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Management of MS Disorders > Exam 5: Anatomy of the Forearm, Wrist and Hand through CRPS > Flashcards

Exam 5: Anatomy of the Forearm, Wrist and Hand through CRPS Flashcards

1
Q

The wrist has __ bones, more than __ joints, and __ ligaments

A

8, 20, 26

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2
Q

The (hand/wrist/forearm) accounts for approximately 90% of upper limb function

A

hand

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3
Q

The hand accounts for approximately ___% of upper limb function

A

90

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4
Q

What are the three digits that make up the 90% of upper limb function of the hand

A 
thumb (40-50%)
Index finger (20%)
middle finger (20%)
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5
Q

Why do we have more ulnar deviation than radial deviation

A

Because the ulnar styloid is 1/2 inch shorter than the radial styloid

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6
Q

List the proximal row of carpals

A

scaphoid, lunate, triquetrum and pisiform

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7
Q

List the distal row of carpals

A

trapezium, trapezoid, capitate, and hamate

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8
Q

What are the 5 joints of the wrist and hand

A 
distal radial ulnar
radiocarpal
carpometatcarpal
metacarpalphalengeal
interphalangeal (PIP and DIP)
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9
Q

(extrinsic/intrinsic) ligaments provide the majority of wrist stability

A

extrinsic

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10
Q

(extrinsic/intrinsic) ligaments serve as rotation restraints

A

intrinsic

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11
Q

What are the four important ligaments of the hand

A

UCL, RCL, transverse retinacular ligament, and oblique retinacular ligament

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12
Q

Which ligament of the hand holds the extensor mechanism at the PIP joint

A

transverse retinacular ligament

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13
Q

The transverse retinacular ligament hold the (flexor/extensor) mechanism at the ___ joint

A

extensor; PIP

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14
Q

Which ligament inserts on the distal phalanx along with the distal insertion of the extensor mechanism

A

oblique retinacular ligament

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15
Q

Where does the oblique retinacular ligament insert at

A

the distal phalanx along with the distal insertion of the extensor mechanism

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16
Q

annular means _____

A

straight

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17
Q

cruciate means ____

A

crossed

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18
Q

In the pulley system, which fingers are correlated with the annular system

A

fingers A1-A5

thumb A1 and A2

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19
Q

In the pulley system, which fingers are correlated with the cruciate system

A

C1-C4

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20
Q

What is the function of the pulley system? What anatomical structure makes this possible?

A

The pulley system is a series of ligaments that restrain the flexor tendons to the bone’s surface to prevent bowstringing. The flexor retinaculum is what prevent bow stringing in the wrist.

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21
Q

The volar plate provides (weak/strong) capsuloligamentous support and attaches firmly to the base of the (proximal/distal) phalanx

A

strong; proximal

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22
Q

What allows us to form a lumbrical grip or have straight fingers while flexing at the MCP joint

A

extensor mechanism

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23
Q

What are the 6 compartments of the extensor retinaculum

A
  1. Abductor pollicis longus and extensor pollicis brevis
  2. Ext. carpi radialis longus/brevis
  3. Ext. Pollicis longus
  4. Ext. Digitorum and indicis
  5. Ext. Digiti minimi
  6. Ext. carpi ulnaris
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24
Q

What ligament makes up the flexor retinaculum

A

Transverse carpal ligament

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25
Q

Where does the TCL/flexor retinaculum attach

A

radial side: tubercle of trapezium and scaphoid

ulnar side: hook of hamate and pisiform

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26
Q

Which muscles attach at the flexor retinaculum

A

thenar and hypothenar muscles

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27
Q

The flexor retinaculum maintains the ___ ____ arch, acts as a restraint for bowstringing of the extrinsic (flexor/extensor) tendons , and protects the ____ nerve

A

transverse carpal, flexor, median

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28
Q

True or False:

The transverse carpal ligament is the same thing as the flexor retinaculum

A

true

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29
Q

What does TFCC stand for

A

triangular fibrocartilage complex

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30
Q

True or false:

The TFCC is on the radial side of the wrist

A

false, ulnar

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31
Q

What is the function of the TFCC

A

improve joint congruency and cushion against compressive forces

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32
Q

TFCC transmits about 20% of the axial load from the ___ to the ____.

A

hand; forearm

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33
Q

How many extrinsic muscles originate in the forearm and insert in the hand

A

15

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34
Q

State the flexors muscles that originate in the forearm and insert in the hand

A
  1. Flexor carpi ulnaris
  2. Flexor carpi radialis
  3. Palmaris Longus
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35
Q

State the extensor muscles that originate in the forearm and insert in the hand

A

1 & 2. Extensor carpi radialis longus and brevis

3. Extensor carpi ulnaris

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36
Q

State the volar muscles that originate in the forearm and insert in the hand

A
  1. Flexor digitorum superficialis

2. flexor digitorum profundus

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37
Q

State the dorsal muscles that originate in the forearm and insert in the hand

A
  1. Extensor digitorum
  2. extensor indicis
  3. extensor digiti minimi
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38
Q

State the thumb muscles that originate in the forearm and insert in the hand

A

1 & 2. Extensor pollicis longus and brevis

  1. Abductor pollicis longus
  2. flexor pollicis longus
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39
Q

There are ___ muscles that arise and insert within the hand

A

19

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40
Q

State the muscles in the hypothenar eminence that arise and insert within the hand

A
  1. abductor digiti minimi
  2. flexor digiti minimi
  3. Opponens digiti minimi
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41
Q

State the muscles in hand/fingers that arise and insert within the hand

A

Interossei, lumbricals

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42
Q

State the muscles in the thenar eminence that arise and insert within the hand

A
  1. Abductor pollicis brevis
  2. flexor pollicis brevis
  3. opponens pollicis
  4. adductor pollicis
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43
Q

What are the four nerves that run through the forearm, wrist, and hand`

A

radial, ulnar, median, digital nerves

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44
Q

The (radial/ulnar) nerve can be found in the posterior interosseous and recurrent branch

A

radial

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45
Q

The (radial/ulnar) nerve can be found in the anterior interosseous and recurrent branch

A

ulnar

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46
Q

Explain where the peripheral nerve distribution of the radial nerve is located

A

On the dorsal surface of the thumb, index, middle, and half of the ring finger

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47
Q

Explain where the peripheral nerve distribution of the median nerve

A

on the plamar surface of the hand everywhere except the pinky and half of the ring finger

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48
Q

Explain where the peripheral nerve distribution of the ulnar nerve

A

On the dorsal and palmar surface of the pinky and half of the ring finger

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49
Q

What are the 6 arteries in the hand

A 
Brachial
Radial
Ulnar
Deep palmer arch
Superficial palmer arch
Digital
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50
Q

What are the 6 motions of the wrist

A

pronation, supination, flexion, extension, radial and ulnar deviation

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51
Q

(pronation/supination) is limited by bony impaction between the radius and ulna

A

pronation

52
Q

What is pronation limited by

A

by bony impaction between the radius and ulna

53
Q

(pronation/supination) is limited by the interosseous membrane and the bony impaction between the ulnar notch of the radius, and the ulnar styloid process

A

supination

54
Q

What is supination limited by

A

the interosseous membrane and the bony impaction between the ulnar notch on the radius and the ulnar styloid

55
Q

The majority of wrist flexion occurs at the _____ joints

A

midcarpal

56
Q

The majority of wrist extension occurs at the _____ joint

A

radiocarpal

57
Q

Radial deviation primarily occurs between the two _____ ____. RD is limited by the impact of the ____ bone onto the radial styloid and the UCL

A

carpal rows; scaphoid

58
Q

What is radial deviation limited by

A

The impact of the scaphoid bone onto the radial styloid and UCL

59
Q

Ulnar deviation occurs primarily at the _____ joint and is limited by the RCL

A

radiocarpal

60
Q

What is UD limited by

A

the RCL

61
Q

What are the normal and functional ROM’s for wrist pronation

A

norm: 85-90
functional: 0-50

62
Q

What are the normal and functional ROM’s for wrist supination

A

norm: 85-90
functional: 0-50

63
Q

What are the normal and functional ROM’s for wrist flexion

A

norm: 80-90
functional: 0-10

64
Q

What are the normal and functional ROM’s for wrist extension

A

norm: 70-90
functional: 0-40

65
Q

What are the normal and functional ROM’s for wrist radial deviation

A

norm: 15
functional: 0-40 (RD and UD combined)

66
Q

What are the normal and functional ROM’s for wrist ulnar deviation

A

norm: 30-45
functional: 0-40 (RD and UD combined)

67
Q

What are the normal ROM’s for thumb flexion at the CMC, MCP, and IP joints

A

CMC: 45-50
MCP: 50-55
IP: 85-90

68
Q

What are the normal ROM’s for thumb extension at the MCP and IP joints

A

MCP: 0
IP: 0-5

69
Q

What is the normal ROM for thumb adduction

A

30

70
Q

What is normal ROM for thumb abduction

A

60-70

71
Q

From the pulp of the thumb to the base of the small finger, opposition should measure ___ centimeters

A

0 cm

72
Q

Is flexion or adduction occurring when the thumb moves across the palm

A

flexion

73
Q

`What are the three functional arches of the hand and what are their functions

A

There 2 transverse arches and 1 longitudinal arch. The intercarpal articulations allow for cupping and un-cupping/all for the finger and thumb to hold objects in the hand

74
Q

What position of the wrist creates the greatest flexion force of the fingers

A

Wrist in neutral deviation and slight extension

75
Q

What position of the wrist creates the weakest flexion force of the fingers

A

wrist flexion

76
Q

A hook fist has maximum differential glide between the ____ and ____.
A straight fist has maximum ____ excursion.
A full fist has maximum ____ excursion.

A

FDS and FDP
FDS
FDP

77
Q

What does this say in layman’s terms

“The pulley system maintains constant relationship between the tension and joint axis to provide for maximum joint motion within the limits of the muscle excursion.”

A

The stronger the grip, the more flexed the fingers will be. The pulley system makes this happen my preventing bow stringing

78
Q

Which annular ligaments of the pulley system are the most critical and why

A

A2 and A4 are most critical because they create composite flexion

79
Q

When will bowstringing of a tending occur

A

when a pulley is absent

80
Q

If bowstringing of a tendon occurs, the moment arm (increases/decreases) requiring (increased/decreased) tendon excursion to produce the same arc of motion

A

increase, increase

81
Q

What did complex regional pain syndrome used to be called

A

reflex sympathetic dystrophy

82
Q

What condition is a chronic neurological syndrome characterized by tenderness and pain of varying intensity that is disproportionate to the precipitating injury or disease or disease usually to a hand or a foot

A

reflex sympathetic dystrophy

83
Q

What are three things that are associated with RSD

A 
vasomotor instability (heat flashes)
skin changes
osteoporosis
84
Q

What does CRPS stand for

A

complex regional pain syndrome

85
Q

CRPS has two types. Which type relates to RSD

A

type 1

86
Q

CRPS has two types. Which type relates to causalgia

A

type 2

87
Q

CRPS (RSD/Causalgia) can be described as a pain syndrome triggered by a noxious event that is not limited to a single peripheral nerve

A

RSD

88
Q

CRPS (RSD/Causalgia) can be described as a pain syndrome that involves direct partial or complete injury to a nerve or one of its major branches

A

causalgia

89
Q

Describe the history behind CRPS

A

First noted in soldiers who sustained nerve injuries. Causalgia is named after “kausos” meaning heat and “algos” due to the burning and hyperesthesia pain as well as trophic changes and glossy skin

90
Q

Trophic changes are correlated with the _____ nervous system

A

autonomic

91
Q

What are the four diagnostic criteria for CRPS type I/RSD

A
  1. An initiating noxious event or cause of immobilization
  2. Allodynia, hyperalgesia, and continuous disproportionate pain
  3. Evidence of edema, skin blood flow changes, or abnormal sudomotor activity
92
Q

What are several clinical characteristics of CRPS type 1

A 
burning stinging pain
allodynia
hyperalgesia
hyperesthesia
hyperpathia
swelling
trophic changes
fatigue
sweating
93
Q

How many stages are there of CRPS type 1

A

3

94
Q

Describe stage 1 of CRPS type 1

A

onset of severe pain
start of hyperesthesia
swelling/cramps
warm dry red skin that starts to change to cyanotic and cold and sweaty

95
Q

Can the first stage of RSD-CRPS subside or respond to treatment

A

yes in mild cases

96
Q

Describe stage 2 of CRPS type 1

A

pain becomes more severe
swelling spreads and becomes brawny
hair and nail changes
osteoporosis and muscle wasting begins

97
Q

How long does CRPS type 1 stage 1 last

A

a few weeks

98
Q

How long does CRPS type 1 stage 2 last

A

three to six months

99
Q

Describe stage 3 of CRPS type 1

A

irreversible atrophy
intractable pain involving the entire limb instead of at the injury site
May develop general RSD that affects the entire body

100
Q

How long does CRPS type 1 stage 3 last

A

a lifetime

101
Q

Type 1 CRPS affects more (men/women) and has an average age onset of mid ___.

A

women, 30’s.

102
Q

Explain the mechanism behind RSD type 1 or in other words, what is the pathology behind this syndrome

A

Normally, the SNS is activated during a fight or flight response. Blood vessels contract which forces blood deep into muscles, which is normal, and usually shuts down within minutes to hours. In RSD type 1, it continues to stay activated and causes an inflammatory response in which the blood vessels spasm and lead to increased swelling and pain.

103
Q

What are the diagnostic tests used to confirm CRPS type 1

A 
Thermogram
Bone scan
Sympathetic blocks
X-rays, EMGs, CT scan
MRI to rule out other pathologies
104
Q

What is the most widely used diagnostic test to diagnose CRPS type 1

A

Thermogram

105
Q

____ ____ is the cornerstone in the treatment of RSD and encourage the patient to use the affected part as much as possible

A

patient education

106
Q

What type of medication treatment for CRPS type 1 would be used for a patient in constant pain

A

Narcotics

107
Q

What type of medication treatment for CRPS type 1 would be used for a patient with pain that is causing sleeping problems

A

Antidepressants

108
Q

What type of medication treatment for CRPS type 1 would be used for a patient with inflammatory pain

A

NSAIDS

109
Q

What type of medication treatment for CRPS type 1 would be used for a patient with spontaneous spasms

A

anti-convulsants

110
Q

What type of medication treatment for CRPS type 1 would be used for a patient with muscle cramps

A

Klonopin

111
Q

What type of medication treatment for CRPS type 1 would be used for a patient with sympathetic maintained pain

A

Clonidine patch, neurontin

112
Q

What are the 9 types of treatment styles that can be used for CRPS type 1

A 
Patient education
Medication
Sympathetic blocks
Sympathectomy
Spinal cord stimulation
Psychological Intervention
Biofeedback
PT
113
Q

If a sympathetic block is used in the treatment of CRPS type 1, what type of block would be appropriate for the UE

A

Stellate ganglion block

114
Q

If a sympathetic block used in the treatment of CRPS type 1, what type of block would be appropriate for the LE

A

Lumbar sympathetic block

115
Q

When would sympathectomy be appropriate in the treatment of CRPS type 1

A

for patients with chronic intractable sympathetic maintained pain and for patients who have responded well to a series of 3-6 blocks

116
Q

Why is spinal cord stimulation appropriate for the treatment of CRPS type 1

A

Because it replaces the area of intense pain with a more pleasant tingling sensation which will remain relatively constant

117
Q

True or false:

Immobilization is appropriate for the treatment of CRPS type 1

A

False do not do it

118
Q

What modalities are appropriate with the treatment of CRPS type 1

A

contrast baths - avoid ice
most heat, fluidtherapy
TENS

119
Q

How would a PT control edema while treating CRPS type 1

A

compression gloves
gentle soft tissue mobilization
jobst pump
elevation of involved limb

120
Q

are open or closed chain activities better for treating CRPS

A

closed

121
Q

During the patient education part of treating CRPS, it is import to tell the patient to modify activities and avoid what three things

A

avoid caffeine, alcohol, and environmental extremes

122
Q

What does the newest CRPS research involve about treatment

A

laterality, imagery, and mirror therapy can be useful

123
Q

Prognosis for CRPS is (good/variable/poor) if the patient is in stage 1 and/or intervention began 3-6 months after onset of symptoms

A

good

124
Q

Prognosis for CRPS is (good/variable/poor) if the patient is in stage II and/or intervention began 6-12 months after onset

A

variable

125
Q

Prognosis for CRPS is (good/variable/poor) if the patient is in stage III and/or interventions began 1 year after onset with pain persisting throughout the patient’s lifetime

A

poor

126
Q

Treatments for CRPS are (brief/extensive) and (cheap/expensive)

A

extensive and expensive

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