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BIOMECHANICS FINAL REVIEW - ELBOW AND HAND > Hand Osteology, Arthrology and Muscle/Joint Interaction Lecture 15 > Flashcards

Hand Osteology, Arthrology and Muscle/Joint Interaction Lecture 15 Flashcards

1
Q

What is made up of the 1st metacarpal and trapezium?

A

CMC thumb joint

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2
Q

What shape is the CMC thumb joint?

A

Saddle

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3
Q

What do we need to know about the capsule of the CMC thumb joint?

A

naturally loose, strengthened by tension in embedded ligaments (3-7)

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4
Q

When are ligaments tight in the CMC thumb joint?

A

Tight in opposition, flexion and abduction

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5
Q

Does the CMC thumb joint have sensory receptors?

A

YES many!

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6
Q

What is common at the CMC thumb joint?

A

Osteoarthritis

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7
Q

What can osteoarthritis at the CMC thumb joint cause?

A

Radial dislocation and ‘hump’

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8
Q

What is a classic saddle joint?

A

Each articular surface convex in one direction and concave in the other

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9
Q

How many degrees of freedom does the CMC thumb joint have? where?

A

2 - add/add in sagittal plane; flexion/extension in frontal plane

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10
Q

_________ and _______ from 2 planes with the CMC thumb joint

A

Opposition/reposition

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11
Q

What amount of abduction is full with the CMC thumb joint?

A

45 degrees anterior to plane of palm

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12
Q

What happens with the arthrokinematics of the thumb during CMC thumb abduction and adduction?

A

Convex articular surface of thumb metacarpal moving on fixed concave trapezium

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13
Q

What roll and slide is there with abduction of the CMC thumb joint?

A

rolls palmar and slides dorsally

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14
Q

What does abd/add of the CMC thumb joint do to the musculature & ligaments?

A

Elongates adductor pollicis and most ligaments

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15
Q

What roll and slide is there with adduction of the CMC thumb joint?

A

rolls dorsally and slides palmar

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16
Q

What is flexion and extension of the CMC thumb joint associated with?

A

Varying amount of axial rotation; flexion medial rotation and prontation

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17
Q

Why is flexion / extension of the CMC thumb not a 3rd degree of motion?

A

Cannot be done independently

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18
Q

How much more can the CMC thumb joint be extended from anatomical position?

A

10-15 degrees

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19
Q

How much does the CMC thumb joint flex from full extension?

A

45-50 degrees

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20
Q

What os the arthrokinematics of CMC thumb flexion ?

A

Concave metacarpal on convex trapezium

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21
Q

What is the roll and slide with CMC thumb flexion?

A

Metacarpal rolls and slides in ulnar direction

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22
Q

What guides medial rotation with CMC thumb flexion?

A

Shallow groove in trapezium

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23
Q

What is the slide and glide with CMC thumb extension?

A

Slide/glide in lateral direction

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24
Q

What are the osteokinematics of thumb abduction and adduction?

A

sagittal plane movement around a medial-lateral axis of rotation through the metacarpal

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25
Q

What is the joint geometry of thumb abduction and adduction?

A

Convex diameter of metacarpal moving on concave surface of trapezium

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26
Q

What are the arthrokinematics of thumb abduction?

A

palmar roll and dorsal slide

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27
Q

What are the arthrokinematics of thumb adduction?

A

Dorsal roll and palmar slide

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28
Q

What are the osteokinematics of flexion and extension of the thumb?

A

Frontal plane movement around an anterior-posterior axis of rotation through the trapezium

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29
Q

What is the joint geometry of flexion and extension of the thumb?

A

Concave diameter of the metacarpal moving on a convex surface of the trapezium

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30
Q

What are the arthrokinematics of thumb flexion?

A

Medial roll and slide

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31
Q

What are the arthrokinematics of thumb extension?

A

Lateral roll and slide

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32
Q

What does effectiveness of pinching and gripping motions depend on?

A

Opposition

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33
Q

What is thumb opposition a combination of?

A
  1. Thumb MC abduction
  2. flexion and medial rotation towards small finger, trapezium also spins slightly; small and ring finger cup to help
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34
Q

Is full thumb opposition closed or open packed?

A

Closed

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35
Q

What are the general features of the MCP joints?

A

Ovoid, convex head of metacarpal and shallow concave proximal phalanges

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36
Q

What is critical to the stability of the hand?

A

Mechanical stability

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37
Q

What is each MCP joint capsule made up of?

A

pair of radial and ulnar collateral ligaments and one palmar plate

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38
Q

What kind of connective tissues are part of the MCP joints?

A

elaborate and interconnecting

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39
Q

Where do collateral ligaments attach proximally?

A

Proximal attachment at tubercle

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40
Q

What are the different parts of the collateral ligaments?

A

Cord part (thick and strong) & accessory part

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41
Q

What are volar (palmar) plates?

A

Dense, thick fibrocartilage; runs base of proximal phalanx thinner elastic portion to MC

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42
Q

What do fibrous digital sheaths form?

A

Form tunnels or pulleys for extrensic finger flexors

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43
Q

Where are fibrous digital sheaths anchored?

A

Plates

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44
Q

What is the MCP joint formed by?

A

Concave proximal phalanx; collateral ligaments and dorsal surface of the plate

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45
Q

What accepts the large MC head?

A

A 3-sided recepticle

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46
Q

What does the 3 sided recepticle do in the MCP joint?

A

Increases articular area and stability

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47
Q

How many deep transverse metacarpal ligaments are there in the MCP joints?

A

3

48
Q

What are the ostrokinematics of MCP joint flexion/extension?

A

Sagittal plant around medial-lateral axis

49
Q

How does MCP flexion/extension increase?

A

Increases from 2nd to 5th MCP (90-115)

50
Q

How much extension past neutral do the MCP joints get?

A

up to 30-45 degrees

51
Q

What are the osteokinematics of abduction/adduction?

A

Frontal plane around anterior-posterior axis

52
Q

How far each way do MCP joints go from midline during abduction/Adduction?

A

20 degrees

53
Q

What are the accessory motions of the MCP joints?

A

distracted/compressed; translation A-P / side-side; axial rotation

54
Q

What do the accessory motions of the MCP joints allow for?

A

Conforming to objects in grasp

55
Q

What are the arthrokinematics of MCP joints?

A

Head of MC rounded at apex/ flat palmar surface

56
Q

What are MCP joints covered in?

A

Articular cartilage

57
Q

What moves on what with MCP joints?

A

Concave phalanx moving on convex MC head

58
Q

What is the roll/slide of the MCP joints?

A

Roll and slide the same way

59
Q

What is the difference in flexion and neutral with abduction?

A

Less motion in flexion than neutral

60
Q

When are ligaments taut with abduction? also does what?

A

Taut in full flexion, also compresses joint

61
Q

What is in contact with the phalanx?

A

The flatter potion of head

62
Q

Why does flexion at the MCP joint increase distance between the attachment points of most of the cord part of the collateral ligaents?

A

Cam -shaped metacarpal head

63
Q

What happens to the distance between the proximal and distal attachments of the collateral ligaments with the PIP joint?

A

Remain essentially constant throughout flexion

64
Q

What are the ostrokinematics of the MCP joint of the thumb?

A

Convex head of 1st metacarpal and concave proximal phalanx of thumb

65
Q

How many degrees of freedom are there of the MCP joint? What?

A

1 - flexion/ext in frontal plane

66
Q

What are considered accessory motions of the MCP joint of the thumb?

A

Abduction/Adduction

67
Q

What injury is due to large forces and not motion of the thumb?

A

“skiier’s injury”

68
Q

When is the thumb vulnerable especially?

A

30 degrees

69
Q

Where are the two kinds of IP joints?

A

Proximal and distal IP joints

70
Q

How many degrees of freedom at the IP joints? What are they?

A

1 - flexion / extension

71
Q

What are the head of proximal phalanx shaped by? What are the separated by?

A

Head of proximal phalanx 2 rounded condyles separated by central groove

72
Q

What does the central groove of the IP joint help with?

A

guiding flexion/extension, limits rotation

73
Q

What does the palmar plate limit with IP joints?

A

Hyperextension

74
Q

What do the check-rein ligaments do in the IP joints?

A

Reinforce palmar plates and assists in limiting hyperextension

75
Q

What has no check-rein ligaments?

A

DIP joints

76
Q

What are part of the IP joints? (ligaments / plates)

A

Radial and ulnar colateral ligaments and palmar plates

77
Q

What are the kinematics of the PIP joint?

A

100-120 degrees flexion, minimal hyperextension

78
Q

What are the kinematics of the DIP joint?

A

70-90 degrees of flexion, 30 degrees of hyperextension

79
Q

What is the roll and slide of the IP joints?

A

Concave base rolls and slide in palmar direction

80
Q

What helps stabilize the IP joints?

A

The dorsal capsule tension

81
Q

When is the IP joint closed packed?

A

Full extension

82
Q

How many degrees of freedom of the thumb IPs? What degrees?

A

1 degree of freedom, flexion 70 degrees, extension to 20 degrees

83
Q

What is unique about the innervation of the hand?

A

Small fiber-per-axon ratio typical of most intrinsic hand muscles, single axon may innervate as few as 100 muscle fibers

84
Q

What does the radial nerve innervate?

A

Extensive extensor muscles (ED, EDM, EI, EPL, EPB, APL)

85
Q

What does the median nerve innervate?

A

Most of the extrinsic flexors (FDS, FDP, FPL; ABP, OP, FPB - thenar eminence and lateral 2 lumbricals)

86
Q

What does the ulnar nerve innervate?

A

Medial half of FDP, hypothenar muscles (FDM, ADM, PB) and 2 medial lumbricals; all interossei and add pollcis

87
Q

Where are the extrinsic attachments?

A

In forearm and epicondyles

88
Q

Where are the intrinsic attachments?

A

Hand

89
Q

Where is the proximal attachments of the extrinsic flexors of digits?

A

Humerus and forearm

90
Q

What do all the extrinsic flexors of digits do?

A

All flex digits (grasp) and subtle opposition

91
Q

What does the flexor digitorum superficialis do? where is it located?

A

Flexes PIP joints, independently

Deep to 3 wrist flexors, pronator teres; 4 tendons cross wrist and split at proximal phalanx - attached middle phalanges

92
Q

Where is the FDP? What does the flexor digitorum profundus do?

A

Deepest of forearm, attaches base of distal phalanx

Sole flexor of DIP, index indep

93
Q

What does the flexor pollicis longus do? Where does it run?

A

Flexes and radially deviates wrist if unopposed

Lateral to FDP, sole flexor of IP

94
Q

What are the tendons surrounded by?

A

Synovial sheaths

95
Q

What does the synovial sheath around tendons do?

A

Reduces friction between structrues

96
Q

What can cause fibrotic changes tot he connective tissue in the wrist?

A

Overcrowding, small tunnel, water retension, inflammation, swelling of tendons, repeated or excessive stress to wrist

97
Q

Where is the fibrous digital sheath anchored?

A

To plates and phalanges

98
Q

What is embedded in the fibrous digital sheath?

A

Bands of tissue called flexor pulleys A1-A5 and C1-C3

99
Q

What does the digital synovial sheath serve as?

A

Nutritional and lubrication

100
Q

What can be developed post laceration/surgery?

A

Adhesions

101
Q

What exercises do we do with adhesions?

A

Tendon gliding exercises

102
Q

What are flexor pulleys?

A

5 annular pulleys for each finger (A1-A5) embedded within fibrous digital sheath

103
Q

Where do flexor pulley attach to shafts?

A

Major at A2 and A4 (mid and prox)

104
Q

Where do flexor pulley attach to palmar plates?

A

Minor at A1, A3, and A5

105
Q

What are cruciate pulleys?

A

C1-3 thin, crisscross over tendons where digital sheaths bend during flexion

106
Q

What ligaments of thumb are pulleys for FPL?

A

Annular and oblique ligaments

107
Q

What happens without the flexor pulleys?

A

Get “bowstring”; A2 & A4 reduce torque significantly if injured

108
Q

What is tenosynovitis?

A

Tendons/synovial lining inflammed

109
Q

What can be developed with tenosynovitis?

A

Nodule which gets “stuck” in sheath and can snap through it

110
Q

What is another name for tenosynovitis?

A

Trigger finger

111
Q

What percentage of climbers have pulley injuries?

A

20%

112
Q

Which pulley is the most frequently injured?

A

A2

113
Q

What do the proximal stabilizer muscles do during active finger extension?

A

Greater force at PIPs and greater force stabilizer at extensor digitorum

114
Q

What is tenodesis action of a healthy person?

A

As the wrist is extended, the thumb and fibers automatically flex because of the stretch placed on the extrinsic digital flexors; flexion occurs passively

115
Q

What are the extrinsic extensors of fingers?

A
  • Extensor digitorum (wrist and finger extensor)
  • Extensor indicis
  • Extensor digiti minimi (often connected to ED)
  • Cross wrist under retinaculum
    ** within synovial lined compartments
116
Q

What are tendons connected by?

A

Juncturae tendinae

117
Q
A

BIOMECHANICS FINAL REVIEW - ELBOW AND HAND (4 decks)

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