Wrist Flashcards
The wrist is made up of (one/two) separate joints: what are the names of those joints?
two; radiocarpal joint and midcarpal joint
The radiocarpal joint is made up of the radius and the (distal/proximal) row of carpal bones
proximal
The midcarpal joint is formed by what?
The proximal and distal row of carpal bones
What are the motions that can be performed at the wrist joint?
Flexion/extension, radial/ulnar deviation, & circumduction
Circumduction of the wrist is a combination of what movements?
All of the movements available at the wrist: flexion/extension & radial/ulnar deviation
Extrinsic muscles of the hand originate (outside/inside) of the hand and they are coming from the elbow region. These muscles can be affected by a painful or dysfunctional wrist. Because these muscles cross the wrist joint, they can really affect how well you can use your hand. If the wrist is painful, dysfunctional, or arthritic, it can really affect the way the hand moves because the muscles that move the hand originate (outside/inside) of the hand.
outside; outside
Palmer and volar = (posterior/anterior)
Dorsal = (posterior/anterior)
anterior; posterior
The distal radius is (convex/concave) in both medial-lateral and anterior-posterior directions
concave
What kind of joint is concave in one direction and convex in the other?
A saddle joint
The (proximal/distal) end of the radius angles 25 degrees towards the ulnar (medial) direction. This is referred to as an “Ulnar Tilt” and it allows the wrist and hand more (ulnar/radial) deviation than (ulnar/radial) deviation
distal; ulnar; radial
The (proximal/distal) end of the radius angles 10 degrees in the palmar (anterior) direction. This is referred to as a “Palmar Tilt” and it allows for greater amounts of (flexion/extension) than (flexion/extension).
distal; flexion; extension
Tilts are important because a lot of people suffer injuries to their distal radius and those tilts are one of the main factors that orthopedists and orthopedic surgeons want to preserve in order to have a functioning wrist. They are looking at this stuff on xrays and they are deciding on whether or not to cast the person or perform a surgery on them in order to maintain the tilt. If the palmar tilt after a fracture had less than the normal 10 degrees then (flexion/extension) would be limited. But if you have more than 10 degrees of a palmar tilt, let’s say 25 degrees then (flexion/extension) would be limited.
flexion; extension
In between the proximal and distal poles of the scaphoid lies the waist. That is important if we are talking about fractures of the scaphoid. There Is (increased/decreased) blood flow that goes into this particular area of the scaphoid and it can become ischemic. Ischemic means that there is no blood flow going to the area. If there is no blood flow going to the bone you can get necrosis which is death of the bone.
decreased
If a patient comes in and says they had a bad fall on their wrist, if they have tenderness in their __ they have to get an xray to rule out a fracture.
anatomical snuffbox
The (scaphoid/pisiform) acts almost as a sesamoid bone and it is within your flexor carpi ulnaris so it is intricately involved in wrist flexion.
pisiform
The (lunate/capitate) forms a very rigid attachment with the 3rd metacarpal. The (lunates/capitates) ability to move through different directions is what directs the whole hand through its movement because of how stable that attachment is.
capitate; capitates
The hamate is one of the bones that has the attachment of the ____ ligament and it “forms” the carpal tunnel.
transverse carpal
The pisiform and the hook of the hamate are on the (radial/ulnar) side of the transverse carpal ligament. The scaphoid/trapezium are on the (radial/ulnar) side of the transverse carpal ligament.
ulnar; radial
The _____ ligament is an attachment site for the hand intrinsic muscles and the palmaris longus.
transverse carpal
The transverse carpal ligament (allows for/prevents) bowstringing of the tendons. Think of the pull of the tendon coming through. It’s almost creating a force where that tendon.. If not for the retinaculum or tissues like that or the TCL, it would bowstring outwards and they would lose their leverage, but the fact that they can go through that tight space when they contract it redirects the force of those muscles and keeps the moment arm advantageous. It is like a pulley going through that small tunnel (carpal tunnel) and its able to redirect the force well in order to have good force and pull your fingers into flexion. If it wasn’t there, there would be this weird tendon pulling it “this” direction.
prevents
The radiocarpal joint has the (concave/convex) surface of the radius and articular disc (TFCC). The TFCC is a continuation of the (concave/convex) surface of the distal radius. The (concave/convex) surface of the radiocarpal joint is formed by the scaphoid, lunate, and triquetrum in an ulnar deviated position. If you were to ulnarly deviate your hand, the triquetrum now starts to articulate, but it does not articulate unless it is ulnarly deviated.
concave; concave; convex
When talking about the forces that are dissipated, we talked about how the radius has more force with direct compression through the hand. Your hand is hitting the ground and the interosseous membrane will redirect force. _% of that force is felt by the radius at the wrist and that other _% is felt by the ulna and the articular disc of the TFCC.
80; 20
The midcarpal joint is made up of __ different compartments. Name them.
2; the medial compartment and the lateral compartment
What is in the medial compartment of the midcarpal joint?
The head of the capitate and the hamate
What is in the lateral compartment of the midcarpal joint?
The scaphoid articulation with the trapezium and the trapezoid
Most of the motion at the midcarpal joint happens at the (lateral/medial) compartment, meaning that the capitate is moving and the hamate is moving.
medial
The wrist ligaments are an extension of the capsule and there are ligaments on the dorsal side, palmar side, radial side, and ulnar side. What are the names of these ligaments?
The dorsal radiocarpal ligament, palmar radiocarpal ligament, radial collateral ligament, and the ulnar collateral ligament.
The palmar radiocarpal ligament of the wrist will resist (flexion/extension).
extension
The dorsal radiocarpal ligament of the wrist will resist (flexion/extension).
flexion
The radial collateral ligament of the wrist will resist (radial/ulnar) deviation.
ulnar
The ulnar collateral ligament will resist (radial/ulnar) deviation.
radial
If a valgus force is applied to the wrist, the (radial collateral/ulnar collateral) ligament will be the ligament in the wrist resisting this force.
ulnar collateral
The ___ securely binds the distal end of the radius and ulna while also allowing the radius to rotate around a fixed ulna (pronation and supination)
TFCC
The TFCC reinforces the (radial/ulnar) side of the wrist
ulnar
The TFCC transfers compression forces form the hand to the forearm (20%). So when doing a pushup 20% is going to the (radial/ulnar) side because of the TFCC.
ulnar
Flexion/extension of the wrist occurs in the (sagittal/frontal) plane.
sagittal
Flexion of the wrist is limited by the (dorsal/palmar) radiocarpal ligament.
dorsal
Extension of the wrist is limited by the (dorsal/palmar) radiocarpal ligament.
palmar
You get more wrist (flexion/extension) than you get of wrist (flexion/extension).
flexion; extension
Radial/ulnar deviation occurs in the (sagittal/frontal) plane.
frontal
You are able to get more (ulnar/radial) deviation than (ulnar/radial) deviation.
ulnar; radial
As you extend your wrist you naturally (radially/ulnarly) deviate and as you flex your wrist you naturally (radially/ulnarly) deviate and this has to do with the joint structure.
radially; ulnarly
When I move my hand and wrist into flexion, it is really the (lunate/capitate) that is moving and directing the hand into flexion.
capitate
When I am moving into flexion and extension or radial and ulnar deviation I am getting movement both at the radiocarpal joint and midcarpal joint from the (medial/lateral) compartment.
medial
In extension of the wrist there is a (anterior/posterior) roll and (anterior/posterior)slide that is happening at the radiocarpal joint between the (concave/convex) lunate and(concave/convex) radius.
posterior; anterior; convex; concave
In flexion of the wrist there is an (anterior/posterior) roll and (anterior/posterior) slide that is happening at the radiocarpal joint between the (concave/convex) lunate and the (concave/convex) radius.
anterior; posterior; convex; concave
In extension of the wrist there is a (anterior/posterior) roll and (anterior/posterior) slide that is happening at the midcarpal joint between the (concave/convex) capitate and (concave/convex) lunate.
posterior; anterior; convex; concave
In flexion of the wrist there is an (anterior/posterior) roll and (anterior/posterior) slide that is happening at the midcarpal joint between the (concave/convex) capitate and (concave/convex) lunate.
anterior; posterior; convex; concave
In ulnar deviation the midcarpal joint gets (more/less) motion than the radiocarpal joint because the proximal carpals have to roll uphill in ulnar deviation and they will run into the radius which prevents more motion.
more
In ulnar deviation at the radiocarpal joint the scaphoid, lunate, and the triquetrum roll (medially/laterally) and slide (medially/laterally).
medially; laterally
In ulnar deviation at the midcarpal joint, the capitate rolls (medially/laterally) and slides (medially/laterally).
medially; laterally
In radial deviation at the radiocarpal joint the scaphoid, lunate, and the triquetrum roll (medially/laterally) and slide (medially/laterally)
laterally; medially
In radial deviation at the midcarpal joint, the capitate rolls (medially/laterally) and slides (medially/laterally).
laterally; medially
The major load bearing column of the wrist (70-85% of load goes through that side of the wrist) is comprised of what structures?
Carpometacarpals II & III, the capitate, most of the scaphoid, the lunate, and the distal radius
The major load bearing column of the wrist occurs on the (medial/lateral) side of the wrist
lateral
The minor load bearing column of the wrist (15-30% of load goes through that side of the wrist) is comprised of what structures?
Carpometacarpals IV & V, the hamate, triquetrum, TFCC, and the distal ulna
The minor load bearing column of the wrist occurs on the (medial/lateral) side of the wrist
medial
Carpal instability:
If you get a high enough load crushing down you can get a dislocation of the lunate or instability of the lunate. This is a displaced lunate dorsally from excessive loads coming down on an outstretched arm with compression forces coming down and up from the ground pressing in the other direction. That capitate bone goes into that articulation that can cause a fracture of the scaphoid. And remember we have the scapholunate ligament and as the force is coming through and can tear that ligament so now the scaphoid and lunate are no longer stably connected together. That scapholunate ligament is very important to (stability/mobility).
stability
Another type of carpal instability you can have is ulnar translocation of the carpus and an example of that is rheumatoid arthritis. We know that this disease process overall weakens ligaments and when we see people with badly deformed hands and wrists. Part of that is because it weakens the ligaments so now the passive subsystem is out and it is allowing too much motion and this palmar radiocarpal ligament is going to restrict this movement from happening and if that ligament gets weakened and you have increased forces then it is going to allow it to drift in the (radial/ulnar) direction.
ulnar
The radial nerve is going to innervate all of the muscles on the (palmar/dorsal) side of the wrist
dorsal
The median and ulnar nerves are going to innervate all of the muscles on the (palmar/dorsal) side of the wrist
palmar
(Primary/secondary) extensors of the wrist are responsible for only moving the wrist.
Primary
What are the names of the primary wrist extensors?
Extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris
(Primary/Secondary) extensors of the wrist are responsible for primarily moving the fingers but also play a role in moving the wrist.
Secondary
What are the names of the secondary wrist extensors?
Extensor digitorum, extensor indicis, extensor digiti minimi, and extensor pollicis longus
Where is the primary origin of all of the wrist extensors?
Lateral epicondyle of the humerus
What are the names of the primary wrist flexors?
Flexor carpi radialis, flexor carpi ulnaris, and palmaris longus
(Primary/Secondary) flexors of the wrist are responsible for primarily moving the fingers but also play a role in moving the wrist.
Secondary
What are the names of the secondary wrist flexors?
Flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus, abductor pollicis longus, and extensor pollicis brevis
The primary origin of all the wrist flexors is where?
The medial epicondyle of the humerus
The___ ligament acts as a retinaculum. In those tendons now they create a leverage point so they can optimally flex the wrist.
palmar carpal
You can go through and look at all of the muscles we have talked about and for example you can look at the extensor carpi ulnaris and say this is a very strong ulnar deviator due to its (small/large) moment arm distance from the axis of rotation. The muscles that have a (smaller/larger) moment arm from the axis of rotation will not play as big a part in performing the muscle action as the muscles that have a (smaller/larger) moment arm.
large; smaller; larger
Muscles posterior to the axis of rotation will have the capability of (flexing/extending) the wrist. Muscles anterior to the axis of rotation will have the capability of (flexing/extending) the wrist.
extending; flexing
What muscles radially deviate the wrist in order from the muscles that play the largest part to the smallest part in the movement?
Extensor pollicis brevis, abductor pollicis longus, extensor carpi radialis longus, extensor pollicis longus, extensor carpi radialis brevis, flexor carpi radialis, & flexor pollicis longus
As you radially deviate your flexors and extensors are working synergistically but are also antagonists. The flexors and extensors are working against each other as well as together to (promote/prevent) any deviation to flexion or extension as you radially deviate.
prevent
What muscles ulnarly deviate the wrist in order from the muscles that play the largest part to the smallest part in the movement?
The extensor carpi ulnaris, flexor carpi ulnaris, flexor digitorum superficialis and flexor digitorum profundus, then extensor digitorum
The FDP & FDS are finger flexors but can also flex the wrist. Because of their cross sectional area if you take those finger flexor muscles and you put them next to the FCU & FCR they are actually pretty strong and pretty equal in terms of contribution to wrist flexion, they just happen to also flex the fingers. A strong activation of grip also produces wrist (flexion/extension). If I make a really strong wrist and I contract these muscles they are going to contract down here and create a wrist flexion torque, so the wrist extensors must act in order to negate this. When you quickly make a fist back and forth the wrist moves into extension and that is an example of that extensor muscle group turning on.
flexion
Tenodesis is the idea of the normal passive movement of when you extend your wrist the fingers (flex/extend) and when you flex your wrist the fingers (flex/extend). So if I am going into extension of the wrist the surfaces or the tissue that are on the flexion aspect of it are getting tensed and it pulls the finger flexors into passive (flexion/extension).
flex; extend; flexion
When your wrist is maximally (flexed/extended) it is difficult to create a large torque to grip things, but when you move into (flexion/extension) you create a large torque to be able to grip things.
flexed; extension
In terms of grip strength from minimal to maximal amount of grip strength you can produce, what is the correct order out of in flexion, neutral, and in extension?
In flexion, in neutral, and in extension
If my wrist was flexed, all of those extensor tendons that go across the dorsum in my wrist and into my fingers now have to have (slack/tension) if I am flexed. So that passive tension is working against me so I have to work harder to curl my fingers because the opposite muscle group is stretched out.
tension
Motion at the radiocarpal joint and mid carpal joint are (equal/not equal) in flexion / extension
Equal
In radial / ulnar deviation most of the motion comes from the (midcarpal/radiocarpal) joint
Midcarpal
