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K&B Test 1 > Hand > Flashcards

Hand Flashcards

0
Q

_____ is the principle vehicle of complex and precise motor activity

A

The hand

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1
Q

The _____ has a strong functional relationship with the eyes

A

Hand

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2
Q

What is the function of the upper extremity

A

Position the hand for optimal function

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3
Q

The proximal transverse arch is made by the ____

A

Distal row of carpal bones

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4
Q

What arch passes through the mcp joints

A

Distal transverse arch

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5
Q

What arch follows the shape of the 2nd and third rays

A

Longitudinal arch

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6
Q

_____ is the “rigid tie beam”

A

Longitudinal arch

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7
Q

_____ creates a concavity of the palmar surface of the hand

A

Longitudinal arch

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8
Q

______ allows the hand to hold and manipulate objects of various shapes ans sizes

A

Longitudinal arch

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9
Q

_____ articulation between the distal row of carpal bones and the base of the 5 metacarpal bones

A

Carpometacarpal joints

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10
Q

How many degrees of freedom do the Cmc joints have

A

2 degrees of freedom
Flexion/extension
Abduction/adduction

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11
Q

_______ Cmc joints are rigid stable central pillars

And what ones are mobile

A

2 and 3

1 4 and 5

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12
Q

All Cmc joints are surrounded by _____ and strengthened by ____

A

Articular capsules

Ligaments

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13
Q

What ligaments strengthen the Cmc joints

A

Dorsal
Palmar
Interosseous

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14
Q

_____ cmc joint has jagged interlocking surfaces, strong ligamentous support, and permit very little movement

A

2 and 3

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15
Q

What is the joint structure of 4 and 5 Cmc joints

A

Convex metacarpal base, concave hamate

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16
Q

What is functional about the 4 and 5 Cmc joints

A

It improves effectiveness of grasp

Enhances the functional interaction with opposable thumb

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17
Q

______ is the articulation formed between the convex metacarpal and concave proximal phalanx (P1)

A

Metacarpophalangeal joints or mcp

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18
Q

What are the degrees of freedom at the mcp joints of the digits

A

2 degrees of freedom
Flexion extension
Abduction
Adduction

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19
Q

What is the axis of rotation in the mcp finger joints

A

Passes through the metacarpal head.

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20
Q

What is in the capsule of each mcp joint

A

Pair of radial and ulnar collateral ligaments

Volar plate

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21
Q

_____ is oblique palmar direction from metacarpal to proximal phalanx (2 distinct parts)

A

Collateral ligaments

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22
Q

The collateral ligaments are more taut in _______

A

Flexion than extension

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23
Q

What is the function of the Volar plate ligament

A

Strengthens the mcp joint

Prevents hyperextension

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24
Q

The Volar plate is a dense _____ structure found in every mcp Joint

A

Fibrocartilage

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25
Q

How would an mcp joint dislocate

A

Rupture of the Volar plate at its proximal attachment

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26
Q

Simple vs complex mcp joint dislocation

A

Cannot be reduced because Volar plate or other structures become entrapped within the joint.

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27
Q

_____ is the attachment between Volar plates and the mcp joint

A

Deep transverse metacarpal ligaments

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28
Q

What ligament binds the fourth and fifth metacarpals

A

Deep transverse metacarpal ligaments

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29
Q

what limits the distance by which metacarpal heads may separate

A

Deep transverse metacarpal ligaments

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30
Q

There is substantial accessory motion in _____ joints

A

Mcp

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31
Q

What is good about substantial accessory motion in the mcp joints

A

Permits fingers to conform to the shapes of objects

Increases grasp control

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32
Q

Mcp rom increases gradually from digits 2-5 from _____ to _____ mcp joint flexion

A

90-115

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33
Q

Where is the greatest rom flexion of the mcp joints

A

Ring finger and small finger

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34
Q

Describe the arthrokinematics of the mcp joint of the fingers

A

Concave phalanx moving against convex metacarpal

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35
Q

Explain the arthrokinematics of active mcp finger joint flexion (FDP)

A

Proximal phalanx rolls and slides volarly

Passive tension increases in the dorsal capsule and the collateral ligaments are taut

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36
Q

______ of the mcp finger joints are stabilizing the joints during flexion and useful during grasp

A

Active mcp joint flexion (FDP)

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37
Q

Explain the arthrokinematics of active mcp finger joint extension (co-activation of ED and intrinsic muscles of the finger)

A

Proximal phalanx rolls and slides Dorsally

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38
Q

During ______ the Volar plate elongates to support the head of the metacarpal

A

Active mcp finger joint extension

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39
Q

_______ creates slack in the radial collateral ligament of the mcp finger joints

A

Active mcp joint extension

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40
Q

How is the mcp finger joint positioned to heal after trauma

A

70 degrees of flexion to place a stretch on the collateral ligaments to prevent mcp joint contracture

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41
Q

Explain the arthrokinematics of active mcp finger joint adduction

A

Proximal phalanx rolls and slides radially

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42
Q

_____ muscle directs abduction at mcp finger

A

First interossei

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43
Q

What are the collateral ligaments doing when mcp finger joints are abductiing. How does this stabilize the joint

A

Ucl is taut

Rcl is on slack

This stabilizes the joint radially

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44
Q

How do the pip joints articulate

A

Articulation between the concave middle phalanx surface and the convex proximal phalanx

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45
Q

_____ joint articular surface appears as a tongue in groove articulation. It guides flexion and extension as it restricts axial rotation

A

Pip joint

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46
Q

Within the capsule each pip joint is reinforced by _____.

A

Radial collateral ligament

Ulnar collateral ligament

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47
Q

Accessory motion of the collateral ligament in pip joints reinforces ____

A

The Volar plate

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48
Q

______ limits pip joint hyperextension via check rein ligaments

A

Collateral ligaments

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49
Q

How will the pip joints be placed if they need to heal after dis location

A

15-20 degrees of flexion for the Volar plate to heal

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50
Q

Pip joint dislocation can cause…

A

Partial or complete damage to the collateral ligaments and central slip or Volar plate

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51
Q

_____ articulation between the bases of the concave distal phalanx and convex middle phalanx.

A

Dip

52
Q

How do the pips and dips differ

A

Dips don’t have the check rein ligaments

53
Q

Describe active pip joint flexion

A

Concave middle phalanx rolls and slides volarly by the extrinsic finger flexors (FDS and FDP)

54
Q

Axis of rotation for pip joint flexion

A

Medial lateral direction through the convex joints

55
Q

How is the thumb oriented in anatomical position

A

Medially and anteriorly. It is almost rotated 90 degrees in relation to the fingers for optimal prehension

56
Q

What is the Cmc thumb joint arthrology

A

Articulation between the trapezium and the base of the first metacarpal. It’s saddle shaped

57
Q

Explain the saddle shape

A

Articular surface is convex in one direction and concave in the other.

58
Q

Shape of the trapezium and 1st metacarpal (convex/concave)

A

Trapezium: Concave longitudinally and convex transversely

Base of the 1st metacarpal is convex longitudinally and concave transversely

59
Q

What are the degrees of freedom for the Cmc thumb joint

A

2

Flexion extension
Abduction adduction
Opposition reposition

60
Q

What are the ligaments of the Cmc thumb joint

A 
Rcl 
Ucl 
Anterior oblique ligament 
Posterior oblique ligament 
1st inter metacarpal
61
Q

_____ is the most important ligament for thumb stability and resists dorsal translation of Cmc on the trapezium

A

Anterior oblique ligament

62
Q

Arthrokinematics of thumb Cmc joint flexion

A

Concave metacarpal rolls and slides medially on the convex trapezium.

63
Q

Cmc thumb joint flexion does what to the Rcl

A

Elongates

64
Q

Arthrokinematics of thumb Cmc joint extension

A

Concave metacarpal rolls and slides laterally on the convex trapezium. This stretches the Ucl and anterior oblique ligament. There is also slight metacarpal lateral rotation on the groove on the trapezium

65
Q

What is the axis of rotation of the Cmc joint of the thumb

A

Passes thorough the head of the metacarpal bone

66
Q

Arthrokinematics of Cmc thumb joint abduction

A

Convex metacarpal surface rolls volarly and slides Dorsally on the concave trapezium. Stretching the adductor pollicis and most ligaments

67
Q

Arthrokinematics of Cmc thumb joint adduction

A

Convex metacarpal rolls Dorsally and slides volarly on the concave trapezium

68
Q

What are the two phases of opposition

A

Thumb metacarpal abducts

Metacarpal flexes and medially rotates across the palm and towards the small finger.

69
Q

______ guides and rotates the thumb metacarpal

A

Opponens pollicis

70
Q

_____ is the articulation between concave proximal phalanx and convex metacarpal

A

Thumb mcp

71
Q

What are the Osteokinematic differences between thumb and finger mcp joints

A

One degree of freedom–flexion extension
Arom and prom at mcp joint significantly less
Active abduction adduction are limited due to collateral ligament structure and bone congruity

72
Q

What is the axis of rotation for the thumb ip joint

A

Anterior posterior direction, through the convex joints

73
Q

Flexion of the thumb is powered by ___ and ____

A

FPL and fpb

74
Q

Hand movements cannot be achieved without _____. It requires _____ contraction of the muscles that cross the wrist.

A

Wrist stabilization

Isometric contraction

75
Q

______ supplies all the extensors of the wrist and digits with proximal attachments in the forearm and the lateral epicondyle

A

Radial nerve

76
Q

_____ supplies most of the flexors of the wrist and digits with proximal attachments on the forearm and the medial epicondyle

A

Median nerve

77
Q

_____ supplies most of the small muscles in the hand.

A

Ulnar nerve

78
Q

What are the exceptions to the innervations

A

Half of FDP and lumbricals supplied by the median and ulnar nerves

Ulnar nerve supply to FCU

Median nerve supply to the thenar muscles

79
Q

_____ flexes the ip joint of the thumb

A

FPL

80
Q

_____ exerts flexion torque at mcp and Cmc joints

A

FPL

81
Q

Extrinsic flexor tendons travel to their distal attachment via ____

A

Fibrous sheath tunnels

82
Q

Embedded within each digital sheath there are bands of tissues called ____

A

Pulleys

83
Q

______ is inflammation of flexor tendons and surrounding synovial membranes

A

Stenosing tenosynovitis

84
Q

Stenosing tenosynovitis is also known as

A

Trigger finger

85
Q

_____ stabilize tendons relative to underlying joints

A

Flexor pullys

86
Q

What are the flexor pulleys

A

5 annular pulleys (A1-A5)– A2 and A4 are the main ones

3 cruciate pulleys (C1-C3)

87
Q

What is the tenodesis action

A

As the wrist actively extends, digits automatically flex due to the increased passive tension of the extrinsic flexor muscles.

88
Q

_____ are the interconnections between ED tendons

A

Juncturae tendinae

89
Q

______ do isolated finger extension of digit 4 and 5

A

Juncturae tendinae

90
Q

____ works independently in wrist extension if you do extension with a fist

A

Extensor indicis

91
Q

ED is firmly anchored to the dorsal aspect of the mcp joint by the ____

A

Sagittal bands

92
Q

_____ travel from the ED tendon Dorsally to the Volar plate volarly

A

Sagittal bands

93
Q

___ transmit extension power of the ED to the mcp joint

A

Sagittal bands

94
Q

_____ stabilize the ED over the dorsum of the hand

A

Sagittal bands

95
Q

What is the central feature of the extensor mechanism

A

Dorsal hood

96
Q

_____ consists of a triangular sheet of thin aponeurosis

A

Dorsal hood of extensor mechanism

97
Q

Multiple attachments of the extensor mechanism into the phalanges allow the _____ to transfer extensor force distally throughout the entire finger.

A

Extensor digitorum

98
Q

_____ flexes the ip and mcp joint

A

FPL

99
Q

_____ is the only muscle that flexes the thumb ip joint

A

FPL

100
Q

What generates a firm grip

A

FDS and FDP

101
Q

_____ extends the ip, mcp, and Cmc joint

A

EPL

102
Q

_____ extends the mcp and cmc joints

A

EPB

103
Q

_____ abducts the Cmc joint

A

APL

104
Q

____ flexes the mcp and Cmc joint of the thumb

A

Flexor pollicis brevis

105
Q

_____ opposes the thumb for pinch and grasp against fingers

A

Abductor pollicis brevis

106
Q

_____ opposes and rotates the thumb medially towards the fingers. It flexes and abducts the Cmc joint

A

Opponens pollicis

107
Q

What is the dominant muscle at the Cmc joint

A

Adductor pollicis

108
Q

_____ pass volarly to the deep transverse carpal ligament

A

Lumbricals

109
Q

______ pass dorsal to the deep transverse carpal ligament

A

Interossei

110
Q

Explain the early phase of finger extension

A

ED extends the mcp joint

ED and intrinsics are primary finger extensors

111
Q

Explain the middle phase of finger extension

A

Intrinsic muscles effect in ip joint extension
Direct: proximal pull of the extensor mechanism
Indirect: flexion torque at the mcp joint

112
Q

Explain the late phase of finger extension

A

Muscle activation continues through full finger extension

113
Q

Explain the phases of finger flexion

A

Early phase: FDP, FDS, and interossei actively flex ip joints pulling the extensor mechanism distally

Late phase: muscle activation continues through full flexion. Lumbricals remain inactive but passively assist. ED decelerates mcp flexion with consistent EMG activity when the hand is closing. The ECRB stabilizes the wrist in slight extension.

114
Q

Where is the oblique retinacular ligament

A

Palmar side of the pip joint to the dorsal side of the dip joint

115
Q

What happens to the oblique retinacular ligament when ED and intrinsics initiate extension of the pip joint

A

It stretches, and passive tension is transferred distally to extend the dip joint

116
Q

What is rheumatoid arthritis

A

Autoimmune disease
Chronic systemic inflammatory disorder
Primarily attacks the synovial joints–> chronic synovitis

117
Q

_____ reduces tensile strength of the connective tissue s

A

Synovitis

118
Q

What happens in rheumatoid arthritis

A

Mechanical integrity of the joint is destroyed –> joints become misaligned, unstable and frequently deformed.

119
Q

_____ is the collapse of multiple interconnected joints in alternating directions

A

Zigzag deformity thumb

120
Q

What does zigzag deformity involve

A

Cmc flexion and adduction
Mcp hyperextension
Ip flexion

121
Q

How can you tell you have volar dislocation

A

When the fingers flex during grip, FDP transmits force palmarly away from the mcp joint. Proximal phalanx translates palmarly causing mcp dislocation

122
Q

_____ is excessive ulnar deviation and translation of the proximal phalanx, ulnar directed forces generated by the thumb. Flexion torque causes Volar dislocation, in addition to this

A

Ulnar drift

123
Q

_____ is a huge trauma to Volar plates of he digits. There is a weakened or attenuated Volar late at the pip joint. Lateral bands bowstring Dorsally away from the joint axis of rotation.

A

Swan neck deformity

124
Q

What does swan neck deformity look like

A

Increasing moment arm of the pip joint extension causing hyperextension and dip joint flexes because of increased FDP passive tension placed across the pip joint

125
Q

What is the primary cause of boutonnière deformity

A

And normal displacement of the bands of the extensor mechanism at the pip joint.

126
Q

What causes boutonnière deformity

A

Chronic synovitis which causes a rupture of the central slip. Lateral bands slip volarly to the axis of rotation.

127
Q

What does the boutonnière deformity look like

A

Forces cause flexion at the pip joint

Dip joint hyper extends due to the increased tension of the stretched lateral bands.

K&B Test 1 (4 decks)

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