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Applied Kinesiology > EXAM #3 > Flashcards

EXAM #3 Flashcards

1
Q

Bones of the elbow joint complex

A
  • Distal humerus (anterior & posterior)
  • Proximal ulna
  • Proximal radius
  • Olecranon process
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2
Q

Elbow important for:

A
  • dressing
  • throwing
  • grooming
  • feeding
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3
Q

Elbow joint

A
  • Humeroulnar joint, also humeroradial joint
  • superior radioulnar joint
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4
Q

Elbow joint is…

A
  • synovial
  • compound joint
  • single capsule
  • hinge joint for flexion and extension
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5
Q

Proximal radioulnar joint:
- part of _ _ _ - not needed for flexion/extension
- radial notch of ulna (+) radial head (+) annular ligament
- allows _ and _

A
  • elbow joint complex
  • pronation, supination
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6
Q

Elbow movements

A
  • flexion
  • extension
  • pronation
  • supination
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7
Q

Elbow movements:
Flexion ROM = _

A

150 degrees

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8
Q

Elbow movements:
Extension ROM = _

A

0 degrees or beyond

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9
Q

Elbow movements:
Pronation & supination ROM = _

A

0-90 degrees

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10
Q

Elbow ligaments

A
  • ulnar collateral ligament
  • radial collateral ligament
  • annular ligament of radius
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11
Q

Elbow ligaments:
Provides protection against valgus stresses to the elbow

A

medial (ulnar) collateral ligament

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12
Q

Elbow ligaments:
provides protection against varus stresses to the elbow

A

lateral (radial) collateral ligament

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13
Q

Elbow ligaments:
Holds radial head in place

A

annular ligament

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14
Q

Proximal elbow joint complex is a _, compound joint comprising three articular surfaces ( _, _, _ ) surrounded by a single _ _

A
  • synovial
  • distal humerus, proximal radius, proximal ulna
  • articular capsule
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15
Q

Elbow muscles

A
  • Biceps brachii
  • Brachialis
  • Brachioradialis
  • Triceps brachii
  • Anconeus
  • Pronator teres
  • supinator
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16
Q

Elbow muscles:
Biceps Brachii
- Origin: long head - _
- Origin: short head - _

A
  • O: long head - glenoid & labrum
  • O: short head - coracoid process
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17
Q

Elbow muscles:
Biceps Brachii
- Insertion: _

A

I: proximal radius

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18
Q

Elbow muscles:
Biceps Brachii
- Action: _

A

A: shoulder flexion, elbow flexion, wrist supination

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19
Q

Elbow muscles:
Brachialis
- Origin: _

A

humerus

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20
Q

Elbow muscles:
Brachialis
- Insertion: _

A

Ulna

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21
Q

Elbow muscles:
Brachialis
- Action: _

A

elbow flexion

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22
Q

Elbow muscles:
Brachioradialis
- Origin: _

A

humerus

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23
Q

Elbow muscles:
Brachioradialis
- Insertion: _

A

distal radius

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24
Q

Elbow muscles:
Brachioradialis
- Action: _

A

elbow flexion

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25
Q

Elbow muscles:
Triceps brachii
- Origin: long head - _
- Origin: lateral head - _
- Origin: medial head - _

A
  • O: long head - glenoid
  • O: lateral head - upper part of posterior humerus
  • O: medial head - middle part of posterior humerus
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26
Q

Elbow muscles:
Triceps brachii
- Insertion: _

A

olecranon process of ulna

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27
Q

Elbow muscles:
Triceps brachii
- Action: _

A

elbow extension

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28
Q

Elbow muscles:
Anconeus
- Origin: _

A

lateral humerus

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29
Q

Elbow muscles:
Anconeus
- Insertion: _

A

olecranon and ulna

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30
Q

Elbow muscles:
Anconeus
- Action: _

A

elbow extension

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31
Q

Elbow muscles:
Pronator teres
- Origin: _

A

medial epicondyle of humerus

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32
Q

Elbow muscles:
Pronator teres
- Insertion: _

A

middle radius

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33
Q

Elbow muscles:
Pronator teres
- Action: _

A

wrist pronation, elbow flexion

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34
Q

Elbow muscles:
Supinator
- Origin: _

A

lateral epicondyle of humerus and lateral ulna

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35
Q

Elbow muscles:
Supinator
- Insertion: _

A

radius

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36
Q

Elbow muscles:
Supinator
- Action: _

A

supination of elbow

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37
Q

Elbow injuries

A
  • Elbow Bursitis
  • Elbow Dislocation
  • Elbow Fracture
  • Ulnar Collateral Ligament Rupture
  • Distal Biceps Tendon Rupture
  • Elbow Arthritis
  • Elbow Replacement
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38
Q

Elbow injuries:
Bursa Sac of Fluid to Protect the Olecranon Process
- Allows skin to move freely
- Can get injured:
▪ Trauma
▪ Prolonged Pressure
▪ Infection

A

elbow bursitis

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39
Q

Elbow injuries:
Humerus and Ulna become Disarticulated
- Extreme Trauma
▪ Fall at High Speed
▪ MVA

A

elbow dislocation

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40
Q

Elbow injuries:
- Can be open or closed
- May sever artery or nerve
- Reduction may be painful
- May or may not require surgery
- May not regain full motion

A

elbow dislocation

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41
Q

Elbow injuries:
- Unable to Regain Full ROM
- Loss of Elbow Extension
- May Be Permanent

A

elbow arthrofibrosis

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42
Q

Elbow injuries:
- Due to trauma
- May or may not require surgery
- depends on alignment

A

elbow fracture

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43
Q

Elbow injuries:
- Stressed with valgus force at the elbow
▪ Pitchers, Throwers
▪ May rupture
▪ May require surgery

A

Ulnar collateral ligament rupture

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44
Q

Elbow injuries:
- Sharp Pain in Arm
- Black and Blue
- “Popeye” Sign
- Usually does not require surgery

A

Distal biceps tendon rupture

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45
Q

Elbow injuries:
Disruption of the Articular Cartilage of the Humerus or Ulna
- May or May Not Have Pain

A

elbow arthritis

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46
Q

Elbow injuries:
- End Stage Operation
- For Pain Relief
- Hard to Regain Full Motion

A

elbow joint replacement

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47
Q

Elbow injuries:
- End Stage Operation
- For Pain Relief
- Hard to Regain Full Motion

A

elbow joint replacement

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48
Q

6 phases of the throwing cycle

A
  1. wind-up
  2. early cocking
  3. late cocking
  4. acceleration
  5. deceleration
  6. follow-through
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49
Q

Throwing cycle phases:
- Shoulder in slight internal rotation (IR)
- Minimal abduction
- Phase with minimal shoulder stress

A

Wind-Up

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50
Q

Throwing cycle phases:
- Contralateral Hip to 90 degrees Hip Flexion
- Shoulder in Neutral Rotation – 0 Internal and 0 External Rotation
- End of phase: increased activity of the rotator cuff
– Supraspinatus
– Infraspinatus
– Teres Minor

A

Early cocking

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51
Q

Throwing cycle phases:
- Begins with planting of the striding leg
- Scapular retraction
- Abduction to 90 degrees
- Torso starts to rotate forward
- 400 N shear force on anterior shoulder
- Increase in supraspinatus, infraspinatus, and
teres minor activitycompressive force of 650 N
- Maximal ER (up to 180 degrees)
- Shoulder Capsule is Tight

A

Late cocking

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52
Q

Throwing:
- Bony twist about the long axis of the humerus
- Results in more external ROM

A

humeral torsion

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53
Q

Throwing cycle phases:
- Beginning of forward movement of the arm
- Arm internally rotates
- Increased activity of :
– Pec major
– Lats
– Serratus anterior
- Shoulder rotates at speeds >700 degrees/ sec
- Elbow moves from flexion to extension
– Early triceps activity
- Capsule unwinds

A

Acceleration

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54
Q

Throwing cycle phases:
- Begins when object (ball) is released
- Violent eccentric contraction of all muscle groups
– Rotator Cuff
- Maximal load on joints (posterior shear
forces of 400 N, inferior shear forces of
300 N, and compressive force of 1,000 N)

A

Deceleration

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55
Q

Throwing cycle phases:
- Body moves forward with arm until motion stops

A

follow-through

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56
Q

Throwing cycle phase with maximal external rotation

A

late cocking

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57
Q

Shoulder injuries

A
  • Laxity and Instability
  • Superior Labrum Anterior-Posterior (SLAP) lesion
  • Rotator Cuff Tears
  • Impingement
  • Glenohumeral Internal Rotation Deficit (GIRD)
  • Scapular dyskinesia
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58
Q

The thrower’s shoulder must be lax enough to allow excessive external rotation but stable enough to prevent symptomatic humeral head subluxations and functional stability

A

“Thrower’s Paradox”

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59
Q

Throwing:
Result of repetitive stresses during the cocking and acceleration phases
– May make the shoulder loose – _
– Or too loose – _

A
  • laxity (normal)
  • instability (abnormal, pathologic)
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60
Q

Shoulder injuries:
- Caused by extreme ER
- “Peel back mechanism” (Burkhart and Morgan, 1998)
- Pain in late cocking phase and loss of velocity of the pitch

A

Shoulder labrum lesions

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61
Q

Shoulder injuries:
- Compression of rotator cuff between acromial arch and humeral head
- Superior migration of the humeral head due to fatigue of RC

A

Shoulder impingement

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62
Q

Shoulder injuries:
- Posterior shift in total arc of motion
- Increase in length of anterior capsule –> excessive ER
- Loss of IR motion

A

GIRD (Glenohumeral Internal Rotation Deficit)

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63
Q

Shoulder injuries:
- Imbalance of scapular muscles secondary to fatigue, direct trauma, or nerve injury
- Can lead to:
– impingement during late cocking phase
– anterior instability

A

Scapular Dyskinesia

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64
Q

Elbow injuries

A

Ulnar Collateral Ligament
* Ulnar neuritis
* Medial epicondylitis
* Valgus extension overload syndrome with
posterior olecranon impingement

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65
Q

Elbow injuries:
- During late cocking phase MCL experiences forces reaching its tensile limit
- Leads to microtrauma, ligament attenuation, and eventual rupture

A

Ulnar collateral ligament (UCL) injury

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66
Q

Elbow injuries:
- pediatric injuries

A
  • GIRD
  • Medial epicondyle apophysitis (“Little leaguer’s Elbow)
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67
Q

Elbow injuries:
- fatigue fracture, widened epiphyseal line, stress
- displaced medial epicondyle fracture
- entrapment of epicondyle in joint

A

Little Leaguer’s Elbow

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68
Q

Bones of the hand (fingers to wrist)

A
  • Distal phalanges
  • Intermediate phalanges
  • proximal phalanges
  • metacarpals
  • carpals
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69
Q
A

Distal phalanges

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70
Q
A

Intermediate phalanges

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71
Q
A

proximal phalanges

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72
Q
A

metacarpals

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73
Q

Phalanges:
Numbered:
1 = _
5 = _

A
  • thumb
  • pinky finger
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74
Q

5 joints of the wrist & hand

A
  1. Carpometacarpal (CMC)
  2. Metacarpophalangeal (MCP)
  3. Proximal Interphalangeal (PIP)
  4. Distal Interphalangeal (DIP)
  5. Interphalangeal Joint (IP) (Thumb)
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75
Q

All joints of the hand are _ _ with joint capsules

A

synovial joints

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76
Q

Wrist & hand joints:
Distal Carpals and Metacarpals
- Function: Helps Cup the Hand – Palmar Cupping
- Conforms to Shape of an Object
- Maximizes Surface Contact
- Increases Sensory Feedback
- Enhances Stability

A

Carpometacarpal (CMC)

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77
Q

Wrist & hand joints:
- CMC 1 - Digit 1 (Thumb) to Trapezium is unique
- Called a Saddle Joint
- Trapezuim looks like a saddle
- Allows Many Motions
- CMC 2-5 are Different than CMC 1

A

Carpometacarpal (CMC)

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78
Q

Wrist & hand joints:
- Metacarpals to the Phalanges
- Convex Metacarpal Head and Concave Base of Proximal Phalanx
- Gripping

A

Metacarpophalangeal (MCP)

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79
Q

Wrist & hand joints:
- Proximal Phalanx with Middle Phalanx
- Gripping
- Proximal Phalanx (PP) is convex
- Middle Phalanx (MP) is concave

A

Proximal Interphalangeal (PIP)

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80
Q

Wrist & hand joints:
- Middle Phalanx with Distal Phalanx
- Fine Motor Control
- Pinching
- Threading
- Writing

A

Distal Interphalangeal (DIP)

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81
Q

Wrist & hand movements:
Digit 1 = thumb
- CMC 1 moves in many directions

A
  • Flexion
  • Extension
  • Adduction
  • Abduction
  • Circumduction
  • Opposition
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82
Q

Wrist & hand movements:
CMC 2-4

A

almost no motion

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83
Q

Wrist & hand movements:
CMC 5

A

20 degrees of flexion and abduction

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84
Q

Wrist & hand movements:
MCP

A
  • Flexion
  • Extension
  • Abduction
  • Adduction
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85
Q

Wrist & hand movements:
MCP flexion/extension motion _ _

A

increases ulnarly

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86
Q

Wrist & hand movements:
MCP unable to abduct nor adduct with MCP _ _

A

maximal flexion

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87
Q

Wrist & hand movements:
PIP

A

only flexion & extension ( motion increases ulnarly)

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88
Q

Wrist & hand movements:
DIP

A

only flexion & extension ( motion increases ulnarly)

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89
Q

Ulnar grip:
With more motion ulnarly at MCP, PIP, and DIP:

A
  • Tighter Grip
  • Greater Closure
  • Some objects are wider at digit 2 and narrower at digit 5
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90
Q

Wrist & hand ligaments:
Radiocarpal joint
- Radial collateral ligament limits _ _

A

ulnar deviation

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91
Q

Wrist & hand ligaments:
Radiocarpal joint
- Ulnar collateral ligament limits _ _

A

radial deviation

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92
Q

Wrist & hand ligaments:
Radiocarpal joint
- Palmar radiocarpal and ulnocarpal ligaments limits _

A

extension

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93
Q

Wrist & hand ligaments:
Radiocarpal joint
- Dorsal radiocarpal ligament limits _

A

flexion

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94
Q

Wrist & hand ligaments:
Carpometacarpal joints (CMC)

A

intermetacarpal ligaments

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95
Q

Wrist & hand ligaments:
_ _ Reinforced By
- Joint capsule
- Volar plates
- Medial collateral ligaments
- Lateral collateral ligaments

A

Metacarpophalangeal Joints

96
Q

Wrist & hand ligaments:
_ _ Reinforced by
- Medial and lateral collateral ligaments
- Volar plate
- Joint capsule

A

Interphalangeal Joints

97
Q

Wrist & hand ligaments:
Reinforcement of Joint Capsule on Palmar Side
-Fibrocartilage
-Helps prevent hyperextension
- At the MCP, PIP, and DIP Joints

A

Volar plate

98
Q

Hand muscles:
Muscles who’s origin lies outside of the hand itself

A

extrinsic hand muscles

99
Q

Hand muscles: wrist flexors

A
  • flexor digitorum superficialis
  • flexor digitorum profundus
100
Q

Hand muscles:
Flexor Digitorum Superficialis
- Origin: _
 Insertion: Middle phalanx
 Action: Wrist flexion & finger flexion

A

Medial epicondyle of humerus

101
Q

Hand muscles:
Flexor Digitorum Superficialis
- Insertion: _
 Action: Wrist flexion & finger flexion

A

Middle phalanx

102
Q

Hand muscles:
Flexor Digitorum Superficialis
- Action: _

A

Wrist flexion & finger flexion

103
Q

Hand muscles:
Flexor Digitorum Profundus
- Origin: _
 Insertion: Distal phalanx
 Action: Wrist flexion & finger flexion

A

Medial epicondyle of the ulna

104
Q

Hand muscles:
Flexor Digitorum Profundus
- Insertion: _
 Action: Wrist flexion & finger flexion

A

Distal phalanx

105
Q

Hand muscles:
Flexor Digitorum Profundus
- Action: _

A

Wrist flexion & finger flexion

106
Q

Extrinsic muscles of the wrist & hand

A
  • flexor digitorum superficialis
  • flexor digitorum profundus
  • extensor digitorum
  • extensor indicis
  • extensor digiti minimi
  • extensor pollicis longus
  • extensor pollicis brevis
  • abductor pollicis longus
107
Q

Hand muscles:
Extensor Digitorum
- Origin: _
 I: Middle and distal phalanx
of digits 2-5
 A: Extension of phalanges 2-5, extension of the wrist

A

Lateral epicondyle of humerus

108
Q

Hand muscles:
Extensor Digitorum
- Insertion: _
 A: Extension of phalanges 2-5, extension of the wrist

A

Middle and distal phalanx of digits 2-5

109
Q

Hand muscles:
Extensor Digitorum
- Action: _

A

Extension of phalanges 2-5, extension of the wrist

110
Q

Hand muscles:
Extensor Indicis
- Origin: _
 I: Base of the 2nd phalange
 A: Extension of the index finger

A

Distal ulna

111
Q

Hand muscles:
Extensor Indicis
- Insertion: _
 A: Extension of the index finger

A

Base of the 2nd phalange

112
Q

Hand muscles:
Extensor Indicis
- Action: _

A

Extension of the index finger

113
Q

Hand muscles:
Extensor Digiti Minimi
- Origin: _
 I: Base of the fifth phalanx
 A: Extension of the little finger

A

Lateral epicondyle of the humerus

114
Q

Hand muscles:
Extensor Digiti Minimi
- Insertion: _
 A: Extension of the little finger

A

Base of the fifth phalanx

115
Q

Hand muscles:
Extensor Digiti Minimi
- Action: _

A

Extension of the little finger

116
Q

Hand muscles:
Extensor Pollicis Longus
- Origin: _
 I: Base of the distal phalanx of thumb, dorsal surface
 A: Extension of the thumb

A

Posterior surface of the ulna

117
Q

Hand muscles:
Extensor Pollicis Longus
- Insertion: _
 A: Extension of the thumb

A

Base of the distal phalanx of thumb, dorsal surface

118
Q

Hand muscles:
Extensor Pollicis Longus
- Action: _

A

Extension of the thumb

119
Q

Hand muscles:
Extensor Pollicis Brevis
- Origin: _
- I: Base of the proximal phalanx of the thumb, dorsal surface
- A: Extension of the thumb

A

Posterior surface of the radius

120
Q

Hand muscles:
Extensor Pollicis Brevis
- Insertion: _
- A: Extension of the thumb

A

Base of the proximal phalanx of the thumb, dorsal surface

121
Q

Hand muscles:
Extensor Pollicis Brevis
- Action: _

A

Extension of the thumb

122
Q

Hand muscles:
Abductor Pollicis Longus
- Origin: _
- Insertion: Base of 1st metacarpal, dorsal surface
- Action: Abduction of the thumb

A

Posterior radius and ulna

123
Q

Hand muscles:
Abductor Pollicis Longus
- Insertion: _
- Action: Abduction of the thumb

A

Base of 1st metacarpal, dorsal surface

124
Q

Hand muscles:
Abductor Pollicis Longus
- Action: _

A

Abduction of the thumb

125
Q

Hand muscles:
Muscles who’s origin and insertion lie within the hand itself

A

intrinsic hand muscles

126
Q

intrinsic hand muscles

A
  • opponens digiti minimi
  • abductor digiti minimi
  • flexor digiti minimi brevis
  • flexor pollicis brevis
  • abductor pollicis brevis
    -adductor pollicis
  • opponens pollicis
  • lumbricals
  • palmar interossei
  • dorsal interossei
127
Q

Hand muscles:
Opponens Digiti Minimi
- Origin: _

A

Hamate bone

128
Q

Hand muscles:
Opponens Digiti Minimi
- Insertion: _

A

5th metacarpal

129
Q

Hand muscles:
Opponens Digiti Minimi
- Action: _

A

Flexes the 5th metacarpal

130
Q

Hand muscles:
Abductor Digiti Minimi
- Origin: _
- Insertion: Proximal phalanx of 5th digit
- Action: Abduction of the 5th digit

A

The pisiform bone

131
Q

Hand muscles:
Abductor Digiti Minimi
- Insertion: _

A

Proximal phalanx of 5th digit

132
Q

Hand muscles:
Abductor Digiti Minimi
- Action: _

A

Abduction of the 5th digit

133
Q

Hand muscles:
Flexor Digiti Minimi Brevis
- Origin: _

A

Hamate bone

134
Q

Hand muscles:
Flexor Digiti Minimi Brevis
- Insertion: _

A

Proximal phalanx of the 5th digit

135
Q

Hand muscles:
Flexor Digiti Minimi Brevis
- Action: _

A

Flexion of the 5th digit

136
Q

Hand muscles:
Flexor Pollicis Brevis
- Origin: _

A

Trapezoid, Trapezium and Capitate
bones

137
Q

Hand muscles:
Flexor Pollicis Brevis
- Insertion: _

A

Proximal phalanx of the thumb

138
Q

Hand muscles:
Flexor Pollicis Brevis
- Action: _

A

Flexion of the thumb

139
Q

Hand muscles:
Abductor Pollicis Brevis
- Origin: _

A

Scaphoid and Trapezium

140
Q

Hand muscles:
Abductor Pollicis Brevis
- Insertion: _

A

Proximal phalanx of the thumb

141
Q

Hand muscles:
Abductor Pollicis Brevis
- Action: _

A

Abduction of the thumb

142
Q

Hand muscles:
Adductor Pollicis
- Origin: _

A

Capitate bone, 2nd and 3rd metacarpal bones

143
Q

Hand muscles:
Adductor Pollicis
- Insertion: _

A

Base of the proximal phalanx of thumb

144
Q

Hand muscles:
Adductor Pollicis
- Action: _

A

Adduction of the thumb

145
Q

Hand muscles:
Opponens Pollicis
- Origin: _

A

Trapezium Bone

146
Q

Hand muscles:
Opponens Pollicis
- Insertion: _

A

1st metacarpal bone

147
Q

Hand muscles:
Opponens Pollicis
Action: _

A

Flexes and abducts the 1st metacarpal

148
Q

Hand muscles:
Lumbricals
- Origin: _

A

Tendons of flexor digitorum profundus

149
Q

Hand muscles:
Lumbricals
- Insertion: _

A

Metacarpal bones

150
Q

Hand muscles:
Lumbricals
- Action: _

A

Extends interphalangeal joints

151
Q

Hand muscles:
Palmar Interossei
- Origin: _

A

Radial sides of metacarpals 1,2,4, and 5

152
Q

Hand muscles:
Palmar Interossei
- Insertion: _

A

Extensor expansion

153
Q

Hand muscles:
Palmar Interossei
- Action: _

A

Adducts 1st,2nd,4th and 5th digits toward the middle finger

154
Q

Hand muscles:
Dorsal Interossei
- Origin: _

A

Each of the two metacarpal bones between which it inserts

155
Q

Hand muscles:
Dorsal Interossei
- Insertion: _

A

Base of proximal phalanx of the 2nd, 3rd, and 4th digits

156
Q

Hand muscles:
Dorsal Interossei
- Action: _

A

Abducts the 2nd, 3rd and 4th digits from an axis through the 3rd digit

157
Q

Hand injuries

A
  • mallet finger (baseball finger)
  • Dupuytren’s Contracture
  • Tenosynovitis “Trigger Finger”
  • Carpal Tunnel Syndrome
  • Hand Fractures
  • Boutonniere Deformity
  • Gamekeeper’s/Skier’s Thumb
158
Q

Hand injuries:
- MOI: Ball or other object strikes the tip of the finger or thumb, the force damages the thin tendon that straightens the finger (extensor tendon)
- S/S: The finger is usually painful, swollen, and bruised. The fingertip may droop noticeably
- Rx: Usually splinting of finger to hold it
straight

A

Mallet Finger (Baseball Finger)

159
Q

Hand injuries:
- MOI: Progressive shortening, thickening, and fibrosis of the palmar fascia and aponeurosis
- S/S: The fingers affected by Dupuytren’s contracture bend normally but they can’t be straightened completely. Usually not painful
- Rx: Non-surgical: Focus on restoring full extension to the affected fingers
- Surgical: Excision of fibrotic parts of fascia

A

Dupuytren’s Contracture

160
Q

Hand injuries:
- MOI: Often idiopathic, but can result from repetitive overuse of the hand. Leads to inflammation of the tendon and synovial sheath
- S/S: Tendon may thicken or form a nodule, preventing smooth extension of the finger. Finger may lock in flexion, or “trigger” suddenly into extension
- Rx: Non-Surgical usually involves splinting
- Surgical: Tendon release

A

Tenosynovitis “Trigger Finger”

161
Q

Hand injuries:
- MOI: Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist
- May occur from repetitive wrist/hand motion
- May occur after trauma/injury
- Occur 3x more often in females (possibly smaller carpal tunnel)
- Often insidious onset
- Often misdiagnosed
- s/s: Usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers
- Symptoms may 1st appear at night with
sustained wrist flexion
- Often symptoms are on both sides

A

Carpal Tunnel Syndrome

162
Q

Hand injuries
Tunnel is composed of:
- _: Transverse Carpal Ligament
- _: Triquetrum and Lunate
- _: Pisiform
- _: Scaphoi

A
  • Roof
  • Floor
  • Medial Wall
  • Lateral Wall
163
Q

Structures within Carpal Tunnel

A
  • Median Nerve
  • Flexor Digitorum Profundus (4 tendons)
  • Flexor Digitorum (4 tendons)
  • Flexor Pollicis Longus
164
Q

Hand injuries:
- Rx: PT: Stretching and strengthening exercises
- Wrist splinting
- Anti-inflammatory drugs
- Surgery: Carpal Tunnel Release
- One of the most common surgeries performed in the United States
- Recommended if symptoms last for 6 months
- Surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve
- Can be performed endoscopically or open

A

Carpal Tunnel Syndrome

165
Q

Hand injuries:
- MOI: Variety of possible causes, usually traumatic in nature
- Occur in metacarpals and phalanges
- S/S: History of traumatic injury to the hand
- Pain in the finger or hand
- Swelling
- Inability to flex or extend the finger
- Deformity of the finger
- Non-Surgical: Casting/Splinting, 4-6 weeks, ROM and Strength afterward
- Surgical:
- ORIF: Open reduction with internal fixation
- Manually re-align broken bone
- Insert screw/pin or plate to fixate bone
- Casting/Splinting
- ROM and strength

A

Hand Fractures

166
Q

Hand injuries:
Finger Fracture Surgeries
- All hardware inside the body

A

Internal Fixation

167
Q

Hand injuries:
Finger Fracture Surgeries
- Part of hardware is outside the body

A

External Fixation

168
Q

Hand injuries:
- MOI: Commonly the central slip of the extensor tendon tears or pops off its attachment on the bone when the finger is jammed from the end, forcing the PIP joint to bend
- S/S: The finger is painful and swollen around the PIP joint. The PIP joint may not straighten out completely under its own power
- Non-Surgical:
- Splinting of the PIP joint for six weeks should allow the bone to heal and prevent the boutonniere deformity from occurring
- Will only work if injury is relatively new
- Surgical:
- May be indicated if deformity has had time to develop
- Surgery may be required to reconstruct and rebalance the extensor hood
- Many types of surgeries, none completely successful

A

Boutonniere Deformity

169
Q

Hand injuries:
- MOI: Any hard force on the thumb that pulls the thumb away from the hand can cause damage to the ulnar collateral ligament
- S/S: The MCP joint becomes painful and swollen
- Thumb feels weak when you pinch or grasp
- May see bruise-like discolorations on the skin around the joint
- Nonsurgical Rx:
- If the thumb ligaments are only partially torn, they usually heal without surgery
- Your thumb will be immobilized for four to six weeks in a special cast
- Surgery:
- Usually indicated with full ligament tears
- Involves repair of the ligament with stitches that anchor them back to the bone

A

Gamekeeper’s/Skier’s Thumb

170
Q

Forearm bones

A
  • radius
  • ulna
171
Q

Radius: Bony Landmarks

A
  • Head
  • Radial styloid process
  • Carpal articular surface
  • Ulnar notch
172
Q

Ulna: Bony Landmarks

A
  • Head
  • Ulnar Styloid Process
  • Radial notch
173
Q

Carpal Bones: “PT’s Love Sports However Can’t Take Time”

A
  • Pisiform
  • Triquetrum
  • Lunate
  • Scaphoid
  • Hamate
  • Capitate
  • Trapezoid
  • Trapezium
174
Q

Carpal bones: proximal row

A
  • Pisiform
  • Triquetrum
  • Lunate
  • Scaphoid
175
Q

Carpal bones: distal row

A
  • Hamate
  • Capitate
  • Trapezoid
  • Trapezium
176
Q

Forearm & wrist bones:
- Classification: short bones
- Arrangement: 8 bones arranged in proximal and distal rows of four
- Function: Movement
- These 8 bones give flexibility to the wrist
- Pisiform: a sesamoid bone (embedded within flexor carpi ulnaris tendon)

A

carpal bones

177
Q

Forearm movements

A
  • supination
  • pronation
178
Q

Forearm movements:
supination ROM = _ degrees

179
Q

Forearm movements:
pronation ROM = _ degrees

180
Q

Wrist movements

A
  • flexion
  • extension
  • radial deviation
  • ulnar deviation
181
Q

Wrist movements:
flexion ROM = _ degrees

182
Q

Wrist movements:
extension ROM = _ degrees

183
Q

Wrist movements:
radial deviation ROM = _ degrees

184
Q

Wrist movements:
ulnar deviation ROM = _ degrees

185
Q

Forearm joints

A
  • proximal radioulnar joint
  • distal radioulnar joint
186
Q

Forearm joints:
- Allows Pronation and Supination
- Convex head of radius and concave radial notch of ulna

A

Proximal Radioulnar Joint

187
Q

Forearm joints:
- Also allows Pronation and Supination
- Convex head of ulna and concave ulnar notch of radius

A

Distal Radioulnar Joint

188
Q

Forearm joints:
_ Radioulnar motion
- Axis is from radial head to ulnar head
- _: radius crosses over ulna
- _: radius and ulna lie side-by-side

A
  • Pronation
  • Supination
189
Q

Wrist joints

A
  • Radiocarpal joint
  • Midcarpal joint
190
Q

Wrist joints:
- Carpal articular surface of radius articulates
with the row of proximal carpal bones

A

Radiocarpal Joint

191
Q

Wrist joints:
- Row of proximal carpal bones articulates
with row of distal carpal bones

A

Midcarpal Joint

192
Q

Wrist joints:
- Carpal articular surface of radius is concave
- Both proximal and distal articular surfaces of row of proximal carpal bones are convex
- Proximal articular surface of row of distal
carpal bones is concave

A

Concave - Convex Rule

193
Q

Wrist joint movements:
Neutral to full flexion is mainly midcarpal joint motion

194
Q

Wrist joint movements:
Neutral to full extension is mainly radiocarpal
joint motion

195
Q

Forearm ligaments

A
  • interossesous membrane
  • annular ligament
  • Triangular Fibrocartilage
196
Q

Forearm ligaments:
- Binds radius & ulna together
- Allows transmission of forces

A

Interosseous Membrane

197
Q

Forearm ligaments:
- Goes around radial head and attaches to ulna like “staple”

A

Annular Ligament

198
Q

Wrist ligaments: Radiocarpal Joint

A
  • Ulnar Collateral Ligament
  • Radial Collateral Ligament
  • Triangular Fibrocartilage (aka articular disc)
199
Q

Forearm ligaments:
- Triangular in shape
- Located between head of ulna and row of proximal carpal bones
- Helps approximate ulna and radius

A

Triangular Fibrocartilage

200
Q

Wrist ligaments:
- Ulnar collateral ligament: limits excess radial
deviation
- Radial collateral ligament: limits excess ulnar
deviation

A

Midcarpal Joint

201
Q

Forearm muscles:
Wrist Flexors _
- 4/5 have common origin (medial epicondyle of humerus)
- All located in anterior forearm
Wrist Extensors _
- All have common origin (lateral epicondyle of humerus)
- All located in posterior forearm
Forearm Pronators/Supinators _
- All have common insertion (radius)

A
  • (5)
  • (4)
  • (3)
202
Q

5 Wrist flexor muscles

A
  1. Flexor Carpi Radialis*
  2. Flexor Carpi Ulnaris*
  3. Palmaris Longus*
  4. Flexor Digitorum Superficialis*
  5. Flexor Digitorum Profundus
203
Q

Wrist Flexors:
Flexor Carpi Radialis
- Insertion: _

A

metacarpals

204
Q

Wrist Flexors:
Flexor Carpi Radialis
- Action: _

A

wrist flexion & radial deviation

205
Q

Wrist Flexors:
Flexor Carpi Ulnaris
- Insertion: _

206
Q

Wrist Flexors:
Flexor Carpi Ulnaris
- Action: _

A

wrist flexion & ulnar deviation

207
Q

Wrist Flexors:
Palmaris Longus
- Insertion: _

208
Q

Wrist Flexors:
Palmaris Longus
- Action: _

A

wrist flexion

209
Q

Wrist Flexors:
Flexor Digitorum Superficialis
- Insertion: _

A

middle phalanx

210
Q

Wrist Flexors:
Flexor Digitorum Superficialis
- Action: _

A

wrist flexion & finger flexion

211
Q

Wrist Flexors:
Flexor Digitorum Profundus
- Insertion: _

A

distal phalanx

212
Q

Wrist Flexors:
Flexor Digitorum Profundus
- Action: _

A

wrist flexion & finger flexion

213
Q

4 Wrist Extensor muscles:
Common origin = lateral epicondyle of humerus

A
  1. Extensor Carpi Radialis Longus
  2. Extensor Carpi Radialis Brevis
  3. Extensor Carpi Ulnaris
  4. Extensor Digitorum
214
Q

Wrist Extensors:
Extensor Carpi Radialis Longus
- Insertion: _

A

metacarpals

215
Q

Wrist Extensors:
Extensor Carpi Radialis Longus
- Action: _

A

wrist extension & radial deviation

216
Q

Wrist Extensors:
Extensor Carpi Radialis Brevis
- Insertion: _

A

metacarpals

217
Q

Wrist Extensor muscles:
Extensor Carpi Radialis Brevis
- Action: _

A

wrist extension

218
Q

Wrist Extensor muscles:
Extensor Carpi Ulnaris
- Insertion: _

A

metacarpals

219
Q

Wrist Extensor muscles:
Extensor Carpi Ulnaris
- Action: _

A

wrist extension & ulnar deviation

220
Q

Wrist Extensor muscles:
Extensor Digitorum
- Insertion: _

A

middle & distal phalanx digits 2- 5

221
Q

Wrist Extensor muscles:
Extensor Digitorum
- Action: _

A

wrist extension & finger extension

222
Q

3 Wrist Pronators/Supinators:

A
  1. Pronator Teres
  2. Pronator Quadratus
  3. Supinator
223
Q

Wrist Pronators:
Pronator Teres
- Origin: _

A

med. epicondyle

224
Q

Wrist Pronators:
Pronator Teres
- Action: _

225
Q

Wrist Pronators:
Pronator Quadratus
- Origin: _

226
Q

Wrist Pronators:
Pronator Quadratus
- Action: _

227
Q

Wrist Supinators:
Supinator
- Origin: _

A

lat. epicondyle and ulna

228
Q

Wrist Supinators:
Supinator
- Action: _

A

supination

229
Q

Wrist & forearm injuries

A
  • Colles Fracture
  • Scaphoid Fracture
  • Lateral Epicondylitis
  • Medial Epicondylitis
230
Q

Wrist & forearm injuries:
- MOI: FOOSH (fall on out-stretched hand)
- Dx: radiography confirms
- Tx: long arm cast 3 wks, short arm cast 3 wks,
splint 6 wks
- PT: ROM and strengthening

A

Colles Fracture (distal radius fracture)

231
Q

Wrist & forearm injuries:
- MOI: FOOSH
- Dx: tenderness over the scaphoid, radiographs
- Prognosis: fair due to tenuous blood supply
- Tx: long arm cast 6 wks + short arm cast 6 wks

A

Scaphoid Fracture

232
Q

Wrist & forearm injuries:
- At-risk: anyone who uses repetitive wrist extension: tennis players (backhand), painters, carpenters
- MOI: repetitive abnormal forces cause
microtears/fibrosis of common extensor tendon
- Pathology: if injury is chronic or sub-acute then likely tendonosis is present instead of tendonitis
- S/S: gradual aching pain over lateral elbow region aggravated by use wrist extensors
- Tx: PT focuses on stretching / eccentric
strengthening of common extensor tendon
- May contribute to:
- Weak or inflexible shoulder / wrist muscles
- Tennis: improper backhand, tightly strung racket, too narrow grip

A

Lateral Epicondylitis (Tennis Elbow)

233
Q

Wrist & forearm injuries:
- At-risk: anyone who uses repetitive wrist flexion: golfers, pitchers, carpenters, rock climbers
- MOI: repetitive abnormal forces cause
microtears/fibrosis of common flexor tendon
- Pathology: if injury is chronic or sub-acute then likely tendonosis is present instead of tendonitis
- S/S: gradual aching pain over medial elbow region aggravated by use wrist flexors
- Tx: PT focuses on stretching / eccentric
strengthening of common flexor tendon
- May contribute to:
- Weak or inflexible shoulder / wrist muscles
- Carrying heavy suitcase, chopping wood, frequent use of other hand tools

A

Medial Epicondylitis (Golfers Elbow)

234
Q

Forearm & wrist surgeries:
- Candidates: patients with displaced, unstable, or non-union scaphoid fractures
- Procedure: open-incision; if bone graft is used it is usually harvested from the pelvis; pin or screw is inserted to approximate the fracture

A

Scaphoid Surgery

235
Q

Forearm & wrist surgeries

A
  • scaphoid Surgery
  • prosthetic arm

Applied Kinesiology (3 decks)

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