MS II 11 wrist

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MS II 11 wrist
2013-04-14 21:12:41
MS II 11 wrist

pivko and rosen spring 2013
Show Answers:

  1. how many degrees of freedom in wrist?
  2. what kind of joint is the radiocarpal joint?
    ellipsoidal - 2 degrees of freedom - it can do circumduction bc so round
  3. ellipsoidal joint  - aliases and def
    condyloid, condylar, bicondylar

    • a condyle that is received into an elliptical cavity
    • permits movement in two planes, allowing flexion, extension, adduction, abduction, and circumduction

    ex: wrist, MCPs, MTPs
  4. tell me about the mid carpal joint
    • it's S shaped
    • lat part is plane
    • medial part is condylar
  5. joint surface of radius on carpals?
    • bi-concave - radius is concave med/lat and ant/post
    • also, the articular disc there is concave
    • so, the prox row of carpals is convex
  6. how to move carpals to increase ext, flex, rad dev, unlar dev?
    • ext: volar
    • flexion: dorsal
    • rad dev: ulnar
    • ulnar dev: radial
  7. how many mobilization techniques do we have for the carpals?
     5 - flex ext rad ulnar distraction
  8. the thing about the midcarpal joint
    • it's not a normal joint, it's a functional unit - no muslces make mvmnt here directly, rather it moves passively bc of attachments on either side of it
    • no synovial jt btwn rows of carpals
  9. how do you do med/lat glide at mid-carpal joint?
    you can't due to the S shape of the joint
  10. in wrist flex to ext, what moves first?
    distal row of carpals moves until it close-packs the prox row, then they move as a unit

    when each part moves into ext, its distal part goes dorsal while its prox part goes ventral
  11. zero starting pos of the wrist?
    longitudinal axes thru the radius and 3rd metacarpal are in a straight line
  12. close packed for midcarpal jt?
    ext w ulnar dev

    45 ext - carpals acta as a functional unit as you go further into ext
  13. how do carpals move in ulnar dev?
    • the two rows move as a unit, sooo
    • prox part of prox row moves radially
    • distal part of distal row moves ulnarly

    (reverse this for radial dev)
  14. ulnar/rad dev - which more, why?
    ulnar > radial bc of big radial styloid process
  15. radiocarpal resting pos
    neutral btwn flex/ext w a bit of ulnar dev

    (axis thru radius an 3rd metacarpal are straight but with a bit of ulnar dev)
  16. radiocarpal close-packed pos?
  17. midcarpal jt resting pos
    neutral or slight flexion w ulnar dev
  18. capsular pattern for midcarpal joint?
    • flex = ext
    • "works w RC jt"
  19. capsular pattern for radiocarpal joint
    restricted equally in all dir
  20. the take-away about movement at radiocarpal and midcarpal joints in flex & ext

    and numbers
    • flex: radiocarpal > midcarpal mvmnt
    • ext: radiocarpal < midcarpal mvmnt

    • roughly:
    • flexion to 85 degrees - midcarpal does 35, radiocarpal does 50
    • ext to 85 degrees - midcarpal does 50, radiocarpal does 35

    but these numbers vary. But basically for flex/ext you want symmetry (85:85 is nice)
  21. pos of pt's hand in radiocarpal distraction -- and list of for others
    • pronated -- supinate for dorsal glide, pronate for volar, go to side for ulnar glide (can for radial, but can also do it prone)
    • (I'm not detailing how to do a lot of these bc I think you know... so be sure to double check)
  22. a movement to remember in wrist glides?
    piccolo distraction
  23. Tinel's sign in wrist
    • tap median nerve, see if you get tingle
    • I think the only times it's superficial enough to tap is a bit prox to the wrist, and then again in the cubital fossa
  24. Tourniquet test
    put a sphigmometer on prox to elbow, inflate, see if there's tingling within 60 sec - tests the median N.
  25. Finglkestein's test / DeQuervain's Disease test - looks for what? tests how?
    • looks for tenosynovitis of the snuff box
    •  pt puts thumb in palm, makes a fist, does ulnar dev ... look for pain
  26. tenosynovitis def
    inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon
  27. Watson's test - how?
    stabilize radius, put thumb on scaphoid, glide in ulnar & radial dev, looking for pain, crepitus, clicking
  28. Watson test - what for?
    scaphoid-lunate instability/dissociation
  29. Murphy's sign -- how?
    look into a fist and see if the knuckles make a straight line, checking out alignment of MCP joints -- the 3rd one should be higher
  30. Murphy's sign - tests for what?
    lunate dislocation (or at least, if the MCPs are in a straight line that's one explanation)