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Elbow complex includes what?
- 3 bones
- 3 ligaments
- 1 capsule
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Which 3 bones are in the elbow complex?
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Which 3 ligaments are in the elbow complex?
- medial collateral
- lateral collateral
- annular
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which capsule is in the elbow complex?
joint capsule
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What is the elbow joint articulation?
the humerus with the ulna and radius
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the elbow uniaxial joint allows only what?
extension/flexion of 145 degrees
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An elbow having no active hyperextension motion is blocked by what?
olecranon process of ulna fitting into the olecranon fossa of the humerus
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What type of joint is the radioulnar joint?
uniaxial pivot joint
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The radioulnar joint allows only what?
- pronation - 80 degrees
- supination - 90 degrees
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Where does the radioulnar joint articulate?
- b/t the radius and ulna
- there is articulation at both ends
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What forms the inferior/distal radiulnar joint?
the distal end of the radius rotating around the distal end of the ulna
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What forms the superior/proximal radioulnar joint?
the head of the radius pivoting w/in the radial notch of the ulna
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When pronation/supination occur the _______ moves around and the _______ does not
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What forms the carrying angle-anatomical position?
the longitudinal axes of the humerus and forearm
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What is the carrying angle in women?
10-15 degrees
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What is the carrying angle in men?
5 degrees
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What is the end feels for supination?
firm muscle ligament tension and soft tissue stretch
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What is the end feels for pronation?
hard contact b/t the radius and ulna
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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
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What shape is the medial collateral ligament?
triangular
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How far does the medial collateral ligament span?
the medial side of the elbow
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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
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what shape is the lateral collateral ligament?
triangular
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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
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What 2 ligaments provide a great deal of medial/lateral stability to the elbow?
lateral collateral & annular ligament
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where does hte annular ligament attach?
anteriorly and posteriorly to the radial notch of the ulna
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what does the annular ligament do?
encompasses the head of the radius and holds it against the ulna
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where does the joint capsule attach?
- around the distal end of the humerus
- surrounds the trochlea and capitulum & the fossas located above them
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______ & _______ hold the radioulnar articulations together
annular ligament & interosseous membranes
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In a closed chain does the proximal segment move or is it fixed?
moves
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In an open chain does the proximal segment move or is it fixed?
fixed
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In a closed chain does the distal segment move?
no
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In an open chain does the distal segment move?
yes
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What is the interosseous membrane?
broad flat membrane located b/t the radius and ulna for most of their length
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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
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Where does the interosseous membrane attach?
at the base of the annular and medial collateral ligaments
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What is the cubital fossa?
shallow somewhat triangular depression on the anterior elbow
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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
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What are some common elbow pathologies?
- Lateral epicondylitis (tennis elbow)
- medial epicondylitis (golfer's elbow)
- Pulled elbow (nursemaids elbow)
- Elbow dislocation
- Supracondylar Fracture
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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
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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
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What does the force on the arm in Pulled Elbow cause?
the radial head to sublux out from under annular ligament
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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
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What is the most common fracture in children caused by falling on outstretched hands?
supracondylar fracture
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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
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What can a supracondylar fracture lead to in very rare cases?
volmann ischemnic contracture
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What are the possible synovial joint shapes?
- irregular (plane)
- saddle
- hinge
- pivot
- condyloid
- ball-socket
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how many axes can synovial joints have?
0-3
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When has a muscle become actively insufficient?
when it has contracted over all its joints as far as it can
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What determines whether an action is an open or closed kinetic chain movement?
whether the distal segment is fixed
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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
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Which 2 biaxial joints make up the wrist joint?
radiocarpal & midcarpal
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the radiocarpal joint consists of which end of the radius?
the distal end of the radius
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The radiocarpal joint consists of what proximately?
the radioulnar disks
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The radiocarpal joint consists of what distally?
- scaphoid
- lunate
- triquetrium
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Does the Pisiform articulate with the radiocarpal joint?
no
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What does the biaxial joint allow?
- flexion
- extension
- radial/unlar deviation
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Where are the midcarpal/intercarpal joints located?
b/t the two rows of carpal bones
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What do the midcarpal and intercarpal joints contribute to?
wrist motion
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What shape do midcarpal/intercarpal joints have?
irregular - classified as plane joints
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midcarpal/intercarpal joints are ________ joints that allow ________ motions
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Where is the CMC located?
b/t the distal row of carpal bones and proximal end of hte metacarpal bones
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What are the various joint motions?
- wrist flexion/palmar flexion
- neutral/extension, neutral
- extension/hyperextension, dorsiflexion
- radial deviation/abduction
- ulnar deviation/adduction
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What constitutes wrist flexion/palmar flexion?
- fingers down/sagittal
- frontal/soft tissue stretch
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What constitutes neutral/extension, neutral?
- anatomical position
- saggital-frontal
- soft tissue stretch
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What constitutes extension/hyperextension, dorsiflexion
- posterior from anatomical position
- s-f
- soft tissue stretch
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What constitutes radial deviation/abduction?
- lateral from anatomical position
- f-s
- bony end feel
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What constitutes ulnar deviation/adduction?
- medial from anatomical position
- f-s
- soft tissue stretch
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Where does the radial collateral ligament attach?
- to the styloid process of the radius
- to the scaphoid & trapezium bones
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Where does the ulnar collateral ligament attach?
- to the styloid process of the ulna
- pisiform/triquetrium
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which 2 ligaments provide lateral and medial support to the wrist joint?
radial collateral ligament & ulnar collateral ligament
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What does the palmer radiocarpal ligament limit?
wrist extension
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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
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Where does the dorsal radiocarpal ligament attach?
posterior surface of the distal radius to the scaph, lunate, triquetrium
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What does hte dorsal radiocarpal ligament limit?
the amount of flexion allwed by the wrist
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Is the dorsal radiocarpal ligament as strong as the palmer radiocarpal ligament?
no
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What does the joint capsule enclose?
radiocarpal joint
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what is the joint capsule reinforced by?
the radial/ulnar collateral ligaments & palmer/dorsal radiocarpal ligaments
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how much motion does an isometric contraction have?
relatively none
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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
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What are the palmar fascia/palmer aponuerosis?
- relatively thick, triangular
- located superficially in the palm of the hand
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what do the palmar fascia/palmer aponeurosis cover?
tendons of the extrinsic mm and provides protection to the structures in the palm
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do mm attachments move closer together or further apart with a concentric contraction?
closer together
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what is an eccentric contraction?
- decleration activity
- lengthening of mm
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when using a longer lever arm is more or less force needed?
less force
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does working against gravity require more work than working with gravity or when gravity is eliminated?
yes
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What are the joints of the hand from top to bottom?
- distal interphalangeal DIP
- proximal interphalangeal PIP
- Metacarpal MCP
- Carpals CMC
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CMC - hand is what kind of joint?
nonaxial plan (irregular) synovial joints
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Which does the CMC in the hand provide more of - stability or support?
stability
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What shape joint is the Metacarpal MCP?
- biaxial condyloid joint
- convext rounded heads of the metacarpals
- knuckles
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What actions do the Metacarpal MCPs do?
- flexion
- extension
- hyperextension
- adduction
- abduction
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What is the flexor retinaculum made up of?
palmar/tranqnsverse carpal ligament
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Where does the flexor retinaculum attach?
spans the ant surface of the wrist in a horizontal direction
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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
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Carpal Tunnel is made up of what?
- 4 flexor digitorum profundus
- 4 flexor digitorum superficialis
- 1 flexor pollicis longus
- 1 median nerve
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Where is the extensor retinaculum ligament located?
top part of the hand
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what does the extensor retinaculum ligament do?
holds extensor tendons close to the wrist during wrist extension
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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
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Where is the proximal carpal arch and what is it maintained by?
- proximal end of metacarpals and carpal bones
- maintained by flexor retinaculum
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Common wrist/hand pathologies
- colle's fracture
- smith's fracture
- greenstick facture
- gangilion cist
- carpal tunnel syndrome
- tenosynovitis
- DeQuervains disease
- Dupuytren's ontracture
- stenosing tenosynovitis
- skiier's thumb
- swan neck deformity
- ulnar drift
- mallet finger
- scaphoid fracture
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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
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What is Smith's fracture and what causes it?
- distal fragment is displaced anteriorly
- caused by a fall on the back of the hands
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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
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What is a gangilion cist?
a benign tumor mass commonly seen as a bump on the top surface of the wrist
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what causes carpal tunnel syndrome?
compression of median nerve
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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
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What is tenosynovitis?
inflammation of tendons and surrounding sheaths
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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
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What is stenosing tenosynovitis (trigger finger)
a problem with the sliding mechanism of a tendon in its sheath
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what is skiier's thumb?
ana cute tear of the ulnar collateral ligament of thumb
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What is involved in swan neck deformity?
- flexion @ MCP
- hyperextension of the PIP
- flexion of the DIP
- (boutonnierre deformity in opposite direction)
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What is an ulnar drift?
ulnar deviation of the fingers at MCP joint
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What causes mallet finger?
- disruption of the extensormechanism of DIP joint
- from tendon severed or tore away from the distal phalanx
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What causes a scaphoid fracture?
- fall on outstretched hand of a younger person
- poor vascular supply risk of avascular necrosis
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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
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What is the power grip of the hand?
- isometric contraction with no movement b/t hand and object being held
- (i.e. - hammer/doorknob)
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What is the cylindrical grasp?
- all fingers flexed around the object with thumb in opposite direction
- (i.e. - holding hammer, racquet, or wheelbarrow handle)
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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)
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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)
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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
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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)
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What is the most common precision grip?
three jaw chuck - thumb & 2 fingers holding a pencil
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Which grips are used to pick up a coin?
- pinch grip (pincer)
- tip to tip grip - tip of thumb against another digit
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What grip is used to put keys in car ignition?
pad to side - lateral prehension
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which grip is difficult with long nails?
pincer
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what grip is used to hold a cigarette?
- side to side grip
- not much precision
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What type of contractions are used to stabalize or hold a body part in position?
isometric
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Which 3 grips are used for power hand movements?
- cylindrical
- spherical
- hook
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If a grip isn't used for power hand movements what is it used for?
precision hand movement
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Does a convex joint surface move in the opposite direction of the body segment movement?
yes
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Does a concave joint surface move in the same direction as the body's segment movement?
yes
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Sagittal plane divides the body into what?
left and right parts
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Frontal plan divides the body into what?
front and back
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transverse dives the body into what?
top and bottom parts
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