Kinesiology Quiz 2: Hand and Wrist

wrist joint

condyloid joint - allows flexion, extension, abduction, and adduction - motion occurs primarily between distal radius & proximal carpal row (scaphoid, lunate, & triquetrum)

Proximal interphalangeal (PIP)

ginglymus (hinge) joint flex 90-120 degrees from full extension

radial nerve from C6, C7, C8

- Extensor carpi radialis brevis - Extensor carpi radialis longus

radiohumeral joint

contact between humerus and radius- increases in flexion

wrist adductors

cross wrist joint anteromedially & posteromedially to insert on ulnar side of hand

The wrist joint moves through the ____ plane about the _____ axis with ulnar deviation.

frontal, sagittal

wrist abductors

generally cross wrist joint anterolaterally & posterolaterally to insert on radial side of hand

Distal interphalangeal (DIP) joints

ginglymus (hinge) joint flex 80-90 degrees from full extension

carpal bone movements

*vary by shape - proximal schaphoid is convex for radius, concave for capitiate - limited mobility at the lunate, trapezoid and trapezium

flexor digitorum profundus muscles

- flexion of 4 fingers at MCP, PIP, and DIP joints - flexion of wrist

palmaris longus

- flexion of wrist - weak flexion of elbow - easy to palpate

Pronator Quadratus muscle

- pronation of forearm - supports distal radioulnar joints

Pronator Teres Muscle

- pronation of forearm (resisted or rapid) - weak elbow flexor

radioulnar pronators

- pronator teres - pronator quadratus - brachioradialis

insertions of muscles that flex and extend the elbow

ulna and radius

__________ is much larger proximally than ___________

ulna; radius

The muscles that perform radioulnar supination include all of the following except? - Anconeus - Biceps brachii - Supinator - Brachioradialis

Anconeus

The carpal tunnel houses flexor tendons as well as the median nerve. What wrist flexor tendon does not pass through the carpal tunnel, making it an easy tendon to harvest and use during a UCL reconstruction surgery ? (hint : it's absent in a small % of the population)

Palmaris longus

Which of the following muscles performs adduction of the wrist ? - Palmaris longus - flexor carpi ulnaris - flexor pollicis longus - extensor carpi radialis longus

extensor carpi radialis longus

thumb (IP)

interphalangeal (IP) joint flex 80-90 ginglymus

radioulnar joint

joint between the radius and ulna held tightly together between their proximal & distal articulations by an interosseus membrane (syndesmosis) - trochoid/pivot joint - radial head rotates around proximal ulna - distal radius rotates around distal ulna - annular ligament maintains radial head in its joint - substantial rotary motion between the bones - translates forces from radius to ulna

what does the radiocarpal joint mean for joint stability?

joint capsule provides stability

clinical insight: tennis elbow

lateral epicondylitis - common overuse injury - extensor digitorum near its origin on the lateral epicondyle - muscles cross elbow but acts primarily on wrist & hand - gripping & lifting

radial collateral ligament

lateral stability, rarely injured

wrist adduction

ulnar flexion - movement of little finger side of hand toward medial aspect or ulnar side of forearm - movement of fingers toward middle finger

distal bony landmarks for wrist muscles

base of 2nd, 3rd, & 5th metacarpals, pisiform, & hamate

wrist extension agonists

-Extensor carpi radialis longus -Extensor carpi radialis brevis -Extensor carpi ulnaris -Extensor digitorum -Extensor indicis -Extensor digiti minimi -Extensor pollicis longus -Extensor pollicis brevis

wrist abduction agonists

-Flexor carpi radialis -Extensor carpi radialis longus -Extensor carpi radialis brevis -Abductor pollicis longus -Extensor pollicis longus -Extensor pollicis brevis

elbow flexion agonists

agonists: bicep brachii, brachialis, brachioradialis, pronator teres ex: bicep curl

radioulnar supination agonists

agonists: supinator muscle, brachioradialis, biceps brachii ex: tightening a screw

elbow extension agonists

agonists: triceps brachii, anconeus ex: push up

Which of the following muscles performs adduction of the wrist?

flexor carpi ulnaris

Elbow moves from __ degrees of extension to _____-______ degrees of flexion

0; 145-150 *always measure into flexion

Tightening a screw with a screwdriver using the right hand depends significantly upon the action of the _____.(significantly means I'm asking for the strongest/largest CSA)

Biceps brachii

metacarpophalangeal (MCP) joints

Condyloid 0 to 40 degrees of extension 85 to 100 degrees of flexion

Elbow stability is locked when at full _______ and unlocked at > _______

Extension; 20 degrees flexion

Which of the following is the sole action of the brachialis muscle?

Flexion of the elbow

each finger has 3 joints

Metacarpophalangeal (MCP) joints Proximal interphalangeal (PIP) joints Distal interphalangeal (DIP) joints

Of the carpal bones, which articulates with the radius and is critical in transfering force from the hand into the forearm ?

Scaphoid

posterior interosseous nerve from radial nerve

- Extensor carpi ulnaris - Extensor digitorum - Extensor digiti minimi - Abductor pollicis longus - Extensor pollicis longus - Extensor pollicis brevis - Extensor indicis

wrist flexion agonists

- Flexor carpi radialis - Flexor carpi ulnaris - Palmaris longus - Flexor digitorum superficialis - Flexor digitorum profundus - Flexor pollicis longus

median nerve- arising from C6, C7, C8, & T1

- Flexor carpi radialis - Palmaris longus - Flexor digitorum superficialis

abductor pollicis longus muscle

- abduction of thumb at CMC joint - abduction of wrist - extension of thumb at CMC joint - weak supination of forearm from a pronated position - weak flexion of wrist

bony landmarks for finger muscles

- base of proximal, middle, & distal phalanxes - base of 1st metacarpal, proximal & distal phalanxes of thumb

elbow flexors

- biceps brachii - brachialis - brachioradialis - pronator teres

radioulnar supinators

- biceps brachii - supinator muscle - brachioradialis

carpal bone 3 sided arch

- concave on palmar side - bony arch is spanned by transverse carpal & volar carpal ligaments - creates the carpal tunnel - frequently a source of problems known as carpal tunnel syndrome

extensor digitorum muscle

- extension of 2nd, 3rd, 4th, & 5th phalanges at MCP joints - extension of wrist - weak extension of elbow

triceps brachii muscle

- extension of arm - loss or weakness has profound affect on arm extension In order of contribution: medial head lateral head long head - extension of shoulder - adduction of shoulder - horizontal abduction

extensor indicis muscle

- extension of index finger at MCP joint - weak wrist extension - weak supination of forearm from pronated position

extensor digiti minimi muscle

- extension of pinky at MCP joint - weak wrist extension - weak elbow extension

extensor pollicis brevis muscle

- extension of thumb at CMC & MCP joints - weak wrist extension - wrist abduction

extensor pollicis longus muscle

- extension of thumb at CMC, MCP, & IP joint - extension of wrist - abduction of wrist - weak supination of forearm from a pronated position

extension carpi radialis brevis muscle

- extension of wrist - abduction of wrist - weak flexion of elbow

extensor carpi ulnaris muscle

- extension of wrist - adduction of wrist together with flexor carpi ulnaris muscle - weak extension of elbow

extensor carpi radialis longus muscle

- extension of wrist - abduction of wrist - weak flexion of elbow - weak pronation to neutral from a fully supinated position

supination of elbow

- external rotary movement of radius on ulna that results in hand moving from - palm-down to palm-up position

biceps brachii muscle

- flexion and supination of forearm - glenohumeral joint stabilization - crosses two joints - sensitive to length tension relationship fusiform - active insufficiency (combining elbow and shoulder flexion)

brachioradialis muscle

- flexion of elbow - from pronated position to neutral - from supinated pronation to neutral - "hitchhiker muscle"

flexor digitorum superficialis muscle

- flexion of fingers at MCP & PIP joints - flexion of wrist - weak flexion of elbow

flexor pollicis longus muscle

- flexion of thumb carpometacarpal, metacarpophalangeal, & interphalangeal joints - flexion of wrist - abduction of wrist

flexor carpi radialis muscle

- flexion of wrist - abduction of hand - weak flexion of elbow - weak pronation of forearm

flexor carpi ulnaris muscle

- flexion of wrist - adduction of wrist together with extensor carpi ulnaris muscle - weak flexion of elbow

wrist adduction agonists

- flexor carpi ulnaris - extensor carpi ulnaris

anterior interosseous nerve form median nerve

- flexor digitorum profundus for index & long finger - flexor pollicis longus - intrinsic muscles (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, and 1st & 2nd lumbrical)

elbow joint

- ginglymus (hinge) - only flexion and extension - 2 interrelated joints (humeroulnar joint and radiohumeral joints) - 3rd joint (radioulnar- supination/pronation)

pronation of elbow

- internal rotary movement of radius on ulna that results in hand moving from - palm-up to palm-down position

bony landmarks in elbow

- medial condyloid ridge - olecranon process - coronoid process - radial tuberosity

bony landmarks for wrist and hand muscles (located on elbow)

- medial epidondyle - lateral epicondyle - lateral supracondylar ridge

phalanges

- radiounlar motion limited by base design - heads designate direction during flexion/extension

Anconeus muscle

- small contribution to elbow extension - attached posterior to joint capsule - pulls joint capsule away form olecranon process and fossa during elbow extension

elbow extensors

- triceps brachii - anconeus

brachialis muscle

- true flexion of elbow - large force - pennate muscle - no role in supination or pronation - no attachment to radius

wrist joint movements

70-90 degrees of flexion 65-85 degrees of extension 15-25 degrees of abduction 25-40 degrees of adduction

Posterolaterally at elbow & forearm and posterior at hand

Primarily wrist extension •Extensor carpi radialis longus •Extensor carpi radialis brevis •Extensor carpi ulnaris Primarily wrist & phalangeal extension •Extensor digitorum •Extensor indicis •Extensor digiti minimi •Extensor pollicis longus •Extensor pollicis brevis •Abductor pollicis longus

Anteromedially at elbow & forearm and anterior at hand

Primarily wrist flexion •Flexor carpi radialis •Flexor carpi ulnaris •Palmaris longus Primarily wrist & phalangeal flexion •Flexor digitorum superficialis •Flexor digitorum profundus •Flexor pollicis longus

The most commonly injured ligament in the elbow due to throwing is the ______.

Ulnar collateral ligament

radioulnar pronation agonists

agonsits: pronator teres, pronator quadratus, brachioradialis ex: loosening a screw

which elbow flexor produces the greatest force?

brachialis

thumb (CMC)

carpometacarpal (CMC) joint of thumb, unique saddle-type joint, 50-70 degrees abduction, flex 15-45 degrees and extends 0-20 degrees

clinical insight- golfer's elbow

medical epicondylitis - less common - medical wrist flexor & pronator group near their origin on medical epicondyle - muscles cross elbow but act primarily on wrist & hand

thumb (MCP)

metacarpophalangeal (MCP) joint, full extension into 40-90 degrees of flexion, ginglymus (hinge) joints

wrist extension

movement of back of hand and/or phalanges towards posterior or dorsal aspect of forearm

Extension of elbow

movement of forearm away from shoulder by straightening the elbow to increase its angle

Flexion of elbow

movement of forearm to shoulder by bending the elbow to decrease its angle

wrist flexion

movement of palm of hand and/or phalanges towards anterior or volar aspect of forearm

wrist opposition

movement of thumb across palmar aspect to oppose any or all of the phalanges

wrist reposition

movement of thumb as it returns to anatomical position from opposition with hand and/or fingers

elbow motion

primarily involves movement between articular surfaces of the humerus and ulna

Supinator muscle

primary supinator - added resistance brings in the biceps brachii - at full elbow extension the biceps brachii has minimal effect

ulnar collateral ligament

provides medial support larger, more robus of 2 ligaments, 3 portions: anterior, posterior, transverse critical to high-velocity sports requireing elbow stability- "tommy john procedure"

carpal bones

proximal: scaphoid, lunate, triquetrum, pisiform distal: trapezium, trapezoid, capitiate, hamate

Stability in flexion is more dependent on

radial collateral (lateral) ulnar collateral (medial)

wrist abduction movement

radial flexion - movement of thumb side of hand toward lateral aspect or radial side of forearm - movement of fingers away from middle finger

where do radioulnar joint muscles insert?

radius

__________ is much larger distally than __________

radius; ulna

radiocarpal joint

scaphoid, lunate, and radius contact - not uniform - not constant

origins of muscles that flex and extend the elbow

scapula & humerus

origins of muscles that pronate and supinate elbow

scapula, humerus, and ulna

annular ligament

sling effect around radial head for stability- no actual attachment to the radius narrow neck- lateral and distal displacement clinical insight: nursemaid's elbow