Exam 3 Study Cards Flashcards
1
Q
What is the importance of the pisotriquetral joint?
A
Gives strength in grip
Attachment for transverse carpal ligament
2
Q
How many bones are in the entire wrist?
A
15 bones
3
Q
What bones make up the wrist?
A
8 carpal bones, ulna, radius, 5 metacarpal bones
4
Q
what articulations make up all of the digits?
A
Carpalmetacarpal joint (CMC) Metacarpalphalangeal joint (MCP) interphalangeal joint (IP)
5
Q
How many bones are in your hand?
A
19 bones Metacarpals -5 Proximal phalanges- 5 Middle Phalanges- 4 Distal Phalanges- 5
6
Q
What are the three arches on your hand?
A
Proximal Transverse Arch
Distal Transverse Arch
Longitudinal Arch
7
Q
Explain the location of each arch of the hand
A
Proximal Transverse Arch- along CMC joints
Distal Transverse Arch - along MCP joints
Longitudinal Arch - runs from wrist to fingertips, apex at metacarpal heads
8
Q
What does weakness of intrinsic muscles cause?
A
loss of the arches
9
Q
what are the functions of the arches in the hand?
A
- It allows palmar cupping
2. important to consider arches when splinting
10
Q
What are the articulations of the hand?
A
Carpometacarpal (CMC) Joints Metacarpophalangeal Joints (MCP) Proximal Interphalangeal Joints (PIP) Distal Interphalangeal Joints (DIP)
11
Q
Explain the articulations of the CMC joints?
A
Articulation between digits 2-5 with distal carpal bones and a base to base articulation between adjacent matacarpals
12
Q
What is the function of the 2nd & 3rd, 4th & 5th CMC?
A
2nd & 3rd- primary stabilizers of The hand
4th & 5th- permits cupping
13
Q
T/F the primary stabilizers are the 2nd and 3rd CMC joint?
A
True
14
Q
What type of joint is the CMC joint?
A
Plane joint, synovial, only gliding occurs
15
Q
What are the movements of the CMC joint?
A
Flexion and Extension
16
Q
What are the approximate ROM of 2&3, 4, and 5th CMC joints?
A
2nd&3rd- minimal
4th- 10-15 degrees
5th- 25-30 degrees
17
Q
what movement in the CMC joint permits hand cupping?
A
Flexion
18
Q
What movement in the CMC joint permits hands to be flat?
A
Extension
19
Q
What are the arthrokinematics of Flexion in the CMC joint?
A
Metacarpals slide on the carpals in volar (palmar)
direction
20
Q
What are the arthrokinematics of Extension in the CMC joint?
A
Metacarpals slide on the carpals in dorsal direction
21
Q
T/F During Flexion of the CMC joint the Transverse Arch increases
A
True
22
Q
What happens to the Transverse arch during extension of the CMC joint?
A
The Transverse Arch decreases
23
Q
Which muscles contribute to the CMC joint?
A
Radial wrist muscles: - flexor carpi radialis - extensor carpi radialis - extensor carpi radialis brevis - extensor carpi ulnaris Flexor digitorum superficialis Flexor Digitorum Profundus
24
Q
What structures cause the CMC to be stable?
A
Joint capsules Dorsal carpometacarpal ligaments Palmar carpometacarpal ligaments Interosseous carpometacarpal ligaments Intermetacarpal ligament
25
What are the movements of the CMC joint at the THUMB?
Flexion/Extension
Abduction/Adduction
Opposition/Circumduction
26
In what plane is abduction/adduction of the CMC joint at the thumb?
Sagittal Plane
27
In what plane is flexion/extension of the CMC joint at the thumb?
Coronal Plane
28
Explain each movement of the CMC joint at the thumb for abduction/adduction
Movement perpendicular to the palm
29
What is circumduction of the CMC joint at the thumb ?
Combination of abduction, flexion, adduction, and extension with medial rotation of metacarpal
30
What type of joint is the CMC at the thumb?
Biaxial, sellar joint
31
What is the concave, convex rule of flexion and extension in the CMC joint of the thumb?
CONVEX trapezium articulates on the CONCAVE base of the metacarpal. (roll and slide in the same direction)
32
What is the movement of flexion and extension in the CMC joint at the thumb?
Flexion- medial direction
| Extension- lateral direction
33
What is the concave, convex rule of abduction or adduction in the CMC joint of the thumb?
CONCAVE trapezium articulates on the CONVEX base of the metacarpal. (Roll in same direction of movement; slide in opposite direction of movement)
34
What is the movement of abduction and adduction in the CMC joint at the thumb?
Abduction- roll in palmar direction, slide in dorsal direction
Adduction- roll in dorsal direction, slide in palmar direction
35
What causes arthritis of the CMC Joint?
large functional demands on ADLs/IADLs
36
What does arthritis in the CMC joint cause?
limited functional grasp and ability to maintain grasp
37
T/F Arthritis in the CMC joint is more common in women over 50?
True
38
What causes women to have more CMC arthritis?
smaller trapezium and joint laxity
39
What is the articulation of the Metacarpalphalangeal (MCP) joint?
articulation of metacarpal with adjacent proximal phalanx
40
What are accessory movements important for?
Important for control and functional grasp
41
How much accessory movement is there when MCPs are flexed?
Little accessory movement
42
How much accessory movement is there when MCPs are extended?
Greater accessory movement and joint distraction
43
What type of joint is MCP?
Condyloid, Biaxial Joint
44
How many planes of moment are in the MCP joint?
3 planes
Flexion/Extension
Abduction/Adduction
Slight Rotation
45
Flexion and Extension are in what plane?
Sagittal Plane
46
How many degrees of flexion and hyperextension are in the MCP joint?
Flexion- 70-115 degrees
| Hyperextension (passively) - 30-45 degrees
47
When does abduction occur in the MCP joint?
When the 2nd, 4th, and 5th finger moves away from the 3rd finger
48
Which digit is the point of reference?
The middle finger
49
What type of joint is the MCP of the thumb?
Condyloid Joint
50
What are the degrees of movement of the MCP joint at the thumb?
Flexion/ Extension
| Abduction/Adduction
51
T/F The thumb has less movement at the MCP joint compared to other fingers?
True
52
What is the arthrokinematics of Extension and Flexion in the MCP joint at the thumb?
Flexion- Roll and slide in palmar direction
Extension- Roll and Slide in dorsal direction
(CONCAVE phalange moves on the CONVEX metacarpal head)
53
How many interphalangeal joints are in the hand?
9
54
Is there more ROM moving radially or ulnarly?
There is more ROM moving radially
55
What is the function of 2nd and 3rd IP joints?
Precision
56
What is the function of the 3rd, 4th, and 5th IP joints?
Power
57
T/F The 3rd digit has the function of precision and power?
True
58
What is the Average ROM of PIP, DIP, and thumb IP?
PIP: 0 – 120 degrees of ROM
DIP: 0 – 90 degrees of ROM
Thumb IP: 0 – 80 degrees of ROM
59
What are the movements of the IP joints?
Flexion and Extension
60
Describe the arthrokinematics of the IP joints
CONCAVE proximal end of the phalange moving on the CONVEX distal end of the phalange
61
In the IP joint in what direction does the bones roll and slide in flexion and extension?
Flexion – Roll and slide in palmar direction
| Extension - Roll and slide in dorsal direction
62
What causes the stablility of the MCPs, PIPs, DIPs?
Joint Capsule
Radial collateral ligaments
Ulnar collateral ligaments
Palmar ligament
63
What is the function of the Radial and Ulnar Collateral Ligaments?
Limits Abduction and Adduction
64
What is the function of the Palmar Ligament
Limits hyperextension, reinforces the joint
65
Which is the most important finger of the hand?
The thumb
66
The thumb accounts for ____% loss of function in the hand if immobile.
50%
67
What is prehension?
reaching, grasping, releasing
68
The thumb is a defining functional factor because it _____?
Defines stability, control of direction and power
69
What does nonmanipulative/power mean?
thumb is non-functional
70
What does Manipulative/Precision mean?
thumb and other fingers are involved
71
The thumb/4th/5th CMC joints provide_______.
mobility
72
The 2nd and 3rd CMC joints provide _______.
stability
73
What are the four stages of grasp?
1. Opening hand
2. Closing hand around the object
3. Correct Force Application
4. Release of the Object
74
What happens in the first stage of grasp?
Opening hand; coordination of intrinsics and extensors
75
What happens in the second stage of graps?
Closing hand around the object; Coordination of flexors
76
What happens in the third stage of grasp?
Correct force application; Gaging weight, size, characteristics
77
What is Power Grip?
Digits position an object against the palm
Thumb is nonfunctional
Produce significant amount of force
78
What are the three types of power grip ?
Hook, Cylindrical/Spherical, Fist
79
What does hook power grip allow to carry?
objects such as purses or briefcase and sustain force for a long time
80
How are the MCPs, PIPs &DIPs and thumb in the hook grip?
MCPs: neutral or extended
PIPs and DIPs : flexed
thumb: non-functional
81
Which fingers are involved in hook grip?
2nd – 5th fingers around an object in a hooklike manner
82
Explain the cylindrical power grip
Is like “Holding a can of soda”
The Thumb is in Opposition
Fingers are Flexed and ADDucted
83
Explain the spherical power grip
Is like “Holding a ball”
Thumb: Opposition
Fingers: Flexed and ABDucted
84
Explain the fist power grip
Holding a narrow object like a Broom Handle
85
What is Precision Grip ?
Holding objects between the tips of the fingers and thumb
86
T/F Precision Grip is Fine motor coordination and precise manipulation of objects
True
87
What are the three types of precision grip
lateral pinch, tip pinch, and palmar pinch
88
T/F Palmar pinch is most commonly used in ADLs
True
89
What does the Lateral Pinch involve?
Involves palmar surface of thumb and
| lateral index finger
90
What is the lateral pinch used for?
used to hold thin objects in hand
91
Explain how the thumb, IPs, and index finger appear in lateral pinch
Thumb adducted
IP- flexed
Index finger- Flexed and abducted
92
What does the Precision Pinch involve?
Involves tip of finger with tip of thumb
| to pick up a small object. Forms a circle
93
Explain the postion of the thumb and fingers in precision pinch
Thumb: Opposition and Flexion
Fingers: MCP, PIP, DIP Flexion
94
What is precision grip involved in?
Fine Motor Cordination not power
95
What does the Palmar Pinch involve?
Palmar surfaces of distal phalange in
| contact with palmar surface of thumb. Forms an oval
96
Explain the postion of the thumb and fingers in palmar pinch
Thumb: Opposition, slight flexion
Fingers: MCP and PIP flexion
97
What is another name for Palmar Pinch
Three-Jar-Chuck - thumb, index and middle fingers
98
What is the functional hand position
Slightly cupped
Wrist in slight extension and ulnar deviation
- Optimal length for finger flexors
Fingers progressively more flexed radial -> ulnar side
- Important for splinting
99
When observing the hands of a client you want to make sure to looks at ....
Comparison of both hands
Thenar and Hypothenar eminences
Arches and creases
Swelling
100
When comparing both hands of a client you must note...
Color, temperature, apperance of skin, shape of fingers
101
T/F The dominant hand is usually slightly larger
True
102
What is Swan Neck Deformity ?
Contracture of intrinsic muscles or tear of volar plate
MCP flexion
PIP extension
DIP flexion
103
What is Boutonniere Deformity?
```
Rupture of the extensor hood
Extensor tendons separate and the joint protrudes
MCP extension
PIP flexion
DIP extension
```
104
What IP joint of the finger cannot extend in Mallet finger ?
DIP CANNOT extend
105
What happens during ulnar drift?
Extensor digitorum tendon slips off dorsal
portion of MCP and moves to ulnar side
“Wind Swept Hands”
106
What nerve gets damaged during Carpal Tunnel Syndrome?
Median Nerve
107
What is more commonly fractured the metacarpals or the phlanges?
Metacarpal fracture and subluxation more common than phalanges
108
What are the most common tendon hand injury?
Shortening due to immobilization, contractures, spasticity
| Extensor tendon rupture
109
How is the movement for flexion/ extension of the thumb at the CMC joint?
parallel to the palm
110
How many middle phalanges do you have in your hand?
4
111
What are the primary stabilizers of the hand?
2nd and 3rd CMC joints
112
What 2 joints permit cupping?
4th and 5th CMC joints
