OSPE - fractured wrist

Question 1

Suggest how you would measure ROM at the wrist joint for both flexion and extension AND radial and ulnar flexion

Answer 1

Goniometer:
(Flexion and extension) 
 - axis on ulna styloid
 - stationary arm parallel to the ulna
 - moving arm parallel to 5th metacarpal
(Radial and ulnar flexion)
 - axis on midline of radiocarpal joint
 -  stationary arm parallel to forearm
 - moving arm parallel to 3rd phalanx

Question 2

Suggest how you would measure strength at the wrist joint

Answer 2

Oxford Scale: Graded 0-5, begin with 2
 - 2 = full ROM, gravity eliminated
 - 3 = full ROM, against gravity
 - 4 = full ROM, small resistance applied
 - 5 = full ROM, full resistance applied
Hand grip dynamometer

Question 3

Suggest some exercises for improving wrist strength

Answer 3

Wrist flexion: Hold a small weight (can of beer) with palm facing up. Bend the wrist up and slowly lower back down.
Wrist extension: Same as above, but palm faces down and you lift the wrist up
Grip strengthening: Squeeze a soft rubber ball. Hold for 5 seconds. STATIC GRIP

Question 4

What pulse can be found at the wrist and where?

Answer 4

Radial pulse

Below the base of the thumb

Question 5

Name the main muscles involved in flexing the hand.

Answer 5

1. Flexor carpi radialis
2. Flexor carpi ulnaris
3. Palmaris longus

Question 6

Name the main muscles involved in extending the hand.

Answer 6

1. Extensor carpi radialis brevis
2. Extensor carpi radialis longus
3. Extensor carpis ulnaris

Question 7

Name a muscle responsible for pronating the forearm

Answer 7

Pronator teres

Question 8

Name the origin, insertion and the action for the pronator teres

Answer 8

(2 headed muscle)
Origin: medial epicondyle of humerus and coronoid process of ulna
Insertion: lateral radius by a common tendon
Pronates forearm

Crosses forearm diagonally, from medial side of humerus to lateral 1/3 of radius

Question 9

Name the origin, insertion and the action for the flexor carpi radialis

Answer 9

Origin: medial epicondyle of humerus
Insertion: base of 2nd ad 3rd metacarpals
Powerful flexor of the hand.

Question 10

Name the origin, insertion and the action for the flexor carpi ulnaris

Answer 10

Origin: medial epicondyle of humerus
Insertion: pisiform, hamate and base of 5th metacarpal
Powerful flexor of the hand

Question 11

Name the origin, insertion and the action for the palmaris longus

Answer 11

Origin: medial epicondyle of humerus
Insertion: fascia of palm
Powerful flexor of the hand

Question 12

Name the origin, insertion and the action for the extensor carpi radialis longus

Answer 12

Origin: lateral supracondylar ridge of humerus
Insertion: base of 2nd metacarpal
Extends hand

Question 13

Name the origin, insertion and the action for the extensor carpi radialis brevis

Answer 13

Origin: lateral epicondyle of humerus
Insertion: base of 3rd metacarpal
Extends hand

Question 14

Name the origin, insertion and the action for the extensor carpi ulnaris

Answer 14

Origin: lateral epicondyle of humerus
Insertion: base of 5th metacarpal
Extends hand

Question 15

How do you palpate the ulna styloid?

Answer 15

Bony prominence at the distal end of the ulna

Question 16

How do you palpate the radius styloid?

Answer 16

Bony prominence at the distal end of the radius

Question 17

How do you palpate the capitate bone?

Answer 17

Found in the small depression, proximal to the base of 3rd metacarpal

Question 18

How do you palpate the pisiform bone?

Answer 18

The medial bone of the proximal row of carpal bones

Question 19

How do you palpate the snuff box

Answer 19

Small skin depression found at the base of the thumb.

Question 20

Locate and name the origin and insertion of the brachioradialis and its main action

Answer 20

A superficial muscle of the lateral forearm
Origin = lateral supracondylar ridge at distal end of humerus
Insertion = radial styloid
Action = flexes forearm at the elbow