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