Gross & Functional Test 4
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Elbow complex includes what?
- 3 bones
- 3 ligaments
- 1 capsule
Which 3 bones are in the elbow complex?
Which 3 ligaments are in the elbow complex?
- medial collateral
- lateral collateral
which capsule is in the elbow complex?
What is the elbow joint articulation?
the humerus with the ulna and radius
the elbow uniaxial joint allows only what?
extension/flexion of 145 degrees
An elbow having no active hyperextension motion is blocked by what?
olecranon process of ulna fitting into the olecranon fossa of the humerus
What type of joint is the radioulnar joint?
uniaxial pivot joint
The radioulnar joint allows only what?
- pronation - 80 degrees
- supination - 90 degrees
Where does the radioulnar joint articulate?
- b/t the radius and ulna
- there is articulation at both ends
What forms the inferior/distal radiulnar joint?
the distal end of the radius rotating around the distal end of the ulna
What forms the superior/proximal radioulnar joint?
the head of the radius pivoting w/in the radial notch of the ulna
When pronation/supination occur the _______ moves around and the _______ does not
What forms the carrying angle-anatomical position?
the longitudinal axes of the humerus and forearm
What is the carrying angle in women?
What is the carrying angle in men?
What is the end feels for supination?
firm muscle ligament tension and soft tissue stretch
What is the end feels for pronation?
hard contact b/t the radius and ulna
What are open chain activities?
the concave radial and ulnar joint surfaces slide on the humerus in the same direction as the motion of the forearm
What shape is the medial collateral ligament?
How far does the medial collateral ligament span?
the medial side of the elbow
Where does the medial collateral ligament attach?
on the medial epicondyle of hte humerus and runs obligquely to the medial sides of hte coronoid process and olc p of u
what shape is the lateral collateral ligament?
where does the lateral collateral ligament attach?
- proximately on the lat epic of the humerus
- distally on the annular ligament
- on the lateral side of the ulna
What 2 ligaments provide a great deal of medial/lateral stability to the elbow?
lateral collateral & annular ligament
where does hte annular ligament attach?
anteriorly and posteriorly to the radial notch of the ulna
what does the annular ligament do?
encompasses the head of the radius and holds it against the ulna
where does the joint capsule attach?
- around the distal end of the humerus
- surrounds the trochlea and capitulum & the fossas located above them
______ & _______ hold the radioulnar articulations together
annular ligament & interosseous membranes
In a closed chain does the proximal segment move or is it fixed?
In an open chain does the proximal segment move or is it fixed?
In a closed chain does the distal segment move?
In an open chain does the distal segment move?
What is the interosseous membrane?
broad flat membrane located b/t the radius and ulna for most of their length
What does the interosseous membrane do?
keeps the 2 bones (radius & ulna) from separating and provides more surfae area for attachment of the forearm and wrist mm
Where does the interosseous membrane attach?
at the base of the annular and medial collateral ligaments
What is the cubital fossa?
shallow somewhat triangular depression on the anterior elbow
What is lateral epicondylitis (tennis elbow)?
- overuse condition that affects the common extensor tendon where it inserts on the LEH
- Extensior Carpi Radialis Brevis is partially affected
- common in racquet sports and other repetitive wrist extension activities
What are some common elbow pathologies?
- Lateral epicondylitis (tennis elbow)
- medial epicondylitis (golfer's elbow)
- Pulled elbow (nursemaids elbow)
- Elbow dislocation
- Supracondylar Fracture
What is medial epicondylitis (golfer's elbow)?
- inflammation of the common flexor tendon that inserts into the med epicondyle
- it is an overuse condition that results in ternderness over med epic and pain on resisted wrist flexion
What is Pulled Elbow (nursemaid's elbow)?
- Children under 5 experienced ea sudden strong traction force on the arm when either:
- (1) an adult suddenly pulls on the child's arm or
- (2) child falls away from an adult while being held by the arm
What does the force on the arm in Pulled Elbow cause?
the radial head to sublux out from under annular ligament
What causes elbow dislocation?
- a great deal of force being applied to an elbow that is in a slightly flexed position
- causes the ulna to slide posteriorly to the distal end of the humerus
What is the most common fracture in children caused by falling on outstretched hands?
What is involved in an supracondylar fracture (where does it break and what damage can it cause)?
- the distal end of the humerus fractures above the condyles
- can cause damage to the brachial artery b/c of close proximity
What can a supracondylar fracture lead to in very rare cases?
volmann ischemnic contracture
What are the possible synovial joint shapes?
- irregular (plane)
how many axes can synovial joints have?
When has a muscle become actively insufficient?
when it has contracted over all its joints as far as it can
What determines whether an action is an open or closed kinetic chain movement?
whether the distal segment is fixed
What is the convext concave rule?
- convex joint surface moves in a direction opposite to the movement of the body segment
- concave joint surface moving in the same direction as the body segment
Which 2 biaxial joints make up the wrist joint?
radiocarpal & midcarpal
the radiocarpal joint consists of which end of the radius?
the distal end of the radius
The radiocarpal joint consists of what proximately?
the radioulnar disks
The radiocarpal joint consists of what distally?
Does the Pisiform articulate with the radiocarpal joint?
What does the biaxial joint allow?
- radial/unlar deviation
Where are the midcarpal/intercarpal joints located?
b/t the two rows of carpal bones
What do the midcarpal and intercarpal joints contribute to?
What shape do midcarpal/intercarpal joints have?
irregular - classified as plane joints
midcarpal/intercarpal joints are ________ joints that allow ________ motions
Where is the CMC located?
b/t the distal row of carpal bones and proximal end of hte metacarpal bones
What are the various joint motions?
- wrist flexion/palmar flexion
- neutral/extension, neutral
- extension/hyperextension, dorsiflexion
- radial deviation/abduction
- ulnar deviation/adduction
What constitutes wrist flexion/palmar flexion?
- fingers down/sagittal
- frontal/soft tissue stretch
What constitutes neutral/extension, neutral?
- anatomical position
- soft tissue stretch
What constitutes extension/hyperextension, dorsiflexion
- posterior from anatomical position
- soft tissue stretch
What constitutes radial deviation/abduction?
- lateral from anatomical position
- bony end feel
What constitutes ulnar deviation/adduction?
- medial from anatomical position
- soft tissue stretch
Where does the radial collateral ligament attach?
- to the styloid process of the radius
- to the scaphoid & trapezium bones
Where does the ulnar collateral ligament attach?
- to the styloid process of the ulna
which 2 ligaments provide lateral and medial support to the wrist joint?
radial collateral ligament & ulnar collateral ligament
What does the palmer radiocarpal ligament limit?
Where does the palmer radiocarpal ligament attach?
- from anterior surface of the distal radius/ulna to the anterior surface of proximal carpal bones
- capitates in distal row
Where does the dorsal radiocarpal ligament attach?
posterior surface of the distal radius to the scaph, lunate, triquetrium
What does hte dorsal radiocarpal ligament limit?
the amount of flexion allwed by the wrist
Is the dorsal radiocarpal ligament as strong as the palmer radiocarpal ligament?
What does the joint capsule enclose?
what is the joint capsule reinforced by?
the radial/ulnar collateral ligaments & palmer/dorsal radiocarpal ligaments
how much motion does an isometric contraction have?
what acts as a shock absorber and a filler b/t the dist ulna and adjacent carpal bones-triquetrium/lunate?
artiuclar disks/located distal end of ulna/articulates with the triquetrium/lunate bones
What are the palmar fascia/palmer aponuerosis?
- relatively thick, triangular
- located superficially in the palm of the hand
what do the palmar fascia/palmer aponeurosis cover?
tendons of the extrinsic mm and provides protection to the structures in the palm
do mm attachments move closer together or further apart with a concentric contraction?
what is an eccentric contraction?
- decleration activity
- lengthening of mm
when using a longer lever arm is more or less force needed?
does working against gravity require more work than working with gravity or when gravity is eliminated?
What are the joints of the hand from top to bottom?
- distal interphalangeal DIP
- proximal interphalangeal PIP
- Metacarpal MCP
- Carpals CMC
CMC - hand is what kind of joint?
nonaxial plan (irregular) synovial joints
Which does the CMC in the hand provide more of - stability or support?
What shape joint is the Metacarpal MCP?
- biaxial condyloid joint
- convext rounded heads of the metacarpals
What actions do the Metacarpal MCPs do?
What is the flexor retinaculum made up of?
palmar/tranqnsverse carpal ligament
Where does the flexor retinaculum attach?
spans the ant surface of the wrist in a horizontal direction
What does the flexor retinaculum do?
- holds tendons close to the wrists
- prevents the tendens from pulling away from the wrist (bowstringing) when the wrist flexes
- prevents 2 sides of carpal bones from spreading apart or separating
Carpal Tunnel is made up of what?
- 4 flexor digitorum profundus
- 4 flexor digitorum superficialis
- 1 flexor pollicis longus
- 1 median nerve
Where is the extensor retinaculum ligament located?
top part of the hand
what does the extensor retinaculum ligament do?
holds extensor tendons close to the wrist during wrist extension
What is the extensor expansion ligament (extensor hood) and where is it located?
triangular small flat aponuerosis covering the back and sides of proximal phalanx of the fingers
Where is the proximal carpal arch and what is it maintained by?
- proximal end of metacarpals and carpal bones
- maintained by flexor retinaculum
Common wrist/hand pathologies
- colle's fracture
- smith's fracture
- greenstick facture
- gangilion cist
- carpal tunnel syndrome
- DeQuervains disease
- Dupuytren's ontracture
- stenosing tenosynovitis
- skiier's thumb
- swan neck deformity
- ulnar drift
- mallet finger
- scaphoid fracture
What is a Colle's fracture in the wrist/hand, what causes it, and who is it common to?
- transverse fracture of distal fragment
- results from a fall on the outstretched hand
- common in elderly people
What is Smith's fracture and what causes it?
- distal fragment is displaced anteriorly
- caused by a fall on the back of the hands
What is a Greenstick Fracture and to whom is it more common?
- incomplete fracture, usually of the radius and more proximal than Colle's
- more common in children than adults
What is a gangilion cist?
a benign tumor mass commonly seen as a bump on the top surface of the wrist
what causes carpal tunnel syndrome?
compression of median nerve
what are the symptoms of carpal tunnel syndrome?
- tingling and weakness in hand that begins at night
- tingling, pain, and weakness in the thumb, index, and middle fingers
What is tenosynovitis?
inflammation of tendons and surrounding sheaths
When does dupuytren ontracture occur?
- when palmar aponeurosis undergoes a nodular thickening
- are of the palm in line with the ring finger
- often those fingers develop flexion contractures
What is stenosing tenosynovitis (trigger finger)
a problem with the sliding mechanism of a tendon in its sheath
what is skiier's thumb?
ana cute tear of the ulnar collateral ligament of thumb
What is involved in swan neck deformity?
- flexion @ MCP
- hyperextension of the PIP
- flexion of the DIP
- (boutonnierre deformity in opposite direction)
What is an ulnar drift?
ulnar deviation of the fingers at MCP joint
What causes mallet finger?
- disruption of the extensormechanism of DIP joint
- from tendon severed or tore away from the distal phalanx
What causes a scaphoid fracture?
- fall on outstretched hand of a younger person
- poor vascular supply risk of avascular necrosis
When the wrist is in a slightly extended position, where are the MCP, PIP joints of fingers and thumb?
- MCP & PIP joints - slightly flexed
- thumb - opposite position
What is the power grip of the hand?
- isometric contraction with no movement b/t hand and object being held
- (i.e. - hammer/doorknob)
What is the cylindrical grasp?
- all fingers flexed around the object with thumb in opposite direction
- (i.e. - holding hammer, racquet, or wheelbarrow handle)
What is the sperical grip?
- all fingers and thumb abducted around an object with fingers more spread out apart
- (i.e. - holding an apple, turning doorknob, picking up glass by its top)
What is the Hook Grip?
- 2nd thru 5th fingers diexed around an object in a hooklike manner
- (i.e. - holding on a handle, bucket, suitcase, wagon)
The hook grip is the only power grip possible in a person who has what kind of injury?
median nerve injury and has lost ability to oppose thumb
What is a precision grip/precision prehension?
- when an object has to be maniupulated in finger type movement
- (i.e. - holding a pen, threading a needle)
What is the most common precision grip?
three jaw chuck - thumb & 2 fingers holding a pencil
Which grips are used to pick up a coin?
- pinch grip (pincer)
- tip to tip grip - tip of thumb against another digit
What grip is used to put keys in car ignition?
pad to side - lateral prehension
which grip is difficult with long nails?
what grip is used to hold a cigarette?
- side to side grip
- not much precision
What type of contractions are used to stabalize or hold a body part in position?
Which 3 grips are used for power hand movements?
If a grip isn't used for power hand movements what is it used for?
precision hand movement
Does a convex joint surface move in the opposite direction of the body segment movement?
Does a concave joint surface move in the same direction as the body's segment movement?
Sagittal plane divides the body into what?
left and right parts
Frontal plan divides the body into what?
front and back
transverse dives the body into what?
top and bottom parts
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