Hand & Wrist Flashcards
What are the bones of the hand & wrist?
Radius
Ulna
Carpals
Metacarpals 1-5
Phalanges (proximal, middle-except thumb, distal)
Which bone has 60-80% of wrist motion occurring at it?
Radius
What are bony landmarks of the dorsal wrist?
- Anatomical snuffbox
- Scaphoid distal pole
- Triscaphe joint
- Scapholunate joint
- Lister’s tubercle
What 3 joints are at the wrist?
Radiocarpal
Ulnocarpal
Distal Radioulnar
What are the joints of the hand at each finger?
Metacarpophalangeal (MCP)
Proximal Interphalangeal (PIP)
Distal Interphalangeal (DIP)
What bones make up the radiocarpal joint?
Radius
Scaphoid
Triquetrium
What bones make up the Ulnocarpal joint?
Ulna
Triquetrium
What bones form the distal Radioulnar joint?
Triangular Fibrocartilage (disc that overlays the ulnar head between the Triquetrium, Lunate, & Ulnar head)
What is the carpi metacarpal joint?
Its where the carpals & metacarpals meet
Are the MCP, PIP, & DIP surrounded by a joint capsule?
Yes
What is the MCP and PIP reinforced by?
Collateral ligaments & a Condyloid joint
What is Hulten’s variance?
The relationship between length of ulna & radius
What does ulnar variance affect?
It changes the loads borne by the ulna
What is a positive ulnar variance?
The ulna extends >/= 1mm beyond the radius
What is neutral ulnar variance?
The lengths of the ulna and radius differ < 1mm
What is negative ulnar variance?
The ulnar is shorter >/= 1mm than the radius
What are the 4 proximal carpal bones?
Scaphoid
Lunate
Triquetrium
Pisiform
What are the 4 distal carpals?
Trapezium
Trapezoid
Capitate
Hamate
What is the hook of the hamate called?
Hamulus
What type of bone is pisiform?
Sesamoid bone (it’s free floating, only insertion is FCU)
Which bone is the keystone of the carpal bone arch?
Capitate- it is the largest & most central bone
What tunnel is between the pisiform & the hook of the hamate?
The tunnel of Guyon
What is normal wrist joint extension?
0-70 degrees
What is normal wrist joint Flexion?
0-80 degrees
What is normal wrist joint radial deviation?
0-20 degrees
What is normal wrist joint ulnar deviation?
0-30 degrees
What is the place of function of the wrist (best place for finger Flexion)?
20-35 degrees extension & 10-15 degrees of ulnar deviation
What is the triangular fibrocartilaginous disk?
It is a disk that cover the ulna and acts as a cushion (like meniscus) between it and the carpals
What are the arches of the hand?
Longitudinal
Carpal transverse
Metacarpal transverse
What are the ligaments of the wrist?
Intercarpal ligaments
Flexor retinaculum (transverse carpal ligament)
Palmar carpal ligament (volar carpal ligament)
Extensor retinaculum
What is the carpal tunnel?
Area of the wrist that the median nerve & the flexor tendons pass through underneath the flexor retinaculum
What makes up the floor of the carpal tunnel?
The proximal & distal carpal rows
What makes up the ulnar border of the carpal tunnel?
The pisiform & hook of the hamate
What makes up the radial border of carpal tunnel?
The scaphoid & greater multangular
How many wrist tunnels are there?
8 (6 dorsal, 2 volar)
What structures are included in tunnel 1 or the medial snuffbox?
Abductor pollicis longus
Extensor pollicis brevis
What structures are included in tunnel 2?
Extensor carpi radialis brevis
Extensor carpi radialis longus
What structures are included in tunnel 3 or the lateral snuffbox?
Extensor pollicis longus
What structures are included in tunnel 4?
Extensor digitorum communi
Extensor indicis
What structures are included in tunnel 5?
Extensor digiti minimi
What structures are included in tunnel 6?
Extensor carpi ulnaris
What artery passes through the anatomical snuffbox?
Radial artery
What structures run within the carpal tunnel on the volar surface (wrist tunnel 7)?
Flexor digitorum profundus
Flexor digitorum superficialis
Median nerve
Flexor pollicis longus
What structures run outside the carpal tunnel on the volar surface (wrist tunnel 8)?
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Ulnar nerve
Do we need to make sure our wrist tendons have excursion (movement)?
Yes
What passes through the tunnel of guyon?
Ulnar nerve
What is the floor of the anatomical snuff box?
Scaphoid
What make up the borders of the anatomical snuff box?
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
What does the attitude of the hand help with?
- Facilitates venous & lymphatic drainage
- Minimizes restraining action (excursion) of the extrinsic tendons, allowing full flexion & extension of the fingers
What is the attitude of the hand?
At rest, the MCP, PIP, & DIP joints are in slight flexion
What constitutes the palm of the hand?
Fibrous fasciculi anchor skin to the palm, permitting very little sliding of the skin
What constitutes the dorsal surface of the hand?
Loose areolar tissue anchors the skin on the dorsal surface, allowing for skin to move freely, lymphatic system
What are skin creases?
- Indicate lines of adherence between skin & fascia with no intervening adipose tissue
- serve to identify important anatomical landmarks
What are the creases of the hand?
Radial longitudinal (thenar crease)
Proximal palmar (transverse crease)
Distal palmar (transverse crease)
What are the creases of the fingers?
Palmar digital
Middle (PIP)
Distal (DIP)
Where is the frontal plane center of axis of hand?
Through the 3rd metacarpal
What is normal Flexion ROM at fingers 2-5 MCP joint?
0-90 degrees
What is normal extension ROM at fingers 2-5 MCP joint?
0-45 degrees
What is normal abduction ROM at fingers 2-5 MCP joint?
0-20 degrees
What is normal adduction ROM at fingers 2-5 MCP joint?
0-20 degrees
What is PIP Joint movement (Flexion)?
0-100 degrees
What is the DIP joint movement (Flexion)?
0-80 degrees
What is normal ROM for thumb MCP joint Flexion?
0-50 degrees
What is normal ROM for thumb MCP joint abduction?
0-70 degrees
What is normal ROM for thumb MCP joint adduction?
0 degrees to 2nd metacarpal
What is zone 1 of the hand?
From DIP to finger tips
What is zone 2 of the hand?
The MCP joint area of the thumb and the top of the palm through the DIP of fingers 2-5
What is zone 3 of the hand?
The top middle of the palm & the middle of the thenar eminence
What is zone 4 of the hand?
The bottom middle of the palm touching the wrist
What is zone 5 of the hand?
The wrist where the flexor retinaculum lays
What 4 structures does each MCP, PIP, & DIP joint have?
- Joint capsule
- Radial collateral ligament
- Ulnar collateral ligament
- Volar (palmar ligament) plate
What do these 3 ligaments collectively form?
They form a “box” around each of the joints
Is the palmar plate distal attachment cartilaginous or membranous?
Cartilaginous
Is the palmar plate proximal attachment cartilaginous or membranous?
Membranous
What are the extrinsic muscles of the hand?
- flexor digitorum superficialis (pip)
- flexor digitorum profundus (dip)
- extensor digitorum communi
Where are the muscle bellies of the hand extrinsic muscles?
In the forearm
What are the intrinsic muscles of the hand?
Dorsal interossei (4)
Volar interossei (3)
Lumbricals
Hypothenar eminence muscles
Thenar eminence muscles
What muscles make up the hypothenar eminence?
- abductor digiti minimi
- flexor digiti minimi brevis
- opponens digiti minimi
What muscles make up the thenar eminence?
- abductor pollicis brevis
- flexor pollicis brevis
- opponents pollicis
Where do the muscle bellies of the hand intrinsic muscles?
In the hand
Do any muscle bellies lie within the finger proper?
No, only tendons
What are the other 4 ligaments of the hand?
- Transverse retinacular ligament
- Oblique retinacular ligament (ligament of landsmere)
- Triangular ligament
- Juncurae tendinum
What are the FDS & FDP muscles encased in for the flexor pulley?
A synovial sheath which is bound to the phalanges by fibrous digital sheaths made up of alternating stronger annular & weaker cruciform parts (A1-A5 & C1-C4)
What does the flexor pulley allow for?
A smooth curve
What are spoon nails?
The nail is indented/concave like a spoon
What are clubbed nails?
What is the opera glove pathology?
Paresthesia going from above the elbow all the way to the finger tips surrounding the arm like an opera glove
What is Swan neck deformity?
A hyperextension of the PIP and a forced Flexion of the DIP
What is boutonnière deformity?
A hyperflexion of the MCP & DIP and a forced Flexion of the PIP
What are claw fingers?
When the fingers are stuck in a claw shape curve
What is trigger finger?
What is bishop’s hand?
What is drop wrist?
What is Z deformity?
What is dupuytren’s contraction?
What is mallet finger?
A rupture or avulsion of the extensor digitorum communi tendon at its attachment site at the base of the fingernail
What is pill rolling?
A neurological pathology where older folks remember the motion of rolling pills from there younger days and do it subconsciously even if they don’t remember other things in their life
What is Volkmann’s contracture?
This can occur after an elbow dislocation or Fx where the radial? Vein becomes occluded so blood is still going into the forearm and hand but can’t be pumped back to the heart and eventually tissue death occcurs