wrist/hand Flashcards by Hanna Consoldane

wrist joints

radiocarpal
midcarpal

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DoF of wrist

2
flex/ext
rad/ulnar dev

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radiocarpal joint carpal bones

scaphoid
lunate
triquetrum

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orientation of radius

oblique + volarly/ulnarly angled

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TFCC articulates with …

triquetrum

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TFCC connects distally with 4 structures

ECU tendon
triquetrum
hook of hamate
base of 5th

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what is pisiform’s job

increase MA for FCU

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keinbock’s disease

ulnar negative variance (short ulna)

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ulnar positive variance is typically seen with what type of injury

radial fracture

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t/f: the distal radiocarpal segment is an incongruent joint

true

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scaphoid and lunate receive ___% of axial load
TFCC receives ___% of load

80%
20%

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what happens with the TFCC in ulna positive? How about ulna negative?

+ = TFCC impingement
- = TFCC thickening + abnormal force distribution

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structures FCU attaches to

5th metacarpal
hook of hamate
pisiform

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what is the only carpal bone the capitate does not articulate with

triquetrum

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overall arthrokinematic rule of midcarpal joint

concave on convex

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which carpal bones are most strongly bound together

capitate and hamate

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dorsal vs volar ligament strucutre

dorsal = thin
volar = thicker/stronger

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what connects the carpal bones together

intrinsic ligaments

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3 intrinsic ligaments of the wrist

scapholunate
lunotriquetral
V-deltoid

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dorsal radiocarpal ligament orgin + attachment

radial head to triquetrum

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dorsal intercarpal ligament attaches…

triquetrum, lunate, scaphoid, and trapezium together

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dorsal carpal ligaments become taut with what motion

wrist flexion

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what bone is the “keystone” of the wrist

capitate

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close packed wrist position

full extension

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DISI

laxity/tear of scapholunate ligament causes lunate (and triquetrum) EXTENSION dorsally this separates lunate from scaphoid

SLAC

progressive degenerative problem where the scaphoid and lunate collapse (DISI progression)

VISI

laxity/tear of lunotriquetral ligament causes lunate (and scaphoid) FLEX volarly this separates lunate from triquetrum

optimal grip strength wrist position

slight wrist extension + ulnar deviation

what 2 wrist muscles do NOT travel under the flexor retinaculum

palmaris longus flexor carpi ulnaris

ECRL and ECRB insertions

ECRL = 2nd MC ECRB = 3rd MC

primary wrist extensors

ECRL ECRB ECU

primary wrist flexors

PL FCR FCU

deep transverse metacarpal ligament limits

abduction

ligament that forms carpal tunnel

proximal transverse arch

5th CMC type of joint + DoF

saddle joint 2 DoF (flx/ext + abd/add)

2-4 CMC type of joint + DoF

plane 1 Dof (flx/ext)

which are mobile vs fixed: proximal arch distal arch longitudinal arch

fixed = proximal mobile = distal + longitudinal

palmar arch system is assisted by...(3)

finger flexors opponens digiti minimi flexor carpi ulnaris

MCP joint arthrokinematic rules

convex metacarpal head on concave base of phalanx

what type of joint is the MCP + how many DoF

condyloid 2 DoF = flex/ext + abd/add

function of volar plates

limit hyperextension supports longitudinal arch inc congruency prevents flexor tendon pinching

collateral ligament proper is more taut during _____ while accessory collateral ligament is more taut during ______

flexion extension

flexion of MCP increases from 2 --> 5 or 5 --> 2

2 --> 5

where is the most abd/add avalible in MCP

2nd and 5th

PIP and DIP DoF

1 (flx/ext)

which produces more torque at MCP: FDS or FDP

FDS!!

pistol grip

tool larger on radial side for greater length and force (think baseball bat or hammer)

vincula tendinum

folds in synovial membrane providing nutrients

simultaneous IP extension requires active force from...

dorsal interossei volar interossei lumbricals

isolated ED activation causes

MP hyperextension passive IP flexion (clawing/intrinsic minus position)

what nerve injury would cause intrinsic hand muscles to be weak

ulnar nerve

how many DI and VIs are there

4 DI 3 VI (4 if thumb is considered)

CMC of thumb joint type + DoF

saddle 2 DoF = flx/ext + abd/add

closed packed position for thumb

extreme abd + add

opposition sequence

abd flx add (with simultaneous rotation)

head of 1st MC + base of prox phalanx joint type + DoF

condyloid 2 DoF = flx/ext + abd/add

snuff box

APL EPB EPL

4 extrinsic thumb muscles

FPL EPB EPL APL

power grip vs precision handling

power grip has to maintain static grip

4 types of power grips

cylindrical spherical hook lateral prehension

cylindrical grip

like holding a bat

spherical grip

like holding a baseball

hook grip

like holding a dumbell in fingers

lateral prehension

like holding a cig

pad to side

key hold grip

tip to tip

holding a pencil

pad to pad

holding tweezers

functional ROM of w ext ulnar dev MPs PIPs DIPs

20 10 45 30 slight flexion