Lecture 12, Wrist and Hand

Question 1

The wrist has both ____ and ______ segments

Answer 1

fixed/stable
mobile

Question 2

Fixed segment consists of

Answer 2

distal row of carpal bones
2nd and 3rd MC

Question 3

Why is having fixed and mobile segments important?

Answer 3

stability without rigidity
enables the hand to move more discretely
enhances function of digits

Question 4

Mobile segment makeup

Answer 4

5 phalanges
1st, 4th, 5th MC

Question 5

Contributions of arches

Answer 5

enable hand to grasp objeects
direct motor skill of fingers and control power of grasp
intrinsic muscles maintain arches

Question 6

Proximal transverse arch

Answer 6

at distal row of carpals. rigid, very little movement

Question 7

Distal transverse arch

Answer 7

heads of MC, mobile, allows the palm to flatten & cup

Question 8

Longitudinal arch

Answer 8

rigid proximally @ CMC and mobile distally for fingers

Question 9

Conjunct rotation

Answer 9

can be tested by folding and fanning the hand

Question 10

Tenodesis

Answer 10

passive changes in finger posture

passive finger exntesion occurs when wrist is flexed
finger flexion occurs when wrist is extended

Question 11

Wrist tenodesis reflects _____ length tension relationships

Answer 11

passive

Question 12

Active extensor mechanism

Answer 12

stabilization during grip

As the fingers and thumb flex, wrist extensors stabilize the wrist to prevent flexor digitorum superficialis from flexing wrist at the same time

Question 13

Active flexor mechanism

Answer 13

stabilization during release of grip

During finger and thumb extension, wrist flexors stabilize so that EDC, ext indicus & others can function more efficiently

Question 14

Key features of thumb

Answer 14

60% of hand function
mobility and force

Question 15

Index finger features

Answer 15

strength and its interaction with thumb
loss = pinch and power grip

Question 16

Middle finger

Answer 16

strongest in flexion
important for precision and power grips

Question 17

Ring finger

Answer 17

least functional role in hand

Question 18

Little finger

Answer 18

enhances power grips, holds objects, affects capacity of hand

Question 19

Power grip types

Answer 19

hook
cylinder
fist
spherical

Question 20

What is a power grip?

Answer 20

clamping object against palm of hand w/partially flexed fingers and adducted thumb

isometric muscle action, fingers are flexed, ER, ulnar deviation

Question 21

Precision patterns

Answer 21

involve manipulating object that is not in contact with palm
fingers and thumb work in opposition to hold object
input from sensory surfaces, help with fine adjustments
small objects are manipulated btwn index and thumb

Question 22

Types of precision patterns

Answer 22

pap to pad (holding pencil)
tip to tip (pinch)
pad to lateral prehension (keys)

Question 23

Combined grips

Answer 23

include pinch where index or middle and thumb hold isometrically and 3-5 supplement with power

Question 24

What structural and functional impairments would you expect to see related to finger joint hypomobility?

Answer 24

decreased ROM
weakness
adherent tendon sheath
effusion

Question 25

What would you expect to detect with PROM?

Answer 25

hard end feel, pain with overpressure caused by tendon adhesion from inflammation

Question 26

What would you expect to detect with RROM?

Answer 26

decreased muscle performance

Question 27

OA and post-trauma arthrosis

Answer 27

OA most commonly involves CMC of thumb, DIPs trauma can occur at any joint PIP joint common articular fracture site resulting in degeneration be mindful of fractures that might not appear on x-ray

Question 28

Ulnar drift

Answer 28

rupture of collateral ligaments at MCP resulting bowstringing of tendons caused by subluxation of proximal phalanges

Question 29

Swan neck deformity

Answer 29

hyperextension of PIP and flexion of DIP

Question 30

Boutonniere deformity

Answer 30

PIP flexion and DIP extension

Question 31

Z deformity of thumb

Answer 31

MCP dislocation of thumb with swan or boutonniere deformity

Question 32

What is the diagnostic gold standard for RA?

Answer 32

lab tests for inflammatory markers medical treatment to slow deformity Work with CHT to provide splinting for joint protection

Question 33

Acute stage of Finger hypomobility

Answer 33

control pain and protect joints patient education (joint protection) pain management (gd 1 distractions) splinting conserve energy (w/RA)

Question 34

Goals of acute phase

Answer 34

maintain joint and tendon mobility and muscle integrity

Question 35

Interventions for finger hypomobility, post trauma

Answer 35

passive, assistive, active ROM tendon-gliding exercises to prevent adhesions multiple angle muscle setting exercises

Question 36

Return to function phases interventions

Answer 36

increase joint play and accessory motions --> joint mob improve joint tracking and pain free motion --> MWM, tendon blocking progressive strengthening --> putty, rubber bands

Question 37

Zone 2

Answer 37

FDP and FDS share the same tendon sheath up to this point