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Ortho Tx 700 > Wrist > Flashcards

Wrist Flashcards

1
Q

Listers tubercle acts as a pulley for

A

EPL

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2
Q

Radial styloid process

A

Distal radius. Insertion of Brachioradialis

Fall into joint gap on lateral side, ulnar deviate to feel it pop into thumb.

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3
Q

Ulnar styloid process

A

Distal ulna.

Posterior and proximal to radial styloid process.

No muscle attachment, but TFCC

Radially deviate to find it, flex/extend to rule out carpals

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4
Q

Palpate scaphoid

A

Most lateral of the proximal carpals

Can Palpate dorsally in floor of anatomical snuff box

On palmar side it is at the base of the thenar eminence, at the intersection of the four digits when fingers flexed.

If palpated when fingers flexed will slide forward during radial deviation and flexion

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5
Q

Palpate lunate

A

Proximal carpal, in between scaphoid and triquetrum

Dorsal: roll medially off Listers Tubercle, then distal into joint space.

Flex wrist and lunate should pop into contact.

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6
Q

Palpate triquetrum

A

Medial proximal carpal.
“Under” pisiform; articulates with ulna and hamate.

Move distal from ulnar styloid process into joint space. Radially deviate and it should pop into contact.

Can also roll off pisiform

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7
Q

Palpate pisiform

A

Palpate medial aspect of most distal crease in wrist

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8
Q

Palpate trapezium

A

Most lateral distal carpal

Articulates with 1st MC and scaphoid.

Come proximal to MC 1, flex/extend to confirm. Or “top” of floor of anatomical snuff box.

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9
Q

Palpate trapezoid

A

Articulates with MC #2 and scaphoid

Palpate proximal to base of MC 2.

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10
Q

Palpate capitate

A

Articulates with MC #3 and lunate

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11
Q

Lister’s tubercle

A

Distal dorsal radius

Extend thumb to verify palpation

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12
Q

Palpate hamate

A

Dorsally, drop proximally off the end of 5th MC

Hook of hamate: 1cm distal and slightly lateral to pisiform.

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13
Q

What tendon attaches to the proximal pisiform?

A

FCU

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14
Q

Anatomical snuff box

A 
Lateral: APL and EPB
Medial: EPL
Posterior: radial styloid process 
Floor: Scaphoid (and trapezium)
Radial artery
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15
Q

Tendons associated with DeQuervain’s

A

APL
EPB

(Another Long Exam Blows)

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16
Q

Transverse carpal ligament

A

AKA flexor retinaculum

Attaches to pisiform, Hook of Hamate, scaphoid, and the tubercle of the trapezium

Covers carpal tunnel

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17
Q

Palpate EDMinimi tendon

A

Compartment 5

Just lateral to ulnar styloid process

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18
Q

Carpal tunnel

A

Under flexor retinaculum
Deep to palmar flexor

Lateral border: scaphoid and tubercle of trapezium
Medial border: pisiform and hook of hamate

Contain: median nerve, FDS, FDP, FPL

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19
Q

Tunnel of Guyon

A

AKA ulnar tunnel

Ulnar artery and nerve pass in between pisiform and the Hook of Hamate

Floor: pisohamate ligament and flexor retinaculum
Roof: palmar carpal ligament and palmaris brevis ligament

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20
Q

Thenar eminence (superficial to deep)

A

AbPB
FPB
OppPolBrev

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21
Q

Hypothenar eminence (superficial to deep)

A

AbDigMin
Flex Dig Min B
OpDigMin

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22
Q

Distal Radioulnar joint

A

Synovial pivot

Head of ulna (convex) on Ulnar notch of radius (concave)

1 degree of freedom (sup/pro)

Resting: 10° sup
Closed pack: 5° sup
Capsular pattern: pain at extreme pronation or supination

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23
Q

Distal RU: ROM and end feel

A

Supination 90° firm

Probation 70-90° firm/hard

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24
Q

Radiocarpal joint

A

Synovial ellipsoid

Scaphoid and lunate (convex)’on distal radius (concave)

2 degrees of freedom (flex/ext, rad/uln dev)

Resting: neutral, slight ulnar deviation
Closed pack: full extension
Capsular pattern: equal all around

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25
Q

Ulnomeniscotriquetral joint

A

Synovial ellipsoidal

Triquetrum (convex) on disc (concave)

2 degrees of freedom (flex/extend and uln/rad dev

Resting: neutral, slight ulnar dev
Closed pack: full extension
Capsular pattern: equal all around

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26
Q

Midcarpal joints

A

Between proximal and distal rows of carpal (except pisiform)

Resting: neutral or slight flexion, with slight ulnar deviation
Closed pack: extension with ulnar deviation
Capsular pattern: flexion=extension

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27
Q

RadCarp, UMT and MidCarp: ROM and end feel

A

Flexion: 80° firm
Extension: 70° firm

Radial Dev: 20° firm
Ulnar Dev: 30° firm

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28
Q

Radial collateral ligament

A

Radial styloid process to tubercle of scaphoid and trapezium

Limits ulnar deviation

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29
Q

Palmar radiocarpal ligament

A

Limits extension

stronger then dorsal

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30
Q

Dorsal radiocarpal ligament

A

Limits flexion

Weaker than palmar

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31
Q

Ulnar collateral ligament

A

Ulnar styloid process to triquetrum and hamate

Limits radial deviation

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32
Q

Ulnocarpal ligaments

A

Palmar and dorsal.

Limit extension and flexion respectively

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33
Q

UMT joint primarily involved in what movement

A

Supination/pronation.

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34
Q

Triangular fibrocartilage complex (TFCC)

A

The meniscus and disc in the UMT

Disc Extends from medial distal radius to ulnar styloid process, prevents direct articulates of ulna with triquetrum (and maybe lunate)

Cushion and stabilizer for distal RadUln jt

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35
Q

With supination/pronation the TFCC:

A

Disc moves with radius and carpals, sweeps around ulna

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36
Q

With flexion/extension the TFCC:

A

Disc stays with radius and ulna; movement occurs between disc and carpals.

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37
Q

Intercarpal joints

A

Between carpals of the same row

Only slight gliding movement

Dorsal, palmar and interosseus ligaments

Resting: neutral or slight flexion
Closed pack: extension
No capsular pattern.

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38
Q

Palmar ligaments are _______ than dorsal.

A

Stronger.

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39
Q

Carpometacarpal Joint #1

A

Trapeziometacarpal

Saddle joint
3 degrees of freedom (flex/ext, ad/abduction, rotation)

Dorsal and palmar ligaments

Resting: midway
Closed pack: full opposition
Capsular pattern: abd then extension

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40
Q

Carpometacarpal joints 2-5

A

Plane joints (slight gliding only)

Dorsal, palmar and interosseus ligaments

4&5 more mobile

Resting: midway between flex/ext
Closed pack: full flex
Capsular pattern: equal in all directions

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41
Q

Intermetacarpal joints

A

2-5 only

Slight gliding

Palmar, dorsal and interosseus ligaments

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42
Q

Metacarpophalangeal joint # 1

A

Semicondyloid joint

3 degrees of freedom: flex/ext, ab/adduction, rotation

Resting: slight flexion
Closed pack: full opposition
Capsular pattern: flexion more than extension

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43
Q

Sesamoid bones (thumb)

A

On palmar surface of MC 1. With tendons of Add Pol and FPB

Attach to volar plate and to medial and ulnar collateral ligament

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44
Q

Metacarpophalangeal joints 2-5

A

Condyloid joints
2 degrees of freedom (flex/ext, ab/adduction)

Collateral, palmar and deep transverse ligaments.

Resting position: slight flexion
Closed pack: full flexion
Capsular pattern: flexion more than extension

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45
Q

Volar plates

A

Thick ligament that span MCP and IP joints

Anterior/palmar

Reinforce capsule, limit hyperextension

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46
Q

Interphalangeal Joints

A

Hinge

Flex/ext

Some rotation during flexion
Fibrous capsule, palmar and collateral ligaments

Resting: slight flexion
Closed pack: full extension
Capsular pattern: flexion > extension

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47
Q

Lumbricals manus

A

3 and 4 bipennate: also insert at Prox phalanx of digits 3&4

Digits 2-5
Origin: tendon of FDP to proximal tendons go ExtDig of same finger. Lateral side of finger MC->Prox phalanx

Flexion MCP 2-5
Extension PIPs and DIPs 2-5

Median and/or ulnar nerve
Ulnar and radial artery

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48
Q

Palmar interossei

A

Unipennate. Three.

Base of MC 2, 4, 5 –> base of prox phalanx 2,4,5

ADduction of 2,4,5

Ulnar nerve
Radial and ulnar artery

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49
Q

Dorsal interossei

A

Bipennate. Four.

Bodies of MC 1-5 –> base of prox phalanx 2,3,4

Abduction of 2,3,4

Ulnar nerve
Radial and ulnar artery

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50
Q

MMT: ECRL

A

Seated. Elbow 90°. Forearm pronated, resting on table. Wrist extended and radially deviated.

Pressure against wrist flexion and ulnar deviation

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51
Q

MMT: ECRB

A

Seated. Leaning forward so elbow fully flexed. Forearm pronated and resting on table. Wrist extended and radial deviated

Apply pressure towards flexion and ulnar deviation.

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52
Q

MMT extensor digitorum

A

Seated. Elbow flexed. Elbow stabilized. MCP extended PIPs and DIPs flexed

Apply pressure towards MCP flexion

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53
Q

MMT ECU

A

Seated. Elbow at 90°. Wrist extend and ulnar deviated

Apply pressure towards wrist flexion and radial deviation.

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54
Q

MMT Palmaris Longus

A

Elbow 90°. Forearm up. Wrist flexed. Fingers making beak hand.

Attempt to open beak and extend wrist

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55
Q

MMT FDS

A

Seated. Sublimated forearm on table. Flex at PIPs. Stabilize DIPs, MCP

Apply pressure towards PIP extension

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56
Q

MMT FDP

A

Supinated forearm resting on table. Flex at DIPs. Stabilize PIPs

Apply pressure towards DIP extension.

57
Q

Primary axis for flexion-extension is through the __________ (carpal).

A

Capitate

58
Q

Wrist flexion is primarily at what joint,

A

Midcarpal

59
Q

Wrist extension is primarily at what joint?

A

Radiocarpal

60
Q

Close pack position of the wrist

A

Slight supination with extension

61
Q

“Screw Home” mechanism (wrist)

A

As wrist extends, the distal carpals become close-packed with the scaphoid.

Lunate and triquetrum then move independent of scaphoid

Resulting supination twists capsules and ligaments –> close packed

62
Q

Most commonly fractured carpal

A

Scaphoid

63
Q

Most commonly dislocated carpal

A

Lunate

Dislocates anteriorly/palmarly

64
Q

During ulnar and radial deviation the axis of movement is through the

A

Capitate

65
Q

What happens to the proximal carpals during radial deviation?

A

PPUF

Pronation
Ulnar glide
Flexion

66
Q

What happens to the distal carpals during radial deviation?

A

DSUE

Supination
Ulnar glide
Flexion

67
Q

During extension what direction do the carpals glide?

A

Anterior

68
Q

Carpal Tunnel Syndrome

A

Compression of the median nerve through the carpal tunnel.

69
Q

CTS compression occurs because of

A

1 decreased tunnel size
2 increased component size
3 combination of the above

70
Q

CTS: Hallmark sign

A

Nocturnal neuro Sx

Also: “tearing” sensation at palmar fascia
HT forearm flexors
Atrophied thenars
Decreased dexterity

71
Q

CTS: thumb sensation

A

Unaffected because palmar cutaneous branch of median nerve doesn’t pass through carpal tunnel.

72
Q

CTS: special tests

A 
Phalens
Flexion ligamentous stress test
Reverse Phalens
Extension ligamentous stress test
Tinel's
73
Q

CTS: DDx

A

Pronator teres syndrome (Rule out with pronator teres syndrome test. No nocturnal Sx)

C6-7 Radiculopathy (increased Sx with neck movement)

TOS (Sx more ulnar)

Double crush. ULTT if positive decrease tension on that site and test other sites

74
Q

Dupuytren’s Contracture

A

Flexion deformity due to contraction of palmar fascia. Non inflammatory. No pain

Usually HT of palmaris longus; it that’s absent then FCU

Idiopathic

75
Q

Dupuytren’s: Sx

A

Bilateral
Thick, puckered, noduled palmar fascia

MCP and IP flexion, usually D4&5

HT wrist flexors

Decreased IP AROM

76
Q

Dupuytren’s; Tx

A

MFR: flexors, palmar fascia

NMT: flexors (palmaris longus, FCU)

JM: tractions; ant glide MCP DIP PIP

PStretch: flexors

Remex: DMH, SFMR fascia, stretch flexors, selfPROM finger extensor a

77
Q

How many functional arches of the hand?

A

4 (1 longitudinal, 3 transverse)

78
Q

What do the functional arches of the hand allow for?

A

Gripping, cupping

79
Q

Longitudinal arch of the hand

A

Each finger and its corresponding carpal

Arches centered around their MCP joints

80
Q

Focal point of the longitudinal arch

A

Capitate + long finger

81
Q

Transverse arches of the hand

A

2 transverse carpal + 1 transverse metacarpal

82
Q

Transverse carpal arch

A

Made of the proximal and distal rows of carpals

Distal row centres around the capitate and is less mobile.

83
Q

Transverse metacarpal arch

A

Formed by heads of metacarpals

Centre point: MC 3, lunate, capitate

84
Q

Cascade sign

A

In finger flexion, the index finger flexes in the sagittal plane (straight down) and the other fingers flex toward the scaphoid tubercle.

85
Q

Cupping of the hand involves ____________; flattening involves _______________.

A

finger flexion

finger extension

86
Q

Muscles of the wrist perform what two functions?

A
  1. provide fine adjustment of the hand into its functioning position
  2. once in position, stabilize the wrist to provide a stable base
87
Q

As grip strength increases, wrist extensors ….

A

Slacken

This allows for flexors to shorten

88
Q

Greatest IP flexion force is during

A

ulnar deviation and neutral flexion/extension (power grip)

89
Q

Dorsal digital expansion is composed of

A

Extrinsic extensor tendon and sheath (posteriorly)

Intrinsic tendons of interosseous muscles and lumbricals (anteriorly)

90
Q

DDE: Origin and insertion

A

O: posterior, medial and lateral proximal phalanges 1-5
I: posterior distal phalanges 1-5

91
Q

Extrinsic extensor tendon

A

Extensor digitorum and Extensor pollicis longus
Attach posteriorly to the DDE

Exert force at the MCP

92
Q

Intrinsic extensor tendon

A

Lumbricals and interossei
Attach anteriorly to the DDE

Extend IP 2-5 only

93
Q

4 types of prehension

A

Pinch
Encircle
Push
Adhere

94
Q

2 groups of prehension

A

Power and precision

95
Q

Power grip

A

Forceful act with isometric flexion at all fingers

Cylindrical
Spherical
Hook
Fist/Lateral

96
Q

In power grip, movements are produced by

A

Radial or ulnar deviation at the wrist (think hammering), supination and pronation of the wrist, and/or elbow extension

97
Q

Precision grip

A

No contact with palm. No static phase

Isotonic contraction of D1-3

Palmar pinch
Lateral pinch (opposition)
Tip prehension

98
Q

Nerve(s) involved in power grip

A

Median and ulnar

99
Q

Nerve(s) involved in precision grip

A

median

100
Q

Primary muscles in power grip

A

extrinsic

101
Q

Primary muscles in precision grip

A

intrinsic

102
Q

Swan Neck deformity

A

Flexion in MCP and DIP
(hyper)Extension in PIP

Caused by contracture of intrinsic muscles or tearing of the volar plate

RA, trauma

103
Q

Boutonniere deformity

A

Extension of MCP an dDIP
Flexion of PIP

Rupture of central slip of DDE

RA, trauma

104
Q

Dupuytren’s contracture

A

Contracture of the palmar fascia
Fixed flexion deformity of MCP and PIP joints

Idiopathic

105
Q

Heberden’s Nodes

A

Dorsal DIP

Associated with OA

106
Q

Bouchard Nodes

A

Dorsal PIP

Associated with OA

107
Q

Ulnar Drift

A

Seen in RA

Due to weakening of MCP capsuloligamentous structures and pull of long tendons

108
Q

Zigzag deformity

A

Thumb
CMC flexion
Hyperextended MCP

RA

109
Q

Z deformity

A

Thumb
hyperextension of IP

Familial

110
Q

Mallet Finger

A

Permanent flexion of the DIP because of rupture/avulsion of extensor tendon at distal insertion

111
Q

Ape hand

A

Median nerve palsy.

Thumb in line with fingers because of unchecked extensors

Inability to flex or oppose thumb
Muscle wasting at thenar eminence

112
Q

Benediction Hand/Ulnar Claw

A

Ulnar nerve palsy

MCP hyperextension, DIP/PIP flexion in D4&5

Can’t extend 4&5

Wasting of hypothenars, interossei, 2 medial lumbricals

113
Q

Oath Hand

A

Median nerve palsy

Can’t flex 1-3
MCPs flexed

114
Q

Claw fingers

A

Combined ulnar and median nerve palsy

MCP hyperextended and PIPs/DIPs flexed
Loss of intrinsic muscle function and loss of functional arches of the hand

115
Q

Wrist drop

A

Radial nerve palsy

Inability to extend fingers and wrist

116
Q

What movements primarily happen at the midcarpal joint?

A

Flexion and radial deviatioin

117
Q

What movements primarily happen at the RC joint?

A

Extension and ulnar deviation

118
Q

Which muscle’s referral pattern is similar to the pain felt in lunate dislocation?

A

FCR

119
Q

Abductor digiti minimi manus

A

O: pisiform and tendon of FCU
I: proximal phalanx of D5

Abduction of D5

Ulnar nerve
Ulnar artery

120
Q

Flexor digiti minimi manus

A

O: flexor retinaculum and hook of hamate
I: proximal phalanx of D5

Flexion of D5

Ulnar nerve
Ulnar artery

121
Q

Opponens digiti minimi

A

O: flexor retinaculum and hook of hamate
I: MC#5

opposition of D5 at CMC joint

Ulnar nerve
Ulnar artery

122
Q

Adductor pollicis

A

Oblique head: bases of MC 2 & 3, capitate (travels through medial sesamoid)
Transverse head: distal MC 3

Insertion: medial proximal phalanx thumb

Adduction of thumb at CMC

Ulnar nerve
Radial artery

123
Q

Carpal Tunnel

Syndrome

A

Compression of the
Median nerve as it passes through carpal tunnel.

Due to small tunnel and/or big contents.

124
Q

CTS: Sx

A

Hallmark: nocturnal neurological Sx

Unilateral

Also:
Tearing sensation in palmar fascia
HT flexors
Atrophied thenars

125
Q

CTS and Thumb

A

Unaffected because palmar cutaneous branch passes over carpal tunnel.

126
Q

CTS: special tests

A

Phalens, Flexion Ligamentous
Reverse Phalens, Extension Ligamentous
Tinels

127
Q

CTS: DDx

A

C6-7
Pronator Teres syndrome
TOS
Double Crush

128
Q

CTS vs C6-7 Radiculopathy

A

C6-7 Radiculopathy: Sx increase with neck movement

CTS: Sx increase with wrist movement

129
Q

TOS vs CTS

A

TOS: Sx prox to wrist. Thumb involvement. Tends to be more ulnar

130
Q

Pronator Teres Syndrome vs CTS

A

Pronator Teres; no nocturnal pain, Sx increase with elbow flexion; thumb involvement; Sx proximal to wrist

CTS: nocturnal pain; Sx worse with wrist movement; no thumb involvement

=> pronator Teres syndrome test

131
Q

Double Crush Syndrome vs CTS

A

ULTT. When one site tests positive, relax it but continue testing remaining sites.

132
Q

CTS: Tx

A

MFR: flexor retinaculum

NMT: FDS, FDP, FPL

JM: wrist

MLD

PStretch: palmar fascia, flexors

ReMex: stretch flexors;

133
Q

Gamekeeper’s thumb

A

UCL sprain of MCP 1
AKA skiers thumb

Pain in webspace
Weakness and pain in punch

134
Q

Trigger Finger

A

Digital tenovaginitis/tenosynovitis

Thickening of flexor tendon sheath, development of nodules

Sticking when going from Flexion to extension

Idiopathic

135
Q

Lunate Dislocation

A

Most common carpal dislocation

MOI FOOSH with hyperextension

Sx: swollen wrist, pain with extension, possible median nerve Sx

Extension ligament stress test

136
Q

Lunate dislocation: ROM

A

Pain with extension - A,P,R

Bony end feel
Weak extension

137
Q

Scaphoid Fracture

A

Most commonly fractures carpal

MOI: FOOSH with radial deviation

Sx: radial side pain, especially with radial deviation and extension

Tender anatomical snuffbox

138
Q

Complication of galeazzi fracture

A

Ulnar nerve lesion

139
Q

Complication of Colles fracture

A

Median nerve lesion

Ortho Tx 700 (12 decks)

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