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Kinesiology Term 1 > Wrist / Hand Complex > Flashcards

Wrist / Hand Complex Flashcards

1
Q

Wrist (Carpus) Complex

A

The radiocarpal and midcarpal joints

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2
Q

Major contribution of the Wrist Complex

A

-Control length-tension relationship in the multiarticular hand muscles
-Allow fine adjustment of grip

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3
Q

Wrist muscles designed for …

A

balance and control vs force production

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4
Q

Radiocarpal joint composed of:

A

Proximally:
Radius
Radioulnar disc

Distally:
Scaphoid
Lunate
Triquetrum

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5
Q

Radiocarpal joint articulation

A

Scaphoid w/ lateral radial facet
Lunate w/ medial radial facet
Triquetrum w/ triangular fibrocartilage complex TFCC)

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6
Q

Midcarpal joint composed of:

A

Scaphoid
Lunate
Triquetrum
Trapezium
Trapezoid
Capitate
Hamate

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7
Q

Wrist complex

A

Biaxial

Flexion/extension around coronal axis
Radial / Ulnar Deviation around A-P axis

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8
Q

Radiocarpal joint surface is…

A

Oblique and angles slightly volarly and ulnarly

Normal angle inclination: 23 deg (Ulnar)
11 deg (Volar)

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9
Q

Palmer / Volar Ligaments

A

-Palmer Radiocarpal Ligament
-Radial Collateral Ligament
-Palmer Intercarpal Ligament
-Transverse Carpal Ligament

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10
Q

Dorsal Ligaments

A

-Dorsal Radiocarpal Ligament
-Dorsal Intercarpal Ligament
-Ulnar Collateral Ligament

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11
Q

Importance of the Scaphoid

A

-Greatest mobility of the proximal carpal bones
-Acts as a link between the proximal and distal carpal rows

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12
Q

Triangular Fibrocartilage Complex (TFCC)

A

-Articulates with triquetrum and partially with the lunate
-Radioulnar disc is a continuation or the articular cartilage of the radius

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13
Q

Wrist Movement

A

Open packed-neutral between flex/ ext

Closed packed-full ext and radial deviation

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14
Q

Wrist flexion Normal Range

A

65-85 deg

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15
Q

Wrist Extension Normal Range

A

60-85 deg

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16
Q

Radial deviation Normal Range

A

15-21 deg

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17
Q

Ulnar deviation Normal Range

A

20-45 deg

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18
Q

Volar Wrist Musculature

A

6 muscles cross volar surface of wrist and contribute to wrist flexion

PL, FCR, FCU, FDS, FDP, FPL

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19
Q

Carpal Tunnel

A

FDS tendons
FDP tendons
FPL tendon
Median nerve

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20
Q

Dorsal Wrist Musculature

A

9 muscles cross the dorsal aspect of wrist and contribute to wrist extension

Extensor retinaculum provides 6 distinct compartments for these muscles

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21
Q

Compartment 1 and 2

(dorsal)

A
  1. APL, EPB
  2. ECRB, ECRL
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22
Q

Compartment 3 and 4

(dorsal)

A
  1. EPL
  2. ED, EI
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23
Q

Compartment 5 and 6

(dorsal)

A
  1. EDM
  2. ECU
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24
Q

Flexion/Extension

A

Carpals on radius = convex on concave
Opposite roll and glide

Flexion; scaphoid tends to move with the distal carpal row with the proximal row following
Extension initiated by distal carpal row

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25
Q

Radial/ Ulnar Deviation

A

*Ex: With Radial Deviation
-Carpal complex slides ULNARLY
on the radius
-Flexion of PROXIMAL carpal rows
-Extension of DISTAL carpal rows
-Full Radial Deviation puts the radiocarpal and midcarpal joints in close-packed

26
Q

FOOSH
(Fall on an Outstretched Hand)

A

Most common trauma to the radiocarpal joint

27
Q

Kienbock’s Disease

A

-Avascular necrosis of the lunate
-Usually seen in relation with ulnar negative variance
-Due to abnormal force distribution across the radiocarpal

28
Q

Ulnar Positive Variance

A

-POSITIVE variance: often seen after a distal radius fx with healing in a shortened position
-Present with pain at end range ulnar deviation / pronation

29
Q

Dorsal Intercalated Segmental Instability (DISI)

A

-injury to ligaments stabilizing lunate + scaphoid
-Scaphoid (flex), lunate (extend)
-Subluxation of scaphoid occurs with compressive loading of wrist

30
Q

Volar Intercalated Segmental Instability (VISI)

A

-lunate and triquetrum lose ligamentous stability

31
Q

Scapholunate
Advanced Collapse
Wrist (SLAC)

A

-Degenerative changes at the radioscaphoid joint
-progression to intercarpal joints
-capitate can eventually sublux

32
Q

Hand Complex

A

Comprised of:
-5 digits
-19 bones distal to the carpus

33
Q

Digits include:

A

-Carpometacarpal joint (CMC)
-Metacarpophalangeal joint (MP)
-2 interphalangeal joint (IP); proximal and distal
-Thumb has only one (IP)

34
Q

Extrinsic Muscle Group of Thumb

A

FCL, EPL, EPB, AbPL

35
Q

Intrinsic Muscle Group of Thumb

A

OP, FPB, AbPB, AdP, 1ST palmar interossei

36
Q

Thumb Structures

A

1st CMC Joint
Saddle joint with 2 DOF
Flex/ ext
ABd/ ADd
Primary function is opposition = abd followed by flex followed by add
Almost all Prehension;
Fine motor and grasp

37
Q

CMC arthritis

A

-Most common pathology
-Trapezium and 1st metacarpal affected due to degenerative changes
-Pain with prehension
Common elective surgery of the hand

38
Q

CMC - Deep Transverse Metacarpal Ligament

A

-Base of metacarpal and distal carpal row
-Spans btw 2nd and 4th metacarpal heads
-Helps w/ CMC stab and limits abd
Blends with ant. joint capsule of e/digit
-Prevents entrapment of the FDP with MCP flex and maintains the interossei in a position dorsal to the ligament

39
Q

CMC - Opponens Digiti Minimi (ODM)

A

-only muscle to exclusively impact movement of a CMC joint
-flex and rotate the 5th metacarpal along it long axis
Acts on CMC joint ALONE

40
Q

Palmer Arches of Hand

A

Proximal, distal and longitudinal arches

Allow palm and digits to conform to objects being held
-Max surface contact
-Greatest stab
-Increasing sensory feedback

41
Q

Metacarpophalangeal
(MCP) Joints

A

2 DOF:
Flex/ ext
ABd/ ADd

Metacarpal head -convex
Base of prox phalanx -concave

Reinforced by Deep Transverse Metacarpal Ligament

42
Q

Flexion/ extension of MCP joint

A

Flexion- volar roll and volar glide of phalanx on MC

Extension- dorsal roll and dorsal glide of phalanx on MC

43
Q

Interphalangeal (IP)
Joints

A

Synovial hinge joint
1 DOF

Volar plates reinforce IP joint capsules

44
Q

IP ligaments

A

Collateral lig. proper -taut with MCP flex

Accessory collateral lig. -taut with ext

45
Q

What other functions IP ligaments have?

A

Stability to MCP and IP during AROM
Stability with varus and valgus stress

46
Q

Volar plate

A

reinforces IP joint capsule
improves stab
limits hyperext.

47
Q

Sagittal Bands

A

Help to stabilize the volar plates over the 4 MC heads
Connects volar plate to the extensor digitorum communis tendon and extensor expansion

48
Q

Anatomical pulleys of the fingers and thumb

A

5

49
Q

Extrinsic Finger Flexors

A

FDS-more torque at MCP jt than FDP

FDP-more active than FDS/flexes all 3 jts of fingers/more superficial at PIP than FDS

50
Q

Intrinsic Finger
Musculature

A

Dorsal and Palmar Interossei
DABs and PADs
Lumbricals
FPB-palmar interossei
AbDM-dorsal interossei

51
Q

Intrinsic Finger
Musculature

A

ED, EI, EDM

52
Q

Extensor Mechanism formed by:

A

EDC, EIP and
EDM tendons
Extensor hood
Central Tendon
Lateral Bands
Terminal Tendon
Triangular lig
Oblique retinacular lig
Sagittal bands

53
Q

Extensor Mechanism Influence on MCP
and IP Joint Function

A

ED contracts=tension created on sagittal bands
ProPhalanx rolls and glides dorsally on MC
Interossei, dorsal, volar, lumbricals help IP extension

54
Q

Functional Position of the Hand

A

Wrist in slight extension 20deg
Slight ulnar deviation 10deg
Fingers moderate flexion at MCP 45deg and PIP jts 30deg
Slight flexion at DIP jts

55
Q

2 categories of Prehension

A

Power Grip: involves full hand

Precision Handling: utilizes finger and thumb

56
Q

Power grip - Cylindrical

A

-Finger flexors primary
-FDP main contributor

57
Q

Power grip - Spherical

A

-Similar to cylindrical
-Fingers in more ABd.
-Interossei more active in this grip

58
Q

Power grip - Hook grip

A

-FDS, FDP,
-No thumb involvement
-Often allows greater endurance

59
Q

Power grip - Lateral prehension

A

-static hold of an object btw 2 fingers

60
Q

Precision Handling - Tip to Tip

A

-Similarities in muscle activity to pad to pad
-Requires more joint flexion for tip to tip contact

61
Q

Precision Handling - Pad to Pad

A

-Opposition of pad of thumb to pad of finger
-80% prehension handling in life
-FDP, APB, FPL among others active

62
Q

Precision Handling - Pad to Side

A

-Key/lateral grip
-ADP, FPD, OP

Kinesiology Term 1 (5 decks)

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