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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
Radio-carpal joint articulation and movements:
- condyloid joint between radius and carpal bones (scaphoid, lunate, triquetrum) - flexion, extension, deviation - ulnocarpal joint is continuous with radio-carpal joint
26
Distal radio-ulnar joint articulation and movements:
- pivot joint between ulna and radius | - pronation and supination
27
ROM at wrist:
- flexion/extension - radial deviation/ulnar deviation - pronation/supination
28
ROM of D2-D5:
- flexion/extension/hyper-extension - abduction - adduction
29
ROM of D1:
- abduction - adduction - extension - flexion - opposition - reposition
30
Wrist joint capsule:
- thin capsule that is continuous with the joint - many folds - laxity
31
Observation of swelling at wrist capsule:
- intracapsular (capsular) swelling | - structures inside the capsule
32
Mobility at wrist is a sum of glides of the joint:
- radiocarpal joint - midcarpal joints - intercarpal joints - carpometacarpal joints
33
Wrist joint IOS bony implications:
- consider pain in ROM - flex/extension - radial or ulnar deviation
34
Fibrocartilage at ulnocarpal joint:
- involves distal end of ulna - articulates with the TFCC which articulates with carpal bones (lunate and triquetrum) - articulates in ulnar deviation
35
Triangular fibrocartilage complex (TFCC):
- articular disc purpose - increase wrist joint stability - load transmission and load absorption - involves ulnocarpal joint (articulates in ulnar deviation)
36
Tear of TFCC:
- from lunate and triquetrum through the ulnocarpal ligaments - graded tears - pain in ROM - decrease in joint stability
37
3 key ligaments at the wrist joint:
- radial collateral ligament - ulnar collateral ligament - the web of ligaments
38
Radial collateral ligament at wrist joint:
- from styloid process of radius to radial side of scaphoid - in relation with radial artery - limits ulnar deviation
39
Ulnar collateral ligament at wrist joint:
- from styloid process of ulna and divides to triquetral bone, pisiform and flexor retinaculum - limits radial deviation
40
The web of ligaments at wrist joint:
- mid-carpal and inter-carpal joints | - MTP joints
41
Digits = _____ joints at _____ and _____.
- hinge - metacarpals - phalanges
42
Metacarpal-phalangeal (MCP) joints and ROM:
- 1-5 | - flex, ext, abd, add
43
Proximal and distal interphalangeal joints of each digit (DIP/PIP): ROM:
flex, extension
44
Stability of digit joints:
- joint capsule - ligaments - tendinous attachments
45
2 nerves of wrist and hand:
- median nerve | - ulnar nerve
46
Median nerve and flexor tendons travel through ____ _____.
carpal tunnel
47
Carpal tunnel is comprised of:
- carpal bones | - transverse carpal ligament (palm side)
48
Ulnar nerve passes through _____ ____.
Gyron's Canal
49
Gyron's Canal is comprised of:
- pisiform | - hamate
50
Nerves of the wrist and hand are subject to constant ____ and _____ due to...
- bending - straightening - wrist flex/ext
51
Radial artery:
- bifurcation of brachial artery in cubital fossa | - runs on anterior forearm, passing through anatomical snuffbox
52
Ulnar artery:
arises from brachial artery and terminates in superficial palmar arch
53
Circulation:
- colour of hand, fingers | - arterial insufficiency to fingers
54
Additional subjective assessment questions for elbow, wrist, and hand in personal history:
age, growth plates in youth, inflammation (> 35 years)
55
Additional subjective assessment questions for elbow, wrist, and hand in activity history:
- dominant hand (function, ADL, fine motor skills, grip, ROM) - demands of activity (changes in technique, occupational requirements, loads, changes to FITT, overuse)
56
Additional subjective assessment questions for elbow, wrist, and hand in injury history:
- MOI: acute vs chronic, repetitive MOI, traumatic, insidious, load or traction mechanism - pain - unusual sounds: grating, clicking, cracking
57
Pain questions for elbow, wrist, and hand:
- 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
____ and _____ forces during throwing can cause injury.
- compressive | - tensile
59
Nursemaid's elbow MOI:
- tensile forces - force causes radial head to subluxate from anular ligament - lump caused by displaced head of radius - muscle pulls radial head superiorly
60
Additional global observations of elbow, wrist and hand:
- 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
Additional local observations of elbow, wrist and hand:
- swelling type: capsular (intracapsular) or discrete (extracapsular) - alignment and symmetry (posture and positioning)
62
Influences of carrying angle:
- 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
Observe and palpate an equilateral triangle formed by_______ and _____:
- olecranon - epicondyles - forms a line in extension - forms a triangle in flexion - will be distorted in dislocations or fractures
64
Alignment (posture) of the hands and fingers includes:
- joint positions - soft tissue nodules - observe digits in ROM - appearance and joint postures
65
Joint positions of hands and fingers consists of...
- digit alignment | - joint alignment (eg. MCP joint levels)
66
Soft tissue of hands and fingers consists of...
- asymmetry - hypertrophy - atrophy
67
Nodules consists of...
- joint formation | - bony formation
68
PIP in flexion and DIP in extension means:
injury of the extensor tendon (hood) from middle phalanx (boutonniere deformity)
69
DIP remains in flexion when the finger is extended means:
injury of the extensor tendon from distal phalanx rupture or avulsion (mallet finger)
70
DIP remains in extension means:
injury of flexor digitorum profundus tendon (jersey sign)
71
Observe colour/circulation consists of:
- colour of fingers (pale, white, blanched) - arterial insufficiency to hand and fingers - pulse, capillary refill
72
Lateral epicondylitis special test:
- resisted wrist extension | - passive wrist flexion
73
Medial epicondylitis special test:
- resisted wrist flexion | - passive wrist extension
74
ROM wrist flexion tests for
lunate
75
ROM wrist deviation tests for:
- radial (scaphoid) | - ulnar (TFCC)
76
Tinel's sign (tap test):
- assess neurological dysfunction by tap area of nerve | - unusual sensation (tingling) distal to point of nerve compression
77
Tinel's sign for ulnar nerve is where?
between the olecranon process and medial epicondyle
78
Tinel's sign for median nerve is where?
palmar aspect of carpal transverse arch
79
Phalen's test:
- joint position of maximal flexion or extensions to assess neurovascular involvement - painful, numbness/circulation - IE median nerve in carpal tunnel syndrome
80
Finkelstein test:
- 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
Functional tests at elbow, wrist, hand, fingers: load at the joint:
- lift off - push off - push up - pull - grip
82
Functional tests at elbow, wrist, hand, fingers: evaluating for:
- pain - unusual sounds or sensations - strength
83
How to assess grip:
- perform a number of functionally relative movements as required by ADL, job, activity, sport - assessment of strength (grade / 5, bilaterally compare)
84
Carpal bones:
- scaphoid - lunate - triquetrum - pisiform - trapezium - trapezoid - capitate - hamate
85
Common injuries to the elbow, wrist and hand:
- 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
Rehab: overuse conditions require ...
- identification of cause - correction - muscle re-education
87
Interplay between the elbow pain and dysfunction/imbalance in the remainder of the ____ ____.
upper quadrant
88
______ strengthening exercise for tendonitis.
eccentric
89
Time required for settling of ____ ____ related problems.
chronic tendon
90
Aggressive ROM exercise following _____.
immobilization
91
____ ____ and ____ ____ ____ are employed to strengthen muscles.
- functional activities | - progressive resistive exercises
92
Fine motor skills of hand:
- grip | - pinch
93
Neuro conditions require identification of _____, and role of ____ _____ considered.
- cause | - protective equipment
94
Joint mobility improvement aligned with joint _____ ____ - tissue response to ____.
- stability healing | - trauma

KIN 440 (10 decks)

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