The Wrist

What are the Superficial muscles of the posterior forearm that originate at the lateral supracondylar ridge?

-Brachioradialis -Extensor Carpi Radialis Longus

What are the Superficial muscles of the posterior forearm that originate at the lateral epicondyle?

-Extensor Carpi Radialis Brevis -Extensor Digitorum -Extensor Digiti Minimi -Extensor Carpi Ulnaris

What are the superficial muscles of the anterior forearm?

-Flexor Carpi Radialis -Flexor Carpi Ulnaris -Palmaris Longus -Flexor Digitorum Superficialis - Pronator Teres

What are the deep muscles of the anterior forearm?

-Pronator Quadratus -Flexor Pollicis Longus - Flexor Digitorun Profundus

The radius articulates with which carpal bones?

-Scaphoid -lunate

What are the deep muscles of the posterior forearm?

-Supinator -Abductor pollicis longus -Extensor Pollicis longus -Extensor pollicis brevis -Extensor indicis

What are the symptoms of CTS?

-atrophy of the thenar eminence -parasthesias in median nerve sensory distribution -loose opposition and CMC Palmar abduction

What is the flexor retinaculum?

-covers the pisiform, hamate, trapezium, and scaphoid -Forms tunnel for extrinsic digit/thumb flexors and median nerve

What is the Extensor retinaculum?

-crosses the dorsal wrist and forms the roof for finger/wrist extensor tendons -Inserts on the pisiform/triquetrum ulnarly and blends with flexor retinaculum radially

What structures of the ulna should you be able to palpate in the wrist?

-head of the ulna -ulnar styloid process

What is a Scapulolunate ligament tear?

-if ligament is injured, the scaphoid flexes and the lunate extends and a gap opens, thus leading to carpal instability -most common site of ligament tears

What does the TFCC do?

-provides a smooth gliding surface for ulnar side of the wrist. -binds distal end of the radius and ulna providing stability for the distal RU joint -separates the ulna from the proximal carpal row.

What structures of the 2 wrist creases should you be able to palpate in the wrist?

-proximal wrist crease -distal wrist crease

What are the extrinsic ligaments?

-radial collateral ligament -ulnar collateral ligament -radiocarpal ligament

What structures of the radius should you be able to palpate in the wrist?

-radial styloid process -listers tubercle (ular of EPL)

What are the intrinsic ligaments?

-scapholunate ligament -lunotriquetral ligament

What muscles are in the 2nd extensor compartment?

1) Extensor Carpi Radialis longus 2) Extensor Carpi Radialis brevis

Which muscle is in the 5th extensor compartment?

1) Extensor Digiti Minimi

What muscles are in the 1st extensor compartment?

1) Extensor Pollicis Brevis 2) Abductor Pollicis Longus

Which Muscle is in the 3rd extensor compartment?

1) Extensor Pollicis longus

What muscles are in the 4th extensor compartment?

1) Extensor digitorum 2) Extensor Indicis

What are the Steps in performing a wrist assessment?

1) Occupational Profile 2) Observe/palpate 3) edema (dorsum, tendon) 4) Pain 5) vascularity (color/temp) 6) ROM 7) MMT 8) Stability: provocative tests

What are 9 common injuries to the wrist?

1) TFCC lesion 2) Scapulolunate ligament tear 3) Osteoarthritis 4) FOOSH 5) Carpal Tunnel Syndrome 6) Strains, sprains 7) Dislocation 8) Tendonitis 9) Scaphoid fracture

What is the purposes of the wrist?

1) allows for change in location and orientation of the hand relative to the forearm and placing the hand in space 2) permits fine gradation of prehension and powerful grasp 3) skilled movement or stabilization of the hand 4) expression and non verbal communication 5) transmits loads and forces from hand to and from forearm 6) movements allow for maximal finger movement

__1__ carpals moving on a __2__ concave radio

1) convex 2) concave

What muscles create the anatomical snuffbox?

1) extensor pollicis longus (medial border) 2) Extensor pollicis brevis (lateral border) 3) Abductor pollicis longus (lateral border)

What joints does the wrist consist of?

1) radiocarpal (proximal) 2) midcarpal (distal)

What are the 3 joints that the Flexor Digitorum Superficialis crosses?

1) wrist 2) MPs 3) PIPs

What are the 4 joints that the Flexor Digitorum Profundus crosses?

1) wrist 2) MPs 3) PIPs 4) DIPs

The Palmaris Longus is absent in how much of the population?

10-15%

What bones make up the wrist?

15 bones total (8 carpal, ulna, radius, 5 metacarpals

How many joints are in the wrist?

17 joints

What divides the 1st and 2nd extensor compartment?

1st 2 snuffbox tendons

How many DoF does the wrist have?

2 DoF

What divides the 2nd and 3rd extensor compartments

2 radial extensor tendons

What does the trapezoid articulate with?

2nd metacarpal

What does the capitate articulate with?

3rd metacarpal

What divides the 3rd and the 4th extensor compartments?

3rd snuffbox tendon

What separates the 4th and 5th extensor compartments

4 digit extendors

What articulates with the hamate?

4th-5th metacarpals

What divides the 5th and 6th extensor compartments?

5th digit extensor

What is a Ganglion Cyst?

A non-cancerous lump often on the tendons or joints of wrist and hands (also called synovial cyst)

When do AI and PI occur in the wrist?

Attempting wrist flexion and your MP, DIP, and PIP joints are all flexed. Attempting wrist extension and your MP, DIP, and PIPs are all extended

When can you palpate the scaphoid bone?

Can palpate during ulnar deviation, NOY during radial deviation

do carpals slide towards or away from the movement of the hand?

Carpals glide oppositse movement of the hand

Why is creating a close packed position for extension more difficult than a close packed position with flexion?

Close packed is the most stable position, however it is the hardest to get back full extension after injury

What is the flexor retnaculum

Consists of 9 tendons (4 FDP, 4 FDS, 1FPL)

What is one of the major issues with a scaphoid fracture?

Could cut off blood supply constantly monitored

What is the action of the Flexor Digitorum Profundus?

DIP digit flexion

What is the action of the Extensor Digitorum?

Digital extension, assists with wrist extension

What is the action of the Brachioradialis?

Elbow flexion when the arm is in neutral

How does the TFCC function as a "shock absorber"?

Endure compressive forces between the ulna and triquetrum

Most functional position of the wrist

Extension (30-40) & slight ulnar deviation

What is the most effective wrist extensor when the elbow is extended?

Extensor Carpi Radialis Brevis

Which muscle is in the 6th extensor compartment?

Extensor Carpi ulnaris

What is an example of PI at the wrist?

Extensors are not allowing the maximal flexion because of last of elasticity

How do you test for DeQuervain's Syndrome?

Finkelsteins

What motion is done by the Flexor Carpi Ulnaris?

Flexes wrist with ulnar deviation

Which muscle is the strongest wrist flexor?

Flexor Carpi Ulnaris

What is the action of the extensor indicis?

Index MP extension; assist with wrist extension

What the the Triquetrium articulate with?

It articulates with NOTHING

What is the most frequently dislocated bone?

Lunate bone

What is CTS?

Median nerve compression

Where does the motion occur for the wrist to go from neutral to 45* of extension?

Motion occurs at both joints

Where does the motion occur for the wrist to go from 45* of extension to maximum extension?

Motion occurs only at the radiocarpal joint

What kind of joints make up the wrist?

Multi-articulating, complex joints

When AI and PI occur, do they occur together or in seperate incidents

Occur together

Where are the intrinsic ligaments of the wrist?

Origin and insertion with the carpals

What are the functional implications of having and untreated ganglion cyst?

Overtime size will increase and becomes painful with wrist flexion

What action is done by the Flexor Digitorum Superficialis?

PIP flexion

what can cause there to be poor healing of the scaphoid bone?

Poor circulation

What action is done by the Palmaris Longus?

Produces weak wrist flexion

What is the action of the Pronator Teres?

Pronation

What is one of the main functions for the ligaments in the wrist?

Provide stability

What causes DeQuervain's Syndrome?

Repetitive stress (ex. new moms, carpenters)

What bone is the most common site of fracture?

Scaphoid bone

What kind of bone is the pisiform bone?

Sesamoid bone

What is DeQuervain's Syndrome?

Tenosynovitis of the synovial tendon sheath of the 1st extensor compartment (APL, EPB)

What is the midcarpal joint?

The articulations between the proximal (scaphoid, lunate, triquetrum) and distal (trapezium, trapezoid, capitate, hamate) row of carpals

What is necessary for Active and passive insufficiency to occur?

The muscles must cross more than 1 joint

In which tendon is the pisiform bone located?

The tendon of the Flexor carpi ulnaris

What is the action of the Extensor pollicis longus?

Thumb IP extension; assist with wrist extension and radial deviation

What is the action of the Flexor Pollicis Longus?

Thumb IP flexion

What is the action of the Extensor pollicis brevis?

Thumb MP extension; assist with wrist extension and radial deviation

What is the action of the Abductor pollicis longus?

Thumb extension (CMC radial abduction), assists in radial deviation

What is the superficial ligament that forms and maintains the palmar arch?

Transverse carpal ligament

What carpal bones are part of the distal row in the wrist?

Trapezium Trapezoid Capitate Hamate

What is the functional effects of having a problem with one's wrist in every day lives?

Very little pure wrist motion is necessary for everyday activities BUT important for positioning hand in space and prehension

What is an example of AI at the wrist?

When all fingers are flexed there is diminished ability to achieve isometric tension int he wrist and therefore you can't achieve full wrist flexion

Why is AI and PI significant to practice?

When measuring wrist flexion, have the fingers extended. When measuring wrist extension, have the fingers flexed

What is the action of the Extensor Carpi Radialis Brevis?

Wrist extension with radial deviation

What is the action of the Extensor Carpi Radialis Longus

Wrist extension with radial deviation; assists with elbow flexion

What is the action of the extensor carpi ulnaris?

Wrist extension with ulnar deviation

what is the close packed position for the radiocarpal (wrist) joint?

Wrist extension, slight ulnar deviation

Are there possible compensations for the wrist that clients may use ?

Yes, adjacent joints can be used to compensate

What is the Triangular Fibrocartilage Complex (TFCC)

a meniscus- like structure on the ulnar side of the wrist (ulnarcarpal articulation)

Where is the scaphoid located?

at the distal radial styloid

What type of joint is the wrist?

biaxial

What movement can the wrist not successfully complete?

circumduction

Main function

create and control function of fingers

Where are the extrinsic ligaments of the wrist?

distal radius and ulna to carpals

What is FOOSH?

distal radius/scaphoid fracture

What does the trapezium articulate with?

distal scaphoid & 1st metacarpal of the thumb

What is an example of how the movements of the wrist all for maximal finger movement?

ex. when wrist is in full flexion, IP joints can't fully flex due to insufficiency of the wrist flexors

What extensive system keeps the wrist functional?

extensive ligament system

What motion is done by the Flexor Carpi Radialis?

flexes wrist with radial deviation

What are the movements of the wrist?

flexion/extension radial/ulnar deviation

What does the hamate serve as an attachment for?

flexor renaculum

Do the joints of the wrist work in groups or in isolation

in groups-- each joint affects the position of another

What is a key feature of the hamate when palpating?

it has a "hook like" surface

Where does the motion occur for the wrist to go from flexion to neutral?

most of the motion occurs at the midcarpal joint

Where are ganglion cysts most common?

most often observed at the dorsal wrist (scaphoid/lunate)

What are the articulations that create the proximal wrist

radius and articular disc (no ulna)

In what position can the pisiform be moves?

relaxed flexion

What carpal bones are part of the Proximal row in the wrist?

scaphoid lunate Triquetrium pisiform

What creates the floor of the anatomical snuffbox?

scaphoid bone

What are the articulations that create the distal wrist?

scaphoid, lunate, triquetum

What is the action of the Extensor Digiti minimi?

small digit extension, assist with wrist extension

What provides the midcarpal joint with stability?

surrounded by ligaments: -radial ligaments -palmar ligaments -dorsal ligaments -volar ligaments

Are you more likely to tear a ligament or break a bone?

tear a ligament

What group of bones should you be able to palpate in the wrist?

the carpal bone

What is active insufficiency?

the inability of a muscle to exert enough tension and shorten sufficiently to cause full ROM in all joints at the same time

What serves as the axis for all radial and ulnar deviation?

the proximal head of the 3rd metacarpal

Wrist motion

tiny motions of radiocarpal/midcarpal joints to create big motion

What is Passive insufficiency?

when the antagonist muscles lack elasticity in order to achieve the motion