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Kinesiology > Test 2 > Flashcards

Test 2 Flashcards

0
Q

SCJ anterior/posterior ligaments do what?

A

Check ant/post translation

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1
Q

7 joint involved in shoulder elevation

A 
AC
GH
SC
ST
thoracic spine
Costotransverse/ costovertebral
Costochondral
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2
Q

SCJ interclavicular ligaments do what?

A

Checks clavicular depression

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3
Q

SCJ costoclavicular ligament

A

Anterior and posterior fibers
Limits elevation
Contributes to inferior gliding of clavicle

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4
Q

SCJ type of joint

A

Saddle shape, plane synovial

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5
Q

SCJ frontal plane

A

Frontal plane- convex on concave

Elevation and depression

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6
Q

SCJ elevation

A

48 degrees

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7
Q

SCJ depression

A

10 degrees

- you don’t depress often

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8
Q

SCJ in transverse plane

A

Concave on convex
Protraction
Retraction

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9
Q

SCJ protraction

A

20 degrees

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10
Q

SCJ retraction

A

30 degrees

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11
Q

SCJ in sagittal plane

A

Saddle shape
Posterior rotation
Anterior rotation

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12
Q

SCJ posterior rotation

A

50 degrees

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13
Q

SCJ anterior rotation

A

<10 degrees

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14
Q

ACJ joint

A

Capsule is weak
Superior and inferior ligaments
Superior checks distal clavicle from moving posteriorly

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15
Q

ACJ coracoclavicular ligament- Conoid

A
  • resist distal clavicular superior motion
  • limit upward rotation of scapula
  • posteriorly rotates clavicle
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16
Q

ACJ coracoclavicular- trapezoid

A

Limit posterior displacement of clavicle
Limits upward rotation of scapula
Posteriorly rotates clavicle

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17
Q

ACJ coracoacromial ligament

A

Roof for GHJ

protects subacromial bursa and RTC

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18
Q

What kind of joint is the ACJ

A

Planar

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19
Q

Movement of ACJ

A

Minimal
20-40 degrees anterior/posterior tilting
30 degrees upward/downward rotation
30 degrees IR/ER

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20
Q

Scapulothoracic joint positioning

A

30-45 degrees coronal plane
10-15 degrees anteriorly tilting
10 degrees upwardly rotated

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21
Q

Scapulothoracic joint upward rotation mobility

A

60 degrees
Axillary line
- coupled with posterior rotation SCJ
Coupled with clavicular elevation

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22
Q

Scapulothoracic joint elevation and depression occurs where

A

At SCJ

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23
Q

Scapulothoracic joint protraction retraction occurs where

A

At SCJ

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24
Q

Scapulothoracic joint IR/ER and anterior/posterior tilting occurs where

A

At ACJ

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25
Q

Scapulo-humeral rhythm

A
  • maintain optimal alignment of the glenoid and humeral head
  • increase ROM available in elevation
  • maintain optimal length-tension relationship for the scapulo-humeral muscles
  • -> minimize activity insufficiency
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26
Q

What effect does gravity have on GHJ

A

Fall-out

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27
Q

What prevents subluxation of GHJ

A

Labrum
Joint capsule acts as suction
RTC
amongst others

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28
Q

Labrum does what to GHJ

A

Increases depth by 50%

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29
Q

GHJ capsule

A

Loose anteriorly and inferiority
Tight superiorly
Creates intrarticular pressure

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30
Q

Superior GH ligament

A

1) labrum to humerus connects with coracohumeral ligament

2) anterior and inferior stability

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31
Q

Middle GH ligament

A
  • superior anterior labrum to anterior humerus

- anterior joint stability up to 60 degrees abduction

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32
Q

Inferior GH ligament

A
  • 45 degrees abduction resists inferior translation
  • ER resists anterior translation
  • IR resists posterior translation
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33
Q

GHJ coracohumeral ligament

A

Limits inferior translation

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34
Q

Humeral head orientation

A

Medially
Superiorly: 130-150 degrees
Posteriorly: 30 degrees

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35
Q

GHJ mobility

A

Convex on concave

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36
Q

Describe the GHJ motions that occur with abduction

A

External rotation

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37
Q

GHJ motions that occur with scapular plane

A

Less ER

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38
Q

GHJ motion that occurs with flexion

A

Internal rotation

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39
Q

Scapulo humeral rhythm movements of humerus and scapula

A

Elevation of the humerus
Upward rotation and posterior tilting of scapula
2:1 ratio (GHJ:STJ)

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40
Q

4 joints getting to 180 degrees

A

SCJ-40 elevation and upward rotation
ACJ- minimal motion
STJ- 60 degrees upward rotation
GHJ- 120 degrees elevation

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41
Q

How many muscles act on the shoulder during elevation?

A 
18
Biceps
Triceps
Deltoid x3
Traps x3
SITS
rhomboids x2
Levator scapulae
Serrated anterior
Lats 
Teres major
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42
Q

Upward scapular rotators

A

Upper trapezius
Middle trapezius
Lower trapezius
Serratus anterior- prime mover

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43
Q

Compression and joint stabilization muscles of shoulder

A

Infraspinatus
Teres minor
Subscapularis
Supraspinatus- some elevation too

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44
Q

angle of pull causes what on humerus?

A

Compression and spin

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45
Q

Glenohumeral elevation

A
  • Supraspinatus: test in scapular plane. Most active 0-60 degrees abduction, scapula starts moving at 60
  • Deltoid: prime elevator for flexion, assist abduction after 15 degrees. More superior force
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46
Q

Supraspinatus lever arm

A

Much better lever arm than deltoid, larger axis of rotation so get more force
Deltoid turns off up top because moment arm is smaller because of active insufficiency

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47
Q

Deltoid and Supraspinatus during arm elevation

A

Deltoid has poor ma during early elevation
Supraspinatus has longer ma during elevation
Deltoid ma improves in mid-range
Deltoid provides greater abduction force than Supraspinatus

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48
Q

Deltoid and rotator cuff during arm elevation

A

Deltoid causes superior glide of humerus- impingement

Cuff causes inferior glided

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49
Q

Shoulder depression muscles in weight bearing

A

Latissimus Doris
Pectoral is major

  • need to work because they are counteracting upper trap. Ys Ts Ws
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50
Q

What muscle prevents scapular internal rotation

A

Rhomboids

  • serratus anterior does the IR of scapula
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51
Q

Teres major and internal rotation

A

Extends humerus, if teres major is activated without the rhomboids, scapula would internally rotate

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52
Q

Shoulder muscles for scapular depression and abduction

A

Pec minor

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53
Q

GIRD

A

Glenohumeral IR deficit
-a loss of IR of 20 degrees or more compared to contralateral side

Seen primarily in baseball athletes and overhead throwing. Huge difference in dominant vs. non dominant hand

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54
Q

Factors in shoulder overuse injuries

A

Impingement
RTC tears
SLAP tears

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55
Q

Causes of GIRD

A

Humeral retroversion (so sits more posterior in GHJ)
Throwing causes ER torque
Humeral head sits posteriorly on glenoid

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56
Q

GIRD measurements

A 
Total motion
ER + IR= total motion
>5 degree loss in total motion
Increase risk of injury
Greater number of lost games
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57
Q

Causes of serratus anterior weakness

A

Long thoracic nerve palsy

Disuse

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58
Q

Scapular winging in flexion

A

Because serratus anterior is not holding scapula

  • could be because pec minor internally rotates the scapula from the front and if it’s stronger than the serratus then winging will occur
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59
Q

Causes of upper trap weakness

A 
Spinal accessory nerve palsy (SNAP) 
Positives scapular flip
Trapezius atrophy
Depressed scapula
Trap weakness
Limited shoulder abduction
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60
Q

Patient has weakness in shoulder flexion, which muscle is it?

A

Serratus anterior

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61
Q

Serratus anterior vs. trapezius weakness

A

Winging vs. flipping out

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62
Q

Upper trapezius weakness

A

Cannot abduct
Downwardly rotate and scapula flips out
Check medial border of scapula to see the downward rotation

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63
Q

Upper trapezius overuse

A

Decrease upward rotation of scapula

Increase shoulder impingement

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64
Q

Causes of rotator cuff weakness

A 
Overuse
Surgery
Disuse
Injury
C5 rediculopathy
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65
Q

Rotator cuff weakness signs

A

Shoulder hike, cannot ER so cannot abduct

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67
Q

To abduct the arm you must:

A

Externally rotate the arm

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68
Q

Shoulder subluxation

A

no deltoid or RC
upper trap atrophy
posture is #1

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69
Q

How can we improve shoulder subluxation

A

muscle strength
posture
upper trap
RC muscles

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70
Q

The elbow complex

A
  • designed to improve mobility for the hand in space
  • provide stability for the hand during forceful movements
  • consists of elbow joint (humeroulnar or humeroradial) and proximal and distal radioulnar joints
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71
Q

The elbow joint

A
  • compound joint; modified or loose hinge joint

- functions as a modified or loose hinge joint

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72
Q

how many degrees of freedom is the elbow joint

A

1 degree of freedom

  • flexion and extension in the sagittal plane
  • slight axial rotation and side to side motion of the ulna during flexion and extension: therefore a modified or loose hinge joint
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73
Q

In what position is the elbow joint close packed?

A
  • extension
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74
Q

close packed position

A

bones and ligaments and position of least mobility

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75
Q

open packed position

A

bones and ligaments are in most mobile position

- The more swelling in a capsule, the more you want the joint to be in open packed position

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76
Q

What kind of joint is the radius when attached to the humerus?

A

spin joint so we can pronate and supinate

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77
Q

Elbow in flexion

A
  • has a larger surface area to provide joint surfaces and more stability in weight bearing
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78
Q

Elbow joint capsule

A
  • single joint capsule for 3 joints
  • capsule fairly loose and weak anteriorly and posteriorly
  • Reinforced with ligaments medially and laterally
  • in flexion and extension bone sits really well but not side to side
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79
Q

most common side for baseball injury in the elbow

A

medially

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80
Q

elbow joint medial ligaments

A
  • flexors on medial side to stabilize
  • proximal MCL fused with common flexor tendon
  • limits extension at end range
  • guides joint motion throughout flexion
  • provides some resistance to longitudinal distraction
  • pronation
  • Main restraint 20-120 degrees; not 20-0 because bony component takes over
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81
Q

primary restraint of valgus stress on elbow

A

anterior MCL at 20-120 degrees of elbow flexion

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82
Q

valgus stress test

A

put elbow in valgus by moving forearm laterally
get more joint play MCL; wrist flexors resist
in 30 degrees flexion

A lot of motion damages the ligaments

83
Q

varus stress test

A

move forearm medial, test LCL
wrist extensors resist
in 30 degrees flexion

A lot of motion damages ligaments

84
Q

Elbow joint lateral ligaments

A
  • LCL fused with common extensor tendon
  • stabilizes against varus stress and combined varus and supination stress
  • reinforces humeroradial joint
  • stabilizes radial head
  • secure ulna to humerus
85
Q

Muscles on anterior aspect of the elbow: flexors

A 
brachialis
biceps brachii
brachioradialis
supinator teres
pronator teres
flexor carpi radialis
flexor carpi ulnaris
flexor digitorum superficialis
palmaris longus
86
Q

muscles on posterior aspect of elbow: extensors

A 
triceps brachii
anconeus
supinator teres
pronator teres
extensor carpi radialis longus
extensor carpi radialis brevis
extensor carpi ulnaris
extensor digitorum communis
extensor digiti minimi
87
Q

Elbow joint:

function- axis of motion

A

slight angle; not as fixed as previously thought
AoR is important so you know joint movement and angles by which they move.
Want to do ROM in the direction it should be done

88
Q

Carrying angle

A
  • cubitus valgus
  • in anatomical position
  • caused by configuration of articulating surfaces
  • normal 10-15 degrees
  • females> males
  • at 30 degrees of flexion, the carrying angle disappears
  • benefit is you can carry heavy things without hitting the legs
89
Q

More PROM of the elbow because

A

of assistance, don’t activate biceps and soft issue approximation won’t stop you so soon

90
Q

The amount of range of motion available at the elbow depends on

A
  • type of motion (active or passive): AROM flexion 135-145 degrees, PROM flexion 150-160
  • Position of forearm (supination and pronation): if arm pronated earlier, stop because radius is over ulna
  • BMI
  • position of shoulder (2 joint muscle): i.e triceps
  • Swelling: stays within capsule
91
Q

Capsule

A
  • holds joints together
  • lubricates inner layer
  • holds fluid in joint
  • crucial
  • stretched ballon can be manipulated, if swollen capsule is distended and can’t be moved
  • -> in open packed, won’t get full ROM
92
Q

Elbow joint 2 functions

A

stability
mobility
muscle action

93
Q

elbow joint stability

A
  • full ext: close packed
  • bony contacts
  • MCL prevents valgus stress/force
  • LCL prevents varus stress/force
  • The joint capsule’s ability to prevent varus and valgus stress depends on elbow position: better in full extension
  • open packed: less stability from capsule, greater stability from ligaments
  • Co- contraction of flexor and extensor muscles of the wrist and elbow help to provide stability
94
Q

Elbow joint: brachialis

A
  • flexor- use most
  • one joint muscle
  • A mobility muscle: allow for movement
  • 3rd class lever; mechanically insufficient in concentric contraction
  • large physiological cross sectional area (PCSA)
  • moment arm greatest at 100 degrees flexion
  • unaffected by forearm position because attaches to ulna
  • active during all types of contractions and speeds
95
Q

Elbow joint: biceps brachii

A
  • flexor
  • 2 joint muscle
  • a mobility muscle
  • long head has the largest volume amongst the flexors (can get big)
  • relatively small PCSA
  • M.A is greatest between 80-100 degrees flexion
  • affected by shoulder and forearm position: helps in supination
  • activation depend on forearm position and magnitude of resistance
  • in pure pronation, can’t produce most power because it supinate
96
Q

When flexing you start with which muscle

A

brachialis

if need alot of force–> biceps brachii

97
Q

Why do you sometimes get shoulder extension when carrying stuff?

A

because if bending and not at optimal length tension, won’t produce enough force

98
Q

elbow joint: brachioradialis

A
  • flexor
  • 1 joint muscle
  • compression: ALOT
  • small PCSA
  • M.A greatest at 100-120 degrees of flexion
  • Affected by forearm positions an types of contractions; contracting have more stability
  • helps stabilize the joint
99
Q

Elbow joint: triceps brachii

A
  • extensor
  • 2 joint muscle and 1 joint muscle
  • small PCSA
  • maximum isometric torque produced at 90 degrees of flexion
  • not affect by forearm positions: attaches right to olecranon
  • synergist during supination when biceps brachii is active
100
Q

Why are the triceps a synergist during supination when biceps are active

A

because when you need a lot of force to supinate when use biceps you get supination and flexion. Triceps will limit that flexion

101
Q

Proximal radioulnar joint

A

uniaxial pivot joint
annular ligament- rotates
Quadrate ligament- stays in position

102
Q

distal radioulnar joint

A

interosseous membrane

dorsal and palmar radioulnar ligaments

103
Q

what does interosseous membrane do?

A

helps transfer force through ulna
from radius to ulna
increased risk of damage when you condense force to small area

104
Q

Radioulnar joint range of motion

A
  • longitudinal axis
  • total of 150 degrees ROM
  • measure at 90 degrees of elbow flexion to distinguish between radioulnar joint motion and shoulder rotation
105
Q

pronation of radioulnar joint limited by

A

bony approximation
tension dorsal radioulnar ligament
posterior fibers of MCL in elbow
At extension, may be tension in biceps

106
Q

supination of radioulnar joint limited by

A

passive tension of palmar radioulnar ligament and oblique cord

107
Q

Radioulnar joint supination

A

supinator always active and biceps when increasing the force

108
Q

radioulnar joint pronation

A

pronator quadratus always active, pronator teres always flex elbow

109
Q

Function of elbow complex

A
  • to accomplish most simple tasks
  • -> 30-130 degrees of flexion
  • -> 50 degrees of pronation to 50 degrees of supination

Use telephone: requires large arc flexion and sup/pro

110
Q

elbow complex relationship to hand and wrist

A
  • radioulnar joint provides mobility to the hand but then sacrifice stability
  • The forearm is therefore not a stable base for attachment of hand and wrist muscles
  • Many of those muscles therefore attach to distal end of humerus
  • These muscles provide stability (compression) to the elbow joint
  • wrist muscles not really affected by forearm position
111
Q

Elbow complex and age

A
  • decreased muscle strength with increased age

- elderly also more severe errors in judgement about the amount of effort needed to accomplish motor task

112
Q

Injuries to elbow complex

A
  • injuries fairly common
  • compression injuries (bony contact)
    • bony failure when landing on extended elbow. forcing bone together will crack
113
Q

Forceful muscle contraction injuries in the elbow

A
  • high compression- such as in baseball
  • nerve compression (ulnar nerve compressed n the cubital tunnel by flexor carpi ulnaris)
    • cubital tunnel syndrome
  • more contraction, more compression, jam cartilage which doesn’t heal if damaged
114
Q

Distraction injuries in the elbow

A
  • radial head pulled out of the annular ligament in elbow extension and pronation
115
Q

varus and valgus injuries in the elbow

A
  • distraction medially will cause compression laterally

- avascular necrosis of compressed surface (capitulum of radial head)

116
Q

medial epicondylitis or tendinopathy

A

golfers elbow

117
Q

lateral epicondylities or tendinopathy

A

tennis elbow

118
Q

2 joints of wrist

A

Radiocarpal

Midcarpal

119
Q

What is good about having 2 joints at the wrist

A

Larger ROM with less articular surface exposed

Flatter joint surfaces that can tolerate more pressure

120
Q

Wrist circumduction is a combo of what

A

Flexion
Extension
Radial and ulnar deviation

121
Q

Wrist flexion normal range

A

65-85

122
Q

Wrist extension normal range

A

60-85

123
Q

Wrist radial deviation normal value

A

15-21

124
Q

Wrist ulnar deviation normal value

A

20-45

125
Q

Proximal segment of Radiocarpal joint

A

Concave

Radius and radioulnar disc

126
Q

Distal segment of radiocarpal joint

A

Convex

Scaphoid, lunate, triquetrium

127
Q

How much is the proximal radiocarpal joint angled

A

Volarly 11 degrees

Ulnarly 23 degrees

128
Q

Why is the proximal radiocarpal joint incongruent

A

Contact surface between 20-40% of the surfaces

129
Q

Proximal radiocarpal joint allows for which movements

A

Flex>ext

Ulnar deviation >radial deviation

130
Q

Compression in wrist

A

80%of load in scaphoid, lunate ( 60% contact with scaphoid, and 40% lunate)
TFCC: 20%

131
Q

Why is having an ulna the same length as the radius bad?

A

Ulnar positive variance: more weight bearing in ulna!

132
Q

FOOSH

A

Fall on outstretched hand

  • dorsal displacement of ulna
  • fracture of distal radius
  • most common is colles
  • in pronation and dorsiflexion
133
Q

Proximal midcarpal joint

A

Scaphoid
Lunate
Triquetrium

134
Q

Distal midcarpal joint

A

Trapezium
Trapezoid
Capitate
Hamate

135
Q

Extrinsic wrist ligaments

A

Connect carpals to radius and ulna

Weaker but better potential for healing

136
Q

Intrinsic wrist ligaments

A

Interconnect the carpals
Stronger but have to rely on synovial fluid for nutrition
- no bld flow for nutrition

137
Q

Wrist flexion and extension

A 
Complex and varied
Difficulty determining where AoR is 
- affects goniometry
Closed packed in extension
1st capitate moves, then scaphoid, then lunate
138
Q

Why is closed packed wrist extension good?

A

That is how we weight bear

139
Q

Wrist radial and ulnar deviation

A

Complex and varied

Full radial deviation is closed packed position for radiocarpal and midcarpal joints

140
Q

How much wrist motion do ADLs requiring the hand need?

A

Minimal requirements
10 degrees flexion, 35 degrees extension (so flexors are in optimal to grip)
54 degrees flex, 60 degrees ext, 40 degrees UD,17 degrees RD

Consensus is that wrist extension and ulnar deviation is most important

For fusion: use 20 degrees extension and 10 degrees UD

141
Q

Primary role of wrist muscles

A
  • Provide stable base for hand
  • while adjusting position to achieve optimal length tension relationship in the long finger muscles

*if wrist injury and cannot bend, may accommodate with a wider grip so they can hold things

142
Q

Primary volar wrist muscles

A

Palmaris longus
Flexor carpi radialis
Flexor carpi ulnaris

143
Q

Which volar muscles work together during flexion to avoid deviation?

A

FCU

FCR

144
Q

In what percentage of people is the palmaris longus absent?

A

14%

145
Q

How is the moment arm increased in the volar side of the wrist?

A

FCU envelopes the pisiform

Pisiform sits on the triquetrium

146
Q

If you have carpal tunnel what is cut to correct it?

A

Flexor retinaculum

147
Q

Primary dorsal wrist muscles

A

Extensor carpi ulnaris
Extensor carpi radialis longus
Extensor carpi radialis brevis

148
Q

What muscles work together during wrist extension to avoid deviation

A

ECU
ECRL
ECRB

149
Q

How is the extensor carpi ulnaris affected by forearm position?

A

Decreased moment arm in pronation

In supination, you extend and ulnarly deviate which is when the wrist is strong

150
Q

Which muscles pair in wrist flexion

A

FCR

FCU

151
Q

Which muscles pair in wrist extension

A

ECRL
ECRB
ECU

152
Q

Which muscles pair in wrist radial deviation

A

FCR
ECRL
ECRB

153
Q

Which muscles pair in ulnar deviation

A

ECU

FCU

154
Q

The carpal tunnel

A
  • Proximal transverse arch- persists even when hand fully opened
  • transverse carpal ligament between the hook of hamate/ pisiform, and scaphoid/ trapezium
  • contains median nerve, and extrinsic flexor tendons
155
Q

Where the transverse carpal ligament span?

A

Between hook of hamate/ pisiform

Between scaphoid/ trapezium

156
Q

Carpal tunnel syndrome

A

Long term median nerve compression can lead to atrophy of the median nerve innervated by muscles in the thenar eminence

  • “ape hand”
  • cannot get full opposition
157
Q

Joints of the hand

A

CMC
MCP
PIP
DIP

158
Q

How many bones are in the hand

A

19

159
Q

How many joints are in the hand distal to the carpals?

A

19

160
Q

CMC of the finger

A
  • Distal carpal row and bases of metacarpals
  • 2nd and 3rd have minimal mobility; provide stable base
  • 4th has perceptible flex/ext
  • 5th has 2 df; flex/ext, add/abd
161
Q

MCP Joint of the hand

A
  • convex metacarpal
  • concave base of phalanx
  • condyloid with 2df; flex/ext, abd/add
  • metacarpal head has 180 degrees of articular surface, mainly volarly
  • phalanx has 20 degrees of articulating surface
  • less articulating surface in frontal plane
  • cannot abduct/ addict MCP when flexed
162
Q

MCP of fingers

A
  • capsule lax in extension
  • 2 collateral ligaments
  • volar plate enhances stability; in ext protects joint surface
    - protects articulating surface
    - blend with deep transverse metacarpal ligaments
163
Q

What keeps FDP and FDS close to the bone?

A

Pulleys

- bones aren’t very close together in order to have movement

164
Q

Closed packed position of MCP joints of finger

A

Full flexion

Collateral ligaments taut

165
Q

How does flexion of the MCP joints of the finger increase?

A

Radially to ulnarly

  • index finger: 90 degrees flexion
  • little finger: 110 degrees flexion
166
Q

How does hyper extension of MCP joint vary between fingers?

A

It doesn’t, it’s the same between fingers

Varies among individuals

167
Q

When is abd/add of the MCP joints at a max?

A

At full extension

168
Q

IP joints of fingers

A
  • true synovial hinge
  • 1df; flex/ ext with very little hyperextension
  • proximal joint surface has 2 shallow concave facets with a central ridge
169
Q

PIP flexion vs DIP flexion, which is more

A

PIP

170
Q

Which PIP and DIP have the greatest ROM?

A

Increased ROM achieved ulnarly

5th DIP and PIP have the most

171
Q

IP joints of fingers favor angulation toward which bone?

A

Scaphoid- facilitates opposition of fingers with thumb

172
Q

Anti-deformity positioning of the hand

A
  • immobilization in a position that will minimize contractures
  • MCP flexion
  • IP joints more in extension
  • thumb in CMC abduction

*open packed position so that tissues are not stretched and won’t cause a contracture

173
Q

Extrinsic finger flexors

A

FDS
FDP

  • both muscles dependent on wrist position for optimal length tension relationship
174
Q

FDS

A
  • attaches proximal to DIP joint
  • flex PIP joint
  • assist in MCP flexion
  • greater moment arm at the MCP but lesser at PIP
  • used when greater force necessary or during wrist flexion ( with active insufficiency of FDP)
175
Q

FDP

A
  • flexes DIP,PIP, and MCP

- primary muscles with gentle pinch

176
Q

When FDS is not present, what happens when you forcefully press the thumb and finger tip together?

A

Produces DIP flexion with PIP extension

FDP not able to flex both joints

177
Q

Finger flexion grip

A
  • pistol grip
  • wider ulnarly
  • longer flexors of digits 4-5 will not have to flex as much which minimizes loss of tension
  • not a concern with light grip then shape accommodates the greater flexion range
178
Q

Mechanisms of finger flexors

A
  • long tendons of finger flexors needs to glide smoothly and stay close to hand
    • flexor retinaculum
    • bursae
    • digital tendon sheet
179
Q

Extrinsic finger extensors

A

Extensor digitorum
Extensor indicis
Extensor digiti minimi

  • only muscles able to perform MCP extension
  • also perform wrist extension
180
Q

What does the extensor digitorum tendon split into

A

Central tendon

Lateral bands distal to PIP

181
Q

Extensor mechanism

A
  • ED passes dorsal to MCP joint axis
  • ED contracts
  • tension on extensor hood cause MCP joint extension
  • PIP and DIP flexion due to passive tension in FDS and FDP
  • need intrinsic muscle assistance to also achieve DIP and PIP ext
182
Q

Intrinsic finger musclse

A

Dorsal and Volar interossei

Lumbricals

183
Q

Dorsal and Volar interossei

A
  • Arise from between metacarpals
  • Attach to the extensor hood and lateral bands
  • Important for extensor mechanism
  • Just volar to the MCP joint axis
  • Compress MCP joint when in extension- helps prevent clawing (MCP hyperextension)
  • Performs finger add/abd of fingers when MCP in ext
184
Q

Dorsal and Volar interossei have a greater moment arm when?

A
  • In MCP joint flexion greater moment arm and therefore produce greater flexion torque at MCP
185
Q

Where do the dorsal and volar interossei attach

A

to central tendon and lateral bands and therefore produces DIP and PIP extension (together)

186
Q

When are interossei consistently active

A

with MCP flexion

with PIP and DIP extension

187
Q

Lumbricals

A
  • attaches at both ends to tendons of other muscles; so not pulling on bone.
  • FDP and lateral bands of the extensor mechanism
  • Contraction causes PIP and DIP extension while decreasing tension in FDP tendon (decreased passive flexion force)
  • IP extensors regardless of MCP joint position
  • Hood helps with extension by decreasing resistance
188
Q

Loss of intrinsic: Clawing

A

splint to keep MCP in flexion so that the EDC can cause PIP and DIP extension without the intrinsic muscles
- the flexor tendon not as tight, still get pull

189
Q

If fingers are hypermobile then what happens?

A

able to hyperextend the PIP and then able to only flex DIP

190
Q

Intrinsic plus position of fingers

A

looks like holding wood with lumbricals

191
Q

intrinsic minus position of fingers

A

look like claw, can’t use intrinsic muscles

192
Q

Boutonniere deformity

A

ruptured central tendon

finger stuck up and curved

193
Q

SWan’s neck deformity

A

DIP look curved up like neck

hyperextend PIP

194
Q

Thumb CMC

A

trapeziometacarpal joint

  • saddle joint
  • 2 df
  • flex/ext and add/abd
  • can perform opposition: tip of thumb can oppose tip of fingers
  • Capsule relative lax but reinforced with ligaments
  • can’t hold cup without ligaments
195
Q

Thumb MCP

A

condyloid joint
2 df
less ROM compared to fingers
sesamoid bones on volar surface increase m.a

196
Q

thumb IP

A

identical to the fingers IP joints

197
Q

extrinsic thumb muscles

A 
FPL flexor and located volarly
EPB, EPL, APL are dorsally
EPL attaches to base of distal phalanx
EPB attaches to proximal phalanx
APL attaches to base of metacarpal
since multi joint- affected by wrist position
198
Q

Intrinsic thumb muscles

A
  • five thenar muscles
  • OP, APB, FPB, AP, 1st dorsal interossei
  • 1st dorsal interossi is bipennate arising from metacarpal 1 and 2
199
Q

Power grip

A

full hand prehension

200
Q

Precision handling

A

finger thumb prehension

201
Q

Power grip- grasps (4)

A

cylindrical
spherical
hook grip
lateral prehension: abd/add

202
Q

precision handling- pinch

A

pad to pad: do not need DIP flexion
Tip to tip prehension
pad to side prehension (lateral pinch)

203
Q

Pistol grip

A

Ring and little finger long flexors shorten over > range
Results in loss of tension
If object heavy, it is wider ulnarly
Limits MCP/IP flex while wrist ext stabilize wrist against strong contraction
If a gentle grip is necessary, object may be thinner ulnarly like a wine glass

Kinesiology (3 decks)

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