Wrist & Hand

Immobilizations of the hand should occur in the ___________ position, which is wrist at 30º extension, MCPs at 60-90º of flexion, thumb neutral, IP extension 0º

"intrinsic plus"

What are the arthrokinematics of the MCP joint extension?

(concave on convex) roll & glide dorsal

What are the arthrokinematics of the MCP joint flexion?

(concave on convex) roll & glide volar

Who is more commonly affected by Colles' fractures?

- middle age/elderly - women>men - osteoporosis

only _____% of the TFCC is vascularized

15-20%

Index and middle fingers contribute to _____% of hand function

20%

Red flag in the wrist and hand that you should expect if the patient had a history of traumatic event, hypersensitivity, pitting edema, trophic changes including brittle nails, course hair growth, erythema, poor response to alnalgesics 1) fracture 2) tendon rupture 3) infection 4) complex regional pain syndrome 5) Raynaud's phenomenon

4) complex regional pain syndrome (CRPS)

The thumb is involved in _____% of hand function

40-50%

What is normal ROM for ulnar deviation?

40º

What is a possible complication of a scaphoid fracture?

Avascular necrosis (b/c blood enters scaphoid from distal to proximal so loses blood supply)

___________ is a complete fracture of the distal radius. The lunate acts as a wedge to shear off the distal 2 cm of radius leading to a posterior displacement of the distal fragment

Colles' fracture

Which two tendons are involved in intersection syndrome?

ECRL and ECRB tendons (where they cross under the ABL and EPB)

What is the common mechanism of injury for a scaphoid fracture?

FOOSH

What is the treatment for mallet finger (if fx)?

Immobilization x 6 weeks or ORIF

Metacarpophalangeal joint (MCP) 2-5th have ____º flexion, ____º extension, ____º abduction/adduction

MCP 2-5th have 90º flexion, 25º extension, 20º abduction/adduction

Duptytren's contracture leads to contractues in the ______ & _____ joint

MCP and PIP joints

Flexor digitorum superficialis O: I: Innerv: Action:

O: medial epicondyle I: middle phalanx of digits 2-5 Innerv: median n (C7-T1) action: flexes wrist, flexes middle and proximal phalanges of digits 2-5

What is the main stabilizer of the DRUJ?

TFCC

What separates the DRUJ from the radiocarpal joint and prevents proximal radial migration?

TFCC

During wrist flexion, which of the following motions occurs at the radiocarpal joint? a. volar roll and dorsal glide b. dorsal roll and volar glide c. dorsal roll and dorsal glide d. volar roll and volar glide

a. volar roll and dorsal glide

What motions occur with proximal interphalangeal extension? a. volar roll volar slide b. dorsal roll and dorsal glide c. volar roll and dorsal glide d. dorsal roll and volar glide

b. dorsal roll and dorsal glide

____________ can occur when a ball knocks the finger into forced flexion and evulses the extensor tendon a. Swan Neck b. mallet finger c. Boutinniere

b. mallet finger

What motions are coupled with wrist flexion? a. pronation and ulnar deviation b. supination and slight ulnar deviation c. pronation and slight radial deviatoin d. supination and radial deviation

b. supination and slight ulnar deviation

Which part of the hand should you feel when checking for temperature?

back of the hand

Flexor pollicis longus inserts at _________

base of distal phalanx of thumb

Where does the extensor pollicis brevis insert?

base of the first phalanx of the thumb

Where does the extensor pollicis longus insert?

base of the last phalanx of the thumb

The carpometacarpal joint of the thumb is a __________ joint specialized to permit axial rotation with angular movements

bi-concave (saddle joint)

What parts of the MSK system need to be cleared for a wrist/hand patient?

c-spine shoulder and thoracic inlet elbow

A _______________ deformity is flexion at the PIP and extension at the DIP a. Swan Neck b. mallet finger c. Boutinniere d. Dinner fork e. Heberden's nodes

c. boutinniere

During pronation at the DRUJ, the ___________ radius glides around the fixed _________ ulnar head; the radius glides [anteriorly or posteriorly]

concave radius convex ulna anteriorly

During supination at the DRUJ, the ___________ radius glides [anteriorly or posteriorly]

concave; posteriorly

A ____________ is when the distal end of the radius is displaced dorsally a. Swan Neck b. mallet finger c. Boutinniere d. Dinner fork e. Heberden's nodes

d. dinner fork deformity

During CMC extension, proximal surfaces glide in a ________ direction

dorsal direction

The conservative intervention for a TFCC injury typically includes a long-arm cast or splint fitted with the elbow in ________, the forearm and wrist in ________ & __________ for 6 weeks, if the TFCC is unstable

elbow in 90º flexion forearm & wrist in ulnar deviation and extension

The capsular pattern of the DRUJ is ________

equal restriction in pronation/supination

The radioulnotriquetral and radiocapitate ligaments are taught in wrist [flexion or extension] and develop tension in the wrist and finger flexors leading to loss of active extension and reduction in grip strength

extension

What is the action of the extensor indicis?

extension of the wrist and joints of the second digit

How do you measure composite finger flexion?

from top of the nail to the DISTAL palmar crease

What should be included in the examination for the wrist and hand?

functional outcome measure assessment observation functional screen AROM PROM passive accessory motion neuro screen/testing neurodynamic assessment special tests palpation

Which of the following carpal bones articulates with the base of the fifth metacarpal?

hamate

Which bones are in the distal row of carpals?

hamate capitate trapezoid trapezium

The DRUJ is covered in _________ cartilage

hyaline cartilage

The ___________ phase of healing is 25 - 100 days after external and internal callus joins to bridge fracture deficit; remodeling occurs, osteoblasts reabsorb callus

late phase (remodeling)

What makes up the longitudinal arch of the hand?

length of the digits

What is the most common complaint at the wrist and hand?

pain (followed by stiffness)

Which muscles adducts fingers?

palmar interossei (3 PAD)

Which carpal bone does the FCU insert?

pisiform

What is the open pack position of the wrist?

semi dorsal flexion

What is the open pack position of the trapexiometacarpal joint?

semi: flex, ext, abd, add

When evaluating AROM, you should provide overpressure if ...

the individual has full AROM and is painless

There is the TFCC the thickest?

thick at periphery, thin at center

If AROM = PROM, but both are limited, it could be due to _____________

tight capsule

The DRUJ is a ___________ joint

uniaxial pivot joint

What are the clinical findings of Carpal tunnel syndrome?

- age > 45 years old - shaking hands to relieve symptoms - wrist ratio >0.67 - symptom severity scale > 1.9 - diminished sensation in median sensory field (thumb)

What PT interventions can be used for carpal tunnel when being managed non-operatively?

- ergonomic adjustments - orthotics: NEUTRAL positioned wrist orthosis worn at night for short term relief, can wear during the day if symptomatic modalities - superficial heat - short-wave diathermy - trial of interferential current - phonophoresis with non-surgical management manual therapy - C-spine and upper extremity, stretching programs

What treatments should NOT be used for carpal tunnel?

- no use of low level laser therapy - no use of thermal ultrasound - no use of iontophoresis - no magnet use

What factors affect fracture healing?

- patient age - character of fracture - systemic disorders - bone disease (osteoporosis/osteopenia)

What are some intervention strategies for the wrist and hand during the acute phase?

- protection to allow healing - decrease pain and edema: control then eliminate edema - restoration of full pain-free ROM in the entire kinetic chain - restore proprioeption - reduce muscle atrophy - scar management - maintain general fitness - independent with HEP

What interventions can be used for Carpal Tunnel?

- tendon gliding (try to minimize adhesions) - use of splints at night - NSAIDs - ice

What is the post-operative plan of care for Dupuytren's?

- within initial 5 days postoperative, the primary interventions are to educate the patient on decreasing edema and the importance of performing a range of motion exercises on the uninvolved fingers - after 5-7 days postop, the primary interventions shift to ROM exercises and splinting - the exercises are adapted to each subject's individual goals and are based on their impairment, physical status and competency - the types of splints used include volar splints, dynamic extension splint, dynamic flexion splints, exercise splints, and wrist splints

In the DASH, a 0 indicates ________ and a 100 indicates _________

0 = no disability 100 = severe disability

Red flag in the wrist and hand that you should expect if the patient had a recent fall or history of direct trauma, exquisite pain, tenderness, edema, ecchymosis from chronic steroid use; history of bone demineralization 1) fracture 2) tendon rupture 3) infection 4) complex regional pain syndrome 5) Raynaud's phenomenon

1) fracture

What are some red flags for the wrist and hand?

1) fracture 2) tendon rupture 3) infection 4) complex regional pain syndrome 5) Raynaud's phenomenon

What are the "5Ps" of compartment syndrome (medical emergency)?

1) pallor 2) parasthesia 3) pulse deficit 4) paralysis 5) pain on passive extension

What are the three stages of Dupytren's Contracture?

1) production of myofibroblasts and nodules 2) alignment of myofibroblasts along lines of tension 3) tissue acellular and bands of thick collagen remain

When is the early (inflammatory) phase of fracture repair?

1-5 days

What is the open pack position of the distal radioulnar joint?

10º supination

What is normal ROM for radial deviation?

15º

Red flag in the wrist and hand that you should expect if the patient has pain with motion and passive stretch, edema, tenderness, or a total loss of motion, palpable defect 1) fracture 2) tendon rupture 3) infection 4) complex regional pain syndrome 5) Raynaud's phenomenon

2) tendon rupture

2-4th CMC joints are _________ joints, 5th digit is ________

2-4th CMC joints are plan, uniaxial joints, 5th digit is biaxial

Out of the five-position grip strength, which is the maximum grip strength?

2nd or 3rd

Red flag in the wrist and hand that you should expect if the patient has a history of recent open injury, presence of an abscess, signs of edema, or chills, fever or malaise 1) fracture 2) tendon rupture 3) infection 4) complex regional pain syndrome 5) Raynaud's phenomenon

3) infection

Red flag in the wrist and hand that you should expect if the patient has blanching and redness in response to cold; pain and paresthesia to cold, history of rheumatoid arthritis, vascular disease, use of beta-blockers or tobacco use 1) fracture 2) tendon rupture 3) infection 4) complex regional pain syndrome 5) Raynaud's phenomenon

5) Raynaud's phenomenon

What is the close pack position of the DRUJ?

5º supination

______% of wrist flexion occurs at midcarpal joint, ____% at the radiocarpal joint

60% at midcarpal joint 40% at radiocarpal joint

In wrist extension, 67% of the motion occurs at the ___________ joint, and 34% occurs at the _____________

67% radiocarpal joint 34% midcarpal joint

What is normal ROM for pronation?

75 - 90º

What is normal ROM for supination?

85-90º

What are some endocrine issues you should screen for in hand/wrist patients?

B12 deficiency diabetes thyroid issues

What is the carpal tunnel syndrome specific outcome measure that has 11 items, scored from 1 to 5 (5 being worst)?

Boston Carpal Tunnel Questionnaire-symptom severity scale

Which joints allow the palm to conform with hand motions ?

CMC joints

_________ are enclosed by a common joint cavity and supported by a transverse and longitudinal ligaments

CMC joints 2-5

The Katz diagram and criteria is for ____________

Carpal Tunnel

The ________ is a 30-item functional outcome measure that measures the disability of the arm, shoulder, and hand

DASH

What are some post-op red flags?

DVT infection (drainage that is green/malaise/fever) chest pain or associated arm pain w/ exertion myelopathies (hand weakness, dropping things, ataxic gait, multi-level change sin sensation, UMN lesion reflex signs)

____________ is progressive tenosynovitis of the tendons in the first dorsal compartment; thickening of the extensor sheath, stenosing of the fibrous canal, entrapment of the tendons; involves the ABL & EPB

DeQuervain Disease

Clinical findings for ___________- include: - swelling/tenderness around radial styloid process - severe pain with wrist ulnar deviation and thumb flex/add - crepitus of the tendons - palpable thickening

DeQuervain's Disease

___________ is an active cellular process in the fascia of the hand that leads to the development of nodules and tendon like cord formation in the palmar fascia

Duptytren's Contracture

T/F: When patients fall and land on an outstretched hand/wrist, they are less likely to tear ligaments because the wrist in extension is in the open pack position

FALSE: When patients fall and land on an outstretched hand/wrist, they are MORE likely to tear ligaments because of the max tension in wrist extension of ligaments

What is the mechanism of injury for a Colles' fracture?

FOOSH

A Grade ___ ,___ tendon rupture is pain with motion and passive stretch, edema, tenderness

Grade I, II

A Grade ___ tendon rupture results in a total loss of motion, palpable defect, edema, and tenderness

Grade III

Flexor digitorum profundus O: I: Innerv: Action:

O: proximal 3/4 of anterior and medial surfaces of the ulna and the interosseus membrane I: base of palmar surface of the distal phalanges 2-5 innerv: interosseus branch of the median and ulnar n action: flexes wrist, flexes distal phalanx for digits 2-5

What interventions should take place in the acute phase of healing for the wrist and hand?

POLICE - protect optimal loading ice compression elevation

The __________ is an outcome measure for the arm, shoulder, and hand where the higher the score, the greater the disability. It has a reliability of 0.92.

QuickDASH-9

What is the capsular pattern of the CMC joint of the thumb?

abduction more limited than extension

Which muscle shares a common tendon sheath with extensor pollicis brevis?

abductor pollicis longus

What are the two flexor pulleys that retrain the flexor tendons to the metacarpals and phalanges (anchor tendons to bones to allow for more efficient use of muscles for grasping)?

annular cruciate

What motions are coupled with wrist extension? a. pronation and ulnar deviation b. supination and slight ulnar deviation c. pronation and slight radial deviation d. supination and radial deviation

c. pronation and slight radial deviation of forearm

Which muscle abducts fingers?

dorsal interossei (4 DAB)

During CMC extension there is a _______ roll and _______ glide of the metacarpal on the trapezium

dorsal roll and dorsal glide

During CMC adduction there is a _______ roll and _______ glide of the metacarpal on the trapezium

dorsal roll, volar glide

___________ are nodules on medial & lateral sides of joints from osteoarthritis a. Swan Neck b. mallet finger c. Boutinniere d. Dinner fork e. Heberden's nodes

e. Heberden's nodes

What is/are the actions of the extensor pollicis brevis ?

extension of thumb, abduction of wrist

What is/are the actions of the extensor pollicis longus?

extension of thumb, abduction of wrist

Which muscles form the common extensor tendon?

extensor carpi radialis brevis extensor digitorum extensor carpi ulnaris extensor digiti minimi

T/F: Interphalangeal joints have 2 degrees of freedom

false: 1 (flex/ext)

T/F: The superior/inferior surfaces of the TFCC are convex

false: CONCAVE

T/F: For capsular patterns of restriction at the DRUJ, pronation is more limited than supination

false: DRUJ has equal limitation of pronation and supination

T/F: The TFCC remains stationary with pronation/supination but moves with wrist flexion/extension

false: TFCC moves with pronation/supination but remains stationary with wrist flexion/extension

T/F: The cording associated with Dupuytren's contracture is a tightening of the tendons

false: it is the FASCIA

T/F: There is very little CMC mobility at the thumb and fifth finger, but lots of motion of the second and third CMC joint

false: little motion at second and third CMC, lots of mobility in CMC of thumb and fifth finger

T/F: For a capsular pattern of restriction, you will see more difficulty folding the hand than the ability to flatten it (2-5 CMC)

false: more limited ability to flatten the hand than to fold the hand

T/F: The dynamic wrist stability dart-thowers motion should be used in the acute phase of healing

false: subacute

What is an easy way to measure swelling in the wrist and hand?

figure 8 measurement (b/c volumetric measurements using water displacement is more time consuming)

What is the action of the lumbricals?

flex MCP, extend PIPs and DIPs

What are the movements of the MCP joints?

flex/ext abd/add rotation

MCP joints are supported by a volar and two collateral ligaments that become taut in full [flexion or extension]

flexion

What is the capsular pattern of MCP joints?

flexion more limited than extension

What are the osteokinematic motions of the wrist?

flexion/extension radial/ulnar deviation circumduction (combination)

What are the normal ROMs for radiocarpal joint flexion extension radial deviation ulnar deviation

flexion: 85º extension: 80º radial deviation: 20º ulnar deviation: 35º

What is an AROM functional testing you can do when examining the wrist and hand?

hook fist standard fist straight hand looking for both AROM + pain

Which bones make up the ulnar side of the proximal arch of the hand?

hook or hamate/pisiform

The volar plate at the interphalangeal joint prevents ___________

hyperextension

What are some treatments for CMC OA ?

immobilization - edema control - gloves with spandex - wrapping - neoprene support - tendon gliding - splinting in a functional position (opposition) - Heat/LLPS - taping with parafin - soft tissue massage - joint mobs

What are the clinical implications of positive ulnar variance?

increases the risk of degenerative changes in the TFCC

____________ is the proliferation of osteogenic cells of the periosteum and marrow; differentiation of chondroblasts, and osteoblasts which reabsorb dead bone

inflammatory response

The ___________ is 4-40 days after fracture; external callus formation; new bone replaces cartilaginous callus; internal callus if formed by osteogenic cells of endosteum

intermediate (reparative) phase

Which nerve innervates the flexor pollicis longus?

interosseus branch of median nerve

What limits supination at the DRUJ?

interosseus membrane and bony impaction between the ulnar notch of the radius and ulnar styloid process

______________ is tenosynovitis of the ECRL and ECRB where they cross under the ABL and EPB, leading to pain on the dorsal surface 4-8 cm proximal to Lister's tubercle. Pain is exacerbated by wrist flexion/extension (rowers, weightlifters, canoers)

intersection syndrome

Prolonged immobilization after fractures can result in persistent stiffness: early motion program that avoids re-stressing injured structures prevents ____________

joint contractures and minimizes adhesions

_______________ is a traumatic disruption of the terminal tendon due to a sudden external force into flexion leading to a rupture of the extensor tendon

mallet finger deformity

What is the close packed position of the wrist?

max extension and radial deviation

What is the close pack position of MCP and IP joints?

max flexion

What is the close pack position of the trapeziometacarpal joint?

max opposition

Carpal tunnel is due to compression of the ________ nerve

median

Which nerve innervates the opponens mucle?

median nerve

Which nerve is compressed in Carpal Tunnel?

median nerve

Which nerve provides sensory innervation to the palmar side of the first three and a half digits of the hand and dorsal sensation to tips of first 3 fingers?

median nerve

What makes up the distal arch of the hand ?

metacarpal heads

The dart-thrower's motion esp after carpal ligament injuries/repairs, radial extension to ulnar flexion, motion occurs mainly at the _________ joint and mimics motion with functional activities

mid-carpal joint

In radial deviation, the movement is primarily between which two joints?

midcarpal and radiocarpal joints

If AROM <<< PROM, it could be due to ___________ or ___________

motor control or muscle weakness

________ ulnar variance: ulna proximal to the radius and can lead to Kienbocks disease (avascular necrosis of the lunate)

negative

Which are the intrinsic hand muscles?

opponens adductor pollicis brevis flexor pollicis brevis abductor digiti minimi flexor digiti minimi lumbricals palmar interossei dorsal interossei

Which position should a CMC OA joint be splinted?

opposition (functional position)

What can you do to provide pain relief for Heberden's nodes (nodules on medial & lateral sides of joints from osteoarthritis) ?

parafin wax for pain relief (can also be injected with steroids, but won't remove nodules)

_________ ulnar variance: ulna distal to the radius

positive

Where does the extensor indicis insert?

posterior digital expansion of the second digit

If there is a radial head midshaft distal radial head, the arm should be in a __________

posterior elbow splint @ 90, or hinged elbow brace

The _________________ nerve can become compressed as it enters the dorsal wrist capsule from repetitive wrist extension, weak wrist and finger extension, inability to extend the thumb, proximal phalanges, and decreased sensation over first dorsal interosseous space

posterior interosseous nerve (branch of radial nerve)

What does the radial nerve branch into at the elbow?

posterior interosseus nerve (deep branch) and superficial radial nerve

What exercise can be used to minimize adhesions in carpal tunnel syndrome?

progressive tendon gliding exercise

Where should you place the goni for pronation? Supination?

pronation - outside arm (@radial styloid) supination - inside arm (@ulnar styloid)

What are the osteokinematic motions at the distal radioulnar joint?

pronation/supination

What is the primary movement at the DRUJ?

pronation/supination

What is the capsular pattern at the forearm?

prox RUJ - equal loss of supination and pronation DRUJ: min to no limitation

Wrist drop (patient can't keep hand straight) is a sign of ________ nerve compression

radial

What ligament limits ulnar deviation?

radial collateral ligament

During radial deviation at the radiocarpal joint & midcarpal joint, there is a ____ roll & ____ glide

radial roll & ulnar glide

Where is the extensor pollicis longus' distal attachment?

radial side of base of first metacarpal bone

Movement during ulnar deviation occurs primarily at the __________ joint

radiocarpal joint

The __________ joint consists of the concave surface of the distal radius and the proximal carpal row, and the TFCC

radiocarpal joint

Clinical findings of ____________ include joint pain, swelling, stiffness, and instability or deformity

rhemuatoid arthritis

If your patient has a swan neck deformity or boutonniere deformity, they likely have ___________

rheumatoid arthritis

Ulnar drift, damage to collateral ligaments, muscle imbalance, swan neck deformity, and Boutonniere deformity are all results of the disease process for _____________

rheumatoid arthritis

___________ is a systemic autoimmune disorder that leads to changes to the soft tissue and articular structures

rheumatoid arthritis

What are the arthrokinematics of the MCP joint abduction?

roll away from palm of hand

During wrist extension @ the radiocarpal joint, the scaphoid and the lunate roll _________ on the radius and glide __________

roll dorsal, glide volar

What are the arthrokinematics of the MCP joint adduction?

roll toward palm of hand

Which carpal bones are in the proximal row?

scaphoid lunate triquetrum pisiform

What does the radial collateral ligament attach to?

scaphoid and trapezium

If a patient has tenderness in the base of the anatomical snuffbox after a FOOSH injury, what might you suspect?

scaphoid fracture

___________ presents clinically as dorsal and radial sided wrist pain (floor of the anatomical snuff box), tenderness to palpation and possible swelling

scaphoid fracture

During ulnar deviation at the radiocarpal joint the scaphoid, lunate, and triquetrum roll ________ & glide _________

scaphoid, lunate, and triquetrum roll ulnarly and glide radially

What type of splint can be used for DeQuervain's?

small opponens HFO

What is the treatment of CTS post-operatively?

splint 2+ weeks edema control (glove) + elevation median nerve gliding exercises scar mobilization ROM, strengthening exercises, dexterity

What are some interventions for intersection syndrome?

splint immobilization of the wrist and thumb, wrist in 15-20º extension deep TFM patient education

How should you splint for post-op Duptytren's Contracture?

splint in 10-12º of MCP flexion and PIP extension

What are some interventions for DeQuervains Disease?

splinting modalities MWM - radial glide of proximal row, ulnar glide of trapezium neutral mobes cervical joint mobilization cortisone injection

Describe how to measure a figure of 8 for hand/wrist edema

start at the ulnar styloid (medial surface draw across the anterior/ventral wrist to radial styloid process diagonally across the posterior aspect of the hand over the 5th MCP brought across anterior/ventral surface over the 2nd MCP joint wrapped diagonally back to starting point

What is the progression for the progressive tendon gliding exercise for Carpal tunnel?

start with flat hand hook fist straight fist MCP flexion fully folded hand

A _________ deformity can be seen when there is extension at the PIP and flexion at the DIP; the result of a tendon tearing and joint subluxing through tendon from rheumatoid arthritis a. Swan Neck b. mallet finger c. Boutinniere

swan neck deformity

What should you be observing in the wrist and hand examination?

temperature changes wounds atrophy (e.g. ulnar nerve "gutter" atrophy or hypothenar eminence)

At the midcarpal joint in wrist flexion, the trapezium, trapezoid roll [dorsal or volar] and glide [dorsal or volar] while the capitate and hamate roll [volar or dorsal] and glide [volar or dorsal]

trapezium, trapezoid roll volar and glide volar (concave on convex) capitate and hamate volar roll and dorsal glide (convex on concave)

Which bones make up the radial side of the proximal arch of the hand?

trapezium/scaphoid

During wrist extension @ the midcarpal joint: the trapezium and the trapezoid roll ______ & glide ______; the capitate and hamate roll ______ & glide ________

trapezoid and tapezium roll & glide dorsal capitate & hamate roll dorsal & glide volarly

The ___________ attaches ulnarly to the styloid process and radially to the distal radial articular surface, binding distal radius and ulna

triangular fibrocartilage complex (TFCC)

What does the ulnar collateral ligament of the radiocarpal joint attach to?

triquetrum/pisiform

T/F: At the wrist, the capsular pattern is equal loss of flexion and extension, and equal loss of radial and ulnar deviation

true

T/F: Colles' fracture requires a precise reduction to maintain normal length of the radius

true

T/F: During radial deviation, the mid carpal joint rolls radially and glides ulnarly

true

T/F: Edema can increase risk of infection, stiffness, and decrease motion, inhibit artery/vein/lymphatic flow

true

T/F: For capsular pattern of restriction at the radiocarpal joint, there is equal limitation of flexion and extension

true

T/F: In the case of decreased fracture stability, there should be no movement of involved joints and cast or orthosis should adequately stabilize the joints

true

T/F: Powerful gripping loads the TFCC and can lead to degeneration

true

T/F: The elbow is a common place for median nerve entrapment

true

T/F: The interphalangeal joints are true synovial hinge joints

true

T/F: The mid-carpal joint has deep interosseus ligaments and superficial dorsal and palmar intercarpal ligaments

true

Which ligaments support the MCP joints?

two lateral collateral two accessory collateral volar plate

At the DRUJ, the ulna is [convex or concave] and the radius is [convex or concave]

ulna convex radius concave

The tunnel of Guyon is clinically significant because it contains the __________ nerve and artery

ulnar

What are the ligaments of the radiocarpal joint?

ulnar and radial collateral ligaments palmar radiocarpal ligament

Which ligament limits radial deviation?

ulnar collateral ligament

A claw hand or "Bishop's Hand" ("Benediction Sign") is a sign of _______ nerve neuropathy

ulnar nerve

At the midcarpal joint during ulnar deviation, there is a ____ roll & _____ glide

ulnar roll & radial glide

Which tendons make up the anatomical snuffbox?

ulnar side - EPL radial side - Abductor pollicis longus

Under normal conditions, which is styloid process is shorter - ulna or radius?

ulnar styloid process shorter

During CMC flexion, the proximal surfaces glide in a __________ direction

volar direction

The __________ is a tough fibrocartilagenous tissue that inserts into the base of the proximal phalanx and allows reinforcement for the metacarpal to stay in the joint with flexion and restrict hyperextension

volar plate

If you see a finger cross over when you ask your patient to make a fist when evaluating AROM, warning sign for a ______________ and the patient should get an X-ray

volar plate disruption/fracture

Abduction of the CMC joint of the thumb involves ______ roll and _____ glide

volar roll & dorsal glide

What are the arthrokinematics ar the radiocarpal joint in wrist flexion?

volar roll and dorsal glide

During CMC flexion there is a _______ roll and _______ glide of the metacarpal on the trapezium

volar roll and volar glide (same b/c concave on convex)

During CMC abduction there is a _______ roll and _______ glide of the metacarpal on the trapezium

volar roll, dorsal glide (opposite b/c convex on concave)

When is there the greatest stability of the CMC joint of the thumb?

when in complete pronation and full opposition