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Kinesiology > Wrist > Flashcards

Wrist Flashcards

1
Q

Bony landmarks of the wrist

A
  • radial styloid
  • ulnar styloid
  • carpal bones
  • metacarpals
  • phalanges
  • carpal bones
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2
Q

Carpal bones

A
  • proximal row = scaphoid, lunate, triquetrum, pisiform
  • distal row = hamate, capitate, trapezoid, trapezium
  • pisiform
    • volar ulnar aspect of wrist
    • attached to triquetrum
    • insertion for FCU
  • hook of hamate
    • distal and radial to pisiform
    • protects ulnar nerve as it passes through palm
  • capitate
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3
Q

Metacarpals

A
  • first segment of each finger
  • form the bone section of the palm
  • form the transverse arches that enhance grasp and in hand manipulation
  • longitudinal arch allows for radial and ulnar aspects of palm to come together
  • metacarpal heads = knuckles
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4
Q

Phalanges

A
  • make up the fingers
  • proximal, middle, and distal sections on digits 2-5
  • the thumb only has proximal and distal
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5
Q

Joints of the wrist

A
  • distal radioulnar joint
  • radiocarpal joint
  • ulnocarpal complex
  • intercarpal joint
  • carpometacarpal (CMC) joint
  • carpometacarpal (CMC) joint of thumb
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6
Q

Distal radioulnar joint

A

Facilitates rotation of the forearm

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7
Q

Radiocarpal joint

A
  • movements = flexion/extension, radial deviation, ulnar deviation
  • sustains 80% of force of the wrist
  • radius, scaphoid, lunate, triquetrum
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8
Q

Ulnocarpal complex

A
  • ulna, lunate, triquetrum
  • triangular fibrocartilage complex separates ulna and carpal bones
  • sustains 20% of force
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9
Q

Intercarpal joints

A
  • complex arthrokinematic pattern (no set movements, just can mobilize them)
  • bones slide and move against each other
  • know that some patients may lack mobility here
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10
Q

Carpometacarpal (CMC) joint

A
  • gliding joints
  • base of metacarpals articulate with distal row of carpals
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11
Q

Carpometacarpal (CMC) joint of thumb

A
  • saddle joint
  • flexion/extension, abduction/adduction
  • facilitates pinch and fine motor coordination
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12
Q

ROM of wrist flexion

A
  • primer movers = flexor carpi radialis, flexor carpi ulnaris
  • patient position = sitting, forearm in pronation on tabletop, hand off table; fingers relaxed
  • goniometer axis = dorsal wrist over capitate (goniometer upright)
  • stationary arm = midline of dorsal forearm
  • moving arm = 3rd metacarpal
  • compensatory movement = elbow flexion and finger flexion
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13
Q

Prime movers of wrist flexion

A
  • flexor carpi radialis
  • flexor carpi ulnaris
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14
Q

Typical ROM of wrist flexion

A

80 degrees

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15
Q

Compensatory movement of wrist flexion

A
  • elbow flexion
  • finger flexion
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16
Q

ROM of wrist extension

A
  • prime movers = extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris
  • patient position = sitting with the forearm in supination on tabletop, hand off table; fingers relaxed
  • goniometer axis = volar wrist crease
  • stationary arm = midline of volar forearm
  • moving arm = 3rd metacarpal
  • compensatory movement = elbow flexion, finger extension
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17
Q

Prime movers of wrist extension

A
  • extensor carpi radialis longus
  • extensor carpi radialis brevis
  • extensor carpi ulnaris
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18
Q

Typical ROM of wrist extension

A

70 degrees

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19
Q

Compensatory movement

A
  • elbow flexion
  • finger extension
20
Q

ROM of radial deviation (wrist)

A
  • prime movers = extensor carpi radialis longus, extensor carpi radialis brevis, flexor carpi radialis
  • patient position = forearm in pronation on tabletop wrist neutral; fingers and thumb relaxed
  • goniometer axis = capitate bone (base of 3rd metacarpal)
  • stationary arm = midline of dorsal forearm
  • moving arm = 3rd metacarpal
  • compensatory movement = elbow flexion, finger/thumb abduction
21
Q

Prime movers of radial deviation (wrist)

A
  • extensor carpi radialis longus
  • extensor carpi radialis brevis
  • flexor carpi radialis
22
Q

Typical ROM of radial deviation (wrist)

A

20 degrees

23
Q

Compensatory movement of radial deviation (wrist)

A
  • elbow flexion
  • finger/thumb abduction
24
Q

ROM of ulnar deviation (wrist)

A
  • prime movers = extensor carpi ulnaris, flexor carpi ulnaris
  • patient position = forearm in pronation on tabletop wrist neutral; fingers and thumb relaxed
  • goniometer axis = capitate bone (base of third metacarpal)
  • stationary arm = midline of dorsal forearm
  • moving arm = 3rd metacarpal
  • compensatory movement = elbow extension, finger abduction
25
Q

Prime movers of ulnar deviation (wrist)

A
  • extensor carpi ulnaris
  • flexor carpi ulnaris
26
Q

Typical ROM of ulnar deviation (wrist)

A

30 degrees

27
Q

Compensatory movement of ulnar deviation (wrist)

A
  • elbow extension
  • finger abduction
28
Q

MMT of wrist flexion

A
  • against gravity = forearm in supination on tabletop, wrist in midrange flexion; fingers relaxed
  • stabilizing hand = forearm stabilizing against tabletop (more distal/medial forearm)
  • resistive hand = mid-volar palm
  • force application = against flexion
  • gravity eliminated = sitting with forearm neutral (thumb up) and ulnar forearm and hand resting on tabletop
  • stabilization = radial forearm
  • palpation = flexor carpi radialis and flexor carpi ulnaris at volar wrist
29
Q

Palpation of wrist flexion

A

Flexor carpi radialis and flexor carpi ulnaris at volar wrist

30
Q

MMT of wrist extension

A
  • against gravity position = forearm resting in pronation on tabletop; wrist in midrange extension; fingers relaxed
  • stabilizing hand = mid-dorsal forearm stabilizing against tabletop
  • resistive hand = dorsal metacarpals
  • force application = against extension
  • gravity eliminated = sitting with forearm neutral (thumb up) and ulnar forearm and hand resting on tabletop
  • stabilization = radial forearm against tabletop
  • palpation = extensor carpi ulnaris, extensor carpi radialis longus, and extensor carpi radialis brevis at dorsal wrist
31
Q

Palpation of wrist extension

A

Extensor carpi ulnaris, extensor carpi radialis longus, and extensor carpi radialis brevis at dorsal wrist

32
Q

Palpation of radial deviation (wrist)

A

Extensor carpi radialis longus and brevis at dorsal wrist; flexor carpi radialis at volar wrist (MMT not tested in practical)

33
Q

Palpation of ulnar deviation (wrist)

A

Extensor carpi ulnaris at dorsal wrist; flexor carpi ulnaris at volar wrist

34
Q

Clinical implications

A
  • carpometacarpal osteoarthritis (CMC OA) of thumb
  • flexor tendon injuries
  • extensor tendon injuries
  • carpal tunnel syndrome
  • distal radius fracture
  • peripheral nerve injuries
  • ulnar nerve injury
  • median nerve injury
  • radial nerve injury
35
Q

Carpometacarpal osteoarthritis (CMC OA) of thumb

A
  • common place for osteoarthritis due to activity demands
  • interventions = activity modifications, adaptive grips, orthoses, surgical intervention
36
Q

Flexor tendon injuries

A
  • often result from a laceration from a sharp object
  • categorized into zones of injury
  • intervention = surgical repair, dorsal blocking orthosis, early motion to promote tendon gliding, one handed techniques
  • difficulty bending fingers
37
Q

Extensor tendon injuries

A
  • less common than flexor tendon injuries
  • interventions = one handed techniques, orthoses
38
Q

Carpal tunnel syndrome

A
  • carpal tunnel contains 9 tendons and median nerve
  • occurs with increased pressure caused by repetitive motion
  • reduces blood flow to arteries that supply the median nerve
  • intervention = surgical intervention, orthosis, task modification, education
39
Q

Distal radius fracture

A
  • 25% of all fractures in pediatrics
  • 18% of all fractures in older adults
  • occurs most often from a FOOSH
  • complications = edema, swelling, scar tissue, nerve compression, joint stiffness
  • post-op interventions = scar management, edema management, adjacent joint mobility, ADL modifications, balance/fall assessment
40
Q

Peripheral nerve injuries

A
  • vision, touch, and proprioception guide the movement and place of our hands
  • stereognosis
  • somatosensation
  • both are important for safety
  • intervention = orthoses
41
Q

Stereognosis

A

Ability to identify an object using hands alone
- no visual input

42
Q

Somatosensation

A

Ability to determine temperature and pain

43
Q

Ulnar nerve injury

A
  • may present with sensory and motor deficits
  • motor = interossei muscles, ADPL, lumbricals of ring and small finger
  • ring and small fingers may begin to claw = claw hand
  • hyper extension in MCPs and loss of IP extension in ring and small fingers
44
Q

Median nerve injury

A
  • also called the Hand of Benediction
  • unable to flex thumb , pointer finger, and middle finger
  • loss of webspace of thumb
45
Q

Radial nerve injury

A
  • wrist drop = loss of wrist and digit extension

Kinesiology (11 decks)

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