Chapter 12: Wrist and Hand Complex

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radial tubercle (Lister's tubercle)

Acts like a pulley. Bone projection on dorsal aspect of distal radius; guides direction of several wrist and thumb extensor muscle tendons (EPL, ED and EI); Lister's tubercle separates the tendon of the ECRB from the EPL

D. Opponens pollicis

All of the thumb musculature attach to the first proximal phalanx EXCEPT for one muscle. Which of the thumb muscles attach to the first metacarpal? A. Abductor pollicis brevis B. Adductor pollicis C. Flexor pollicis brevis D. Opponens pollicis

Arthrokinematics: Distal Radioulnar Joint

Supination: Concave radius on convex ulna-concave ulnar notch glides posteriorly on the ulnar head

third metacarpal

The bone distal to the capitate is the: A. first metacarpal B. second metacarpal C. third metacarpal D. fourth metacarpal

trapezium

The carpal bone that articulates with the first metatarsal is the: A. capitate B. hamate C. trapezium D. trapezoid

styloid process

The distal, lateral bony process of the radius is known as the: A. extensor process B. flexor process C. Lister's process D. styloid process

C. scaphoid, trapezium, metacarpal

When palpating the wrist and hand, identify the order of the bones of the lateral row. A. scaphoid, capitate, metacarpal B. scaphoid, lunate, metacarpal C. scaphoid, trapezium, metacarpal D. scaphoid, trapezoid, metacarpal

convex on concave

When the proximal carpals move on the distal radius, the respective joint surfaces are: A. concave on concave B. concave on convex C. convex on concave D. convex on convex

convex; concave

When viewing the phalanx, one would note that all proximal articulating surfaces are ____ and all distal articulating surfaces are ____. A. concave; concave B. concave; convex C. convex; concave D. convex; convex

D. Pad-to-pad prehension

Which of the following is NOT a power grip? A. Cylindrical grip B. Hook grip C. Lateral prehension D. Pad-to-pad prehension E. Spherical grip

Capitate

Which of the following is NOT a proximal carpal bone? A. Capitate B. Lunate C. Scaphoid D. Triquetrum

arthokinematics: extension and flexion

Wrist extension: Simultaneous convex-on-concave rotations at both radiocarpal and midcarpal joints Kinematics occur as roll and slide in opposite directions simultaneously at radiocarpal and midcarpal joints

B. Pain with proximal interphalangeal (PIP) flexion more than distal interphalangeal (DIP) flexion

Your patient has had a tendon laceration of the third finger flexor tendons. Which impairment would indicate more damage to the FDS versus the FDP tendon? A. Pain with resisted distal interphalangeal (DIP) flexion more than proximal interphalangeal (PIP) flexion B. Pain with proximal interphalangeal (PIP) flexion more than distal interphalangeal (DIP) flexion C. Pain equal with proximal interphalangeal (PIP) and distal interphalangeal (DIP) flexion D. Pain with resisted metacarpophalangeal flexion.

carpal tunnel

a tunnel formed by the distal row of carpals that is concave anteriorly and houses the long finger flexor tendons and median nerve

palmar tilt

allows for more flexion than extension; looking at distal radius ulna joint - ulnar tilt is radius is tilted ulnarly 25° allowing for more ROM.

anatomical snuffbox

an area formed by the tendons of the thumb located on the lateral surface of the hand

flexion

anatomical position, bone moves anterior, open chain, convex proximal carpal bones and concave radius, glide is posterior

radiocarpal joint

approximately 80% of force that crosses wrist passes through scaphoid, lunate, and radius

pronation and supination

are motions of forearm - not hand or wrist

arthrokinematics: midcarpal joint

articulation between lunate and capitate, scaphoid

arthrokinematics: radiocarpal joint

articulation between radius and lunate and scaphoid

TFCC

attaches to the distal end of the radius and the styloid process of the ulna proximally and the apex attaches to the triquetrum distally; binds radius and ulna together;

midcarpal joint

most prominent articulation is formed between head of capitate and socket formed by distal surfaces of scaphoid and lunate

opposition

movement of the thumb or fifth finger across the palm of the hand

reposition

movement of the thumb or fifth finger back to neutral from opposition

radial deviation

movement of the wrist, hand or fingers laterally toward the radius

ulnar deviation

movement of the wrist, hand or fingers medially toward the ulna

extrinsic muscles

muscles that insert in the hand but originate proximally outside of the hand

intrinsic muscles

muscles that originate and insert in the hand

wrist instability

normally, wrist remains stable when compressed, even under substantial forces

osteokinematics

of wrist involve flexion and extension and ulnar and radial deviation; wrist doesn't spin; portions of radiocarpal joint naturally block this twisting motion

carpal tunnel

partly formed by transverse carpal ligament bridging palmar side of carpal bone; serves as passageway that helps protect median nerve and tendons of extrinsic flexor muscles of digits; prevents bowstringing of tendons anteriorly;

median nerve

peripheral nerve also have areas of sensation. Supplies 3 1/2 palmar aspect (thumb, pointer, middle, and half the ring finger)

palmar

pertaining to the anterior surface of the hand

hypothenar

pertaining to the muscles of the fifth finger

Thenar

pertaining to the muscles of the thumb

dorsal

pertaining to the posterior surface of the hand

lunate

prone to dislocation

radiocarpal joint

proximal part consists of biconcave surface of radius and adjacent articular disc

Closed and Loose Packed Positions Distal Radioulnar: closed packed

5° supination

scaphoid

most commonly fractured; broken due to foosh (fall on outstretched hand)

Arthrokinematics: Distal Radioulnar Joint

Concave ulnar notch on radius Convex Ulnar head

C. wrist flexion; radial deviation

Contraction of the flexor carpi radialis produces ____________. Co-contraction of the flexor carpi radialis and extensor carpi radialis produces ____________. A. radial deviation; wrist extension B. radial deviation; wrist flexion C. wrist flexion; radial deviation D. wrist flexion; ulnar deviation

extension

Full wrist extension elongates palmar radiocarpal ligaments, palmar capsule, and wrist and finger flexor muscles Helps stabilize wrist in extended position; useful when weight is borne through upper extremity

C. radius/ulna to the carpals

Ligaments of the wrist are described as extrinsic or intrinsic. By definition, extrinsic ligaments attach: A. metacarpals to the phalanges B. phalanges to the carpals C. radius/ulna to the carpals D. within the carpals

A. extension; anterior

Mary fell on an outstretched hand and fractured her distal radius. After the cast is removed, she does not have a functional grip. To increase her grip, you should work on wrist ____________ by gliding the proximal carpals ____________ on the radius. A. extension; anterior B. extension; posterior C. flexion; anterior D. flexion; posterior

Ulnar and Radial Deviation of Wrist

Motions of ulnar and radial deviation occur through simultaneous convex-on-concave rotations, at both radiocarpal and midcarpal joints

C. Flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), pollicis longus (PL), flexor pollicis longus (FPL), flexor carpi radialis (FCR)

Palpating from medial to lateral, the tendons of the wrist are: A. Flexor carpi radialis (FCR), flexor pollicis longus (FPL), pollicis longus (PL), flexor digitorum superficialis (FDS), flexor carpi ulnaris (FCU) B. Flexor carpi radialis (FCR), pollicis longus (PL), flexor pollicis longus (FPL), flexor digitorum superficialis (FDS), flexor carpi ulnaris (FCU) C. Flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), pollicis longus (PL), flexor pollicis longus (FPL), flexor carpi radialis (FCR) D. Flexor carpi ulnaris (FCU), pollicis longus (PL), flexor digitorum superficialis (FDS), flexor carpi radialis (FCR), flexor pollicis longus (FPL)

Arthrokinematics: Distal Radioulnar Joint

Pronation: Concave radius on convex ulna-concave ulnar notch glides anteriorly on the ulnar head

Ulnar and Radial Deviation of Wrist

Radial deviation at wrist is limited; radial aspects of carpal bones abut against styloid process of radius, thereby limiting extent of radial deviation across wrist

wrist extension and finger extension

The muscles found on the posterior surface of the forearm are known to participate in: A. wrist extension and finger extension B. wrist extension and finger flexion C. wrist flexion and finger extension D. wrist flexion and finger flexion

A. has greater finger spread with more interosseous activity

The primary difference in muscle activity between the cylindrical and the spherical grip is that the spherical grip: A. has greater finger spread with more interosseous activity B. has greater finger spread with more lumbrical activity C. has less finger spread with less interosseous activity D. has less finger spread with less lumbrical activity

A. ulna, lunate, triquetrum

The structures that surround the triangular fibrocartilage complex are: A. ulna, lunate, triquetrum B. ulna, pisiform, hamate C. ulna, scaphoid, lunate D. ulna, triquetrum, hamate

carpal tunnel

The transverse carpal ligament provides a ceiling for the: A. carpal tunnel B. metatarsal tunnel C. radial tunnel D. ulnar tunnel

triquetrum

The triangular fibrocartilage complex can be found between the ulna and: A. capitate B. hamate C. trapezium D. triquetrum

14

There are ____ phalanx in each hand. A. 10 B. 12 C. 14 D. 15

ulnar translocation

bones shifted ulnarly because the bones are angled that way and there's more space.

wrist instability

damage from large force (a fall) or typical wear and tear from aging can significantly destabilize this region or Rheumatoid Arthritis

radiocarpal joint

distal part consists primarily of the convex articular (proximal) surfaces of scaphoid and lunate

sagittal plane: flexion and extension

extension limited by tension in thicker palmar carpal ligaments and carpal bones making contact with dorsal side of distal radius

TFCC

fills space - runs form radius to ulna to triquetrium

end feel

firm for wrist flexion, extension, ulnar deviation; hard for radial deviation

distal radius and ulna

form a concavity that articulates with the convex (proximal) row of carpal bones; concavity is bordered laterally by the radial styloid process and medially by the ulnar styloid process

sagittal plane: flexion and extension

from neutral position, wrist flexes about 70-80° and extends about 60-65°

frontal plane: radial and ulnar deviation

from neutral position: full ulnar deviation allows about 30-35°; radial deviation allows about 1-20°

PTA

goals for a weak, painful wrist typically include strengthening, relief of pain, education on ways to protect the wrist, and splinting

intrinsic ligaments

have both proximal and distal attachments located within carpal bones; origin is inside the area

extrinsic ligaments

have proximal attaches outside carpal bones but attach distally within carpal bones; origin is outside the area

hamate

hook (fractured easily by golfers)

intrinsic ligaments

interconnect various carpal bones, help transfer forces between hand and forearm; maintain natural shapes of radiocarpal and midcarpal joints, thereby minimizing joint stress during movement.

carpal tunnel

is due to swelling in small area

maximum ulnar deviation

is normally twice that of radial deviation, mostly because of void created by ulnocarpal space and the bones are angled that way

midcarpal joint

joint between two rows of carpals

capitate

largest carpal bone, central location and serves as axis for motion (axis for wrist)

wrist instability

ligaments weakened by injury or disease lead to instability or collapse of the wrist (intrinsic or extrinsic ligaments)

ulnocarpal space

relatively wide space between distal ulna and ulnar carpal bones; helps buffer forces that cross wrist

dorsal radiocarpal ligament

resists extreme of flexion; attaches between radius and dorsal side of carpal bone

ulnar collateral

resists extremes of radial deviation; helps stabilize distal radioulnar joint; part of ulnocarpal complex/part of TFCC

radial collateral ligament

resists extremes of ulnar deviation; strengthened by muscles such as abductor pollicis longus and extensor pollicis brevis

palmar radiocarpal

resists extremes of wrist extension; thickest ligament of wrist

capsular pattern

restricted equally in all directions

arthrokinematics: carpometacarpal joint

rigid articulation between capitate and base of third metacarpal

carpal instability

rotational collapse "zigzag" deformity; ulnar translocation of the carpus

axis

runs medial-lateral for flexion and extension and anterior-posterior for radial and ulnar deviation

trapezium

saddle shaped allowing for wide ROM of thumb

proximal row carpal bones

scaphoid, lunate, triquetrum and pisiform, loosely joined, strong ligaments tightly bind distal row

midcarpal joint

separates proximal and distal rows of carpal bones

TFCC

separates the distal RU joint and the ulna from the radiocarpal joint

arthrokinematics: central wrist column

series of articulations, or links, between the radius, lunate, capitate, and third metacarpal bone

pisiform

sesamoid bone within tendon of FCU

loose-packed

slight palmar flexion (10°) and slight ulnar flexion

trapezoid

stable base for 2nd MC

rotation of capitate

to direct overall path of entire hand

sagittal plane: flexion and extension

total flexion normally exceeds extension by about 15°

distal row carpal bones

trapezium, trapezoid, capitate, and hamate; stability provides an important rigid base for articulations with metacarpal bones

triquetrum

triangular appearance

TFCC

triangular fibrocarilaginous complex

radiocarpal joint

ulnar-located carpal bones and distal ulna are less likely to fracture from falls because they are not in the direct path of weight bearing

close-packed

wrist in maximal extension with radial deviation

ligaments

wrist joints are enclosed within fibrous capsule, thickened by extrinsic and intrinsic ligaments


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