| Question | Answer |
|---|---|
| What does the distal Radius articulate with | Scaphoid and Lunate |
| Lister's Tubercle is a pulley for what | Extensor pollicis longus |
| where is the TFCC located | medial edge of the radius |
| What does a Colle's fracture Result in? | the ulnar being longer than the radius… Ulnar positive variance |
| what does the distal ulna articulate with | not the carpals |
| what are the proximal row carpals | scaphoid lunate triquetrum pisiform |
| what are the distal row carpals | Trapezius Trapezoid Capitate Hammate |
| Is the scaphoid concave of convex | convex |
| most frequently fracture hand bone | scaphoid |
| midline of the wrist | scaphoid |
| where do all of the fingers angulate towards | scaphoid |
| is the lunate concave or convex | both, convex proximally and concave distally |
| what is the central bone in the proximal row of the hand | lunate |
| what is keinbock's disease | Associated with the lunate; it is an avascular necroses due to trauma |
| most frequently dislocated hand bone | lunate |
| what bone is the attachment site for the UCL | triquetrum |
| which bone is distal to the ulnar styloid process | triquetrum |
| what bone is formed with the Flexor carpi ulnaris tendon | pisiform |
| which bone is the medial border of guyons canal | pisiform |
| the trapezium shape | proximally and medially concave, distally saddle shaped |
| what bone does the trapezium articulate with | trapezoid |
| what is the lateral attachment for the RCL | trapezium |
| what two carpals sandwich the trapexoid | capitate and trapezium |
| what is the lateral border of Guyons tunnel | hook of hammate |
| central bone of the distal hand bones | capitate |
| What type of joint is the thumb joint | diarthrodial Saddle, articulation of 1st metacarpal and trapezium |
| what bones do the 2nd metacarpal articulate with | trapezoid, trapezium, and capitate |
| what bones do that 3rd metacarpal articulate with | capitate |
| what bones to the 4th metacarpal articulate with | capitate and hammate |
| what bones do the 5th metacarpal articulate with | hammate |
| radoiocarpal joint arthrokinimatics | convex scaphoid, lunate and triquetrum on concave radial facet and TFCC disc |
| how many degrees of flexion and extension are at the radoiocarpal joint | flexion: 35 extension: 45 |
| what type of joint is the mid carpal joint | synovial condyloid joint |
| arthrokinimatics of mid carpal joint | convex distal row on concave proximal row |
| AKM of ulnar deviation at the mid carpal joint | Capitate and hammate roll ulnar/ glide radial, trapezium and trapezoid glide palmarly |
| AKM of radial deviation at the mid carpal joint | capitate and hammate roll radial/ glide ulnar, trapezium and trapezoid glide dorsally |
| most common joint location for OA in the hand | 1st CMC joint (thumb) |
| flexion of thumb AKM | concave MC rolls and glides ulnar |
| extension of thumb AKM | concave MC tolls and glides radial |
| abduction of thumb AKM | convex MC rolls palmarly and glides dorsally on concave trapezium |
| adduction of thumb AKM | convex MC rolls dorsally and glides palmarly on concave trapezium |
| what type of joint is the radiocarpal, mid carpal and MCP joint s | synovial condyloid |
| what type of joint is the distal radioulnar | pivot |
| distal radio-ulnar joint AKM | concave ulnar notch (on radius) and convex ulnar head (articular disc (TFCC)) |
| what actions occur at the distal radio-ulnar joint | pronation and supination (1 DF) |
| what type of joints are the cmc joints 2-4 | plane synovial (1DF) |
| MCP joint AKM | concave base of proximal phalanx on convex MC head |
| PIP joint AKM | concave base of middle phalanx on convex head of proximal phalanx |
| DIP joint AKM | concave base of distal phalanx on convex head of middle phalynx |
| what type of joints are the PIP and DIP joints | hinge |
| purpose of radioulnar joint | stabilize the forearm during pronation/ supination |
| common fracture site of the wrist | distal radio-ulnar joint, radius displaced palmarly |
| distal radioulnar joint supination AKM | concave ulnar notch on radius glides dorsal, ulnar head moves proximal and medial (anterior) |
| distal radio-ulnar joint pronation AKM | concave ulnar notch glides anteriorly on ulnar head, ulnar head moves distally and dorsally |
| what causes the fingers to angulate toward the scaphoid | IP, PIP and DIP joints |
| which digit has the tightest grip | 5th |
| which has greater ROM, PIP or DIP | PIP |
| when do IP joints have the greatest force | ulnar deviation |
| when to IP joints have the least force | wrist flexion |
| which muscles do not pass under the flexor retinaculum | palmaris longus and flexor carpi ulnaris |
| primary flexor of the wrist | Flexor carpi radialis |
| which muscle flexes the wrist as well as the PIP joints | Flexor digitorum superficialis |
| which muscle the wrist and the DIP joints | flexor digitorum profundus |
| which wrist flexor is likely to become actively insufficient | flexor digitorum profundus |
| which muscles make up the largest part of the dorsal wrist extensor mass | extensor carpi radialis longus and brevis |
| where does the Extensor carpi ulnaris connect to prevent bowstringing | TFCC |
| which muscle exchanges intertendinous connections with Ext indicus | extensor digitorum communis |
| which muscle lies between the ECRL and braves and extends the wrist and digits 2-5 | extensor digitorum communis |
| which extensor muscle of the hand passes through a a separate synovial compartment | extensor digitorum minimi |
| extends IP joint of the thumb | extensor pollicis longus |
| which are the extrinsic thumb muscles | Flexor pollicis longus, extensor pollicis brevis, abductor pollicis longus |
| which are the intrinsic thumb muscles | opponens pollicis, abductor pollicis brevis, flexor pollicis brevis, adductor pollicis |
| which muscle sits between the sesamoid bones in the hand | flexor pollicis longues |
| which muscles arise from the FDP in the palm | lumbricals |
| which muscles pass anterior and dorsally to the transverse metacarpal ligament | interossei: dorsal, lumbricals: anterior |
| where do the lumbricals attach | lateral band of extensor hood |
| lumbrical action | IP extensors and flexion at MCP joint |
| TFCC blood supply | very poor, only about 20 % is vascularized |
| ulnar negative variance | TFCC is thicker, short ulnar, causes kneinbocks disease |
| ulnar positive variance | TFCC is thinner, long ulna, causes impingement |
| loading of TFCC | 80% from scaphoid lunate and radius 20% TFCC and ulna |
| carpal tunnel | 4 tendons of FDS, 4 tendons of FDP, 1 tendon of FPL, median N, flexor retinaculum, transverse carpal ligament |
| does radoiocarpal joint have more extension or flexion | extension |
| which works harder, wrist flexors or extensors | flexors X2 |
| A1 pulley | head of MC |
| A2 pulley | volar side of proximal phalanx |
| A3 pulley | distal portion of proximal phalanx |
| A4 pulley | central on middle phalanx |
| A5 pulley | if present….. base of distal phalanx |
| C1 pulley | between A2 and A3 |
| C2 pulley | between A3 and A4 |
| C3 pulley | Between A4 and A5 |
| thumb includes which ligaments | 2 annular and 1 oblique |
| types of power grip | cylindrical, spherical, hook, lateral |
| types of precision handling | two jaw chuck, three jaw chuck, pad to pad, tip to tip, pad to side |
| cylindrical grin involves mainly which muscle | FDP |
| spherical grip involves mainly which muscles | interossei |
| hook grip involves mainly which muscles | FDS and FDP |
| two jaw chuck | thumb and index finger |
| pad to pad is… | 80% of all precision handling |
| tip to tip is… | most precise form of grip, needs FDP FPLand interossei to function |
| pad to side is… | known as the "key grip" and is least precise |
| mechanical Axis vs. Anatomical Axis | M: through head of femur, A: through shaft of femur |
| longitudinal axes form angle medially @ knee joint of… | 185 degrees |
| Screw Home mechanism | when locking into extension, Medial condyle with cause ER of the tibia because it is longer than the lateral condyle |
| knee flexion to extension closed chain | Femur IR |
| knee flexion to extension open chain | Tibia ER |
| knee extension to flexion closed chain | Femur ER |
| Knee extension to flexion open chain | Tibia IR, unlocked by politieus, before flexion |
| 3 factor's guiding "screw home" | 1. shape of medial femoral condyle. 2. tension of ACL. 3. Lateral pull of quads |
| semitendinoses OIA | O: ischial tub I: Pes anseurin A: Extend thigh, IR @ knee when flexed |
| Semimembranoses OIA | O: ischial tub I: medial meniscus A: Extend thigh, IR @ knee when flexed |
| Biceps Femoris OIA | O: ischial tub and lateral supracondylar line I: head of fib A: extend thigh flex knee, Knee ER when flexed |
| Popliteus OIA | O: lat meniscus/ condyle I:post tibia A: unlock knee by IR tibia |
| Sartorius OIA | O: ASIS I: pes ansuerine A: *cross legs |
| Gracilis OIA | O: Inf pubic ramus I: pes ansuerine A: adduct IR |
| Knee extensors MA is greatest at…. degrees | 45 degrees of flexion |
| all of the knee extensors insert where? | patella and tibial tuberosity |
| Rectus femoris Origin | AIIS |
| Vastus medialis Origin | Linea aspera and trochanteric line |
| Vastus lateralis Origin | intertrochanteric line |
| Vastus intermedius Origin | Anterior lateral femur |
| if the patella was removed the MA of the quads would be decreased by what % | 49% |
| what is patella alta | a long tendon… which makes the patella sit higher on the knee |
| what is patella baja | short tendon, can caused tight compression problems and OA |
| when the knee is fully extended how much patellar contact is made with the femur | little |
| when is the the patella at full contact with the femur | at 90 degrees |
| when does the patella equal the patella tendon | knee extension |
| the extensor retinaculum of the knee joint has two layers: deep and superficial.. what does the deep consist of? | longitudinal fibers, connecting capsule to the menisci by the coronary ligaments |
| the extensor retinaculum of the knee joint has two layers: deep and superficial.. what does the superfical consist of? | has transverse fibers which blend with vests medalis and laterails |
| where does the synovial lining of the knee joint capsule adhere to? | the inner wall of fibrous layer (but not posterior) and ACL/ PCL |
| what is synovial septa | (plicae) tissue on the inside of joint along the synovium, little synovial capsular tissue that regresses |
| transverse meniscal ligament | anterior horn of medial to lateral meniscus |
| coronary meniscal ligament | attaches meniscus to tibial plateau, highly innervated |
| meniscopatellar ligaments | attach meniscus to femur, pull menisci anterior during extension |
| lateral meniscus | O shaped, attaches to PCL and Popliteus, very mobile! |
| medial meniscus | C shaped, attaches MCL ACL and semimembranoses, not mobile, injured more than Lateral meniscus |
| peripheral 1/3 of meniscus anatomy | RED, vascularized, aneural |
| Middle 1/3 of meniscus anatomy | RED/WHITE semi vascularized, aneural |
| Inner 1/3 of meniscus anatomy | WHITE, avascular, anueral |
| what happens with the meniscus and patella during knee extension | meniscus pulled anterior by meniscopatellar ligaments, patella moves superiorly |
| what happens with the meniscus during knee flexion | medial meniscus is puled posteriorly by semimembranoses and lateral meniscus is pulled posteriorly by popliteus |
| when the meniscus is removed, what % of the contact area is decreased | 40% |
| what is the knee closed packed position | full extension |
| passive and active insuficiency | passive= cannot lengthen anymore active= cannot shorten anymore |
| what type of joint is the knee joint | double condyloid , 2 DF |
| which femoral condyle is longer? | medial |
| which tibial plateau is larger | medial |
| what is the shape of the lateral tibial plateua | it is a little convex, but with the lateral meniscus it become concave |
| where is the patellofemoral joint located | interface between the articular side of the patella and the intercondylar groove on the femur |
| what is the motion of the patella during tibial on femoral flexion | the patella slides against the femur |
| what is the motion of the patella during femoral on tibial flexion | the femur slides against the patella |
| what is the patellofemoral joint considered | anatomic pulley and reduces friction |
| during extension and flexion where does the patella slide on the femur | ext= ant surface of distal femur, flex= between femoral condyles |
| what are some external features on the patella | medial and lateral facets, groove or sucks, concave side to side, convex top and bottom |
| what is the patellofemoral joint congruence (extending the knee) | patella equals the patellar tendon |
| what happens with increase patellofemoral flexion | increased compression with increased flexion |
| what does the patella contribute to for the quads from full flexion to full extension | length of lever arm for quads muscle force |
| what happens to the patella in full flexion | patella is in the intercondylar groove, producing anterior displacement of quads |
| what happens to the patella as the knee extends | patella rises from the intercondylar groove producing significant anterior displacement of tendon |
| when does the length of the patellar tendon diminish | extension beyond 45 degrees |
| when does the patella contact the femur near its superior pole | at 135 degrees |
| at the superior pole, where does the patella rest? | below the intercondylar groove bridging the intercondylar notch of femur |
| what happens at 90 degrees to the patella in flexion | contact region on the patella starts to migrate down |
| what haps to the patella femoral joint between 90-60 degrees | greatest contact area of the patella |
| angle of inclination | between femoral neck and medial femoral shaft normally 125 degrees…. coxa vara < 125 and coxa alga is > 125 |
| femoral torsion | rotation between the fromoral shaft and neck, normally anteverted 15 degrees |
| excessive ante version can lead to | > 15 degrees = IR (pigeon toed) |
| Retrovesion | torsion < 15 degrees that cause excessive ER (toes point out) |
| what way is the femoral head typically oriented | medially, superiorly and anteriorly |
| center edge angle (angle of Wilberg) | how much the acetabulum covers the top of the femoral head… normally 35 degrees, |
| excessive center edge angle leads to… | > 40 degrees (coxa profunda) and leads to impingement (PENSOR) |
| insuffienct center edge angle leads to… | < 20 degrees(congenital dysplasia) leads to dislocation of joint |
| coxa vara | less than 125 degrees AOI |
| coxa valga | more than 125 degrees AOI |
| retroversion | any torsion degree less than 0 |
| acetabular labrum deepens the acetabulum socket by…. % | 30 |
| iliofemoral ligament | (Y ligament) attaches from the ilium to the intertrochanteric line of the femur taut in hip extension and ER, strongest hip ligament |
| pubofemoral ligament | superior pubic ramus to the femur, taut in hip abduction and extension, thin fibers |
| ischiofemoral ligament | attaches from the ischium to the femur,taut in full hip extension, IR, and adduction |
| closed packed position of the hip | (soccer player) extension, IR and abduction |
| innominate | pelvis– having no name, union of 3 bones (ilium, ischium and pubis) connected anteriorly by pubic symphysis and posteriorly by the sacrum. |
| pubic symphysis anatomy | immobile synarthrosis joint, lined with hyaline cartilage, interpubic disc and ligaments, provides stress relief during walking |
| resting position of the hip | (shaq) 30 deg flexion, 30 deg abduction, ER |
| bony closed packed position | 90 deg flexion, abduction, ER |
| ligamentous closed packed position | (kicking soccer ball) |
| average pelvic on femoral motion | 30 degrees of anterior pelvic tilt or 15 degrees of posterior pelvic tilt while sitting |
| if someone is standing on the left leg, and the pelvis laterally tilts up on the right.. then the left hip is…. | abducted (pelvic hike) |
| if someone is standing on the left leg, dropping the pelvis on the right results in… | adduction of the left hip joint (pelvic drop) |
| the cane should be used on the…. side of the injured leg | contralateral |
| the briefcase should be carried on the….. side of the injured leg | ipsilateral (side of injury) |
| what are the primary hip internal rotators | none |
| which finger does not have a dorsal interossei | 5th |
| which fingers have proximal and distal interossei attachments | middle and ring |
| where does the TFCC transmit force too | hand to forearm |
| ape hand | median N |
| claw hand | ulnar n, intrinsic minus position because of no interrossei or lumbricals |
| dypuytrens contracture | 4th and 5th flexor contracture and palmar aponeurosis scarring |
| mallet finger | extensor digitorum at distal phalanx and flexion of DIP |
| intrinsic plus | flexion @ MCP extension @ PIP and DIP |
| extrinsic plus | MCP joint hyperextension IP flexion (claw hand) |
| extensor hood | serves as a cable system for extension of MCP and IP joints, extensor muscles pull extensor hood and pull MCP joint |
| intrinsic muscles of the hand | extend DIP and PIP |
| extrinsic muscles of the hand | create tension in the central tendon and lateral bands pulling those structures proximally (towards wrist) |
| flexor mechanism | relaxation of central tendon, lateral band relaxes , FDS and FDP flex pip and dip |
| muscles responsible for flexion of PIP and DIP | PIP= FDS, DIP= FDP |
| lateral collateral ligament of knee prevents… | varus and IR of tibia |
| MCL of knee prevents… | valgus, extension, ER of tibia, |
| ACL of knee prevents… | ant displacement of tibia on femur (tested in flexion) |
| PCL of knee prevents | post displacement of tibia on femur |
| which muscle tendon reinforces the anterior region of the petellofemoral joint capsule | quads |
| which muscle tendons reinforce the lateral region of the petellofemoral joint capsule | LCL, biceps femoris, popliteal tendon, gastroc |
| which muscle tendons reinforce the posterior region of the petellofemoral joint capsule | popliteus, gastroc, hamstrings |
| which muscle tendons reinforce the posterolateral region of the petellofemoral joint capsule | popliteal tendon |
| which muscle tendons reinforce the medial region of the petellofemoral joint capsule | semimembranoses, sartorial, gracilis, semitendinoses |
| pelvic on femoral abduction | 30 degrees |
| pelvic on femoral adduction | 25 degrees |
| femoral on pelvic flexion | 120 degrees |
| femoral on pelvic extension | 20 degrees |
| femoral on pelvic abduction | 40 degrees |
| femoral on pelvic adduction | 25 degrees |
| femoral on pelvic IR and ER | IR- 35 degrees, and ER-45 degrees |
| piriformis action | ER until 90 degrees of hip flexion then it does IR |
| anterior fibers of the Gluteus Maximus action | ER until 90 degrees of hip flexion then it does IR |
| adductor longus action | aids hip extension when the hip is flexed, in a position to flex the hip when the hip is extended |
| what do the gracilis, adductor longs, adductor braves and pectinous have in common | greater contribution to hip flexion once it is flexed 40 to 50 degrees |
| hip adductors are____________ in neutral and.____________when hip is flexed | hip flexors, hip extensors |
| primary hip flexors | iliopsoas, sartorius, TFL, RF, adductor longus, pectineus |
| secondary hip flexors | adductor brevis, gracilis, glut max |
| primary hip extensors | glut max, BF LH, semitendinoses, membranoses, |
| secondary hip extensors | glut med |
| primary hip ER's | glut max, piriformis, obturator interns, gemellus's |
| secondary hip ER's | glut med, min, obturator externes, sartorius, BF LH |
| hip IR's | glut min, med, TFL adductor longus, adductor braves, pectineus |
| primary hip adductors | pectinous, adductor longs, gracilis, adductor brevis, adductor Magnus |
| secondary hip adductors | biceps femoris LH, glut max, quadrates femoris |
| primary hip abductors | glut med and min, TFL |
| secondary hip abductors | piriformis, satorius |