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KIN 440 > The Elbow, Wrist & Hand > Flashcards

The Elbow, Wrist & Hand Flashcards

1
Q

Functional movements of elbow, wrist and hand:

A
  • large role in ADL

- fine motor skills for activity or work

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2
Q

What type of injuries are the elbow, wrist and hand subject to?

A
  • vulnerable to both repetitive stress and to traumatic injury
  • arthritis, tendonitis
  • trauma: FOOSH, instinctively shield upper body from a fall or face contact
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3
Q

Grip:

A
  • dexterity

- injury result in loss of function of fine dexterity motor skill

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4
Q

Elbow joint =

A

humeroulnar joint + humeroradial joint + proximal radioulnar joint

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5
Q

Humeroulnar joint articulations and movements:

A
  • hinge joint
  • between ulna and humerus
  • flexion, extension
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6
Q

Humeroradial joint articulations and movement:

A
  • pivot-hinge joint
  • between head of radius and capitulum of humerus
  • flexion, extension, rotation
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7
Q

Proximal radioulnar joint articulations and movement:

A
  • pivot joint
  • between head of radius to radial notch of ulna
  • rotation
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8
Q

Supination, pronation normal ROM:

A

75-90 degrees

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9
Q

Elbow flexion, extension normal ROM:

A

150 degrees

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10
Q

Elbow joint capsule is highly ______ (_____ linking).

A
  • innervated

- neurological

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11
Q

Bursa at elbow:

A
  • olecranon
  • extracapsular
  • identify pain in ROMs
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12
Q

Ligaments at elbow are _____.

A

intracapsular

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13
Q

3 ligaments at the elbow:

A
  • medial (ulnar) collateral ligament
  • lateral (radial) collateral ligament
  • annular ligament
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14
Q

Medial (ulnar) collateral ligament is where:

A

from medial epicondyle humerus to coronoid process and olecranon

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15
Q

Lateral (radial) collateral ligament is where:

A

from lateral epicondyle to annular ligament

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16
Q

Annular ligament is where:

A

encircles head of radius at radial notch of ulna

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17
Q

2 important neurovascular structures at the elbow:

A
  • ulnar nerve

- brachial artery

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18
Q

Ulnar nerve:

A
  • largest unprotected nerve from brachial plexus
  • innervates into palm of hand and 4/5 digits
  • tap test
  • injury with UCL
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19
Q

Brachial artery:

A

branches to joint

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20
Q

Open chain exercises:

A

a system in which the furthermost end (the distal end) is free to move and unconstrained

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21
Q

Ex. of open chain exercises:

A
  • LE seated knee extension

- UE throwing

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22
Q

Closed chain exercises:

A

a system when the distal end is fixed whereby it cannot move during the execution without involving another chain

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23
Q

Ex. of closed chain exercises:

A
  • LE squats

- UE horizontal bench exercises

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24
Q

Wrist joints includes:

A
  • radio-carpal joint
  • distal radio-ulnar joint
  • midcarpal joints
  • intercarpal joints
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25
Q

Radio-carpal joint articulation and movements:

A
  • condyloid joint between radius and carpal bones (scaphoid, lunate, triquetrum)
  • flexion, extension, deviation
  • ulnocarpal joint is continuous with radio-carpal joint
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26
Q

Distal radio-ulnar joint articulation and movements:

A
  • pivot joint between ulna and radius

- pronation and supination

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27
Q

ROM at wrist:

A
  • flexion/extension
  • radial deviation/ulnar deviation
  • pronation/supination
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28
Q

ROM of D2-D5:

A
  • flexion/extension/hyper-extension
  • abduction
  • adduction
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29
Q

ROM of D1:

A
  • abduction
  • adduction
  • extension
  • flexion
  • opposition
  • reposition
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30
Q

Wrist joint capsule:

A
  • thin capsule that is continuous with the joint
  • many folds
  • laxity
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31
Q

Observation of swelling at wrist capsule:

A
  • intracapsular (capsular) swelling

- structures inside the capsule

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32
Q

Mobility at wrist is a sum of glides of the joint:

A
  • radiocarpal joint
  • midcarpal joints
  • intercarpal joints
  • carpometacarpal joints
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33
Q

Wrist joint IOS bony implications:

A
  • consider pain in ROM
  • flex/extension
  • radial or ulnar deviation
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34
Q

Fibrocartilage at ulnocarpal joint:

A
  • involves distal end of ulna
  • articulates with the TFCC which articulates with carpal bones (lunate and triquetrum)
  • articulates in ulnar deviation
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35
Q

Triangular fibrocartilage complex (TFCC):

A
  • articular disc purpose
  • increase wrist joint stability
  • load transmission and load absorption
  • involves ulnocarpal joint (articulates in ulnar deviation)
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36
Q

Tear of TFCC:

A
  • from lunate and triquetrum through the ulnocarpal ligaments
  • graded tears
  • pain in ROM
  • decrease in joint stability
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37
Q

3 key ligaments at the wrist joint:

A
  • radial collateral ligament
  • ulnar collateral ligament
  • the web of ligaments
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38
Q

Radial collateral ligament at wrist joint:

A
  • from styloid process of radius to radial side of scaphoid
  • in relation with radial artery
  • limits ulnar deviation
39
Q

Ulnar collateral ligament at wrist joint:

A
  • from styloid process of ulna and divides to triquetral bone, pisiform and flexor retinaculum
  • limits radial deviation
40
Q

The web of ligaments at wrist joint:

A
  • mid-carpal and inter-carpal joints

- MTP joints

41
Q

Digits = _____ joints at _____ and _____.

A
  • hinge
  • metacarpals
  • phalanges
42
Q

Metacarpal-phalangeal (MCP) joints and ROM:

A
  • 1-5

- flex, ext, abd, add

43
Q

Proximal and distal interphalangeal joints of each digit (DIP/PIP): ROM:

A

flex, extension

44
Q

Stability of digit joints:

A
  • joint capsule
  • ligaments
  • tendinous attachments
45
Q

2 nerves of wrist and hand:

A
  • median nerve

- ulnar nerve

46
Q

Median nerve and flexor tendons travel through ____ _____.

A

carpal tunnel

47
Q

Carpal tunnel is comprised of:

A
  • carpal bones

- transverse carpal ligament (palm side)

48
Q

Ulnar nerve passes through _____ ____.

A

Gyron’s Canal

49
Q

Gyron’s Canal is comprised of:

A
  • pisiform

- hamate

50
Q

Nerves of the wrist and hand are subject to constant ____ and _____ due to…

A
  • bending
  • straightening
  • wrist flex/ext
51
Q

Radial artery:

A
  • bifurcation of brachial artery in cubital fossa

- runs on anterior forearm, passing through anatomical snuffbox

52
Q

Ulnar artery:

A

arises from brachial artery and terminates in superficial palmar arch

53
Q

Circulation:

A
  • colour of hand, fingers

- arterial insufficiency to fingers

54
Q

Additional subjective assessment questions for elbow, wrist, and hand in personal history:

A

age, growth plates in youth, inflammation (> 35 years)

55
Q

Additional subjective assessment questions for elbow, wrist, and hand in activity history:

A
  • dominant hand (function, ADL, fine motor skills, grip, ROM)
  • demands of activity (changes in technique, occupational requirements, loads, changes to FITT, overuse)
56
Q

Additional subjective assessment questions for elbow, wrist, and hand in injury history:

A
  • MOI: acute vs chronic, repetitive MOI, traumatic, insidious, load or traction mechanism
  • pain
  • unusual sounds: grating, clicking, cracking
57
Q

Pain questions for elbow, wrist, and hand:

A
  • changes in pain symptoms over time
  • pain in many joints
  • pain in a movement or in function
  • radiating and referred pain
  • unusual or abnormal sensations to hands, digits, shoulder, elbow, hand, fingers
  • changes to strength or coordination (motor)
58
Q

____ and _____ forces during throwing can cause injury.

A
  • compressive

- tensile

59
Q

Nursemaid’s elbow MOI:

A
  • tensile forces
  • force causes radial head to subluxate from anular ligament
  • lump caused by displaced head of radius
  • muscle pulls radial head superiorly
60
Q

Additional global observations of elbow, wrist and hand:

A
  • if insidious onset, observe full posture
  • at elbow: carrying angle, equilateral triangle
  • at wrist and hand: posture and positioning of joints or of fingers
61
Q

Additional local observations of elbow, wrist and hand:

A
  • swelling type: capsular (intracapsular) or discrete (extracapsular)
  • alignment and symmetry (posture and positioning)
62
Q

Influences of carrying angle:

A
  • the angle is greater in the dominant limb
  • influences how objects are held
  • more extreme angle = pronate to keep closer to body
  • angle varies through flexion and extension
63
Q

Observe and palpate an equilateral triangle formed by_______ and _____:

A
  • olecranon
  • epicondyles
  • forms a line in extension
  • forms a triangle in flexion
  • will be distorted in dislocations or fractures
64
Q

Alignment (posture) of the hands and fingers includes:

A
  • joint positions
  • soft tissue nodules
  • observe digits in ROM
  • appearance and joint postures
65
Q

Joint positions of hands and fingers consists of…

A
  • digit alignment

- joint alignment (eg. MCP joint levels)

66
Q

Soft tissue of hands and fingers consists of…

A
  • asymmetry
  • hypertrophy
  • atrophy
67
Q

Nodules consists of…

A
  • joint formation

- bony formation

68
Q

PIP in flexion and DIP in extension means:

A

injury of the extensor tendon (hood) from middle phalanx (boutonniere deformity)

69
Q

DIP remains in flexion when the finger is extended means:

A

injury of the extensor tendon from distal phalanx rupture or avulsion (mallet finger)

70
Q

DIP remains in extension means:

A

injury of flexor digitorum profundus tendon (jersey sign)

71
Q

Observe colour/circulation consists of:

A
  • colour of fingers (pale, white, blanched)
  • arterial insufficiency to hand and fingers
  • pulse, capillary refill
72
Q

Lateral epicondylitis special test:

A
  • resisted wrist extension

- passive wrist flexion

73
Q

Medial epicondylitis special test:

A
  • resisted wrist flexion

- passive wrist extension

74
Q

ROM wrist flexion tests for

A

lunate

75
Q

ROM wrist deviation tests for:

A
  • radial (scaphoid)

- ulnar (TFCC)

76
Q

Tinel’s sign (tap test):

A
  • assess neurological dysfunction by tap area of nerve

- unusual sensation (tingling) distal to point of nerve compression

77
Q

Tinel’s sign for ulnar nerve is where?

A

between the olecranon process and medial epicondyle

78
Q

Tinel’s sign for median nerve is where?

A

palmar aspect of carpal transverse arch

79
Q

Phalen’s test:

A
  • joint position of maximal flexion or extensions to assess neurovascular involvement
  • painful, numbness/circulation
  • IE median nerve in carpal tunnel syndrome
80
Q

Finkelstein test:

A
  • flexion of thumb with ulnar deviation of the wrist, actively or passively
  • pain over tendons of abductor pollicis longus and extensor pollicis brevis
  • IE tendonitis, tenosynovitis
81
Q

Functional tests at elbow, wrist, hand, fingers: load at the joint:

A
  • lift off
  • push off
  • push up
  • pull
  • grip
82
Q

Functional tests at elbow, wrist, hand, fingers: evaluating for:

A
  • pain
  • unusual sounds or sensations
  • strength
83
Q

How to assess grip:

A
  • perform a number of functionally relative movements as required by ADL, job, activity, sport
  • assessment of strength (grade / 5, bilaterally compare)
84
Q

Carpal bones:

A
  • scaphoid
  • lunate
  • triquetrum
  • pisiform
  • trapezium
  • trapezoid
  • capitate
  • hamate
85
Q

Common injuries to the elbow, wrist and hand:

A
  • contusions (myositis ossificans)
  • sprains (ligaments)
  • strains (musculature, tendon)
  • epicondylitis (lateral, medial)
  • nerve injury: ulnar, median (acute, chronic)
  • dislocation (elbow joint, radial head, carpal bones, DIP/PIP)
  • fractures
  • olecranon bursitis
86
Q

Rehab: overuse conditions require …

A
  • identification of cause
  • correction
  • muscle re-education
87
Q

Interplay between the elbow pain and dysfunction/imbalance in the remainder of the ____ ____.

A

upper quadrant

88
Q

______ strengthening exercise for tendonitis.

A

eccentric

89
Q

Time required for settling of ____ ____ related problems.

A

chronic tendon

90
Q

Aggressive ROM exercise following _____.

A

immobilization

91
Q

____ ____ and ____ ____ ____ are employed to strengthen muscles.

A
  • functional activities

- progressive resistive exercises

92
Q

Fine motor skills of hand:

A
  • grip

- pinch

93
Q

Neuro conditions require identification of _____, and role of ____ _____ considered.

A
  • cause

- protective equipment

94
Q

Joint mobility improvement aligned with joint _____ ____ - tissue response to ____.

A
  • stability healing

- trauma

KIN 440 (10 decks)

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