Exam 4 Flashcards
1
Q
what is the primary goal of elbow and FA
A
placement of hand
2
Q
what connects on the med epicondyle
A
common flexors/pronators
3
Q
what connects on the lat epicondyle
A
common extensor/supinators
4
Q
describe the proximal ulna
A
thick
olecranon process
trochlear notch
radial notch
5
Q
describe the distal ulna
A
articular cartilage
styloid process
6
Q
what attaches to the supinator crest
A
LCL and sup mm
7
Q
what attaches to the tuberosity of the ulna
A
brachialis
8
Q
how is the radius positioned in supination
A
parallel and lateral
9
Q
describe the distal end of radius
A
large
styloid process
10
Q
describe the proximal end of radius
A
small
radial head
fovea
11
Q
describe radial head
A
disc like articular cartilage
280 deg of rim
radial notch on ulna
12
Q
what is the fovea on the radial head
A
shallow up connected to capitulum
13
Q
describe the humeral-ulnar jt
A
FLX/EXT
stability
14
Q
describe the humeroradial jt
A
FLX/EXT
ligaments attach to radial head and capitulum
15
Q
what is the normal cubitus valgus
A
carrying angle
13 deg
excessive = 20-25 deg
16
Q
describe the capsule/ligaments of the elbow
A
encompass 3 jts
multiplanar stability
17
Q
describe the ant fibers of MCL
A
strongest
resist valgus
med epicondyle to coronoid process
stability in sagittal
17
Q
describe the post fibers of MCL
A
posterior/med capsule
med epicondyle to olecranon
resist valgus
tight in flexion
18
Q
describe the transverse fibers of the MCL
A
olecranon to coronoid process
articular stability
19
Q
what is a WB injury to MCL
A
extended/valgus force
compression fx
ant capsule
med muscles at epicondyle
20
Q
what is a NWB injury to MCL
A
repetitive valgus force (overhead athletes)
ant fibers damaged - tommy john surgery
21
Q
what is the RCL
A
annular lig
supinator
extensor carpi radialis brevis
22
Q
what is the LCL
A
thicker
taut at full flexion
sling for radial head
frontal/horizontal plane stability
23
Q
what is a triad injury in the elbow
A
full outstretch supinated
elbow jt dislocation
fx radial head
fx coronoid process
24
what are complications of the triad injury
persistent instability
n damage
stiffness
25
what level of spinal injury can cause paralysis in elbow
above C5 spinal injury
26
what is a flexion contracture
after immobilization
ossification
inflammation
m spasticity
tricep paralysis
scarring
27
what is the functional arc of elbow
145-150
28
what are the humero-ulnar jt arthro
concave trochlear notch on convex trochlea
29
what fibers are taut in full elbow extension
anterior m and tissues
ant capsule
ant MCL fibers
30
what fibers are taut in FLX
elongation of ulanr n
post capsule and m
post MCL fibers
31
what are the humeroradial arthro
radius rolls and slides
cuplike fovea and capitulum
32
what is the fovea doing in active FLX
firmly against capitulum
33
how is the central band of interosseus membrane positioned
directed distally medially at 20 deg from radius
34
what are complications of interosseus membrane tears
proximal migration of radius
35
Describe the proximal radio-ulnar jt
Radial notch + annular ligament
Lined with cartilage
Attachment for radial collateral and supination m
36
Describe the distal radio-ulnar jt
Convex head of ulna
Shallow concavity on radius
TFC, disc, m
37
What is the TFC
Triangular fibrocartilage
Holds the ulna head to the notch during supination and pronation
38
What are the stabilizers of the distal radio-ulnar jt
TFCC, pronator quadratus, ECU, interosseus membrane
39
What limits supination
Pronator teres
Pronator quadratus
Flexor carpi radialis
TFCC
quadrate lig
Interosseus membrane
40
what limits pronation
biceps
supinator
radial wrist extensors
extensor pollicis longus
TFCC
41
how do the bones move during supination at the proximal and distal seg
radius and carpal bones rotate around fixed humerus and ulna
prox- radial head RT
distal- radius rolls and slides same direction
42
where is the axis of RT in the radio-ulnar jt
nearly parallel to the interosseus membrane
limits tension
stabilizer
43
what is happening in pronation in open chain activities
pronator rotates the radius around fixed ulna
44
what is happening in pronation in closed chain activities
the infraspinatus rotates the humerus relative to fixed scapula
ER of ulna around fixed radius
45
what are the elbow flexors
brachialis (MSC n)
bicep brachii (MSC n)
brachioradialis (radial n)
pronator teres (median n)
46
what are the elbow extensors
tricep brachii (radial n)
anconeus (radial n)
47
what are the FA pronators
pronator quadratus (median n)
pronator teres (median n)
48
what are the FA supinators
bicep brachii (MSC n)
supinator (radial n)
49
what is the job of the 3 heads of tricep
medial - workhorse
lateral - mod to high levels of demand
long - reserve for high performance
50
when does the tricep have max torque
80-90 elbow flexion
51
what does the tricep do in WB
stability as isometric or low velocity eccentric
52
when does the tricep do high velocity concentric
sports
pushing up from a chair
pushing up from door
53
what are the secondary supinator m
radial wrist extensors
extensor pollicis longus
extensor indicis
brachioradialis
54
when is the bicep recruited for supination
90 deg elbow flexion
55
where does the median n pass through
2 heads of pronator teres
56
what is an effect of median n injury
pronators are paralyzed
57
what are secondary pronators
flexor carpi radialis
palmaris longus
brachioradialis
58
what is different from carpul tunnel syndrome and pronator teres syndrome
pronator teres has pain in medial FA plus the paresthesia on palmar 3.5 digits
59
what is the ulna tilt
distal end of radius tilts towards ulna 25 deg
60
what is the palmar tilt
ulna is 10 deg more in flexion than wrist ext
61
what makes up the prox carpal row
scaphoid, lunate, triquetrum, and pisiform
loosely joined
62
what makes up the distal carpal row
trapezium, trapezoid, capitate, and hamate
bound tightly by ligaments
63
describe the scaphoid
undersurface of radius
holds head of capitate
lined with articular cartilage
synovial jt with 4 other carpals
64
what is the mostly fx carpal
scaphoid
65
what is kienbocks disease
softening of lunate- AVN
66
describe the lunate
moon shaped
central bone of prox row
most unstable
67
describe the triquetrum
triangular bone
most ulnar
articular facet that accepts pisiform
68
describe the pisiform
shaped like a pea
articulates with triquetrum
embedded in FCU
acts like sesamoid bone
attachment for ABD DM, transverse carpal lig
69
describe the capitate
largest, central
articulates with 7 bones
stable
axis through captitate
70
describe the trapezium
asymmetrical
concave at scaphoid
distal saddle
tubercle is attachment for transverse carpal lig
FCR groove
71
describe the trapezoid
small
between capitate and trapezium
firm attachment to 2nd metacarpal
72
describe the hamate
large hook
at 4/5th metacarpal
functional mobility- cupped hand
attachment of transverse lig
73
what makes the carpal tunnel
transverse carpal lig
74
what are the attachments for transverse carpal lig
pisiform, hook of hamate, tubercle of trapezium and scaphoid
75
describe the radiocarpal jt
concave radius and convex scaphoid and lunate
greatest contact at slight ext and ulnar dev (triquetrum is apart of it)
76
describe the midcarpal jt
between prox and distal rows
lat and med compartment
77
how many joints are in the intercarpal jt
13
78
how many DOF are within the wrist
2
sagittal and frontal plane
79
what is the degrees of sagittal plane
FLX- 0-70/85
EXT- 0-60/75
80
what is the degrees of frontal plane
R dev- 0-50/60
U dev- 0-35/40
81
what are functional ranges for ADLS
40 deg FLX/EXT
10 deg R dev
30 deg U dev
82
what is the position of function for wrist
10-15 deg EXT
10 deg U dev
83
what are the motion combos of the wrist
EXT occurs with R dev
FLX occurs with U dev
84
what is the central column
formed by linkages between radius and lunate, med compartment of midcarpal jt
85
describe the arthro of wrist EXT
concave on convex
lunate rolls dorsally and slides palmarly
capitate rolls dorsally and slides palmarly on lunate
closed packed position in wrist EXT
86
describe the arthro of wrist FLX
lunate rolls palmar and slides dorsal
capitate rolls palmar and slides dorsal on lunate
87
describe the arthro of R dev
prox row rolls radially and slides ulnar
capitate rolls radially and slides ulnar
carpals run into radius
88
describe the arthro of U dev
prox row rolls ulnarly and slides radially
capitate rolls ulnarly and slides radially
MC jt has most motion
89
what do the prox row of carpals do with R dev
scaphoid and lunate rock into FLX
90
what carpal is most likely dislocated
lunate
91
what m are innervated by the radial n
ECRB
ECRL
ECU
92
what m is innervated by the ulnar n
FCU
93
what m are innervated by the median n
FCR
Palmaris longus
94
what is the sensory innervation of RC
C6-7
95
what is the sensory innervation of MC
C6-8
96
what are the primary wrist EXT that act only on the wrist
ECRL
ECRB
ECU
97
what are the secondary wrist EXT that act on wrist and hand
ED
EXT indicis
EDM
EPL
98
what is in compartment 1
extensor pollicis brevis
abd pollicis longus
99
what is in compartment 2
ECRL
ECRB
100
what is in compartment 3
extensor pollicis longus
101
what is in compartment 4
ED
extensor indicis
102
what is in compartment 5
EDM
103
what is in compartment 6
ECU
104
what are the primary wrist fLX
FCR
FCU
PL
palmar carpal lig
105
what are the secondary wrist FLX
FDP
FDS
FPL
ABD PL
106
what m has the greatest torque for wrist FLX
FCU
107
what mm work together as synergists for wrist deviations
FCR and FCU
108
what motion is able to produce more isometric torque, wrist FLX or EXT
wrist FLX
109
what is peak wrist fLX torque
40 deg
110
what is peak wrist EXT torque
30-70 deg
111
what mm produce R dev
ECRB
ECRL
ABD PL
EPL
EPB
FCR
FPL
112
what mm produce U dev
ECU
FCU
FDP
FDS
ED
113
describe the arches of the hans
natural concavity allows for control
114
What are the arches of the hand
proximal transverse
distal transverse
longitudinal
115
what is the proximal transverse arch
formed by distal row of carpals
forms carpal tunnel
capitate is the key
116
what is the distal transverse arch
MCP joints
sides of arch are mobile
MCP of 2nd/3rd is key
117
what is the longitudinal arch
follows shape of 2nd/3rd rays
proximal end is rigid
distal end is mobile
MCP at 2nd/3rd is key
118
where is the central pillar
2nd/3rd CMC rigidly joined
119
what is the CMC joints
distal row carpals and bases of MC bones
120
match the carpal with the MC
2- trapezoid/capitate/trapezium
3-capitate
4-hamate/capitate
5-hamate
121
describe the kinematics of the 2nd/3rd
very little motion
central pillar
firm attachments
122
describe the kinematics of 4th
FLX/EXT at 20 deg
IR- 27 deg
123
describe the kinematics of 5th
FLX/EXT- 28 deg
IR- 22 deg
124
describe the kinematics of 4/5th
convex base to concave hamate
mobility for cupping- FLX and IR
they are linked- 44 deg FLX/EXT
125
what is the kinematics of the thumb
saddle joint
2 DOF- FLX/EXT(frontal) and ABD/ADD(sagittal)
126
what is the arthro of the thumb in ABD/ADD
ABD- palmar roll dorsal slide
ADD- dorsal roll palmar slide
127
what is the arthro of the thumb in FLX/EXT
FLX- medial roll/slide
EXT- lateral roll/slide
128
describe the thumb kinematics of ABD/ADD
convex MC on concave trapezium
elongates ADD pollicis and most ligs
129
describe the thumb kinematics of FLX/EXT
concave MC on convex trapezium
130
what is the combo of thumb opposition
thumb MC ABD
FLX and medial RT toward pinky
closed pack position
131
what is the key for mechanical stability critical for stability of the hand
MCP jts
132
what is collateral lig of the fingers
attach at tubercle
cord is thick and strong
133
what is volar plate
dense, thick fibrocartilage
base of prox phalanx thinner elastic portion
134
what is fibrous digital sheath
form tunnels or pulleys for extrinsic finger flexors anchored to plates
135
what is the osteo of MCP joints
FLX/EXT- sagittal 90-115, ext past neutral 20-45
ABD/ADD- frontal 20 deg from midline
136
what is the arthro of MCP
concave phalanx on convex MC head
roll and slide same way
137
what is the arthro/osteo of the MCP thumb
convex head and concave prox phalanx
1 DOF- FLX/EXT
ABD/ADD is accessory motion
138
what limits hyperextension in IP joints
volar plates
139
what are check rein lig
reinforce palamar plates and assist in limiting hyperextension
140
what are the kinematics of of the IP joints
concave base rolls and slides palmar direction
141
which IP joint has hyperextension
DIP- 30 deg
142
what helps provide tension and helps stabilize in IP joints
dorsal capsule
143
what m group does the radial n innervate in the hand
extensive extensor
ED, EDM, EI, EPL, EPB, ABD PL
144
what m group does the median n innervate in the hand
extrinsic flexors
FDS, FDP, FPL, ABD PB, OP, FPB, thenar eminience, lat 2 lumbricals
145
what m group does the ulnar n innervate in the hand
hypothenar m
medial half of FDP, FDM, ABD DM, PB, ADD P, all interossei, and 2 medial lumbricals
146
what does the digital synovial sheath serve as
nutritional and lubrication
147
what has a greater force at PIP as a proximal stabilizer
greater force stabilizer at ED
148
where do the extrinsic extensors of fingers cross
at the wrist under retinaculum
149
what attaches to the hood and assists ED with EXT at IP joints
lumbricals and interossei
150
where does the extrinsic m of the thumb comprise at
snuff box
151
what are the intrinsic m of the hand
thenar
hypothenar
ADD pollicis
lumbricals/interossei
152
describe the thenar eminence
ABD PB, FPB, OP
attach to transverse carpal lig
grasp and opposition, CMC ABD, FLX, IR
153
describe the hypothenar eminence
FDM, ABD DM, ODM, PB
ABD DM FCU contracts to stabilize
cupping- transverse arch
154
what m in the hand has high level m spindles
lumbricals and interossei
155
what force couple happens when trying to extend the thumb
FCU activates with thumb EXT (EPL and ABD PL)
156
what force couple happens when flexing your IP joints
ED activates to resist wrist flexion when flexing IP jts (FDS/FDP)
