Wrist and hand joints Flashcards
What are the joints of the wrist?
radiocarpal - between radius and carpal bones
intercarpal - between carpal bones of proximal and distal rows
midcarpal - between proximal and distal rows ( each row acts as a unit
Describe the radiocarpal joint, its BS and NS, and its clinical complications.
Condyloid joint - F/E, sideways, radial/ulnar deviation
Ligaments present - Medial collateral, ulnar collateral, palmar+dorsal radiocarpal, palmar+dorsal radioulnar
There is a triangular fibrocartilaginous disc - styloid process at distal end of ulna and radiocarpal bones
BS: palmar + dorsal carpal arches
NS: deep branch of ulnar, ant + post IO
What are the movements at the wrist joint?
Flexion: FCR, PL, FPL, FCU, FDS, FDP, APL
Extension: ECRL, ECRB, ED, EDM, ECU, EI, EPL, EPB
Radial deviation: FCR, APL, ECRL
Ulnar deviation: ECU, FCU
Describe the intercarpal joint, BS, NS, clinical conditions.
intercarpal joint - joint capsule same as MCM
ligaments present: ant, post, IO
BS: palmar and dorsal carpal arch
NS: deep branch of ulnar, ant IO
Movements: gliding between carpals
Clinical conditions: FOOSH - fracture of scaphoid
Describe the mid carpal joint, BS, NS, clinical conditions.
midcarpal joint - functional joint. it is the joint between proximal row of carpal bones and the distal row of carpal bones. it is a condyloid joint.
Movements: F/E, Radial deviation>ulnar deviation
What are the joints of the hand?
CMC - carpometacarpal
IMC - intermetacarpal
MCP - metacarpophalangeal
IP - interphalangeal
describe CMC and ICM
CMC - 2nd and 3rd planes - capitate and trapezoid (immobile), 4th and 5th (plane), 1st (saddle) - F/E, rotation, opposition, AB/AD
ligaments of CMC and ICM - collateral, CMC, IMC, IO
BS: palmar arterial arch, dorsal and palmar metacarpal a.
NS: deep ulnar, ant and post IO
describe MCP and IP & clinical conditions
IP: between head of proximal phalanx and base of distal phalanx
hinge joint - F/E
MCP: between head of metacarpal and proximal base phalanx
condyloid joint - F/E, Ad/Ab
Ligaments: collateral transverse metacarpal volar plate (palmar) - allows gliding dorsal plate modified hinge - FDS, FDP
BS: palmar arterial arch
NS: median + ulnar n.
clinical conditions: skier’s thumb (forced abduction and extension) causing the rupture of medial collateral ligament - pollicis muscles get pinched
- ventral IP: hyperextension of finger
- dorsal IP: flexion of finger “boutonneire deformity”
- distal IP: “mallet” - flexion (finger to ball)
describe the synovial sheaths
common synovial sheath (FDS, FDP, FPL) - digital synovial - fibrous digital sheaths (connects sheath of little finger)
there is an absence of sheath at lumbricals
describe the fibrous flexor sheaths and it’s clinical applications
annular fibres
cruciform fibres
clinical applications: spread of infection in synovial sheath,
digital tenovaginitis stenosans, de quervain’s tenosynovitis
- little finger infection can spread to ulnar bursa as they are connected.
What does the median nerve innervate?
C5-T1
Muscles: anterior forearm
Skin: nail bed and 3 and a half lateral digits
Median nerve goes through carpal tunnel - susceptible to carpal tunnel syndrome
clinical conditions: median nerve lesions - hand of benediction 1) pointing of index finger when hands are clenched 2) loss of sensation 3) oppenens wasting
What does the ulnar nerve innervate?
C8, T1
Muscles: supplies remaining muscles of ant forearm and hand except thumb
Skin: medial 1 and a half fingers
it runs superficial to FR
Clinical conditions: handlebar neuropathy - deep to hook of hamate (compression of ulnar n.), compression/stretch on posterior of medial epicondyle - inability to flex ring and little finger
What does the radial nerve innervate?
C5-T1
Muscles: extensor compartment of arm, forearm
Skin: extensor compartment of arm, forearm, back of hand
It run across shaft of humerus (between lateral and medial heads of triceps) which is susceptible to injury if there is a fracture - compression (sat night palsy), wrist drop - unable to extend fingers at MCP joint
