Wrist & Hand Flashcards
WRIST & HAND:
double jointed - ROM, impinge, pressure
distal/prox RCJ - which sharper, FLEX vs. EXT, UD vs. RD
proximal carpals
- cave/vex, cover, shape, (?) segmental (= if compressed)
- pisiform: type, muscle
- where axial load (2)
carpals - distal how movement & load + for, which more mobile & collapse, radius with (2)
TFCC - (5), which cont with radius, cont with, thicker where, prox distal apex base
- double jointed = inc ROM, less impingement, inc resistance to pressure
- distal RCJ sharper; FLEX>EXT, UD>RD
proximal carpals
- convex, covered by cartilage, shape depend on function
- intercalated segments (no attachment): if compressed = middle will detach & move in opposite direction as above & below
- pisiform: sesamoid, FCU
- axial load: 80% on SL 20% on TFCC
carpals
- distal: move & equal load with MCP, for arches
- prox more mobile/collapse
- radius with SL
TFCC
- meniscus, articular/radioulnar disc (cont with radius), ECU, ulnolunate ligament, ulnotriquetral ligament
- thicker in periphery
- prox (ulna) distal (carpals), apex (fovea & styloid) base (ulnar notch)
- cont with UCL
WRIST & HAND: RCJ
type, prox (2) distal (3), muscle (1)
distal radius - cave/vex, sharper, inclined + radius vs. ulna length, tilted + ant vs. pos radius length
prox joint - lat/med facet, angled (2)
ulnar variance - pathology, TFCC, pain in (2.x), etiology
- condyloid
- prox: radioulnar disc & radius
distal: scaphoid, lunate, triquetrum - muscle: FCU
distal radius
- concave, sharper antpos
- inclined (23) = radial longer than ulna
- tilted volarly (11) = pos radius longer
proximal RCJ
- lateral facet (with scaphoid), medial facet (with lunate)
- angled volarly & ulnarly
ulnar variance
- positive (ulna longer than radius): d/t fx, thinner TFCC = impingement, pain in PRO & UD
- negative (ulnar shorter): d/t imbalance, thicker TFCC, kienbock
WRIST & HAND: RCJ
functional unit (3)
compression force travels - 1>2>2, radius vs. ulna %
volar vs. dorsal ligament - thicker, for stability, taut
intrinsic vs. extrinsic ligament - connect, nutrition, strength, heal
wrist extension - (1>1>1) + degree + CPP, MCP/PIP/DIP order in flexion/extension + which more torque
- functional unit: scaphoid lunate capitate
- compression: 82% radius 18% ulna, capitate -> scapholunate -> radioulnar
- dorsal ligament: for stability, taut in FLEX
- volar: thicker, taut in EXT
- extrinsic ligament: connect carpals with radioulna & MCP, vascular, weaker but easier heal
- intrinsic ligament: connect carpals together, avascular, stronger
wrist extension
- distal carpals -> scaphoid on lunate & triquetrum -> all carpals move at 45 EXT
- CPP: full EXT
- wrist flexion = PIP -> MP -> DIP
- wrist extension = MP -> DIP -> PIP
- MCP: most torque/moment arm
WRIST & HAND: RCJ - Extrinsic Ligaments
extrinsic volar
- volar radiocarpal: (3) + which stabilizer for scaphoid & part of something
- radial collateral: what
- ulnocarpal: (3)
extrinsic dorsal
- dorsal radiocarpal: attach (3)
- dorsal intercarpal: attach (4)
EXTRINSIC VOLAR LIGAMENTS
- volar radiocarpal: radioscaphocapitate (for scaphoid proximal pole stability & part of palmar intracapsular radiocarpal ligaments, radioscapholunate, radiolunotriquetral
- radial collateral: continuation of VRCL
- ulnocarpal ligaments: TFCC, ulnolunate, ulnar collateral
EXTRINSIC DORSAL LIGAMENTS
- dorsal radiocarpal: with lunate, triquetrum, lunotriquetral ligament
- dorsal intercarpal: scaphoid lunate triquetrum trapezium
WRIST & HAND: RCJ - Intrinsic Ligaments
(2)
if no intercarpal ligament = (2), capitate aligned with (2)
VISI vs. DISI vs. SLAC - what/how/structures/etiology, capitate what happens in DISI
scapholunate & lunotriquetral interosseous ligament
- if no intercarpal ligament = scaphoid go volar, triquetrum go dorsal
- capitate aligned with 3rd MCP & radius
volar intercalated segmental instability
- bye lunotriquetral = scaphoid can pull lunate volarly
dorsal intercalated segmental instability
- bye scapholunate = triquetrum can pull lunate dorsally
- capitate sublux & go between scapholunate
scapholunate advanced collapse
- d/t untreated DISI
WRIST & HAND: MCJ
functional vs. anatomical - capsule with (2), articular surface is never what
type, inc ROM in what motion (2)
RD/UD - prox vs. distal carpals movement + FLEX/EXT
if ligament lax = inc FLEX/EXT vs. UD/RD
- functional: capsule is with capsule of ICJ & CMCJ, no articular surface is never uninterrupted
- saddle, inc ROM in EXT RD
radial deviation
- distal carpals move first radially/EXT, prox move ulnarly/FLEX
- if ligament lax = inc in FLEX/EXT > inc in UD/RD
WRIST & HAND: Muscles
designed for (2>1)
flexor retinaculum - name, except (2), bone
which has most tension, for surgical, for gentle pinch
extensor compartment - separated by (+attach)
ECRL vs. ECRB - active when, more overuse
FPB vs. OP in opposition to digits
- designed for balance & control > torque
- flexor retinaculum/transverse carpal ligament: except FCU & palmaris longus; at hook of hamate
- FCU: most tension
- palmaris longus: for surgical
- gentle pinch = FDP
- opposition to index & middle = FPB>OP
- opposition to ring = OP>FPB
- opposition to litte = FPB=OP
extensor compartment
- separated by septa (attached to dorsal lig)
- ECRL: active in RD & forceful finger flexion
- ECRB: inactive in supinated; more overuse
WRIST & HAND: Muscles
intrinsics & ED in extending PIP
extensor hood - contents, junctura (what)
ORL - origin insertion, where in PIP/DIP + therefore during motion, how stretch
lumbrical - where to interossei, origin/insertion, position, PIP vs. MCP strength
interossei
- where to MCP axis, prox vs. distal wing attach (2.2)
- VI: attach/wing
- DI: index vs. middle vs. ring vs. little finger
- ED can’t extend PIP alone so need intrinsics
- extensor hood: has ED & intrinsics
- junctura tendinae: connects ED tendon with adjacent fingers = if one finger extend the rest follow
oblique retinacular ligament
- from side of 1st finger to distal site of lateral bands
- volar to PIP & dorsal to DIP = if PIP ext then DIP ext
- stretched in PIP ext DIP flex
lumbricals
- ant to interossei
- tendon (FDP) to tendon
- regardless of position; more power on PIP d/t palmaris longus attachment on MCP
interossei
- ant to MCP axis
- proximal wing: attach to extensor hood & PP
- distal wing: attach to central tendon & lateral band
- VI: distal wing only
- DI: index & ring prox wing only
WRIST & HAND: Hand
volar plate - attach (2) + to capsule via what, purpose (4)
sagittal band - where, connect (1.2), stabilize what
IPJ - prox phalanx head shape, ROM per digit
volar plate
- attach to proximal phalanx & MCP head
- blend with capsule via deep transverse metacarpal ligament
- purpose: inc congruency of MCPJ, prevent pinching of long finger flexors during flexion, support longitudinal arch, limit EXT
sagittal band
- at sides of MCP, connects volar plate to extensor tendons
- stabilizes volar plates over MCP heads
IPJ
- phalanx head: pulley shape
- ROM inc from index to little
WRIST & HAND: Arches
prox transverse arch - carpals, supported by (2), forms
distal transverse arch - name, formed by + mobility
longitudinal arch - formed by
proximal transverse arch
- prox carpals
- supported by flexor retinaculum & intercarpal ligaments
- forms pposterior border of carpal tunnel
distal transverse arch/metacarpal arch
- formed by MCPs (2nd-3rd are stable)
longitudinal arch
- MCP + IP
