1
Q
What are the arthokinematics of radial deviation
A
- occurs primarily in the mid carpal joint 20-25 degrees
- proximal row- convex prox surface ulnar direction and distal concave surface radial tensioning palmar radial carple ligaments with scaphoid entering a closed pack position with lateral radial facet and triquetral separating about 1.5 cm from TFCC
- hamate capitate spin so that there proximal surface glides in an ulnar direction while the hamate separates from the triquetral
- the Ts rotate like the capitate and hamate and climbs up on top of the scaphoid
2
Q
How does the volar plate move during interphalangeal movement?
A
- flexion- cartilage portion hinges palmarly while the fibrous portion glides proximally
- extension- glides distally to increase joint surface area
3
Q
What are the differentials for a volar plate?
A
1.pain with active flexion or extension
2.pain with passive extension
3.no pain with semiflexion
4.distinct tenderness at the site of the lesion
5hyperextension deformity greater than 15 degrees
4
Q
What is the most common site for volar plate injuries?
A
distal attachement of the middle phalanx
5
Q
how can a contracture occur after volar plate injuries
A
with immobilization the membranous part can become retracted
6
Q
what are the ligaments of the interphalangeal joints and their attachment points
A
- two colateral ligament (main and accessory)
- pass from upper part of proximal over the the axis of motion to the palmar part of distal
- ties into the volar ligament
7
Q
What are the ROM of the interphalangeal joints?
A
1.prox 5-120degree, distal 10-90 degrees
8
Q
What are the key joint position of the interphalangeal joints.
A
- open pack- slight flexion
- closed pack- full extension
- capsular pattern- limited in all driection
9
Q
describe the behavior of the colateral ligagment of of IP joint with motion
A
- resist hyperextension
- during extension the palmar fibers are taut
- in flexion the dorsal fiber are taut
- lateral motion is most limit in flexion by the colaterals
10
Q
What are the characteristics of the MP joint capsule?
A
- very lax with 2 extensive synovial pouches on the dorsal and palmar aspect
- volar plate similar to IP joint, but is more mobile due to its attachments to various mobile structures
11
Q
What structure limits individual finger flexion?
A
1.deep transverse ligament
12
Q
What structures maintain the transverse arch of the wrist?
A
- flexor retinaculum
- anterior carpal ligament
- carpometacarpal liigament
13
Q
What are the palmar arches of the hand
A
- transverse
- oblique
- longitudinal
14
Q
What are the open and closed pack position of the first CMC?
A
- open-midway between all movements
2. closed-full extension and adduction with radial deviation of the wrist
15
Q
What are the three functional joint groups of the wrist?
A
- radiocarpal joints
- midcarpal joint
- intercarpal joints
16
Q
What are the attachements of the radial colateral ligament?
A
O:radial styloid process
I:scaphoid, trapezium, first metacarple
limits- ulnar deviation tightens it
17
Q
what are the attachments of the radiate ligament
A
- center of the capitate
2. distal and proximal rows of carpls
18
Q
What are the palmar radiocarpal ligaments and their function?
A
1.radiotriquetral
2.radiocapitate
3.raioscaphoid
funciton
1.help maintain the arch
2.pulls the hand along with the radius during supination
19
Q
What are is the attachment of the dorsal radial carp
A
O:radial styloid process
I:lunate and triquetral
taut with full wrist flexion and pulls the hand along as the radius move around the ulna in pronation
20
Q
What is the ligament of henle>
A
the convergence of the palmar ulna and radial carpal ligament at the lunate and capitate
21
Q
Name the dorsal carpal ligaments
A
1.palmar radial carpal
22
Q
What are the palmar ulnarcarpal ligaments?
A
1.ulnotirquetral
2.ulnocapitate
3.ulnolunate
4.capitotriquetral
taut with supination when the elbow is flexed to 90 degrees
23
Q
How is the joint of the IP (interphalangeal) shaped?
A
- concave distal surface with 2 facets
- convex proximal surface somewhat pully shaped
- modified sellar joint so there is a slight reversal of the joint arrangement medial to lateral
- proximal surface larger that distal surface
24
Q
What is the volar plate?
A
- thickening of the the articular capsule on the palmar surface of the interphalangeal joint
- increases the articular surface during extension and reinforces the joint volarly/palmarly
25
What is the function of the volar plate?
1. increases the articular surface area of the IP joint for extension
2. reenforces and protects joint volarly
26
What are the attachments of the volar plate?
attaches to the base of the phalynx by the distal fibrous band or hinge like insisura
27
What other ligaments must be checked with volar plate injuries
Colateral ligaments in flexion
28
What part of the IP colateral is tight with extenion , flexion
extenion-palmar protions
| flexion:dorsal fibers
29
At what position of the IP joint is lateral motion most limited
flexion
30
what type of force usally ruptures colateral ligaments
lateral or rotational force, typically at the proximal IP
31
Is there conjunct motion at the IP joints?
YES Lateral transverse plane
32
Describe the shape of the metacarpalphalangela joint
functional ball and socket
1. biconvex metacarpal head
2. smaller biconcave proximal pahlance
3. synovial joint
33
What are the ligaments of the MCP joint?
1. Deep transverse
| 2. collateral ligament
34
Describe the structure and function of the MCP colateral ligaments
1. arises dorsal to the axis of motion
| 2. lax during extension and taut during flexion
35
What causes the colaterals of the MCP to tighten in flexion?
1. ovoid or ball peen hammer shaped articular head of the metacarpal places the joint surface during extension closer to the axis of motion than the joint surface during flexion
2. lateral surface fo the metacarpal head is flared
36
In what position should you test the colaterals of the MCP?
90 degrees of flexion because they are most tight in this position
37
What is the ROM of the MCP jont?
```
varies between I and II-V
1. flexion- 75-80 (I) , 90 (II-V)
2. extenion 0 , 30
3.abduction 50 , 80
4.adduction 20 , 0
5 circumduction 0 , greatest in II
```
38
What are the key joint positions of the MCP joints?
1.closed full flexion
39
What are the motions of the of the digits?
2-4 flexion/extension with radial drift, abduction/adduction
| 1 flex/ext across the hand or parallel to the palm, abd/add away from the hand
40
What type of joint is the carpal metacarpal joint?
1st.sellar or saddle joint
2nd.very little motion
3rd.a little more than very little
4th and 5th modified sellar
41
How would you mobilize a hand lacking digital flexion?
1. palmarly
| 2. medially
42
What articulations make up the 1st CMC joint?
1st metacarpal- concave medial to lateral
| trapezium- concave anterior to posterior
43
What are the different motions of the 1st CMC joint?
1. adduction-perpindicular to the plane of the palm with radial deviation
2. abduction with ulnar or medial rotation
3. flexion across the hand with medial rotation
4. extension with lateral rotation
44
What are the articulation of the 2nd CMC?
the 2nd articulates with the 3rd, capitate, trapezium, trapezoid
45
what are the articulations of the 4th CMC joint?
4th articulates with the hamate and capitate
46
what are the articulations fo the 5 th CMC joint?
5th articulates with the hamate
47
What makes the radiocarpal joint?
proximal articular surface- the biconcave surfaces of the distal radius and articular disc of the ulna
48
How would you describe the radiocarpal joint?
1. proximal biconcave surface is the distal end of the radius and articular disc of ulna
2. distal biconvex is made of the scaphoid lunate and triquetral
3. the capsule is strong and loose
4. the capsule is reinforced by the dorsal, palmar, ulnar, radial and interoseus ligaments
5. does not include the capsuleless ulnar-menisco-tirquetral joint
49
Why is the unbar-menisco-triquetral joint considered a clinical joint?
1. it has not capsule or separate synovial cavity
| 2. only during ulnar deviation doe the triquetral actually contact the disc
50
The disc of the ulanr-menisco-triquetral joint contacts what carpal bones
1. during pronation and supination it engages the lunate
| 2. duing end range ulnar deviation it contacts the triquetral
51
What is the shape of the pisiform triquetral joint?
1. its a plane joint with a separate synovial cavity
52
What are the key positions of the wrist?
1. open pack- slight ext and ulnar deviation
| 2. closed- extension with radial deviation
53
What is the average ROMs of the wrist?
flexion - 85
extension- 80
radial deviation - 20
ulnar deviation - 45
54
What attaches to the pisiform?
1. adductor digit minimi
2. flexor carpi ulnaris
3. flexor and extensor retinaculum
4. piso-hamate ligament
5. piso-metatcarpal ligagment
55
What muscle can cause a hamate fracture?
flexor carpi ulnaris via its insersion through the pisohamate ligament can result in a hamate fracture "golfer's wrist"
56
What is golfer's wrist?
fracuture of the hamate due to violent contraction of the FCU
57
What passes through the tunnel of Guyon and where is the tunnel located?
1. superficial branch of the terminal ulnar and ulnar artery
| 2. under the hood of the hamate
58
How come the proximal row of carpals move as a unit?
Tight interosseus connections
59
What does the distal articulating surface of the radius look like?
It has two distinct facets
1. laterally a triangular facet that articulates with the scaphoid
2. medially a rectangular facet that articulates with the lunate
60
What is the function of the scaphoid tubercle?
attachement of the flexor retinaculum
61
What does the scaphoid articulate with?
1. radius
2. capitate
3. Ts (trapezuim and trapezoid)
4. lunate
62
Why is the scaphoid susceptible to AVN?
1. it take most the foes through the wrist with falls so it has a higher fracture risk
2. also in 1/3 of the population they lack specific blood supply to the proximal pole
63
What part of the scaphoid has poor blood flow?
proximal pole
64
How is the scaphoid shaped?
boat like
65
What is the shape and articulations of the lunate
1. semi lunar
2. convex proximally articulating with the radius and articular disc
3. lateral semilunar articulation with the scaphoid
4. medial square articulation with triquetral
5. distal concave A/P with capitate and edge of hamate
66
How does the lunate contribute to wrist pathology?
1. it is the most frequently dislocated carpal bone
| 2. close proximity to the median nerve and flexor digitorum profundus can lead to compression of the carpal tunnel
67
What dictates the movement of the carpal bones?
1. forces through the abundant ligaments
2. muscles attached distal to the mid carpal bones
3. shape and arthokinematics of the carpals
68
What does the the mid carpal joint look like?
1. it is a functional joint rather than a true anatomic joint
2. it does not have its own capsule or uninterupted joint surface
3. made up of the trapezium, trapezoid, capitate hamate distally on the scaphoid, lunate and triquetral
69
Describe the shape and articulation fo the trapezium?
1. palmar surface is grooved for the FCR
2. tubercle for the flexor retinaculum that is continuous with scaphoid tubercle
3. distal articulation with the first met is sellar in shape concave A/P, convex Med/Lat
4. proximally articulates with schaphoid
5. medially with trapezoid
70
What makes the tunnel of Guyon?
1. pisiform
2. hook of the hamate
3. pisohamate ligament
71
What stabilizes the capitate and what does it articulate with?
1. radiate ligament stabilizes it
2. proximal convex surface articulates with scaphoid and luante
3. distally it articulates with the 3rd and 4th met
4. lateral concave facet with hamate and 2nd met
5. medially with trapezoid
72
What makes up the lateral pillar of the wrist?
1. Ts - concave
2. scaphoid- biconvex
3. radius - concave
73
What makes up the medial pillar?
1. capitate/hamate - convex
2. triquetral/lunate - concave distal, convex proximal
3. radius - concave
74
What is the joint shape between the scaphoid and the Ts
Saddle
- convex scaphoid A/P
- concave scaphoid med/lat
75
What is the unlar-menisco-triquetral joint?
1. realted to the ulnar colateral ligament
2. there is a small meniscus attached to the ligament
3. acts like a windshield wiper over the ulna during pronation and supination
4. typially restircts supination with entraped
76
What structures fortify the hand for impact (ie punching)
1. intercarpal ligaments
2. 2nd and 3rd metacarpals fixed with the 4th and 5th gaining strength from their attachments to the strong central pillar
77
What are the articulations of the 3rd CMC joint?
2nd met and captitate
78
Describe wirst medial pillar extension
1. Primary interaction of the radius concave, convex lunate concave, convex capitate
2. extension begins at distal row for 30 degrees
3. once the capitate glides down on the lunate the lunate is pulled so that is glides down on the radius for 50 degrees of extension
79
Describe wrist radial pillar extension
1. primarily and interation of the radius concave, convex scaphoid convex, concave Ts
2. the distal carpal row glides up on scaphoid 30 degrees
3. scahpoid then spins to allow 50 degress of extenion
80
How do the scaphoid and capitate interact during wrist flexion and extension?
1. during extension at the neutral position they are drawn into a closed pack position by the palmar ligament
2. during flexion the dorsal ligament do not create a closed pack postion
81
How does medial and lateral pillar flexion differ from extension?
1. you have 50 degrees of motion at the distal joint
| 2. you have 35 degrees of motion at the proximal joint
82
How is the transverse carpal arch deepend during flexion?
the triquetral and scaphoid rotate in opposite directions deepening the transverse carpal arch
83
Describe the arthokinematics of ulnar deviation?
1. 45 degrees of motion mainly at the radial carpal joint
2. proximal row move together in a radial direction decreasing tension on the radial carpal ligaments
3. hamate rotate ulnarly and moves posteriorly into a closed pack position on the triquetral
4. triquetral compresses disc
5. capitate and Ts rotate ulnarly
84
What is significant about the orientation of the dorsal ans palmar radio carpal ligaments?
They run in an ulnar direction allowing the radius to pull the wrist along with both pronation and supination
wrist
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