Wrist & Hand Complexes: Kinesiology

provides a dynamic base of support for the wrist and hand

shoulder

provides ability to reach away from the body

elbow

allows for adjustment of the "approach" of hand to object

forearm

acts as a "functional spacer" and affects the function of the hand

wrist

primary effector organ for our most complex motor behaviors

hand

______ different muscles drive the ______ bones and 19 articulations within the hand

29 different muscles, 19 bones

carpals are ______ joints

planar

angle of the radius toward the ulna

25 degrees

greater amount of ulnar deviation is possible in comparison to radial deviation (T/F)/

true

radial deviation end feel

hard

radius angle toward the palm (allows for greater flexion compared to extension)

10 degrees

ulnar deviation end feel

firm

carpal bone most likely to dislocate

lunate

the "keystone" of the hand

Capitate

pisiform is a _________ joint

syndesmosis

radiocarpal is an _______ joint

ellipsoidal

true wrist bones

distal end of radius, scaphoid, and lunate

carpal shaped like a "boat"

scaphoid

very stable carpal bone; "captain" of ship

capitate

what makes lunate the most unstable carpal bone

lack of connections to capitate

patient's using high velocity, oscillatory type tools are more prone to _____________ syndrome

carpal tunnel

in ulnar deviation, the roll is _________ the ulna and the slide is toward the ____________

roll is toward the ulna, slide is toward the radius

in radial deviation, the roll is __________ the radius and the slide is ______________ the ulna

roll is toward the radius, slide is toward the ulna

what muscles provide the radial collateral ligament with support (radial deviation support)

abductor pollicus longus and extensor pollicus brevis

what muscles provide the ulnar collateral ligament with support (ulnar deviation)

palmar ulnar ligament, TFCC, FCU, ECU

the carpal rows all move as one (T/F)

true

Neuman states that distal to proximal carpal row is like a __________ joint

ball and socket

compartment of the hand that has the most mobility

medial; scaphoid, lunate, triquetrum, capitate, hamate

carpal row of the hand that has more movement potential

proximal

compartment of the hand that has the least mobility

lateral

medial compartment (midcarpal joint)

scaphoid, lunate, triquetrum; capitate and apex of hamate

lateral compartment (lateral joint)

scaphoid, trapezium, trapezoid

ligaments of the carpals are short/long (choose 1)

short

the angle of the radius towards the palm (10 degrees) allows for better..

flexion

a "ray" includes

metacarpal and all its associated phalanx's

arches of the hand

proximal transverse, distal transverse, and longitudinal arches

function of the arches of the hand

-allow the hand to securely hold and manipulate objects
-give the hand integrity; unique curves allow for functionality

proximal transverse arch of hand

formed by the distal carpal bones and forms the carpal tunnel. the keystone is the capitate.

distal transverse arch of hand

formed by the MCP joints, mobile and passes through metacarpal heads

longitudinal arch of the hand

begins at the wrist and follows the 2nd and 3rd rays of the hand. keystone is the 2nd and 3rd MCP joints

the CMC joints (2nd through 5th) are ________ joints

complex saddle

complex saddle joints at the 2nd and 3rd CMC joints allow for...

very little to no motion

complex saddle joints at the 4th and 5th CMC joints allow for...

slight flexion and internal rotation

potential for movement at the CMC joints is..

challenged

thenar eminence

the fleshy mass at the base of the thumb (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis)

hypothenar eminence

the fleshy mass at the base of the little finger (abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi, palmaris brevis)

the distal phalanx is CC/CV (choose one) upon the middle phalanx

concave (CC)

the middle phalanx is CC/CV (choose one) upon the distal phalanx

convex (CV)

the middle phalanx is CC/CV (choose one) upon the proximal phalanx

concave (CC)

the proximal phalanx is CC/CV (choose one) upon the middle phalanx

convex (CV)

the proximal phalanx is CC/CV upon the second metacarpal

concave (CC)

the 2nd metacarpal is CC/CV upon the proximal phalanx

convex (CV)

MCP joints are _______ joints

condyloid

roll and slide of the phalanx on metacarpal for flexion occurs in the ___________ direction

same

the PIP and DIP joints are ________ joints

hinge

the 1st CMC joint is a _____________ joint

saddle

the 1st CMC joint is roughly _______ degrees compared to the rest of the hand

90

during radial adduction and abduction, the proximal end of the metacarpal is CC/CV (choose one)

concave (CC)

during adduction, the 1st metacarpal rolls _________ the ulna

toward

during abduction of the 1st metacarpal, the MC rolls _________ the radius

toward

during palmar adduction and abduction, the proximal end of the metacarpal is CC/CV (choose one)

convex (CV)

radial adduction is the same as thumb flexion (T/F).

true

opposition

-palmar adduction and flexion/medial rotation combined
-multiple planes of movement involved

radiocarpal open packed position

neutral with slight ulnar deviation

CMC open packed position

midway between abduction-adduction and flexion-extension

MCP open packed position

slight flexion

IP open packed position

slight flexion

radiocarpal close packed position

extension with radial deviation

MCP (fingers) close packed position

full flexion

MCP (thumb) close packed position

full opposition

IP close packed position

full extension

radiocarpal capsular patterns (limited ROMs)

flexion and extension equally limited

MCP capsular patterns (limited ROMs)

flexion > extension

IP capsular patterns (limited ROMs)

flexion > extension

primary wrist flexor muscles

flexor carpi radialis, flexor carpi ulnaris, palmaris longus

secondary wrist flexor muscles

flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus

primary wrist extensor muscles

extensor carpi radialis longus
extensor carpi radialis brevis
extensor carpi ulnaris

secondary wrist extensor muscles

Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor digitorum, extensor digiti minimi, extensor indicis

other intrinsic muscles of the hand

adductor pollicis, lumbricals, interossei

the line of the pull is anterior/posterior to the MCP and anterior/posterior to the PIP and DIP.

anterior, posterior

in the hand, the __________ muscles have the longest lever arm

lumbricals

the _____________ muscles of the hand have the largest cross sectional area, so they primarily flex MCP and extend PIP and DIP

interossei

a disrupted tendon is going to ___________ the ability to flex

decrease

"bowstringing" of tendons

when the tendons come away from the joints over which they pass (moving away from its osseous counterpart)

is adductor pollicis a PAD or a DAB?

PAD

the way the lumbricals travel

-anterior to the MCP
-posterior to the PIP and DIP

muscles that produce radial deviation

ECRL, ECRB, FCR, EPL, EPB, APL, FPL

muscles that produce ulnar deviation

ECU, FCU, FDS, FDP, ED

functional ROM for wrist flexion/extension

40 degrees

combined ulnar/radial deviation (arc)

40 degrees

functional ROM for finger flexion (MCP)

45 degrees

functional ROM for PIP flexion

60 degrees

functional ROM for DIP flexion

50 degrees

functional range of motion usually pertains to

ADL completion

bones of the wrist/hand that are most commonly fractured (from greatest to least prevalence)

1. scaphoid
2. lunate
3. triquetrum (most lateral to medial)

Terry Thomas sign

scapholunate dislocation

typically, the wrist bone we see fail in FOOSH is the ______________

radius

Boxer's fracture

5th metacarpal fracture

in Boxar's fracture, the radius moves volarly/dorsally (choose one)

volarly

Colle's fracture

-fracture of the distal radius at the wrist; radius moves palmarly
-extension fracture