Wrist, Hand, Ankle and Foot Flashcards
Describe the main features of the distal radio-ulnar joint ?
- Interosseous membrane
- Fibrous capsule
- Anterior and posterior Radio- ulnar ligaments (weak)
- Sacciform recess facilitates movement
Which joint do pronation and supination involve a movement of ?
Proximal radioulnar joint
Describe the main features of the tibio-fibular joint ?
- Interosseous membrane
- Tibio-fibular ligaments (strong), including the anterior, posterior and inferior transverse tibio-fibular ligament N
What types of joints are the radio-ulnar and tibio-fibular joints ?
Syndesmoses
Which movement moves the tibio-fibular joint ?
(Very slight movement) during dorsiflexion
What is the major role of the tibio-fibular joint ?
Stability of the ankle
Where is the inferior transverse tibio-fibular ligament found ?
Forms the posterior wall for the talus (trochlea)
What are the groups of bones of the hand ?
Carpals
Metacarpals
Phalanges
Name all the carpals, lateral to medial.
Proximal: Scaphoid, Lunate, Triquetrum, Pisiform
Distal: Trapezium, Trapezoid, Capitate, Hamate
How many metacarpals are there ? How are they named ?
Five
Using roman numerals
Name all the phalanges.
Proximal and distal phalanges in the thumb
Proximal, middle and distal phalanges in other 4 fingers
What are the groups of bones of the foot ?
Tarsal bones, metatarsals and phalanges
Name all the tarsals, medial to lateral.
Proximal row: Talus, Calcaneus
Intermediate row: Navicular
Distal row: medial cuneiform, intermediate cuneiform, lateral cuneiform, cuboid
What is the only bone to link leg with foot ?
Talus bone
Which bones form the wrist joint ?
Distal end of radius and articular disc (NOT ulna) articulate with proximal carpal bones (but NOT pisiform)
Which bones form the ankle joint ?
Distal end of tibia (medial malleolus) and fibula (lateral malleolus) articulate with the talus.
What are the main features of the wrist joint capsule ?
- Loose fibrous capsule
- Synovial folds within capsule
- Strong ligaments reinforce joint
1. Radial and ulnar collateral ligament
2. Palmar and dorsal radiocarpal ligament
What are the main features of the ankle joint capsule ?
- Loose fibrous capsule
- Synovial folds within capsule
- Collateral ligaments of ankle all originate at malleoli and fan out to tarsal bones:
- Medial (deltoid) ligament
- Lateral ligament
What is the role of the two collateral ligaments of the ankle ?
- Medial (deltoid) ligament: Prevents dislocation during eversion of the foot
- Lateral ligament: Resists over-inversion
What type of joint are the wrist and ankle respectively ? Which of these two is a weight bearing joint ?
Wrist: Condyloid joint
Ankle: Hinge Joint (weight-bearing)
What is the actual name of the ankle and wrist joints respectively ?
Radiocarpal joint (wrist) Talocrural articulation (ankle)
What movements are allowed at the wrist ?
- Flexion, extension
- Abduction, adduction
- (Some) Circumduction
What movements are allowed at the ankle ?
- Extension (dorsiflexion)
- [Plantar] Flexion
Which one of dorsiflexion or plantar flexion is more stable at the ankle ?
Plantar flexion is less stable because of narrow trochlea
What are the flexors of the wrist ?
Main: Flexor carpi ulnaris, Flexor carpi radialis, Palmaris longus
Also: Flexor digitorum superficialis, Flexor digitorum profundus, Flexor pollicis longus:
What is the origin and insertion of the main flexors the wrist ?
FLEXOR CARPI ULNARIS
-Origin:
Humeral head: Medial epicondyle of humerus
Ulnar head: Olecranon and posterior border of ulna (via aponeurosis)
-Insertion: Pisiform, hook of hamate, 5th metacarpal
FLEXOR CARPI RADIALIS
- Origin: Medial epicondyle of humerus
- Insertion: Base of 2nd (3rd) metacarpal
PALMARIS LONGUS
- Origin: Medial epicondyle of humerus
- Insertion: Distal half of flexor retinaculum, palmar aponeurosis
What is the common flexor origin of the wrist flexors ?
Medial Epicondyle
What are other functions of flexor carpi ulnaris and radialis in addition to flexing the wrist ?
FLEXOR CARPI ULNARIS
-Adducting the hand
FLEXOR CARPI RADIALIS
-Abducting the hand
How are the flexors of the wrist innervated ?
- Flexor carpi ulnaris: ulnar nerve
- Flexor carpi radialis, palmaris longus, flexor digitorum superficialis, Flexor digitorum profundus, Flexor pollicis longus: median nerve
At the wrist, where are the ulnar vessels and the ulnar nerve located relative to the tendon of the flexor carpi ulnaris ?
At the wrist, ulnar vessels and the ulnar nerve is immediately lateral to the tendon of the flexor carpi ulnaris
Where does the ulnar nerve pass relative to the flexor carpi ulnaris ?
Ulnar nerve passes between the two heads of the flexor carpi ulnaris
What are the flexors of the ankle ?
Main: Triceps surae (Gastrocnemius, soleus and plantaris), and Tibialis posterior
Also: Flexor digitorum longus, Flexor hallucis longus
What is the origin and insertion of the main flexors of the ankle ?
GASTROCNEMIUS -Origin: Lateral head: lateral condyle of femur Medial head: medial condyle of femur -Insertion: Posterior surface of calcaneus via calcaneal tendon
SOLEUS
- Origin: Posterior aspect of head of fibula, superior quarter of posterior surface of fibula, soleal line, and medial border of tibia
- Insertion: Posterior surface of calcaneus via calcaneal tendon
PLANTARIS
- Origin: Inferior end of lateral supracondylar line of femur and oblique popliteal ligament
- Insertion: Posterior surface of calcaneus via calcaneal tendon
TIBIALIS POSTERIOR
- Origin: Interosseous membrane, posterior surface of tibia inferior to soleal line, and posterior surface of fibula
- Insertion: Tuberosity of navicular, medial cuneiform
How are the flexors of the ankle innervated ?
By the tibial nerve
What two muscles participate in inversion of the foot ?
Tibialis posterior (its main function) and tibialis anterior
What muscles supports the medial plantar longitudinal arch ?
Tibialis posterior and Tibialis anterior
What actions of the body (more general than flexion of the ankle) does the triceps surae perform ?
- propels the body forward off the planted foot during walking
- elevates the body upward onto the toes when standing
What are the extensors of the wrist ?
Main: Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris
Also: Extensor digitorum, Extensor indicis, Extensor digiti minimi, Extensor pollicis longus and Extensor pollicis brevis
What is the origin and insertion of the main extensors of the wrist ?
EXTENSOR CARPI RADIALIS LONGUS
- Origin: Lateral epicondyle of humerus
- Insertion: dorsal base of 2nd metacarpal
EXTENSOR CARPI RADIALIS BREVIS
- Origin: Lateral epicondyle of humerus
- Insertion: dorsal base of 3rd metacarpal
EXTENSOR CARPI ULNARIS
- Origin: Lateral epicondyle of humerus
- Insertion: dorsal base of 5th metacarpal
How are the extensors of the wrist innervated ?
Radial nerve
What is the common extensor origin of the wrist extensors ?
Lateral epicondyle of the humerus
What action of the hand (other than extension of the wrist) do the extensors of the wrist perform ?
Flexion of the fingers (gripping)
What are the extensors of the ankle ?
Main: Tibialis Anterior
Also: Extensor hallucis longus , Extensor digitorum longus, Fibularis tertius
What is the origin and insertion of the main extensor of the ankle ?
TIBIALIS ANTERIOR
Origin: Lateral condyle and superior-lateral surface of tibia and interosseous membrane
Insertion: medial cuneiform and base of 1st metatarsal
What is another name for extension of the ankle ?
Dorsiflexion
How is the main extensor of the ankle innervated ?
Tibialis anterior, as with all muscles in the anterior compartment of the leg is supplied by the deep peroneal nerve
Are the adductors of the wrist joint located on the ulnar or radial side ? The abductors of the wrist ?
Adductors of wrist joint:
• Positioned on ulnar side
Abductors of wrist joint:
• Positioned on more towards
radial side
What are the adductors of the wrist ?
Extensor carpi ulnaris
Flexor carpi ulnaris
What are the abductors of the wrist ?
Extensor carpi radialis longus, and brevis
Flexor carpi radialis
Abductor pollicis longus
Classify the following joints:
- Radiocarpal
- Intercarpal
- Intermetarpal & Carpo-Metacarpal
- Metacarpo-phalangeal
- Interphalangeal
- Radiocarpal = Condyloid joint
- Intercarpal = Plane joint
- Intermetarpal & Carpo-Metacarpal = Plane joint (CMC-1 (Thumb) joint is a saddle joint)
- Metacarpo-phalangeal = Condyloid joint
- Interphalangeal = Hinge joint
What movements are allowed at the following joints ?
- Radiocarpal
- Intercarpal
- Intermetarpal & Carpo-Metacarpal
- Metacarpo-phalangeal
- Interphalangeal
RADIOCARPAL:
Flex / extension, Abduction and adduction
INTERCARPAL:
Sliding movements
Increase range of flex / extension of wrist
INTERMETACARPAL and CARPOMETACARPAL:
Flex / extension, Abduction and adduction
METACARPO-PHALANGEAL:
Flex and extension, Abduction and adduction
INTERPHALANGEAL:
Flex / extension
Classify the following joints:
- Distal Tibiofibular
- Ankle
- Intertarsal
- Intermetatarsal and Tarso-Metatarsal
- Metatarsophalangeal
- Interphalangeal
- Distal Tibiofibular = Syndesmose
- Ankle = Hinge joint
- Intertarsal = Plane joints
- Intermetatarsal and Tarso-Metatarsal = Plane joints
- Metatarsophalangeal = Condyloid joints
- Interphalangeal = Hinge joints
What movements are allowed at the following joints ?
- Distal Tibiofibular
- Ankle
- Intertarsal
- Intermetatarsal and Tarso-Metatarsal
- Metatarsophalangeal
- Interphalangeal
DISTAL TIBIOFIBULAR
No movement, helps to stabilise ankle and foot
ANKLE
Plantar flexion and dorsiflexion
INTERTARSALS
Inversion and eversion
INTERMETATARSAL and TARSO-METATARSAL
Gliding movements
METATARSOPHALANGEAL
Flexion, extension, Abduction, adduction
INTERPHALANGEAL
Flexion and extension
Name the different intertarsal joints.
Talo-calcaneo-navicular joint
+ Calcaneo-cuboid joint
=Transverse tarsal joint
Subtalar (Talocalcaneal) joint
What is the difference between intercarpal, midcarpal and Pisotriquetral joints ?
Intercarpal joints between carpals (within prox or dist rows) Midcarpal joint (between rows) Pisotriquetral joint between pisiform and triquetral bone
At which joints does extension and abduction of the hand occur ?
At midcarpal joint
Which of distal or proximal row is more mobile ?
Proximal row is most mobile
Which articular feature of the hand favors the spread of infection ?
Intercarpal, midcarpal, and pisotriquetral joints share common articular cavity with CMC joint
What two bones make up the subtalar joint ?
Talus and calcaneus
Which structures reinforce the subtalar joint ?
Ligaments, including interosseal ligament of the subtalar joint
What are the components of the Transvers tarsal joint ?
Talonavicular part of TCN + CC
What movements does the Transvers tarsal joint participate in ?
Inversion and eversion
What is the site for surgical amputation of foot ?
Transverse tarsal joint
What important ligaments support the joints and plantar arches ?
- Long plantar ligament
- Spring ligament: supports head of talus, and much of the body weight
What are movements at CMC-1 joint ?
Flexion, Extension
Abduction, Adduction
Opposition of thumb
What bones make up the CMC-1 joint ?
Trapezium and first metacarpal
Which characteristic of the CMC-1 joint gives it increased mobility ?
Loose joint capsule
True or false: CMC-1 has separate articular cavity.
True
What are the extrinsic flexors of the fingers ?
Flexor digitorum superficialis, Flexor digitorum profundis, Flexor pollicis longus
What is the origin and insertion of the extrinsic flexors of the fingers ?
FLEXOR DIGITORUM SUPERFICIALIS
-Origin: Humero-ulnar head: medial epicondyle of humerus and coronoid process of ulna
Radial head: oblique line of radius
-Insertion: Middle phalanges of medial four digits
FLEXOR DIGITORUM PROFUNDIS
- Origin: Proximal three quarters of medial and anterior surfaces of ulna and interosseous membrane
- Insertion: Distal phalanges of medial four digits
FLEXOR POLLICIS LONGUS
- Origin: Anterior surface of radius and adjacent interosseous membrane
- Insertion: Distal phalanx of thumb
How are the extrinsic flexors of the fingers innervated ?
All flexor muscles in the forearm are supplied by the median nerve except Flexor digitorum profundus (by both ulnar and median nerves) and flexor carpi ulnaris (by the ulnar nerve)
What is meant by extensor expansion/dorsal digital expansions ?
Expansion of the tendons of the extensor digitorum and extensor pollicis longus muscles over the proximal phalanges
What are the extrinsic extensors of the fingers ?
Extensor pollicis longus, Extensor pollicis brevis, Extensor indicis, Extensor digitorum, Extensor digiti minimi
What is the origin and insertion of the extrinsic extensors of the fingers ?
EXTENSOR POLLICIS LONGUS
- Origin: Posterior middle ulna and interosseous membrane
- Insertion: Distal phalanx of 1st finger
EXTENSOR POLLICIS BREVIS
- Origin: Posterior distal radius and interosseous membrane
- Insertion: Proximal phalanx of 1st finger
EXTENSOR INDICIS
- Origin: Posterior distal ulna and interosseous membrane
- Insertion: Extensor expansion of 2nd finger
EXTENSOR DIGITORUM
- Origin: Lateral epicondyle of humerus
- Insertion: Extensor expansions of medial four fingers
EXTENSOR DIGITI MINIMI
- Origin: Lateral epicondyle of humerus
- Insertion: Extensor expansions of 5th finger
How are the extrinsic extensors of the fingers innervated ?
All extrinsic extensors of the fingers are supplied by the radial nerve
Where and how are the extensor communis tendons of the fingers joined together ?
The extensor communis tendons of the fingers are joined together at the distal part of the back of the hand by the connexus intertendineus
What are the extrinsic extensors of the toes ?
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
What is the origin and insertion of the extrinsic extensors of the toes ?
EXTENSOR HALLUCIS LONGUS
- Origin: Middle part of anterior surface of fibula and interosseous membrane
- Insertion: Dorsal aspect of base of distal phalanx of great toe (hallux)
EXTENSOR DIGITORUM LONGUS
- Origin: Lateral condyle of tibia and superior 2/3 of anterior surface of fibula and interosseous membrane
- Insertion: Middle and distal phalanges of lateral four digits
FIBULARIS TARTIUS
- Origin: Inferior third of anterior surface of fibula and interosseous membrane
- Insertion: Dorsum of base of 5th metatarsal
How are the extrinsic extensors of the toes innervated ?
All are supplied by the deep fibular [peroneal] nerve
What are the extrinsic flexors of the toes ?
Flexor digitorum longus and Flexor hallucis longus
What is the origin and insertion of the extrinsic flexors of the toes ?
FLEXOR DIGITORUM LONGUS
- Origin: Medial part of posterior surface of tibia inferior to soleal line and by a broad tendon to fibula
- Insertion: Bases of distal phalanges of lateral four toes
FLEXOR HALLUCIS LONGUS
- Origin: Inferior two thirds of posterior surface of fibula and inferior part of interosseous membrane
- Insertion: Base of distal phalanx of hallux
How are the extrinsic flexors of the toes innervated ?
All muscles in the posterior compartment of the leg are supplied by the tibial nerve
