radioulnar, wrist, and digital joints

Question 1

movements of the wrist joint

Answer 1

flexion, extension, abduction (radil deviation), adduction (ulnar dev.)

Question 2

proximal row of carpal bones

Answer 2

scaphoid, lunate, triquetrum, pisiform

Question 3

distal row of carpals

Answer 3

trapezium, trapezoid, capitate, hamate

Question 4

radiocarpal articulation

Answer 4

distal radius–>scaphoid and lunate. flex/ext

Question 5

intercarpal articulation

Answer 5

between adjacent carpal bones. little movement

Question 6

midcarpal articulation

Answer 6

art. btw the proximal and distal rows. lack of ligaments, flex ext movement

Question 7

carpometacarpal articulation

Answer 7

btw base of metacarpals and the distal row of carpals. little movement because of shape in joints 2-5, but joint 1 (on thumb) is a saddle joint btw the trapezium and the 1st metacarpal (allows for opposable thumbs)

Question 8

what separates the ulna and the triquetrum?

Answer 8

a triangular fibrocartilagenous disc, allows for greater range of motion in adduction

Question 9

triangular fibrocartilagenous complex

Answer 9

helps distribute force from the hand to both the radius and ulna. greater range of motion. increases capacity of the wrist to absorb a blow from forces applied to wrist

Question 10

wrist flexion

Answer 10

ant surface of wrist to toward forearm, occurs at radiocarpal joint

Question 11

wrist extension

Answer 11

occurs at midcarpal joint

Question 12

wrist abduction

Answer 12

moving toward radius, radiocarpal joint

Question 13

wrist adduction

Answer 13

toward ulna, radiocarpal joint

Question 14

ulnar collateral ligament of the wrist

Answer 14

binds the styloid process of the ulna to the proximal row of carpal bones. very stong, limits abduction

Question 15

radial collateral ligament of the wrist

Answer 15

attaches radial styloid process to carpal bones. limits adduction

Question 16

palmar radiocarpal ligament

Answer 16

binds carpals on the palmar wrist, limits extension

Question 17

dorsal radiocarpal ligament

Answer 17

binds carpals on the dorsal surface of the wrist, limits flexion

Question 18

flexor retinaculum

Answer 18

continuation of deep fascia of forarm that attaches to scaphoid, trapezium, pisiform, and hamate bones. converts space into carpal tunnel which passes the median nerve and flexor tendons to all digits

Question 19

sensory to wrist?

Answer 19

median nerve (anterior interosseus branch), radial nerve (post interosseus branch), and the ulnar nerve (carpal branch)

Question 20

blood supply to wrist

Answer 20

radial and ulnar arteries via dorsal and palmar carpal branches

Question 21

FOOSH injury

Answer 21

fall on an outstretched hand, fracture most common in scaphoid, pain in anatomical snuffbox

Question 22

colles fracture

Answer 22

fracture to the distal radius. pain and swelling just above wrist, inability to hold onto things or lift anything. Wrist may be back over the broken bone making it look like a dinner fork

Question 23

symptoms of radial nerve damage

Answer 23

1. drop wrist: injury to any part of the radial nerve will be especially noticable when the hand is pronated.
2. gravity will extend the wrist when it is supine. when the hand is supine and extended, the patient will not be able to resist an attempt to flex the hand
3. loss of sensation to the radial side of the dorsum of the hand

Question 24

tenosynovitis

Answer 24

inflammation/irritation within the synovial sheath that surrounds the tendons of the forearm muscles as they cross the wrist.

Question 25

DeQuervain’s Disease

Answer 25

overuse injury that involves the swelling of the first dorsal extensor pollicis brevis tendons. flexion of the thumb at the MP joint along w/ ulnar deviation of the wrist exacerbates this condition

Question 26

palmar carpal ligament (plate)

Answer 26

made of fibrocartilage, reinforces the IP and MP joints of the digits

Question 27

ulnar and radial collateral ligaments of the IP and MP joints

Answer 27

thickenings of the capsule of each joint that strengthens each joint on the medial and lateral side, also attach to palmer carpal plates
MP collateral ligaments: taut during flexion and loose during extension

Question 28

Game Keepers thumb

Answer 28

results from hyper abduction of the MP joint of the thumb. tears the ulnar collateral ligament and possible fractures from the head of the 1st metaparpal and prox phalanx onf the thumb

Question 29

digital sheaths

Answer 29

annular and cruciform bands that bind the palmar plates to form longitudinal grooves in which the digital tendon sheath are supported as they cross the joints

Question 30

deep transverse metacarpal ligament

Answer 30

unity of the palmar plates of digits 2-5. keeps heads of MC’s from being mobile

Question 31

innervation of IP and MP joints

Answer 31

digital branches of median and ulnar nerves

Question 32

blood supply of IP and MP joints

Answer 32

digital branches of the superficial palmar arch

Question 33

power grip

Answer 33

holding an object tightly between the palm and flexed fingers making a tight fist. involves:

1. wrist extension (radial direction)
2. IP joints flexed by flexor digitorum sup and prof., MP joints flexed by interossei
3. thumb adducted at the MP joint by adductor pollicis and IP may or may not be flexed by the flexor pollicis longus

Question 34

variations of the power grip

Answer 34

hook: only fingers used and they are flexed strongly at IP and MP joints
fist: grasping tightly within a fist, finger flexed, thumb adducted and flexed

Question 35

precision grip

Answer 35

precision and accuracy, involving thumb and pointer finger

1. lumbricals active in 1st finger if MP joint is flexed while IP is extended
2. if IP are flexed, interossei flex MP
3. thenar mucles oppose thumb

Question 36

carpal tunnel syndrome

Answer 36

nerve entrapment syndrome of the carpal tunnel. inflammation of tendons causes pressure on median nerve

sensory symptoms: pain and redness to parathesia and anethesia along the cutaneous distribution of the median nerve, pain in palmar surface of first 3.5 digits

motor symptoms: weak opposition of the thumb, inability to oppose it could happen and the wasting of the thenar eminence, ape hand deformity

to fix: they cut open the flexor retinaculum to relieve pressure

Question 37

pronator teres syndrome

Answer 37

when median nerve is compressed as it passes thru the 2 heads of the pronator teres muscle in the prox forearm. Symptoms:

1. weakening of wrist flexion and radial deviation due to loss of function of flexor carpi radialis
2. papal hand
   - IP joint of digits 1 and 2 are in an extended position
   - extensor digitorum and interossei act unopposed to extend the MP and IP joints, ape position
3. inability to make a closed fist
4. difficulty performing a precision grip

Question 38

guyons tunnel syndrome

Answer 38

compression of the ulnar nerve as it passes through guyons tunnel (between pisiform and the hook of the hamate, covered by palmar carpal ligament).
Symptoms vary, include:
1. parasthesia along ulnar side of hand on the dorsal and palmar surfaces is only sensory branch is affected
2.if only deep motor branch: hyper abducted thumb due to weakness of adductor pollicis, inability to adduct or abduct the MP joints, cant make a fist

Question 39

cubital tunnel syndrome

Answer 39

proximal ulnar nerve lesion, compression of the nerve as it passes through the origin of the flexor carpi ulnaris muscle posterior to the funny bone. all the symptoms of a distal ulnar nerve lesion plus weakining in movements of flexion and ulnar deviation of the wrist due to weakness in flexor carpi ulnaris

Question 40

radial nerve entrapment

Answer 40

affects the post branch of the radial nerve

difficulty extending digits, would have already passed through supinator muscle to the wrist would not be affected

Question 41

tinel sign test

Answer 41

tapping on the entrapped nerve, positive test would be parasthesia when tapping.

1. tapping on flexor retinaculum would compress the median nerve and cause tingling along the palmar thumb and fingers 1&2
2. tapping the cubital tunnel will compress the ulnar nerve, causing tingling along the ulnar side of the hand and medial 1.5 digits

Question 42

phalens test

Answer 42

flexing wrist with the forearm prone then pressing the dorsum of the hands together for at least 30 secs. positive sign if there is tingling along the palmar thumb and digits 1 and 2

Question 43

forment’s sign

Answer 43

indicates ulnar nerve damage, thumb cannot adduct, cant hold tightly to a piece of paper btw the thumb and index finger. instead of adduct the thumb, the patient flexes the IP joint of the thumb

Question 44

mallet finger

Answer 44

damage to the insertion of the lateral slips of the extensor mechanism on the base of the distal phalanx. DIP cant be extended and stays in a flexed position

Question 45

boutinniere deformity

Answer 45

PIP is flexed while DIP is extended

Question 46

swan neck deformity

Answer 46

results from rheumatoid arthritis. MP snf DIP are flexed while PIP is hyper extended

Question 47

trigger finger

Answer 47

affected finger is in a flexed position bc there is swelling of the sheath surrounding the long common digital flexor tendon sheath as well as the ligaments that bind the sheath. Affected digit is painful.