UE Joints II - Wrist And Hand

Question 1

Describe the 3 joints associated with the radius and ulna?

Answer 1

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

Question 2

What ligament is associated with the proximal joint between the radius, ulna, and humerus?

Answer 2

Annular ligament

Question 3

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)?

Answer 3

Radioulnar ligament

Question 4

What motions are present via the 3 radioulnar joints?

Answer 4

Pronation and supination

Question 5

During pronation and supination of the radioulnar joints, what is the bone that rotates?

Answer 5

Radius

Question 6

Supination of the radioulnar joints is primarily driven by which 2 muscles?

Answer 6

Supinator m.

Biceps brachii m.

Question 7

Pronation of the radioulnar joints is primarily driven by which 2 muscles?

Answer 7

Pronator quadratus m.

Pronator teres m.

Question 8

What are the 3 joints of the wrist?

Answer 8

Radiocarpal joint
Intercarpal joint
Carpometacarpal joint

Question 9

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?

Answer 9

Flexion

Question 10

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?

Answer 10

Extension

Question 11

Wrist movements include flexion, extension, abduction, adduction, and rotation (a combination of the first 4 movements).

Which motion is considered radial deviation?

Answer 11

Abduction

Question 12

Wrist movements include flexion, extension, abduction, adduction, and rotation (a combination of the first 4 movements).

Which motion is considered ulnar deviation?

Answer 12

Adduction

Question 13

How is the wrist joint classified?

Answer 13

Condyloid synovial joint

Question 14

What are the bones involved in the wrist joint?

Answer 14

Radius

Styloid process of ulna

3 carpal bones: scaphoid, lunate, triquetrum

Question 15

What 2 ligaments are associated with the wrist joint?

Answer 15

Intercarpal ligament

Metacarpal ligaments

Question 16

What are the roles of the palmar and dorsal transverse metacarpal ligaments in the wrist joint?

Answer 16

Stabilize metacarpal heads

Question 17

What 2 ligaments contribute to wrist stability?

Answer 17

Ulnar collateral ligament of wrist

Radial collateral ligament of wrist

Question 18

The ulnar collateral ligament of the wrist connects what 2 bones?

Answer 18

Ulna styloid process to triquetrum

Question 19

The radial collateral ligament of the wrist connects what 2 bones?

Answer 19

Radial styloid process to scaphoid

Question 20

What ligament forms the carpal tunnel?

Answer 20

Transverse carpal ligament (aka flexor retinaculum)

Question 21

What are the contents of the carpal tunnel?

Answer 21

Median n.

9 flexor tendons of digits

Question 22

Aside from the carpal tunnel, what other anatomical “tunnel” is associated with the wrist joint?

Answer 22

Ulnar tunnel

Question 23

What ligaments are involved in forming the ulnar tunnel

Answer 23

Palmar carpal ligament

Transverse carpal ligament

Question 24

What are the contents of the ulnar tunnel?

Answer 24

Ulnar n.

Ulnar a.

Question 25

What muscle connects to the palmar aponeurosis?

Answer 25

Palmaris longus m.

Question 26

What condition is caused by overuse of the wrist joint causing swelling and compression of the median n., leading to associated neuropathy?

Answer 26

Carpal tunnel syndrome

Question 27

What anatomical changes occur with chronic carpal tunnel syndrome? What are some treatments?

Answer 27

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

Question 28

What are the 2 most common wrist fractures?

Answer 28

Most commonly caused by falling forward onto hands, leading to scaphoid or radial fracture

Question 29

What artery may be damaged with a scaphoid or radial fracture?

Answer 29

Radial a. | Can lead to avascular necrosis if untreated

Question 30

Why is the ulna not usually fractured at the wrist?

Answer 30

Weight is generally transferred to radius

Question 31

If a patient complains of pain in the anatomical snuff box, what bone might they have fractured?

Answer 31

Scaphoid

Question 32

What are the 2 types of distal radial fractures? Which one is more common?

Answer 32

Colle's fracture (most common, associated with osteoporosis) Smith's fracture

Question 33

Colle's fracture is associated with what motion at the wrist? What does this lead to?

Answer 33

Hyperextension Leads to distal radius being displaced dorsally, "dinner fork" presentation

Question 34

Smith's fracture is associated with what motion at the wrist? What does this lead to?

Answer 34

Hyperflexion Leads to distal radius being displaced anteriorly, "shovel deformity" presentation

Question 35

What ligaments are associated with joints of the hand?

Answer 35

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]

Question 36

What condition is characterized by the PIP stuck in flexion and the DIP in hyperextension? What are some causes of this deformity?

Answer 36

Boutonniere Deformity Causes: Rupture of central slip of extensor tendon at PIP due to trauma Ehlers-Danlos Syndrome Rheumatoid arthritis

Question 37

What condition is characterized by extensor tendon damage, causing a disruption of digit extension, and presents as DIP flexion?

Answer 37

Mallet Finger (baseball/basketball finger) If left untreated can progress to swan neck deformity

Question 38

What causes mallet finger?

Answer 38

Blunt force trauma to finger

Question 39

Describe the swan neck deformity of the finger including potential causes

Answer 39

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)

Question 40

What ligament is ruptured in Skier's Thumb? What are some causes of Skier's thumb?

Answer 40

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

Question 41

What injury is characterized by sprain of radial collateral ligament and avulsion fracture of the lateral proximal phalanx of the thumb?

Answer 41

Bull Rider's thumb Caused by trauma or sports

Question 42

What is the boxer's fracture?

Answer 42

Fracture of 5th metacarpal often due to punching with a closed and abducted fist