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KIN: Wrist and Hand
| Question | Answer |
|---|---|
| Do you have more UD or RD and why? | UD because there is not as much stopping the ulna |
| Why is the wrist being a two-joint system a good thing? | Can withstand more pressure |
| What makes up the proximal part of the radiocarpal joint? | Radius Radioulnar disk TFCC |
| What makes up the distal part of the radiocarpal joint? | Scaphoid Lunate Triquetrium |
| T/F: The proximal radiocarpal joint is biconcave | True |
| What does the lateral radial facet articulate with? | Scaphoid |
| What does the medial radial facet articulate with? | Lunate and TFCC |
| How is the joint surface of the radiocarpal joint angled? Why? | Volarly and ulnarly because the radius is longer than the ulna |
| What does the inferior surface of the radiocarpal joint articulate with? | Triquetrium |
| What is the radioulnar disk? | TFC |
| What makes up the TFCC? | TFC Dorsal RU ligament Volar RU ligament UCL complex Meniscus homologue |
| What is the function of the TFCC? | Stabilize distal RUJ Cushion ulna on carpus Allow axial loading of ulnar aspect of forearm Increased articular surface for capus Stabilize ulnar side of carpus |
| What does the TFCC have attachments with? | ECU tendon Triquetrium Hamate Base of 5th MCP through UCL |
| What makes up the proximal row of carpals? | Scaphoid Lunate Triquetrium |
| What type of bone is the pisiform? | Sesmoid bone |
| What muscle does the pisiform increase the MA for? | FCU |
| Is the proximal row of carpals crossed by any muscles? How does it move? | No, movement is dependent on proximal and distal movements |
| Do we have great wrist flexion or extension | Flexion, but for the most part they are equal |
| What is ulnar negative variance? | Short ulna in comparison with the radius at their distal ends |
| What can ulnar negative variance be associated with? | Kienbock's disease |
| What is Kienbock's disease? | AVN of lunate |
| Is + ulnar variance associated with a thin or thick TFCC? - ulnar variance? | + ulnar variance = thinner TFCC - ulnar variance = thicker TFCC |
| What bones receive the majority of axial compression when a load is applied to the wrist? | Scaphoid and lunate |
| What makes up the proximal part of the midcarpal joint? | Scaphoid Lunate Triquetrium |
| What makes up the distal part of the midcarpal joint? | Trapezium Trapezoid Capitate Hamate |
| How do the bones of the midcarpal joint move? | As a fixed unit |
| Where are the extrinsic ligaments? | Connect the carpals to the radius or ulna proximally or to the metacarpals distally |
| Where are the intrinsic ligaments? | Innterconnect the carpals themselves |
| Which ligaments are more likely to fail: Extrinsic or Intrinsic? | Extrinsic |
| Which ligaments have a better potential for healing: extrinsic or intrinsic? Why? | Extrinsic due to vascularity |
| How do intrinsic ligaments get nutrition? | Synovial fluid |
| Why don't the intrinsic ligaments heal as well? | Because the blood gets diluted by the synovial fluid and it can't clot as well |
| What word tells us that ligaments are intrinsic rather than extrinsic? | Interosseous |
| Where is the pattern of convergence in the hand? | Middle |
| Are the volar (palmar) or dorsal ligaments thicker and stronger? Why? | Volar because we are more functional with wrist flexion |
| What ligaments form the V that helps stabilize the hand? | Dorsal intercarpal ligaments |
| What happens during ulnar deviation with regards to the double V system? | Passive tension rises diagonally across the wrist by the stretch placed in the lateral leg of the volar intercarpal ligament and fibers of the volar ulnocarpal ligament |
| What is the other V of the double V system? | Fibers of the volar ulnocarpal and volar radiocarpal ligaments |
| What happens during radial deviation with regards to the double V system? | Passive tension rises in the opposite diagonal across the wrist by the stretch placed in the medial leg of the volar intercarpal ligament and fibers of the volar radiocarpal ligament |
| What bone is the keystone of the wrist? Why? | Capitate because motion in both planes bisects this bone |
| What is considered the central column of the wrist joint? | Radius Capitate Base of the 3rd MC |
| What happens to the middle segment of the when compressive forces are applied and what bone does this affect? | Moves the scaphoid in the opposite directions of the segments above and below |
| Arthrokinematics of the movement of radiocarpal? | Convex on concave Roll and slide opposite |
| Arthrokinematics during wrist flexion? | Rolls palmarly Slides dorsally |
| Arthrokinematics during wrist extension? | Rolls dorsally Slides palmarly |
| Arthrokinematics during UD? | Rolls ulnarly Slides radially |
| Arthrokinematics during RD? | Rolls radially Slides ulnarly |
| What does full range of UD cause the triquetrium to contact? | Articular disc |
| What type of activity does the compression caused by UD help stabilize the wrist for? | Large gripping forces |
| Where does most RD occur? | Midcarpal joint |
| When is the wrist in a closed pack position? | Extension |
| When is the wrist in a loose pack position? | Flexion |
| What position allows the greatest force of IPJ? | UD |
| What position allows for the least force of IPJ? | Wrist flexion |
| What are the only muscles that do not pass under flexor retinaculum? | PL FCU |
| O of palmaris longus? | Medial epicondyle |
| N of FCR? | Median N |
| A of FCR? | Flexion RD |
| O of FCR? | Medial epicondyle |
| I of FCR? | Base of 2nd MC |
| N of FCU? | Ulnar N |
| O of FCU? | Medial epicondyle |
| I of FCU? | Pisiform |
| A of FCU? | Flexion UD |
| A of FDS? | Wrist flexion |
| I of FDS? | Middle phalanges of 4 fingers |
| O of FDS? | Medial epicondyle |
| A of FDP? | Wrist flexion |
| O of FDP? | 2/3 medial and anterior surface of ulna Interosseous membrane |
| A of FPL? | Flexion RD |
| O of FPL? | Middle half of anterior radius Interosseous membrane |
| I of FPL? | Thumb |
| What muscles have primary actions at the wrist? | PL FCR FCU |
| What muscles have primary actions at the digits and secondary actions at the wrist? | FDS FDP FPL |
| What is the purpose of both the flexor and extensor retinaculum? | Prevents bowstringing of the long flexor tendons |
| What is another name for the flexor retinaculum? | Transverse carpal ligament |
| When you grip, what other muscles besides your flexors are you using and why? | Your extensors to keep you from actually going into wrist flexion |
| Which muscle is able to exert the greatest tension of all the wrist muscles? | FCU |
| What muscles together make up the largest part of the dorsal wrist extensor mass? | ECRL ECRB |
| Which muscle is used more: ECRL or ECRB? | ECRB |
| I of ECRB? | 3rd MCP |
| I of ECRL? | 2nd MCP |
| How do you test for lateral epicondylitis? | Resisted wrist extension Resisted 3rd digit extension |
| A of extensor indicis? | 2nd MCP extension Wrist extension |
| O of ECU? | Lateral epicondyle Posterior border of ulna |
| A of ECU? | Extension UD Also active in wrist flexion |
| What position would make the ECU less effective as a wrist extensor? Why? | Pronation because the radius crosses over the ulna causing a reduction in MA of ECU |
| O of extensor digitorum? | Lateral epicondyle |
| What muscles does the extensor digitorum lie between? | ECRB ECU |
| What do the digitorum tendons have on them to help keep them functioning as a unit? | Intertendinous connections |
| What is the short extensor of the thumb? | EPB |
| A of EPB? | RD (minor) |
| I of EPB> | Base of proximal phalanx of thumb |
| What is the long extensor of the thumb? | APL |
| What tendon forms the anterior border of the anatomical snuffbox? | APL |
| Which muscles pass under the extensor retinaculum? | All 9 of them |
| T/F: Each tendon is incased within its own tendon sheath to prevent friction between tendons friction on retinaculum | True |
| How many bones are in the hand? | 19 |
| What is the distal carpal row also called? | Midcarpal joint |
| What are the articulations for the 2nd CMCJ? | Trapezoid Trapezium Capitate 3rd MC |
| What are the articulations for the 3rd CMCJ? | Capitate 2nd MC 4th MC |
| What are the articulations for the 4th CMCJ? | Capitate Hamate 3rd MC 5th MC |
| What are the articulations for the 5th CMCJ? | Hamate Ulnar side of 4th MC |
| What is the proximal transverse arch formed by? | Trapezoid Trapezium Capitate Hamate |
| What does the carpal tunnel contain? | Median nerve 9 flexor tendons Extrinsic finger and thumb flexors |
| What are the arches of the volar side of the hand? | Oblique palmar arch Longitudinal palmar arch |
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