Wrist and Hand Flashcards
Hand Architecture
Central Column/ Pillar effect
Stable at CMC 3
Flanked by mobile segments
Keystone Carpal Bone
Capitate
flexion ROM
80-90 degrees
Extension ROM
70-80 degrees
Radial Deviation ROM
20-25 degrees
Ulnar deviation ROM
30-35 degrees
Radiocarpal Joint
Radius and TFC with scaphoid, lunate, and triquetrum
Lateral Radial facet
articulates with scaphoid
46% of RC joint
Medial radial facet
articulates with lunate
43% of RC joint
inferior radioulnar disc
articulates w/ triquetrum
11% of RC joint
RC joint shape
convex carpals on convex radius
Midcarpal joint
functional unit
-no isolated capsule
-interrupted multiarticular surface
condyloid
Clinical implication of ligament integrity
weaked palmar area near the lunate= palmar dislocation of lunate most common
Ganglion cysts on proximal pole of the scaphoid
Dorsal Radiocarpal ligament
Thickening of capsule
Lunate and radius contact
Check rein to end range flexion
Radial and Ulnar Collateral ligaments
check rein to frontal plane motions
Volar radiocarpal ligament
most important of all ligaments for stability and passive motion contribution
3 bands
RC joint flexion
50 degrees
MC joint flexion
35 degrees
Wrist flexion
85%
RC extension
35 degrees
MC extension
50 degrees
Wrist extension
35 degrees
Coupled motions at wrist
Flexion and ulnar deviation
Extension and radial deviation
Ulnar tilt
Tilt of radius from styloid to articulation w/ ulna
~25 degrees
RC joint arthrokinematics
Flexion: palmar roll dorsal glide
Extension: dorsal roll palmar glide
Radial deviatoin: radial roll ulnar glide
Ulnar deviation: Ulnar roll radial glide
Midcarpal ulnar joint arthrokinematics
Convex on Concave in both planes
Flexion: palmar roll and dorsal glide
Extension: dorsal roll and palmar glide
Midcarpal radial joint arthrokinematics
Concave on convex in both planes
Flexion: palmar roll and glide
Extension: dorsal roll and glide
Radial deviation arthrokinematics
Proximal row moves palmarly
Distal row moves dorsally
Ulnar deviation arthrokinematics
Proximal row moves dorsally
Distal row moves palmarly
Wrist closed pack
45 degrees wrist extension and slight radial deviation
Wrist open pack
Slight flexion w/ slight ulnar deviation
Wrist muscle synergies
ECR and ED: Substitution if weak ECR
FCU and ADM: FCU stabilizes pisiform
ECU and EPLB: ECU maintains neutral during thumb ext
Tenodesis
Minimal activity wrist extension shortens flexors
Increased passive tension. Gravity flexes wrist to allow positioning, extension flexes fingers to allow gripping
CMC joints
Plane synovial 2-4 concave on convex
Condyloid saddle 5 2 DF concave on convex
CMC 1 joint
saddle biaxial joint b/w 1 metacarpal and trapezium
trapezium concave saggital plane=convex on concave
trapezium convex frontal plane=concave on convex
CMC ROM
15-20 flexion
20-30 extension
70 abduction
CMC 2-5 Arthrokinematics
Concave on convex
MCP joints arthrokinematics
2-5 condyloid joint
Concave on convex
IP joints
Concave on convex
Power grip
Stability
Large forces
Sphere or cylinder objects
Precision Grip
Requires contour
delicate action
Egg
Precision Pinch
Fine control between index and thumb
tip-to-tip
pulp-to-pulp
Power pinch (Key)
larger forces
stability of object occurs b/w thumb and lateral border of index finger
Hook grip
No thumb
Requires partial flexion PIP and DIP; static natured for longer periods. FDP primarily
Swan-neck deformity
RA implicated
Synovitis
Flexed MCP, extended PIP, flexed DIP
Boutonniere deformity
RA implications
Extended mcp, flexed pip, extended dip
Position of rest
wrist extension 20 Ulnar deviation 10 MCP flexion 45 PIP flexion 30 DIP slight flexion
Position of immobilization
Less wrist extension than rest, more MCP flexion, neutral IP
Minimizes potential for contracture
