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Amputated hand:
o 90% function of UE is gone 1. Capitate
Proximal Joints serve the hand aka Os Magnum
Control length tension relationship in multiarticular joint Largest carpal bone
and muscles to allow fine adjustment of grip At birth/after birth
o Balance and Control Axis of motion for ulnar/radial deviation
Most complex joint in the body:
o Wrist Joint 2. Hamate
2 of freedom aka Uncinate
Normal ROM: Immediately after capitate/at birth
o Flexion: 0-80
o Extension: 0-70 3. Triquetrum
o Abduction: 0-20 aka Triangular
o Adduction: 0-30 2 years old
Axis of motion for wrist flexion/extension
JOINTS
3rd most commonly fractured bone
1. Radiocarpal Joint
Main wrist joint 4. Lunate
Between radius and scaphoid, lunate, and Aka Semilunar
triquetrum
3 years old
Joint Classification:
Most commonly dislocated bone
o Ellipsoid
2nd most commonly fractured bone
Radius extends more distally than ulna Special Test: Murphys Sign Test
1
RADIOCARPAL JOINT
Articulations: Radius & Proximal carpals
Biconcave: Radius LIGAMENTS
Biconvex: Carpals 1. Dorsal Carpal Ligaments
Proximal Joint Surface: Volar radiocarpal
o Lateral radial facet Radiocaphocapitate
o Medial radial facet Radiocapholunate
o TFCC Radiolunate
Oblique and slightly angled volarly (palm) & ulnarly
Average inclination of distal radius volarly: 2. Dorsal Carpal Ligaments
o 11 Dorsal radiocarpal ligament
Average inclination of distal radius ulnarly: Dorsal intercarpal ligament
o 23
3. Greysons & Clelands Ligament
Triangular Fibrocartilage Complex (TFCC) Fix skin to bone of fingers
Attachment: Important for grasping objects
o Distal radius
o Ulnar styloid process MOTIONS OF THE WRIST
o Triquetrum Combination of active (contaction of mm) and passive
Function: (movement of ob bones) structure
o Binds radius & ulna 3 segment linkage:
o Separates distal RU joint and ulna from o Radius
radiocarpal joint o Proximal carpal row
Special Test: Supination Lift Test o Distal carpal row
2
RC joint = 10 Tunnel of Guyon
MC joint = 10 - between pisiform and hamate
Ulnar Deviation = 30
Piso-hamate Ligament
RC joint = 20 MC joint = 10
- where ulnar nerve passes through
INSPECTION OF THE HAND
SENSORY DISTRIBUTION OF HAND
- Complete number of fingers
1. Palmar Aspect:
- attitude of the hand
o Median nerve lateral 3
- damaged flexor tendon
o Ulnar nerve medial 1
- contour of the palmar surfaces
2. Dorsal Aspect:
- 3 arches
o Median nerve lateral distal 3
- hills and valleys (bulges)
o Radial nerve lateral proximal 3
- knuckles
o Ulnar nerve medial
- nails
B. Wrist Extensors
ARCHES OF THE HAND
o ECRL, ECRB, ECU, EDC, EDM, EI, APL, EPB, EPL
Distal Transverse Arch
Longitudinal Arch Mobile Wad of 3 or Henry: brachioradialis, ECRL,
Oblique Arch ECRB
PALMAR CREASES
Extensor Retinaculum
Wrist crease - holds extensor tendons
Thenar crease - divides tendon into 6 tunnels
Proximal/Distal Palmar Crease
Palmar Digital Crease Extensor Tunnels
Proximal/Distal Interphalangel Crease o Tunnel 1 APL, EPB
o Tunnel 2 ECRL, ECRB
SURGICAL NO MANS LAND o Tunnel 3 EPL
Landmark: Distal Palmar Crease o Tunnel 4 ED, EI
: Proximal Interphalangeal Crease o Tunnel 5 EDM
- must not go surgery because of very poor blood o Tunnel 6 ECU
supply
De Quervains/Stenosing Tenosynovitis
MUSCLES OF THE WRIST COMPLEX - Tunnel 1
- provides stable base for the hand
Radial border of Anatomical Snuff Box
A. Wrist Flexors - Tunnel 1
o Palmaris Longus, FCR, FCU, FDS, FDP, FPL - lateral: APL
- medial: EPB
Flexor Retinaculum
- holds/binds flexor tendons at wrist area Ulnar border of Anatomical Snuff Box
- Above: Palmaris Longus, FCU - EPL (Tunnel 3)
- Below: Transverse Carpal Tunnel
Tennis Elbow
Structures that passes beneath Flexor Retinaculum: - Tunnel 2 (ECRB most affected)
o 4 tendons of FDS
o 4 tendons of FDP Hex Sign
o 1 tendon of FPL - Tunnel 4 (individual action of ED & EI)
o Median Nerve
o FCR
Carpal Tunnel
- area beneath Transverse Carpal Ligament
Carpal Tunnel Syndrome median nerve is
affected
3
SPECIFIC MUSCLE ACTIONS MCP Joint
Palmaris Longus pure wrist flexor; used as tendon - Formed by head of metacarpal and base of proximal
grafts phalanx
FCU has greatest tension - Joint classification: condylar
FDS flexes wrist if fingers are flexed; wrist flexor - 2 degrees of freedom
FDP finger flexor Motions: flexion/extension, abduction/adduction
FPL wrist radial deviation Range of Motion: flex/ext; abd/add
ECRB strongest wrist extensor o Flexion/Extension
ECRL strong radial deviator MCP
elbow flexor w/ in neutral PIP
ECU wrist extensor affected by FA position; can also DIP
flex the wrist if FA is neutral/pronated Thumb MCP
EDM extends 5th digit Thumb IP
EI extends 2nd digit Thumb CMC
EDC pure finger extensor (2nd 5th digit); flexion/extension,
extends wrist if fingers are extended abduction/adduction
4
o Lateral/Key Pinch (lateral
prehension)
o Tip Pinch
EXTRINSIC EXTENSORS:
EDC, EIP, EDM
Junctura Tendinae
- connects 2 tendons of EDC
EXTENSOR MECHANISM
o aka Extensor expansion, apparatus, extension
aponeurosis, retinaculum, extension mechanism,
dorsal hood
- termination of almost all digital extensors
and intrinsic muscle (except ECU)
- No tendons in the digits
5
Primary muscle: EDC, Interossei, and Lumbricals
Extensor Hood: assistst in hand opening or finger extension
EDC
- crosses MCP joint and inserts to base of proximal
phalanx
- will give off 3 bands (2 lateral, 1 central)
Lateral band/slip: continue to rejoin over the
middle phalanx and inserts to the base of
distal phalanx
Central band/slip: inserts to the base of
middle phalanx
Interossei attaches to the base of proximal and middle
phalanx, volar plate, and lateral bands
Lumbricals inserts to lateral slip
HAND CLOSURE/OPENING
Light hand closure
o unresisted
o FDP
Foreceful closure
o resisted
o FDS, FDP, and Interossei
Hand Opening
o ED