Wrist & Hand

Question 1

Osteology of the wrist joint

What type of joint is it?

Answer 1

Radiocarpal: radius with scaphoid, lunate, triquetrum

Midcarpal: scaphoid, lunate, triquetrum, Pisiform with trapezium, trapezoid, capitate, hamate

Joint: condyloid (2 DOF)

Question 2

What are the benefits of the “2-joint system” in the wrist

Answer 2

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

Question 3

Radiocarpal joint structure

• proximal compartments
• distal compartment
• articular disc

Answer 3

Proximal: concave surface of radius and TFCC

Distal: convex proximal surfaces of the scaphoid and lunate

Articular disc: disperses forces that cross the wrist

Question 4

What are the carpal bones

Answer 4

Proximal Row:
Scaphoid
Lunate
Triquetrum
Pisiform

Distal Row:
Trapezium 
Trapezoid 
Capitate
Hamate

Question 5

If you have damage to the wrist ligaments what can that lead to?

Answer 5

Vulnerable to weakness, deformity, instability or arthritis

Question 6

Extensor Retinaculum

Function and location

Answer 6

Prevent bowstringing on the backside of the hand

Question 7

What does the Palmar Carpal ligament do?

Answer 7

Prevent bowstringing during flexion

Question 8

What is Carpal Tunnel Syndrome

Answer 8

Median nerve is compressed or stressed

Question 9

What are the osteokinematics of the wrist joint?

Answer 9

Flexion/extension

Radial/Ulnar Deviation

Question 10

Arthrokinematics of Wrist joint

Flex/ext, Deviation

Answer 10

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

Question 11

What are the closed and open packed positions of the wrist joint?

Answer 11

Closed: full extension with radial deviation

Open: Neutral Flexion/Extension with slight ulnar deviation

Question 12

What is the capsular pattern of the wrist?

Answer 12

Flexion = extension, slight radial and ulnar deviation

Question 13

What is the main function of the wrist extensors

Answer 13

Position and stabilize (in a neutral position) wrist within activities that require active flexion of the digits

Question 14

Where will you see max grip in extension

Answer 14

30 degrees

Question 15

Where do you see peak wrist flexion torque and what muscles help

Answer 15

40 degrees

FCU and FCR —> b/c they help oppose radial and ulnar deviation

Question 16

What is active wrist extension and flexion coupled with?

Answer 16

Extension: radial deviation

Flexion: ulnar deviation

Question 17

What is the osteology of the Carpometacarpal joints (CMC) and what type of joint are they

Answer 17

1st through 5th metacarpals
-trapezium, trapezoid, capitate, hamate

Joint type: 1st and 5th: saddle, 2-4 plane

Question 18

What 2 ligaments help stabilization ulnar and radial deviations

Answer 18

Ulnar and radial collateral

Question 19

In regards to injury, what type of movement will cause damage to the ulnar collateral ligaments

Answer 19

Excessive valgus stress to 1st MCP “gamekeeper’s thumb”

Question 20

1st CMC osteokinematics

Answer 20

Flexion/extension
ABD/ADD
Opposition/Reposition

Question 21

1st CMC arthrokinematics

ABD/ADD

Answer 21

Convex (thumb) on concave (trapezium)

ABD: anterior roll and posterior glide
ADD: posterior roll and anterior glide

Question 22

1st CMC arthokinematics

Flexion/Extension

Answer 22

Concave (metacarpals) on convex
(Trapezium)

Flexion: medial roll and glide
Extension: lateral roll and glide

Question 23

1st CMC arthrokinematics

Opposition/Reposition

Answer 23

Opposition: ABD, Flexion & IR
Reposition: ADD, Extension & ER

Question 24

Osteokinematics of 2-5 CMC

Answer 24

Flexion and Extension

Question 25

1st CMC Closed and Open pack position and capsular pattern

Answer 25

Closed: full opposition
Open: mid Flexion/extension and mid ABD/ADD

Capsular pattern: ABD

Question 26

2-5 CMC Closed/open packed position

Answer 26

Closed: full Flexion

Open: mid Flexion/extension

Question 27

MCP osteology and joint type

Answer 27

Metacarpal and proximal phalanx

Joint: condyloid

Question 28

Osteokinematics of MCP joints

Answer 28

Flexion/Extensoin
ABD/ADD
Circumduction

Question 29

Arthrokinematics of MCP joint of flexion and extension

Answer 29

Concave (phalanx) on convex (metacarpal head)

Flexion: anterior roll and glide
Extension: Posterior roll and glide

Question 30

Arthrokinematics of MCP joint of ABD/ADD

Answer 30

Concave (phalanx) on convex (metacarpal head)

ABD: roll and glide away from 3rd digit
ADD: roll and glide toward 3rd digit

Question 31

MCP joint closed/open packed position and capsular pattern

Answer 31

Closed: full Flexion
Open: slight flexion

Capsular: Flexion = extension

Question 32

IP joint osteology and joint

Answer 32

Proximal, middle and distal phalanges

Joint: hinge

Question 33

IP joint osteokinematics

Answer 33

Flexion and extension

Question 34

Arthrokinematics of IP

Answer 34

Flexion: roll palmar/anterior and slide palmar/anterior

Extension: roll dorsal/posterior and slide dorsal/posterior

Question 35

IP joint closed/open pack and capsular pattern

Answer 35

Closed: full extension
Open: slight flexion

Capsular: flexion = extension

Question 36

What are the flexor pulleys function

Answer 36

Prevent bowstring in of the tendons with contraction of extrinsic finger flexors

5 annular pulley and 3 crucial events pulleys

Question 37

Why would a patient be placed in a position of function in a splint or brace?

Answer 37

This allows the muscles and joints to have a stretch while they are recovering

Question 38

What is the position of function of wrist, fingers, and thumb?

Answer 38

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