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elbow wrist hand
elbow wrist hand kinesiology
249
Anatomy
Graduate
11/20/2011

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Term
what are the 4 joints of the elbow and forearm?
Definition
humeroulnar, humeroradial, proximal radioulnar, distal radioulnar
Term
what type of joints are humeroulnar and radial? How many dof?
Definition
hinge, 1 dof
Term
what type joints are prox/dist radioulnar? How many dof?
Definition
pivot, 1 dof
Term
is the elbow joint stable?
Definition
yes
Term
what are the roles of the elbow complex?
Definition
provide mobility for hand by adjusting arm length, assist shoulder in application of forces
Term
what is the true elbow joint?
Definition
humeroulnar
Term
why is the humeroulnar joint the true elbow joint?
Definition
this is where we get articulation
Term
what gives humeroulnar joint stability?
Definition
bony puzzle pieces that fit together: olecranon/olecranon fossa, coronoid process/coronoid fossa, trochlear notch/trochlea
Term
what gives humeroulnar joint mobility?
Definition
large surface area: trochlea spans 300 deg
Term
which trochlea projects further distally?
Definition
medial side of trochlea is more distal than lateral trochlea
Term
what is the poser elbow joint?
Definition
humeroradial
Term
what are the articulatoins of humeroradial?
Definition
head of radius, capitulum of humerus
Term
does the humeroradial joint provide bony stability to the elbow?
Definition
no
Term
what is the fovea of the radius?
Definition
concavity on radial head
Term
what does the humeroradial joint do?
Definition
provides a bony block to valgus motion at elbow
Term
what is carrying angle?
Definition
angle between midlines of humerus and forearm with elbow in extension
Term
what is the average carrying angle?
Definition
15 deg in valgus
Term
what is function of carrying angle
Definition
helps clear hand away from body; you can carry a load without it running into your thigh
Term
what causes cubital valgus?
Definition
medial side of trochlea is more distal than lateral trochlea.forearm lines up with slanted humerus
Term
what happens to forearm when you flex?
Definition
comes back more medial
Term
what joints are in the elbow capsule?
Definition
humeroulnar, humeroradial, proximal radioulnar
Term
describe elbow capsule
Definition
large, loose, weak
Term
what are the weakest parts of elbow capsule?
Definition
anterior/posterior
Term
what reinforces elbow capsule medial/laterally?
Definition
ligaments
Term
what are the ligaments of the elbow?
Definition
annular, medial/ulnar collateral ligament, lateral/radial collateral ligament
Term
why is the elbow capsule weak ant/post?
Definition
flexion/extension
Term
what does the MCL do?
Definition
resist valgus force
Term
when is the MCL taut
Definition
full extension
Term
what are the 3 parts of the medial collateral ligament?
Definition
anterior, posterior transverse
Term
anterior part of MCL
Definition
primary restraint to valgus stress
Term
posterior part of MCL
Definition
weak restraint to valgus stress
Term
transverse MCL
Definition
assists with restraint to valgus stress
Term
when is valgus force greatest?
Definition
neutral supination pronation (like pitching)
Term
when does MCL work the hardest?
Definition
neutral supination pronation (like pitching)
Term
does MCL work more in extension or in flexion?
Definition
flexion
Term
when is the anterior bundle of MCL tightest?
Definition
extension
Term
when is the posterior bundle of MCL tightest?
Definition
flexion
Term
besides MCL, what else helps restrain valgus?
Definition
portions of capsule + bony contact between radius and humerus
Term
function of LCL
Definition
resist varus force, assist with resisting distraction, supports annular ligament, helps restrain excessive supination
Term
what does annular ligament do?
Definition
resists distraction
Term
what is nursemaid's elbow
Definition
radius comes out of annular ligament
Term
what is close packed elbow position?
Definition
extension, supination
Term
loose packed elbow position
Definition
70 deg flexion, 10 deg supination
Term
where is elbow most stable
Definition
end ranges
Term
where are ligaments and bony structures best at resisting varus?
Definition
extension
Term
what provides resistance to distraction?
Definition
LCL, MCL, annular L
Term
what is most unstable position of elbow
Definition
midrange flexoin
Term
arthrokinematics of elbow in flexion
Definition
concave ulna rolls and slides anteriorly on convex humerus
Term
arthrokinematics of elbow in extension
Definition
concave ulna rolls and slides posteriorly on convex humerus
Term
arthrokinematics of pushup at humeroulnar joint
Definition
convex on concave: humerus rolls and glides in opposite directions
Term
what are the primary flexors of the elbow?
Definition
biceps, brachialis
Term
what is the secondary flexor of the forearm and when does it work best?
Definition
brachioradialis, in mid position
Term
what are the elbow extensor muscles?
Definition
triceps, anconeus
Term
how does triceps act as synergist in forceful supination?
Definition
prevents biceps from flexing elbow as it supinates
Term
what is the proximal radioulnar joint?
Definition
head of radius fits into radial notch of ulna
Term
what type of joint is proximal radioulnar, how many dof
Definition
pivot, 1 dof
Term
what ligament stabilizes proximal radioulnar joint and guides accessory motion?
Definition
annular ligament
Term
what are the articulations of distal radioulnar?
Definition
ulnar notch, articular disc, head of ulna
Term
where is compression through forearm initially loaded
Definition
radius
Term
how is force from radius transmitted to ulna
Definition
through interosseous membrane
Term
where is the higher load of force in proximal forearm?
Definition
ulna
Term
total rom of pronation/supinatoin
Definition
160 deg
Term
what is the functional ROM of supination/pronation
Definition
50 deg in either direction
Term
why is supination/pronation assessed with elbow flexed to 90 deg
Definition
avoid internal/external rotation from shoulder
Term
at radioulnar joints, is radius convex or concave?
Definition
concave
Term
arthrokinematics of supination
Definition
concave radius rolls and glides posteriorly on convex ulna
Term
arthrokinematics of pronation
Definition
concave radius rolls and glides superiorly on convex ulna
Term
arthrokinematics of pronation in terms of ulna
Definition
convex ulna rolls anteriorly and slides posteriorly on concave radius
Term
arthrokinematics of supination in terms of ulna
Definition
convex ulna rolls posteriorly and slides anteriorly on concave radius
Term
what 2 muscles pronate?
Definition
pronator teres, pronator quadratus
Term
how does pronator teres affect superior radioulnar joint?
Definition
pronator teres compresses superior radioulnar joint
Term
how does pronator quadratus affect distal radioulnar joint?
Definition
pronator quadratus helps maintain stability on distal radioulnar joint through compression
Term
where is biceps brachii most effective at supination
Definition
90 deg of flexion
Term
what other muscles provides supination at all positions of elbow or forearm?
Definition
supinator
Term
what is tennis elbow?
Definition
lateral epicondylitis
Term
what is pitchers elbow?
Definition
medial epicondylitis
Term
what also looks like lateral epicondylitis with lateral forearm pain?
Definition
radial nerve entrapment/radial tunnel syndrome
Term
what is ulnar nerve entrapment called?
Definition
cubital tunnel syndrome
Term
wrist functions
Definition
optimize length-tension relationships of external finger flexors/extensors; help manipulate location of hand/fingers
Term
what are the 3 joints of the wrist?
Definition
radiocarpal, midcarpal, carpometacarpal
Term
how is the radius angled in the frontal plane?
Definition
25 deg towards ulna?
Term
how is radius angled in sagittal plane?
Definition
10 deg towards palm
Term
what is the shape of the radius medial-laterally and anterior-posteriorly?
Definition
concave
Term
what fills the space between distal radius and ulna?
Definition
fibrocartilaginous disc: triangular fibrocartilage complex
Term
which bone makes most contact with carpal bones?
Definition
radius
Term
what does the radius's angle towards ulna mean?
Definition
more ulnar deviation than radial deviation
Term
what does radius's angle towards palm mean?
Definition
more flexion than extension
Term
functions of triangular fibrocartilage complex
Definition
extension of distal radius, articulates with triquetrum, receivs about 20% of axial load
Term
order of carpal bones?
Definition
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
Term
describe structure of triangular fibrocartilage complex
Definition
radioulnar disc, dorsal and palmar radioulnar ligaments, ties into sheath around extensor carpi ulnaris tendon
Term
describe radioulnar disc that is part of triangular fibrocartilage complex
Definition
fibrocartilaginous extension of the articular cartilage from the radius
Term
is scaphoid medial or lateral?
Definition
lateral
Term
is trapezium lateral or medial?
Definition
lateral
Term
60% of all carpal fractures are to what bone?
Definition
scaphoid
Term
what causes scaphoid fractures?
Definition
forceful hyperextension of wrist
Term
what is a factor in scaphoid healing
Definition
blood supply
Term
how are proximal or distal scaphoid fractures treated?
Definition
surgical pinning
Term
where is there more vascularization of scaphoid?
Definition
on thumb side (laterally) than on wrist side (medially)
Term
what do extrinsic wrist ligaments do?
Definition
connect carpals to radius/ulna or metacarpals
Term
do palmar or dorsal wrist ligaments provide more stability?
Definition
palmar
Term
do you bear weight in wrist flexion or extension
Definition
flexoin
Term
what are the palmar wrist ligaments
Definition
radial collateral, ulnar collateral, palmar radiocarpal
Term
what is the dorsal wrist ligament?
Definition
dorsal radiocarpal
Term
what do intrinsic wrist ligaments do?
Definition
go carpal to carpal
Term
what does volar mean?
Definition
palmar
Term
what are palmar surface intrinsic wrist ligaments?
Definition
transverse carpal, lunotriquetral, scapholunate
Term
what are dorsal surface intrinsic wrist ligaments?
Definition
dorsal intercarpal
Term
what causes carpal instability?
Definition
trauma to ligaments
Term
what are 2 common types of carpal instability?
Definition
translocation of the carpus, rotational collapse
Term
what happens in translocation of the carpus?
Definition
carpals shift over
Term
example of translocation
Definition
Rheumatoid Arthritis: ulnar drift
Term
what causes rotational collapse?
Definition
trauma/foosh
Term
in rotational collapse, what does scaphoid want to do?
Definition
go into flexion
Term
what direction does lunate naturally want to go into?
Definition
extension
Term
if the connection between scaphoid and lunate is ruptured in rotational collapse, what happens?
Definition
scaphoid flexes and lunate extends (lunate goes to dorsal side = dorsal intercalated segment instability = DISI)
Term
if lunate and scaphoid stay connected, what happens during rotational collapse?
Definition
volar intercalated segment instability = VISI; lunate goes to palmar side
Term
primary extrinsic extensors
Definition
extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris
Term
secondary extrinsic extensors
Definition
extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus
Term
what are the primary extrinsic flexors of the wrist?
Definition
flexor carpi radialis, flexor carpi ulnaris, palmaris longus
Term
what are the secondary extrinsic flexors of the wrist?
Definition
flexor digitorum profundus and superficialis, flexor pollicis longus
Term
what goes through the carpal tunnel?
Definition
4 FDP, 4 FDS, Flexor pollicis longus, flexor carpi radialis, median nerve
Term
what is the distribution of the median nerve?
Definition
lateral 3.5 digits
Term
what type of joint is the wrist?
Definition
ellipsoid
Term
how many dof in an ellipsoid joint?
Definition
2
Term
osteokinematics of wrist joint
Definition
flex/ext, rd/ud
Term
where does motion occur in wrist joint?
Definition
radiocarpal joint, midcarpal joint, minimal motion at carpo-metacarpal joint
Term
where is axis of rotation of wrist?
Definition
capitate
Term
is the proximal row of carpals convex or concave at the radiocarpal joint?
Definition
convex
Term
is the radius convex or concave at the radiocarpal joint?
Definition
concave
Term
describe the arthrokinematics of extension at the radiocarpal joint
Definition
convex carpals roll dorsally, slide palmarly
Term
describe what the radius does at the radiocarpal joint in extension
Definition
concave radius slides dorsally
Term
are the distal carpals convex or concave at the midcarpal joint?
Definition
convex
Term
are the proximal carpals convex or concave at the mid-carpal joint?
Definition
concave
Term
what are the arthrokinematics of extension at the midcarpal joint?
Definition
convex distal carpals roll dorsally, slide palmarly
Term
what are the arthrokinematics of extension at the midcarpal joint in terms of proximal row?
Definition
concave proximal carpals slide dorsally
Term
where is close packed position for radiocarpal and midcarpal joints?
Definition
full extension
Term
arthrokinematics of flexion at radiocarpal joint
Definition
convex carpals roll palmarly, slide dorsally
Term
arthrokinematics of flexion at radiocarpal joint in terms of radius
Definition
radius slides palmarly
Term
arthrokinematics of flexion at midcarpal joint
Definition
convex distal carpals roll palmarly, slide dorsally
Term
arthrokinematics of flexion at midcarpal joint in terms of proximal caprals
Definition
concave proximal carpals slide palmarly
Term
in arthrokinematics, are rolls or slides the same for concave and convex?
Definition
rolls are the same direction; slides are opposite
Term
is wrist more stable in flexion or extension?
Definition
extension
Term
do we get more midcarpal joint movement in flexion or extension?
Definition
flexion
Term
do we get more radiocarpal joint movement in flexion or in extension?
Definition
extension
Term
arthrokinematics of radial deviation at radiocarpal joint?
Definition
carpals roll radially, glide ulnarly
Term
arthokinematics of radial deviation at midcarpal joint
Definition
distal carpals roll radially, glide ulnarly
Term
what limits radial deviation?
Definition
radial styloid process
Term
arthrokinematics of ulnar deviation at radioulnar joint
Definition
carpals roll ulnarly, glide radially
Term
arthrokinematics of ulnar deviation at midcarpal joint
Definition
distal carpals roll ulnarly, glide radially
Term
what do muscles on anterior side of hand do?
Definition
flex
Term
what do muscles on posterior side of hand do?
Definition
extend
Term
what do muscles on lateral side of hand do?
Definition
radially deviate
Term
what do muscles on medial side of hand do?
Definition
ulnar deviation
Term
what causes Colles fracture
Definition
FOOSH
Term
what breaks in colles fracture
Definition
distal radius, usually displaces dorsally
Term
what are the joints of the hand
Definition
carpometacarpal, metacapalphalangeal, interphalangeal
Term
shape of metacarpals/phalanges
Definition
proximal concave base, shaft distal convex head
Term
what kind of joints are carpo-metacarpal joints? Dof?
Definition
hinge, 1 dof
Term
what are the movements of carpometacarpal joints?
Definition
flex/ext if anything, some abd/add in 5th CMC
Term
which 2 CMC joints have no movement?
Definition
2nd, 3rd
Term
what does mobility of 4th, 5th CMC do?
Definition
assist in grip
Term
where are there ligaments in the CMC joints?
Definition
between bases of metacarpals and between base of metacarpals and distal carpals
Term
are the CMC ligaments stronger on palmar or dorsal side?
Definition
palmar
Term
what is the proximal transverse arch?
Definition
arch of the base of the metacarpals
Term
what is the distal transverse arch
Definition
arch of the heads of the metacarpals
Term
what is the longitudinal arch?
Definition
arch that centers at midline of hand
Term
what kinds of joints are metacarpal-phalangeal joints?
Definition
condyloid
Term
how many dof in MCP joints?
Definition
2
Term
how does base of phalanx comare to head of metacarpal?
Definition
base of phalanx is smaller than head of metacarpal
Term
which MCP has the most ROM?
Definition
5th
Term
which MCP has the least ROM?
Definition
2nd
Term
what is close packed MCP?
Definition
70-90 deg flexion
Term
where is volar plate?
Definition
anterior to MCP joint
Term
function of volar plate
Definition
increase joint congruence and articular surface, resist hyperextension, prevent "pinching" of flexor tendons
Term
what are the ligaments of the MCP?
Definition
collateral ligaments
Term
when are MCP collateral ligaments taut?
Definition
in flexion
Term
how is MCP immobilized and why?
Definition
60-70 deg flexion to prevent shortening of collateral ligaments
Term
at MCP, is metacarpal head convex or concave?
Definition
convex
Term
at MCP, is proximal phalanx convex or concave?
Definition
concave
Term
in fingers, how does distal part move on proximal part?
Definition
concave distal phalanx rolls/slides in same direction on convex proximal phalanx or convex metacarpal head
Term
what type of joints are interphalangeal joints?
Definition
hinge, 1 dof
Term
how are IP joints similar to MCP joints?
Definition
volar plates, collateral ligaments, concave moves on convex
Term
what is the concern in immobilizing IP joints?
Definition
finger flexor tendons; immobilize in extension
Term
what is coupled motion of DIP and PIP joints?
Definition
hard to flex one without flexing the other
Term
what are the extrinsic finger flexors?
Definition
flexor digitorum profundus and superficialis
Term
what does flexior digitorum superficialis flex?
Definition
wrist, MCP, PIP
Term
what does FDP flex?
Definition
wrist, MCP, PIP, DIP
Term
are extrinsic flexors or extensors stronger?
Definition
flexors
Term
how many annular pulleys on each finger?
Definition
5
Term
which annular pulleys are most important?
Definition
2, 4
Term
how many cruciate pulleys on each finger?
Definition
3
Term
what reduces friction of finger flexors?
Definition
bursa at flexor retinaculum, digitil tendon sheaths
Term
what happens if you have bowstringing in finger?
Definition
can't go through full ROM
Term
what are the extrinsic finger extensors?
Definition
extensor digitorum, extensor indicis, extensor digiti minimi
Term
what do intrinsic muscles of hand insert into?
Definition
extensor hood
Term
action of lumbricals
Definition
extend IP joints, assist with MCP flexion
Term
action of palmar interosseous
Definition
adduct fingers, flex MCP joints, extend IP joints
Term
action of dorsal interossei
Definition
abduct fingers, flex MCP, extend IP
Term
what happens to fully extend fingers?
Definition
intrinsics flex MCP, extend IP. Extrinsic extensors extend MCP.
Term
what happens in closing hand
Definition
intrinsics flex MCP, extend IP. Extrinsic flexors flex IP
Term
where is grip strength strongest and why?
Definition
slight extension: reduce active insufficiency of flexors
Term
what is tenodesis grip?
Definition
a person with quadriplegia who has C6 working will have wrist extension with extensor carpi radialis longus. When your wrist is extended, your fingers close. They can close hand around something by extending wrist
Term
what kind of joint is the carpometacarpal joint of the thumb?
Definition
saddle, 2dof
Term
what are the movements of the thumb's CMC joint?
Definition
flex/ext + abd/add = opposition/reposition
Term
what movements combine to opposition?
Definition
flexion, adduction
Term
what movements combine to reposition?
Definition
extension, abduction
Term
what is the CMC joint of the thumb?
Definition
trapezium and base of 1st metacarpal
Term
when is the trapezium convex?
Definition
flexion/extension
Term
when is the trapezium concave?
Definition
abduction/adduction
Term
when is the base of 1st metacarpal convex?
Definition
abduction/adduction
Term
when is the base of 1st metacarpal concave?
Definition
flexion/extension
Term
where is the CMC joint of thumb open packed?
Definition
midway between flex/ext and abd/add
Term
where is cmc of thumb close packed?
Definition
full abd or add
Term
arthrokinematics of flex/ext at CMC thumb
Definition
concave on convex
Term
arthrokinematics of cmc thumb in abd/add
Definition
convex on concave
Term
arthrokinematics of all joints in fingers except cmc thumb in abd/add
Definition
concave on convex
Term
arthrokinematics of exension at CMC thumb
Definition
concave 1st met rolls and slides laterally
Term
arthrokinematics of cmc thumb in abduction
Definition
convex 1st met rolls and slides in opposite directions
Term
is the CMC thumb susceptible to OA
Definition
yes
Term
how many pounds of compression at CMC for each pound of pinch?
Definition
0.42
Term
what kind of joint is MCP joint of thumb?
Definition
condyloid
Term
how many dof of MCP thumb?
Definition
1: flex/ext
Term
arthrokinematics of IP, MCP joints of thumb:
Definition
concave on convex, roll and slide in same direction
Term
extrinsic thumb muscles
Definition
flexor pollicis longus, extensor pollicis longus, extensor pollicis brevis, abductor pollicis longus
Term
intrinsic thumb muscles in the thenar eminence
Definition
abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, 1st palmar interossei, adductor pollicis
Term
what things are in anatomical snuffbox?
Definition
radial artery, radial nerve, scaphoid
Term
best position for wrist in hand immobilization
Definition
wrist 20-30 deg ext, slight ulnar deviation. If we flex/extend too far, we'll have shortening
Term
best position for MCP in hand immobilization
Definition
flex so that we don't lose ROM of collateral ligaments, which stretch in flexion
Term
best position of IP in immobilization
Definition
straight to prevent shortening of extrinsic flexors
Term
what is sacrificed by immobilizing hand with flexed MCP and extended IP
Definition
intrinsic muscles
Term
what is best position for thumb in hand immobilization
Definition
open packed: 45 deg abduction
Term
what is power grip?
Definition
full hand
Term
what is holding a cell hone
Definition
cylindrical grip
Term
what is carrying a suit case
Definition
hook grip
Term
what is holding a ball
Definition
spherical grip
Term
what is holding a cigarette
Definition
lateral prehension
Term
what is precision handling
Definition
fine motor control
Term
what is holding tweezers
Definition
pad to pad prehension
Term
what is hlding a pencil
Definition
tip to tip prehension
Term
what is holding a key?
Definition
pad to side prehension
Term
what causes swan neck deformity
Definition
volar plate disruption at PIP: lateral bands sublux dorsally, increasing moment arm of the intrinsics to extend PIP
Term
what is the joint position of swan neck deformit
Definition
PIP extension, DIP flexion
Term
how is swan neck deformity treated
Definition
splinting, surgery
Term
what happens in boutonniere deformity
Definition
central band ruptures, lateral band slip to palmar side of PIP
Term
joint position in boutonniere deformity
Definition
PIP flexed, DIP hyper extended
Term
how is boutonniere deformity fixed
Definition
splinting, surgery
Term
what are zig zag deformities?
Definition
swan neck in one finger, boutonniere in the next
Term
what is mallet finger
Definition
unable to extend DIP bc terminal band ruptures
Term
what is the mechanism of injury for mallet finger?
Definition
forced DIP flexion, laceration, compression
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