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