Wrist Joint Flashcards by Stephanie Smith

function of the wrist joint

To provide a mobile and stable foundation for hand

- Control length-tension for hand musculature

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the upper extremity functions to

position the hand in space

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joints of the wrist

radiocarpal & mid-carpal (functional)

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arthrokinematics of radiocarpal

concave - convex rule

moves in the opposite direction

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arthrokinematics of mid carpal joint

gliding

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flexion ROM

85 deg

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extension ROM

70-80 deg

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ulnar deviation ROM

30-35 deg

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radial deviation ROM

20-25 deg

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radius and radioulnar disk make up the

triangular fibrocartilage

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radioulnar disk lies between

the radius & ulna at the base of the ulna –> this is why there is no “ulnacarpal” joints

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functionally, _______ contributes to both proximal & distal carpals

scaphoid

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pisiform

proximal carpal
non-articular
increases the moment arm of FCU (b/c FCU is strung thru the pisiform)
sesamoid bone

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carpals have ____ muscular attachments EXCEPT FOR -______

No;

pisiform & hamate

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Only muscle crossing the radio carpal joint that attaches to the proximal row is:

flexor carpi ulnaris

attaches to pisiform, hamate & base of 5th metatarsal

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lateral facet

46% articulation to scaphoid

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medial facet

43% articulation to lunate

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inferior disk

11% articulation to triquetrum (inferior ulnar disk)

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triangular fibrocartilage complex TFCC

continuous with the articular surface of the radius, covers the ulnar head and forms the articular surface on the ulnar side
this is why you have more ulnar deviation than radial deviation —-> there isn’t as much bone limiting movement
this is the soft spot on the posterior aspect of the wrist

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the triangular fibrocartilage complex TFCC consists of

articular disk (triangular fibrocartilage),
meniscus homologue,
ulnocarpal (ulnar collateral) ligament,
dorsal & volar radioulnar ligament,
floor of ECU sheath

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TFCC is the main stabilizer of:

distal radioulnar joint

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TFCC acts as a buttress to support:

proximal carpal row

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TFCC stabilizes the ulnar _____

head

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TFCC contributes to the ______ stability

ulnarcarpal

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TFCC distributes:

compressive loads | 80% to radius

the TFCC excised increased loads on ____ from _____(%) to ____(%)

radius | 80% to 94%

TFCC ______ congruency

increases

radiocarpal stability

loose, stong capsule reinforced by ligaments that extend to mid carpal joint

midcarpal joint occurs between

``` proximal row (triquetrium, lunate, scaphoid) & the distal row (trapezium, trapezoid, capitate, hamate) ```

midcarpal joint has

intercarpal joint capsule & | numerous ligaments

ligaments of the midcarpal joint

- provide primary stability and support - guide motion - transfer forces

the anterior wrist ligaments are more _______

complex

volar radiocarpal ligament

ANTERIOR WRIST LIGAMENT ***most important for motion & stability can be divided into separate bands

bands of the volar radiocarpal ligament

radiolunate ligament radiocapitate ligament radiotriquetral ligament radioscaphoid ligament

ulnocarpal ligament arises from

the TFCC | at the articular disk & base of the ulnar styloid

ulnocarpal ligament attaches to

triquetrum, capitate, & lunate carpals

Ulnocarpal ligament reinforces

the ulnar side of the wrist

ulnocarpal ligament is on the ___ side

volar radiocarpal ligament is on the _____ side

intercarpal ligament is on the _____ side

intercarpal ligaments prevent

diastasis of the carpals diastasis- separation, pulling apart

intercarpal ligament connects _______ to ________ to help _______ the joint capsule

the dorsal proximal row of the carpals; the distal row of the carpals; strengthen

dorsal radiocarpal ligament is on the ____ side

posterior

dorsal radiocarpal ligament is a ________ ligament

extrinsic

dorsal radiocarpal ligaments attaches

from the posterior edge of the distal radius to the scaphoid, triquetrum, lunate, and slips to the capitate these ligaments are called - radiolunate, radiotriquetral, and radiocapitate ligaments

ulnar collateral ligaments attachment

POSTERIOR | ulna styloid process ---> to the pisiform & triquetrum

radial collateral ligaments attachments

POSTERIOR | radial styloid process --> to the scaphoid, trapezium, to the 1st metacarpal

intrinsic ligaments of the posterior wrist

dorsal intercarpal trapeziotrapezoid trapeziocapitate capitohamate

radiocarpal motion

gliding of convex proximal carpals over concave radius & disk

WRIST JOINT MOTION | - in flexion (moving towards neutral)

distal carpals glide in same direction on fixed proximal carpals

Wrist joint motion | - in neutral

scaphoid & capitate are closed packed

wrist joint motion | - in extension after neutral but BEFORE 45 degrees

combined distal carpals and scaphoid extending together

wrist joint motion | - in extension at 45 deg

scaphoid & lunate are closed packed

wrist joint motion | - in extension greater than 45 deg

carpals all glide on the radius & radioulnar (in the opposite direction)

wrist joint motion- in flexion - scaphoid does what?

contributes to both rows reverse the extension sequence for flexion

radial deviation- the ____ row moves radially on the ____ until the carpals ____

distal; proximal; lock

radial deviation- at the end of the range, both rows moving as ____, until ulnar ligament is _____ & ______ impacts the radius

1; taut; scaphoid

radial deviation is predominant at the

midcarpal joint

ulnar deviation occurs predominantly as _________

radiocarpal motion

the maximum movement for radial deviation & ulnar deviation movement is at ________

neutral

wrist instability secondary to ligamentous disruption: dorsal instability DISI

- maintained extension of lunate - capitate flexion as compensation - zig zag pattern - usually secondary to dissociation between lunate and scaphoid

wrist instability secondary to ligamentous disruption: volar instability VISI

- secondary to ligamentous disruption between lunate and triquetrium (lunate/scaphoid flex, triquetrum/distal row extend) - normally the distal radius, lunate, capitate, and third metacarpal are colinear

which bone on the wrist is most susceptible to fracture?

scaphoid is susceptible to fracture | - poor healing properties secondary to poor vascular supply