The Wrist- Palastanga Flashcards

1
Q

What joints functionally comprise the wrist

A

Intercarpal, midcarpal and radiocarpal articulations

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2
Q

Classification of the radiocarpal joint

A

Synovial ellipsoid

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3
Q

Articular surfaces of the radiocarpal (rc) joint

A

Distal radius and articular disc with scaphoid, lunate and triquetral of the proximal row of carpals

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4
Q

When combined with supination/ pronation at the forearm the hand appears to move as

A

A ball and socket

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5
Q

Why is there great inherent stability at the wrist/ hand

A

Because of the separation of the 3 axes about which movement occurs
Also because of the flexor retinaculum and many tendons crossing the region

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6
Q

Describe the joint capsule of the rcj

A

Fibrous completely enclosing the joint
Thickened anteriorly and posteriorly and hence strengthened in these regions
Blends with collateral carpal ligaments medially and laterally

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7
Q

Capsular ligaments of the rcj

A

Dorsal radiocarpal
Palmar radiocarpal
Palmar ulnocarpal

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8
Q

Functions of the capsular ligaments of the rcj

A

Strengthen the capsule and determine that the hand follows the radius in its movements and displacements
Are taut in flexion and extension

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9
Q

Other supporting ligaments of the rcj

A

The collateral ligaments
Radial collateral carpal ligament is taut and limits adduction
Ulnar collateral carpal ligament is taut and limits abduction

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10
Q

Movements possible at the rcj

A

Flexion/ extension

Abduction/ adduction

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11
Q

Describe flexion/ extension at the rcj

A

Occur about a transverse axis more or less in the sagittal plane
Flexion freer than extension

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12
Q

ROMs of flexion/ extension at the rcj

A

Flexion max 50d

Extension max 35d

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13
Q

Describe abduction/ adduction at the rcj

A

Also referred to as radial and ulnar deviation respectively

Movement of proximal row of carpals in relation to the distal radius

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14
Q

Which movement of ab/adduction at the rcj is more limited and why

A

Abduction/ radial deviation is more limited due to the further extension of the radial styloid process compared to the ulnar styloid process

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15
Q

ROMs of ab/adduction of the rcj

A

Abduction/ radial deviation = 7d

Adduction/ ulnar deviation = 30d

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16
Q

How are the carpal bones arranged

A

Into 2 rows, proximal and distal, between which lies the midcarpal joint

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17
Q

Classification of the intercarpal joints (icj)

A

Most are plane synovial and have various ligaments between them permitting very little movement

18
Q

Articular surfaces of the midcarpal joint (mcj)

A

Laterally - trapezium and trapezoid with scaphoid forming a slight convexity
Medially/ centrally - capitate with scaphoid and lunate, also hamate with lunate and triquetral forming a slight concavity

19
Q

Describe the joint capsule of the mcj

A

Composed primarily of irregular fibrous bands running between the 2 rows of bones
Anteriorly and posteriorly these fibres constitute the palmar and dorsal inetrcarpal ligaments

20
Q

Describe the synovial cavity of the mcj

A

Is large and complex extending between the bones and may be interrupted by interosseous ligaments

21
Q

Ligaments associated with the mcj

A

Palmar intercarpal ligament is the largest
Dorsal intercarpal
Radial and ulnar collaterals

22
Q

Movements possible at the midcarpal joint

A

Flexion/ extension

Abduction/ adduction

23
Q

Which movement of flexion/ extension if freer at the mcj

A

Extension

opposite to the rcj

24
Q

ROMs of flexion/ extension of the mcj

A

Flexion 35d

Extension 50d

25
Abduction/ adduction at the mcj is accompanied by what
Torsion between the 2 rows of bones
26
ROM of ab/adduction at the mcj
Abduction 8d | Adduction 15d
27
What is the principal structure responsible for maintaining the transverse arch of the 2 rows of carpal bones
The flexor retinaculum
28
The rows of carpals + the flexor retinaculum form what important structure
The carpal tunnel
29
What passes through the carpal tunnel
MEDIAN nerve | Tendons of flexor pollicis longus, flexor digitorum profundus, flexor digitorum superficialis
30
A fall onto an outstretched hand may result in a dislocation where
Radiocarpal and/or midcarpal joints
31
What is important about the movements occurring at the wrist
Movements occurring at the radiocarpal and midcarpal joints are happening at the same time so combine to give the wrist its full ROM
32
What is the total range of flexion/ extension possible at the wrist
85d in each direction Flexion - 50d at rcj and 35 at mcj Extension - 35d at rcj and 50d at mcj
33
Where does the axis of flexion/ extension of the wrist fall through
The head of the capitate
34
When is flexion least effective and what limits this movement
Limited by tension in the extensor tendons and is greatly reduced if fingers are flexed I.e. wrist flexion is greatest when fingers are extended
35
What are the total ROMs for ab/adduction at the wrist complex
Abduction - 15d | Adduction - 45d
36
Muscles producing wrist flexion
Flexors carpi radialis and ulnaris Palmaris longus Flexor digitorum profundus/ superficialis Flexor pollicis longus
37
Muscles producing wrist extension
``` Extensors carpi ulnaris and radialis longus and brevis Extensor digitorum Extensor indicis Extensor digiti minimi Extensor pollicis longus ```
38
Muscles abducting the wrist
Flexor carpi radialis | Extensor carpi radialis longus and brevis
39
Muscles adducting the wrist
Flexor carpi ulnaris | Extensor carpi ulnaris
40
What happens at the wrist during flexion/ extension of the fingers
The carpal flexors/ extensors fix the wrist preventing loss of digital power n.b. grip is not as strong when wrist strongly extended or flexed
41
Why is the wrist slightly extended when powerful grip is needed
This extension stretched the digit flexors allowing a powerful grip This is the position the wrist is fused in to allow the maintenance of grip power