hand and wrist
how do you test the median nerve
Phalens test - flex elbow, forearm up, flex wrist
why do we have more ulnar deviation than radial deviation?
because of the radial styloid, the anterior tilt of the radius (10 degrees) and the medial tilt of the radius (25 degrees)
what is the arthrokinematics of the wrist jt from neutral to flexion or extension?
both proximal row and distal row will slide in the opposite direction as the movement.
what is lateral epicondylitis
caused by large stress of extensor muscles to balance strong wrist flexion of finger flexors. symptoms include pain over lateral epicondyle, reduced grip strength, pain during passive wrist flexion and forearm pronation. the ecrb is usually the cause
what is the closed packed position for the cmc, mcp and dip/pip jts?
cmc is full opposition, mcp is flexion, dip/pip is extension
what ligaments are taut for mcp, pip and dip flexion
collateral ligaments
what is the arthokinematic motion for flexion/extension of the thumb
concave on convex. slide and roll in same direction. both will move laterally
what type of joint is the mcp joint
condyloid/ellipsoid
what is the arthokinematic motion for palmar abduction?
convex on concave. slide in posterior direction, roll in anterior direction.
if there is limited pip extension when the fdp and fds are slack, then what may be the reason?
tightness of the volar plate
what is the main function of the wrist extensors
to position and stabalize the wrist during activities which involve active flexion of the fingers
what is the function of the TFCC
to provide stability to the radial/ulnar jt to transfer forces from the radial side to the ulnar side to act as a shock absorber
what is the ligament that forms the roof of the carpal tunner
transverse carpal ligament
true or false, strengthening the ecrl, ecrb and ecu can be carried out with activities which use forceful gripping
true
what is the ulna tilt and palmar tilt of the radius
ulna tilt is radius tilting 25 degrees in an ulnar direction and palmar tilt is it tilting 10 degrees in an anterior direction
what ligaments reinforce the ulnar side of the hand
ulnar collateral ligament anterior oblique ligament
what does the radial collateral ligament restrain against?
ulnar deviation
what is the normal rom for ulnar and radial deviation?
ulnar is 30 degrees and radial is 20 degrees
what is taut during mcp hyperextension
volar plates
when does the orl pull on the terminal tendon?
when the pip jt is extended the orl becomes taut and will pull
what is the position of function for the wrist and when would you splint in it
would want to splint if want to allow adequate positioning of fingers in the hand wrist extension - 20-30 with slight ud mcp flexion - 45 ip flexion - 15 thumb palmar abduction - 45
what is the closed packed position of the wrist
wrist extension with radial deviation
can the wrist extensors contribute to wrist flexion?
yes, during pronation.
what is the posi position and what is it used for
you would use it if you want to prevent pathological shortening of the muscles. it's 70 degrees of flexion at the mcp jt and extension of the ip jts.
if you had paralysis of the intrinsic muscles how would you want to splint?
you would want to prevent hyperextension
during ulnar deviation which paired ligaments become taut through passive tension?
lateral leg of palmar intercarpal ligament and palmar ulnocarpal ligament
what are the two phases of thumb opposition
mcp flexion mcp medial rotation and abduction
normal rom for mcp and pip jts
mcp hyperextension - 45 mcp flexion - 85-110 mcp abduction - 25 pip flexion - 110-120
during radial deviation which paired ligaments become taut
medial leg of palmar intercarpal ligament and palmar radiocarpal ligament
can you begin in zero for opposition?
no, due to the angle of convergence you start in 20 but record it as zero
which prehensile pattern would someone with a median nerve injury still possess
pad to side because the abductor pollicus brevis muscle is not required
what limits extension of the mcp jt?
palmar plates
what is the double v system of ligaments
passive tension within ligaments which move the wrist. distal inverted v formed by medial and lateral legs of the palmar intercarpal ligament. proximal inverted v is formed by the lunate attachments of the palmar ulnocarpal and palmar radiocarpal ligaments
what is the arthrokinematics of the mcp jts??
phalanx concave on mcp convex. during flexion the roll and slide are in the same direction
what type of joint is cmc 2-4
plane
preparation and execution of spherical grip
preparation: apb, dorsal interossei, edc, lumbricals execution: ap,fdp,
preparation and execution of tip pinch
preparation: apb, epl, lumbricals, interossei, opponens execution: opponens, ap, fpl,lumbricals, interossei, fdp
preparation and execution of pad to side pinch
preparation: apb, fpl execution: ap, fpl, di
preparation and execution of cyndrical grasp
preparation: lumbricals, interossei, edc, apb, execution: fdp, fds, ap
preparation and execution of pad to pad pinch
preparation: lumbricals, interossei, edc, apb, opponens execution: ap, opponens, fdp
preparation and execution of hook grip
preparation: lumbricals, interossei, edc, apl execution: fdp, fds (with resist), interossei
what ligaments are taut for thumb mcp flexion
proper collateral ligament deep transverse metacarpal ligament
is there more torque generated at the proximal or distal jts of the fingers for the flexor pulleys
proximal
which row of carpal bones is the most mobile?
proximal row
what is the scaphoid shift test
push on the scaphoid bone to see if there's scaphoid instability - (radial or ulnar deviation)
in which direction does movement increase for your cmc jt
radial - ulnar
what type of joint is the cmc 1 & 5
saddle
what happens to the wrist during finger extension
slight flexion by the fcr (helps maintain integrity of edc)
if someone has radial nerve palsy what would you want to do?
splint them in extension so they have increased grip strength
what is finkelsteins test
test for tenosynovitis. adbuctor pollicus longus and extensor pollicus brevis. grasp the thumb and perform ulnar deviation
what ligaments help prevent "bowstringing"
the annular and cruciate ligaments of the flexor pulley system
in the mcp jt of the thumb what restrains against abduction/adduction?
the collateral ligaments
which arch is best formed by the heads of the 2-5 metacarpal
the distal transverse arch
what contributes to palmar adduction besides the adductor pollicus
the epl
if you want power for pinching which muscle will contract?
the fpb
what happens with an ulnar nerve injury in regards to extension/
the lumbricals and interossei wouldn't work and therefore you would have hyperextension of the mcp jt. without the intrinsic muscles the edc would only function to hyperextend the mcp jt so the pip and dip would remain flexed. this is an intrinsic minus position or "clawing"
what happens when the lunotriquetrum ligament ruptures
the lunate will follow the scaphoid and move in a volar direction (v.i.s.i)
what happens when the scapolunate ligament ruptures?
the lunate will follow the triquetrum and move in a dorsal direction (d.i.s.i)
what is tendonesis
the passive insufficiency of the flexor muscles
what is the arthrokinematic motion of radial and ulnar deviation
the proximal and distal row will slide in the opposite direction of the movement
what is the arthrokinematic motion of the wrist jt from extreme flexion to extension or visa versa?
the proximal row still moves in the opposite direction. the distal row will move in the same direction
what ligament keeps the fingers in line at the mcp jt
the radial and ulnar collateral ligaments
what is the most important ligament in limiting wrist deviation?
the radial collateral ligament
what test produces the greatest carpal pressure
the reverse phalens test.
what happens during ulnar drift?
the sagittal bands rupture. the edc slides off mcp towards the ulnar side. creates bowstringing. all tendons connect via the juncturae so this will pull them all in an ulnar direction
what happens in a swan neck deformity
there is flexion of the dip jt and hyperextension of the pip jt.often happens with ball injuries. volar plate ruptures and since it usually restrains hyperextension of the lateral bands, this hyperextension happens
what happens if the sagittal bands are ruptured
there will be no mcp extension. the edc will sublux and thus have bowstringing
regarding mcp jt motion, is there more in the fingers or the thumb. why?
there's more in the fingers because the collateral ligaments severely restrict abduction/adduction
if someone had weak extensor muscles what could you do to strengthen them
they could perform isometric (just squeezing something), concentric or eccentric exercised.
if there is full extension of the pip jt when the wrist is flexed, what is the reason for limited extension of the pip jt when the wrist is extended
tightness of the fdp and fds
what ligament in the thumb becomes taut during all movements except extension?
radial collateral
what does the ulnar collateral ligament restrain against?
radial deviation
what ligaments in the cmc jt of the thumb become taut in abduction, extension and opposition?
*anterior oblique *ulnarcollateral/palmar oblique
what is the unique function of the epl
*can extend the ip, mcp and cmc jt of thumb *can adduct the thumb and rotate it laterally
what happens in a zigzag deformity of the hand
a ligament ruptures and a metacarpal slides off the carpal bone
what happens during a mallet injury
a terminal tendon is broken off or a piece of bone is broken off and the tendon goes with it. causes flexion of dip jt.
what is carpal instability
alignment with one or more carpal bones cause by rupture of specific ligaments
what is murphys sign?
ask the pt to make a fist. the 3rd metacarpal should be the highest
what would a hand with a combination of ulnar and median nerve injury look like?
atrophied, flat- no real arches
what ligament restrains against abduction of the mcp jts of the fingers
deep transverse mcp ligament
when does the accessory portion of the collateral ligament become taut at the mcp jt of the hand?
during extension
what is considered your all purpose wrist extensor
ecrb
what is your go to muscle for wrist extension
ecrb
what muscle has the greatest moment arm for wrist extension?
ecrb
what wrist extensor muscle is first recruited for light grip closure
ecrb
when grip force increases then what wrist extensor muscles contract
ecu, ecrl
of the ecrb, ecrl, ecu and edc which muscle is the least likely to produce extension without deviation
edc
what is the only muscle which produces hyperextension
epl
which muscle will contract first if you want easy unresisted extension of the thumb
epl
if somebody had a radial nerve injury they would not be able to do what in their fingers?
extend their mcp (the edc is the only muscle that does this function). you could potentially have ip extension but only with mcp flexion (due to lumbricals and interossei). run the risk of developing intrinsic tightness if they are always in the flexed position
where is the greatest jt contact in the radiocarpal jt of the wrist?
extension with ulnar deviation
which muscle has a better torque for producing radial deviation in flexion of the wrist?
fcr
what is the only muscle which attaches to the carpal bones?
fcu
which muscle has a better torque for producing flexion of the wrist?
fcu
which two flexor muscles act as synergists in flexing the wrist?
fcu and fcr
which muscle creates the most flexion force across the mcp jts.
fds
what ligaments in the cmc jt of the thumb become taut in abduction and opposition?
first intermetacarpal posterior oblique
how do you distinguish whether the ecrb or edc is extending the wrist/
flexing your fingers with wrist extension will cause passive insufficiency in the edc
what do we have more of, flexion or extension of the wrist?
flexion
what is the closed packed position of the mcp jt
flexion
what is normal rom for wrist flexion/extension
flexion is 60-90 extension is 55-70
what happens in a boutinere deformity
flexion of pip jt, hyperextension of dip jt (stretched lateral bands). rupture of the central band
which muscle produces the greatest wrist flexion torque potential of the 3 primary wrist flexor muscles?
flexor carpi ulnaris
if the digits are extended, what will be the first muscle to provide flexion of the wrist?
flexor digitorum profundus
what are the muscles for opposition
flexor pollicus brevis abductor pollicus opponens
what are the muscles important for pinching?
flexor pollicus brevis flexor pollicus longus adductor pollicus
what is functional ROM for flexion/extension of the wrist
for flexion it's 5-10 for extension it's 25-35
what type of joint is the dip/pip jt
hinge
what is the restraining ligament against radial abduction of the thumb
intermetacarpal ligament
what ligaments are taut for thumb radial and palmar abduction?
intermetacarpal ligament anterior oblique ligament ulna collateral ligament
what happens to the cord part of the collateral ligament in flexion
it becomes taut
what type of jt is the mcp jt and how many degrees of freedom does it have
it's an ellipsoid jt and it moves in two degrees of freedom - the sagittal and frontal plane.
what is the extrinsic plus position?
it's the position of the extrinsic muscles working - hook fist - extension of the mps and flexion of the ips
what is the intrinsic plus position?
it's the position of the intrinsic muscles working - lumbrical shelf - extension of ip jt and flexion of mp jt
what is the finkelstein test used for and how is it performed
it's to test for tenosynovitis in the ab pl and epb. hold the thumb and move towards ulnar deviation
what tendon attaches the extensor tendons to each other
juncturae tendinae
a client has a right radial nerve injury resulting in wrist drop. what is contributing to her diminished strenght?
lack of active wrist extension active insufficiency of fdp and fds inability to counter the force of fdp and fds with ecrb, ecu and ecrl
