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Winter 2023 - Essential Biomechanics and Kinesiology > Wrist/Hand- WK7 ( Ch7 and 8) > Flashcards

Wrist/Hand- WK7 ( Ch7 and 8) Flashcards

1
Q

Why is the scaphoid susceptible to avascular necrosis ?

A

The scaphoid is the most frequently fractured bone of the wrist due to its location in the direct path of force transmission through the wrist. Most vessels of scaphoid supply the bone at or distal to its waist; meaning that a proximal wrist fracture if untreated could lead to avascular necrosis.

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2
Q

What happens neurologically if the ligaments of the wrist are damaged?

A

Some ligaments in the wrist contain high concentrations of mechano-receptors which if damaged leads to a loss of communication with the brain and thus make the wrist vulnerable to injury, deformity, and possible degenerative arthritis

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3
Q

Which ligaments play a role in scapholunate stability at the wrist ?

A

The scapholunate which binds the lunate to the stable scaphoid

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4
Q

Name the active and passive structures that would limit wrist flexion and extension.

A

(a) Wrist Extension: passive; palmar radiocarpal ligament
active; tendons of wrist flexors
(b) Wrist Flexion: passive; dorsal ligaments of hand and wrist
active; tendons of wrist extensors

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5
Q

What functional ROM’s are needed at the wrist for ADL’s ?

A

40 degrees of flexion and extension, 10 degrees of radial deviation, 30 degrees of ulnar deviation

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6
Q

What are the consequences at the wrist and hand of a radial nerve lesion ?

A

Weakened grip due to loss function of wrist extensors.

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7
Q

What is the dart thrower’s motion ?

A

The dart thrower’s motion describes a natural and effective human tendency to accompany radial deviation with wrist extension and ulnar deviation with wrist flexion; as in throwing darts, combing hair, or opening a jar

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8
Q

Give the arthrokinematics of the radiocarpal and midcarpal joints during: wrist flexion

A

palmar roll; dorsal slide; for both

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9
Q

Give the arthrokinematics of the radiocarpal and midcarpal joints during: Wrist extension

A

Dorsal roll; palmar slide; for both

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10
Q

Give the arthrokinematics of the radiocarpal and midcarpal joints during: Wrist Radial deviation

A

radial roll; ulnar slide; for both

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11
Q

Give the arthrokinematics of the radiocarpal and midcarpal joints during: Wrist Ulnar Deviation

A

ulnar roll; radial slide; for both

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12
Q

What is the difference between DISI and VISI ?

A
  • dorsal v volar intercalated segment instability
    -DISI: dorsal subluxation of the lunate; perhaps caused by scapholunate ligament tear
  • VISI: volar subluxation of the lunate; caused by injury to lunotriquetral ligament
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13
Q

What is DeQuervain’s tenosynovitis ?

A

Inflammation of the tendons and surrounding sheaths of the muscles within compartment I ( APL + EPB ); can be caused by trigger switches on power tools

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14
Q

What is Kienbock’s Disease ?

A

-Lunate softening; characterized by avascular necrosis of lunate
-may be linked to trauma
- as avascular necrosis ensues the lunate becomes fragmented and shortened and may even collapse

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15
Q

What are the muscles in each extensor compartment ?

A

I: APL + EPB
II: ECRL+ECRB
III: EPL
IV: ED + EI
V: EDM
VI: ECU

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16
Q

Define the following: (a) positive ulnar variance (b) negative ulnar variance (c) ulnar impaction syndrome

A

(a) when the ulna extends distally ( towards carpals )
(b) when the ulna retracts proximally ( toward elbow )
(c) distal encroachment of the ulna into the TFCC; impaction may progress to inflammation and degeneration of the TFC.

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17
Q

What are some consequences of a distal radius fracture ?

A
  • positive ulnar variance
  • altered arthrokinematics
  • high articular stress that could lead to OA
  • Loss of functional flexion
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18
Q

What are the arthokinematics for THUMB CMC: flexion, extension, abduction, adduction

A

flexion: ulnar roll and slide
extension: radial roll and slide
abduction: palmar roll and dorsal slide
adduction: dorsal roll and palmar slide

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19
Q

What are the arthokinematics for THUMB MCP: flexion and extension

A

flexion: ulnar roll and slide
extension: radial roll and slide``

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20
Q

What are the arthokinematics for FINGER MCP: flexion, extension, abduction, adduction

A

flexion: palmar roll and slide
extension: dorsal roll and slide
abduction: roll and slide same direction
adduction: roll and slide same direction

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21
Q

What are the arthokinematics for FINGER IP: flexion and extension

A

flexion: palmar roll and slide
extension: dorsal roll and slide

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22
Q

Why can’t you abduct your MCP joints very well when they are flexed ?

A

(1) most of the cord parts of the collateral ligaments are taut during full finger flexion; impeding movement
(2) at about 70 degrees of flexion the articular surface of the proximal phalange contacts the flattened palmar part of the metacarpal heads

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23
Q

What is skier’s thumb ?

A

an injury to the ulnar collateral ligament caused by excessive thumb abduction at the MCP joint which is not suited for abduction

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24
Q

What is the functional position of the hand ? Why are orthoses created to maintain this position ?

A

wrist extension ( 20-30 degrees), MCP flex. ( 35-45 degrees), IP flex. ( 15-30 degrees), thumb CMC abduction ( 35-45 degrees)

to prevent adaptive shortening

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25
Q

What is trigger finger ?

A

during inflammation of the flexor tendons a nodule may develop that inhibits the flexor tendon from moving in its sheath; with added force the tendon may slip through the constriction, making a snap sound

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26
Q

Why are flexor pulleys important for the fingers ?

A

holds underlying tendons close to joints which prevents bowstringing, when the tendon pulls away from the joint

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27
Q

What is tenodesis and how can we use it as therapists functionally ?

A
  • the stretching of a polyarticular muscle across one joint which generates a passive movement at other joints
  • wrist extension to grasp a cup if someone has C6 tetraplegia affecting digital flexors and extensors
28
Q

What is the difference between the intrinsic plus position and the extrinsic plus position ?

A
  • intrinsic + : simultaneous contraction of lumbrical and interossei; MCP flexion w/ IP ext.
  • extrinsic + : simultaneous contraction of ED, FDP, FDS; MCP ext. with IP flexion
29
Q

How does the extensor mechanism work ?

A

lumbricals and interossei flex MCP but extend DIP and IP because the pull behind them is aided by ED which makes up the base of the extensor mechanism.

  • wrist flexors counteract wrist extension potential of ED
  • See pg. 284Opening the Hand: Finger Extension, Closing the Hand: Finger Flexion
30
Q

What is Dupuytren’s Contracture ?

A

a progressive thickening and shortening of the palmar and digital fascia of the hand; results in flexed posture of fingers

31
Q

Explain the following deformity associated with RA: thumb zigzag

A
  • collapse of multiple interconnect joints in alternating directions
  • CMC flexion and adduction, MCP hyperextension, IP joint extension
32
Q

Explain the following deformity associated with RA: Palmar dislocation of MCP joints

A

bowstringing tendons of FDP/FDS and rupture collateral ligaments

33
Q

Explain the following deformity associated with RA: Ulnar drift

A

excessive ulnar deviation and translation at the MCP joint, also due to rupture of RCL in fingers

34
Q

Explain the following deformity associated with RA: Swan Neck deformity

A

hyperextension of PIP and flexion of DIP
- weakened palmar plates at PIP joint, collapse joint into hyperextension; flexors pull on DIP

35
Q

Explain the following deformity associated with RA: Boutonniere deformity

A

flexion of the PIP and hyperextension of DIP

36
Q

For the following pathology give its nerve lesion and location, and muscles that are involved: Claw Hand

A

-Ulnar N.
- Paralyzed intrinsics of digits 4 and 5

37
Q

For the following pathology give its nerve lesion and location, and muscles that are involved: Ape Hand

A
  • Median N. proximal to wrist
    -FDS and FDP unaffected but thenar muscles are
38
Q

For the following pathology give its nerve lesion and location, and muscles that are involved: Hand of Benediction

A
  • Median N. at forearm or elbow
  • thenar muscles can’t flex or oppose thumb
39
Q

Explain the pathology of carpal tunnel syndrome and its functional consequences.

A

Impingement of the median n. through the carpal tunnel; can be due to overcrowding, mechanical stress, fibrotic changes

median n. distal to wrist —> thenar atrophy

40
Q

What is the OPP and CPP for: radiocarpal joint

A

OPP: neutral w/ slight ulnar deviation
CPP: extension w/ radial deviation

41
Q

What is the OPP and CPP for: CMC thumb

A

OPP: midway between abduction/ adduction, flexion and extension
CPP: full opposition

42
Q

What is the OPP and CPP: MCP joint

A

OPP: slight flexion
CPP: full extension

43
Q

What is the OPP and CPP: IP joint

A

OPP: slight flexion
CPP: full extension

44
Q

What are the ROM norms for: MCP flexion and extension

A

flex.: 90
ext: 45

45
Q

What are the ROM norms for: PIP flexion and extension

A

flexion: 100
ext: 0

46
Q

What are the ROM norms for: DIP flexion and extension

A

flexion: 90
extension: 0

47
Q

What are the ROM norms for: Thumb CMC abduction, flexion, extension

A

abduction: 70
flexion: 15
ext: 20

48
Q

What are the ROM norms for: Thumb MCP flexion and extension

A

flexion:50
extension: 0

49
Q

What are the ROM norms for: Thumb IP flexion and extension

A

flexion: 80
extension: 20

50
Q

OIIA: Flexor Digitorum Superficialis

A

O: humeral head: medial epicondyle; ulnar head: coronoid process; radial head: below the radial tuberosity
I: middle phalanges of digits 2-5
I: median nerve
A: flexion of the middle and proximal phalanges of digits 2-5; hand flexion at the wrist

51
Q

OIIA: Flexor Digitorum Profundus

A

O: proximal 3/4 of the anterior and medial surfaces of the ulna and the interosseous membrane
I: base of the palmar surface of distal phalanges of digits 2-5
I: Interosseous branch of median nerve and ulnar nerve
A: flexion of distal phalanges of digits 2-5; flexion of the hand at the wrist joint.

52
Q

OIIA: Flexor Pollicis Longus

A

O:ant surface of the radius and the interosseous membrane
I: base of the distal phalanx of the first digit
I: interosseus branch of the median nerve
A: flexion of the first digit

53
Q

OIIA: Extensor Digitorum

A

O: lateral epicondyle of the humerus
I: dorsal digital expansions of digits 2-5
I: deep radial nerve
A: ext of the joints of digits 2-5; ext of the hand at the wrist.

54
Q

OIIA: Abductor Pollicis Longus

A

O: dorsal surface of the radius and ulna and the interosseous membrane
I: base of the first metacarpal
I: Deep radial nerve
A: abducts and ext of 1st digit at thumb CMC joint

55
Q

OIIA: Extensor Pollicis Longus

A

O: Posterior surface of middle third of ulna and interosseous membrane
I: Dorsal aspect of base of distal phalanx of thumb
Innerv: deep radial nerve
A: ext of 1st digit

56
Q

OIIA: Extensor Pollicis Brevis

A

O: Posterior surface of distal third of radius and interosseous membrane
I: Dorsal aspect of base of proximal phalanx of thumb
I: Deep radial nerve
A: ext of first digit

57
Q

OIIA: Abductor Pollicis Brevis

A

O: flexor retinaculum, scaphoid, trapezium
I: lateral side of base of proximal 1st phalanx
I: Median N.
A: abducts digit 1; helps oppose it

58
Q

OIIA: Opponens Pollicis

A

O: flexor retinaculum, scaphoid, trapezium
I: lateral border of metacarpal 1
I: median nerve
A: opposition of thumb

59
Q

OIIA: Flexor Pollicis Brevis

A

O: superficial head: flexor retinaculum and trapezium. Deep head: trapezium trapezoid and capitate
I: radial side of the base of digit 1
I: median nerve and deep branch of the ulnar nerve
A: flexor proximal phalanx of digit 1

60
Q

OIIA: Adductor Pollicis

A

O: metacarpals 2 and 3 and the carpal bones
I: medial surface of the base of the proximal phalanx of digit 1
I: ulnar nerve
Action: adduction of digit 1

61
Q

OIIA: Abductor Digiti Minimi

A

O: pisiform
I: medial side of proximal 5th phalanx
I: ulnar nerve
A: abducts digit 5

62
Q

OIIA: Flexor Digiti Minimi Brevis

A

O: hook of hamate and the flexor retinaculum
I: base of the proximal phalanx of digit 5
I: deep ulnar branch
A: flexion of digit 5

63
Q

OIIA: Opponens Digiti Minimi

A

O: hook of hamate
I: ulnar border of the 5th metacarpal
I: ulnar nerve
A: opposition of digit 5

64
Q

OIIA: Lumbricals

A

O: tendons of FDP
I: extensor expansion of the same digit
I: median (1,2) and ulnar nerve (3,4)
A: flexes MCP joint, extends DIP and PIP

65
Q

OIIA:Palmar Interossei

A

O: head from the metacarpals of 2, 4,5
I: dorsal digital expansion of 2,4,5
I: ulnar nerve deep branch
A: flexion of MCP joint 2-5, IP extension, adduction of MCP

66
Q

OIIA: Dorsal Interossei

A

O: two heads from the adjacent sides of the metacarpal bones
I: base of the proximal phalanges and dorsal expansions of digits 2-4
I: ulnar nerve, deep branch
A: abduction of MCP joint 2 and 4, flexion of MCP 2-5, ext of 2-5

Winter 2023 - Essential Biomechanics and Kinesiology (16 decks)

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