UE Joints II - Wrist And Hand Flashcards
Describe the 3 joints associated with the radius and ulna?
Proximal: pivot type with radial head articulating with radial notch of ulna
Middle: interosseous membrane
Distal: round head of ulna articulating with notch of radius
What ligament is associated with the proximal joint between the radius, ulna, and humerus?
Annular ligament
What ligament is associated with the distal joint between the radius and ulna (aka the round head of the ulna articulating with the notch of the radius)?
Radioulnar ligament
What motions are present via the 3 radioulnar joints?
Pronation and supination
During pronation and supination of the radioulnar joints, what is the bone that rotates?
Radius
Supination of the radioulnar joints is primarily driven by which 2 muscles?
Supinator m.
Biceps brachii m.
Pronation of the radioulnar joints is primarily driven by which 2 muscles?
Pronator quadratus m.
Pronator teres m.
What are the 3 joints of the wrist?
Radiocarpal joint
Intercarpal joint
Carpometacarpal joint
Wrist movements include flexion, extension, abduction, adduction, and rotation (a combination of the first 4 movements).
Which motion is more prominent at the mid-carpal joint?
Flexion
Wrist movements include flexion, extension, abduction, adduction, and rotation (a combination of the first 4 movements).
Which motion is more prominent at the radiocarpal joint?
Extension
Wrist movements include flexion, extension, abduction, adduction, and rotation (a combination of the first 4 movements).
Which motion is considered radial deviation?
Abduction
Wrist movements include flexion, extension, abduction, adduction, and rotation (a combination of the first 4 movements).
Which motion is considered ulnar deviation?
Adduction
How is the wrist joint classified?
Condyloid synovial joint
What are the bones involved in the wrist joint?
Radius
Styloid process of ulna
3 carpal bones: scaphoid, lunate, triquetrum
What 2 ligaments are associated with the wrist joint?
Intercarpal ligament
Metacarpal ligaments
What are the roles of the palmar and dorsal transverse metacarpal ligaments in the wrist joint?
Stabilize metacarpal heads
What 2 ligaments contribute to wrist stability?
Ulnar collateral ligament of wrist
Radial collateral ligament of wrist
The ulnar collateral ligament of the wrist connects what 2 bones?
Ulna styloid process to triquetrum
The radial collateral ligament of the wrist connects what 2 bones?
Radial styloid process to scaphoid
What ligament forms the carpal tunnel?
Transverse carpal ligament (aka flexor retinaculum)
What are the contents of the carpal tunnel?
Median n.
9 flexor tendons of digits
Aside from the carpal tunnel, what other anatomical “tunnel” is associated with the wrist joint?
Ulnar tunnel
What ligaments are involved in forming the ulnar tunnel
Palmar carpal ligament
Transverse carpal ligament
What are the contents of the ulnar tunnel?
Ulnar n.
Ulnar a.
What muscle connects to the palmar aponeurosis?
Palmaris longus m.
What condition is caused by overuse of the wrist joint causing swelling and compression of the median n., leading to associated neuropathy?
Carpal tunnel syndrome
What anatomical changes occur with chronic carpal tunnel syndrome?
What are some treatments?
Muscle wasting of much of the thenar group and lumbricals 1 and 2
Initial approach is rest and change in ergonomics
Lastly, surgical approach by cutting transverse carpal ligament
What are the 2 most common wrist fractures?
Most commonly caused by falling forward onto hands, leading to scaphoid or radial fracture
What artery may be damaged with a scaphoid or radial fracture?
Radial a.
Can lead to avascular necrosis if untreated
Why is the ulna not usually fractured at the wrist?
Weight is generally transferred to radius
If a patient complains of pain in the anatomical snuff box, what bone might they have fractured?
Scaphoid
What are the 2 types of distal radial fractures? Which one is more common?
Colle’s fracture (most common, associated with osteoporosis)
Smith’s fracture
Colle’s fracture is associated with what motion at the wrist? What does this lead to?
Hyperextension
Leads to distal radius being displaced dorsally, “dinner fork” presentation
Smith’s fracture is associated with what motion at the wrist? What does this lead to?
Hyperflexion
Leads to distal radius being displaced anteriorly, “shovel deformity” presentation
What ligaments are associated with joints of the hand?
Transverse metacarpal ligament
Palmar (valor) plate or ligament (around DIPs)
Metacarpophalangeal collateral ligaments (around MCPs)
Phalangeal collateral ligaments (around PIPs and DIPs)
[extensor hood attaches to outside of collateral ligaments]
What condition is characterized by the PIP stuck in flexion and the DIP in hyperextension?
What are some causes of this deformity?
Boutonniere Deformity
Causes:
Rupture of central slip of extensor tendon at PIP due to trauma
Ehlers-Danlos Syndrome
Rheumatoid arthritis
What condition is characterized by extensor tendon damage, causing a disruption of digit extension, and presents as DIP flexion?
Mallet Finger (baseball/basketball finger)
If left untreated can progress to swan neck deformity
What causes mallet finger?
Blunt force trauma to finger
Describe the swan neck deformity of the finger including potential causes
Extension at PIP
Flexion at DIP
Caused by RA, untreated mallet finger, or trauma (tear of middle palmar plate ligament leading to damage to extensor hood)
What ligament is ruptured in Skier’s Thumb? What are some causes of Skier’s thumb?
Collateral ligament of the first MCP joint; if bad it may be accompanied by avulsion fracture of the metacarpal head
Caused by trauma, FOOSH, commonly seen in skiers
What injury is characterized by sprain of radial collateral ligament and avulsion fracture of the lateral proximal phalanx of the thumb?
Bull Rider’s thumb
Caused by trauma or sports
What is the boxer’s fracture?
Fracture of 5th metacarpal often due to punching with a closed and abducted fist
