Hand packet 2 Flashcards
1
Q
flexor surface of the hand consists of a ____ mechanism & a _____ system
A
gliding;
pulley;
2
Q
flexor surface contains (anatomy)
A
flexor retinaculum
bursae
flexor tendon sheath
ligaments
3
Q
flexor retinaculum prevents
A
bowstringing of flexor tendons of the wrist
4
Q
flexor retinaculum is a ________ _______ ligament
A
transverse carpal
5
Q
bursae decreases _____ between ____ & ______
A
friction;
flexor tendons; & retinaculum
6
Q
bursae has a _____-like sheath and serves as a _____
A
synovial;
lubricant;
7
Q
bursae of the hand begins at the distal
A
radius/ulna
8
Q
ulna bursae location
A
- ends just distal to proximal crease
- continues up 5th digit
9
Q
radial bursa consists of
A
Flexor pollicis longus
10
Q
ulna bursa consists of
A
FDS & FDP
11
Q
digital flexor tendon sheath function
A
- envelope tendons
- synovial-like
12
Q
digital flexor tendon sheath begins
A
just proximal to the 1st annular pulley and ends at FDS split
13
Q
purpose of the anatomical pulleys of the fingers
A
- hold the tendons & sheath to phalanges
- prevents bowstringing of tendons
- minimizes stress/pressure between tendon & sheath
- promotes gliding
14
Q
how many annular pulleys?
A
5
15
Q
how many cruciform pulleys?
A
3
16
Q
A1 is located at the
A
MC Head
17
Q
A2 location
A
base of proximal phalanx
18
Q
A3 location
A
Head of the proximal phalanx
19
Q
A4 location
A
Middle of the middle phalanx
20
Q
A5 location
A
over DIP
21
Q
C1 location
A
middle of proximal phalanx
22
Q
C2 location
A
base of middle phalanx
23
Q
C3 location
A
head of middle phalanx
24
Q
extensor mechanisms of the fingers
A
- Extensor Digitorum
- Extensor expansion/extensor hood/dorsal aponeurosis
- dorsal & volar interossei
- lumbricals
25
As the extensor digitorum progression:
| 5 STEPS
1) under extensor retinaculum (synovial sheath)
2) loses sheath distal to the retinaculum
3) then, distal to MCP the ED tendons flatten leading to a dorsal aponeurosis (DA)
4) DA is joined by interossei tendons (prox wing tendon)
5) DA trifurcates just proximal to the PIP
26
central tendon of the distal aponeurosis goes to
base of the middle phalanx
27
two lateral bands of the distal aponeurosis go to
form a single terminal tendon, which goes to the base of the distal phalanx
28
Two lateral bands of the distal aponeurosis receive contributions from:
- interossei
- lumbricals
- lateral brachi (send slip to terminal tendon)
29
lumbricals fall on the _____ side of the joint
radial
30
lateral brachi receives
ORL (oblique retinacular ligament)
| extension mechanism
31
ORL arises from the sides of _____ & ______
1st phalanx;
digital tendon sheaths
(extension mechanism)
32
triangular ligament/transverse retinaculum consist of
lateral bands interconnected dorsally
| help with extension
33
dorsal hood attached to the _____ metacarpal ligament prevents
transverse;
bowstringing
(help with extension)
34
transverse metacarpal ligament connects
heads of all of the ligaments
35
MCP joints extend because ______ tendon is dorsal to _______
| this causes the pull of the ______ proximally
extensor digitorum;
joint AOR;
hood
36
MCP will extend regardless if lumbricals and/or interossei fire.... why????
because extensor digitorum is stronger than those intrinsic muscles
37
extensor digitorum (central tendon) can extend ____ but not ____
PIP;
| alone
38
if there is an isolated extensor digitorum then the outcome of this is _____
clawing
39
lumbricles and interossei produce ____ to the central tendon/lateral bands through the _____. This causes _____ extension.
tension;
ORL;
PIP
40
lumbrical grip
ex: reading a newspaper
- flex MCPs
- extend IPs
41
DIP & PIP are _____.
| Ex: With active DIP _____ you get active PIP _____
```
interdependent;
extension;
extension;
OR
flexion;
flexion;
```
42
Active intrinsics on the lateral bands/terminal tendons causes:
passive stretching of ORL and DIP extension
43
Intrinsic hand (-)
MCP hyperextension with IP flexion
claw hand
44
active or passive PIP full flexion prevents:
active DIP extension
45
Dorsal interossei do what movement
abduct
46
dorsal interossei _____ MCP when MCP is _____
2 ANSWERS!!!
abduct; extended;
OR
flex; flexed
47
Dorsal Interossei allow for the IP extension of what digits
2nd, 3rd & 4th
48
how does the 5th digit get abducted? (what muscle)
abductor digiti minimi
49
Palmar interossei are responsible for what movement
adduction
50
palmar interossei _______ MCP when MPC is _____
2 ANSWERS!!!
adduct; extended;
OR
flex; flexed
51
Palmer interossei allow for the IP extension of what digits?
2nd, 4th, 5th
| not the middle finger
52
why do the palmer interossei have no effected on the middle finger (digit 3)???
b/c adduction isn't needed
| all of the fingers go to the middle finger during adduction
53
Lumbricals origin
tendon of FDP
54
lumbricals insertion
radial side of the distal lateral bands of EM
55
lumbricals attachment to the _______ allow for effective ________
distal lateral bands; IP extension
56
lumbricals can _____ MCP but weaker than ______
flex;
| interossei
57
function of lumbricales is dependent on function of the FDP & ED because:
lumbricales attach to FDP & ED tendons -- therefore if those muscles are lax than the lumbricles will be wayyy less efficient
58
The FDP can close hand without other musculature, however without _____, there will be uncoordinated finger _____, causing a _________
intrinsics;
flexion;
ineffective grasp;
AKA INTRINSIC NEGATIVE (-) HAND
59
Thumb DOF
2-3 DOF --
flexion/extension
abduction/adduction
axial rotation???
60
type of joint of the thumb CMC
saddle joint
61
articulations of the thumb CMC
trapezium & base of 1st metacarpal
62
thumb opposition is the coupled motion
abduction --> flexion --> adduction & rotation
63
1st CMC joint structure
lax joint capsule with radial, ulnar, velar, & dorsal ligaments
64
1st CMC joint has slips of ______ ligaments to support it volarly & dorsally
intercarpal
65
IP joint of the thumb is what kind of joint
hinge
66
thumb is controlled by more muscles than digits _____
2-4
67
how many muscles control the thumb?
8
68
____#____ extrinsic muscles in the thumb & the names
4
- FPL (volar)
- EPL, APL, & EPB (dorsolaterally -- snuff box)
69
___#_____ intrinsic muscles in the thumb & names
4
- OP
- FPB - 2 heads
- ADP
- APB
70
power grasp 3 types
cylindrical
spherical/ball
hook
71
power grasp occurs when:
- fingers clamp object into palm
- fingers in sustained flexion
- palm conforms to object
- thumb may or may not contribute to this
72
cylindrical power grasp
- fingers surrounds object with counterforce from thenar eminence &/or thumb
73
spherical/ball power grasp
- fingers surrounds object with counterforce from thenar eminence &/or thumb (SAME AS CYLINDRICAL)
- however, there is a GREATER spread of fingers evoking more interossei activity
74
hook power grasp
no opposition of thumb,
| ex: carrying a brief case
75
precision handling types
1) tip to tip pinch
2) pad to pad/palmer pinch
3) pad to side/lateral/key
4) 3-jaw chunk/tripod
76
precision handling definition
objects pinched or manipulated between fingers & thumb
77
functional ROM for slight wrist extension
20-30 degrees
78
functional ROM for slight ulnar deviation
10 deg
79
functional ROM for MCP flexion
45 deg
80
functional ROM for PIP flexion
30 deg
81
functional ROM for DIP flexion
just a slight flexion is k
82
mallet finger
distal terminal tendon rupture of extensor digitorum
it causes flexion of the DIP
83
boutonniere (button hole) finger
disease of the tendon in which the central slip is thinning
this causes the lateral bands to dislocate,
causing flexion of PIP & hyperextension of DIP
84
swan neck finger
spasm & contracture of intrinsics which attaches to lateral bands
- causes a laxity or rupture of the palmer plate (this normally prevents hyperextension)
- lateral bands then dislocate dorsally
- this causes hyperextension of PIP and flexion of PIP
85
swan neck finger occurs in ___% of __________ patients
28%
| rheumetoid arthritis
