Chapter 12 Wrist Joint

What motions occur at the wrist joint?

-Flexion & Extension -Radial Deviation & Ulnar Deviation -Circumduction (combo of all 4 motions)

Name the four main ligaments of the wrist:

-Radial collateral ligament -Ulnar collateral ligament -Palmar collateral ligament -Dorsal collateral ligament

Functional ROM of Radial Deviation is how many degrees?

0-10 degrees

AROM of Radial Deviation is how many degrees?

0-25 degrees

Functional ROM of Ulnar Deviation is how many degrees?

0-30 degrees

AROM of Ulnar Deviation is how many degrees?

0-35 degrees

Functional ROM of Extension is how many degrees?

0-40 degrees

Functional ROM of Flexion is how many degrees?

0-40 degrees

AROM of Extension is how many degrees?

0-70 degrees

AROM of Flexion is how many degrees?

0-90 degrees

The distal articulation surface of the radius is angled about _____ degrees in palmar direction (palmar tilt); this allows greater flex than ext. at the wrist.

10 degrees

The wrist joint has how many degrees of freedom?

2 degrees of freedom

The distal end of radius angles about ______ degrees towards the ulna (ulnar tilt).

25 degrees

Extensor Carpi Radialis Longus, Extensor Carpi Ulnaris Brevis, & Extensor Carpi Ulnaris position & stabilize wrist to allow ________________________ .

Active Finger Flex

Creating optimal length-tension relationship, muscles cross multiple joints. This is called what?

Active Finger Flexion

During Extension, the carpals glide __________________.

Anteriorly

The ____________ _________ acts as a shock absorber & filler.

Articular Disk

Why doesn't the ulna articulate with the carpals?

Because of its shorter length compared to radius.

A of R for ALL WRIST MOTION goes through the __________________ carpal bone.

Capitate

The largest of all carpals; rigidly joined to base of 3rd metacarpal to allow function as single column to give longitudinal stability to the wrist & hand.

Capitate

The function of the ____________ ______________: The passageway for median nerves & tendons of extrinsic flexor muscles of the digits.

Carpal Tunnel

What osteology of the wrist is this? -palmar side of carpals form a concavity that is made into the __________ _____________.

Carpal Tunnel

Which pathology of the wrist is this? -transverse fracture of distal radius (at metaphysis) w/ posterior displacement of fragment -common in elderly

Colles Fracture

Which tendons originate on the lateral epicondyle and branches out to become separate extensor muscles? (EXCEPTION is extensor carpi radial is longus— origin just above)

Common Extensor Tendon

Which tendons originate on the medial epicondyle and branches out to become separate flexor muscles?

Common Flexor Tendons

Which tendons originate on the medial epicondyle and branches out become separate flexor muscles?

Common flexor tendons

Concavity/Convexity The wrist has _________________ on anterior side with ____________________ on posterior side — contributes to thumbs ability to oppose.

Concavity, Convexity

(Concave/Convex) The Radiocarpal Joint is ______________ on _______________.

Convex on concave (opposite movements)

Natural combination of movements is called:

Dart Thrower's Motion

Which pathology of the wrist is this? -inflammation of tendons & sheaths in compartment 1. -causes: repetitively pressing a trigger, gripping tools with simultaneously supination and pronation of the forearm -treatment: photophoresis/iontophoresis, corticosteroid injections, ice, hand-wrist-based thumb splint (thumb spica splint), modify the activities that caused the prob

De Quervain's Tenosynovitis

The articular disk of the wrist is located on the _________ end of the ulna.

Distal end

Which ligament of the wrist is this? -taut in flexion; limits flexion -thinner than & not as strong as palmar radiocarpal ligament

Dorsal Radiocarpal Ligament

Stretch of Extensors: For Extensor Carpi Radialis Longus (ECRL) place the elbow into __________________ & wrist into _________________.

Extension & Flexion

Name the Extensor Carpi Radialis Brevis muscle action of the wrist:

Extension & Radial Deviation

Name the Extensor Carpi Radialis Longus muscle action of the wrist:

Extension & Radial Deviation

Name the Extensor Carpi Ulnaris muscle action of the wrist:

Extension & Ulnar Deviation

The prime movers for Wrist Extension are:

Extensor Carpi Radialis Longus, Extensor Carpi Radialis Brevis, Extensor Carpi Ulnaris

Stretch of Extensors: For Extensor Carpi Ulnaris place both elbow & wrist into ________________.

Flexion

For AROM of _______________ & ________________ : measure on the medial side of the wrist.

Flexion & Extension

Name the Flexor Carpi Radialis muscle action of the wrist:

Flexion & Radial Deviation

Name the Flexor Carpi Ulnaris muscle action of the wrist:

Flexion & Ulnar Deviation

The prime movers for Wrist Flexion are:

Flexor Carpi Radialis & Flexor Carpi Ulnaris

The prime movers for Wrist Ulnar Deviation are:

Flexor Carpi Ulnaris & Extensor Carpi Ulnaris

The prime movers for Wrist Radial Deviation are:

Flexor Carpis Radialis, Extensor Carpi Radialis Longus, & Extensor Carpi Radialis Brevis

Radial Deviation & Ulnar Deviation occur in the _____________ plane around the _____________ axis.

Frontal plane, Sagittal axis

Which pathology of the wrist is this? -benign fluid-filled sac; "bump" on dorsal of wrist -treatment: nothing unless painful

Ganglion Cyst

Which joint is this? -13 separate articulations -b/t each carpal w/in each row -non-axial plane joint -Small gliding & rotary motions, mostly in proximal carpals -motion is small, but essential to full movement at wrist

Intercarpal Joints

The ___________ ____________encloses the radiocarpal joint and reinforced by the radial collateral ligament, ulnar collateral ligament, palmar radiocarpal ligament, and dorsal radiocarpal ligament.

Joint Capsule

Which pathology of the wrist is this? -Overuse syndrome of Extensor Carpi Radialis Brevis by repetitive forceful grasping activities -Symptoms: painful & weak grip, pain w passive wrist flexion, tenderness over lateral epicondyle -Treatment: splint/brace, NSAIDs, stretch/strengthen muscles (extrinsic muscle training) & PAMs

Lateral Epicondylalgia/Epicondylitis

During Ulnar Deviation, the carpals glide __________________.

Laterally

The ______________ is the central bone of the proximal row of carpals.

Lunate

The ______________ is the most inherently unstable carpal (b/c shape, lack of muscle attachments, & lack of strong ligament attachments to capitate)

Lunate

The function of all wrist ligaments as a whole, is to......

Maintain natural alignment & transfer forces within and across carpus.

During Radial Deviation, the carpals glide __________________.

Medially

The _______________ & _____________ nerves innervate all muscles that cross the palmar/anterior side of the wrist (flexors).

Median & Ulnar Nerves

All wrist muscles insert on ___________________ (EXCEPTION is palmaris longus)

Metacarpals

Which joint is this? -Articulation of proximal & distal rows of carpal bones -Surrounding joint capsule is continuous w all of the inter carpal joints

Midcarpal Joint

Which ligament of the wrist is this? -thick,tough ligament -taut in extension; limits extension -very important to wrist function -more likely to be stretched or sprained

Palmar Radiocarpal Ligament

Which muscle of the wrist is this? -typically absent in 21% people -NOT a prime mover -often used to replace a damaged tendon

Palmaris Longus

During Flexion, the carpals glide __________________.

Posteriorly

Which ligament of the wrist is this? -runs on the radial side of wrist -prevents excessive ulnar deviation -provides support against lateral pushing forces

Radial Collateral Ligament

Natural combo movement: Extension with ___________ ___________.

Radial Deviation

For AROM of ________________________ & ______________________ : measure by looking at the dorsal of the hand to see angle b/t radius & shaft of 3rd metacarpal.

Radial Deviation & Ulnar Deviation

The ________________ nerve innervates all muscles that cross the dorsal/posterior side of the wrist (extensors).

Radial Nerve

The innervation of wrist muscles are the:

Radial Nerve, Median & Ulnar Nerve

The wrist joint is made up of two joints:

Radiocarpal & Midcarpal joint

Which joint is this? -Biaxial condyloid joint -Allows flex/ext, rad dev/ulnar deviation, & circumduction (combo of all movements) -Wrist position of slight extension & slight ulnar deviation = greatest contact at radio-carpal joint & position of maximal grip strength. -This Ulna is NOT apart of this joint; neither is pisiform (b/c they do not articulate w carpals)

Radiocarpal Joint

Flexion and Extension occur in the _____________ plane around the _____________ axis.

Sagittal plane, Frontal axis

Which pathology of the wrist is this? -The most frequently fractured carpal b/c of its position in the center of carpus. -Common in Young Males who FOOSH w/ forearm in supination, wrist in flexion & radial deviation.

Scaphoid Comprehension Fracture

Name the 4 Proximal Carpal Bones (beginning at the thumb)

Scaphoid, Lunate, Triquetrum, & Pisiform

Which pathology of the wrist is this? -transverse fracture of distal radius (at metaphysis) w/ anterior displacement of fragment -cause: fall on back of hand

Smith's fracture

For stretch of _____________: place both elbow & wrist into extension, b/c flexors cross multiple joints.

Stretch of Flexors

Radial Deviation of the wrist is limited by bumping against the ________________ ________________ of the radius.

Styloid Process

TRUE/FALSE The Radiocarpal Joint consists of: -Proximal end: concave distal radius & radioulnar disk (triangular fibrocartilage) -Distal end: convex surfaces of the scaphoid, lunate, & triquetrum (in full ulnar dev)

TRUE

The rotation of capitate directs the movement of the whole hand because.......

The firm articulation b/t capitate & base of the 3rd metacarpal.

Which ligament is stretched across the Carpal Tunnel?

Transverse Carpal Ligament

Which ligament of the wrist restrains the flexor tendons from "bowstringing" anteriorly, especially during grasping w/ a partially flexed wrist?

Transverse Carpal Ligament

Name the 4 Distal Carpal Bones (beginning at the thumb)

Trapezium, Trapezoid, Capitate, & Hamate

The _______________ aka triangle bone, most ulnar position in the wrist; and 3rd most frequently fractured bone.

Triquetrum

The articular disk articulates with the _______________ & ________________ (carpal bones).

Triquetrum & Lunate

Which ligament of the wrist is this? -runs on ulnar side of wrist -prevents excessive radial deviation -provides support against medial pushing forces

Ulnar Collateral Ligament

Natural combo movement: Flexion with ____________ _____________.

Ulnar Deviation

The __________ ___________ is perhaps one of the most complex joints of the body.

Wrist Joint

Which pathology of the wrist is this? -common w FOOSH; usually wrist is hyperextended at landing. -most commonly injured ligament is scapholunate ligament

Wrist Sprains