Hand & Wrist Flashcards
Skeletal Structures of Hand: MC
Metacarpals (5), are divided into 3 sections:
* Base (proximal)
* Shaft (middle)
* Head (distal)
Skeletal Structures of Hand: PH & PX
Phalanges (14) P2-P5 divided into:
* Proximal
* Middle
* Distal
Pollux (2)
* Proximal
* Distal
Joints & articulations of hand bones
Phalanges:
Carpometacarpal
-Structural/Functional Classification: Gliding
-Movements: Volar/Dorsal Gliding
Metacarpophalangeal
-Structural Classification: Ellipsoid
-Functional Classification: Biaxial
-Movements: Flexion/extension, abduction/adduction
-Flexion: Volar Gliding
-Extension: Dorsal Gliding
Proximal/Distal Interphalangeal
-Structural Classification: Hinge
-Functional Classification: Uniaxial
-Movements: Flexion/extension
Proximal IP: Power grip
Pollux:
Carpometacarpal
-Structural Classification: Saddle
-Functional Classification: Biaxial
-Movements: Radial & Palmar Abduction, Opposition (w/pinky), **Adduction brings the thumb back from any direction.
Movements & Muscles of Hand: Abduction & Adduction of MCP Joints
-Dorsal Interossei (Abduction)
-Palmar Interossei (Adduction)
Movements & Muscles of Hand: Extension of 2nd-5th Fingers
-Extensor Digitorum
-Lumbricals
-Dorsal Interossei (2nd-4th, Assists)
-Palmar Interossei (2nd, 4th, & 5th, Assists)
-Extensor Indicis (2nd)
Movements & Muscles of Hand: Composite (all joints) Flexion of 2nd-5th Fingers
-Flexor Digitorum Superficialis (PIP, MCP, wrist flexion)
-Flexor Digitorum Profundus (DIP, PIP, MCP, wrist flexion)
-Flexor Digiti Minimi Brevis (5th)
-Lumbricals
-Dorsal Interossei (2nd-4th, Assists)
-Palmar Interossei (2nd, 4th, & 5th, Assists)
Movements & Muscles of Hand: Flexion of MCPs w/ Extended PIPs n DIPs (Intrinsic Plus {Duck} Position)
-Dorsal Interossei
-Palmar Interossei
-Lumbricals
-Flexor Digiti Minimi (5th)
Movements & Muscles of Hand: Thumb CMC Radial Abduction
-Abductor Pollicis Longus
-Abductor Pollicis Brevis
-Extensor Pollicis Longus (Assists)
-Extensor Pollicis Brevis (Extension)
Movements & Muscles of Hand: Thumb CMC Palmar Abduction
-Abductor Pollicis Brevis
-Abductor Pollicis Longus
-Flexor Pollicis Longus (Assists)
-Opponens Pollicis (Assists)
Movements & Muscles of Hand: Thumb CMC Flexion/Extension
-Abductor Pollicis Longus (Extension)
-Extensor Pollicis Longus (Extension)
-Extensor Pollicis Brevis (Extension)
-Flexor Pollicis Longus (Flexion)
-Flexor Pollicis Brevis (Flexion)
-Adductor Pollicis (Flexion)
Movements & Muscles of Hand: Thumb CMC Adduction
-Adductor Pollicis
-Flexor Pollicis Brevis
-Flexor Pollicis Longus (Assists)
Movements & Muscles of Hand: Thumb Opposition
-Opponens Pollicis
-Flexor Pollicis Brevis (Assists)
-Abductor Pollicis Brevis (Assists)
Movements & Muscles of Hand: Thumb MCP/IP Flexion
-Flexor Pollicis Longus (IP)
-Flexor Pollicis Brevis (MCP)
-Adductor Pollicis (Assists MCP)
-Palmar Interossei (1st, Assists MCP)
Extrinsic muscles of the hand (flexor and extension all digits)
These muscles:
*Originate proximal to the wrist
*Generate greater force
Extrinsic FLEXORS:
*Flexor Carpi Radialis & Ulnaris (assist w/movements like self-feeding, writing)
*Palmaris Longus (object grasp)
Flexor Digitorum Superficialis (flexes MCP/PIP; grasp & pinch)
Flexor Digitorum Profundus (flexes MCP/PIP/DIP; grasp & pinch)
Flexor Pollicis Longus (flexes thumb joints)
*Last 3 muscles on this list (with the median nerve) all pass through the carpal tunnel
Extrinsic EXTENSORS:
*Extensor Carpi Radialis Longus & Brevis (assists w/motions like painting a wall)
*Extensor Carpi Ulnaris (assists w/ hammering/playing violin)
*Extensor Digitorum (swiping up on a smartphone)
*Extensor Indicis (pointing at something)
*Extensor Digiti Minimi (pointing with pinky)
*Abductor Pollicis Longus (texting)
*Extensor Pollicis Brevis (giving a thumbs up)
*Extensor Pollicis Longus (giving a thumbs up)
Intrinsic muscles of the hand actions. Relationship with each other and with extrinsic
These muscles:
*Contained entirely within the hand
*Precise control
Intrinsic:
*Thenar Muscles:
-Abductor Pollicis Brevis (abducts thumb)
-Flexor Pollicis Brevis (flexes thumb)
-Opponens Pollicis (brings the thumb back to origin)
*They help each other with the movement of the thumb
*Hypothenar Muscles:
-Abductor Digiti Minimi (abducts pinky)
-Flexor Digiti Minimi (flexes pinky)
-Opponens Digiti Minimi (brings the pinky back to origin)
*They help each other with the movement of the pinky
*Together the THENAR and HYPOTHENAR MUSCLES open and close the palm.
*Palmar Interossei
-Adducts digits toward middle finger
-MCP flexion w/ PIP/DIP extension
-Ex: Holding a book/sandwich
*Dorsal Interossei
-Abduct digits
-Ex: Cutting with scissors
*Adductor Pollicis
-Adducts thumb toward the hand
-Ex: Brushing hair, turning key, swiping a credit card (lateral pinch)
*Lumbricals
-Balances flexion/extension force within fingers
-MCP flexion w/ PIP/DIP extension
-Ex: Holding a book/sandwich
Total Arc Of Motion:
Extension/Flexion measurements-
MCP +10/100
PIP -50/100
DIP 0/50
Total active motion breakdown:
100+100+50= 250
250+10= 260
260-50= 210
TAM= 210
TAM Norm: 260
*There is no plus or minus with palmar of radial abduction
*If something is expected to be “0” and they don’t make it to “0” it is a deficit (-)
*Applies for all of the following:
-DIP
-PIP
-MCP
-Elbow
Hand grasps and pinch patterns
GRASP PATTERNS:
Cylindrical: Holding a bottle
Spherical: Holding s stress ball
Hook: Holding a briefcase
Composite: Griping a bat
PINCH PATTERNS:
Tip: Index finger & thumb; pinching a coin
Lateral: Turning a key
Tripod: Holding a cookie
Closed packed position of MCPs
The intrinsic plus position (MCP joints flexed and IP joints extended)
Extensor mechanism and the function of each component including origin and insertion, innervation, action.
*Extension of the MCP, DIP, & PIP all occur with a combination of the extensor digitorum, extensor indicis, extensor digiti minimi, as well as the palmar/dorsal interossei, and lumbricals.
*Extrinsics and intrinsics coming together to make extension smoother
- The extensor tendon travels along the metacarpal past the MCP joint and splits into 3 parts
- The extensor digitorum goes along distally to join the intrinsics while the central terminates on the middle phalanx
- The palmar/dorsasl interossei run on the lateral sides of the bone and when they cross over the MCP they give a few fibers to join the middle extensor digitorum while the rest move laterally.
- The lumbricals join in further distally but by the time the interossei gives fiber the lumbricals have joined.
- The area where the digitorum and interossei terminates is called the central slip and is responsible for extending the PIP joint.
- The sagittal band keeps the extensor tendon in place. Starts underneath the MCP joint and terminates at the distal phalanx.
- Lateral bands create a terminal tendon at the distal phalanx and are held in place by the triangular ligament.
- Oblique retinacular ligament connects the DIP and PIP joint allowing them to extent together as a main function.
Digital Pulley System
Fishing pole pulley analogy:
Bone = fishing pole
Tendon = fishing line
Pulleys = loops on the rod
Meanings:
Anuular = “go around”
Cruciate = “cross over (x shaped)
Of the 5 annular pulleys, the odd numbers are on a joint (A1 proximal)
A1 Head of metacarpal or MCP joint
A3 PIP joint
A5 DIP joint
A1 indicated in a trigger finger
A2 is the most important pulley; if this pulley is damaged you will not have the
mechanical advantage to flex your fingers. Can be repaired but it can be tricky.
Cruciate are between:
-A2 & A3
-A3 & A4
-A4 &A5
Extrinsic/Intrinsic Relationship
Tenodesis
Tendon Active/Passive Insufficiency
-Extrinsics and intrinsics coming together to make extension smoother.
-Tenodesis (Wrist extension that produces passive finger flexion). Functional grip for individuals with paralysis of finger flexors. (ex: spinal cord injury level C6)
-Active & passive insufficiency refers to the lack of extra movement in the hand due to the tendons reaching their maximum stretch capacity. (ex. not being able to make a tight fist when the wrist is in flexion {volar aspect is active, dorsal is passive insufficiency)
Hyperthenar muscles related to opposition and hand function
*Works with the thenar muscle group to provide and increased span of grasp for large objects as well as opening and closing the palm.
-Abductor digiti minimi: abducts the pinky
-Flexor digiti minimi: flexes the pinky
-Opponens digiti minimi: opposes the thumb
Vascular Supply
Arterial supply:
Axillary artery-> Brachial artery ->splits into Radial & Ulnar arteries
-The brachial artery courses distally along the medial arm and dives below the lacterus fibrosis at the antecubital fossa. From there it splits into the radial & ulnar arteries.
-The ulnar artery supplies 60% of the blood flow to the hand, making it the primary contributor.
-There is a superficial and a deep arterial arch, with the radial artery supplying the deep arch.
-The digital arteries travel distally along the radial and ulnar edges of each digit, along with the digital nerves.
-Nerves and arteries are best friends.
Venous supply:
-Median vein has an “M” shape that connects it to the median cubital vein to get it to the cephalic vein.
-Radial & Ulnar connect to the “M” which moved the blood to the bigger veins whaich are the cephalic & basilic vein.
Hand Landmarks & Arches
PALMAR ARCHES
-Allow palm to fold inward
-Enhance object manipulation
*Distal transverse arch: line from 2nd MCP to 5th MCP
*Proximal transverse arch: line from thumb to 5th metacarpal
*Longitudinal arch: line from finger tips to wrist
FRACTIONATION
-Independent motion of the fingers
The “normal” resting position of the hand and why it is important to maintain
The hand, when in at rest, forms a hollow at the palm, with the fingers flexed and the thumb in slight opposition. There are three distinct arches, longitudinal, oblique and transverse, that are formed by the bones, ligaments and tendons these are of vital importance when gripping and manipulating objects.
Skeletal Structures of Wrist: DU
Distal Ulna
Bony landmark:
Ulnar styloid
Skeletal Structures of Wrist: DR
Distal Radius
Bony landmark:
* Radial styloid
* Lister’s tubercle: is a small and rounded structure found on the dorsal distal radius that works as a pulley for extensor pollicis longus tendon.
Skeletal Structures of Wrist: C
Carpals
Carpal bones and landmarks:
a. Proximal carpal row:
* Scaphoid -> STRAIGHT
(Scaphoid tubercle)
* Lunate -> LINE
* Triquetrum -> TO
* Pisiform -> PINKY
b. Distal carpal row:
* Hamate -> HERE
(Has a “beak” like projection forming a tunnel called Geon’s canal which protects the ulnar nerve.)
* Capitate -> COMES
* Trapezoid -> THE
* Trapezium -> THUMB
(Trapezium tubercle)
Distal Radioulnar Joint
-Structural classification: Pivot
-Functional classification: Uniaxial
-Movements: Pronation, supination
-Support ligaments:
-Volar radioulnar
-Dorsal radioulnar
Radiocarpal Joint
-Structural classification: Ellipsoid
-Functional classification: Biaxial
-Movements: Flexion, extension, radial, & ulnar deviation
*Primary articulation between distal forearm and proximal carpal
bones.
Joint structures of the wrist (TFCC)
STABILIZES THE ULNA
Triangular Fibrocartilage Complex:
-Cushion between distal ulna and carpals
-Stability on ulnar side of wrist
TFCC made up of:
-Dorsal radiocarpal ligament
-Ulnar collateral ligament
-Dorsal radioulnar ligament
-Triangular fibrocartilage disc (shock absorber)
*These ligaments are what crate stability for the entire wrist for grasp movements.
Extrinsic ligaments: Connects carpals to radius or ulna
Intrinsic ligaments: Connects carpals to carpals
*The wrist has a lot of ligaments that give stability to the entire hand but also contain a lot of neurotransmitters that give info to our brain about where our hand is in space.
Wrist muscles & actions: Flexion
-Flexor Carpi Radialis
-Flexor Carpi Ulnaris
-Palmaris Longus
-Flexor Digitorum Superficialis
-Flexor Digitorum Profundus (assists)
-Flexor Pollicis Longus (assists)
Wrist muscles & actions: Extension
-Extensor Carpi Radialis Longus
-Extensor Carpi Radialis Brevis
-Extensor Carpi Ulnaris
-Palmaris Longus
-Extensor Digitorum (assists)
-Extensor Indicis (assists)
Wrist muscles & actions: Radial Deviation
-Extensor Carpi Radialis Longus
-Extensor Carpi Radialis Brevis
-Extensor Pollicis Longus
-Extensor Pollicis Brevis
-Flexor Carpi Radialis
-Abductor Pollicis Longus
Wrist muscles & actions: Ulnar Deviation
-Extensor Carpi Ulnaris
-Flexor Carpi Ulnaris
Wrist muscle that is considered the “workhorse”
Extensor carpi radialis brevis if the workhorse of the wrist because it works no matter the position of the hand.
Extensor retinaculum at the wrist: Compartment 1
PART OF THE SNUFF BOX
2 TENDONS
-Abductor pollicis longus
-Extensor pollicis brevis
Extensor retinaculum at the wrist: Compartment 2
2 TENDONS
-Extensor carpi radialis longus
-Extensor carpi radialis brevis
Extensor retinaculum at the wrist: Compartment 3
PART OF THE SNUFF BOX
1 TENDON
-Extensor pollicis longus
Extensor retinaculum at the wrist: Compartment 4
2 TENDONS
-Extensor digitorum
-Extensor indicis
Extensor retinaculum at the wrist: Compartment 5
1 TENDON
-Extensor digiti minimi
Extensor retinaculum at the wrist: Compartment 6
1 TENDON
-Extensor carpi ulnaris
Structures within the carpal tunnel; all components of the carpal tunnel
Median Nerve: innervates the thumb, index, middle finger, and half of the ring finger and dorsal sides of these fingers up to the PIP
9 TENDONS
-4 tendons of the flexor digitorum superficialis
-4 tendons of the flexor digitorum profundus
-Tendon of the flexor pollicis longus
*Flexor retinaculum is the “roof” of the carpal tunnel
Sections most mobile and normal curve of the spine
LORDOSIS = ANTERIOR
KYPHOSIS = POSTERIOR
Cervical (7) {most mobile – Atlas C1 & Axis C2}: Cervical lordosis
Thoracic (12): Thoracic kyphosis
Lumbar (5) {least mobile}: Lumbar lordosis
Sacral (5): Lumbar kyphosis
Coccygeal (3): part of sacral region
Structures of the vertebral column
Vertebral body:
-Main portion of vertebrae
-Cancellous (spongy) bone
-Absorbs compressive forces
Vertebral arch:
-Formed by pedicles and laminae
-Bony base for processes
Vertebral foramen:
-Opening posterior to vertebral body
-Bony canal for spinal cord
Intervertebral foramen:
-Opening between adjacent vertebrae
-Passage for spinal nerves
Spinous process:
-Projects dorsally and inferiorly
Transverse processes:
-Extend laterally from each side
Superior facets and inferior facets:
-On each side of vertebrae
-Joints between vertebrae
Costal facets:
-Only thoracic vertebrae
-Articular surfaces for ribs
Sacrum:
-Triangular bone
-Beneath 5th lumbar vertebra
-Forms posterior pelvic wall
Foramina:
-Openings on anterior and posterior surfaces
-Passages for spinal nerves
Sacral ala:
-Lateral aspect of superior sacrum
-Articular surface for pelvis
Coccyx:
-Tailbone
-Formed by 3–5 small vertebrae
Annular discs
Intervertebral disc:
-Between vertebral bodies
-Stabilizes and absorbs shock
Annulus fibrosus:
-Fibrous outer ring
Nucleus pulposus:
-Gel-like inner core
Facet joints
§ Zygapophyseal (facet) joint (2)
§ Formed by superior and inferior facets
§ Synovial joints allow small amount of motion at the facet joints
§ The flexed side moves inferiorly and rotates posteriorly
§ The extended side elevates and rotates anteriorly
Other spinal joints
-Interbody joint: connects on vertebral body to the next.
-SI joint is where the sacrum connects with the ilium of the pelvis.
-Anterior superior iliac spine (ASIS)
-Posterior superior iliac spine (PSIS)
Erector Spinae Group
- Iiliocostalis
- Longissimus
- Spinalis
Spinal ligaments
-Anterior longitudinal ligament: runs along the anterior side of the vertebral column.
-Posterior longitudinal ligament: in the vertebral foramen, running along the posterior side of the vertebral column.
-Ligamentum flavum: faces the posterior longitudinal ligament.
-Intertransverse ligaments: in between the transverse processes
-Interspinous ligaments: between the spinous processes
Purpose of posture assessment
Assess the clients alignment (biomechanics), determined the area that is effecting function.
How to perform posture assessment
Must check anterior, lateral, and posterior
Check to see that all areas are aligned:
-Eyes
-Ears
-Shoulder
-Scapula
-Pelvis
-Knees
-Ankles
Laterally, create an invisible line to see what does/doesn’t align.
