Midterm Review - UE

Extension Plane — Wrist

Sagittal

Extension Axis — Wrist

ML

Extension ROM — Wrist

60*-75*

Close-packed position — Wrist

Full extension

Extension Arthokinematics — Radiocarpal joint

Convex lunate rolls dorsally and slides palmarly on concave radius

Extension Arthokinematics — Midcarpal joint

Capitate head rolls dorsally and slides palmarly

Extension Motion limiting CT — Wrist

Palmar radiocarpal ligament, wrist/finger flexors passively

Flexion ROM — Wrist

70*-85*

Flexion Arthokinematics — Radiocarpal Joint

Lunate rolls palmarly and glides dorsally

Flexion Arthokinematics — Midcarpal Toint

Capitate rolls palmarly and glides dorsally

Flexion motion limiting CT — Wrist

Dorsal radiocarpal ligament, wrist/finger extensors passively

Ulnar Deviation Plane — Wrist

Fontral

Ulnar Deviation Axis — Wrist

AP

Ulnar Deviation ROM — Wrist

35*-40*

Ulnar Deviation Arthokinematics — Radiocarpal Joint

Scaphoid rolls ulnarly and slides radially

Ulnar Deviation Arthokinematics — Midcarpal Joint

Capitate head rolls ulnarly and glides radially

Ulnar Deviation motion limiting CT — Wrist

Palmar intercarpal ligament, palmar ulnarcarpal ligament, radial collateral ligament, abductor pollicis longus, extensor pollicis brevis

Radial Deviation ROM — Wrist

15*-20*

Radial Deviation Arthokinematics — Radiocarpal Joint

Scaphoid roll radially and glide ulnarly

Radial Deviation Arthokinematics — Midcarpal Joint

Capitate rolls radially and glides ulnarly

Radial Deviation motion limiting CT — Wrist

Palmar intercarpal ligament, palmar radiocarpal ligament, ulnar collateral ligament, FCU and ECU

Rotational collapse of wrist; most often dislocated at…

Lunate

Arthrodesis (Fusion) after ulnar translocation of carpals…

Often fused at 10*-15* extension and 10* ulnar deviation

How many carpal bones in hand?

8

How many metacarpal bones in hand?

5

How many proximal phalanges in hand?

5

How many middle phalanges in hand?

4

How many distal phalanges in hand?

5

Proximal transverse arch is…

Keystone of arch, capitate provides central stability

Distal transverse arch is…

2nd and 3rd are the more stable central metacarpals

Longitudinal arch is…

Mobile distal end allows for finger mobility

CMC allows for mobility especially in which digits?

1st, 4th, 5th digits

Joint type — CMC joint

Saddle

Degrees of Freedom — CMC joint

2

Ligament role — CMC

Control the extent and direction of joint movement, maintain joint alignment, increase joint stability, dissipate forces produced by activated muscles

Abduction and Adduction Plane — Thumb CMC joint

Sagittal

Abduction and Adduction Axis — Thumb CMC joint

ML

Abduction ROM — Thumb CMC Joint

45*

Abduction Arthokinematics — Thumb CMC joint

Convex MC rolls palmarly and slides dorsally on concave trapezium

Abduction motion limiting CT — Thumb CMC joint

Most CMC ligaments, adductor pollicis muscle

Adduction ROM — Thumb CMC joint

Returns to neutral resting position

Adduction Arthokinematics — Thumb CMC joint

Convex MC rolls dorsally and slides palmarly on concave trapezium

Flexion and Extension Plane — Thumb CMC joint

Frontal

Flexion and Extension Axis — Thumb CMC joint

AP

Flexion ROM — Thumb CMC joint

45*-50*

Flexion Arthokinematics — Thumb CMC joint

Concave MC rolls and slides ulnarly on convex trapezium

Flexion motion limiting CT — Thumb CMC joint

Radial collateral ligament, dorsal capsule, EPB, APB

Extension ROM — Thumb CMC joint

10*-15*

Extension Arthokinematics — Thumb CMC joint

Concave MC rolls and slides radially on convex trapezium

Extension motion limiting CT — Thumb CMC joint

Anterior oblique ligament, ulnar collateral ligament, anterior capsule, FPB, OP, 1st dorsal interossei

Phases of Opposition — Thumb CMC joint

Phase 1: abduction

Phase 2: flexion and medial rotation

Close packed position — Thumb CMC joint

Full opposition

Joint type — MCP joint

Condyloid joints

Degrees of Freedom — MCP joint

2

Ligament Roles — MCP joint

Mechanical stability at the MCP joint is critical to the biomechanics and the architectural stability of hand

Flexion and Extension Plane — MCP joint

Sagittal

Flexion and Extension Axis — MCP joint

ML

Flexion ROM — MCP joint

90* (2nd) to 100*-115* (5th)

Flexion Arthokinematics — MCP joint

Concave phalanx rolls and slides palmarly on convex metacarpal

Flexion motion limiting CT — MCP joint

Dorsal capsule, collateral, extensor digitorum

Close packed position — MCP joint

Full flexion

Extension ROM — MCP joint

30*-45*

Extension Arthokinematics — MCP joint

Concave phalanx rolls and slides dorsally on convex metacarpal

Extension motion limiting CT — MCP joint

Palmar capsule, palmar plate

Abduction and adduction Plane — MCP joint

Frontal

Abduction and adduction Axis — MCP joint

AP

Abduction ROM — MCP joint

20*

Abduction Arthokinematics — MCP joint

Concave MC rolls and slides in the same direction on convex trapezium

Abduction motion limiting CT — MCP joint

Collateral ligaments, fascia of web space between fingers

Adduction Arthrokinematics — MCP joint

Concave MC rolls and slides in the same direction on convex trapezium

Joint Type — Thumb MCP joint

Condyloid joint

Degrees of Freedom — Thumb MCP joint

1

Flexion and Extension Plane — Thumb MCP joint

Frontal

Flexion and Extension Axis — Thumb MCP joint

AP

Flexion ROM — Thumb MCP joint

60*

Flexion Arthrokinematics — Thumb MCP joint

Concave phalanx rolls and slides ulnarly on convex 1st metacarpal

Extension ROM — Thumb MCP joint

Few degrees

Extension Arthrokinematics — Thumb MCP joint

Concave phalanx rolls and slides radially on convex 1st metacarpal

Joint Type — IP joint

Hinge joint

Degrees of Freedom — IP joint

1

Flexion and Extension Plane — IP joint

Sagittal

Flexion and Extension Axis — IP joint

ML

Flexion ROM — IP joint

90* (2nd) to 110*-115* (5th)

Flexion Arthrokinematics — IP joint

Concave surface rolls and slides palmarly on convex mate

Flexion motion limiting CT — IP joint

Dorsal capsule, collateral ligaments, extensor digitorum

Close packed position — IP joint

Full flexion

Extension ROM — IP joint

30*-45*

Extension Arthrokinematics — IP joint

Convex surface rolls and slides dorsally on convex mate

Extension motion limiting CT — IP joint

Palmar capsule, palmar plate

Flexion and Extension Plane — Thumb IP joint

Frontal

Flexion and Extension Axis — Thumb IP joint

AP

Flexion ROM — Thumb IP joint

70*

Flexion Arthrokinematics — Thumb IP joint

Concave surface rolls and slides ulnarly on convex mate

Extension ROM — Thumb IP joint

20* beyond neutral (passively)

Extension Arthrokinematics — Thumb IP joint

Concave surface rolls and slides radially on convex mate

Extrinsic flexor of digits are…

flexor digitorum superficialis and profundus, flexor pollicis longus

Tenosynovitis is…

Inflammation/swelling, which leads to reduced space in the sheath; hinders the glide of tendon

Trigger finger is…

nodule develops on tendon, becoming wedged in narrowed sheath; finger gets stuck in a bent position, may bend or straighten with a snap

To open hand — Tenodesis Grip

Gravity induced wrist flexion

To close hand — Tenodesis Grip

Active wrist extension