Week 7 Wrist Flashcards

1
Q

Joints of the wrist

A
radiocarpal 
pisiform joint
intercarpal joint (mid-carpal)
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2
Q

Why put patients into resting position

A

to reduce pain (when they’re injured)

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3
Q

Zero starting position for the wrist joint complex

A

longitudinal axes through the radius and third metacarpal bone are in a straight line

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4
Q

Resting position of the wrist joint complex

A

zero starting position with a little ulnar flexion

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5
Q

Close packed position

A

wrist in maximal dorsal flexion (extension)

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6
Q

Capsular pattern

A

restricted equally in all directions

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7
Q

Characteristics of the radiocarpal joint

A

-mechanically simple, biaxial
-distal convex surface;
scaphoid, lunate, triquetrum
-proximal concave surface;
radius and articular disc

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8
Q

Intercarpal joint characteristics

A
-mechanically compound,
anatomically simple
- convex scaphoid articulates
with the two trapezii
- scaphoid and lunate form a
concave surface for
articulation with the convex
capitate
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9
Q

Pisiform joint characteristics

A
-anatomically simple, plane
gliding joint
-sesamoid bone in the
insertion of flexor carpi
ulnaris; origin of abductor
digiti minimi
-contraction of these two
muscles will stabilise
pisiform
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10
Q

Wrist joint complex

A

all bones can be moved individually in relation to each other

the two most important carpal bones regard loss of range of motion with pathology are scaphoid and lunate

functional movement does not occur in one plane, all muscles cross the wrist obliquely so movement is radiodorsal & ulnarvolar

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11
Q

Flexion =

Extension =

A

Flexion = partly radiocarpal, mostly midcarpal

Extension = radiocarpal then midcarpal

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12
Q

What is radial deviation

A

proximal row of carpals
and midcarpals slide into dorsal and ulna
glide

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13
Q

What is ulnar deviation

A

proximal row moves into

a palmar and radial glide

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14
Q

Tendon lesions

A

ECR
ECU
FCU
FCR

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15
Q

MCP joint

A

simple biaxial joints

  • convex proximal, concave distal
  • Active movements = flex, ext, abd, add ; passive rotation

Joint stability is maintained by capsule and collateral ligaments as the joint surfaces are incongruent

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16
Q

The hand & fingers

A

PIP & DIP joints are hinge joints
Convex head of proximal phalanx articulates with the concave base of the middle phalanx
Movements of flexion and extension

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17
Q

Classification of MSK disorders

A

soft tissue lesions
joint diseases
bone disorders
nerve entrapments

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18
Q

What is De Quervain’s

A

APL & EPB

stenosing tendovaginitis of the First Dorsal Retinaculum

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19
Q

Intersection syndrome

A

APL/EPB & ECR

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20
Q

Ligament sprains - subluxation/ instability

A

Ulnar collateral ligt 1st MCP

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21
Q

Dupuytren’s contracture

A

pg.. 18

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22
Q

ganglion

A

pg. 19

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23
Q

TFCC (triangular fibro-cartilage complex

A

pg.20

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24
Q

Lacerations

25
Tendon avulsion
Mallet finger jersey finger
26
Joint diseases
degeneration
27
Rheumatoid arthritis
pg. 24
28
distal radius and ulna "Colles"
pg. 25
29
Scaphoid fracture
pg. 26
30
Scapholunate dissociation
pg. 27
31
hook of hamate
pg. 28
32
metacarpal, phalanx
pg. 29
33
Dislocation PIP
pg. 30
34
Bennett's fracture
pg. 31
35
Impingement syndromes
pg. 32
36
Kienbocks disease
pg. 33
37
Nerve entrapments
median nerve -carpal tunnel syndrome Ulnar nerve -guyon's tunnel (karate & cyclists)
38
Phalen's test
pg 36
39
Instability
wrist instability? carpal instability carpal malalignment carpal dysfunction
40
Carpal instability
Inability to bear physiological loads with an associated loss of normal carpal alignment
41
Carpal malalignment
``` dynamic instability (CIND) Static instability (CID) ```
42
Carpal dysfunction
in a normal wrist there is the ability to transfer loads without sudden changes of stress on the articular cartilage(normal kinetics) -and the capacity to move throughout the normal range without sudden alterations of intercarpal alignment (normal kinematics
43
Classifications of carpal dysfunction
dissociative carpal instability (CID) Non - dissociative carpal instability (CIND) Complex carpal instability (CIC) Adaptive carpal instability (CIA)
44
Dissociative carpal instability
dysfunction between bones of the same carpal row (usually proximal) - scapholunate, lunotriquentral - fracture or ligament disruption
45
Non-dissociative carpal instability (CIND)
dysfunction between bones of the different carpal row - triquetralcapitate - radioulnate - radiocapitate
46
Complex carpal instability *+(CIC)
when CID and CIND are found together | e.g. perilunate dislocations
47
Adaptive carpal instability (CIA)
origin of the carpal dysfunction proximal or distal to wrist carpals adapt to an extrinsic pathology -eg. distal radial fracture
48
Dissociative carpal instability (CID)
CID-DISI Dorsal intercalated segment instability CID-VISI Volar intercalated segment instability
49
CID- DISI
Scapholunate dissociation Lunate (intercalated segment) is abnormally extended relative to its proximal and distal links due to extension moment transmitted by triquetrum
50
CID - VISI
Lunotriquetral dissociation | Scaphoid forces unrestrained lunate into palmar flexion
51
Treatment carpal instability
there is no single treatment for carpal instability. the intervention is primarily surgical and six criteria must be considered
52
Trangular Fibrocartilage complex (TFCC)
pg. 51
53
TFCC injuries
mechanism of injury -compression of lunate and the head of the ulna (e.g. fall on outstretched hand) Rotational forces (throwing/ racquet sports) Degenerative lesions
54
TFCC contributing factors
positive ulnar variance - increased load bearing ulnar side of wrist - 18% to 42% with 2.5mm +variance - Decreased thickness of TFC
55
TFCC symptoms
``` ulnar side wrist pain swelling loss of grip strength inability to perform manual activity 'click' with active ulnar deviation ```
56
TFCC signs
``` point tenderness distal to the ulnar styloid Pain with passive pronation/supination/ulnar deviation important to assess stability of DRUJ -piano key test (PA ulna in pronation) Shuck test (AP radius) ```
57
TFCC confirmation
``` plain view radiology -determine ulnar variance Wrist arthrography MRI Arthroscopy ```
58
TFCC treatment
TFCC injury without DRUJ instability - immobilisation 4/52 (Sl. flexion/ulnar dev) - injection local anesthetic/corticosteroid TFCC injury with DRUJ instability -surgical reconstruction