Deck 9: The Wrist and Hand Complex

Question 1

Which of the following is the anatomical basis of the longitudinal palmar arch?

A) The adjustable positions of the first,fourth,and fifth metacarpals around the fixed second and third metacarpals,and the musculature of the flexor digitorum profundus (FDP)and flexor digitorum superficialis (FDS)
B) The fact that the third metacarpal is the longest bone in the hand
C) The relatively mobile unit formed by the second and third metacarpal as they articulate with the trapezium and trapezoid,and the musculature of the FDP and FDS
D) The carpal arch

Answer 1

A

Question 2

The range and direction of motion at the first carpometacarpal (CMC)joint produces opposition of the thumb.Opposition is sequentially ____________________.

A) abduction,flexion,and adduction of the first metacarpal
B) adduction,flexion,and abduction of the first metacarpal
C) abduction,extension,and adduction of the first metacarpal
D) Opposition does not occur at this joint.

Answer 2

A

Question 3

Which carpal bone is not part of the wrist complex?

A) Scaphoid
B) Lunate
C) Trapezoid
D) Pisiform

Answer 3

D

Question 4

Which of the following muscles is the primary finger flexor of digits two through five?

A) Flexor digitorum superficialis (FDS)
B) Flexor digitorum profundus (FDP)
C) Lumbricales
D) Interossei

Question 5

Tip-to-tip prehension involves which of the following muscle groups?

A) Extensor carpi ulnaris,extensor carpi radialis longus,and flexor pollicis brevis
B) Flexor digitorum profundus,opponins pollicis,and abductor pollicis brevis
C) Flexor digitorum profundus and flexor pollicis longus
D) B and C

Question 6

This structure of the extensor mechanism lies volar to the axis of the proximal interphalangeal (PIP)and dorsal to the axis of the PIP.

A) Flexor digitorum profundus (FDP)
B) Lumbricles
C) Oblique retinacular ligament (ORL)
D) Transverse retinacular ligament

Question 7

Your patient demonstrates limited wrist flexion.Which of the following ligaments would be taut in full wrist flexion?

A) Volar radiocarpal ligaments
B) Dorsal radiocarpal ligaments
C) Radial collateral ligament
D) Quadrate ligament

Question 8

The purpose of the volar plate of the metacarpophalangeal (MCP)joint of the finger is to:

A) Restrict MCP joint mobility.
B) Act as a point of insertion for the interossei muscles and extensor digitorum.
C) Prevent pinching of the long flexor tendons during finger flexion.
D) Add surface area to the head of the metacarpal.

Question 9

Extension of the metacarpophalangeal (MCP)joint of the second digit results in a ________________roll and a ________________glide of the proximal phalanx on the metacarpal.

A) dorsal,dorsal
B) volar,volar
C) dorsal,volar
D) volar,dorsal

Question 10

In which of the following types of grip does the thumb play a very minimal role?

A) Hook grip
B) Tip-to-tip prehension
C) Spherical grip
D) Cylindrical grip

Question 11

Which of the following muscles is the only muscle capable of extending the metacarpophalangeal (MCP)joint of the digits?

A) Interossei
B) Lumbricales
C) Extensor digitorum
D) Extensor carpi ulnaris

Question 12

Which of the following muscles act as strong interphalangeal (proximal interphalangeal [PIP] and distal interphalangeal [DIP])extensors and weak metacarpophalangeal (MCP)flexors?

A) Interossei
B) Extensor indicis
C) Lumbricales
D) Oblique retinacular ligaments

Question 13

In abduction of the first carpometacarpal (CMC)joint,the first metacarpal would roll in a ________________direction and glide in a ________________direction on the trapezium.

A) volar,dorsal
B) radial,ulnar
C) volar,volar
D) radial,radial

Question 14

Which of the following is true regarding the proximal interphalangeal (PIP)and distal interphalangeal (DIP)joints of the digits two through five?

A) They are not true synovial joints.
B) They do not have any collateral ligaments to resist valgus and varus stresses.
C) The proximal articulating surface is larger than the distal articulating surface.
D) They are biaxial joints with two degrees of freedom.

Question 15

Which ligament blends with the triangular fibrocartilage complex (TFCC)of the wrist?

A) Radial collateral ligament
B) Ulnar collateral ligament
C) Volar radiocarpal ligament
D) Dorsal radiocarpal ligament

Question 16

Which of the following carpal bones shows the greatest amount of motion during wrist flexion/extension?

A) Scaphoid
B) Lunate
C) Triquitrum
D) Pisaform

Question 17

Which of the following factors would explain why there is a weaker grip on the ulnar side of the hand?

A) Active finger flexion range of motion (ROM)increases from the radial to the ulnar side of the hand,lending to increased occurrence of active insufficiency of the ulnar digits.
B) Active finger flexion ROM increases from the ulnar to the radial side of the hand,lending to increased occurrence of active insufficiency of the radial digits.
C) Active finger flexion is the same in all fingers.
D) Weaker grip is not possible with the ulnar side of the hand.

Question 18

The midcarpal joint favors which of the following directions?

A) Flexion and radial deviation
B) Flexion and ulnar deviation
C) Extension and ulnar deviation
D) Extension and radial deviation

Question 19

Which of the following statements is true regarding the extensor mechanism of the fingers?

A) Lumbricales and interossei allow active metacarpophalangeal (MCP)joint flexion,and proximal interphalangeal (PIP)and distal interphalangeal (DIP)joint extension.
B) Extensor digitorum extends the PIP and DIP joints,but not the MCP joint.
C) Lumbricales and interossei work to extend the MCP joint against the force of the long finger flexors.
D) Extensor digitorum is the only muscle that can extend the DIP joint.

Question 20

Which of the following best represents the closed pack position of the wrist?

A) 15° wrist flexion
B) 10° wrist extension
C) Full wrist flexion
D) Full wrist extension

Question 21

If finger flexion strength is measured at each extreme of the four wrist motions,which position is least effective for grasp? If wrist positions were combined (multiplanar),which would give the most effective grip?

Question 22

What role do the ligaments of the wrist joint play in wrist motion?

Question 23

Describe the joint capsule of the midcarpal joint.

Question 24

What metacarpophalangeal (MCP)joint position is most prone to injury and why?

Question 25

What requirement does spherical grip have that differentiates it from a cylindrical grip?

Question 26

What role does the transverse metacarpal ligament play at the carpometacarpal (CMC)joint? What role at the metacarpophalangeal (MCP)joint?

Question 27

What is the finest (most precise)form of prehension that can be accomplished by someone without intact intrinsic or extrinsic hand function?

Question 28

What secondary motions do the extensor pollicis longus,pollicis brevis,and abductor pollicis longus cause at the wrist? What synergy do they require to function effectively as thumb extensors?

Question 29

Why can't the distal interphalangeal (DIP)joint be actively extended if the proximal interphalangeal (PIP)joint is fully flexed?

Question 30

What is the major function of the wrist complex?

Question 31

Why is it hypothesized that the ECU is active during wrist flexion?

Question 32

Describe the attachments of the interossei and lumbricales to the extensor mechanism.How do these attachments enable these muscles to contribute to interphalangeal (IP)extension?

Question 33

Describe the radiocarpal joint,including its articular surfaces,its general range of motion,and the direction of intra-articular movement.

Question 34

At what points in the range do each of the following joint motions begin and end as the wrist moves from flexion to extension: (a)radiocarpal motion,(b)midcarpal motion,or (c)distal carpal row/scaphoid on lunate/triquetrum.

Question 35

What are the annular pulleys (vaginal ligaments)? Where are they found and what function(s)do they serve?

Question 36

Compare the joint structure of the metacarpophalangeal (MCP)joints with that of the interphalangeal (IP)joints of the fingers.Identify both similarities and differences.