Kinesiology Quiz 2: Hand and Wrist
wrist joint
condyloid joint - allows flexion, extension, abduction, and adduction - motion occurs primarily between distal radius & proximal carpal row (scaphoid, lunate, & triquetrum)
Proximal interphalangeal (PIP)
ginglymus (hinge) joint flex 90-120 degrees from full extension
radial nerve from C6, C7, C8
- Extensor carpi radialis brevis - Extensor carpi radialis longus
radiohumeral joint
contact between humerus and radius- increases in flexion
wrist adductors
cross wrist joint anteromedially & posteromedially to insert on ulnar side of hand
The wrist joint moves through the ____ plane about the _____ axis with ulnar deviation.
frontal, sagittal
wrist abductors
generally cross wrist joint anterolaterally & posterolaterally to insert on radial side of hand
Distal interphalangeal (DIP) joints
ginglymus (hinge) joint flex 80-90 degrees from full extension
carpal bone movements
*vary by shape - proximal schaphoid is convex for radius, concave for capitiate - limited mobility at the lunate, trapezoid and trapezium
flexor digitorum profundus muscles
- flexion of 4 fingers at MCP, PIP, and DIP joints - flexion of wrist
palmaris longus
- flexion of wrist - weak flexion of elbow - easy to palpate
Pronator Quadratus muscle
- pronation of forearm - supports distal radioulnar joints
Pronator Teres Muscle
- pronation of forearm (resisted or rapid) - weak elbow flexor
radioulnar pronators
- pronator teres - pronator quadratus - brachioradialis
insertions of muscles that flex and extend the elbow
ulna and radius
__________ is much larger proximally than ___________
ulna; radius
The muscles that perform radioulnar supination include all of the following except? - Anconeus - Biceps brachii - Supinator - Brachioradialis
Anconeus
The carpal tunnel houses flexor tendons as well as the median nerve. What wrist flexor tendon does not pass through the carpal tunnel, making it an easy tendon to harvest and use during a UCL reconstruction surgery ? (hint : it's absent in a small % of the population)
Palmaris longus
Which of the following muscles performs adduction of the wrist ? - Palmaris longus - flexor carpi ulnaris - flexor pollicis longus - extensor carpi radialis longus
extensor carpi radialis longus
thumb (IP)
interphalangeal (IP) joint flex 80-90 ginglymus
radioulnar joint
joint between the radius and ulna held tightly together between their proximal & distal articulations by an interosseus membrane (syndesmosis) - trochoid/pivot joint - radial head rotates around proximal ulna - distal radius rotates around distal ulna - annular ligament maintains radial head in its joint - substantial rotary motion between the bones - translates forces from radius to ulna
what does the radiocarpal joint mean for joint stability?
joint capsule provides stability
clinical insight: tennis elbow
lateral epicondylitis - common overuse injury - extensor digitorum near its origin on the lateral epicondyle - muscles cross elbow but acts primarily on wrist & hand - gripping & lifting
radial collateral ligament
lateral stability, rarely injured
wrist adduction
ulnar flexion - movement of little finger side of hand toward medial aspect or ulnar side of forearm - movement of fingers toward middle finger
distal bony landmarks for wrist muscles
base of 2nd, 3rd, & 5th metacarpals, pisiform, & hamate
wrist extension agonists
-Extensor carpi radialis longus -Extensor carpi radialis brevis -Extensor carpi ulnaris -Extensor digitorum -Extensor indicis -Extensor digiti minimi -Extensor pollicis longus -Extensor pollicis brevis
wrist abduction agonists
-Flexor carpi radialis -Extensor carpi radialis longus -Extensor carpi radialis brevis -Abductor pollicis longus -Extensor pollicis longus -Extensor pollicis brevis
elbow flexion agonists
agonists: bicep brachii, brachialis, brachioradialis, pronator teres ex: bicep curl
radioulnar supination agonists
agonists: supinator muscle, brachioradialis, biceps brachii ex: tightening a screw
elbow extension agonists
agonists: triceps brachii, anconeus ex: push up
Which of the following muscles performs adduction of the wrist?
flexor carpi ulnaris
Elbow moves from __ degrees of extension to _____-______ degrees of flexion
0; 145-150 *always measure into flexion
Tightening a screw with a screwdriver using the right hand depends significantly upon the action of the _____.(significantly means I'm asking for the strongest/largest CSA)
Biceps brachii
metacarpophalangeal (MCP) joints
Condyloid 0 to 40 degrees of extension 85 to 100 degrees of flexion
Elbow stability is locked when at full _______ and unlocked at > _______
Extension; 20 degrees flexion
Which of the following is the sole action of the brachialis muscle?
Flexion of the elbow
each finger has 3 joints
Metacarpophalangeal (MCP) joints Proximal interphalangeal (PIP) joints Distal interphalangeal (DIP) joints
Of the carpal bones, which articulates with the radius and is critical in transfering force from the hand into the forearm ?
Scaphoid
posterior interosseous nerve from radial nerve
- Extensor carpi ulnaris - Extensor digitorum - Extensor digiti minimi - Abductor pollicis longus - Extensor pollicis longus - Extensor pollicis brevis - Extensor indicis
wrist flexion agonists
- Flexor carpi radialis - Flexor carpi ulnaris - Palmaris longus - Flexor digitorum superficialis - Flexor digitorum profundus - Flexor pollicis longus
median nerve- arising from C6, C7, C8, & T1
- Flexor carpi radialis - Palmaris longus - Flexor digitorum superficialis
abductor pollicis longus muscle
- abduction of thumb at CMC joint - abduction of wrist - extension of thumb at CMC joint - weak supination of forearm from a pronated position - weak flexion of wrist
bony landmarks for finger muscles
- base of proximal, middle, & distal phalanxes - base of 1st metacarpal, proximal & distal phalanxes of thumb
elbow flexors
- biceps brachii - brachialis - brachioradialis - pronator teres
radioulnar supinators
- biceps brachii - supinator muscle - brachioradialis
carpal bone 3 sided arch
- concave on palmar side - bony arch is spanned by transverse carpal & volar carpal ligaments - creates the carpal tunnel - frequently a source of problems known as carpal tunnel syndrome
extensor digitorum muscle
- extension of 2nd, 3rd, 4th, & 5th phalanges at MCP joints - extension of wrist - weak extension of elbow
triceps brachii muscle
- extension of arm - loss or weakness has profound affect on arm extension In order of contribution: medial head lateral head long head - extension of shoulder - adduction of shoulder - horizontal abduction
extensor indicis muscle
- extension of index finger at MCP joint - weak wrist extension - weak supination of forearm from pronated position
extensor digiti minimi muscle
- extension of pinky at MCP joint - weak wrist extension - weak elbow extension
extensor pollicis brevis muscle
- extension of thumb at CMC & MCP joints - weak wrist extension - wrist abduction
extensor pollicis longus muscle
- extension of thumb at CMC, MCP, & IP joint - extension of wrist - abduction of wrist - weak supination of forearm from a pronated position
extension carpi radialis brevis muscle
- extension of wrist - abduction of wrist - weak flexion of elbow
extensor carpi ulnaris muscle
- extension of wrist - adduction of wrist together with flexor carpi ulnaris muscle - weak extension of elbow
extensor carpi radialis longus muscle
- extension of wrist - abduction of wrist - weak flexion of elbow - weak pronation to neutral from a fully supinated position
supination of elbow
- external rotary movement of radius on ulna that results in hand moving from - palm-down to palm-up position
biceps brachii muscle
- flexion and supination of forearm - glenohumeral joint stabilization - crosses two joints - sensitive to length tension relationship fusiform - active insufficiency (combining elbow and shoulder flexion)
brachioradialis muscle
- flexion of elbow - from pronated position to neutral - from supinated pronation to neutral - "hitchhiker muscle"
flexor digitorum superficialis muscle
- flexion of fingers at MCP & PIP joints - flexion of wrist - weak flexion of elbow
flexor pollicis longus muscle
- flexion of thumb carpometacarpal, metacarpophalangeal, & interphalangeal joints - flexion of wrist - abduction of wrist
flexor carpi radialis muscle
- flexion of wrist - abduction of hand - weak flexion of elbow - weak pronation of forearm
flexor carpi ulnaris muscle
- flexion of wrist - adduction of wrist together with extensor carpi ulnaris muscle - weak flexion of elbow
wrist adduction agonists
- flexor carpi ulnaris - extensor carpi ulnaris
anterior interosseous nerve form median nerve
- flexor digitorum profundus for index & long finger - flexor pollicis longus - intrinsic muscles (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, and 1st & 2nd lumbrical)
elbow joint
- ginglymus (hinge) - only flexion and extension - 2 interrelated joints (humeroulnar joint and radiohumeral joints) - 3rd joint (radioulnar- supination/pronation)
pronation of elbow
- internal rotary movement of radius on ulna that results in hand moving from - palm-up to palm-down position
bony landmarks in elbow
- medial condyloid ridge - olecranon process - coronoid process - radial tuberosity
bony landmarks for wrist and hand muscles (located on elbow)
- medial epidondyle - lateral epicondyle - lateral supracondylar ridge
phalanges
- radiounlar motion limited by base design - heads designate direction during flexion/extension
Anconeus muscle
- small contribution to elbow extension - attached posterior to joint capsule - pulls joint capsule away form olecranon process and fossa during elbow extension
elbow extensors
- triceps brachii - anconeus
brachialis muscle
- true flexion of elbow - large force - pennate muscle - no role in supination or pronation - no attachment to radius
wrist joint movements
70-90 degrees of flexion 65-85 degrees of extension 15-25 degrees of abduction 25-40 degrees of adduction
Posterolaterally at elbow & forearm and posterior at hand
Primarily wrist extension •Extensor carpi radialis longus •Extensor carpi radialis brevis •Extensor carpi ulnaris Primarily wrist & phalangeal extension •Extensor digitorum •Extensor indicis •Extensor digiti minimi •Extensor pollicis longus •Extensor pollicis brevis •Abductor pollicis longus
Anteromedially at elbow & forearm and anterior at hand
Primarily wrist flexion •Flexor carpi radialis •Flexor carpi ulnaris •Palmaris longus Primarily wrist & phalangeal flexion •Flexor digitorum superficialis •Flexor digitorum profundus •Flexor pollicis longus
The most commonly injured ligament in the elbow due to throwing is the ______.
Ulnar collateral ligament
radioulnar pronation agonists
agonsits: pronator teres, pronator quadratus, brachioradialis ex: loosening a screw
which elbow flexor produces the greatest force?
brachialis
thumb (CMC)
carpometacarpal (CMC) joint of thumb, unique saddle-type joint, 50-70 degrees abduction, flex 15-45 degrees and extends 0-20 degrees
clinical insight- golfer's elbow
medical epicondylitis - less common - medical wrist flexor & pronator group near their origin on medical epicondyle - muscles cross elbow but act primarily on wrist & hand
thumb (MCP)
metacarpophalangeal (MCP) joint, full extension into 40-90 degrees of flexion, ginglymus (hinge) joints
wrist extension
movement of back of hand and/or phalanges towards posterior or dorsal aspect of forearm
Extension of elbow
movement of forearm away from shoulder by straightening the elbow to increase its angle
Flexion of elbow
movement of forearm to shoulder by bending the elbow to decrease its angle
wrist flexion
movement of palm of hand and/or phalanges towards anterior or volar aspect of forearm
wrist opposition
movement of thumb across palmar aspect to oppose any or all of the phalanges
wrist reposition
movement of thumb as it returns to anatomical position from opposition with hand and/or fingers
elbow motion
primarily involves movement between articular surfaces of the humerus and ulna
Supinator muscle
primary supinator - added resistance brings in the biceps brachii - at full elbow extension the biceps brachii has minimal effect
ulnar collateral ligament
provides medial support larger, more robus of 2 ligaments, 3 portions: anterior, posterior, transverse critical to high-velocity sports requireing elbow stability- "tommy john procedure"
carpal bones
proximal: scaphoid, lunate, triquetrum, pisiform distal: trapezium, trapezoid, capitiate, hamate
Stability in flexion is more dependent on
radial collateral (lateral) ulnar collateral (medial)
wrist abduction movement
radial flexion - movement of thumb side of hand toward lateral aspect or radial side of forearm - movement of fingers away from middle finger
where do radioulnar joint muscles insert?
radius
__________ is much larger distally than __________
radius; ulna
radiocarpal joint
scaphoid, lunate, and radius contact - not uniform - not constant
origins of muscles that flex and extend the elbow
scapula & humerus
origins of muscles that pronate and supinate elbow
scapula, humerus, and ulna
annular ligament
sling effect around radial head for stability- no actual attachment to the radius narrow neck- lateral and distal displacement clinical insight: nursemaid's elbow
