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Wrist & Hand - Coggle Diagram

- - - - ellipsoid joint
    - - 2
        
        what motions does it allow (4)
        
        Flexion/extension
        • Radial/ulnar deviation
    - - lunate and scaphoid
        
        has a little contact with what other carpal
        
        Triquetral
        
        which artery supplies scaphoid
        
        radial a.
    - - What is concave
        
        Radius and ulna
      - Close-pack position
        
        Full extension
      - Loose-pack position (2 things)
        
        Slight flexion and ulnar deviation
  - - - what type of joint
        
        saddle
      - between which 2 bones
        
        trapezium & 1st metacarpal
      - what special thing can the thumb due bc of this joint
        
        can touch each finger (opposition)
        
        why is this important
        
        Very important in all gripping and prehension tasks
    - - very restricted
    - - 10-30° of CMC flexion/extension available
    - - Concave transverse arch (what does this help with)
        
        Facilitates the gripping function of the hand
    - - 1st CMC ROM values (6 motions)
        
        ~ 50-80° of flexion/extension
        
        • ~ 40-80° of abduction/adduction
        
        • ~ 10-15° of rotation
        
        ~ 90° opposition
    - - Joint orientation
        
        Trapezium (3)
        
        – inferior, anterior, lateral
        
        1st metacarpal (3)
        
        – superior, posterior, medial
      - Concave surface (2 ways)
        
        Trapezium concave
        posterior to anterior
        
        1st metacarpal concave lateral (radial) to
        medial (ulnar)
      - Loose-pack (2 things)
        
        Midway between
        FLEX/EXT and ABD/ADD
      - Close-pack position
        
        Full opposition
      - Roll and glide during abduction
        
        Palmar roll and dorsal glide
      - Roll and glide during flexion
        
        Medial roll and glide
  - - - condylar (what motions does this allow (4))
        
        Flexion/extension
        • Abduction/adduction
    - - with wrist in 20-30° wrist
        extension
    - - hinge
        
        how many degrees of freedom
        
        1
      - is it connected to the others
        
        no (what separates it)
        
        deep transverse ligaments
      - Arthrokinematics
        
        Joint orientation
        
        Metacarpals (3)
        
        inferior, anterior, lateral
        
        Phalanges (3)
        
        superior, posterior, medial
        
        concave joint surface
        
        Phalanx
        
        Loose-pack position
        
        Slight flexion
        
        Close-pack position
        
        Full extension
    - - Arthrokinematics
        
        Joint orientation
        
        Metacarpals
        
        inferior
        
        Phalanges
        
        superior
        
        Concave joint surface
        
        phalanx
        
        Loose pack position
        
        Slight flexion and slight ulnar deviation
        
        Close pack
        
        full flexion
  - - - hinge
    - - collateral ligaments
    - - Joint position
        
        Proximal phalanx
        
        inferior
        
        Distal phalanx
        
        superior
      - concave surface
        
        distal phalanx
      - Loose pack position
        
        Slight flexion
      - Close pack position
        
        full extension
  - - - Proximal carpals (4)
        
        scaphoid, lunate, triquetral, pisiform
      - Distal carpals (4)
        
        Trapezium, trapezoid, capitate, hamate
      - what is the articulation between rows called
        
        midcarpal joint
        
        this joints accounts for what (2 things)
        
        ~ 60% of total wrist flexion Gross ROM ( what is the other 40% coming from)
        
        ~40% is due to scaphoid and lunate moving on
        radius
        
        which carpals help the most during flexion
        
        proximal carpals
        
        30% of wrist extension (what is rest coming from)
        
        Radiocarpal joint accounts for ~60% of total
        wrist extension ROM
        
        which carpals help the most during extension
        
        distal carpals
      - what is the articulation between 2 carpal bones called
        
        • Intercarpal joint
    - - carpal tunnel
        
        whats inside
        
        flexor tendons and median nerve
        
        what arches over tunnel
        
        transverse carpal ligament
        
        which bones is it between
        
        Between pisiform, hook of hamate on one side and tubercle of scaphoid, trapezium on the other side
    - - what 4 motions occur
        
        radial deviation
        
        what occurs
        
        Proximal row moves toward ulna
        
        ulnar deviation
        
        what occurs
        
        Proximal row moves toward radius
        
        wrist flexion
        
        wrist extension
        
        how does the proximal row move
        
        they glide over distal row
    - - Joint orientation
        
        proximal row
        
        inferior
        
        distal row
        
        superior
      - Concave joint surface
        
        Varies, depending on specific joint
      - Loose-pack position (2 things)
        
        Slight flexion and ulnar deviation
      - Close-pack position
        
        Full extension
- - - - 4th or 5th
    - - what is the origin and insertion
        
        origin: lateral supracondylar ridge; Insertion:3rd metacarpal
    - - what is the origin and insertion
        
        origin: lateral supracondylar ridge; Insertion:2nd metacarpal
  - - - • Flexor carpi radialis
        
        • Flexor carpi ulnaris
        
        • Palmaris longus
      - which flexor is the only one that attaches to carpal bones
        
        flexor carpi ulnaris
        
        which carpal
        
        pisiform
  - - - Extensor carpi radialis longus
      - • Extensor carpi radialis brevis
      - • Extensor pollicis longus
      - • Extensor pollicis brevis
      - • Flexor carpi radialis
      - • Abductor pollicis longus
      - • Flexor pollicis longus
  - - - Power grip – holding a hammer, etc
      - • Precision grip – holding an egg
      - • Power pinch (key pinch) – holding a key
      - • Precision pinch – holding a pin
      - • Hook grip – holding a suitcase
    - - all of them
  - - - Stretching exercise, manual resistance, isotonic resistance
- - - - Dorsal radiocarpal ligaments
      - • Radial collateral ligaments
      - • Palmar radiocarpal ligaments (3)
        
        Radiocapitate
        
        radiolunate
        
        radioscapholunate
      - Ulnocarpal complex (3)
        
        articular disc
        
        Ulnar collateral ligament
        
        palmar ulnocarpal ligament
    - - they originate outside of the hand
  - - - • Lunotriquetral
        
        • Scapholunate
        
        • Scaphotrapezial
    - - Medial Palmar intercarpal ligament
      - Lateral palmer intercarpal ligament
      - dorsal intercarpal ligament
- - - - • ~45-50° in sagittal plane movement and
        • ~20-25° in frontal plane movement
    - - ~10-15° extension and ~10° ulnar deviation
  - - - brachial plexus
    - - ulna supplies
        
        front & back of pinky and half of ring finger
      - median supplies
        
        all of palm except for pinky and half of ring; dorsal tips except for pinky and half of ring
      - radial supplies
        
        dorsal hand 1-4 digits (half of 4) not including the tips
- - - - • Scaphoid Fracture
        
        typical MOI
        
        FOOSH with hand in supination
        
        Diagnosis often based on clinical signs of what 3 things
        
        local pain, edema, and little
        resolution of symptoms
        
        it is a high risk of mal-union if what does not occur'
        
        if not immobilized
        
        so what to do if not sure it is a scaphoid fx yet
        
        treat all tenderness at snuffbox as Fx
      - • Boxer’s Fracture
        
        what ccurs
        
        fx of 5th metacarpal
        
        5th metacarpal is especially necessary for what function
        
        mobility for cupping hand
        
        when is it usually casted
        
        after closed reduction
      - • Mallet finger
        
        aka
        
        baseball finger
        
        MOI usually
        
        Long extensor tendon avulsed from base of phalanx
        
        how is splinting usually positioned
        
        Positioned so DIP in extension or hyperextension, PIP in
        flexion
      - • Colle's fracture
        
        what does it include
        
        Includes a dorsal displacement of distal radial
        
        typical MOI
        
        FOOSH
        
        what population are highly susceptible
        
        Post-menopausal women
        
        what are 2 associated problems
        
        Distal edema and mal-union
        
        what is mal-union
        
        fracture that heals in an abnormal position
        
        what deformity sometimes results
        
        dinner fork deformity
        
        what does this result in (2)
        
        permanent loss of full wrist flexion and ulnar
        deviation
    - - Colle's fx
    - - bone
  - - - what occurs
        
        Compression of median nerve as it passes thru
        carpal tunnel
      - what is in the dorsal segment
        
        carpal bones
      - what is in the palmer segment
        
        transverse carpal ligament
      - dislocation of what carpal can cause this
        
        lunate
    - - what occurs
        
        Irritation of the tendon and it’s surrounding synovial
        sheath
        
        what sheath does it commonly affect
        
        sheath of tendon shared by abductor
        pollicus longus (APL) and extensor pollicis brevis (EPB)
        
        these tendons are the border for what anatomical area
        
        anatomical snuff box
      - what population is most affected
        
        Middle-aged women most affected
      - when does it commonly occur'
        
        in pts using thumb for repetitive
        pinching, wringing, and grasping motions with simultaneous wrist extension
- - - - weakens the others
    - - Carpal bones
        • Rigid, immobile
    - - • Heads of metacarpals
        • Mobile
    - - Flexible
        • Mobile