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how many degrees of freedom in wrist?
2
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what kind of joint is the radiocarpal joint?
ellipsoidal - 2 degrees of freedom - it can do circumduction bc so round
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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
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tell me about the mid carpal joint
- it's S shaped
- lat part is plane
- medial part is condylar
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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
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how to move carpals to increase ext, flex, rad dev, unlar dev?
- ext: volar
- flexion: dorsal
- rad dev: ulnar
- ulnar dev: radial
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how many mobilization techniques do we have for the carpals?
5 - flex ext rad ulnar distraction
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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
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how do you do med/lat glide at mid-carpal joint?
you can't due to the S shape of the joint
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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
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zero starting pos of the wrist?
longitudinal axes thru the radius and 3rd metacarpal are in a straight line
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close packed for midcarpal jt?
ext w ulnar dev
45 ext - carpals acta as a functional unit as you go further into ext
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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)
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ulnar/rad dev - which more, why?
ulnar > radial bc of big radial styloid process
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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)
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radiocarpal close-packed pos?
extension
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midcarpal jt resting pos
neutral or slight flexion w ulnar dev
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capsular pattern for midcarpal joint?
- flex = ext
- "works w RC jt"
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capsular pattern for radiocarpal joint
restricted equally in all dir
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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)
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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)
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a movement to remember in wrist glides?
piccolo distraction
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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
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Tourniquet test
put a sphigmometer on prox to elbow, inflate, see if there's tingling within 60 sec - tests the median N.
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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
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tenosynovitis def
inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon
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Watson's test - how?
stabilize radius, put thumb on scaphoid, glide in ulnar & radial dev, looking for pain, crepitus, clicking
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Watson test - what for?
scaphoid-lunate instability/dissociation
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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
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Murphy's sign - tests for what?
lunate dislocation (or at least, if the MCPs are in a straight line that's one explanation)
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