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 |