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hand Flashcards

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1
Q

explain the joints of the hand

A

CMC: carpal metacarpal
MCP: metacarpal phalange joint
PIP: proximal interphalange joint
DIP: distal interphalange joint

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2
Q

describe which is concave/convex in each joint of the thumb

A

CMC: carpal= Concave in the sagittal plane and convex in the transverse
metacarpal base = convex in the sagittal plane and concave in the transverse
MCP: metacarpal head = convex and base of proximal phalange = concave

PIP: proximal phalange head = convex and base of middle phalange = concave

DIP: middle phalange head = convex and base of distal phalange = concave

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3
Q

What is in the third ray of the hand

A

-capitate
-3rd metacarpal
-3rd proximal phalanx
-3rd middle phalanx
-3rd distal phalanx

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4
Q

what is the most stable part of the hand

A

the 3rd ray - everything moves around it

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5
Q

describe the thumbs orientation to the palm

A

rotated anterior about 90* for a functional grasp

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6
Q

What are the arches of the hand

A
  1. longitudinal: 3rd metacarpal to 3rd disal phalange (keystone arch)
  2. proximal transverse: distal row of carpals
  3. distal transverse: around the MCP joints of all digits
    2&3 accommodate BV and nerves that enter the hand
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7
Q

Which fingers have the most mobility at the CMC joints

A

1st, 4th, and 5th

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8
Q

Joint support at the CMC joint on the dorsal side

A

-dorsal inter metacarpal ligaments and dorsal carpometacarpal ligaments reinforce joint capsule externally
-carpometacarpal joint: more reinforcement of the thumb CMC joint
~posterior oblique ligament
~radial collateral ligament

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9
Q

Joint support of the CMC joint on the palmar side

A

-palmar intermetacarpal ligaments and palmar carpometacarpal ligaments reinforce joint capsule
anterior oblique ligament adds support to the thumb side

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10
Q

Arch that forms when you close your fist

A

-based around movement of 4th and 5th metacarpal on 3rd ray and movement on the 2nd ray on the 3rd ray

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11
Q

CMC joint surfaces

A

saddle joint
-concave in one direction and convex in the other

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12
Q

Osteokinematics of he CMC joint ROM

A

-flexion: 0-45-50*
-extension: 0-10-15*
-abduction: 0-45*
-adduction: return back to neutral

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13
Q

Arthrokinematics thumb CMC–abduction

A

roll and slide happen in opposite directions: (convex moving on concave)

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14
Q

Arthrokinematics thumb CMC–flexion/extension

A

roll and slide in the same direction: concave moving on convex

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15
Q

what produces opposition

A

flexion and some medial rotation

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16
Q

What are palmar plates

A

cartilaginous extensions off the distal end of metacarpals, proximal phalanx, middle phalanx, and distal phalanx
-protect joint surfaces and keep flexor tendons from getting trapped in joint surface

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17
Q

what are the MCP, IP joints reinforced by?

A

palmar plate, joint capsule, and collateral ligaments
and fibrous sheaths that holds tendons in place so they do not get caught in the join surfaces

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18
Q

osteokinematics of MCP of the four digits

A

-flexion: 0-90-110-115* (motion increases as you move to ulnar side)
-extension: 0-30-45*
-abduction: 0-20*
-adduction: back to neutral

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19
Q

arthrokinematics of MPC flexion/extension

A

flexion: anterior/palamar roll and slide (Same direction)
extensions: posterior/dorsal roll and slide

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20
Q

arthrokinematics of MPC– abduction/adduction

A

-roll and slide in same direction
~laterally/radially if it goes towards thumb
~ulnarlly if it goes towards 5th digit

21
Q

Thumb osteokinematics of IP

A

flexion: 0-70*
extension: 0-20*

22
Q

osteokinematics of digit IP

A

-flexion: more motion in more lateral digits (2nd/5th)
~PIP: 0-10-120*
~DIP: 0-70-90*
Extension (hyperextension): 0-30*

23
Q

Thenar muscles

A

-flexor pollicis brevis
-abdutor pollicis brevis
-opponens pollicis

24
Q

Hypothenar muscles

A

-opponens digit minimi
-flexor digit minimi
-abductor digit minimi

25
Q

What makes up the the carpal tunnel

A

scaphoid, lunate, triquatruim, pisiform, transverse carpal ligament

26
Q

What runs though the carpal tunnel

A

Flexor digitorum superficialis tendons
flexor digitorum profundus tendons
-flexor pollicis longus tendon
-mediaan nerve

27
Q

What happens to the fingers when they are relaxed and the wrist is flexed

A

fingers extend due to passive length tension (created by the non contractile components such as CT and fibrous tissue such as tendons)

28
Q

What happens to the fingers when they are relaxed and the wrist is extended

A

fingers flex due to passive length tension (created by the non contractile competes such as CT and fibrous tissue like tendons)

29
Q

Tenodesis

A

can use passive tension to grasp lightweight objects by changing the wrist position

30
Q

What’s muscles of the hand are responsible to fine motor skills and what do the other group of muscles do?

A

intrinsic does the finer motor control where as the extrinsic positions fingers, wrist and hand

31
Q

describe the toque differences between different muscles of the hand and their relation to the axis of rotation

A
  • further from the center axis means more torque that can be generated (larger internal moment arm)
  • adductor pollicis gives a powerful grip
  • the flexors generate more torque because there not many times where the extensors work against resistance
32
Q

intrinsic positive meanse

A

lumbricals and interossei are working
-position is flexion of the MCP and extension of the IP joints

33
Q

Extrinsic positive

A

FDS, FDP
-extension of the MCP and flexion of the IP joints

34
Q

Describe the phases of opening the hand and muscles that work

A
  1. early phase: most of the force is produced by Extensor digitorum, and FCR
  2. middle phase: extensor digitorum and FCR are still producing more of the face but the lumbricals and interossei are starting to produce force
  3. late phase: Extensor digitoum and FRC as well as the lumbricals and interossei are producing the force to fully extend the phalanges
35
Q

What happens when a patient with an ulnar nerve injury extends the fingers?

A

-it is difficult to fully extend finger 4 and 5 IP joints
-the ulnar nerve injury will also affect the lumbricals and interossei
-get the claw hand deformity
-would need to be stabilized to extend the IP joint

36
Q

describe the extensor hood mechanism

A

extensor hood on the dorsal side with fibrous insertions
-lateral band is above the PIP and DIP joints but below th joint axis on the MCP joint

37
Q

Muscle activity during closing of the hand

A
  1. early phase: FDP and FDS produce a majority of the force as well as ECRB and ECRL producing some force at the CMC joint
  2. Late phase: the lumbricals and interossei will increase the contribution of finger flexion
38
Q

Review each type of grip

A

see powerpoint

39
Q

Key pinch grip

A

other fingers provide the index finger with support
extrinsic and intrinsic muscles will provide power

40
Q

common injuries of the hand

A

-tendonitis
-fractures
-dislocations
-other

41
Q

Joint deformities: Zig-zag deformity of the thumb

A

-taut flexor pollicis longus
-overstretched palmar plate at MCP joint
-ruptured ligaments/dislocation at CMC joint
-happens when you over stretch palmar plate/ligaments
-can happen when you fall on an outstretched hand or pull on it
-makes the thumb very unstable

42
Q

Swan-neck deformity

A

lateral band shifts below DIP and causes flexion and the lateral band shifts above the PIP giving hyperextension
-lax joints and muscles will over pull on some joint

43
Q

Boutonniere deformity

A

DIP hyperextension and PIP flexion
the lateral band shift more dorsal causing hyperextension

44
Q

ulnar drift

A

musculature on ulnar side over power and pulls the joints that way
-common in people with arthritis

45
Q

Bowstring deformity

A

-palmar dislocation of MCP joint can cause the tendons to bowstring
-due to a ruptured collateral ligament and the loss of the anatomical bully that keeps the tendons close to the bones

46
Q

The development of ulnar drift

A

A ruptured RCL can cause a bowstringing force
-can happen when there is disruption of the dorsal hood mechanism
-there is an overpowering ulnar force that results in the distal end being pulled ulnarly
-there is a rotation that occurs at the MCP joint and then a shift of the carps towards the ulnar side

47
Q

radial nerve injury

A

-nerve injuries can happen at different levels
-wrist drop means that there is an issue with the wrist extensors which can mean the innervation is disrupted in the forearm

48
Q

ulnar nerve injury

A

-claw hand
-cannot extend finger IP joints
-intrinsic problem – presentation when you cannot extend the fingers

49
Q

Median nerve injury

A

-impact thumb and the thenar emeniace
-cannot oppose, flex or abduct the thumb

Movement Science (17 decks)

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