Exam 3 Study Cards Flashcards
What is the importance of the pisotriquetral joint?
Gives strength in grip
Attachment for transverse carpal ligament
How many bones are in the entire wrist?
15 bones
What bones make up the wrist?
8 carpal bones, ulna, radius, 5 metacarpal bones
what articulations make up all of the digits?
Carpalmetacarpal joint (CMC) Metacarpalphalangeal joint (MCP) interphalangeal joint (IP)
How many bones are in your hand?
19 bones Metacarpals -5 Proximal phalanges- 5 Middle Phalanges- 4 Distal Phalanges- 5
What are the three arches on your hand?
Proximal Transverse Arch
Distal Transverse Arch
Longitudinal Arch
Explain the location of each arch of the hand
Proximal Transverse Arch- along CMC joints
Distal Transverse Arch - along MCP joints
Longitudinal Arch - runs from wrist to fingertips, apex at metacarpal heads
What does weakness of intrinsic muscles cause?
loss of the arches
what are the functions of the arches in the hand?
- It allows palmar cupping
2. important to consider arches when splinting
What are the articulations of the hand?
Carpometacarpal (CMC) Joints Metacarpophalangeal Joints (MCP) Proximal Interphalangeal Joints (PIP) Distal Interphalangeal Joints (DIP)
Explain the articulations of the CMC joints?
Articulation between digits 2-5 with distal carpal bones and a base to base articulation between adjacent matacarpals
What is the function of the 2nd & 3rd, 4th & 5th CMC?
2nd & 3rd- primary stabilizers of The hand
4th & 5th- permits cupping
T/F the primary stabilizers are the 2nd and 3rd CMC joint?
True
What type of joint is the CMC joint?
Plane joint, synovial, only gliding occurs
What are the movements of the CMC joint?
Flexion and Extension
What are the approximate ROM of 2&3, 4, and 5th CMC joints?
2nd&3rd- minimal
4th- 10-15 degrees
5th- 25-30 degrees
what movement in the CMC joint permits hand cupping?
Flexion
What movement in the CMC joint permits hands to be flat?
Extension
What are the arthrokinematics of Flexion in the CMC joint?
Metacarpals slide on the carpals in volar (palmar)
direction
What are the arthrokinematics of Extension in the CMC joint?
Metacarpals slide on the carpals in dorsal direction
T/F During Flexion of the CMC joint the Transverse Arch increases
True
What happens to the Transverse arch during extension of the CMC joint?
The Transverse Arch decreases
Which muscles contribute to the CMC joint?
Radial wrist muscles: - flexor carpi radialis - extensor carpi radialis - extensor carpi radialis brevis - extensor carpi ulnaris Flexor digitorum superficialis Flexor Digitorum Profundus
What structures cause the CMC to be stable?
Joint capsules Dorsal carpometacarpal ligaments Palmar carpometacarpal ligaments Interosseous carpometacarpal ligaments Intermetacarpal ligament
What are the movements of the CMC joint at the THUMB?
Flexion/Extension
Abduction/Adduction
Opposition/Circumduction
In what plane is abduction/adduction of the CMC joint at the thumb?
Sagittal Plane
In what plane is flexion/extension of the CMC joint at the thumb?
Coronal Plane
Explain each movement of the CMC joint at the thumb for abduction/adduction
Movement perpendicular to the palm
What is circumduction of the CMC joint at the thumb ?
Combination of abduction, flexion, adduction, and extension with medial rotation of metacarpal
What type of joint is the CMC at the thumb?
Biaxial, sellar joint
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)
What is the movement of flexion and extension in the CMC joint at the thumb?
Flexion- medial direction
Extension- lateral direction
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)
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
What causes arthritis of the CMC Joint?
large functional demands on ADLs/IADLs
What does arthritis in the CMC joint cause?
limited functional grasp and ability to maintain grasp
T/F Arthritis in the CMC joint is more common in women over 50?
True
What causes women to have more CMC arthritis?
smaller trapezium and joint laxity
What is the articulation of the Metacarpalphalangeal (MCP) joint?
articulation of metacarpal with adjacent proximal phalanx
What are accessory movements important for?
Important for control and functional grasp
How much accessory movement is there when MCPs are flexed?
Little accessory movement
How much accessory movement is there when MCPs are extended?
Greater accessory movement and joint distraction
What type of joint is MCP?
Condyloid, Biaxial Joint
How many planes of moment are in the MCP joint?
3 planes
Flexion/Extension
Abduction/Adduction
Slight Rotation
Flexion and Extension are in what plane?
Sagittal Plane
How many degrees of flexion and hyperextension are in the MCP joint?
Flexion- 70-115 degrees
Hyperextension (passively) - 30-45 degrees
When does abduction occur in the MCP joint?
When the 2nd, 4th, and 5th finger moves away from the 3rd finger
Which digit is the point of reference?
The middle finger
What type of joint is the MCP of the thumb?
Condyloid Joint
What are the degrees of movement of the MCP joint at the thumb?
Flexion/ Extension
Abduction/Adduction
T/F The thumb has less movement at the MCP joint compared to other fingers?
True
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)
How many interphalangeal joints are in the hand?
9
Is there more ROM moving radially or ulnarly?
There is more ROM moving radially
What is the function of 2nd and 3rd IP joints?
Precision
What is the function of the 3rd, 4th, and 5th IP joints?
Power
T/F The 3rd digit has the function of precision and power?
True
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
What are the movements of the IP joints?
Flexion and Extension
Describe the arthrokinematics of the IP joints
CONCAVE proximal end of the phalange moving on the CONVEX distal end of the phalange
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
What causes the stablility of the MCPs, PIPs, DIPs?
Joint Capsule
Radial collateral ligaments
Ulnar collateral ligaments
Palmar ligament
What is the function of the Radial and Ulnar Collateral Ligaments?
Limits Abduction and Adduction
What is the function of the Palmar Ligament
Limits hyperextension, reinforces the joint
Which is the most important finger of the hand?
The thumb
The thumb accounts for ____% loss of function in the hand if immobile.
50%
What is prehension?
reaching, grasping, releasing
The thumb is a defining functional factor because it _____?
Defines stability, control of direction and power
What does nonmanipulative/power mean?
thumb is non-functional
What does Manipulative/Precision mean?
thumb and other fingers are involved
The thumb/4th/5th CMC joints provide_______.
mobility
The 2nd and 3rd CMC joints provide _______.
stability
What are the four stages of grasp?
- Opening hand
- Closing hand around the object
- Correct Force Application
- Release of the Object
What happens in the first stage of grasp?
Opening hand; coordination of intrinsics and extensors
What happens in the second stage of graps?
Closing hand around the object; Coordination of flexors
What happens in the third stage of grasp?
Correct force application; Gaging weight, size, characteristics
What is Power Grip?
Digits position an object against the palm
Thumb is nonfunctional
Produce significant amount of force
What are the three types of power grip ?
Hook, Cylindrical/Spherical, Fist
What does hook power grip allow to carry?
objects such as purses or briefcase and sustain force for a long time
How are the MCPs, PIPs &DIPs and thumb in the hook grip?
MCPs: neutral or extended
PIPs and DIPs : flexed
thumb: non-functional
Which fingers are involved in hook grip?
2nd – 5th fingers around an object in a hooklike manner
Explain the cylindrical power grip
Is like “Holding a can of soda”
The Thumb is in Opposition
Fingers are Flexed and ADDucted
Explain the spherical power grip
Is like “Holding a ball”
Thumb: Opposition
Fingers: Flexed and ABDucted
Explain the fist power grip
Holding a narrow object like a Broom Handle
What is Precision Grip ?
Holding objects between the tips of the fingers and thumb
T/F Precision Grip is Fine motor coordination and precise manipulation of objects
True
What are the three types of precision grip
lateral pinch, tip pinch, and palmar pinch
T/F Palmar pinch is most commonly used in ADLs
True
What does the Lateral Pinch involve?
Involves palmar surface of thumb and
lateral index finger
What is the lateral pinch used for?
used to hold thin objects in hand
Explain how the thumb, IPs, and index finger appear in lateral pinch
Thumb adducted
IP- flexed
Index finger- Flexed and abducted
What does the Precision Pinch involve?
Involves tip of finger with tip of thumb
to pick up a small object. Forms a circle
Explain the postion of the thumb and fingers in precision pinch
Thumb: Opposition and Flexion
Fingers: MCP, PIP, DIP Flexion
What is precision grip involved in?
Fine Motor Cordination not power
What does the Palmar Pinch involve?
Palmar surfaces of distal phalange in
contact with palmar surface of thumb. Forms an oval
Explain the postion of the thumb and fingers in palmar pinch
Thumb: Opposition, slight flexion
Fingers: MCP and PIP flexion
What is another name for Palmar Pinch
Three-Jar-Chuck - thumb, index and middle fingers
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
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
When comparing both hands of a client you must note…
Color, temperature, apperance of skin, shape of fingers
T/F The dominant hand is usually slightly larger
True
What is Swan Neck Deformity ?
Contracture of intrinsic muscles or tear of volar plate
MCP flexion
PIP extension
DIP flexion
What is Boutonniere Deformity?
Rupture of the extensor hood Extensor tendons separate and the joint protrudes MCP extension PIP flexion DIP extension
What IP joint of the finger cannot extend in Mallet finger ?
DIP CANNOT extend
What happens during ulnar drift?
Extensor digitorum tendon slips off dorsal
portion of MCP and moves to ulnar side
“Wind Swept Hands”
What nerve gets damaged during Carpal Tunnel Syndrome?
Median Nerve
What is more commonly fractured the metacarpals or the phlanges?
Metacarpal fracture and subluxation more common than phalanges
What are the most common tendon hand injury?
Shortening due to immobilization, contractures, spasticity
Extensor tendon rupture
How is the movement for flexion/ extension of the thumb at the CMC joint?
parallel to the palm
How many middle phalanges do you have in your hand?
4
What are the primary stabilizers of the hand?
2nd and 3rd CMC joints
What 2 joints permit cupping?
4th and 5th CMC joints
