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DPT 702: Biomechanics > Lecture 14: Wrist osteology and Arthrology Final > Flashcards

Lecture 14: Wrist osteology and Arthrology Final Flashcards

1
Q

where is listers tubercle

A

dorsal radius

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2
Q

describe the distal articular surface of the radius

A

concave in both M-L and A-P with facets in the articular surface

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3
Q

what are the 2 important biomechanical configurations of the wrist

A

distal end of the radius is 25 deg toward ulna = “ulna tilt”; allows more ulnar dev than radial

palmar tilt = 10 deg allows more flexion than ext of wrist

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4
Q

describe the carpals

A

proximal row = scaphoid, lunate, triquetrum, and pisiform; loosely joined

distal row = trapezium, trapezoid, capitate, and hamate; tightly bound by ligaments

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5
Q

describe the scaphoid bone

A

looks like a boat

associated with both carpal rows

undersurface rides on radius

75% is lined with articular cartilahe

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6
Q

cargo area of the scaphoid holds what

A

head of capitate

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7
Q

scaphoid has synovial joints with how many other carpals

A

4

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8
Q

describe teh 2 poles of the scaphoid

A

2 convex poles

proximal articulates with radius; distal with trapezium and trapezoid

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9
Q

small concavity on scaphoid holds what

A

lunate

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10
Q

where can you palpate the scaphoid tubercle

A

thenar musculature

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11
Q

most frequent fractured carpal

A

scaphoid

midway between poles

proximal can develop AVN

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12
Q

what is kienbocks disease

A

softening of lunate AVN

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13
Q

describe the lunate

A

moon shaped

central bone in prox row

most unstable carpal due to lack of strong ligaments and no muscle attachments

fits into radius

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14
Q

describe triquetrum

A

triangular bone

most ulnar just distal to ulna

articular facet that accepts pisiform

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15
Q

describe pisiform

A

pea shaped

loose articulation with triquetrum

movable/palpable

embedded in FCU tendon

acts as sesamoid

attachment for abd digiti minimi and transverse carpal ligament

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16
Q

describe capitate

A

largets/central; means head

articulates with 7 bones

articulates with concavity of scaphoid and lunate

well stabilized by stong/short ligaments

joined to 2-4 metacarpal

provides longitudinal stability

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17
Q

describe trapezium

A

asymmetrical

concave at scaphoid

distal saddle like surface

tubercle = attachment for trans carpal lig

FCR groove

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18
Q

describe trapezoid

A

small

wedged between capitate and trapezium

firm attachment to 2nd metacarpal

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19
Q

describe hamate

A

large hooklike process

4th and 5th metacarpals

functional mobility “cupped hand”

attachment for trans carpal lig

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20
Q

what is carpal tunnel

A

thick fibrous band of connective tissue = trans carpal lig

connected on 4 raised points

attachment site for many intrinsic muscles in the hand and palmaris longus

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21
Q

what 4 raised points is the carpal tunnel attached to

A

pisiform

hook of hamate

tubercles of scaphoid and trapezium

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22
Q

what is the joint structure of the radiocarpal joint

A

concave radius and disc and convex scaphoid and lunate

triquetrum contacts with ulnar dev

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23
Q

when is there greatest contact at the radiocarpal joint

A

at slight ext and ulnar dev

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24
Q

how much force is present at the disc of the radiocarpal joint

A

20% compressive force

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25
Q

joint structure of mid carpal joints

A

between proximal and distal rows

continuous capsule

lateral and medial compartmetns; more movement in medial

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26
Q

how many intercapral joints

A

13

small gliding and rotatory motions

ligaments help disipate force

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27
Q

importance of ligaments of wrist

A

essential to maintain carpal alignment and transfer forces

stretched ligaments hold muscle produced energy and help with arthrokinematics

mechanoreceptors in ligaments; especially dorsal

28
Q

describe the fibrous capsule of the hand/wrist

A

surrounds wrist and distal radioulnar joint

ligaments embedded in capsule

29
Q

describe what you might see where the TFCC is on a radiograph

A

looks like empty space

30
Q

osteokinematics of the wrist

A

2 degrees of freedom

flx/ext

radial/ulnar dev

31
Q

what is wrist circumduction

A

combo of movements; not a 3rd degree of freedom

32
Q

where is the axis of the wrist

A

through head of capitate

M-L axis for flexion and extension

A-P for radial/ulnar dev

axis migrates through ROM

Rt of capitate directes osteokinematics of the whole hand

33
Q

movement of wrist in sagittal plane

A

130-160 total

flexion = 0-70/85

ext = 0-60/75

greater than normal palmar tilt of radius may limit ext

34
Q

movements of wrist in frontal plane

A

50-60 total

ulnar dev = 0-35/40

radial dev = 0-15/20

35
Q

ROM required for ADLs

A

40 deg flexion and extension in each direction

10 deg radial dev

30 deg ulnar dev

36
Q

position of function of wrist

A

10-15 degree of ext

10 deg ulnar dev

37
Q

what movements naturally occur with radial and ulnar dev

A

extension naturally occurs with radial dev

flexion naturally occurs with ulnar

38
Q

arthrokinematics of wrist ext

A

convex lunate rolls dorsally (distal surface) and slides in a palmar direction

head of capitate rolls dorsally on lunate and slides in palmar direction

combination of both

39
Q

closed packed position of wrist

A

full extension

40
Q

arthrokinematics of wrist flexion

A

convex lunate rolls palmarly and slides dorsally

head of capitate rolls palmarly on lunate and slides in dorsal direction

41
Q

arthrokinematics of ulnar deviation

A

metacarpal more than radiocarpal

RC: scaphoid, lunate, and triquetrum roll in ulnar direction and slide radially

42
Q

radial deviation arthrokinematics

A

roll radially and slide ulnarly

carpals run into radius

80% mvmt at MC joint

43
Q

what is carpal instability

A

excessive mobility between carpals

usually laxity/ruptured lig

can be static or dynamic

44
Q

describe rotational collapse of the wrist

A

mechanically proximal carpals are a row of mobile bone between 2 relatively rigid segments

may collapse due to compression

lunate is most frequently dislocated carpal bone

45
Q

radial n supplies what

A

all muscles that cross dorsal side of wrist

ECRB, ECRL, ECU

46
Q

median and ulnar nn supply what

A

all muscles that cross the palmar side of the wrist

median = FCR, PL

ulnar = FCU

47
Q

sensory innervations of wrist joint

A

RC and MC = C6 and C7

MC = C8

48
Q

primary wrist extensors

A

act only on wrist

extensor carpi radialis longus and brevis

extensor carpi ulnaris

49
Q

secondary wrist flexors

A

act on wrist and hand

extensor digitorum

extensor indicis

extensor digiti minimi

extensor pollicis longus

50
Q

what structure secures extensor tendons into place

A

extensor retinaculum

prevents bowstringing up

51
Q

how many fibro-osseus compartments are in the wrist/hand

A

6

can develop tenosynovitis

52
Q

what compartment does de quervains tenosynovitis occur

A

in compartment I

pressing on power tools, gripping, or wringing out clothes

53
Q

each muscles moment arm for a particular action is equal to what

A

perpendicular distance between the particular axis and the position of the muscles tendon

54
Q

describe the muscle mechanics involved with producing a string grip

A

contraction of extrinsic finger flexors = flexion of fingers and creates wrist flexion torque

activation of wrist extensors = block wrist flexion caused by activated flexors

wrist extensors maintain optimal length of finger flexors to effectively flex fingers

55
Q

when does maximal grip force occur

A

about 30 deg extension

56
Q

sxs of lateral epicondylitis

A

painful/weak grip

pain with passive wrist flexion and pronation

tender over lateral epicondyle

can see degeneration/inflammation

57
Q

what happens with lateral epicondylistis

A

light grasp ECRB

force increases with ECR and ECRL

58
Q

primary wrist flexors

A

flexor carpi ulnaris and radialis

palmaris longus (absent in 15%)

palmar carpal ligament stabilizes/prevents bowstringing

59
Q

secondary flexors of the wrist

A

flexor digitorum profundus and superficialis

flexor pollicis longus

abductor pollicis longus

extensor pollicis longus

60
Q

what muscle provides the greatest wrist flexion torque of all 3 flexors

A

FCU

61
Q

what muscles work together as synergists opposing deviations

A

FCU and FCR

62
Q

force comparison between wrist flexors and extensors

A

wrist flexors are able to produce at 70% greater isometric torque than extensors

63
Q

peak wrist flexion torque is when

A

at 40 deg flex

64
Q

peak wrist ext torque is when

A

30-70 deg of ext

65
Q

muscles that radially deviate

A

Extensor carpi radialis loggus and brevis

Extensor pollicis longus and brevis

abductor pollicis longus

flexor pollicis longus

radial deviators are greater than ulnar by 15%

66
Q

muscles that ulnarly deviate

A

extensor carpi ulnaris

flexor carpi ulnaris

flexor digitorum profundus and superficialis

extensor digitorum

DPT 702: Biomechanics (13 decks)

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