Lec. 3: Kin of the H Flashcards
CPP, Cap. pattern, and Typical dislocation of CMC jts
CPP:
-thumb: full opposition
-digits: full FLEX
Cap. pattern:
-thumb: ABD>EXT
-digits: all motions equally
Typical dislocation: uncommon, carpal dislocation or metacarpal fracture
arthrokinematics of the 1st CMC jt
FLEX/EXT: Concave base of 1st MC moving on convex distal trapezium. Roll and glide same direction of moving bony lever
ABD/ADD: Convex base of 1st MC moving on concave distal trapezium. Roll and glide opposite direction of moving bony lever
an ANT concavity formed by the DIST row of carpals
carpal arch OR PROX transverse arch
T or F: ADD/ABD only occurs at CMC jts of digits 1 and 5
T
the _____ ______ arch is formed by the mobile 1st, 4th and 5th CMC jts moving about the stable 2nd and 3rd jts which augments the ____ ____ arch and allows for more palmar surface area when grasping and holding objects
mobile transverse, fixed transverse (carpal arch)
the mobile transverse arch is an ____ arch formed at the _____ ends of the ____
ANT, DIST, metacarpals
CPP, Cap. pattern, and Typical dislocation of the MCP jts
CPP:
-thumb: full opposition
-digits: full FLEX
Cap. pattern: FLEX>EXT
Typical dislocation: PROX phalanx moves posterosuperior, 2nd and 5th digits are most commonly dislocated
CPP, Cap. pattern, and Typical dislocation of IP jts
CPP: full EXT
Cap. pattern: FLEX>EXT Typical dislocation: POST displacement of phalanx
arthrokinematics of IP jts
Concave base of distal phalanx moves on convex head of proximal phalanx
Thus roll and glide in same direction
arthrokinematics of 5th CMC jt
FLEX/EXT: Concave 5th Metacarpal moving on convex articular surface of hamate. Thus roll & glide in the same direction.
ABD/ADD: Convex base of the 5th MC moving on concave articular surface of hamate. Thus roll & glide in the opposite direction
arthrokinematics of 1st and 5th CMC are the same T or F
T, but planes and axes are different
arthrokinematics of MCP jts
Concave base of proximal phalanx moves on convex head of MC; therefore roll & glide in same direction as moving bony lever
when flexing the digits FDS and FDP require synergistic action from ____ or ____ to avoid simultaneous wrist FLEX and therefore active insufficiency
ED and ECRB
optimal action at the thumb requires synergistic action of the wrist and thumb extensors or flexors b/c both ____ and ____ demonstrate _____ ______ with simultaneous wrist FLEX, or wrist, CMC and MCP extension
FPL and EPL, active insufficiency
EPB and APL both require synergistic activity from___ _____ to avoid Rad Dev during thumb mvts
Uln Deviators
activities of the hand involving grasping or taking hold of an object b/w any two surfaces in the hand; thumb may or may not participate
prehension
3 examples of power grip
cylindrical, spherical, and hook grip
Fingers and thumb grasp an object with the objective of manipulating it within the hand. Thumb always involved, palm not.
precision handling
examples of precision handling
pad to pad, tip to tip and pad to side
5 presentations of peripheral nerve lesions in the wrist and H
Claw H
Drop wrist
Ape H
Bishop’s H
Boutenniere deformity
Presentation and lesion with claw hand
Presentation: hyperext of MCPs and FLEX of IPs
Lesion: ulnar nerve palsy
Loss of function and unopposed activity w/ claw hand
Loss of function of: lumbricals of digits 4 and 5, all palmar and dorsal interossei,
if due to cubital tunnel entrapment, then loss of FCU and MED portion of FDP
Unopposed activity:
-hyperext of MCPs d/t ED
-hyperflex of PIPs and DIPs d/t FDS and FDP
Presentation and lesion with drop wrist
Presentation: lack of EXT at radiocarpal jt and MCP jts
Lesion: radial n palsy
Loss of function and unopposed activity w/ drop wrist
Loss of function: ED, ECRL, ECRB, ECU, EDM, EI, EPL, EPB, APL
Unopposed activity:
-hyperflex of radiocarpal jt due to overactivity of FDS, FDP and FCR
-some PIP and DIP EXT still possible as lumbricals are innervated by the median and ulnar nerve, and the dorsal and palmar interossei are innervated by the deep ulnar n
Presentation and lesion with Ape H
Presentation: wasting of thenar eminence, EXT at the MCP jts, slight FLEX at the PIPs and DIPs
Lesion: median n palsy
Loss of function and unopposed activity w/ Ape H
Loss of function: intrinsic thenar mms (excluding adductor pollicis), lumbricals of digits 2 and 3, superficial, intermediate and deep forearm flexors (excluding FCU and MED half of FDP)
Unopposed activity of: all extensors (radial nerve innervation) and dorsal and palmar interossei
Presentation and lesion with Bishop’s H
Presentation: FLEX of the 4th and 5th digits with simultaneous EXT of 1st, 2nd, and 3rd when trying to move all fingers into full EXT
Lesion: ulnar n palsy
Loss of func. and unopposed activity with Bishop’s H
Loss of func.: hypothenar group, lumbricals of digits 4 and 5, and dorsal and palmar interossei
Unopposed activity of: FDS and FDP (causing unwanted PIP and DIP FLEX)
Presentation and pathophysiology of Boutenniere deformity
Presentation: hyperext of MCP and DIP jts w/ FLEX of the PIP jt
Pathophysiology:
-may occur w/ trauma to the affected tendon (laceration)
-occurs secondary to jt effusion (swollen jt) and RA
-may affect any number of digits
