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EPHE 355 > Hand and Wrist > Flashcards

Hand and Wrist Flashcards

1
Q

how many intrinsic and extrinsic muscles of the hand

A

19 intrinsic

20 extrinsic

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2
Q

main function of the wrist

A

fine tune position of the hand

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3
Q

three main roles of the hand

A

expression and communication
protection
sensory

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4
Q

how many bones of the whole wrist hand complex and what are the main groups

A

radius/ulna
carpals
metacarpals
phalanges

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5
Q

three parts of the distal ulna

A

ulnar styloid process
fovea - attachment for the disc
pole

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6
Q

what is the function of the pole of the ulna

A

articular surface for the TFCC

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7
Q

three main features of the distal radius

A

distal surface
radial styloid process
ulnar notch

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8
Q

what is landmark of the radius where it interacts with the ulna

A

ulnar notch

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9
Q

function and location of listers tubercle

A

dorsal distal aspect of the radius
it is a pulley, redirect action of extensor digitorum longus and extensor indices on radial side
redirects action of extensor policies longus on the ulnar side

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10
Q

name the bones of the hand

A 
scaphoid
lunate
triquetium 
pisiform 
trapezium
trapezoid 
capitate 
hamate
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11
Q

shape of pisiform and what inserts here

A

sesamoid, flexor carpi ulnaris

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12
Q

what is unique about the capitate

A

central position of the hand, axis of the hand

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13
Q

how many phalanges for each of the digits

A

thumb: two

digits 2-5: three

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14
Q

shape of base of phalanges

A

biconcave, smaller articular surface than head

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15
Q

shape of heads of phalanges

A

bicondylar

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16
Q

how many bones and joints in the wrist complex

A

15 bones

1`7 synovial joints

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17
Q

movements and type of joint: distal radioulnar

A

uniaxial pivot joint

pronate/supinate

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18
Q

three structures that connect the distal radioulnar joint

A

TFCC, obliques fibres of the distal interosseous membrane, radioulnar ligaments

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19
Q

movements and type of joint: radiocarpal

A

ellipsoid synovial, 2 DOF

flex/ex, radial and ulnar deviation

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20
Q

what is articulating with what at the radio carpal joint

A

distal radius with scaphoid and lunate

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21
Q

what the TFCC articulate with at the radoiocarpal joint

A

ulnar stylus and triquetrium

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22
Q

what types of joint are the mid carpal joints and what movements do they do (compound articulation, two parts to to this)

A

synovial plane joints
Planar laterally: scaphoid, trapezium, trapezoid
Condylar medially: scaphoid, lunate, triquetrium, capitate and hamate
general flex/ex, ulnar/radial deviation

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23
Q

what type of joint is intercarpal and what it is between

A

joint between bones of proximal and distal rows

plane synolvia joints, allowing for gliding movements

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24
Q

what is the arch in teh hand formed by (general structures)

A

carpals, metacarpals, and ligaments

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25
Q

carpometacarpal joints 2 to 5

  • which have the movement movement (how much)
  • which have the least movement
A

minimal at 2nd and less at third
4th = 10-15 degress
5 = 25-35 degrees

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26
Q

function of movements at the carpometacarpal joints 4 and 5

A

allow transition of the hand from flat to fist

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27
Q

1st carpometacarpal: type of joint, between what bones

A

synovial saddle

between base of 1st MC and trapezium

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28
Q

movements of teh 1st CMC

A

flex, ex, abduction, adduction, opposition, repositioning

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29
Q

metacarpalphalangeal joints: type, movements

A

synovial condyloid with 2 DOF (flex, ex, ad, ab)

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30
Q

what are the head of the metacarpals covered with

A

articular cartilage

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31
Q

what are the bases of the metacarpals extended with with

A

fibrocartilaginous volar plates

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32
Q

interphalangeal joints: type, movements

A

synovial hinge, flex/ex

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33
Q

what two structures to DIPs and PIPs have that help them move as well and reinforce them

A

volar plates, check rein ligaments

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34
Q

what is volar plate

  • structure
  • attaches to?
  • motion through joint motion
  • function
  • prevents
A

thin capsule proximally and thick capsule distally
attaches to distal phalanx and collateral ligaments
as joint flexes, volar plate slides proximally UNDER MC with a folding of its membrane
allows for large ROM over small surface area
prevents hyperextension and Doral subluxation

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35
Q

distal radioulnar ligaments = O, I, A

A

O: ulnar notch of radius
I: ulnar styloid process and ulnar fovea
A: part of the TFCC that stabilizes the distal radioulnar joint

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36
Q

radial collaateral ligament:

O, I, function

A

O: radial styloid process
I: scaphoid and lunate
Function: restrict ulnar deviation, lateral stabilization of the radial wrist

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37
Q

ulnar collateral ligament: O, I, Function

A

O: ulnar styloid process
I: pisiform and triquetrum
Function: restrict radial deviation, lateral stabilization of ulnar wrist

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38
Q

Radoiocarpal ligaments - palmar: O, I, function

A

O: anteroinferior radius, radial styloid process, palmar anteromedial ulna
I: palmar surface of scaphoid, lunate, capitate, triquetrum
A: volubly stabilize radius to carpals, limit excessive wrist extension

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39
Q

Radoiocarpal ligaments - dorsal: O, I, function

A

O: posterioinferio radius
I: dorsal surface of scaphoid, lunate and triquetrum
A: dorsally stabilize radius to carpal, limits excessvie wrist flexion

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40
Q

What is the TFCC made of

A

complex composed of articular disc, menisci homologue, ulnocarpal ligaments, dorsal and volar distal radioulnar ligaments, sheath of extensor carpi ulnaris and prestyloid recess

41
Q

where des TCFF insert

A

distally into triquetrum, hamate and base of 5th metacarpal

42
Q

functions of TFCC

A

load absorption and transmission

stabilize distal radioulnar joint

43
Q

axial loading of wrist is split into what percent onto radius and ulna

A

82% radius, 18% ulna

44
Q

where do ulna carpal ligaments originate

A

from the fovea

45
Q

how much does pronation increase ulnar variance

A

1mm

46
Q

how much does grip increase island variance

A

4mm

47
Q

what is the flexor retinaculum

  • attachments
  • function
  • point of origin for what
A

“carpal tunnel”

  • attached to triquetrum, pisiform, hook of hamate, tubers of trapezium and scaphoid
  • create passage for tendon of flexor pollicus longs, flexor digitorum superficial and profundus and median nerve
  • point of origin for thenar eminence
48
Q

what is teh extensor retinaculum

  • what does it restrict
  • what reduces friction
A

thickening of dorsal forearm fascia
subdivided into compartments
restricts tendon bowstring during wrist hyperextension
tendon wrapped in synovial sheath to reduce friction

49
Q

medial and lateral collateral of the fingers: O, I, function in flexion and extension

A

O: head of metacarpal phalanx
I: base of neighbouring phalange
Flex: tight, assist with grip
Ex: loose: allow ab/ad at MCP

50
Q

deep metacarpal transfer ligament: attachments, function

A

attaches for metacarpal head 2-5, volar plates

allows for flexible metacarpal arch

51
Q

what muscles on ulnar and radial side of thumb attach to volar plate and control thumb

A

Ulnar: adductor polices and first dorsal interossi tendon
Radial: flexor policies Brevis and abductor Brevis

52
Q

what is the shape of teh structure that facilitates pinching precision

A

sesamoid

53
Q

when elbow flexed greater than 15 degrees, how does the line fo pul and action of elbow wrist extensors changes, what muscle is best at this

A

anterior elbow axis transitions and wrist extensors can become elbow flexors
extensor carpi radialis longus can be and effective elbow flexor

54
Q

wrist flexors originate where

A

medial epicondyle of elbow

55
Q

name the primary wrist flexors

A 
flexor carpi radialis 
flexor carpi ulnaris 
flexor digitorum superficualis 
flexor digitorum profundus
palmaris longus 
flexor pollicis longus 
abductor pollicis longus
56
Q

can wrist flexors acts at elbow extensors? how so compared to wrist extensors?

A

they can if elbow is flexed, not as powerful s wrist extensors though

57
Q

what muscle interactions causes ulnar and radial deviation

A

extensors and flexors work synergistically
ECU, FCU together!
ones further from centre axis help more

58
Q

main function of extrinsic muscles of finger

A

strength and gross motor control

59
Q

which muscle extends all teh fingers

A

extensor digitorum

60
Q

flexor digitorum superficialis: how does this muscle split and where do the split ends insert

A

split into two, which each split into two tendons
2 superficial tendons go to digits 3 and 4
2 deeps tendons go to digits 2 and 5

61
Q

location of flexor digitorum profundus, what does it go under

A

anterior ulnar side of forearm

goes unser FDS and splits into four tendons

62
Q

four main thumb extrinsic muscles and function

A 
flexor pollicus longus
- primary thumb flexor, only IP flexor 
extensor pollicus longus and Brevis
- extension synergists
abductor pollicius longus 
- main thumb abductor
63
Q

function of intrinsic hand muscles

A

fine motor movements

64
Q

what is the group name of the thumb intrinsic muscles

A

thenar muscles

65
Q

what is the group name of the pinky pinger muscles

A

hypothenar

66
Q

function of the Interossei muscles

A

adduct fingers

67
Q

function of lumbricals

A

flex MCP and extend IP

68
Q

what is the function extensor hood and flexor tendon sheath

A

structure of the fingers and thumb designed to

  • hold flexor and extensor tendons in place
  • allow them to move and glide
  • guide direction of pull
69
Q

what is the extensor mechanism of the fingers made up of

A

intrinsic muscles
long finger extensors
long finger flexors
mechanism made up of distal tendinous attachments, retinacula and ligaments

70
Q

what is the purpose fo the extensor mechanism

A

allow extension of digits in multiple finger positions and permit full flexions

71
Q

what is trigger finger

A 
dysfunction of the flexor pulley 
module or thickened tendon sheath 
glide through pulley interrupted
72
Q

flexion is made up of how much movement at radoiocarpal and how much at mid carpal joint

A

50 degrees at radoiocarpal and 35 degrees at mid carpal joint

73
Q

extension is made up of how much movement at radoiocarpal and how much at mid carpal joint

A

50 degrees at midcarap, 35 degrees and radoiocarpal

74
Q

axis for flex ex of the wrist is

A

capitate

75
Q

closed position for the wrist

A

full wrist extension

76
Q

how much flexion at MCP joints

A

90 degrees

77
Q

closed packed position of MCPS

A

full flexion

78
Q

up to how many degrees extension at MCPs

A

45 degrees

79
Q

how much ad and ab at MCP when MCPs are extended

how much when flexed

A

20 degrees when extended for both

almost none when flexed

80
Q

how much flex and ex for thumb

A 
flex = 45-60
ex = 0-20
81
Q

how much flex at ex at IP joints

A

120 flex

0 ex

82
Q

closed packed position of Thumb

A

full extension

83
Q

closed packed position of MCP and IP 2-5

A

full flexion

84
Q

what are power grips of the hand

A

incorporate the entire hand
used for grasping activities
involved in holding an object between partially flexed fingers and palm while thumb provides pressure

85
Q

what are the four power grips of the hand

A

fist, cylindrical, hook, spherical

86
Q

what are precision grips

A

used for accuracy and refinement, object manipulation

thumb abducted, ready to oppose

87
Q

types of precision grips

A

tip to tip pinch
lateral key pinch
three prong Chuck

88
Q

grip strengt males vs females and dominant vs non dominant

A

males average 2x greater than females of similar age

6% stronger on dominant side

89
Q

what wrist position decreases grip strength

A

wrist flexion

90
Q

optimal wrist position for grasping

A

20-35 degrees extension with slight ulnar deviation

91
Q

what is mallet finger

A

trauma to DIP
generally caused by an impact force to the fingertip
avulsion of the lateral bands of the extensor tendon
permanent flexion of teh DIP

92
Q

what is boutinneir deformity

A

central slip of extensor digitorum at middle phalanx
flexed position of PIP results in lateral band being place posterior to teh axis of motion for the DIP causing hyperextension

93
Q

what is swan neck deformity

A

primarily associated with arthritis
weakened fo teh hand intrinsics resulting in the PIPS hyperextending
causes lateral slop of the extensor tendon to shift dorsally relative to the joint

94
Q

what is Dupuytren’s contracture

A

palmar fascia is thickened with fibrosis
primarily at digits 3 and 4
pits and modules, tendon not directly involved

95
Q

what is Volkmanns contracture

A

ischemic flexion deformity
from ischemic necrosis of the forearm flexors
pressure injury with forearm compartment
muscles replaced by contracted fibrous tissue

96
Q

radial nerve injury causes

A

effects extensors

wrist drop - effective grasp not possible

97
Q

median nerve injury causes

A

innervate most flexors (not FCU)
hand of benediction
ape hand (inability to oppose)

98
Q

ulnar nerve injury causes

A

supplies most small muscle of the hand except FDP/lumbrical split/thenars

ulnar claw
- injure can occur at forearm or wrist
fourth and fifth digits mostly affected

EPHE 355 (5 decks)

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