the wrist and hand Flashcards
what are the 8 carpel bones
scaphoid, lunate, triquetium, pisiform, trapezium, trapezoid, capitate, hamate
physiologic motion of the wrist
flexion and extension; radial and ulnar deviation
what kind of lever is the brachioradialis
type 2; elbow is the fucrum, load is the hand or the weight in the hand.
anconeus is not working properly what should you work on
quick motions of flexion and extension
why does radial deviation go less then ulnar deviation and why does ulnar deviation have a soft end feel
radial styloid process extends further then the ulnar styloid process and their is a menisci on the ulnar side that gives a softer end feel
medial mass muscles
pronator teres and the wrist flexors
lateral mass muscles
supinator and the wrist extensors
what position is the ulnar nerve stretched (tension)
in elbow flexion
what position is the radial and median nerve stretched (tension)
in extension
when do most neuro problems start to happen?
once the plexus leaves the axilla
common sites of nerve entrapments
ulnar at the cubital tunnel (funny bone)
medial at the pronator and supinator (anterior portion of the forearm)
radial at the superior and supracondylar ridge extensor carpi radialis and brachioradialis
what is a sign of a medial nerve entrapment?
a dip in the palm of the hand
what causes throwers elbow
repetitive valgus stress
little league elbow
stress on the growth plate of the medial humeral epicondyle
nursemaids elbow
a slip of the annular ligament caused by distraction elbow extension and pronation (can be fixed my quickly moving the arm in flexion and supination)
the “cock up muscles” for hand function
wirst extensors and finger flexors
what should PTs bias when working with elbows
flexion and supination
what is a sign of a radial nerve injury
wrist drop
what does ulnar deviation have more of when compared to radial deviation?
more mobility, less stability
more ROM
-this can leas to ulnar drift and chronic conditions of instability
the hand rule of 1/2
the thumb is 1/2 of hand function
sensation is 1/2 of hand function
how to stretch the triceps
arm by the ear with a flexed elbow
how to stretch the biceps
elbow extension and pronation behind the back
rheumatoid arthritis
eats away at the tendons and tendon shafts that lead to joint instability and ulnar drift
the articulations of the carpal bones compared to the elbow
week articulation
why are you unable to make a strong fist in wrist flexion
due to active insufficiency: the wrist flexors are too shortened and the myofiliments have nowhere to go
radial nerve palsy
paralysis of the wrist extensors from the lateral epicondyle; will need a splint to hold the hand in extension and hold a grasp
function of the hand
control and sensation
MP joint in the hand motions
flexion and extension
abduction and adduction
DIP joint motions
flexion and extension
digit alignment
when the fingers flex all together they will all point to the lunate without overlapping eachother
carpal metacarpal motions (opposible thumb)
abduction/adduction
flexion/extension
circumlocution
ligaments at the hand
collateral ligaments and transverse ligament across the hands of the finger metacarpals
CAM configerations
-loose pack postion allows for distraction and joint play with MP joint in extension
-mobility in extension due to axis of rotation being close to the proximal pharynx
-stability in flexion due to the axis of rotation being further away from the proximal pharynx
saddle joint (carpel/metacarpal)
flexion/extension: distal concave on convex
abduction and adduction: distal convex on concave
thenar crease
crease for thumb opposition
allows for us to easily find the CMC
need to split around the thenar crease to allow for thumb motion
distal and proximal palmer crease
allows for freedom the the MP joints
static split
split at distal palmer crease, allows for MP flexion
resting hand position splint (pismo clam)
-30 degrees of wrist extension
-80 degrees of MP flexion and full IP extension
-allows for cam ligaments to stay lengthened
-maintain the transverse arches
-thumb is opposed
intrinsic muscles of the hand
lumbricals and interossei
lumbricals
innervated by the median and ulnar nerve. action MP flexion and IP extension
Extrinsic thumb muscles
flexor pollicis longus, abductor pollicis longus, extensor pollicis longus and brevis
intrinsic thumb muscles
thenar eminence
muscles that help with grip
extrinsic- long finger flexors
intrinsic - abductions and opposable thumb
what goes through the carpal tunnel
median n, flexor tendons, transverse ligament
what goes through the dorsal tunnel
extensors and radial nerve
carpal tunnel syndrome
median nerve entrapment can be detected by pressing down in the flexor (palmer) retinaculum (positive tinel sign)
entrapment of the ulnar nerve
in the tunnel of guyon (between the hook of hamate and pisiform)
circulation at the hand
the radial artery is bigger then the ulnar and goes to the digits
what is required for normal movement
P1 at or after R2; accessory and joint play
