OTD 509 Quiz 4

proximal and distal radioulnar joints

synovial, pivot, uniaxial

Elbow landmarks

medial epi, lateral epi,, olecronon

male vs female elbow

males 5-10 degrees

females are 10-15 because of hips

supination

supinator

bicep brachii

pronation

pronator teres

pronator quadatrus

Common Pathologies of the elbow

lateral epicondylitis= tennis elbow

medial/ ulnar epicondylitis= golfers elbow

elbow dislocation

Elbow Extension

triceps

elbow flexion

brachialis

bicep brachii

brachioradialis

Proximal row of bones

Scaphoid, lunate, triquetrum, pisiform

Distal row

Trapezium, trapezoid, capitate, hamate

Scaphoid bone

Biggest of the proximal, most commonly fractured, floor on snuffbox

Lunate

Most frequently dislocated bone in the wrist

Triquetrum

3rd most fractured bone

Capitate

Largest carpal bone in the distal carpal row

Hamate

Has a hook of hamate

Metacarpals

Between the carpals and phalanges, each has a head, beck body and base

Radiocarpal

Wrist joint, between the radius and the proximal row of carpal bones.

Condyloid joint, concave on convex joint type

Mid carpal

Between the proximal and distal row of carpals

Intercarpal joints

Between adjacent carpal bones

Non axial plane

Arthrokinematic glide

Carpometacarpal joint

Joint between the carpal and the metacarpals

Articular disk

Disk between the ulnar head and the proximal row Separate ulna to wrist

flexion and extension of the wrist

Flexion= 80

Extension= 70

Flexion is greater and extension is less because radius head gets in the way for extension

ulnar and radial deviation

Ulnar= 30

Radial= 20

Ulnar is greater and radial is less because radius head gets in the way

Joint capsule

Entire structure of ligaments that protects the wrist

Reinforces

Radial collateral ligament

Reinforces lateral aspect of capsule

Limits ulnar deviation

Ulnar collateral ligament

Reinforces medial aspect of capsule

Limits radial deviation

Palmar radiocarpal ligament

Limits wrist extension

On the palm

Dorsal radiocarpal ligament

Reinforces posterior aspect of the capsule

Limits wrist flexion

Flexor and extensor retinaculum

Bands of connective tissue that protect and don't allow mobility

Keeps everything in place holds tendons and nerves in place

Palmar aponeurosis

Thick connective tissue

Keeps palm intact

Wrist flexion

FCR, FCU

Flexor carpi radialis

- Origin: Medial epicondyle

- Insertion: Base of the 2nd and 3rd metacarpals

- Action: WF and RD

- Nerve: Median C6 and C7

palmaris longus

- Origin: medial epicondyle

- Insertion: palmar aponeurosis

- Action: WF

- Nerve: median C6 and C7

Flexor carpi ulnaris

- Origin: medial epicondyle

- Insertion: pisiform and 5th metacarpal

- Action: WF and UD

- Nerve: Ulnar C8 and T1

wrist extension

ECRL/B, ECU and EDC

Extensor carpi radialis longus

- Origin: lateral supracondylar

- Insertion: 2nd metacarpal dorsal side

- Action: WE and RD

- Nerve: radial C6 and C7

Extensor carpi radialis brevis

- Origin: lateral epicondyle

- Insertion: 3rd metacarpal

- Action: WE

- Nerve: radial C6 and C7

Extensor carpi ulnaris

- Origin: lateral epicondyle

- Insertion: 5th metacarpal

- Action: WE and UD

- Nerve: radial C6 and C7

Radial deviation

FCR, ECRL

ulnar deviation

FCU and ECU

Common pathologies of wrist

- Colles, Smyths, greenstick and scaphoid fracture

- Ganglion cyst

- sprains

bones in the hand

5 metacarpals

4 middle phalanges

5 distal phalanges

joint in the hand

DIP, PIP. IP, MP, Thumb CMC

DIP distal interphalangeal

4 in the hand (digits 2-5)

ROM flexion= 90*

Extension= 0*

PIP proximal interphalangeal

4 in the hand (digits 2-5)

ROM flexion 100*

extension 0*

IP interphalangeal

1 in the thumb

4 DIP and 4 PIP

uniaxial (flex/ext)

ROM extension for all 0*

MP metacarpal phalangeal

5 (digits 1-5)

synovial/ biaxial

flex/ext and abd/add

Thumb CMC carpometacarpal

synovial/biaxial

motions: flex/ext, abd/add and opposition

ROM flexion 15 extension 20

ROM abd 70 and add 0

Ligaments of the hand

ulnar collateral ligament, radial collateral ligament

Ulnar collateral ligament in the hand

Prevents excessive RD of the joint

IP and MP joint

Radial collateral ligament in the hand

Prevents excessive UD of the joint

IP and MP joints

Dorsal/ Extension of fingers

EDC, EDM,EI,

Extensor digitorium communis (EDC)

-- O: lateral epicondyle

- I: middle phalanges of digits 2-5

- A: extends 2-5 to the DIP, wrist extension

- N: Radial

Extensor digit minimi (EDM)

- O: lateral epicondyle

- I: base of the 5th proximal phalanx

- A: extends the 5th digit

- N: radial

Extensor indicis (EI)

- O: Ulna

- I: 2nd proximal phalanx into ED of the index finger

- A: 2nd digit extension at MP and IP's

extrinsic/flexion of fingers

FDS, FDP, lumbricals

secondary: FDM

Flexor digitorum superficialis (FDS)

- O: medial epicondyle and coracoid process

- I: middle phalanges 2-5, splits at PIP and stops at medial and lateral PIP

- A: flexes the PIP digits 2-5

- N: median

Flexor digitorum profundus (FDP)

- O: anteromedial surface of the proximal ulna

- I: splits into 4 and inserts on the bases of phalanges 2-5, goes under the FDS

- A: flexes DIP digits 2-5

- N: median 2 and 3 ulnar 4 and 5

Lumbricals

- O: central hand from tendons of FDP

- I: dorsal expansion of 2-5 from PIP

- A: flexes the MP joints and extends the PIP and DIP

- N: 2/3 median, 4/5 ulnar

Flexor digiti minimi (FDM)

- O: hypothenar eminence

- A: FDM= flexes the small finger

- N: ulnar

Finger ADD

Palmar interossei (PAD)

Palmar interossei (PAD)

- O: between 2nd and 3rd, 3rd and 4th and 4th and 5th metacarpals and proximal phalanges

- I: base of phalanges 2,4 and 5

- A: Adducts digit 2,4 and 5 N:ulnar

Finger ABD

ABD DM

Dorsal interossei (DAB)

Abductor digiti mini

Abductor digiti mini

- O: hypothenar eminence

- A: abductor digiti minimi= abducts the small finger

- N: ulnar

Dorsal interossei (DAB)

- O: adjacent MC's

- A: abduction of 2-4 N: Ulnar

thumb flexion

FPL

secondary (FPB)

flexor pollicis longus (FPL)

- O: A radius and interosseous membrane

- I: base of the 1st distal phalanx, palmar side

- A: Flexion of thumb at CMC, MP, IP

- N: median

Flexor pollicis brevis (FBP)

- A: flexion of the MP of the thumb

- N: median nerve

thumb extension

EPB, EPL

secondary ABD PL

Abductor pollicis longus (APL)

- O: middle 1/3 of posterior surface of radius and ulna and base of the 1st metacarpal

- I: base of the 1st MC (dorsal)

- A: extends the 1st CMC

- N: radial

Extensor pollicis brevis (EPB)

- O: distal 1/3 of posterior surface of radius

- I: base of the thumb

- A: extends the thumb at the CMC and MCP

- N: radial

Extensor pollicis longus (EPL)

- O: Middle 1/3 of the posterior surface of ulna

- I: base of the thumb

- A: extends the thumb at the CMC, MP and IP N:Radial

Thumb ADD

ADD pollicis

- O: 3rd MC

- I: base of the thumb

- A: ADD of the thumb MP

- N: ulnar nerve

Thumb ABD

Abductor pollicis longus (APL)

Abductor pollicis brevis (APB)

Abductor pollicis longus (APL)

- O: middle 1/3 of posterior surface of radius and ulna and base of the 1st metacarpal

- I: base of the 1st MC (dorsal)

- A: ABD 1st MC

- N: radial

extrinsic primary finger flexors

Digits 2-5 FDS and FDP

lumbricales

FPL

Digits 2-5 FDS= Flexor digitorum superficialis (FDS)

- O: medial epicondyle and coracoid process

- I: middle phalanges 2-5, splits at PIP and stops at medial and lateral PIP

- A: flexes the PIP digits 2-5

- N: median

Digits 2-5 FDP = Flexor digitorum profundus (FDP)

- O: anteromedial surface of the proximal ulna

- I: splits into 4 and inserts on the bases of phalanges 2-5, goes under the FDS

- A: flexes DIP digits 2-5

- N: median 2 and 3 ulnar 4 and 5

Lumbricales (MP's)

- O: central hand from tendons of FDP

- I: dorsal expansion of 2-5 from PIP

- A: flexes the MP joints

- N: 2/3 median, 4/5 ulnar

Flexor pollicis longus (FPL)

- O: A radius and interosseous membrane

- I: base of the 1st distal phalanx, palmar side

- A: Flexion of thumb at CMC, MP, IP

- N: median

Intrinsic muscles of the hand

Thenar eminence, add pb, hyopthenar, finger intrinsics, interossei, lumbricals

Intrinsic thenar

thenar= thumb

OP, ABD FPB

Opposition

abduction

flexion

all come from the median nerve

Intrinsic hypothenar

hypo= pinky

OP, ABD FPB

Opposition

abduction

flexion

all come from the ulnarnerve

ADD PB

- O: 3rd MC

- I: base of the thumb

- A: ADD of the thumb MP

- N: ulnar nerve

Instisics- Lumbricals

- O: central hand from tendons of FDP

- I: dorsal expansion of 2-5 from PIP

- A: flexes the MP joints and extends the PIP and DIP

- N: 2/3 median, 4/5 ulnar

Intrinsic plus

- + Tabletop

- MP= 70-80 flexed

- IP=0 extension

- Safe position for splinting with the wrist slightly flexed

Intrinsic minus

- (--) hook

- MP= extension

- IP= Flexion

Palmar interossei

- O: between 2nd and 3rd, 3rd and 4th and 4th and 5th metacarpals and proximal phalanges

- I: base of phalanges 2,4 and 5

- A: Adducts digit 2,4 and 5

N: ulnar

Dosal interossei

- O: adjacent MC's

- I: sides of the PIP joint

- A: flexes the MP joints

- A: extends the PIP and DIP joint

- A: abduction

N: ulnar

carpal tunnel components

- Dorsal border= carpal bones

- Volar border= transverse carpal ligament

- Nerve= median

The sheath of carpal tunnel

- Inside FDS x4 and FDP x4

- Outside= FPL and median nerve