MSK #11- A&P Wrist and Hand Flashcards
ROM Norms: Wrist
Flexion 0-80
Extension 0-70
Radial Deviation 0-20
Ulnar Deviation 0-30
ROM Norms: Thumb CMC
Abduction 0-70
Flexion 0-15
Extension 0-20
Opposition- tip of thumb to base of 5th digit (BIL comparison?)
ROM Norms: Thumb MCP
Flexion 0-50
ROM Norms: Thumb Interphalangeal
flexion 0-80
ROM Norms: Digits 2-5 MCP
Flexion 0-90
Hyperextension 0-45
ROM Norms: Digits 2-5 PIP
Flexion 0-100
ROM Norms: Digits 2-5 DIP
Flexion 0-90
Hyperextension 0-10
Manual Therapy
Joint: Distal Radioulnar
Resting Position, Concave/Convex, Osteo/arthrokinematics
Resting Position: 10 degrees supination
Concave: radius
Convex: ulna
Osteo/arthrokinematics: same direction
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
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
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
Muscles involved w/ wrist flexion
- flexor carpi radialis
- flexor carpi ulnaris
- palmaris longus
Muscles involved w/ wrist extension
- extensor carpi radialis longus
- extensor carpi radialis brevis
- extensor carpi ulnaris
Muscles involved w/ radial deviation
- extensor carpi radialis
- flexor carpi radialis
- extensor pollicis longus
- extensor pollicis brevis
Muscles involved w/ ulnar deviation
- extensor carpi ulnaris
- flexor carpi ulnaris
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
Radiocarpal Joint: osteokinematic motions
flexion, extension, radial deviation, ulnar deviation
Radiocarpal Joint: loose packed and close packed positions
Loose: neutral w/ slight ulnar deviation
Closed: extension w/ radial deviation
Radiocarpal Joint: Capsular Pattern
flexion and extension equally limited
Midcarpal joint. Go!
- complex motion between distal an proximal carpals w/ exception of pisiform
- joint surfaces reciprocally convex and concave
5 primary ligaments or structures of wrist
dorsal radiocarpal ligament palmer radiocarpal ligament radial collateral ligament carpal tunnel interosseous membrane
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
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
