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Kines Test 2 > Wrist and Hand > Flashcards

Wrist and Hand Flashcards

0
Q

What is circumduction and can the wrist perform it?

A

combine flexion, extension, radial and ulnar deviation

*yes

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1
Q

Wrist complex - how many joints

A

2
radiocarpal & midacarpal
*having 2 joints permits greater ROM with less articular surface and more pressure

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2
Q

Normal ROM: wrist flexion

A

80

65-85

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3
Q

Normal ROM: wrist extension

A

70

60-85

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4
Q

Normal ROM: Ulnar deviation

A

30

20-45

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5
Q

Normal ROM: Radial deviation

A

20

15-21

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6
Q

Proximal segment of wrist joint

A

radiocarpal joint

concave radius and radioulnar disc - convex carpals (scaphoid,lunate and Triquetrum)

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7
Q

what does TFCC stand for

A

triangular fibrocartilage complex

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8
Q

Proximal radiocarpal joint is angled

A

volarly - 11 degrees
ulnarly - 23 degrees
*because the radius is longer

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9
Q

There is contact between __ & __ % of the surfaces

A

30 & 40

*this alows for more flexion than extension and more ulnar deviation than radial

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10
Q

Compression at the wrist

A

80% in scaphoid and lunate
- lunate =40% contact while scaphoid is 60% contact)
TFCC 20%

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11
Q

Ulnar variance

A 
positive - radius and ulna at same level
*possible inpingement of TFCC
*thinner TFCC
negative - unla shorter than radius
*abnormal force distribution
*avascular necrosis of lunate
THick TFCC
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12
Q

FOOSH

A

(fall on outstretched hand)
* a long ulna may be present after a distal radius fracture
trouble with ulnar deviation and pronation

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13
Q

Midcarpal joint structure

A

Proximally - Scaphoid, lunate and triquetrium
distal - trapezium, trapezoid, capitate, hamate
*concave - convex

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14
Q

Extrinsic ligaments

A
  • connect carpals to radius and ulna

- weaker but better potential for healing

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15
Q

Intrinsic Ligs

A
  • interconnect the carpals

- stronger but rely on synovial fluid for nutrition

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16
Q

Closed pack position for wrist

A

extension

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17
Q

Closed pack position for radiocarpal and midcarpal

A

full radial deviation

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18
Q

min ROM for ADLs

A

flex: 10
ex: 35
OR
Flex: 54
Ex: 60
UD: 40
RD:17
*wrist extension and ulnar deviation is most important

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19
Q

Best position to stabilize wrist in

A

20 degrees extension and 10 degrees of ulnar deviation

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20
Q

Volar wrist muscles

A

flexion
PL, FCR, FCU
* FCR and FCU work together in flexion to avoid deviation
*PL absent in 14%
*FCU - on the pisiform - increases the MA

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21
Q

Dorsal wrist muscles

A

extensors
* ECU, ECRL, ECRB
* all work together to avoid deviation
ECU - affected by forearm position; decreased moment arm in pronation

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22
Q

Carpal Tunnel

A
  • Proximal transverse arch - transverse carpal lig
  • between hook of hammate&pisiform and Scaphoid&trapezium
  • contents = median nerve and 9 extrinsic flexor tendons
  • FPL, 4 FDS, 4 FDP
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23
Q

Long term median nerve compression at the carpal tunnel will cause

A

atrophy of the thenar eminence = ape hand

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24
Q

If force is transmitted from FCU –> pisiform where does it go next?

A

hamate and 5th metacarpal

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25
Q

bones of the distal carpal row contribute to __ degrees of freedom to the wrist

A

2

*flexion/extension & ulnar/radial deviation

26
Q

Midcarpal joint favors which motions?

A

extension and radial deviation

27
Q

Which ligaments are thicker? dorsal or volar?

A

volar (palm)

28
Q

Volar ligaments

A

volar radiocarpal lig

  • radiocapitate
  • radiolunte
  • radioscapholunate
  • radial collateral
  • ulnar collateral
  • all extrinsic
  • Scapholunate
  • Lunotriquetral
  • both intrinsic
29
Q

Dorsal ligaments

A
  • dorsal radiocarpal

- dorsal intercarpal

30
Q

distal to the carpals, there are __ bones

A

19

31
Q

2nd-4th CMC joints

A

plane synovial

*1 degree of freedom

32
Q

5th CMC

A

saddle

  • 2 degrees
  • the immobile second and third allow 1st 4th and 5th to move
33
Q

MCP joints

A 
convex metacarpal on concave base of phalanx
condyloid
2 degrees of freedom
flex/ex ab/add
capsule is lax in extension
34
Q

Volar plate limits

A

hyperextension of MCP

35
Q

Closed pack position of MCP

A

extension

36
Q

Flexion at MCP increases __

A

radially to ulnarly

  • index finer 90
  • little finger 100
37
Q

Abuction and adduction at max when MCP

A

is in extension

38
Q

IP joints

A

are synovial hinge

1 degree of freedom

39
Q

Which has more ROM DIP or PIP

A

PIP

40
Q

when fingers are flexed they point towards

A

scaphoid

41
Q

Best position to immobilze hand in

A

MCP flexion
IP joint extension
thumb CMC abduction

42
Q

FDS attachs to

A

proximal to DIP

43
Q

FDS action

A

flex PIP
assist in MCP flexion
greater MA at MCP and less at PIP
used when greater force needed during wrist flexion

44
Q

FDP

A

Attaches to DIP
flexes DIP, PIP and MCP
primary muscle with gentle pinch

45
Q

T or F: FDS and FDP do not depend on wrist position

A

F

both muscles depend on wrist position for optimal length-tension relationship

46
Q

When FDS is not active/present what happens when pinch pinky to thumb?

A

the DIP flexes and PIP extends ; the FDP is not able to flex both joints

47
Q

Pistol grip

A

wider ulnarly
hammer or cup
FDS and FDP can work better on the and 5th fingers
more ulnar deviation

48
Q

Gliding mechanism

A

Flexor retinacula, bursae and digital tenon sheath

49
Q

Only muscles able to form MCP extension

A

ED, EDM and EI

  • also perform wrist extension
  • the ED splits into a central tendon and lateral bands distal to the PIP joint
50
Q

ED contraction

A

tension on extensor hood and causes MCP joint extension
causes PIP and DIP flexion due to passive insuff.
need assistance from intrinsic muscles to achieve PIP and DIP extension

51
Q

Dorsal and Volar interossei

A

-arise between metacarpals
-attach to extensor hood and lateral bands
-just volar to MCP joint axis
- compress MCP joint when in extension
-when in extension they perform finger ab and add
-extension occurs together
DAB
PAD

52
Q

Lumbricals

A
  • FDP and lateral band of extensor mechanism
  • IP extension regardlessof MCP poisition
  • L
53
Q

Clawing is a result of

A

loss of intrinsic muscles

* wear a splint to keep MCP in flexion so that ED can cause PIP and DIP extension without the intrinsic muscles

54
Q

a ruptured central tendon can cause

A

Boutonniere deformity - flex PIP - ex DIP

55
Q

Swan neck deformity

A

Ex of PIP - flex DIP

56
Q

1st CMC joint

A

trapezoid and 1st metacarpal
saddle
2 degrees of freedom

57
Q

MCP of thumb

A

condyloid
2 degrees of freedom
less ROM than fingers

58
Q

IP of thumb

A

identical to fingers

hinge

59
Q

Extrinsic thumb muscles

A 
FPL - volar
EPB - dorsal; base of prox phalanx
EPL - dorsal; base of distal phalanx
APL - dorsal; base of metacarpal 
* all are affected by wrist position
60
Q

Intrinsic thumb muscles

A
  • 5 thenar muscles
  • OP, APB, FPB, AP, first volar interossei
  • 1st dorsal interossei is bipennate arising from both 1st and 2nd metacarpal
61
Q

Power grip

A 
full hand prehension - grab something 
cylindrical grip (cup), spherical (ball)*more interossei, hook (suit-case), lateral (paper between fingers)
62
Q

Precision handling

A

finger-thumb prehension

  • pad to pad
  • tip-tip * worst - less SA
  • pad -side or lateral pinch
  • lateral pinch generates more force - greater surface area and use of FPB bc thumb more adducted * less precise because creates most force
63
Q

Which position of the wrist optimizes force of finger flexors

A

ulnar deviation

Kines Test 2 (4 decks)

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