The Wrist (Radiocarpal Jt.) and Hand Joints Flashcards
1
Q
Objectives
9: Differentiate among ROM, AAROM, AROM and FROM
11: Perform PROM on the trunk, UEs and Cspine
12: Measure functional, active, and passive ROM with a goniometer and accurately record
13: Discuss manual muscle testing principles
14: Recognize a variety of muscle strength scales used in PT
15: Demonstrate accurate technique for performing manual muscle tests
16: Interpret results from a manual muscle test
A
fyi
2
Q
Bones and Landmarks of the Wrist
A
- The carpal bones (lateral to medial)–
- Styloid process –
- Hook of hamate
- Medial epicondyle –
- Lateral epicondyle –
- Supracondylar ridge –
3
Q
Bones and Landmarks of the Wrist
The carpal bones (lateral to medial)–
scaphoid, lunate, triquetrum, pisiform
trapezium, trapezoid, capitate, hamate
A
- scaphoid
- lunate,
- triquetrum
- pisiform
- trapezium
- trapezoid
- capitate
- hamate
4
Q
Bones and Landmarks of the Wrist
provides attachment for the radial collateral ligaments on the radius.
A
Styloid process
5
Q
Bones and Landmarks of the Wrist
attachment for the transverse carpal ligament= which carpal?
A
Hook of hamate
6
Q
Bones and Landmarks of the Wrist
attachment of the common flexor tendon on the humerus
A
Medial epicondyle
7
Q
Bones and Landmarks of the Wrist
attachment for the common extensor tendon
A
Lateral epicondyle
8
Q
Bones and Landmarks of the Wrist
attachment for the extensor carpiradialis muscle on the humerus
A
Supracondylar ridge
9
Q
name the Ligaments of the wrist
A
- Radial collateral ligament
- Ulnar collateral ligament
- both above Provide lateral & medial support to the wrist
- Palmar radiocarpal ligament
- Dorsal radiocarpal ligament
10
Q
Ligaments and Structures of the wrist
attached at styloid process of the radius to the scaphoid and trapezium
A
Radial collateral ligament
11
Q
Ligaments and Structures of the wrist
styloid process to the pisiform and triquetrum
- Provide lateral & medial support to the wrist
A
Ulnar collateral ligament
12
Q
Ligaments and Structures of the wrist
attaches to the anterior surface & limits wrist ext
A
Palmar radiocarpal ligament
13
Q
This ligament attaches to the posterior surface of the distal radius to the same surface of the scaphoid, lunate, and triquetrum.
It limits wrist flexion
A
Dorsal radiocarpal ligament
14
Q
Ligaments and Structures of the wrist
encloses the radiocarpal joint is reinforced by the RCL and UCL ligaments and the dorsal and palmar radiocarpal ligaments
A
Joint capsule
15
Q
Ligaments and Structures of the wrist
- located on the distal end of the ulna and articulates with the triquetrum and lunate bones
- Acts as a shock absorber and a filler between the distal ulna and its carpal bones
A
Articular disk
16
Q
Ligaments and Structures of the wrist
- thick, triangular shaped fascia located superficially in the palm of the hand
A
Palmar fascia
17
Q
Muscles of the Wrist
YOU WILL BE RESPONSIBLE FOR THE FOLLOWING MUSCLES AND THEIR OIAN’S
A
- Flexor carpi ulnaris
- Flexor carpi radialis
- Palmaris longis
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
- Extensor carpi ulnaris
18
Q
The Fingers-Joints and Motions
The first is a saddle jt. The rest are nonaxial plane synovial joints that provide more stability than mobility
A
CMC Joints
19
Q
Trapezium to 1st MC=name of joint
A
CMC 1
20
Q
The Fingers and joints
Trapezoid to 2nd MC
A
CMC 2
21
Q
The Fingers and joints
Capitate to 3rd MC***
A
CMC 3
22
Q
The Fingers and joint
Hamate to 4th MC
A
CMC 4
23
Q
The Fingers and joint
Hamate to 5th MC
A
CMC 5
24
Q
This joint is the most mobile of the fingers and allows for a small amount of opposition of the 5th digit
Hamate to 5th MC
A
CMC 5
25
MCP joints are what kind of joint?
biaxial condyloid joints
26
IP joints are what kind of joint?
uniaxial hinge joints
27
the trapezium bone articulating with the base of the first metacarpal
CMC 1joint
28
Joints and Motions of the Thumb
Saddle joint with both surfaces convex and concave
what are all the motions?
1. Flexion / Extension in the frontal plane, so like a windshield wiper across your palm
2. Abduction / Adduction in the sagittal plane
3. In anatomical position, of course.
4. Opposition / Reposition is a combination of the above with a little accessory rotation mixed in.
29
fibrous band that spans the anterior surface of the wrist in a mediolateral direction and it holds those tendons close to the wrist
Flexor retinaculum
30
more proximal and superficial than the transverse carpal ligament that it blends with
it attaches the styloid processes of the radius and ulna
Palmar carpal ligament
31
lies deeper and more distally than the palmar carpal ligament
attaches to the pisiform and the hook of hamate on the medial side and to the scaphoid and trapezium on the lateral side
Transverse carpal ligament
32
The Transverse carpal ligament arches over the carpals forming what tunnel?
Carpal tunnel
33
fibrous band on the posterior side of the wrist traversing the joint in a horizontal, mediolateral direction and attaches to the ulnarstyloid process and triquetrum, pisiform and lateral side of the radius
* Holds the tendons of the wrist down during wrist extension
Extensor retinaculum ligament
34
also called the extensor hood – small triangular shaped aponeurosis covering the dorsum and sides of the proximal phalanx of the fingers
* Provides attachments for several muscles on the finger
Extensor expansion ligament
35
Muscles of the Thumb and Fingers
YOU WILL BE RESPONSIBLE FOR THE FOLLOWING MUSCLES AND THEIR OIAN’S
* 5=F
* 5=E
* 4=A
* 2=O
* 1=I
* 1=L
1. Flexor digitorum superficialis
2. Flexor digitorum profundus
3. Extensor digitorum
4. Extensor digiti minimi
5. Extensor indicis
6. Flexor pollicis longus
7. Abductor pollicis longus
8. Extensor pollicis longus
9. Extensor pollicis brevis
10. Flexor pollicis brevis
11. Abductor pollicis brevis
12. Opponens pollicis
13. Flexor digiti minimi
14. Abductor digiti minimi
15. Opponens digiti minimi
16. Adductor pollicis
17. Interossei
18. Lumbricles
36
all fingers are flexed around the object, usually lies at a 90 degree/perpendicular angle to the forearm, holding hammer
what type of grip?
Cylindrical grip
power grip
37
what is prehension?
grasp of the hand- It means that the hand is desinged to hold or manipulate objects
38
What are the two types of prehension?
1. Power grip
2. precison grip
39
* Functional position of the wrist and hand – wrist is in slight flexion, MCP/PIP joints are in slight flexion
* considered the most powerful grip
Power Grips
40
all fingers and the thumb around the object, opening a jar
* Fingers are more spread apart and the palm is not often involved
what type of grip?
Spherical grip
power
41
involves the second thru fifth fingers flexed around an object in a hook like manner
* MCP joints are extended, PIP and DIP joints are flexed, like when carrying a purse
what grip and what type of grip?
Hook grip
Power
42
Pad to pad grip –
Pinch grip – when two fingers are used
Three point/jaw chuck – 3 fingers like when holding a pencil
Precision grips
43
pick up small objects like a coin
Also called Pincer grip
What grip and what type
Tip to tip grip
precision
44
the pad of the thumb is against the radial side of the finger, holding keys
what grip and what type of grip?
Pad to side grip
precision
45
MCP/PIP joints are flexed and DIP joints are extended, like when carrying a plate
what grip and what type of grip?
Lumbrical grip
46
Fun Facts
* The hand, including the wrist, consists of 27 bones.
* Carpals are the 8 bones that make up the wrist
* There are 5 metacarpals
* 14 phalanges
* Injuries to the thumb ligament is one of the more common skiing injuries…it ranks second only to knee sprains
47
1. Can involve any of the three bones in each finger
2. Most can be treated with a finger splint
3. If too severe, the fracture could be fixed with pins, wires ore screws
Finger Fractures
48
* Fracture to the 5th metacarpal
* Often the result of slamming a clenched fist against a solid object
Boxer Fracture
49
* Typically results from when an object strikes the tip of a finger
* Bends the distal phalange downward beyond its normal range of motion
* The force of the blow tears the finger tendon and destroys the surrounding cartilage
Baseball (Mallet) Finger
50
* Opposite of a mallet finger, caused by a tearing of the flexor tendon to the finger tip (which tendon??)
* Usually occurs when grabbing a jersey during a tackle
* Most often affects the ring finger
* Requires surgery to reattach the tendon to the base of the fingertip
Jersey Finger
51
* Most commonly fractured bone in athletics
* Receives an extraordinary amount of force when the wrist is placed into extension
* FOOSH (fall on out-stretched hand)
* Palpation at the anatomical snuffbox will cause pain
* Positive sign for a fracture
* Careful evaluation will prevent a misdiagnosis as a wrist sprain
Scaphoid Fracture
52
* Common fracture of the radius, just proximal to the carpal bones
* Occurs when a person extends their hand in an attempt to break a fall
* The force of the impact is absorbed by the wrist
Colle’s Fracture
53
Treatment of Fractures
RICE
Rest
Ice
Compression
Elevation
Evaluation by a physician for proper care is advised
54
Displacement of any bone from the normal position of the bone
* Occurs when there is a force directed at a finger or if the finger gets caught in equipment
Dislocation
55
abnormal movement of one of the bones that constitute a joint.
Subluxation
56
Signs and Symptoms: of what
Immediate pain
Immediate swelling
Obvious deformity
Inability to move the joint through normal range of motion, if at all
Treatment:
Immobilization
Evaluation by a physician
Subluxations
57
* Caused by direct blows or falling onto a hard surface
* Unique to the fingers and toes, contusions of the nails occur and blood pools underneath the nail
* Might require a physician to drain the blood from beneath the nail
* Refrain from self treatment
* High risk of infection
Contusions
58
* Sprain of the ulnar collateral ligament of the metacarpophalangeal joint
* Named in the 1950’s for gamekeepers (hunters) whose profession required them to break the necks of rabbits
* This procedure resulted in damage of the ulnar collateral ligament of the thumb
* Common injury today with skiing
* Force is applied to the medial side of the thumb, forcing hyperextension
Gamekeeper’s Thumb
59
* Inflammation of tendons caused by overuse or repetitive stress
* Signs and Symptoms:
* Ache or pain at the wrist
* Worsened with forceful gripping, rapid wrist movements or moving the wrist into extreme positions
* Most common sites
* Base of the thumb (De Quervain’s)/snuffbox
* Back or palm side of the wrist
Tendonitis
60
* passageway that runs from the forearm through the wrist
* Median Nerve runs through this passageway,
* innervates the thumb, index and ring fingers
* 9 tendons that flex the fingers also run through this passageway
Carpal Tunnel a Nerve Impingement
61
* Considered an inflammatory disorder caused by
* Repetitive stress
* Physical injury
* Other conditions that result in swelling of the tissues surrounding the carpal tunnel
* Think of when you kink a hose and it slows the flow of water
* Compression of the median nerve alters the transmission of nerve signals through the carpal tunnel
Carpal Tunnel Syndrome
62
Signs and Symptoms:
* Pain
* Numbness
* Tingling
* All fingers except the little finger
* Weakness, tendency to drop objects
* Loss of hot/cold sensation
* Swelling with rest or use
Carpal Tunnel Syndrome
63
Treatment:
* Rest
* Ice (if it provides relief to the patient)
* Splinting/Immobilizing at night or during activity to help keep the wrist from bending
* Weeks/months depending on the severity of the problem
* Mixed reviews, some splints can aggravate the problem
* Surgical intervention
Carpal Tunnel Syndrome
64
Small, usually hard lump above a tendon or in a capsule that encloses the joint
* Also called a synovial hernia or synovial cyst
Usually appears on the back of the wrist
* Can occur on the palm side or the base of the fingers
Fluid filled cysts arise from the tissue that lines the joints or tendons
Ganglion Cyst
65
Treatment
* Small and painless cysts
Does not need to be treated
* Large or rapidly enlarging
Seek treatment for draining/removal
Ganglion Cysts
66
Extensor Tendon Injury affecting 2 joints of the finger, PIP and DIP
Tear in the central part of the tendon that extends the finger
Finger bends down at the PIP and is pulled up at the DIP
The tear looks like a “buttonhole” and the end of the finger bone begins to stick through the tear
Boutonnière Deformity
67
Treatment:
* Obtain medical attention immediately
* Doctor will be able to diagnose condition and limit further damage
* Many people fail to seek attention d/t assumption of having a locked/jammed joint
* Prompt treatment increases the probability of return to function
Boutonnière Deformity
