Wrist And Hand Preclass Flashcards
Thumb contributes what percent of hand function
40
3 main arches of hand
Longitudinal
Metacarpal phalangeal transverse
Carpal tunnel
Distal radioulnar joint
Uniaxial pivit joint
Pronation supination occur here-ulna not fixed
Ulna moves ___ for pronation
Back and lateral
Ulna moves ___ for supination
Forward and medial
Distal RU resting
10 deg supination
distal RU closed pack
5 deg supination
Distal RU capsular pattern
Pain at extreme of rotation
DRUJ trauma
Fall on pronated and ulnarly deviated hand
Injury here accompanies forearm fx
DRUJ trauma symptoms
Ulnar sided wrist pain associated w/ pronation and supination
Tenderness and swelling over joint
Clunks during rotation (possible TFCC tear)
Forces when you fall
80% up radius
20% up ulna
Load differential based on radial angulation of 10-15 deg volar LT and 20-25 deg toward ulna
During immobilization for collies Fox
Edema control and retrograde massage of hand
-HEP for mainting ROM of shoulder, elbow, digits (full MP flex)
-full composite digitize flexion and extension
Tendon gliding
Radiocarpal joint
2 deg freedom
Radius post portion extends distally
Articulate w/ scaphoid and lunate
CONVEX rule
TFC disc
Attaches at ulnar side of radius Attaches to ulnar styloid process Articulates w/ lunate and triquetrum Acts as stabilizer and shock absorber Commonly injured w/ FOOSH
Load bearing ration for TFC disc
Intact 60:40 radius to ulna
Removed is 95:5
TFCC acute trauma
Peripheral tears
TFCC degeneration
Central tears
TFCC injury
Ulnar impaction or positive ulnar variance may contribute to lesion
Local tenderness, pain w/ pronation/sup and forceful gripping
May also hear clicking w/ motion
Ulnar impaction and positive ulnar variance - radiograph
May show flattening, subchrondral sclerosis or cysts, lyric changes in lunate/triquetrum w/ similar changes seen over distal ulna
- pt may have positive ulnar variance
- in subtle cases, a pronation grip gradiophragph may demonstrate ulnar variance
Carpal stability
Ligaments
Scapholunate ligament is commonly injured
Palmar ligaments stronger than dorsal
Scaphoid Fx
Falling onto radial side of hand w/ supination and ext
Young active people
Most frequently fractured bone in the wrist
Scaphoid
Fractures and the waist
70% occur through the waist
Proximal Fx above the waist lead to a vascular necrosis
Scaphoid Fx symptoms
Snuff box effusion and tenderness
Local tenderness to palpation over scaphoid tubercle w/ wrist extended
Snuff box pain w/ resisted pronation
Wrist dislocation
Most commonly involve Lunate and scaphoid
May or may not spontaneously reduce
Can compress median n
Wrist hyperextension dislocation
Volar subluxation of lunate
Dorsal wrist syndrome
Scapholunate snovitis w/ or w/out measurable ligamentous disruption
- pain w/ activity
- post activity aching
- dorsal tenderness over scapholunate joint
- provocation w/ resisted finger ext in wrist flexion
Tears of IO ligament
Volar lunate—> dorsal scaphoid
Volar rotary subluxation occurs w/ complete disruption of scapholunate lig
Radiocarpal resting
Neutral w/ slight ulnar deviation
Radiocarpal closed pack
Extension
Radiocarpal capsular pattern
Flexion and extension equally limited
Most common site for restricted motion after immobilization
Intercarpal joints
Minimal amounts of gliding occur here
Intercarpal resting
Neutral or slight flexion
Intercarpal closed pack
Extension
Intercarpal capsular pattern
None
Medial midcarpal joints
Scaphoid, lunate, triquetrum
Articulate w/
Capitate and hamate
Lateral medial carpal joints
Scaphoid articulates w/ trapezium and trapezoid
Midcarpal joints bound by
Palmar and dorsal lig
No IO
Midcarpal center of rotation
Base of capitate for wrist flexion/ext, radial/ulnar deviation
Wrist extension and flexion occurs primarily at
Radiocarpal joint
So target here before midcarpal if they’re lacking movement
Midcarpal resting position
Neutral or slight flexion w/ ulnar deviation
Midcarpal closed pack
Extension w/ ulnar deviation
Midcarpal capsular pattern
Equal limitation of flexion and extension
Carpal tunnel roof
Volar
Transverse carpal lig
Carpal tunnel floor
Dorsal
Volar radiocarpal lig, volar intercarpal lig, carpals form concave arch
Carpal tunnel medial wall
Pisiform and hook of hamate
Carpal tunnel lateral wall
Tuberosity of scaphoid and tubercle of trapezium
Carpometacarpal joint
2-4 plane synovial - gliding
5 resembles stellar
Thumb is true stellar
First CMC joint arthro
Radial ab/ad concave
Palmar ab/ad convex
MCP movements
2-5 flex/ex, and ab/ad
1 only flex/ext and some rotation
Collateral light right in flexion
Wrist power
Extrinsic muscles
Wrist fine control
Interinsic muscles
20-30 deg wrist ext allows
Maintenance and development of required tension
Functional position of the hand
20-25 deg wrist ext
10-15 deg ulnar devation
Position of hand immobilization
Similar to functional position but MP flexed, IP extended
Decreased potential for contracture
Power grip
Finger flexion, ulnar devation and wrist ext
Median nerve entrapment - wrist
Pronator teres or FDS
Carpal tunnel
The air eminence
Radial nerve entrapment - wrist
Arcade of froshe
B/n tendon os ECRL and brachioradialis
Along the radius
Ulnar nerve course
Courses through 2 heads of FCU • Enters Guyon’s tunnel formed by the pisiform,
hook of the hamate and pisohamate ligament
Wrist hyperextension injuries may result in
Capsuloligamentous injury
Lightamentous sprain and/or fx
Long standing wrist/hand problems may have
RSD or CRPS
Wrist drop
Radial nerve palsy
Claw hand
Intrinsic minus hand
Combined median and ulnar nerve palsy
MP ext
PIP and DIP flexion
Ape hand
Median nerve palsy
Put unable to oppose or flex thumb
Thenar eminence wasting
Bishop’s hand
Ulnar nerve palsy
Waisting of hypothenar eminence
Loss of interossei and two medial lumbricals
OA hand deformities
Heberden’s nodes
Bouchard’s nodes
RA hand deformities
Ulnar drift
“Z” deformity (flexed MP, ext IP)
Swan neck
Extension at PIP (rupture of ext hood)
Flex at DIP, MCP
Boutonnière
Flexion at PIP (rupture of ext hood)
Ext at DIP, MCP
Hand tendon deformities
Mallet finger
Dupuytren’s contracture
Trigger finger
