Upper Extremity Lecture

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Biomechanics of Elbow,Wrist & Hand:

Biomechanics of Elbow,Wrist & Hand June 2016

Elbow Complex:

Elbow Complex Humoulnar Jt Between trochlear & ulnar notch Humeroadial Jt Between capitellum & head of radius Proximal Radioulnar Jt. Between head of radius & radial notch

Elbow Ligaments:

Elbow Ligaments Medial Collateral Ligament/Ulnar Collateral Ligament Strong ligament with anterior, posterior and transverse bands Lateral Collateral Ligament/Radial Collateral Ligamemt Weak ligament that attaches to the annular ligament Annular Ligament Strong circular ligament that wraps around radial head

Elbow Movement:

Elbow Movement Osteokinematic Joint Movement Flexion 0-140/150 degrees Prontation 0 – 80/90 degrees Supination 0-80/90 degrees Carrying Angle 5 degrees in males 10-15 degrees in females ** Results from medial end of trochlea being distal to capitellum which positions the ulna and radius at an angle lateral to the humerus

Elbow Movement:

Elbow Movement Arthokinematic Joint Movements – Let’s Review!! Humeroulnar flexion Humeroradial flexion Humeroulnar extension Humeroradial extension Promation Supination

Wrist:

Wrist Distal Radioulnar between the head of the ulna and the ulnar notch of the radius; supination and pronation Radiocarpal joint between the distal radius and the scaphoid and lunate bone flexion/extension Ulnocarpal joint between the head of the ulna and an interarticular disc and between the disc and the triquetrum; flexion/extension Midcarpal joint between the proximal carpal row and the distal carpal row; flexion/extension, radial and ulnar devation

Wrist:

Wrist What is the difference between extrinsic and intrinsic ligaments? Extrinsic Ligaments Radius/Ulna to carpal bone Intrinsic Ligaments Dorsal/Palmar intrinsic – Named by the carpal bones they attach Interosseous - Between adjacent carpal bones

Wrist Movements:

Wrist Movements Osteokinematics Flexion 0-85/90 degrees Extension 0-75/80 degrees Radial Deviation 0-15/20 degrees Ulnar Deviation 0-35/37 degrees Pronation 0-80/90 degrees Supination 0-80/90 degrees

Wrist Arthrokinematics:

Wrist Arthrokinematics Proximal Row Bones: Scaphoid, Lunate, Triquetrum, Pisiform Distal Row Bones : Trapezium, Trapezoid, Capitate, Hamate **Mnemonic So Long To Pinky Here Comes The Thumb

How do to the carpal bones move? :

How do to the carpal bones move?

Wrist Arthrokinematics:

Wrist Arthrokinematics Palmar flexion 60% of the movement occurs at the midcarpal joint 40% of the movement occurs at the radiocarpal joint  Dorsiflexion (Extension) 60 - 70% of the movement occurs at the radiocarpal joint 30 - 40% of the movement occurs at the midcarpal joint

Muscles of the Wrist:

Muscles of the Wrist Wrist is designed to withstand compression Compression is transmitted mainly through the lunate/scaphoid to the radius and less so through fibrocartilage disc to ulna About 80% of the compression forces at the wrist are transmitted to the large distal radius About 20% of the compression forces by disc What happens in a FOOSH? 3 rd metacarpal  capitate  lunate & scaphoid  radius

Muscles of the Wrist:

Muscles of the Wrist Extensors – ECRL, ECRB, ECU, ED, EI, EDM Flexors – FCR, FCU, FDS, PL Radial Deviation – ECU, FCU Ulnar Deviation – ECRL, ECRB, FCR (Abductor pollicis longus, extensor pollicis brevis)

Muscle of the Wrist:

Muscle of the Wrist Where do these muscles attach? Common Extensor Tendon (4) Extensor Carpi Radialis Brevis Extensor Carpi Ulnaris Extensor Digitorum Extensor Digit Minimi

Muscles of the Wrist:

Muscles of the Wrist Common Flexor Tendon (5) Flexor Carpi Radialis Flexor Carpi Ulnaris Palmaris Longus Flexor Digitorum Superficialis (part) Pronator Teres (part)

Wrist Function:

Wrist Function Wrist Extension Stretches finger flexors to take up elastic component of muscles and increase force production Slackens finger extensors which decreases force production Can’t fully extend fingers!! Wrist Flexion Stretches finger extensors to take up elastic component of muscles and increase force production Slackens finger flexors which decreases force production Can’t fully flex fingers!! ** What position of wrist produces greatest grip strength?

The Hand:

The Hand Osteology Carpals Metacarpals Phalanges Joints Carpal Metacarpal (CMC) Metacarpal Phalangeal (MCP) Proximal Interphalangeal (PIP) Distal Phalangeal (DIP) Interphalangeal of Thumb (IP)

Arches of the Hand:

Arches of the Hand Proximal transverse arch is at level of the distal carpal row and carpometacarpal joints Distal transverse arch is through the heads of the metacarpals at the metacarpophalangeal joints Longitudinal arch extends through the center of the hand from the proximal carpal row through the four fingers **Arches are maintained by the intrinsic muscles of the hand

Ranking of Extrinsic Muscles by Force:

Ranking of Extrinsic Muscles by Force 1. flexor digitorum superficialis (FDS) 2. flexor digitorum profundus (slightly less than flexor digitorum superficialis ) 3. extensor digitorum ( 1/3 of FDS) 4. flexor pollicis longus ( 1/4 of FDS) 5. extensor indicis ( 1/10 of FDS) 6. abductor pollicis longus ( 1/10 of FDS) 7. extensor pollicis longus ( 1/50 of FDS) extensor pollicis brevis ( 1/50 of FDS) ** Notice that the force output of the flexor digitorum superficialis and profundus is much greater then that of the extensor digitorum

Actions of Fingers & Thumb:

Actions of Fingers & Thumb Extrinsic vs Intrinsic muscle actions Fingers move in reference to the middle finger for abduction and adduction Know finger & thumb movements in reference to planes of the body Sagittal/Frontal Don’t forget convex/concave rule for fingers & thumb Know your nerves (Median, Radial, Ulnar)

Questions :

Questions

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