Wrist and Inferior RU joint Flashcards
Function of wrist
Help us position hands
- Use powerfully eg open a jar, carry a suit case
- dexterously eg writing, phone, communication
Bones with the wrist
- Radius
- Ulnar
- Carpal bones
Scaphoid Lunate Triquetrum Pisiform Distal row: Trapezium Trapezoid Capitate Hamate
Which is bigger at the wrist ulnar or radius?
The radius
Trapzium / trapeziod which one where rhyme?
TrapeziUm is by the thUmb, trapeziod is right besiod
Carpal bones?
Proximal row:
Scaphoid - Some
Lunate - Lovers
Triquetrum - Try
Pisiform - Positions
Distal row:
Trapezium - That
Trapezoid - They
Capitate - Can’t
Hamate - Handle
Radio carpal joint - classification, movements, ART, structures ect.. 5 points
- Classification - Synovial ellipsoid
- Bi-axial
- Flexion / extension
- Adduction - ulnar deviation
- Abduction - radial deviation
[deviation = towards]
- ART:
- proximal carpal bones - scapoid, lunate, triquetrum
- distal end of radius , intra-articular disc
- joint capsule which is strengthened by collateral ligaments
- Triangular fibrocartilage complex [TFCC] - acts like a meniscus (separates the ulnar styliod and triqurium)
- shock absorption help with WB of arm / hitting / hammering
- increase surface area for increased stability
- increase the congruence of SA
- joint capsule which is strengthened by collateral ligaments
- Ligaments
Intracapsular ligs:
- Dorsal radiocarpal ligament - taut in flexion
- Palmar radiocarpal ligament - taut in extension
Extracapsular
- Radio collateral ligament - taut in adduction
- Ulnar collateral ligament - taunt in abduction
Distal / inferior radio ulnar joint – classification, movements, ART, structures ect.. 4 points
- Classification - synovial pivot joint
- uni axial (one pair of movements)
- Articulating surfaces
- Concave ulnar notch
- Medial aspect of the distal end of the radius
- Include Triangular fibrocartilage complex [TFCC]
Movements
- Supination - palm up
- Pronation - palm down
Carpal tunnel - what is it?
- A tunnel formed by the carpal bones
- Area innervated by the median nerve = painful
- Flexor retinaculum ligaments give structure - stops the tendons from bowstringing - more efficient use of forces
Measuring ROM + degrees of wrist, positioning - end feel?
Flexion - 60-80 - Fulcrum on triquretum - moving hand on 5th met - firm end feel
Extension - 60-75 - Fulcrum on triquretum - moving hand on 5th met - firm end feel
Radial deviation / abduction - 15-25 - fulcrum on capiate / lateral epicondyle - moving arm on medial metacarpal
Ulnar deviation / adduction - 30-40
Supination - 90 - start in midprone (karate chop position) - pt to hold pen
Pronation - 90 - start in midprone - pt to hold pen
Muscles flexion - 2 types generally?
Short / long flexors
Short flexors
Muscles flexion - 2 types generally?
Short / long flexors
Short flexors - only act on the wrist + a bit a the elbow
- Flexor carpi ulnaris (B)
- Flexor carpi radialis (B)
Long flexotrs - act on the hand AND wrist
- Flexor digitorum superficialis (flex fingers) (B)
- Flexor digitorum profundus (flex fingers) (B)
- Flexor pollicis (thumb) longus (flex thumb) (C)
ALL flex the wrist..
[+ lumbricles flex the finger]
Muscles extension- 2 types
Short:
- Extensor carpi radialis longus (B) +Extensor carpi radialis brevis (C - Tennis elbow )
- Extensor carpi ulnaris
Long
- Extensor digitorum - Work on fingers
- Extensor pollicis longus+ Extensor pollicis brevis - Extend thumb
- Extensor Indicis - extend index finger
long flexors / long extensors what are they?
2 joint muscles - flex / extend at the wrist and also the fingers, for finger flexion, wrist extensors are required to cancel out the wrist flexion that the long flexors want to do whilst flexing the fingers (contract = pull on all attachements).. true neurtalisers
Muscles for radial / ulnar deviation
radial deviation - (towards thumb)
- extensor carpi radialis longus
- extensor carpi radialis brevis
- flexor carpi radialis longus
- flexor carpi radialis brevis
[helping neutrilisers, cancel out each others flex / extension to do the desired movements]
ulnar deviation
- extensor carpi ulnaris longus
- extensor carpi ulnaris brevis
- flexor carpi ulnaris longus
- flexor carpi ulnaris brevis
[helping neutrilisers, cancel out each others flex / extension to do the desired movements]
muscles pronation
- pronator retes
- pronator quadratus
muscles supination
- supinator
- biceps brachi [especially fast movements in elbow flexion]
Radial styloid process model position / how to find?
model in sitting
forearm pronated, palpate deeply on lateral side of wrist, easier if wrist slightly radially deviated.
Provides attachment for; Radial collateral ligt
Ulnar styloid process model position / how to find?
model in sitting
Forearm pronated, palpate deeply medially and towards anterior surface.
Provides attachment for; Ulnar collateral ligt
Head of the ulna model position / how to find?
model in sitting
Forearm pronated head of ulna clearly seen on posterior aspect as rounded emminence medial side above the wrist.
Surface mark the joint line
Wrist
Wrist: Corresponds to a line, concave proximally, between the styloid processes of ulna and radius
where the skin fold is …
Surface mark the joint line
Inferior radio-ulnar joint
Represented by a vertical line, palpable posteriorly, between lateral edge of the head of the ulna and distal end of the radius.
‘Find the medial border of radius / ulnar and then palpate.. hand in pronation. NB: radius = bigger. J line more towards the lil finger side
https://www.youtube.com/watch?v=l_94hqe4mho
Identify the common extensor tendon
Identify the common flexor tendon
Common ext tendon: Lateral humeral condyle the slightly down
Common flex tendon: Medial humeral condyle then slightly anterior
Put muscles on a stretch / palpate co
Flexor digitorm superficalis
Flexor digitorum profundus
Extensor digitorum
Flexor digitorm superficalis - extend wrist + fingers [pressure on middle finger biases superficalis] - note FDS attaches to the middle phalanges of 2-5 mets
Flexor digitorum profundus - extend wrist + fingers [ pressure on end of finger biases prfondus] note this is where FDP attaches, the distal phalanges of the fingers 2-5
Extensor digitorum - flex wrist / finger
PAMs
Wrist joint
Inferior radio ulnar joint
GIVE PILLOW
Wrist: PT POSITION: lying - https://www.youtube.com/watch?v=Do06wdW1gDc
- Want to have a kind of hand shake grip [don’t necessarily have to do].. and swap hand so that the hand on top is making a downward force
- Grip either side of the joint line, hand on first line of carpals = giving pressure
- AP - supination
- PA - pronation
Inf radio ulnar joint:
- Move the radius [against what reynold said but in line with youtube / louise] and fix the ulnar head…
- Supination = AP (top and downward force)
- pronation = PA (top and downward force)
https://www.youtube.com/watch?v=Fn3JSdqaZFE
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