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מסקולוסקלטל ליד > Wrist > Flashcards

Wrist Flashcards

0
Q

Midcarpal Joint

A

medial: condyloid
lateral: planar

functional unit and not synovial because between rows of carpals

scaphoid convex on concave trapezium and trapezoid

lunate concave on convex capitate

triquitrium concave on convex hamate

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1
Q

Radiocarpal Joint

Type

convex/concave

A

ellipsoidal

Convex on concave (for both AP and mediolateral)

btwn concave radius and convex carpals
ARTICULAR DISC: triangular fibrocartilage

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2
Q

TFCC

A

triangular fibrocartilage complex: ulnar support for carpal bones, between ulna and carpals

often injure: pain with forearm pronation and supination and painful wrist ulnar deviation. history of clicking in the wrist at ulna side

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3
Q

Boundary for articular disc formed by what complex

A

ECU tendon sheat

ulnotriquitrial ligament
ulnolunate ligament
palmar radioulnar ligament
dorsal radioulnar ligament

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4
Q

meniscus homologue

A

not a meniscus or a ligament

has a cushioning effect
if it is ruptured and gets into the joint it would mess up the mechanics

need to be intact for TFCC complex

manage: support distal wrist (distal ulna)

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5
Q

Flexion to Extension: midcarpal jt/radiocarpal joint

what moves first and next

radioscaphoid vs radiolunate

A

distal row moves first (convex on concave, except scaphoid on trapezium/trapezoid)

proximal row moves next (convex on concave)

FLEXION: 75% radioscaphoid/ 50% radiolunate

EXTENSION: 92% radioscaphoid / 52% radiolunate

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6
Q

Radial and Ulnar Deviation

midcarpal/radiocarpal

A

the distal row of carpals follow the metacarpals

Midcarpal Joint: convex on concave

then the proximal row of carpals move: convex on concave: they move radiallly in ulnar deviation: radial glide plus extension

(most of radial deviation is at the midcarpal joints)

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7
Q

Dart Throwers Arc

–what is the motion

A

Radial Deviation and Extension–>Ulnar Deviation and Flexion

  • -scaphoid and lunate are stable in this motin
  • -see if pick up anything in TFCC area

Need this motion in ADL: do it gently for carpal ligament repair to SCAPHOID or LUNATE to protect this repair

if issue at TFCC do it gently not ballistic

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8
Q

Radiocarpal Joint

positions:

  • zero
  • rest position
  • closed packed position
  • capsular pattern
A

zero: longitudinal axes through radius and 3rd metacarpal

rest position: slight ulnar dev/wrist flexion –longitudinal axis through radius and 3rd metacarpal are straight

closed packed: full extension

capsular pattern: restricted equally in all directions

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9
Q

Midcarpal Joint Positions

rest

closed packed

capsular pattern

A

rest: neutral or slight flexion with ulnar deviation

closed packed: full extension with ulnar deviation

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10
Q

Midcarpal and Radiocarpal Flexion and Extension

ROM: where most?

A

85 degrees:
Flexion: 50 radiocarpal, 35 midcarpal

Extension: 35 radiocarpal, 50 midcarpal

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11
Q

goniometer

wrist flexion/extension

radial/ulnar deviation

A

flexion/extension

pivot: distal to ulnar styloid
static: in line with ulna
moving: 5th metacarpal

radial/ulnar deviation

pivot: capitate
static: midline of forearm
moving: 3rd metacarpal

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12
Q

Radiocarpal Joint

-distraction

A

patient position: seated, forearm pronated, wrist in resting position (slight ulnar and flexion)

stabilize: forearm just proximal to wrist on table (radius and ulna close to joint as possible)
mobilize: mobilize just distal to wrist arond row of carpals (encircle scaphoid and triquitrium)
direction: distal

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13
Q

Radiocarpal

palmar glide

A

*do picolo first

patient position: patient seated, forearm pronated, longitudinal axis straight through radius and 3rd metacarpal, wrist in slight ulnar flexion

stabilize: distal forearm just proximal to wrist
mobilize: proximal carpal bones
direction: mobilizing hand moves in volar direction to the floor

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14
Q

Radiocarpal: dorsal glide

A

*start with picolo

patient position: sit, forearm supinated, longitudinal line between radius and 3rd metacarpal, slight ulnarflex

stabilize: distal forearm
mobilize: just distal to wrist around carpal bones
direction: dorsal to floor

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15
Q

Radiocarpal Joint

radial glide

A

*start with picolo

patient position: seated, forearm resting on radial aspect, wrist in resting position
***for ulnar deviation

  • start with picolo
    stabilize: distal forearm
    mobilize: just distal to wrist around proximal carpals
    direction: radial glide to floor
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16
Q

Radiocarpal Joint

Ulnar Glide

A

for radial deviation

patient position: patient seated, forearm resting on ulnar aspect, wrist in resting position

stabilize: forearm proximal to wrist on radial side
mobilize: just distal to wrist around carpals
direction: ulnar direction to floor

17
Q

Which radiocarpal glide for wrist flexion?

A

DORSAL GLIDE

18
Q

Which radiocarpal glide for wrist extension?

A

Palmar Glide

19
Q

Midcarpal Joint Distraction

A

position: seated, foreram pronated, wrist in resting position
stabilize: distal to wrist on proximal carpals
mobilize: distal row of carpals (support as needed)
direction: distal distraction

20
Q

Midcarpal Joint

dorsal glide

volar glide

A

position: seated, forearm supinated (in dorsal) or pronated (in volar), wrist in resting position (prox carpals on wedge or edge of table)
stabilize: distal to wrist on proximal carpals
mobilize: distal row of carpals
mobilize: dorsal

21
Q

Carpal Tunnel Syndrome

3 tests

A
  1. Tinel’s Sign: gentle tap anterior wrist where median nerve emerges from under the flexor retinaculum to the hand before it goes deep: median nerve distribution pain or parasthesia
  2. Phalens Test: mechanically compress both median nerves by brining dorsal hands together with maximal wrist flexion for 1 minute. median nerve needs time to conduct so hold for about 1 minute : pain or parasthesia in median nerve distribution
  3. tourniquet tets: 200mmHg inflate and see if pain or parasthesia in median nerve distribution
  4. Tourniquet Test
22
Q

Finklestein Test

A

for de-quevarian disease: you will be suspicious because it will be hot and painful

AbPL or EPB

–put muscle on stretch: thumb into hand (MCP flexion) and then do ulnar deviation

+pain on AbPL or EPB

isolate tendons by their specific function

23
Q

Watson Test:

A

scaphoid/lunate instability

HOLD THE SCAPHOID

ULNAR DEVIATE THE WRIST

+ click or pop

tx: mobilization of scaphoid and lunate

24
Q

Murphy Sign

A

for scaphoid lunate dislocation

patient makes a fist
see if third metacarpal is level with second and fourth instead of being highest

indicate lunate dislocation

25
Q

2 tests for scaphoid-lunate dislocation

A
  1. Watson Test (stabilize scaphoid and ulnar deviate-pain, click, clunk)
  2. Murphy sign: (fist, is 3rd metacarpal not the tallest: dislocated lunate)
27
Q

TFCC Test

A
  1. TFCC load test:

ULNAR DEVIATE WRIST
PUSH THROUGH 5th Metacarpal (into triquitrium/ulna)

(+) pain, crepitus, clicking

if not positive can stress tissue further in flexion/extension/supination/pronation

  1. also we have the supination lift test: patient tries to lift examination table with palm flat on undersurface of table (+) pain or weakness

tx: grade 1 in surrounding area ie capitate lunate
joint protection and splinting
modality for inflammation, paraffin

28
Q

MP Joint

A

condyloid, 2DF

29
Q

IP Joint

A

hinge, 1DF

30
Q

1st CMC jt

A

saddle joint, 2DF

flex extend: concave on convex
ab/adduct: convex on concave

31
Q

CMC Positions

thumb vs fingers

A

Fingers:
Rest: midway flex/extend
Closed Packed: full flexion
Capsular Pattern: equal in all directions

THUMB
Rest: midway btwn all
Closed Packed: full opposition
Capsular pattern: ABDUCTION then EXTENSION

32
Q

MCP Positions

thumb vs fingers

A

FINGERs:
Rest: slight flexion
Closed Packed: full flexion
capsular pattern: FLEXION–>EXTENSION

THUMB
rest: slight flexion
Closed Packed: full opposition
Capsular pattern: FLEXION –> EXTENSION

33
Q

DIP and IP Positions

thumb vs fingers

A

Rest: slight flexion

closed packed: full extension

capsular pattern: FLEXION –> EXTENSION

34
Q

What degrees MCP, PIP, DIP in mass grasp

A

MCP: 90

PIP: 120

DIP: 90

35
Q

Types of Glides

MCP, PIP, DIP

and why

A

Distraction

Volar Glide/Dorsal GLide

Radial Glide/Ulnar Glide: MCP for ab/adduction, PIP/DIP to help stretch collateral ligaments that are bound down

36
Q

Types of Glides

1st CMC

and why

A

Palmar: to increase adduction

Dorsal: to increase abduction

Radial: to increase extension

Ulnar: to increase flexion

37
Q

CMC glides

A

patient position: patient seated, (ulnar border, or palm on the table), thumb in resting position (midway between flex/extend/adduct/abduct)

stabilize: trapezium and trapezoid
mobilize: metacarpal just distal to the joint
direction: glide (start picolo and then distract, volar, dorsal, ulnar, radial glide)

38
Q

General Hand Mobility

metacarpals

  1. arch
  2. volar/dorsal
A
  1. patient hand rests on table, grab palmar surface with fingers, and thumbs on dorsal surface: push palmar to flatten or switch fingers and push with fingers underneath to exagerate the arch: spread metacarpals to reverse the arch
  2. patient hand rest on table,

hold metacarpal with your thumb and index finger along the length of the bone.

Mobilize the metacarpals around the 3rd metacarpal which is always held stable. Move from one metacarpal to the next and do a dorsal glide, back to neutral, palmar glide, back to neutral.
My thumb is along the metacarpal and my fingers are dancing on the bone in order to stabilize on the palmar aspect/ can be facing the subject or next to.

39
Q

Carpal Bone Mobility:

A

Dorsal back to neutral, palmar back to neutral

stabilize capitate: trapezei, scaphoid, hamate, lunate

Radial side: stabilize scaphoid and mobilize trapezeii

Ulnar Side: stabilize triquitrium and mobilize hamate or pisiform (pisiform in radial and ulnar directions with a pincer grip)

40
Q

Wartenberg Sign

A

for ULNAR NEUROPATHY

Start: fingers abducted, palm on the table
Say adduct your fingers

+ cannot adduct 5th digit

substitutions: extend finger and drop it where we said to put it
observe: hypertrophy of hypothenar eminance

note sensation loss to part of 4th and 5th

MMT failed: interossei, digiti minimi, lumbricals

NOTE: EDM can abduct the 5th digit

מסקולוסקלטל ליד (14 decks)

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