Wrist Flashcards
Proximal joint surface
Biconcave
Radius and radioulnar disc
Distal joint surface
Convex
Open chain
Convex carpals on concave radius
VEX on CAVE = OPP
Closed chain
Concave on convex
SAME
Ligaments - Volar (palmar) radiocarpal
From radius to carpal bones
Limit extension
Prevents carpal separation
Ligaments - Volar (palmar) radiocarpal - radiocapitate
Stabilizes lunate when tight
Pulls capitate towards radius
Traps scaphoid
Ligaments - Volar (palmar) radiocarpal - radiotriquetral
Stabilizes lunate by pulling obliquely
Ligaments - Volar (palmar) ulnocarpal
Stabilize midcarpal joint
Limit ext
Prevent carpal separation
Ligaments - Dorsal radiocarpal
From radial styloid to lunate and triquetrum
Limits flex and prevents carpal separation
Ligaments - Ulnar collateral
From ulna to pisiform and triquetrum
Limits radial deviation
Ligaments - Radial collateral
From radius to scaphoid, trapezium, and 1st MC
Limits ulnar deviation
Close packed (radiocarpal and midcarpal)
Radiocarpal in full ext and RD
Midcarpal in full ext
Open packed (radiocarpal and midcarpal)
Radiocarpal in neutral with slight UD
Midcarpal in slight flex with UD
Flex to ext Sequence
distal row initiates - distal glides on proximal row
volar radioscaphoid and radiocapitate lig tighten and pull distal row into close packed
at 45 ext, volar radioscaphoid and lunat tighten and pull lunate into close packed on scaphoid
Radial deviation sequence
Distal carpal row initiates mvmnt and moves toward radius
Ulnar lig tighten, prox row moves in ulnar direction
Scaphoid and trapezium approach radial styloid
Scaphoid forced into flex - ligament btw scaph and lunate pulls lunate into flex
Radial dev continues with prox row ulnar glide
Carpal tunnel
upside down arch/bridge
proximal part is more narrow than distal part
If you extend the wrist, the area gets tighter
Carpal tunnel is maintained by
the flexor retinaculum and transverse intercarpal ligaments
Carpal tunnel contains
Flexor digitorum superficialis/profundus
Flexor pollicis longus
flexor carpi radialis
median nerve
Longitudinal arch
From carpal bones to tip of phalanges
centered around 3rd digit
relatively stable
Transverse arch
Proximal through distal row of carpals
Distal through heads of MCs
Mobility of wrist/fingers
Oblique arch
digits move obliquely to thumb/carpals
thumb opposition to fingers
Carpometacarpal joints (CMC) motion increases from
radial to ulnar
2nd and 3rd are immobile
CMC Thumb opposition includes
flex
abd
IR
Metacarpophalangeal joints (MCP) (2nd to 5th) close packed
full flexion
Interphalangeal joints (IP) close packed
full ext
Thenar mm
Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis
Adductor pollicis
Hypothenar mm
Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
Prehension
act of gripping something with the hand
Prehension - Precision grip
For fine movements
great strength not available
mainly index and thumb
Prehension - preciision grip - which has the most strength
Pad to side
Prehension - power grip
Used when strength is needed
fine movement not available
mainly flexion of all fingers
Prehension power grip - palmar grip
gives more dexterity, can have full fist without ulnar deviation
Prehension power grip - hook grip
gives more strength
thumb does not carry weight but locking mechanism stabilizes
Collies fracture
Fracture of the distal radius in an extended position
Most common
Smith fracture
Fracture of the radius in a wrist flexion position
Scaphoid fracture
worry about necrosis
Bennetts fracture
metacarpal fracture
Gamekeepers thumb
Ulnar collateral ligament sprain
Forceful radial deviation of thumb
Dequervains tenosynovitis
Irritation of the tendons and tendon sheath
Abd pollicis longus and ext pollicis brevis
Trigger finger
pulleys not working
stretched out and ruptured
finger stuck in flexion
might have to pull it back with other hand
Dupuytrens contracture
proliferation of palmar fascia
adheres to itself as it grows
usually affects 4th and 5th digits
get finger flex contracture
Volkmanns ischemic contracture
Obstruction of blood supply to forearm mm typically due to cast being too tight
mm necrose and fibrose in as little as 6 hours
flexor mm contracture results
Mallet fingers
Disruption to profundus tendon from OA
Avulsion of extensor tendon at DIP
hangs down in flexion and they will have trouble extending fingers
Heberdens nodes
At DIP joints typically on dorsal aspect
have ext limitations
might also present with stiffness in hands - OA might be starting
RA - ulnar drift often seen at
MCPs
RA - Swan neck deformity
PIP hyperextension
DIP flex
Rupture of volar plate
RA - Boutonniere deformity
PIP flex
DIP ext
rupture of extensor mechanism
RA - Bouchards nodes
at PIP joints
Wrist drop
radial nerve compromise
can;t actively extend wrist but they can passively
Claw hand
intrinsic minus hand
interossei and lumbricals
occurs due to median and ulnar compromise
Ape hand
medain nerve compromise
involvement of 1st and 2nd and 3rd digits
get recessed thumb and MCP extension
indicative of progressive, long term carpal tunnel syndrome
Bishops deformity
Ulnar compromise, flexed fingers
Complex regional pain syndrome
sympathetic dysfunction of unknown origin
hypovascularity to a portion of body due to abnormal sympathetic activity
Raynauds syndrome
Vasospasm of small cutaneous and subcutaneous arteries and arterioles
idiopathic
usually B
Manual dexterity - Jebsen taylor
writing card turning picking up small objects stacking picking up large light and heavy objects
Manual dexterity - Minnesota rate of manupulation tets
wood cutouts, blocks with diff colors
placing, turning, displacing, one hand turning and placing, two hands
Manual dexterity - Purdue pegboard
fine motor assembly place in in holes washer on top of pin then another washer timed test
Manual dexterity - Nine hole peg
time it
Murphys sign
for dislocated lunate
have pt make fist
pos if 3rd MC level with 2nd and 4th
Ulnar snuff box test
for triquetrum integirty
palpate snuff box - pos if pain (compressing triqutrum into disc)
Watsons sign
Scaphoid shift
Scapholunate ligament stability
palpate scaphoid
passively move pt wrist from ulnar dev and ext to rad dev and flex
Finkelstein
for dequervains
trigger finger test
palpate volar surface of PIP
pt flex and extend PIP
pos if snapping
Phalen
Median nerve
B flex elbows at 90
fully flex wrists for 60 sec
Pinch test
median nerve
pt tries tip to tip pinch btw thumb and 2nd
Fromets
Ulnar
Pt hold piece of paper try to pull away
Wartenbergs sign
Ulnar
therapist passively spreads fingers apart and if pt can’t adduct 5th digit is pos
Allens
Radial and ulna rarterial supply
pt amke fist and relax repetitively
squeeze hand tightly and then PT compress both radial and ulnar for 10-20 sec
pt open hand and PT release pressure over one artery - watch for refill
should have rapid refill within 3 sec
Digital blood flow
Compress nailbed and note time to return
avg is 3 sec
Contraindications for neural provocation tests
Irritable and inflammatory conditions Spinal cord lesions Nerve root compression Malignancy Complex regional pain syndrome Suspicion that distal sympts are result of spinal segment issues
