S2_4: Kinesiology of the Wrist and Hand Flashcards
modified T/F
the wrist joint is the most complex joint that is composed of 2 compound joint
It is bi-axial, ellipsoid joint with 2 degrees of freedom like flex/ext (sagittal) & ulnar/radial deviation (coronal/frontal)
TT
modified T/F
The radoiocarpal joint is composed of the radius & distal carpal rows that has more flexion & ulnar deviation movements.
The mid carpal joint is composed of the proximal & distal carpal bones that has more extension & radial deviation movements
TT
match the ff. wrist motions
- ROM 20-45°, wrist adduction, FIRM
- ROM 60-85°, dorsal flexion, HARD
- ROM 15-20°, wrist abduction, HARD
- ROM 65-85°, palmar flexion, FIRM
A. Flexion
B. Extension
C. Ulnar dev
D. Radial dev
- C
- B
- D
- A
- supination & pronation occurs in small range in wrist joint, but mostly done in the forearm
T/F
Triangular fibrocartilage complex (TFCC) is attached to the radius & articulates with triquetrium
F
Triangular fibrocartilage complex (TFCC) is attached to the ULNA & articulates with triquetrium
Components of TFCC includes, EXCEPT:
A. ECU and its sheath
B. Meniscus homologue & disc
C. Ulnotriquetral and ulnolunate ligaments
D. distal radioulnar ligament
E. None of the above
E
modified T/F.
radius is longer distally than ulna.
healed fracture (fx) of radius can make ulna longer & cause pain on pronation & radial deviation
TF
radius is longer distally than ulna.
healed fracture (fx) of radius can make ulna longer & cause pain on pronation & ULNAR deviation
Modified T/F
Positive ulnar variance is where the distal ulna is longer than radius & can lead to thinner TFCC & impinge it between ulna & triquetrium.
Negative ulnar variance is where the ulna is shorter than normal length because of the thick TFCC.
TT
modified T/F
Kienbock’s disease is the avascular necrosis of Scaphoid
Carpal bones favors ext & radial dev
FT
Kienbock’s disease is the avascular necrosis of Lunate
Modified T/F.
Pisiform is a sesamoid bone to inc. moment arm in flexion & ulnar dev. of flexor carpi ulnaris (FCU) which is attached to it.
It has no articulation in the radiocarapal joint.
TT
Modified T/F.
Radio-carpal joint is composed of radius, scaphoid, lunate, triquetrium & they’re not congruent, so it has greater ROM on wrist.
Distal carpal bones is composed of trapezium, trapezoid, capitate, & hamate which are more fixed than proximal carpal bones that are strongly bounded together.
TT
Which of the ff are the Stability of Radiocarpal Joint
A. Ligaments
B. Bony structure (radius, ulna, carpal bones)
C. Muscles and tendons crossing the joint
D. All of the above
D,
- Ligaments
● Dorsal – thin
● Volar – thick and strong (more numerous fibers)
match the ff ligaments
- Intercarpal or interosseous ligaments
- Connect carpals to proximal radius/ulna or distal metacarpals
- Stronger and less stiff, flexible
- Nutrition from vascular supply
- Relies on synovial fluid for nutrition
A. Extrinsic Ligaments
B. Intrinsic Ligaments
- B
- A
- B
- A
- B
modified T/F
- Extrinsic Ligaments - protects intrinsic ligaments by absorbing forces first & prone to failure
- Intrinsic Ligaments - are shorter because it connects 1 carpal bone to the next
TT
which of the ff are part of Volar Radiocarpal Ligament
A. Radioscaphocapitate (Radiocapitate) Ligament
B. Radiolunotriquetral (Radiolunate) Ligament
C. Radioscapholunate Ligament *
D. all of the above
D
- provides most important stabilization to the proximal pole of scaphoid, if torn then it’ll lead to scaphoid instability, it serves little support to the joint & serves as a conduit to neuromuscular supply to scapholunate joint
which of the ff are part of Ulnocarpal Ligament Complex
A. TFCC
B. Ulnolunate Ligament
C. Ulnar Collateral Ligament
D. All of the above
D
Which are part of the extrinsic ligaments (VOLAR)
A. Volar Radiocarpal Ligament
B. Radial Collateral Ligament
C. Ulnocarpal Ligament Complex
D. All of the above
D
modified T/F
Dorsal Radiocarpal Ligament, coverages to triquetrium & oblique in orientation to help slide the proximal carpals on inclined radius while the Dorsal Intercarpal Ligament is horizontal in orientation from triquetrium -> lunate -> scaphoid & trapezius.
Both ligaments are V-shaped that stabilize scaphoid during wrist movements & taut during flexion
TT
* both ligaments are EXTRINSIC LIGAMENT (DORSAL)
modified T/F.
Scapholunate Interosseous Ligament stabilizes scaphoid & lunate which is a key factor in maintaining scaphoid stability & provides stability to the wrist joint.
Lunotriquetral Interosseous Ligament mantain stability in lunate & triquetrium & if there’s degeneration/injury in the joint, it can lead to lunate instability wherein ligaments are stretched towards wrist ext because they’re found in the palmar side & are taut in extending the hand.
TT
* both are INTRINSIC LIGAMENT
(VOLAR)
T/F the wrist complex is a Combination of active (muscles) and passive (ligaments) joint reaction forces
T
which of the ff are true about Capitate
A. “center of rotation” of wrist & Keystone of wrist movements
B. Has Mediolateral axis (flexion and extension)
C. Can move in anteroposterior (AP) axis (ulnar and radial deviation)
D. Rigid center of the fixed carpal arch
E. All of the above
E
modified T/F
mobile segments should have a Stabilizing mechanism like the Scaphoid’s functional and anatomical
connections to the lunate and distal carpals.
To normalize combined mid carpal & radiocarpal motions & prevent full collapse, scaphoid moves together with the distal carpal row, so proximal carpals won’t be distracted.
TT
modified T/F,
when wrist extends, the greatest motion among the proximal carpals is Lunate & the least motion is Scaphoid.
During WRIST EXTENSION, the midcarpal joint moves first then the scaphoid locks with distal carpal to move on to lunate and triquetrum, after that all carpals as a unit move against radius
FT
when wrist extends, the greatest motion among the proximal carpals is Scaphoid & the least motion is Lunate.
modified T/F
For wrist Radial Deviation, the Distal carpals move radially over
the proximal carpals, then as a unit all carpals move ulnarly, after that, there’s Flexion of proximal carpals and
extension of distal carpals then the Scaphoid flexes.
For wrist Ulnar Deviation, the Distal carpals move ulnarly over
the proximal carpals, then as a unit all carpals move radially, after that, there’s extension of proximal carpals and
flexion of distal carpals then the Scaphoid flexes.
TT
- wrist ulnar deviation is the reverse of wrist radial deviation
modified T/F
Intracarpal ligaments will stabilize the lunate to the scaphoid and the lunate to
the triquetrum.
If there were no ligaments the tendency of the triquetrum is to fall in a volar direction and the scaphoid to fall in a
dorsal direction.
TF
If there were no ligaments the tendency of the SCAPHOID is to fall in a volar direction and the TRIQUETRIUM to fall in a dorsal direction.
T/F
If there is a break in the scaphoid, lunate, triquetrial connection then a Dorsal Intercalated Segmental Instability (DISI) or Volar Intercalated Segmental Instability (VISI) malalignment can occur.
T
modified T/F
If the lunotriquetrial ligament is broken then the scaphoid will tip the lunate in a volar direction (VISI).
If the scapholunate ligament is disrupted then the triquetrium will tip the lunate in a dorsal direction (DISI).
TT
Modified T/F.
At the wrist, muscles provide a stable base for the hand while permitting positional adjustments to allow optimal length-tension on long finger muscles.
Stronger finger flexion is with the wrist ulnarly deviated 5-7° and slightly extended at 20-25°.
TT
Which of the ff are Volar Muscles for wrist Flexion
A. Palmaris longus
B. FCR & FCU
C. FPL
D. FDS & FDP
E. All of the above
E
* FDS, FDP, FPL are 2nd wrist flexors
Match the ff. muscles.
(can have multiple answers)
- effective in both flexion and
ulnar deviation of the wrist, inserts on pisiform & acts on hamate that exerts greatest tension like forceful gripping - functions more as a wrist
flexor together with PL than as a
radial deviator - may be absent in 14%of individuals, doesn’t go under flexor retinaculum but attaches in front of it & used for tendon repairs
- predominantly flexors of the digits
- showed varied activity in wrist ulnar & radial deviation
A. PL
B. FCR
C. FCU
D. FDS
E. FDP
F. FPL
- C
- B
- A
- D,E,F
- D,E
modified T/F
FPL function more consistently as a wrist flexor than FDP
FDS contribute to flexion and radial deviation of the wrist
FF
FDS function more consistently as a wrist flexor than FDP
FPL contribute to flexion and radial deviation of the wrist
modified T/F
Dorsal Muscles for wrist Extension include: ECRL, ECRB, ECU, EDC, Extensor Indicis (Proprius), Extensor Digiti Minimi, EPL, EPB, APL
ECRL, ECRB, ECU & EDC are primary extensors of the wrist
TF
EDC is NOT included
modified T/F
extensor & flexor retinaculum prevent bow stringing when fingers are flexed/extended.
the extensor retinaculum has 6 compartments & the 2nd compartment is near lister’s tubercle of radius
TF
the extensor retinaculum has 6 compartments & the 3RD compartment is near lister’s tubercle of radius
modified T/F
1st compartment has EPB & APL, 2nd compartment has ECRB & ECRL, 3rd compartment has EPL
4th compartment has EDC & EIP, 5th compartment has EDM that extends the 5th finger, 6th compartment has ECU that extends wrist & ulnar deviate
TT
* EPB - extensor pollicis brevis
APL - abductor pollicis longus (for thumb movements)
ECRB & ECRL - extensor carpi radialis brevis & longus
EPL - extensor pollicis longus
- EDC - extensor digitorum communis (extends middle & 4th finger)
EIP - extensor indicis propius (extends index finger)
EDM - extensor digitorum minimi
ECU - extensor carpi ulnaris
match the ff muscles
(can have multiple answers)
- increased activity when radial deviation or forceful finger flexion are performed
- active in all grasp-release activities except those performed in supination
- extension, ulnar deviation and wrist flexion as well
- active in wrist extension activities
A. ECRL
B. ECRB
C. ECU
- A
- B
- C
- A,B
match the ff muscles
(can have multiple answers)
- minor role in wrist radial deviation
- do not contribute much to the
functioning of the wrist - have common function– finger and wrist extension
A. EDM (extensor digitorum minimi)
B. EI (extensor indicis)
C. ED (extensor digitorum)
D. APL
E. EPB
F. EPL
- D,E
- D,E,F
- A,B,C
modified T/F
1st CMC Joint is a Trapeziometacarpal Joint & a Saddle joint that can Flex/Ext & Abd/Add with some axial rotation
It can also do movements like CIRCUMDUCTION & OPPOSITION with a Function of prehension, manipulating/touching other finger & palm
TT
modified T/F
CMC Joints have articulations between the distal carpals and bases of
the metacarpals that is supported by strong transverse and weak longitudinal ligaments.
It is a Plane joint with 1 degrees of freedom (DoF) that can flex/ext & the 1st CMC is saddle joint with 2 DoF that can flex/ext, abd/add
TT
modified T/F
Intercarpal ligament is found in the distal portion of flexor retinaculum
transverse carpal ligaments connects carpals together
FF
transverse carpal ligament is found in the distal portion of flexor retinaculum
Intercarpal ligaments connects carpals together
modified T/F
carpal tunnel have 10 structures that enter such as 4 FDS tendon, 4 FDP tendon, 1 FPL, & 1 median nerve.
Proximal transverse carpal arch is formed by trapezium, trapezoid, capitate, hamate & its concavity is maintained by ligaments.
TT
modified T/F
MCP is from the head of metacarpal to the base of proximal phalanx & has a laced capsule in extension with a condyloid joint of 2 DOF (flex/ext & abd/add)
IP is a hinge joint with 1 DOF (flex/ext)
TT
modified T/F
All fingers point to scaphoid on a clenched fist is called starburst phenomenon.
There is an increasing flexion ROM from radial to ulnar when you close your hand with 90° flexion for index finger & 110° flexion for pinkie finger
TT
modified T/F
the volar plate enhances the congruence of MCP joints & limits hyperextension since the convex metacarpal head has a higher surface area than the concave base of phalanges.
The sagittal band present on each side connects the volar plate to the extensor digitorum communis to inc. stabilization of volar plate on MCP heads
TT
modified T/F
MCP joint capsule is laced in extension & the transverse MCP ligament blends with the capsule to inc. stability.
Collateral ligaments is found ulnarly & radially in IP & MCP
TT
modified T/F on extrinsic finger flexors
FDS attaches to PIP & MCP that has more torque since its more superficial but traverses less joint
FDP attaches to DIP, PIP, MCP and traverses more joint
TT
modified T/F
Gentle pinch uses FDP only while stronger pinch uses FDP with FDS.
Camper’s chiasma is the split of FDS tendon since FDS needs to attach to the middle phalanx
TT
modified T/F
the long finger flexor tendons have 3 annular pulleys & 5 cruciate pulleys that are transversely arranged to prevent bow stringing
radial bursa limits/reduce friction when tendons glide in the sheets while the flexor retinaculum & TCL limits bow stringing of the tendons
FT
long finger flexor tendons have 5 annular pulleys & 3 cruciate pulleys
modified T/F
Extrinsic Finger Extensors include EDC, Extensor Indicis (EI), Extensor Digiti Minimi (EDM) while the EI & EDM connects with EDC that’s why you can move the index & pinkie finger independently except for the ring finger
DORSAL HOOD / EXTENSOR HOOD merges with EDC so when EDC contracts, it also extends the MCP even if they aren’t attached to the joint
TT
modified T/F
Lateral Bands inserts to the base of the middle phalanx & extends PIP
Central Band/Tendon insert to the base of the distal phalanx & extends DIP
FF
Central Band/Tendon inserts to the base of the middle phalanx & extends PIP
Lateral Bands insert to the base of
the distal phalanx & extends DIP
- even if no muscles in MCP, EDC can extend fingers
which of the ff statements are incorrect:
A. Extensor Digitorum (ED) tendon passes dorsal to the MCP joint axis to produce extensor force & is also helped by the extensor expansion (EM)
B. Other active forces that are part of the EM include Dorsal & volar interossei, lumbrical pass volar to MCP joint axis to produce flexor force at the joint
C. When the ED, interossei and lumbricals all contract simultaneously, MCP will generally extend
D. None of the above
D
modified T/F
The PIP joint is crossed dorsally at the central tendon and lateral bands where the ED, interossei and lumbricals attach to extensor expansion & located posterior to the joint to produce an extensor force
The PIP joint is crossed volarly at the oblique reticular ligament (ORL) to produce flexion force in IP joint
TT
which of the ff is incorrect
A. Active contraction of ED alone cannot produce sufficient tension to overcome the passive forces of the long finger flexors at the IP joints
B. Isolated contraction of ED causes clawing of the finger
C. Active contraction of interossei and lumbricals generates active tension in the extensor mechanism necessary to extend PIP
D. None of the above
D
modified T/F
in PIP, contraction of ED alone isn’t sufficient to overcome the pull of the flexor forces like the oblique reticular ligament (ORL), it needs help from interossei & lumbricals
Interossei & lumbricals are innervated by the ulnar nerve, if there is ulnar nerve neuropathy, it causes clawing/intrinsic minus deformity of the hand, so ED is the only one extending the IP joints
TT
which of the ff are true about Dorsal and Volar Interossei
A. arises from between the MC and attaching to the bases of the proximal phalanges and/or to the extensor expansion
B. Joins the finger in 2 locations, at the proximal phalanx and extensor hood via proximal wing tendons & at the lateral bands and central tendon via distal wing tendons & attach to middle phalanx
C. passes volar to the coronal MCP joint axis to the flexors of the MCP joint
D. All of the above
D
match the ff interossei
(can have multiple answers)
- both proximal & distal wing tendons
- proximal wing tendon only
- with distal wing tendons only
A. Volar interossei
Dorsal interossei :
B. Index finger
C. Middle finger
D. Ring finger
E. Little finger
- C, D
- B, E
- A
modified T/F
Distal interossei has predominant
effect at MCP joint alone
Proximal interossei has predominant effect at the IP joints with some effect at
the MCP joint
FF
Proximal interossei has predominant
effect at MCP joint alone
Distal interossei has predominant effect
at the IP joints with some effect at
the MCP joint
modified T/F
lumbricals are the only muscle that originals & inserts to a tendon.
Since lumbricals pass volarly to MCP joint, it’ll cause flexion of MCP while if it attaches to the extensor hood, it Extends the IP joints
TT
modified T/F
Thenar eminence (ball of thumb) produce fine, precise movements of the thumb.
Abductor pollicis brevis, adductor pollicis, flexor pollicis brevis & opponens pollicis are active muscles in gripping activities.
TT
modified T/F
Abductor pollicis brevis, flexor pollicis brevis & opponens pollicis can be palpated at the thenar eminence.
opponens pollicis is the more distal attachment to the thumb & an effective abductor, flexor, opposition of the thumb because its line of action is perpendicular to the long axis of MCP joint of the thumb.
TT
*adductor pollicis is located at the side of the web space
which of the ff. are incorrect
A. Opposition to index and middle finger makes Flexor Pollicis Brevis (FPB) more active than Opponens Pollicis (OP) since the thumb is more of a flexing position than an opposition
B. Opposition to ring and pinkie finger makes (OP) more active than (FPB)
C. Increase pressure in opposition brings in activity of Adductor Pollicis (ADP)
D. Reposition is an extrinsic function with some activity of OP and Abductor pollicis brevis (APB)
E. none of the above
E
modified T/F.
Hypothenar eminence (ball of little finger), produce movements of the little finger.
Abductor digiti minimi, Flexor digiti minimi, & opponens digiti minimi produces opposition, flexion, abduction of little finger.
TT
modified T/F
Distal transverse arch is found around MCP heads, & is more mobile because the 1st, 4th, 5th digits moves around the relatively fixed 2nd & 3rd MCP which is evident when we flex fingers.
Oblique arches starts from the base of the hypothenar eminence up to the 2nd MCP, that’s evident when holding a tool like hammer.
TT
modified T/F
Proximal transverse carpal arch is fixed because of the little movements allowed in the distal carpal bones while the deep transverse ligaments keeps the connection of the 4 distal carpal bones.
The longitudinal carpometacarpophalangeal arches transverses the length of the digit.
TT
- the palmar arch system allows the fingers & palm to conform to the shape of the object
match the ff about prehension
- 40% of hand function
- 40% of hand function (20% each) that is essential for bidigital grip or tridigital grip
- 20% of the hand function (10% each) for full palmar grip or any firm grip like power grip
A. Thumb
B. Index & middle fingers
C. Ring & little fingers
- A
- B
- C
modified T/F
lateral aspect of the hand (index & thumb) is important for precision, manipulating objects when writing using a pen.
Medial aspect/ulnar side of the hand is essential that comprises the pinkie & middle finger.
TT
match the ff power grip
- grip performed between 2 adjacent fingers like thumb & index finger, extensor muscle of the fingers are more predominantly activated
- not powerful, but with sustained contraction on the muscle of the hand when gripping like when holding cigarette between fingers
- includes the palm not the thumb, FDS & FDP is mainly used like when holding briefcase, carrying grocery bags
- fingers are spread apart & abducted. FDS, FDP, thenar, hypothenar are also active, mainly uses abductor interossei like when holding a small ball
- thumb in adduction so hand can hold to the object firmly. fingers are in sustained flexion & palm is used to conform to the object being held
- Uses FDP mainly & FDS for more grip. Other muscles being used are interossei, thenar, & hypothenar. example is when holding a can of soft drink
A. Cylindrical
B. Spherical
C. Hook
D. Lateral Prehension
- D
- D
- C
- B
- A
- A
the ff are true about precision grip EXCEPT:
A. Pad-to-pad / Pulp-to-pulp / Pinch Grip is used for small objects like coins, marbles to pick up
B. Three jaw chuck uses thumb, index & middle finger to manipulate/position the pen
C. Tip-to-tip (smaller than pad-to-pad like getting a pin) / Pincer Grip (pick up small & thin objects)
D. Pad-to-side / Lateral Pinch (pad touches side of index finger like turning the key or holding a ticket)
E. Lumbrical grip / Plate grip (for holding plate/weights in an intrinsic plus grip where the lumbrical flexes MCP & extends IP
F. none of the above
F
match the ff functional position of a resting hand splint to continue to function
- 20° extension, 10° Ulnar deviation
- 45° flexion
- 30° flexion
- slight flexion
A. Wrist
B. MCP
C. PIP
D. DIP
- A
- B
- C
- D
- all muscles are in equal position & will give opportunity for a disabled hand to interact with the brain & still be able to use the hand in a functional manner.
*Even if there are tightness/weakness, the hand can still hold on an object/do weak prehension activities
- if there’ll be prolonged immobilization, then there’ll be tightness/weakness in the muscles of the hand & passive structures around it
