Hand and Wrist Flashcards
1
Q
why are the bones of hand important
A
-provide support and flexibility for the soft tissues
2
Q
what does the wrist joint comprise of
A
- the TFCC, distal radius , scaphoid and lunate bone
3
Q
why is the ulna not part of the wrist joint
A
- because the TFCC overlays it
4
Q
imaeg
A
image
5
Q
in terms of shapes what are the shapes of these bone at the site of articulation
A
- concave surface of ; radius and ulna articulates with the -convex surface of the carpal bones
6
Q
what type of joint capsule is the wrist? what type of (x) is it? and because of that whats the plane and movement permitted?
A
- synovial - ellipsoid - 2 axes - flexion / extension/ abduction (ulnar deviation of wrist) / abduction (radial deviation of the wrist) -circumduction wc is all of these movements
7
Q
whats ulnar/radial deviation of the wrist
A
- U= adduction -R = abdcution
8
Q
whats circumduction
A
- all four movements (flex,exte,adb,add) -hand in circle
9
Q
why can you adduct more than abduct
A
- because the radial styloid process extends further distally than the ulnar
10
Q
imaeg
A
image
11
Q
what stabilised the wrist joint
A
-ligamnets
12
Q
name the ligaments of the wrsit
A
- dorsal and palmar radiocarpal ligaments -ulnar collateral ligament of the wrist joint - radial collateral ligament of the wrist joint
13
Q
whats the function of x ligament
A
- radiocarpal ligament plays a role I ensure the hand follows the wrist during pronation and supination
14
Q
what are the major muscles for wrist flexion
A
- flexor carpi ulnaris -FCR - (weak) palmaris longus
15
Q
what are the long flexors of the wrist
A
- flexor D S, FDP, FPL
16
Q
what are the extensors of the wrist
A
- ECR -ECRB -ECU
17
Q
what other muscle assists extension
A
-ED -EPL -EDM -EI -EPB -EPL
18
Q
what causes abduction of the wrist
A
-FCR -ECRL -ECRB
19
Q
what causes adduction of the wrist
A
-FCU -ECU
20
Q
what are the groups of bones in the hand and their numbers
A
- CARPALS; 8 - METACARPALS ; 5 - PHALANGES ; 14
21
Q
whats special about the thumb compared to other fingers
A
-thumb only has 2 phalanges - all other fingers have 3 ; proximal , middle , distal
22
Q
describe the carpals
A
- 8 of them -2 rows ; PROXIMAL and DISTAL
23
Q
what are the proximal phalanges
A
-scaphoid , lunate , pisiform , triquetrum and pisiform (near little finger)
24
Q
what are the distal phalanges
A
-trapezoid, hamate, capitate and trapezium (near thrombi)
25
image
image
26
what does the proximal row articulate with
-scaphoid and lunate of the proximal row articulate with the ulnar and radius (scaphoid ulnar, radius lunate
27
whats special about the hamate bone
- has a projection known as HOOK OF HAMATE, it forms the ulnar boarder of the carpal tunnel and radial board of guyots canal -flexor retinaculum , FCU and transverse carpal tunnel attach to it
28
what is the b supply to the scaphoid
- dorsal carpal branch of radial artery -it enters the scaphoid from distal end and supplied 80% of proximal scaphoid via retrograde flow (flow back towards the wrist
29
scaphoid fractures
- accounts fro 70-80% of carpal bone fractures and 10% of hand fractures -any age but mostly adolescents and young adults -d fall on outstretch hand c hyperextension and impact of schapoid against the rim of the radius otindrect racial 'end-n'compression of scaphoid -patients present with pain when in the anatomical snuffbox position , pain exacerbated when move wrist, passive movement reduced, swelling around radial and posterior aspects of wrist common
30
image
anatomical snuffbox position
31
where on the scaphoid do fractures occur and their %
- 70-80% waist -20% proximal pole -10%distal pole (scaphoid tubercule)
32
x ray of scaphoid fracture
- doesn't always show up straight after, so give 10 day after x ray where the fracture line will be more visible d bone respiration
33
if after 10 days not clear if fracture of the scaphoid , but patient is symptomatic ?
- CT / MRI may be used - blood supply scaphoid is mainly retrograde from distal pole (via dorsal carpal branch of radial artery) towards the proximal pole , and since the b supply to the proximal pole is tenuous, fractures through the waist of the scaphoid can cause avascular necrosis - this puts displaced fractures of the scaphoid at 8-10% nonunion, high risk of non-union, malunion, avascular necrosis and late complications of carpal instability and secondary osteoarthritis
34
what is this ? and what can is lead to?
- malunion waist of scaphoid fracture
- 8-10% risk of malunion necrosis
- late compliations ;^ risk of secondary osteoarthritis and carpal instability
35
osteoarthiritis is more common...
-non-union, malunion or avascular necrosis
36
what are the metacarpals and what do they articulate with
- 5 bones and they articulate with distal row of the carpals (trapezium, trapezoid, hamate, capitate
37
which carpal articulates with wich
- I = trapezium articulates with the proxmial phalanx of the thumb distally -II= trapezoid articulates with the proximal phalanx of the index finger distally -III= capitate articulates with the proximal phalanx of the middle finger distally -IV= hamate articulates with the proximal ring finger distally -V = hamate articulates with the proximal little finger distally
38
describe the metacarpal bone parts and its shape and why
- base, shaft, head - concave lateral surfaces of the shaft -to allow the attachment of inerossei muscles
39
what are the movements of the thumn
image -oppositon -retropulsion -radial abduction (coronal plane) -palmar abduction /add. (sagittal plane) -flexionn / ex -reposition
40
muscles of the hands groups
-intrinsic (originate within the. hand) -extrinsic (originate within the forearm and insert into the hand)
41
what can the intrinsic muscles be further divided into?
- 4 compartments; -thenar compartment (THUMB); abd.pol.lungus, flexor pol. brevis, opponens pollicis - abbuctor compartment; adductor pollicis - hypothenar compartment ; (hypothenar =littleh finger), aductor digit minimi, f d minimi, opponesse digiti minimi -central compartment ; interossei , palmaris brevis, lumbricals
42
muscles of the thumb and what do they form and what are they supplied by
- opponens pollicis (largest forms the thumb eminence) - abductor poll. brevis (wc is on most lateral side) - flexor pol. brevis wc most medial side -op.and abduc= median nerve, -felx DEEP HEAD supplied by =ulnar
43
opponens pollicis
-O= trapezium and flexor retinaculum -I= lateral boarder of 1st metacarpal -F= oppose the thumb (by medially rotating first M) -IN= median nerve
44
abductor pollicis brevis
- O= scaphoid , trapezium , FR -I= lateral boarder of proximal phalanx of thumb -IN= median nerve -F= palmar abduction
45
flexor pollicis brevis
-2 heads ; -O SUPERFICIAL HEAD = trapezium and FR -O= deep head = capitate and trapezoid -F=flex metacphal joint of thumb
46
what flexes the interphalangeal joint of thumb
flexor pollicis longus
47
interphalangal vs metacarpophalangal joints
- M= puppet hand - I= flex completely everything so hand in ball
48
adductor compartment of hand muscle
- adductor policis
49
adductor pollicis
-2 orgins -TRANSVERSE HEAD; shaft of 3rd M -OBLIQUE HEAD; capitate and base of 2nd and 3rdM -I= ulnar aspect of proximal base of thumb -IN? - F=adduct the thumb in both radial and palmar adduction
50
litte finger muscles
- flexor digiti minimi brevis -opponens digiti minimi - abductor digitiminimi -all innervated by ulnar -responsiblefor hypothenar eminence
51
opponens digiti minimi
-O= hook of hamate -I= ulnar margin 5th M -F= rotate the 5th me towards the palm allowing opposition to occur -IN= ulnar
52
abductor digiti minimi
-o= PISIFORM and tendon of FCU -I = base of proximal phalanx of little finger -F= abductos the little finger -IN= ulnar
53
flexor digiti minimi
-O= hook of hamate and FR -I= base of proximal phalanx of little finger -F=. flexion of metacarpalphalngeal of little finger
54
central compartment
-palmaris brevis and dorsal interossei ,palmar interossei and 4lumbricals - ulnar palmar and dorsal interossie supplied by ulnar - radial 2 lumbricals supplied y mediannerve
55
palmar brevis
- small thin muscle superficial in subcutaneous tissue lining the hypothenar eminence -O= palmar aponeurosis and FR -I= dermis of the skin on medial margin of hand -F= wrinkles the skin of hypothenar eminence and deepens the curvature of the palm improivng grip -IN= superficial branch of ulnar nerve
56
how many lumbricals in the hand? their role?
-4 - link the flexor digitorium profuncdus tendon on the palmar surface to the extensor digitoriumtendon on dorsal -when they contract the they flex fingers at MCP and extend at ICP
57
describe the muscle type of the lumbricals
- index and middle are unipennate - ring and little = bipennate -O= is flexor digitorium profundus tendon
58
lumbticals 1
-O=FDP -I= extensor digitorium to index finger -F= flexion at metacarpophalangeal joint and extension at the interphalangeal joint -IN =median
59
lumbrical 2
-OR=FDPmiddle finger -I=ED middle -IN= median -F=flex at MCP and ex IP
60
lumbrical 3
-O= FDP ring -I = ED ring -IN=ulnar - F = f MCP and e IJ
61
lumbrical 4
-O= FDP little -I=ED = little -F = flex MCP and ex IJ -IN= ulnar
62
interossei muscel
-between bone - 2 groups ; dorsal interossei abduct DAB / palmar interossei abdcut - they also assist with th flexion at the MCP joint and IJ extension -4 muscles
63
1 intersoseui
-O= shaft of 1st and 2nd metacarpal -I= radial aspect of proximal phalanx of index finger adnextesnsor expansion -F = abduct index finger , f MCJ, eIJ
64
2intersosseu
-O= shaft 2 3 meta. -I=radial aspect of base of proximal phalanx of middle finger and extesnor expansion -F= abduct middle finger radiallyand ssit f MCJ and e IP
65
dorsal vs palmar interossei abductor muscles
-D= bipennate , shaft of 2 metacarpals , 4 of them , c abduction -P = unipennate , shaft of 1 carpal, 3starts at the second metacarpal, c adduction
66
extrinsic muscle of the hand
-extensor digiotorium - FDP -FDS
67
describe the tendons of the hand
- at dorsal of wrist tendon dives into 4 and inserts onto index ... each tendon splits into central slit wc inserts into the base of the middle phalanx and 2 lateral slits wc converge and insert on the base of the distal phalnx
68
why are central slits important
-RAc Boutonniere deformity
69
RA affects where the most
- autoimmune disease in which antibodies known as rheumatoid factors attack the synovial membranes penetrated the cartilage and adjacent bone leading to erosion and deformity - in hand affects the MCP and IPJ -described as symmetrical polyarthiris (suusally distributes at same left and right wrist same time)
70
patient with MCP and IJP RA presentaiton
-pain and swelling -erythema overlaying the joints -stiffness in the morning worse or periods of inactivity c difficulty in tasks like putting a button on - carpal tunnel syndrome (compression of the median nerve c swelling of the synovial membrane) - fatigue and flue like symptoms (d inflammation)
71
what do you see in this X ray ? what is it
- joint spacing narrowing - periarticular osteopenia - juxta-articular (also called marginal bony erosions in non-cartilage protected bone wc occurs in RA b of erosion of the cartilage) - subluxation (partial dislocation) and gross deformity
72
what are deformities in RA hand patients
-swan neck deformity -Boutonniere deformity
73
swan neck deformity
- hyper extension of the promixal IPJ d it become more lax as a result of the imbalance in the PALMAR( *_volar)_* aspect of the proximal IPJ as a result adjascent synovitis.
- ext. digitorium tendon can rupture at the base of the distal phalanx and so you get a **mallet deformity**
74
Boutonniere's deformity
- the distal IPJ and MCPJ are extended nad PIPJ is extended - inflammation of the PIJPc lengething (or rupture ) of central slit of ED as it inserts on the base of the middle phalanx on dorsal surface of tiger - the lateral bands are then on the palmar surface at level PIJP and act as extensors of PIJP
75
where does the FDP and FDS insert
- S= abse of middle phalnx - P= base of distal phalanx
76
what happens to the FDS and FDP tendons
-FDS splits into 2 to allow the FDP to pass through it
77
what are tendons that insert like the way FDS and FDP but on the dorsal surface of hand
-ED wc splits into 4 tendons -EI index -ED/m little tfinger
78
carpal tunnel
-narrow passageway on palmar surface where lots of tendons pass and median nerve -superficial boarder formed by flexor retinaculum aka transverse carpal ligament
79
transver carpal ligament
-attatchemt ; latra = scpahoid and trapexium -ulnar = pisiform and hamate-marking is vital wrist crease
80
whats the marina of the flexor retinalculum
distal wrist crease
81
what passes through the carpal tunnel
-FPLtendon -FDS TEN(4) -FDPT(4) -mean nerve
82
whats guyots canal
0 semi-rigid lingitdunial canal in the wrist that allows passageway for ulnar nerve and artery -can palpate it b radial to the pisiform bone and passes between it and the hook of hamate -roof is the palmar carpal ligament not the transverse carpal ligament -site of ulnar nerve compression
83
what is this
anatomical snuffbox
84
whats the boarders of the anatomical snuffbox
- radial = tendon of Abductor PL (its is most lateral) and EPB -medial boarder= tendon of EPL -proximal barder = styloid radius -floor = scaphoid and trapezium -roof=skin
85
whats the contents of the anatomical snuffbox
-radial artery -superficial branch of radial nerve -cephalicvein
86
whats the b supply pf the hadn
-radial and ulnar nerve wc boh branch off to give superficial palmar and Deep palmar branch -radial artery enters the hand between the tendon of brachiaradilaus and FCR to give off superficial branch then it passes dorsal to cross the anatomical snuffbox and supplies the dorsal of the the palm between the 2 heads of the abductor pollicis -rdial artery then anatomsomes with the deep branch of the ulnar artery -ulnar artery can be palpated at the guyots' cancel (between pisiform dn hook of hamate (radial boarder is pisiform) itssperfical branch gives off the common palmar digital arteries
87
in most people was does ulnar artery contribute to
suepfical palmar arch and so b supply to fingers via superficial palmar digital arteries
88
in most people what does the radial artery contribute to
deep palmar arch and therefore supply of the thumb, and radial Side of the index finger
89
whats this
colle's fracture
90
colle's fracture
- extra-articular fracture of distal radial metaphysis with dorsal angulation and impaction
- associated with 50% ulnar styloid fracutre
most common distal radial fracture common in patietns with osteoporosis (rduced bone density) as mot cases are from post menapausal women , young pateinets who have it aquire it from skiing injury
- fall ontooutstrectched hand witha pronated forearm and wrsit in dorsifelxion
- energy transmitted upon impact from carpus to distal radius in a dorsal direction along the long axis of radius so fracture is dorsally angulated and impacted
T = reduced mobilisation in cast
-comlications inlcude malunion, median nerve palsy and post traumatic carpal tunnel syndrome , secondry oestoarthitirs and tear of exnsor pollcisi longus
91
92
oppsoite of colles fracture
- smiths fractre
- occurs due to fall on dorum of wrist
- common in eldery mena dn women
- cmalunion w residual volar displacement of the distal radiusresults in sometic dformity = garden space wc narrows and distors the carpal tunnel
93
carpal tunnel syndrome
compression of median nerve
- rsik factors are obesity, repetivive weist work , pregnancy RA and hpothyroidism
- nerve comression c ischaemia focal deymelination and decrease in axonal calibre and eventually axonal loss
- patient resetn with paraesthsia in median nerve dermatiome (1231/2) , symtoms worse at night due to wrist flexion with sleep and worse in day when doing tasks like combing hair or driving
- seanation to palm is okay since its part of the palmar cutanoues branch of median nerve wc lies superficial to the TCligament
- it can also c motor function issues = atrophy but patient can flex thumb be flxor pollcis longus is innervated by the anterior intersous branch of median nerve and deep f p b is innervated by ulnar and adduction remains since ulnar adductorpollcis
- maual dexterity deminished
94
ulnar nerve compression
- compressio of guyons cancal
- paraestehtic and weaknes in msucles supplied by it
95
whats this
dupuytren's contracture
96
dupuytren's contracture
- ocalised thickening adn contracture of palamar aponeurosis leading to flexio defromity
- atients prestn w ; thickeing of nodules in palm wc cabe painful/less then later nyofibroblasts within the bodule contract leasing to formtion of tiht bands c cords in palmar fascia, theoverlyign skin adheres to the palamr apon. and the disease progresses to involve the proximcal fascia ad skin of fingers, figers get stuck in flexed position and cant be passibley straightened
- most common digits tobe ring and little finger
- 40-50 northen european 70% familyhistory
- ^ risk; obesity, TYP!, forxen shoulder, eplipelsy d mediation youre taking, smokng , hyercholes,
97
damage to ulnar nerve at wrist level c
low ulnar claw thse fingers are hyperextended at MCP and flexed at both distal and proximal ICP
-all muscles suppied by ulnar not funitoning
98
damage to ulna at the elbow level
- msucles damaged and loss of sensation
- ulnar claw does develop but fdp is paralysed so no flexion at the DIPJ of ring and little finger jsut hyperextention o fMCP known as ulnar paradox
99
muscles supplid by ulnar at wrist
-adpoliccis, deeep head of fpb,fdp ,paamr brevis, lumbricals, and strphy of hypothenar emience
100
damage to median nerve
- d supracondrlar fracture forearm supinated, d unoppoesd action of supinator (radal nerve) and icep brech , weak flex wrist and adduction d FCU
- oppop. and adpb x func
- IPJ MCP flex thumb abd thenar eminence
- hand of benediction and ape hand deformity if logn stasning
