Lecture 10 - Wrist/hand Flashcards
Movements at the wrist (7)
Distal radioulnar
Radiocarpal
Intercarpal
Midcarpal
Carpometacarpal
Metacarpalphalangeal
Interphalangeal
Type of joint for distal radioulnar
Uniaxial pivot joint
Distal radioulnar joint - resting position/close packed position/capsular pattern
R.p = 10d of supination
Close p = 5d of supination
Cp = full ROM, pain at extremes of rotation
Type of joint for radiocarpal
Biaxial ellipsoid joint
Radiocarpal joint - resting position/close packed/capsular pattern
RP = neutral with slight ulnar deviation
Close packed = extension with radial deviation
Cap p = flexion and extension limited equally
Carpals - truc pour se rappeler de l’ordre
Please Tell Little Suzie Tucker To Come Home
What is TFCC
Triangular fibrocartilage complex
MOI of TFCC
Compression of the ulnar side and rotation OR excessive radial deviation stretching the TFCC (ex: from swinging a hammer)
Normal functional hand movements
40d flexion
40d extension
15d radial deviation
20d ulnar deviation
4 types of sympathetic changes in nails in observation
- Vasomotor
- Sudomotor
- Pilomotor
- Trophic
List the common hand/wrist deformities
- Benediction hand
- Drop wrist
- Beau’s line
- Mallet finger
- Bouchard’s nodes
- Heberden’s nodes
- Osteoarthritis
- Swan neck deformity
- Boutonniere deformity
- Ulnar drift
- Clubbing
- Ganglion or small cyst swelling
What’s Benediction hand deformity?
Hyperextension of the metacarpophalangeal joint and flexion of the interphalangeal joints
What is ulnar drift?
Results in ulnar deviation of the digits
What is swan neck deformity?
Extension of the proximal interphalangeal joint
What is mallet finger?
Rupture or avulsion of the extensor tendon -> flexion of the distal phalanx consistent
What is Boutonniere deformity?
Extension or the metacarpophalangeal and distal interphalangeal and flexion of proximal interphalangeal joint.
What position you put the wrist for RROM
Neutral at hand/wrist
Mvts of functional wrist/hand scan (5)
- Standard fist
- Hook grasp fist
- Straight fist
- Pulp-to-pulp pinch
- Tip-to-tip pinch
For wrist sagittal plane, most of the motion for extension comes from (66,5%)?
Radiocarpal
How to measure the wrist in frontal plane (ulnar vs radial dev)?
Angle between radius and the third metacarpal
Functional ability - ___ from index and middle
Power
Functional ability - ____ from middle and little
Dexterity
3 tests for precision
3 finger pinch
Lateral pinch
Tip pinch
4 tests for grip (see p.514)
Hook
Fist
Cylindrical
Spherical
What is the functional position of the wrist?
“Position of rest”
Wrist extension 20-35d
Ulnar deviation 10-15d
Functional position plus (wrist immobilization)
- More wrist extension
- More MP flexion
- IP extended
- Potential for contracture is kept to a minimum
What is the ulnomeniscotriquetral dorsal glide test?
Dorsal glide of pisotriquetral complex
-> + for TFCC
looking for excessive laxity
condition where there is a compression of the median n.
Carpal tunnel syndrome
Sx of carpal tunnel syndrome
Inc P at night
Numbness and tingling
Weakness and atrophy in LOAF
What is the LOAF muscles
Lumbricals
Opponens pollicis
ABD/Flex pollicis brevis
What is the double crush syndrome?
Compression of the nerve that happens somewhere else along the root where the first compression occurs, because of compensation
Condition where there is compression of the ulnar n.
Guyon’s canal syndrome
Guyon’s canal syndrome - Type 1
Affects sensory and motor
Palmar sensory loss
Flex carpi uln & flex. digi spared
Guyon’s canal syndrome - type 2
Only motor affected
Interossei and add. pollicis
Guyon’s canal syndrome - Type 3
Distal end of guyon’s canal
Purely sensory (palmar superficial sensory branches)
