Elbow wrist and hand ARTHRO Flashcards
Name the 3 elbow joints
Humeroulnar, Humeroradial, PRUJ (proximal radioulnar joint)
What type of joint is the elbow joint?
Hinge joint or modified hinge joint
What is the elbow carrying angle for males?
10-14 deg
what is the carrying angle for women?
13-16 deg
Describe morphology of the Humeroulnar Joint
CONCAVE trochlear notch of ulna
CONVEX trochlea of humerus
What direction does humeralulnar joint move in
ROLL AND GLIDE in SAME direction
what bones move between the humeroulnar joint?
Ulna moves on humerus, concave moves on convex.
What kind of joint is the humeroulnar joint?
Hinge joint
What kind of joint is the humeroradial Joint?
Hinge Joint
Describe morphology of the humeroradial joint
CONVEX capitulum of humerus & CONCAVE head of radius.
Is the head of the radius CONVEX OR CONCAVE
CONCAVE
Motions of the humeralulnar joint
FLX/EXT
Motions of the humeroradial joint
FLX, EXT, & Rotation of radius
ROLL AND GLIDE FOR humeroradial Joint?
Roll and glide in same direction
What is the ligaments of the Medial Elbow?
Ulnar (medial) colateral lig (3)
ANT band
POST band
Transverse band
What stabilizes the medial elbow
UCL
Where is attachment for ANT band of UCL?
humerus to the ulna
Where is attachment for Post band of UCL?
humerus to olecranon process of ulna
Where is attachment for transverse band of UCL?
Ulna to Ulna
What prevents Valgus stress to elbow
UCL
Which is the strongest part of the UCL ?
ANT band (strongest and stiffest)
Which ligament is more taught during elbow EXT
ANT band
What is most important part of UCL when arm is past 120 deg of FLX ?
POST band since ANT band is now on more slack (its now secondary)
Which is the weakest of the UCL
POST band
Which UCL is fan shaped
POST band
What UCL does not have a role in elbow stability
Transverse band
Whats the role of the transverse band of UCL
deepens the socket of the trochlea
What ligament blends in with the angular ligament ?
RCL
Which is lateral UCL or RCL
RCL
Which is medial UCL or RCL
UCL
Where does the RCL run in orientation
its fan shaped so half runs from lateral epicondyle to the ULNA, other half blends into annular ligament around the radius.
What is the primary restraint against radial subluxation?
RCL
What force does RCL limit
Varus force
What kind of joint is the proximal radioulnar joint?
Pivot joint
Morphology of PRUJ
CONVEX radial head. (note for this joint it is CONVEX articulation, but superiorly the radial head is concave)
& Concave radial notch of the ulna
What glide happens during pronation?
radial head Rolls ANT and glides POST
What glide happens during supination?
Radial head Rolls POST and glides ANT.
DRUJ morphology?
opposite of PRUJ:
CONVEX head of ulna
CONCAVE ulnar notch of radius
Roll and glide of DRUJ?
ROLL and Glide in same direction
Whats the difference between the roll and glide of the PRUJ and DRUJ ?
PRUJ= roll and glide in opposite directions
DRUJ= roll and glide in same direction.
does pronation and supination involve the PRUJ or DRUJ ?
Both of them
What allows for pronation and supination?
PRUJ and DRUJ motion
muscle contraction
rotation of radius at humeroradial joint inside annular lig
interosseous membrane allowing for two bones to move on one another.
What forms the PRUJ?
annular ligament
what provides 80% of articular surface of humeral radial joint ?
Annular ligament
What is the interosseous membrane of elbow?
stability of syndesmosis between radius and ulna
SLTPTTCH
Scaphoid, Lunate, Triquetrum, pisiform, trapezium, trapezoid, capitate, Hamate.
Some lovers?
Try positions that they cant handle
What are the 2 ligaments of the DRUJ ?
1) ANT/POST radioulnar ligaments
2) Triangular fibular cartilage complex (TFCC)
What is the TFCC
KEY portion of stabilizing the distal radioulnar joint
Where is the DRUJ?
between the head of Ulna, TFCC & ulnar notch of radius.
What is the radoiocarpal/ulnocarpal joint?
located between radius/ulna and the proximal row of carpal bones minus the pisiform (so Scaphoid, Lunate, Triquetrum).
Where is the mid carpal joint?
between proximal and distal row of carpal bones.
how many ligaments of the wrist are there.
2 ANT (volar) ligaments and 3 POST (dorsal) ligaments
What is Dorsal ?
POST
What is Volar ?
ANT
What do VOLAR ligaments restrain?
EXT of wrist
What to the DORSAL ligaments restrain?
FLX of wrist
What is the major stabilizer of the DRUJ
TFCC
What are the functions of the TFCC?
stabilizes DRUJ
seperates the radioulnar from radoiocarpal joint
“cushions” ulnar sided force transmission.
Ligaments of the Ulnocarpal side resist/limit what force?
radial deviation
ligaments of the radiocaral side resist/limit what force?
Ulnar deviation
Where does the axis for wrist FLX/EXT/radial/ulnar deviation lie?
between lunate and capitate bone. (but DJ said) axis is through capitate bone along base of 3rd metacarpal
Moving hand into EXT gives what roll and glide to proximal row?
POST roll and ANT glide
Moving hand into FLX gives what roll and glide to proximal row?
ANT roll and POST glide
do the midcarpals move on an individual level?
NOPE the whole row moves
Lichtmans ring theory states?
Ring will move carpal bones together
If bones roll to right (radial deviation) glide will be to the left…vise versa.
very little movement of ligs between bones, the ring does most of movement.
what % of metacarpal or radoiocarpal joints moving with FLX/EXT of wrist?
50% MC
50% Radiocarpal joints
What happens during radial deviation?
Scaphoid and Lunate rocks
What happens during ulnar deviation?
The proximal row (extends) twists.
what motion is limited during full FLX/EXT of wrist ?
RD and UD due to ligamentous constraints.
List the order of bones from proximal to distal from carpal bones on
MCP -> proximal phalanx -> middle phalanx -> distal phalanx
List the order of joints from proximal to distal from carpal bones on..
Caprometacarpal -> metacarpalphlangeal ->
proximal interphalangeal ->
Distal interphalangeal
Does thumb have a middle phalanx
NO just proximal and distal
What kind of joint is the thumb
sellar “saddle” joint
What bones form the thumb?
Trapezium and 1st metacarpal bone
Thumb has how many degrees of freedom?
3
During radial ABD/ADD of the thumb what happens in terms of roll and glide?
MC rolls and glide in same direction
During Palmer abd/add of the thumb what happens in terms of roll and glide?
MC rolls and glides in opposite direction
What kind of joint is the metacarpophalangeal joint of the thumb?
Condyloid joint
What do all the fingers have including the thumb?
volar plates
What finger bone can have a sesamoid bone like the patella?
the thumb, but not common
What fingers have a CMC joint “lock on them” ?
2 & 3
What fingers DONT have a lock on them ? CMC?
4 & 5
how do fingers 2&3 differ from 4&5?
2&3: more stability, less motion, “locked”
4&5: opposite of that since
Distal surface of hamate is concave and proximal 4/5 MC are convex. (more movement)
What ligaments connect the metacarpal heads
transverse metacarpal ligs (deep and superficial) only fingers 2-5
What is the difference between the deep and superficial transverse metacarpal ligaments?
Deep: connect metacarpal heads
Superficial: connect adjacent volar plates
Collateral ligaments of finger 2-5 are?
Strong, oblique orientation
max tension at 70 deg flx
resist ABD/ADD (varus/valgus) forces
Whats the point of volar plates? in FLX and EXT
EXT: increase contact surface with MC head
FLX: allows gliding and prevents tendon pinching
what prevents tendon pinching in fingers?
volar plates
MCP joints are what type of joints (2-5)
ovoid
MCP joints of fingers 2-5 direction of glides?
ROLL AND GLIDE IN SAME DIRECTION
What type of joint are the proximal and distal IP (interphalangeal) joints (2-5)
synovial hinge joints
Morphology of IP joints (2-5)
Proximal is CONVEX
Distal is CONCAVE
**distal segments move on proximal ones
How do IP and MCP joints relate?
both have collateral ligs, volar plates
BUT don’t have transverse ligaments cause we have to move fingers.
Does the elbow joint capsule respond well to injury ?
no neither does it respond well to immobilization
Common elbow injury?
UCL injury due to overhead sports
What is the most common ligament injured in UCL injury
The ANT band of UCL
What is most commonly used to repair UCL injury?
Autograft of palmaris longus tendon
How does a TFCC injury occur?
Disc injury from compression or sheer force.
How do we know if we have a TFCC injury?
Pain with distraction of wrist, or lifting something heavy from ground.
If you wanted to improve elbow extension what mobilization would you perform
Post glide of PRUJ on humerus
