Wrist and Hand
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1
how is the wrist oriented?
flexion and ulnar deviation
2
the radiocarpal joint is made up of the articulation between
distal radius, ulna, TFCC, and the proximal carpal row
3
the TFCC is firmly attached to the
Radioulnar ligaments
4
the TFCC moves with the
radius during pronation and supination
5
the TFCC increases what for the radiocarpal joint?
joint congruency, large space between triquetrum and ulna
6
the TFCC absorbs
forces trasmitted through the wrist on the medial side
7
the TFCC is an attachment for the
ECU tendon
8
midcarpal row is the articulation between
proximal row and the distal row of carpal bones
9
the central pillar and axis of rotation of the wrist is the
capitate
10
the distal carpal joint is the articulation between the
distal carpal row and proximal metacarpals 2-5
11
arthrokinematics of all the wrist joints
proximal radiocarpal - convex on concave
midcarpal - convex on concave
distal - concave on convex
midcarpal - convex on concave
distal - concave on convex
12
Important intercarpal ligaments and their function
scapholunate and lunotriquestral
keep the proximal row together so that they move as a unit
keep the proximal row together so that they move as a unit
13
wrist extensor prime movers
Extensor Carpi Radialis Longus and Brevis, Extensor Carpi Ulnaris
Assistors - ED
Assistors - ED
14
wrist flexor prime movers
Flexor carpi radialis, flexor carpi ulnaris, palmerus longus
Assistors - FDS and FDP and FPL
Assistors - FDS and FDP and FPL
15
Radial Deviators
Prime - Extensor Carpi radialis longus and flexor carpi radialis
Assistors - APL, EPL and brevis
Assistors - APL, EPL and brevis
16
Ulnar Deviators
Prime - FCU, ECU
17
arthrokinematics of MCP, DIP, and PIP
concave on convex
18
MCP degrees of Freedom
2
19
arthrokinematics at the thumb (ab/adduction vs flexion/extension)
ab/adduction - convex on concave
flexion/extension - concave on convex
flexion/extension - concave on convex
20
Gripping Muscles - Main extensor
ECRB - extends the wrist, followed by ECU and ECRL when force increases
21
maximal grip force is produced at what position of the wrist?
20-30 degrees of wrist extension
22
finger flexors (extrinsic and intrinsic)
Extrinsic - FDS and FDP (with ED and ECRB)
Intrinsic - Interossei and Lumbricals
Intrinsic - Interossei and Lumbricals
23
How does finger flexion work?
active contraction: interossei and finger flexors
passive tension: lumbricals (flexion torque)
synergy: ECRB to offset flexion moment + optimize length tension of long finger flexors
Stabilize: ED at MCP
passive tension: lumbricals (flexion torque)
synergy: ECRB to offset flexion moment + optimize length tension of long finger flexors
Stabilize: ED at MCP
24
Finger extensors (extrinsic and intrinsic)
extrinsic - ED, EI, EDM
Intrinsic - Interossei and Lumbricals
all are actively contracting!
Intrinsic - Interossei and Lumbricals
all are actively contracting!
25
How does finger extension work?
ED extends the wrist and flexes the fingers - don't want finger flexion!
fix - contract lumbricals and interossei to pull on the extensor hood and not allow MCP hyperextension
Combat Wrist Extension - use FCR
fix - contract lumbricals and interossei to pull on the extensor hood and not allow MCP hyperextension
Combat Wrist Extension - use FCR
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