- complex motion between distal an proximal carpals w/ exception of pisiform - joint surfaces reciprocally convex and concave

MSK #11- A&P Wrist and Hand Flashcards by MaryBeth Pierce

ROM Norms: Wrist

Flexion 0-80
Extension 0-70
Radial Deviation 0-20
Ulnar Deviation 0-30

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ROM Norms: Thumb CMC

Abduction 0-70
Flexion 0-15
Extension 0-20
Opposition- tip of thumb to base of 5th digit (BIL comparison?)

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ROM Norms: Thumb MCP

Flexion 0-50

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ROM Norms: Thumb Interphalangeal

flexion 0-80

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ROM Norms: Digits 2-5 MCP

Flexion 0-90

Hyperextension 0-45

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ROM Norms: Digits 2-5 PIP

Flexion 0-100

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ROM Norms: Digits 2-5 DIP

Flexion 0-90

Hyperextension 0-10

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Manual Therapy
Joint: Distal Radioulnar
Resting Position, Concave/Convex, Osteo/arthrokinematics

Resting Position: 10 degrees supination
Concave: radius
Convex: ulna

Osteo/arthrokinematics: same direction

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Manual Therapy
Joint: Radiocarpal
Resting Position, Concave/Convex, Osteo/arthrokinematics

Resting Position: neutral w/ slight ulnar deviation

Concave: radius
Convex: carpals

Osteo/arthrokinematics: opposite directions

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Manual Therapy
Joint: MCP of digits 2-5
Resting Position, Concave/Convex, Osteo/arthrokinematics

Resting Position: slight flexion

Concave: phalanges
Convex: metacarpals

Osteo/arthrokinematics: same direction

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Manual Therapy
Joint: DIP and PIP of digits 2-5
Resting Position, Concave/Convex, Osteo/arthrokinematics

Resting Position: slight flexion

Concave: distal phalanges
Convex: proximal phalanges

Osteo/arthrokinematics: same direction

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Muscles involved w/ wrist flexion

flexor carpi radialis
flexor carpi ulnaris
palmaris longus

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Muscles involved w/ wrist extension

extensor carpi radialis longus
extensor carpi radialis brevis
extensor carpi ulnaris

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Muscles involved w/ radial deviation

extensor carpi radialis
flexor carpi radialis
extensor pollicis longus
extensor pollicis brevis

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Muscles involved w/ ulnar deviation

extensor carpi ulnaris

- flexor carpi ulnaris

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Articulation of the radiocarpal joint

proximal joint surface formed by distal radius and radioulnar disc (connects radius and ulna)
Distal joint surface formed by scaphoid, lunate, and triquetrum
2 degrees of freedom
encased in strong capsule reinforced by numerous ligaments shared w/ midcarpal joint

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Radiocarpal Joint: osteokinematic motions

flexion, extension, radial deviation, ulnar deviation

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Radiocarpal Joint: loose packed and close packed positions

Loose: neutral w/ slight ulnar deviation

Closed: extension w/ radial deviation

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Radiocarpal Joint: Capsular Pattern

flexion and extension equally limited

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Midcarpal joint. Go!

complex motion between distal an proximal carpals w/ exception of pisiform
joint surfaces reciprocally convex and concave

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5 primary ligaments or structures of wrist

dorsal radiocarpal ligament 
palmer radiocarpal ligament
radial collateral ligament
carpal tunnel
interosseous membrane

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Tell me about the dorsal radiocarpal ligament

only major ligament on dorsal surface of hand
originates on posterior surface of distal radius and styloid process of the distal radius
attaches to lunate and triquetrum
limits wrist flexion

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Tell me about the palmer radiocarpal ligament

limits hyper extension of wrist
originates from anterior surface of distal radius
attaches to capitate, triquetrum, and scaphoid

Tell me about the radial collateral ligament

limits ulnar deviation and taut w/ extreme wrist extension/flexion
originates from styloid process of radius
inserts on scaphoid and trapezium

Tell me about the interosseous membrane

- dense band of fibrous connective tissue - runs obliquely from radius to ulna - spans from proximal radioulnar joint to distal radioulnar joint - acts as stabilizer against axial forces applied to wrist

Distal radioulnar joint: loose packed and close packed positions

loose: 10 degrees supination close: 5 degrees supination (that's weird)

CMC: loose packed and close packed positions

loose: midway between flex/ext and add/abduction close: not in book

MCP: loose packed and close packed positions

loose: slight flexion close: full flexion * *full opposition for thumb CMC

Interphalangeal: loose packed and close packed positions

loose: slight flexion close: full extension

Shape of Thumb CMC joint

saddle articulation w/ trapezium being convex in medial/lateral direction and concave in anterior posterior direction

What does the ulnar nerve innervate in the hand

- hypothenar region (volar and dorsal) - 5th digit - medial half of 4th digit

What does the median nerve innervate in the hand

- remainder of palmer surface not innervated by ulnar nerve | - dorsal portions of 2nd, 3rd, and lateral half of 4th digit from DIP to tip of finger

What does the radial nerve innervate in the hand

- remainder of dorsum not innervated by ulnar and median

Flexor digitorum (ulnar portion)

Action: 4th and 5th digit DIP flexion Cord Segment: C7-T1 Nerve: Ulnar Profundus

Flexor Carpi Ulnaris

Action: wrist ulnar flexion Cord Segment: C7-T1 Nerve: Ulnar

Adductor Pollicis

Action: thumb adduction Cord Segment: C8-T1 Nerve: Ulnar

Abductor Digiti

Action: 5th digit abduction Cord Segment: C8-T1 Nerve: Ulnar Quinti

Opponens Digiti

Action: 5th digit opposition Cord Segment: C7-T1 Nerve: Ulnar Quinti

Flexor Digiti Quinti

Action: 5th digit MCP flexion Cord: C7-T1 Nerve: Ulnar Brevis

Interossei

Action: 2nd-5th digit MCP flexion, adduction, abduction Cord: C8-T1 Nerve: Ulnar

Flexor Carpi Radialis

Action: wrist radial flexion Cord: C6-C7 Nerve: Median

Palmaris Longus

Action: wrist flexion Cord: C7-T1 Nerve: Median

Flexor Digitorum Sublimis

Action: 2nd-5th digit PIP flexion Cord: C7-T1 Nerve: Median

Flexor Pollicis Longus

Action: thumb IP flexion Cord: C7-T1 Nerve: Median

Flexor Digitorum

Action: 2nd-3rd digit DIP flexion Cord: C7-T1 Nerve: Median

Abductor Pollicis Brevis

Action: thumb abduction Cord: C6-T1 Nerve: Median

Flexor Pollicis Brevis

Action: thumb MCP flexion Cord: C6-T1 Nerve: Median/Ulnar

Opponens Pollicis

Action: thumb opposition Cord: C6-T1 Nerve: Median

Lumbricals

Action: 2nd-5th digit MCP flexion, IP extension Cord: C8-T1 Nerve: Median/Ulnar

Extensor Carpi Radialis

Action: wrist radial extension Cord: C6-C8 Nerve: radial

Extensor Digitorum

Action: 2nd-5th digit MCP, IP extension Cord: C6-C8 Nerve: radial

Extensor Carpi Ulnaris

Action: wrist ulnar extension Cord: C6-C8 Nerve: radial

Abductor Pollicis Longus

Action: thumb MCP abduction Cord: C7-C8 Nerve: radial

Extensor Pollicis Longus/Brevis

Action: thumb extension Cord: C6-C8 Nerve: radial

Extensor Indicis Proprius

Action: 2nd digit extension Cord: C6-C8 Nerve: radial