnar deviation bias
54
Q

what is intercarpal instability?

A

disruption of interosseous and/or mid-carpal ligaments

independent movement of carpals

55
Q

list the various types of tendinopathies of the wrist

A
  1. wrist flexors
  2. finger flexors
  3. extensors of the wrist and fingers
    • intersection syndrome
  4. trigger finger
56
Q

what is intersection syndrome?

A

ECRL and ECRB where crossing deep to APL and EPB

tenderness 6-8 cm proximal to Lister’s tubercle

57
Q

what things in a pt interview make you think tendinopathy of the wrist?

A

typically insidious onset/microtrauma MOI

58
Q

List physical exam findings for tendinopathies of the wrist

A
  1. local tenderness
  2. painful w/tensile loading (stretching)
    1. P/AROM and resistive testing
  3. possibly palpable thickening of tenosynovium
  4. crepitus w/tendon moving through tendon sheath
59
Q

what is trigger finger?

A

enlargement of tendon/pulley affecting tendon as it pistons through A1 pulley

typcially at MC head

most common 3rd digit

*As they try and extend the nodule get caught going through the A1 pulley and then bursts through causing it to rapidly extend (hence trigger finger)​

60
Q

list risk factors for trigger finger

A
  1. DM
  2. young children
  3. menopausal women
  4. RA
61
Q

describe clinical presenation/symtpoms of trigger finger

A
  1. c/o painful snapping at MCP area during flexion/extension motions of fingers
  2. limited/painful finger motions
  3. crepitus w/motion (palpable vs auditory)
62
Q

what is De Quervain’s Tenosynovitis (DQT)?

A

disorder involving the tendons of the abductor pollicus longus (APL) and extensor pollicis brevis (EPB) tendons

thickening of soft tissue structures surrounding the invovled tendons = impaired tendon gliding

no active inflammatory process

more prevalent in women than men

63
Q

list the associated demographics for DQT

A
  1. women
  2. work-related injury
  3. computer users who use a mouse or trackball
  4. text messaging
  5. repetitive fine-motor task (typing)
64
Q

list physical exam findings for de Quervain’s tenosynovitis (DQT)

A
  1. local tenderness
  2. painful ROM that places tensile load (stretch) on APL and EPB
  3. +Finkelstein’s test
  4. painful resistance testing APL and EPB
65
Q

what is a ganglia?

A

AKA bible cyst

thin-walled cyst over joint capsule/tendon sheath

filled w/mucoid hyaluronic acid (spontaneous)

common A/P wrist and fingers

66
Q

list physical exam findings/clinical presentation for ganglia

A

you will see it/notice it

possible compression on ulnar/median nerves

pt interview: may/may not be painful; aches w/flexion/extension of joint

MSK 1 (17 decks)

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