Forearm, hand, wrist
Transverse bundle
- little support - originates & inserts on the Ulna
Hook test
- patient actively supinates the flexed elbow; - intact hook test permits the examiner to hook his or her index finger under the intact biceps tendon from the lateral side; - w/ an abnormal hook test (distal avulsion), there is no cord-like structure to palpate or hook; tests for distal biceps tendon rupture
Moberg pick up test
-An assortment of 9 or 10 objects (bolts, nuts, screws, button, coins, pens) -Timed for the following tests: 1. Putting objects in a box with the affected hand 2. Putting objects in a box with the unaffected hand 3. Putting objects in a box with the affected hand with eyes closed -Examiner notes which digits are used for pretension. -Digits with altered sensation are less likely to be used. - The test is used for median or combined median and ulnar nerve lesions
Box and block test
-Test is for gross dexterity in which 150 blocks, each measuring 1 in on a side, are used -Patient has 1 min. to individually transfer the blocks from one side of a divided box to the other. The number of blocks transferred is given as the score. Patients are given a 15 sec practice trial before the test.
Nine-Hole Peg test
-Test is used to assess finger dexterity. -Patient placed nine 1.3 in. pegs in a 5 by 5 in. board and then removes them. -The score is the time taken to do this task, each hand is tested separately.
Jebson-Taylor Test of Hand Function
1. Writing 2. Card turning 3. Picking up small objects 4. Simulated feeding 5. Stacking 6. Picking up large, light objects 7. Picking up large, heavy objects; primarily measures gross coordination, assessing pre-tension and manipulative skills with functional tests.
Minnesota Rate of Manipulation Test
1. placing 2. turning 3. displacing 4. One-hand turning and placing 5. Two-hand turning and placing; primarily measures gross coordination and dexterity
Trapezium
1st metacarpal joint makes a saddle joint, palpate by flex and extend thumb
trapezoid
2nd metacarpal - not easy to palpate
capitate
3rd metacarpal joint = largest and most prominent - neutral feel the curve of bone, when in flexion comes out from under the lunate
Lunate
3rd metacarpal line = most frequently dislocated, 2nd most fractured = covered by ext. carpi radialis brevis
Boxer's fracture
5th metacarpal fracture
Chair sign
A classic complaint of patients with an insufficiency of the LUCL is an ability or reluctance to push out of a chair and fully extend the elbow with the forearms supinated and the arms abducted greater than shoulder width
Triangular fibrocartilaginous complex (TFCC)
A small, fibrocartilaginous structure in the wrist located between the distal end of the ulna and the carpals.
Flex MCP joints and extend PIP and DIP joints
Action: - Lumbricals 1 and 2 - Lumbricals 3 and 4
pseudoboutonniere deformity
An avulsion of the volar plate from the proximal phalanx (mimics boutonniere deformity)
Kienbock disease
Avascular necrosis of the lunate, often seen in young athletes and thought to be caused by repetitive trauma or an unrecognized lunate fracture.
0-20;>120
Bony stability formed by the relationship between the olecranon and the olecranon fossa is greatest between __________ degrees and ______________ degrees
Biceps
C5 reflexes
Brachioradialis
C6 reflex
Cold urticaria or Raynaud's
Cold areas of skin = ?
Cruciate pulleys
Collapse to allow full digital flexion
Radioscaphoid ligament
Connects radius to scaphoid
deeper creases (increased musculature), more prominent calluses, appears larger in size
Dominant hands tend to have what?
Biceps brachii, brachialis, brachioradialis, supinator
Elbow flexor and supinator group
Boutonniere deformity
Extension of the MCP and DIP joints and flexion of the PIP joint. Rupture of the extensor tendon
Arcade of Struthers
Fibrous band about 8 cm proximal to the medial epicondyle related to the medial head of the triceps and medial intermuscular septum. The ulnar nerve passes beneath.
Purdue Pegboard Test
Fine coordination: 1. Right hand 2. Left hand 3. Both hands 4. Right, left, both 5. Assembly; compared based on gender and occupation
Long finger flexor test
Flexor digitorum superficialis: Hold fingers in extension except suspect and have them flex suspect at PIP Flexor digitorum profundus: DIP isolation by extending PIP and MCP and have them flex suspect DIP
Bunnel-Littler test
For lumbricals and interossei; Hold MCP in extension and try to move PIP into flexion
finkelstein Test
For stenosing tenosynovitis (Dequervain's disease); Thumb tucked in a fist and stabilize forearm and ulnar deviate (pain=positive)
3-9%
Hand, finger, and wrist injuries account for ______ of sports related injuries
Retinacular test
Hold PIP in neutral and move DIP into flexion
loosening extension slightly
How is capsular tension/tightness ruled out in Bunnel-Littler test
1 (flexion/extension)
How many degrees of freedom does IP joints have?
2 (flexion/extension and abduction/adduction)
How many degrees of freedom does the CMC joint of 5 have?
1 (flexion/extension)
How many degrees of freedom does the CMC joints 2, 3, and 4 have?
2 (flexion/extension and abduction/adduction)
How many degrees of freedom does the condyloid MCP joints have?
2 Flexion/extension Radial/Ulnar Deviation
How many degrees of freedom of movement does radiocarpal joint provide?
90;60
In the anterior bundle, the anterior band resists valgus stress until about ____ degrees of flexion; the posterior band is the primary restraint when the elbow is flexed beyond ______ degrees and is primarily stressed in overhead-throwing athletes
DeQuervain's Disease
Inflammation of the synovial sheath surrounding the extensor pollicis brevis and abductor pollicis longus tendons
Gait with arm swing, upper body exam, count fingers, relaxed state is slight flexion, palmar surface, Dorsal surface, skin, Bony palpation, soft tissue palpation, muscle testing, sensation, special tests,
Inspection of the hand, fingers and wrist
annular pulleys
Keep flexor tendons and sheath closely applied to phalanges
Claw fingers
MCP joints are hyperextended, and the PIP and DIP are flexed
Ulnar deviation
Movement of the hand toward the ulnar side of the forearm
Thumb flexion
Muscle testing of Flexor pollicis brevis (MCP) and flexor pollicis longus (MCP)
Thumb abduction
Muscle testing of abductor pollicis brevis and longus
extension finger/wrist
Muscle testing of extensor carpi radialis brevis and longus and ulnaris
Finger extension
Muscle testing of extensor digitorum communis, extensor indicis, extensor digiti minimi
Finger flexion
Muscle testing of flexor digitorum profundis (DIP), flexor digitorum superficialis (PIP), and Lumbricals (MC-P)
Supination/pronation of wrist
Muscle testing of rotation of forearm
Allen Test
Open and close fist rapidly and then squeeze tight with thumb over radial artery, index and middle over ulnar; press against bone to shut down; Hold artery and have open hand, watch blood flow as release one artery at time
Radial collateral ligament
Originates off styloid process of radius and inserts on scaphoid and trapezium
Tight retinacular test
PIP is held in a neutral while the examiner flexes the DIP. If the DIP does not flex, the retinacular (collateral) ligaments or capsule are tight. If the PIP is flexed and the DIP flexes easily, the retinacular ligaments are tight and the capsule is normal.
push-up sign
Patients with insufficiency of the LUCL will be unable to fully extend or be apprehensive in performing a push-up from the floor with the forearms supinated and the arms abducted greater than shoulder width
Raynaud's phenomenon
Periodic ischemic attacks affecting the extremities of the body, especially the fingers, toes, ears, and nose. The affected extremities become cyanotic and very painful. These attacks are brought on by arterial constriction due to extreme cold or emotional stress.
Extensor carpi radialis longus/brevis and extensor carpi ulnaris
Primary wrist extensors?
DIP flexes then retinaculum
Retinacular tension ruled out from joint capsule if?
Extensor retinaculum
Secures the extensor tendons in the wrist so they don't "bow out" when muscles contract
Baby Bennett Fracture
Seen in the 5th metacarpal, becomes displaced by the pull of the extensor carpi ulnaris tendon
Stimulated Activities of Daily Living Examination
Test consists of 19 subtests, including standing, walking, putting on a shirt, buttoning, zipping, putting on gloves, dialing a phone, tying a bow, manipulating safety pins, manipulating coins, threading a needle, unwrapping a Band-Aid, squeezing toothpaste, and using a knife and fork
Posterolateral rotatory instability test (pivot shift)
Test for posterolateral instability of the elbow
Crawford Small Parts Dexterity Test
Test measures fine coordination, including the use of tools such as tweezers and screwdrivers to assemble things, to adjust equipment, and to do engraving
"safe" position
The MCP joints flexed to 50-70 degrees and the IP joints extended
Palmar ligament (volar plate)
The palmar aspect of the MCP joints is reinforced by a thick fibrocartilaginous ________?
Froment's sign
The subject is instructed to hold a piece of paper between the thumb and index finger. The examiner then tries to pull the paper out. (ulnar nerve)
Murphy's sign
The subject is instructed to make a fist. The examiner notes the position of 3 MC (dislocation lunate)
Tinel's sign
The subject is seated with the elbow in slight flexion, and the examiner is standing with the distal hand grasping the subject's wrist (laterally). With the wrist stabilized, tap the ulnar nerve in the ulnar notch with 1 or 2 fingers. Tingling indicative of ulnar nerve compromise.
Pinch Grip test
The subject may sit or stand. The examiner stands next to the subject. The subject is instructed to pinch the tips of the thumb and index finger together. Cannot pinch = anterior interosseous nerve entrapment
Finkelstein test
The subject sits or stands and forms a fist around the thumb. The examiner stands with the proximal hand grasping the subject's forearm and the distal hand grasping the subject's fist. While stabilizing the subject's forearm with the proximal hand, ulnarly deviate the subject's wrist with the distal hand. Pain over the abductor pollicis longus and extensor pollicis brevis tendons distally is indicative of tenosynovitis in these tendons (de Quervain's disease)
Golfer's elbow test
The subject sits or stands and makes a fist on the involved side. The examiner faces the subject and palpates along the medial epicondyle. The examiner's other hand grasps the subject's wrist. The examiner passively supinates the forearm and extends the elbow and wrist. Complaints of discomfort along the medial aspect of the elbow may be indicative of medial epicondylitis.
Hyperextension test
The subject sits or stands with the elbow fully extended and the forearm supinated. The examiner grasps the distal humerus at the areas of the medial and lateral epicondyles with one hand while the other hand grasps the distal forearm of the subject. The examiner passively extends the elbow until no further motion is available. Hyperextension if beyond 0 degrees.
Passive Tennis Elbow Test
The subject sits with the involved elbow in full extensioin. The examiner passively pronates the forearm and flexes the subject's wrist. May indicate lateral epicondylitis.
Valgus Stress Test
The subject sits with the test elbow flexed from 20 to 30 degrees. the examiner stands with the distal hand around the subject's wrist (medially) and the proximal hand over the subject's elbow joint (laterally). with the wrist stabilized, the examiner applies a valgus stress to the elbow with the proximal hand. (UCL)
Resistive Tennis Elbow Test (Cozen's Test)
The subject sits. The examiner stabilizes the involved elbow while palpating along the lateral epicondyle. With a closed fist, the subject pronates and radially deviates the forearm and extends the wrist against the examiner's resistance. May indicate lateral epicondylitis.
Resistive Tennis Elbow Test
The subject sits. The examiner stabilizes the involved elbow with one hand and places the palm of the other hand on the dorsal aspect of the subject's hand just distal to the PIP of third digit. The subject extends the third digit against the examiner's resistance. May indicate lateral epicondylitis.
Watson test
The subject sits. The examiner uses one hand to stabilize the distal forearm at the distal radial ulnar joint while grasping the scaphoid bone of the subject with the other hand. Mobilize the scaphoid anteriorly and posteriorly while ulnarly and radially deviating the subjects's wrist. (sublexing=carpal ligament tear)
Ballottement test
The subject stands or sits. The examiner uses his or her thumb and index finger to stabilize the lunate bone of the subjects involved hand. While stabilizing the lunate bone, the examiner uses his or her other hand to gently move the pisotriquetral complex up and down against lunate bone. Indicative of lunotriquetral dissociation or ligament damage or laxity.
Wrinkle test
The subject's fingers are placed in warm water for approximately 10 minutes. On removal, the examiner assesses the skin around the pulp area for any wrinkling. (denervation of tissue if no wrinkle)
Varus Stress Test
The subkect sits with the test elbow flexed from 20 to 30 degrees. the examiner stands with the distal hand around the subject's wrist (laterally) and the proximal hand over the subject's elbow joint (medially). with the wrist stabilized, the examiner applies a varus stress to the elbow with the proximal hand. (RCL)
central compartment
The tendons of FDS and FDP pass through the ______________?
170-180; 90
The total ROM in pronation and supination is _________ degrees, with approximately ____ degrees of motion in each direction
Trigger finger
Thickening of the flexor tendon sheath, tendon sticks during flexion (audible snap)
10x
Thumbs UCL is injured ____ more than RCL
Ape hand deformity
Wasting of the thenar eminence as a result of median nerve palsy. The thumb lines up with the fingers. Cannot oppose or flex thumb.
innervates muscle of the hypothenar
What does deep branch do?
limit wrist flexion
What does dorsal radiocarpal ligament do?
stops rotary movement of skin during grasping
What does septa and ligaments prevent
dissipates stresses imposed on the forearm during loading by extending the radiocarpal articulation, stabilizes the distal radioulnar joint, and provides stability during pronation and supination
What does the TFCC do?
limit hyperextension of the wrist
What does the palmar radiocarpal ligament do?
Checks radial deviation (taut at end of flexion/extension)
What does ulnar collateral ligament do?
medial to carpal tunnel and through Guyon's canal
What does ulnar nerve travel through?
adductor pollicis muscle
What fills the web space of index and thumb
rotation
What is an accessory component of the thumb?
abductor pollicis brevis, opponens pollicis, flexor pollicis brevis
What is located in the thenar eminence?
lunate exerts a flexion force though scapholunate and extension force through lunotriquetral
What is the relationship of the lunate b/n the scaphoid and traquetrum?
aductor pollicis brevis, flexor pollicis brevis, opponens pollicis
What muscles form the thenar eminence?
ellipsoid joint
What type of joint is the radiocarpal joint?
Cascade sign
When the MCP joints and the PIP joints of the fingers are flexed the converge toward the scaphoid tubercle
Radial portion of palm, palmar side of thumb, index, and middle fingers
Where is the medial nerve
Dorsum of hand radial side of 3rd MC, dorsal side of thumb, index, and middle finger to DIP; also dorsal thumb and index web space
Where is the radial nerve?
ulnar side of ring and pinky fingers dorsal and palmar
Where is the ulnar nerve
Palmar
Which are stronger, the palmar or dorsal interosseous ligaments?
Scapholunate ligament
Which ligament directly attaches the lunate to the scaphoid?
Lunotriquetral ligament
Which ligament directly attaches the lunate to the triquetrum?
36%
_____ of hand fractures involve the metacarpal, most commonly the neck or shaft
Sports related
__________ injuries are the most common cause of phalangeal fx in athletes aged 10-39
pronator teres syndrome
a branch of the median nerve, the anterior interosseous nerve, can become compressed by the pronator teres, causing? (inability to pinch thumb and index finger)
Third degree jersey finger
a fragment of bone is avulsed with the tendon's insertion and retracts to the PIP joint
osteophyte formation or a loose body
a had end-feel in passive flexion of elbow is indicative of what?
Second degree Jersey finger
a portion of the bony attachment is avulsed, and the tendon retracts to the palm
syndactyly
abnormal extension of web space that restricts movement
Carrying angle
angle between the midline and humerus (cubitus varus and cubitus valgus)
Ligament of Struthers
anomalous structure found in about 1% of the population
cubital tunnel
area between olecranon process and medial humeral epicondyle. the ulnar nerve runs through it "funny bone"
ulnar nerve compression
atrophy in hypothenar eminence could be the result of what?
median nerve compression
atrophy in the thenar eminence could be the result of what?
Volar dislocation
avulsion of central slip of extensor tendon which can lead to Boutonniere deformity
Jersey finger
avulsion of flexor digitorum profundus (no flexion of DIP)
Scaphoid compression test
axial load is placed on the first metacarpal toward the scaphoid
Dorsal dislocation
axial load with the digit flexed, most common ring finger PIP, injures volar plate
proximal palmar crease
base of fingers also close to "no man's land" and marks location of proximal pulley
subtendinous olecranon bursa
between olecranon and triceps tendon
clubbed nails
broader and larger = domed = hypertrophy of tissue = respiratory or congenital heart problems
triceps
c7 reflex
Cubitus valgus
carrying angle >15 degrees
Cubitus varus
carrying angle is less than 5-10 degrees
Valgus Extension Overload
collection of tensile, shear, and compressive forces that result from mild UCL laxity
Rolando fracture
comminuted intra-articular fracture of the base of the 1st metacarpal (Y or T)
humerus supracondylar process syndrome
compression of the brachial artery by ligament of struthers; weakness in pronator muscles
Radiocapitate ligament
connects radius to capitate
Radiotriquetral ligament
connects radius to triquetrum
ulnar crease
crease between the 4th and 5th metacarpal
Lunula
crescent moon nail base
Distal interphalangeal crease
crosses fingers at distal interphalangeal joint
Proximal interphalangeal crease
crosses fingers, proximal interphalangeal joint, defines distal border of "no man's land"
Russell's sign
cuts, abrasions on MCP or IP joint can indicate bulimia = self induced vomiting
20-25
degrees of abduction and adduction of fingers
70-80
degrees of abduction in the thumb
20-30
degrees of extension for MCP
75-85
degrees of extension in wrist
70-90
degrees of flexion and extension in DIP
100-110
degrees of flexion and extension in PIP
80-90
degrees of flexion and extension in thumb IP
85-105
degrees of flexion for MCP
60-70
degrees of flexion in CMC of thumb
80-90
degrees of flexion in wrist
Tardy ulnar palsy
delayed onset (years). is caused by the "double crush" phenomena of a cubital tunnel problem and a cervical spine problem
anatomical snuffbox
depression on the radial side, distal and dorsal to radial styloid
Gamekeeper's thumb
described as stretch of UCL resulting decrease grip and pain
Wartenberg's sign
deviation of hand radially during flexion and results in the inability to maintain adduction of the little finger, leaving it resting in an abducted position
hamate
distal and radial to pisiform = hook forms the lateral/radial border of the tunnel of Guyon (transports ulnar nerve and artery to hand)
triquetrium
distal to the ulnar styloid - radial deviation for palpation (lies under styloid and pisiform) - 3rd most fractured
Humpback deformity
dorsal and radial angulation of the scaphoid fragments
Phalen test
dorsal aspect hands together for 1 min
Perilunate dislocation
dorsal displacement of all carpel bones except lunate
anhydrosis
dry areas of skin
may indicate nerve damage
dry areas of skin = ?
triceps brachii, anoconeus, pronator teres, pronator quadratus
elbow extensor and pronator group
cubital fossa
elbow pit
cup shape of hand
eminences = bulge = ?
firm
end-feel in distal radioulnar pronation
firm
end-feel in distal radioulnar supination
hard
end-feel in elbow extension
soft
end-feel in elbow flexion
hard/firm
end-feel in superior radialulnar pronation
firm
end-feel in superior radioulnar joint supination
Radial tunnel syndrome
entrapment of the radial nerve that mimics tennis elbow
Tap or percussion test
examiner applies a firm tap to the end of the finger being tested. Pain at the site of injury is indicative of a fracture.
Compression test
examiner applies compression along the long axis of the bone of the finger being tested. Pain at the site of injury is indicative of a fracture.
Cubital Recurvatum
extension beyond 0 degrees in the elbow
Smith's fracture (reverse Colles' fracture)
fall on excessively flexed wrist; forward displacement of of lower fragment
FOOSH
fall on outstretched hand
Arcade (canal) of frohse
fibrous arch in supinator muscle occurring in 30% of population
Dupuytren's contracture
fixed flexion of the MCP and PIP joints, ususally in the ring finger and pinky finger
Hills
fleshy mounds = neurovascular bundles
Zigzag deformity
flexion at the CMC joint and hyperextended at the MCP joint
Volkmann's ischemic contracture
flexion contraction of the wrist and fingers (claw fingers) resulting in limited extension at these joints (after forearm fracture or decreased blood flow)
4x
flexor tendons require almost _________ as much excursion as the extensor tendons
scaphoid
floor of anatomical snuffbox, largest of proximal row, palpate by ulnar deviation, does NOT have a good blood supply
subungual hematoma
formation of a hematoma below the nail due to pressure and causes purple coloration
Bennett's fracture
fracture of first metacarpal/thumb that extend into articular surface; requires a external or internal fixator to stabalize
Colles fracture
fracture of radius approximately 1.5 inches from radiocarpal joint, backward displacement of lower fragment and radial deviation of the hand - sometimes misused to describe any distal radial fracture (extended wrist)
Ulnar collateral ligament
from ulna's styloid process and attaches on the medial aspect of the triquetrum dorsally and on the pisiform palmarly
35;declines
grip strength increases until age ____ and then __________ as aging continues
lumina
growth plate of fingernail
Bouchard's nodes
hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints; They are seen in osteoarthritis, where they are caused by formation of calcific spurs of the articular (joint) cartilage.
forceful eccentric contraction
how can the distal biceps brachii tendon be ruptured
2 (flexion/extension and abduction/adduction)
how many degrees of freedom of movement does the saddle joint of the thumb have?
20
how many degrees of radial deviation?
35
how many degrees of ulnar devation
capsule
if no flexion in retinacular test means?
fixed to underlying tissue
immobile scar = ?
subcutaneous olecranon bursa
in subcutaneous tissue over olecranon
Varus stress test
in wrist looking at radial collateral ligament and in hand LCL or MCL (gap the joint)
Valgus stress test
in wrist looking at ulnar collateral ligaments and in hand LCL or MCL (gap the joint)
Extensor plus deformity
inability of the finger to simultaneously flex metacarpophalnageal and PIP joints
Myelopathy hand
inability to extend and adduct ring and little finger
pregnancy
increases risk of carpal tunnel syndrome?
"Hex" sign
independent movement of extensor indicis and extensor digiti minimi
Paronychia
infection around periphery of fingernail
lateral ulnar collateral ligament
inferior to radial collateral; provides lateral support of the ulna; disruption results in rotatory instability of the elbow joint
Palmar aponeurosis
insertion of palmaris longus
Wrist Glide Test
involves radial, ulnar, superior, and inferior glide
Ganglion cyst
jelly like pea-sized swelling on wrist - not fixed to connective tissue or extremely tender
styloid
lateral process of radius
Dissociative carpal instability
laxity of the interosseous ligaments alters the synchronous motion of the lunate, scaphoid, and triquetrum
cleland's and Grayson's ligaments
ligaments that attach skin to bone of hand
Felon
localized infection in fascial spaces of finger pad
palmar aponeurosis pulley
located on the distal aspect of the metacarpal, is the most proximal meber of the pully system
volar dislocation
lunate dislocation
Gun stock deformity
medial deviation of the carrying angle
styloid
medial/posterior process of ulna = no wrist articulation with proximal carpal row - ext. carpi ulnaris runs through the groove longitudinally
Carpal tunnel syndrome
median nerve compressed as it passes through the carpal tunnel, affecting motor and sensory distribution in the hand and fingers
wrist crease
meeting of hand and wrist
distal palmar crease
metacarpal-phalange joint (knuckles), surgical "no man's land" (where 2 flexor tendons are in one sheath)
median crease
middle of hand just medial of the thenar crease
Polydactyly
more than the normal number of digits
145-155
most of the elbow's ROM is composed of flexion, ranging between __________ degrees from the neutral position.
pronation
movement at the radioulnar joints allowing for the palm to be turned down
supination
movement at the radioulnar joints allowing for the palm to turn upward
Radial deviation
movement of the hand toward the radial side
Thenar eminence
muscle bell of motor of thumb
hypothenar eminence
muscle belly of motor of little finger
Thumb adduction
muscle testing of adductor pollicis (obliques and transversus)
Finger abduction
muscle testing of dorsal interossei and abductor digiti minimi
Thumb extension
muscle testing of extensor pollicis brevis (MC-P) and extensor pollicis longus (IP)
flexion finger/wrist
muscle testing of flexor carpi radialis and ulnaris
Pinch thumb and index
muscle testing of long flexors and extensors, lumbricals and interossei
Opposition of thumb and pinky
muscle testing of opponens pollicis and digiti minimi
Finger adduction
muscle testing of palmar interossei
wrist slightly extended and fingers/hand in slight flexion
natural, relaxed position?
Heberden's nodes
nodes on dorsal and lateral on DIP (osteoarthritis)
palmar radiocarpal ligament
origin on anterior surface of the distal radius inserts obliquely and medially to 3 individual segments
Preiser's disease
osteoporosis of scaphoid
facia
palmar surface is fixed by what?
valleys
paths = flexor tendons intersection with joints
Extensor digitorum communis
primary extensor of the IP joints (assists wrist extension)
Moving Valgus Stress Test
pt arm is abducted to 90 and elbow fully flexed. PT maintain valgus force and quickly extend pt's elbow. (+) reproduction of pain between 120-70 of flexion (partial tear of MCL
Drop-Wrist
result of radial nerve palsy; the wrist and fingers cannot be actively extended by the pt.
extensor tendons
rheumatoid arthritis can displace what to ulnar side of MC-P joint
Swan neck deformity
rheumatoid arthritis; PIP joint hyper exteded and DIP joint flexed
Mallet finger
rupture or avulsion of extensor tendon at its insertion into distal phalanx flexion of DIP joint usually occurs from trauma, forcing distal phalanx into flexed position
15-40
scaphoid fracture is most prevalent in what ages? (young and old have weaker radius)
pisiform
sesmoid bone - it is within the flexor carpi ulnaris (forms the medial border to tunnel of guyon)
septa & ligaments
skin is attached to bone by what?
Tinel test
tap the volar aspect of the subject's wrist over the area of the carpal tunnel
Buddy tape
tape injured finger to neighboring finger for non and minimally displaced fx (above and below PIP)
Posterior bundle
taut in flexion beyond 90 degrees and is subject to stress only if the anterior bundle is completely disrupted
Anterior bundle
taut throughout the elbow's range of motion; primary restraint against valgus forces
Elbow Posterolateral Rotary Instability
tears of the LUCL permit a transient rotational subluxation of the radius and ulna relative to the humerus causing external rotation of the radius and ulna, and valgus opening of the elbow
first degree jersey finger
the bony attachment is left intact, and the ruptured tendon retracts to the PIP joint
Palmar digital crease
the crease marking the distal metacarpal-phalange joint (5)
2 (flexion and extension; rotation)
the humeroradial joint permits ____ degrees of freedom of movement.
1 (flexion and extension)
the humeroulnar articulation allows for _________ degree of freedom of movement
80%
the majority, over _____, of all carpal fractures involve the scaphoid bone because of its function as a bony block limiting wrist extension
thenar crease
the outline for the thenar eminence
Stener lesions
the proximal end of the UCL of thumb dislocates from under the adductor aponeurosis
1 (pronation and supination)
the radioulnar joints have ___ degree of freedom of movement.
Elbow flexion test
the subject may sit or stand. The examiner stands next to the subject. The subject is instructed to maximally flex the elbow and hold this position for 3-5 minutes. Median nerve distribution pain = cubital fossa syndrome
3rd
this dorsal passageway can have some rheumatoid arthritis (the tendon turns around radial tubercle = friction if problems around this area)
Triphalangism
three phalanges in the thumb
TFCC
triangular fibrocartilage complex
Lister's tubercle
tubercle of radius = 1/3 of the way from the radial styloid lines up with 3rd metacarpal - capitate - lunate
ulnar variance
ulna is longer than the radius
Ulnar drift
ulnar deviation of the digits
Guyon's canal
ulnar nerve can become compressed as it passes though the guyon's or pisohamate canal
possible infection
warm areas of skin = ?
Bishop's hand
wasting of hypothenar muscles, interossei muscle, and two medial lumbrical muscles. Fourth and fith fingers are flexed.
spoon nails
weak structurally and concave = fungal infection
condition and color
what are you looking at with finger nails?
knuckles
what creates peaks and valleys on dorsal surface?
three arches: 1 carpal level, 1 metacarpal head and neck level, 1 on longitudinal center
what creates the cup shape of the hand?
sensory input to palmar surface of little finger and medial 1/2 ring finger
what does superficial ulnar nerve branch do?
Flexor digitorum profundus
what flexes both IP joints?
flexor digitorum superficialis
what flexes the PIP?
abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
what forms the hypothenar eminence?
ruptures
what happens to 3rd dorsal passageways in colles' fracture
flexor carpi ulnaris, tunnel of guyon, ulnar artery and nerve
what is in zone 1 of palmar tunnels
abductor digiti minimi, opponens digiti, flexor digiti minimi
what is located in the hypothenar eminence?
extensor indicis
what is sometimes used to replace the ext. pollicis longus
abductor pollicis and extensor pollicis brevis
what is transported in 1st dorsal passageway on radial border of anatomic snuffbox (site for stenosing tenosynovitis or the inflammation of the synovial lining of the tunnel)
extensor carpi radialis longus and breves
what is transported in 2nd dorsal passageway, radial side of tubercle (clench fist to palpate) - these are tenons used for transplants
extensor pollicis longus
what is transported in 3rd dorsal passageway on ulnar side of radial tubercle (ulnar border of snuffbox)
extensor digitorum communis and extensor indicis
what is transported in 4th dorsal passageway (radial to the radioulnar articulation)
extensor carpi ulnaris
what is transported in 6th dorsal passageway (groove between apex ulnar styloid and ulnar head)
extensor digit minimi
what is transported in the 5th dorsal passageway (overlies distal ends of radioulnar articulation on dorsum) indentation on radial side of ulnar styloid
extensor carpi ulnaris
what may tear in colles fracture, can be a dislocating tendon
median nerve, flexor pollicis longus tendon, FDS tendons, FDP tendons
what passes through carpal tunnel?
ganglion cyst
what sometimes forms here in the 4th dorsal passageway
plane synovial joint
what type of joint are the CMC joints 2, 3, and 4?
Capsular and interosseous
what type of ligaments bind the carpal bones tightly together?
palmaris longus, carpal tunnel, flexor carpi radialis
whats in zone 2 of palmar tunnels
palmar tip of index
where is median nerve the purest
volar surface of tip of pinky
where is the ulnar nerve purest
