Wrist & Hand Flashcards
Osteology of the wrist joint
What type of joint is it?
Radiocarpal: radius with scaphoid, lunate, triquetrum
Midcarpal: scaphoid, lunate, triquetrum, Pisiform with trapezium, trapezoid, capitate, hamate
Joint: condyloid (2 DOF)
What are the benefits of the “2-joint system” in the wrist
Permits large ROM with less exposed articular surface and tighter joint capsules
Less tendency for structural pinch at extremes of motion
Allows for flatter multi joint surfaces that are more capable of withstanding imposed pressures
Radiocarpal joint structure
- proximal compartments
- distal compartment
- articular disc
Proximal: concave surface of radius and TFCC
Distal: convex proximal surfaces of the scaphoid and lunate
Articular disc: disperses forces that cross the wrist
What are the carpal bones
Proximal Row: Scaphoid Lunate Triquetrum Pisiform
Distal Row: Trapezium Trapezoid Capitate Hamate
If you have damage to the wrist ligaments what can that lead to?
Vulnerable to weakness, deformity, instability or arthritis
Extensor Retinaculum
Function and location
Prevent bowstringing on the backside of the hand
What does the Palmar Carpal ligament do?
Prevent bowstringing during flexion
What is Carpal Tunnel Syndrome
Median nerve is compressed or stressed
What are the osteokinematics of the wrist joint?
Flexion/extension
Radial/Ulnar Deviation
Arthrokinematics of Wrist joint
Flex/ext, Deviation
Convex on Concave
- Flexion: anterior roll, posterior glide
- Extension: Posterior Roll and Anterior Glide
- Radial Deviation: Lateral Roll and Medial Glide
- Ulnar Deviation: Medial Roll and Lateral Slide
What are the closed and open packed positions of the wrist joint?
Closed: full extension with radial deviation
Open: Neutral Flexion/Extension with slight ulnar deviation
What is the capsular pattern of the wrist?
Flexion = extension, slight radial and ulnar deviation
What is the main function of the wrist extensors
Position and stabilize (in a neutral position) wrist within activities that require active flexion of the digits
Where will you see max grip in extension
30 degrees
Where do you see peak wrist flexion torque and what muscles help
40 degrees
FCU and FCR —> b/c they help oppose radial and ulnar deviation
What is active wrist extension and flexion coupled with?
Extension: radial deviation
Flexion: ulnar deviation
What is the osteology of the Carpometacarpal joints (CMC) and what type of joint are they
1st through 5th metacarpals
-trapezium, trapezoid, capitate, hamate
Joint type: 1st and 5th: saddle, 2-4 plane
What 2 ligaments help stabilization ulnar and radial deviations
Ulnar and radial collateral
In regards to injury, what type of movement will cause damage to the ulnar collateral ligaments
Excessive valgus stress to 1st MCP “gamekeeper’s thumb”
1st CMC osteokinematics
Flexion/extension
ABD/ADD
Opposition/Reposition
1st CMC arthrokinematics
ABD/ADD
Convex (thumb) on concave (trapezium)
ABD: anterior roll and posterior glide
ADD: posterior roll and anterior glide
1st CMC arthokinematics
Flexion/Extension
Concave (metacarpals) on convex
(Trapezium)
Flexion: medial roll and glide
Extension: lateral roll and glide
1st CMC arthrokinematics
Opposition/Reposition
Opposition: ABD, Flexion & IR
Reposition: ADD, Extension & ER
Osteokinematics of 2-5 CMC
Flexion and Extension
1st CMC Closed and Open pack position and capsular pattern
Closed: full opposition
Open: mid Flexion/extension and mid ABD/ADD
Capsular pattern: ABD
2-5 CMC Closed/open packed position
Closed: full Flexion
Open: mid Flexion/extension
MCP osteology and joint type
Metacarpal and proximal phalanx
Joint: condyloid
Osteokinematics of MCP joints
Flexion/Extensoin
ABD/ADD
Circumduction
Arthrokinematics of MCP joint of flexion and extension
Concave (phalanx) on convex (metacarpal head)
Flexion: anterior roll and glide
Extension: Posterior roll and glide
Arthrokinematics of MCP joint of ABD/ADD
Concave (phalanx) on convex (metacarpal head)
ABD: roll and glide away from 3rd digit
ADD: roll and glide toward 3rd digit
MCP joint closed/open packed position and capsular pattern
Closed: full Flexion
Open: slight flexion
Capsular: Flexion = extension
IP joint osteology and joint
Proximal, middle and distal phalanges
Joint: hinge
IP joint osteokinematics
Flexion and extension
Arthrokinematics of IP
Flexion: roll palmar/anterior and slide palmar/anterior
Extension: roll dorsal/posterior and slide dorsal/posterior
IP joint closed/open pack and capsular pattern
Closed: full extension
Open: slight flexion
Capsular: flexion = extension
What are the flexor pulleys function
Prevent bowstring in of the tendons with contraction of extrinsic finger flexors
5 annular pulley and 3 crucial events pulleys
Why would a patient be placed in a position of function in a splint or brace?
This allows the muscles and joints to have a stretch while they are recovering
What is the position of function of wrist, fingers, and thumb?
Wrist: 20-30 degrees of extension with slight ulnar deviation
fingers: 35-45 degrees of MCP Flexion & 15-30 degrees of PIP and PIP joint flexion
Thumb: 35-45 degrees of CMC joint ABD
