Wrist/Hand

Question 1

Which joints are found in the “wrist”?

Answer 1

Distal R/U, radiocarpal, midcarpal

Question 2

Radiocarpal joint classification(s)?

Answer 2

Distal radius is concave

Scaphoid and lunate are convex

Question 3

RC close packed? Resting?

Answer 3

Extension,

Neutral with slight ulnar deviation

Question 4

RC capsular pattern?

Answer 4

Equal limitation in all directions

Question 5

Midcarpal joint classification(s)?

Answer 5

Capitate & hamate are convex (Medial distal row of carpals)
Trapezium & trapezoid are concave
● Implication: more movement in medial compartment
Individually, they are each planar joints
Joint as a whole is ovoid, but medial and lateral compartments are opposite shapes

Question 6

Midcarpal close packed? Resting?

Answer 6

Extension with ulnar deviation,

Neutral or slight flexion with ulnar deviation

Question 7

List the proximal row of carpal bones.

Answer 7

Scaphoid, lunate, triquetrum, pisiform

Question 8

List the distal row of carpal bones.

Answer 8

Trapezium, trapezoid, capitate, hamate

Question 9

Which carpal bone is most frequently fractured?

Answer 9

Scaphoid

Question 10

Which carpal bone is the largest?

Answer 10

Capitate

Question 11

Which carpal bone has a distal saddle shape that articulates with the 1st MC?

Answer 11

Trapezium

Question 12

Which carpal bone has the axis of rotation for all wrist motion pass through it?

Answer 12

Capitate

Question 13

Which carpal bone increases the moment arm for the flexor carpi ulnaris?

Answer 13

Pisiform

Question 14

Which carpal bone is most unstable?

Answer 14

Lunate

Question 15

Describe the Triangluar Fibrocartilage Complex. (What it is made of and roles it plays in the wrist)

Answer 15

TFCC is a disc made of connective tissues (fibrocartilage) and has fibrous attachments to the structures around it.
It allows for motion, increases congruency between distal ulnar and medial carpal bones, absorbs compressive forces (~20%)

Question 16

Extension AK: assume convex on concave

Answer 16

roll is posterior, slide is anterior

Question 17

Flexion AK:

Answer 17

roll is anterior, slide is posterior

Question 18

Ulnar Deviation AK:

Answer 18

roll is medial, slide is lateral

Question 19

Radial Deviation AK:

Answer 19

roll is lateral, slide is medial

Question 20

Limitations to Flexion

Answer 20

● Dorsal capsule
● Dorsal Radiocarpal ligament
● Normal end feel is capsular

Question 21

Limitations to Extension

Answer 21

● Palmar capsule
● Palmar Radiocarpal ligament
● Normal end feel is capsular

Question 22

Limitations to Radial Deviation

Answer 22

● Scaphoid on Radius
● Ulnar capsule
● Ulnar Collateral ligament

Question 23

Limitations to Ulnar Deviation

Answer 23

● Radial capsule

● Radial Collateral ligament

Question 24

How does wrist position affect grip strength at the fingers?

Answer 24

About 30 degrees of wrist extension provides peak grip strength (finger flexion), see figure 7-26 in Neumann. Excessive flexion puts the flexors out of optimal length and lengthens the extensors, which passively limit flexion.

Question 25

Name the arches found within the hand. What bones/joints comprise these arches?

Answer 25

Longitudinal- structural shape of consecutive bones (along a given ray within the hand)
Proximal Transverse- carpals and CMC joints contribute to this arch
Distal Transverse- arch spread across all of the MCP joints

Question 26

Which MC’s are more stable? Which are more mobile?

Answer 26

More stable- 2nd and 3rd

More mobile- 4th and 5th

Question 27

Thumb CMC joint classification in the radioulnar direction:

Answer 27

● the joint surfaces are: concave MC & convex trapezium

● the motions that occur are: flexion/extension (abduction/adduction in plane of the palm)

Question 28

Thumb CMC joint classification in the anterior/posterior direction:

Answer 28

● the joint surfaces are: convex MC & concave trapezium

● the motions that occur are: abduction/adduction (abduction/adduction perpendicular)

Question 29

Arthrokinematics of the Thumb CMC Joint:

Abduction perpendicular:

Answer 29

roll is anterior, slide is posterior

Question 30

Arthrokinematics of the Thumb CMC Joint:

Adduction perpendicular:

Answer 30

roll is posterior, slide is anterior

Question 31

Arthrokinematics of the Thumb CMC Joint:

● Flexion:

Answer 31

roll is ulnar, slide is ulnar

Question 32

Arthrokinematics of the Thumb CMC Joint:

● Extension:

Answer 32

roll is radial, slide is radial

Question 33

Close packed position of thumb CMC:

Answer 33

full opposition

Question 34

Resting position of thumb CMC:

Answer 34

midway between add/abd perpendicular & midway bettwen flex/ext

Question 35

Capsular pattern of thumb CMC:

Answer 35

abduction perpendicular most limited, followed by extension