Wrist Flashcards
Distal Radioulnar Joint Resting position
10 degrees of supination
Distal Radioulnar Joint closed packed position
5 degrees of supination
Distal Radioulnar Joint capsular pattern
Full ROM, pain at extremes of rotation
Radiocarpal (Wrist) Joint resting position
Neutral with slight ulnar deviation
Radiocarpal (Wrist) Joint
Closed packed position
Extension with radial deviation
Midcarpal Joints resting position
Neutral or slight flexion with ulnar deviation
Midcarpal Joints closed packed position
Extension with ulnar deviation
Midcarpal Joints capsular pattern
Equal limitation of flexion and extension, works with radiocarpal joint
Intercarpal Joints resting position
Neutral or slight flexion
Intercarpal Joints closed packed position
Extension
Intercarpal Joints capsular pattern
None
Carpometacarpal Joints resting position
Thumb, midway between abduction and adduction, and midway between flexion and extension; Fingers, midway between flexion and extension
Carpometacarpal Joints
Closed packed position
Thumb, full opposition; Fingers, full flexion
Carpometacarpal Joints
Closed packed position
Thumb, full opposition; Fingers, full flexion
Carpometacarpal Joints
Capsular pattern
Thumb, abduction and extension; Fingers, equal limitation in all directions
Metacarpophalangeal Joints
Resting position
Slight flexion
Metacarpophalangeal Joints
Closed packed position
Thumb, full opposition; Fingers, full flexion
Metacarpophalangeal Joints
Capsular pattern
Flexion and extension
Interphalangeal Joints
Resting position
Slight flexion
Interphalangeal Joints. Closed packed position
Full extension
Interphalangeal Joints
Capsular pattern
Flexion and extension
What maintains stability
Radioscapholunate ligament
Flexor Zone I
Anatomical Landmark?
Clinical Application?
FDP insertion (DIP)
Tear of FDP, Sweater fingers
Flexor Zone II
Anatomical Landmark
Clinical Application
FDS insertion (PIP), Distal palmar crease
Tear FDP and FDS, No Man’s Land
Flexor Zone III
Anatomical Landmark
Clinical Application
Distal palmar crease, distal to Carpal Tunnel Area
FDP, FDS, and Lumbrical damage
Flexor Zone IV
Anatomical Landmark
Clinical Application
Carpal Tunnel Area
FDP, FDS, FPL Median Nerve Injury
Flexor Zone V
Anatomical Landmark
Clinical Application
Proximal wrist to forearm
All intrinsic and extrinsic flexors; Both ulnar and median nerve; Radial and ulnar arteries
Flexor Zone of Thumb I
Anatomical Landmarks
Clinical Application
TI
Distal phalanx, neck of proximal phalanx
Tear FPL
Flexor Zone of Thumb II
Anatomical Landmarks
Clinical Application
Base of proximal phalanx, neck of first metacarpal
Tear FPL and FPB
Flexor Zone of Thumb III
Anatomical Landmarks
Clinical Application
From first metacarpal going proximally
Thenar muscle
What deformity will manifest if the Extensor zone affected is I and II?
Swan Neck Deformity
What deformity will manifest od the affected structure is Extensor zone III and IV?
Boutonniere Deformity
What will manifest if Extensor zone affected is I and II?
Mallet Finger
Its cause is the weakening of the capsuloligamentous structures of the MCP joint
Bowstring effect of the extensor communis tendon
Ulnar Drift
Inability to simultaneously flex MCP and PIP joints
Caused by adhesions or shortening of the extensor communis tendon proximal to the MCP joint
Extensor Plus Deformity
Thickening of the flexor tendon sheath
Common in third and fourth finger
Trigger Finger / Digital Tenovaginitis Stenosans
Atrophy of thenar muscle
Unable to flex or oppose thumb
Caused by median nerve palsy proximal to wrist joint
Ape Hand Deformity
Both median and ulnar nerve pathology
From an extended fingers, patient ask to flex?
From a flexed position, patient ask to extend?
Bishop’s Hand / Benediction’s Hand
Ext to flex = median nerve
Ext to flex = ulnar
Wrist drop is caused by damage to the ?
What if there is no sensory loss what nerve is damaged
Radial nerve
PNI: has sensory loss - PARESTHESIA
ANI: NO sensory loss
What extensor zone is affected when there is a Tear on central slip and lateral band?
Boutonniere deformity
III &IV
FDP, FDS, FPL, and median nerve injury occur in what area and what flexor zone?
Carpal tunnel area, Flexor zone IV
Common in diabetes
showing area of abnromal sensation
ingatan dahil di malalaman kung may bleedin
Opera glove anesthesia
What degrees are the normal functional movement of the wrist:
Flexion;
Extension;
Radial dev;
Ulnar dev;
Flexion; 40 deg
Extension; 40 deg
Radial dev; 15 deg
Ulnar dev; 20 deg
What range (percent) is the acceptable difference b/w the grip strength of each hand?
grip strength: difference 5-10% in both hand
torn FDP
terminal tendon
EXTENSOR ZONE 1
flex DIP (presentation)
MALLET
What type of hand deformity is usually seen in pt w/ RA?
Zigzag deformity
*common sa thumb, seen in RA
*In severe cases of RA, Zigzag, ulnar drift, and yung nodes
4 stages of grip
- opening of the hand
- positioning and closing the fingers and thumb (grasp)
- Exerted force
- Release
* summarized version
Thorn UCL and MCP of thumb
Also known as Skier’s thumb
Id UCL is torn it will deviate radially
Gamekeeper thumb
DIP is flexed
PIP is extended (most affected)
MCP is flexed
lateral band ung affected
volar plate deformity
EXT zone 1
terminal tendon
Swan neck deformity
PIP joint ang affected
common sa RA
Bouchard’s nodes
DIP is extended
PIP is flexed (flexed)
MCP is extended
zone 3 and 4
central band
Boutonniere deformity
Common in severeRA
MCP flexion
Ulnar deviation
THumb subluxation
palmar subluxation onMCP
MCP is weak due to bow stinging
Ulnar drift
Atrophy of thenar muscle
Unable to flex or oppose thumb
Caused by median nerve palsy proximal to the wrist joint
median nerve
Ape hand deformity
Contracture of palmar fascia
MC: men, 4th and 5th finger
Common in men
palpation: matigas, may nodule
Dupuytren’s contracture
Polydactyly and triphalangism
Other congenital anomaly
Campodactyly:
Clinodactyly: orientation:
Syndactyly:
Macrodactyly:
Polydactyly and triphalangism
Other congenital anomaly
Campodactyly: little finger is bent
Clinodactyly: orientation: diagonal
Syndactyly: magkadikit
Macrodactyly: malaki
