Exam 2 Flashcards
Movements at Elbow Joint
Flexion/extension, supination, pronation
Wrist joint
Flexion/Extension, Ulnar/Radial deviation
Fibrous Joints
Bones joined by fibrous tissue, such as the sutures in the skull or the pelvis, syndesmosis, gomphosis. They allow minimal movement.
Cartilaginous joints
The bones of cartilaginous joints are joined by cartilage. These joints allow a very small amount of movement. Ex: sternocostal joint between sternum and first rib.
Synovial joints
Consist of bones, joint capsule, synovial membrane, articulate covering of bony surface, nerve and blood supply, intrinsic and extrinsic ligaments (collateral ligaments).
Joints of the elbow
Humeroulnar joint-hinge joint, flexion/extension
Humeroradial joint- contributes to hinge, adds stability, carrying angle.
Movements at the elbow joint
Flexion of forearm, extension of forearm.
Primary Flexors of forearm
Brachialis and biceps brachii
Secondary flexors of forearm
Brachioradialus, flexor carpi radialus, flexor digitorum superficialis, flexor carpi ulnaris
Proximal radioulnar joint
Held I place by annular ligament, head of radius rotates with ligament. Dislocation called nursemaids elbow or pulled elbow.
What holds the radioulnar joint in place
Fibrocartilage articular disc
What bone of the forearm moves with pronation/supination and which one doesn’t
Radius moves, ulna does not.
Functions of interosseous membrane
Connects the radius and ulna, separates the anterior and posterior compartments of forearm, and distributes forces transmitted from distal to proximal.
Movement of forearm at radioulnar joint
Supination of forearm and hand. Biceps brachii must be flexed for effective supination
Pronation muscles of forearm/hand
Pronator teres; pulls radius into pronation.
Pronator quadratus
Boundaries of the cubital fossa
Superior- line joining the medial and lateral epicondyles
Lateral-brachioradialus, supinator ms attachment on the radius
Medial-Pronator teres, brachialis (deep)
Nerves, arteries and veins that enter the cubital fossa proximally
Radial nerve, lateral cutaneous nerve of the forearm, median nerve, medial cutaneous nerve of forearm, tendon of biceps brachii, median cubital vein, brachial artery which branches into radial and ulnar
Nerve supply to anterior flexor compartment of forearm
Median nerve innervates all muscles of the flexor compartment except 1.5 of FCU and and 1/2 of FDP (flexor digitorum profundus)
Pronator teres PA, DA, actions
PA-h humeral head. Medial epicondyle of humerus, ulnar head-coronoid process of ulna
DA- Lateral surface of radius, mid-shaft
Actions-flexion of elbow, forearm, pronation of forearm
Flexor carpi radialis PA and DA
PA-Medial epicondyle
DA-base of the second and third metacarpals (anterior surface)
Palmaris longus PA and DA
PA-medial epicondyle
DA- palmar aponeurosis
Flexor carpi ulnaris PA and DA
PA-humeral head is medial epicondyle, ulnar is olecranon and posterior ulna
DA-pisiform bone and then to base of fifth metacarpal (ant./palmar surface)
Flexor digitorum superficialis PA and DA
PA-humerus is medial epicondyle and ulna is coronoid process, radius is ant surface mid shaft
DA-middle phalanges of four fingers by split tendons
Deep anterior compartment of forearm
Flexor digitorum profundus, flexor pollicis longus, Pronator quadratus
Flexor digitorum profundus PA and DA
PA-anterior surface of ulna and adjacent interosseous membrane
DA-base of distal phalanges of fingers
Flexor pollicis longus PA and DA
PA-anterior surface of radius and IOM
DA-distal phalanx of thumb
Pronator quadratus PA and DA
PA-distal 1/4 of anterior ulna
DA-Distal 1/4 of anterior radius
Superficial extensor muscles of posterior compartment
Brachioradialus, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
Brachioradialus PA and DA
PA-lateral supracondylar ridge of humerus
DA-lateral surface of distal radius
Extensor Carpi Radialis longus
PA-lateral supracondylar ridge of humerus
DA-base of second metacarpal
Extensor carpi radialis brevis PA and DA
PA-lateral epicondyle
DA-base of third metacarpal
Extensor digitorum PA and DA
PA-lateral epicondyle
DA-base of proximal phalanges and extensor expansion .
Extensor digiti minimi PA and DA
PA-extensor digitorum muscle belly
DA-base of th fifth proximal phalanx//
Extensor carpi ulnaris PA and DA
PA-lateral epicondyle and posterior shaft of ulna
DA-base of fifth metacarpal
Deep muscles of the posterior compartment of the forearm
Supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indices
Supinator PA and DA
PA-lateral epicondyle of humerus, post ulna, radial collateral and annular ligs
DA-lateral surface of the radius
Abductor Pollicis Longus PA and DA
PA-posterior radius, ulna and IOM
DA-base of the first metacarpal
Extensor Pollicis Brevis PA and DA
PA-posterior radius and IOM
DA-base of proximal phalanx of thumb
Extensor pollicis longus PA and DA
PA-posterior ulna and IOM
DA-base of the distal phalanx of thumb
Extensor indicis PA and DA
PA- posterior ulna and IOM
DA-base of second proximal phalanx
Clinical significance of the median nerve passing through the two heads of the Pronator teres
Protects it. Inflammation of this nerve affects everything distal to it (not Pronator teres)
Two nerves that innervate the forearm (motor)
Median nerve and anterior interosseous nerve. (C5-8 &T1)
What nerve innervates the muscles of the posterior compartment of the forearm
Radial nerve, deep radial nerve, posterior interosseous
Why is the radial nerve anterior to the elbow joint
The protect it
What is the one muscle in the extensor compartment that in not an extensor
Brachioradialis and it is a flexor
What vein is typically used for blood draw
Median cubital vein
Antebrachium cutaneous innervation
lateral cutaneous nerve of forearm, posterior cutaneous nerve of forearm, medial cutaneous nerve of the forearm
Antebrachium vasculature
Brachial artery divides into radial and ulnar. Radial runs parallel to brachioradialis. Ulnar artery passes deep to Pronator teres and common interosseous branches off and becomes anterior and posterior.
Collateral circulation
Mechanism for blood to flow to an organ or region after its normal course has been blocked
Elbow anastomosis vessels
Radial recurrent that connects to radial collateral,interosseous recurrent, anterior ulnar recurrent, posterior ulnar recurrent
Where does the interosseous recurrent artery anastomose
It comes off posterior interosseous and connects proximally to middle collateral artery
Where does anterior ulnar recurrent anastomose
Off the ulnar artery and connects proximally to inferior ulnar collateral artery
Where does the posterior ulnar recurrent anastomose
Off the ulnar artery and connects proximally to superior ulnar collateral artery
Primary articulations of radiocarpal joint
Radius, scaphoid, and lunate.
Damage to what structure of the wrist can greatly alter wrist function
Articular disk
Thumb CMC
Carpal-metacarpal joint. Consists of trapezium and first metacarpal (saddle joint). Functions in flex ion/extension, abduction/adduction, medial-lateral rotation/opposition-reposition
Carpal metacarpal (CMC)
Medial four have no significant movement. Thumb is crucial.
Metacarpophalangeal joints (MCP)
All have two primary movements. Flexion/extension, abduction/adduction, using these combined gives you circumduction.
Which bones are your knuckles
Distal end of metacarpals
Interphalangeal joints (IP)
Two rows in the four fingers; PIP and DIP. Only one in the thumb (IP). All of these are hinge joints capable of flexion-extension
Flexor retinaculum attachments
Attachments to carpal bones laterally; tubercle of scaphoid and trapezium. Medially; pisiform bone and hook of hamate.
Flexor retinaculum functions
Closes carpal groove and creates a tunnel. Holds flexor tendons in place and prevents bowstringing.
Where do thenar and hypthenar muscle groups originate
Flexor retinaculum
Carpal tunnel
The tunnel is the space between flexor retinaculum and planar surface of carpal bones. Flexor retinaculum is not in the tunnel.
What structures are superficial to the flexor retinaculum (not in carpal tunnel)
Flexor carpi ulnaris, ulnar nerve, ulnar artery and vein, tendon of palmaris longus, superficial radial artery.
Structures within the carpal tunnel
Flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, median nerve.
What flexor muscle would not be contributory to carpal tunnel syndrome?
Flexor carpi radialis
Carpal tunnel syndrome
Compression of the median nerve often due to finger flexor tendonitis, fluid retention or delicate wrists.
Symptoms of carpal tunnel syndrome
Tingling and burning (parasthesia) of the later 3 1/2 digits. It can progress to anesthesia. Sensory loss usually involves the median-innervated fingers and spares the thenar eminence. Weakness of thenar muscles and readial 2 lumbricals. Can progress to atrophy or paralysis.
Ulnar tunnel
Consists of ulnar nerve and artery.
Guyons canal syndrome
Ulnar nerve compression in the hand. Characterized by parasthesia of medial 1 1/2 digits, palmar and dorsal side, and weakness of the intrinsic hand muscles interacted by the ulnar nerve.
Dorsal wrist extensors
Abductor pollicis longus, extensor pollicis brevis, extensor carpi radialis longus and ECRBrevis, extensor pollicis longus, extensor digitorum, extensor indicis, extensor digiti minimi, extensor carpi ulnaris.
Why is there no equivalent to CTS on the dorsal side of the wrist?
You have to have a nerve involved to have CTS symptoms.
What structure holds the extensor muscles tendons in place at the wrist
Extensor retinaculum
Palmaris longus, DA, innervation and function
PA-Medial epicondyle
DA-palmar aponeurosis
Innervated by median nerve
Missing in 15% of population
Thenar muscles, PA attachment, N innervation, function
Adductor pollicis brevis, flexor pollicis brevis, opponens pollicis.
PA- all originate form the lateral side of flexor retinaculum
Recurrent branch of the median nerve
Flexion, opposition, reposition, abduction, adduction, extension
Hypothenar muscles, PA, N innervation, functions
Abductor digiti minimi, flexor digiti minimi, opponens digiti minimi. Ulnar nerve innervated. Opposition, reposition, flexion, extension.
Dorsal interosseous muscles
4 interossei, only muscles observed when just skin is removed from the hand. PA are the shafts of adjacent metacarpals. DA are bases of proximal phalanges. Innervated by the deep branch of the ulnar n.
Palmar interosseous muscles
3 interossei. These are the deepest muscles of the palm and are all innervated by the deep branch of the ulnar nerve.
Adductor pollicis
PA- two heads from the anterior surfaces of shaft of the third metacarpal and the capitate. DA-base of proximal phalanx of thumb.
Innervated by the deep branch of the ulnar nerve.
Adducts thumb
Lumbricals
All four originate from tendons of the flexor digitorum profundus and have distal attachments at the extensor expansion of the finger in line with the originating tendon. 1st and 2nd are median n innervated, 3rd and 4th are ulnar nerve. MCP flexion, IP extension
Innervation and functions of lumbricals
1st and 2nd are innervated by the digital branches of the median nerve. 3rd and 4th are innervated by the deep branch of the ulnar nerve. Function in MCP flexion and IP extension. Can’t have one of these actions w out the other.
If an individual has atrophy of the interosseous muscles, what potential anatomical lesion could be the cause?
Ulnar nerve damage/lesion.
What structures lie deep in the digits
Flexor digitorum profundus, flexor digitorum superficialis, deep transverse metacarpal ligament, fibrous flexor sheath
What structure of the hand separates palmar and dorsal metacarpals and keeps them together
Deep transverse metacarpal ligament
Fibrous flexor sheath
Fibrous tubes that hold the flexor tendons in place on fingers
What “bonus” flex does the FDP (of the finger) have
It can flex the distal IP because it extends the length of the finger
Risks associated with crush injuries
Potential adhesion of lumbricals and deep transverse metacarpal ligament
Extensor expansion
A tendinous aponeurosis formed from tendons of extensors of the fingers and it ties into the lumbricals.
How does the extensor expansion affect MCP and PIP/DIP joint movement ?
What artery is the primary contributes to the superficial palmar arch
The ulnar artery
What arteries anastomose to form the deep palmar arch
The deep radial and ulnar
Where do you check your pulse on the wrist
Between the distal brachioradialus and flexor carpi radialis tendons you can feel the pulse of the radial artery.
Where does the princeps pollicis aretery branch from and what does it supply
Branches off the radial artery and supplies the thumb.
What artery is the is the primary contributes to the deep palmar arch?
Radial artery
What artery is the secondary contributor to the superficial palmar arch
Radial artery
Cutaneous effects of carpal tunnel syndrome
Leads to anesthesia of 1st, 2nd, 3rd and half of the fourth digits (palmar and fingertips). And parasthesia of palm innervated by median nerve.
Cutaneous Ulnar nerve innervation of the hand
Palmar and dorsal surface of pinky and pinky half of ring finger
Cutaneous Radial nerve innervation of hand
Dorsal side of the thumb, index finger, middle finger and radial half of the ring finger, minus the fingertips.
Motor innervation of hand from the median nerve
Two lumbricals on the radial side and thenar muscles from the recurrent branch.
Motor innervation of hand by the deep ulnar nerve
Innervates the hypothenar eminance, interossei, two lumbricals on the ulnar side of the hand and the adductor pollicis.
Motor innervation of the hand by the superficial branch of the ulnar nerve
Palmaris brevis
Anatomical snuff box boundaries
Ant/palmar-tendons of abductor pollicis longus and extensor pollicis brevis
Post/dorsal-tendon of extensor pollicis longus
Floor-scaphoid and trapezium
Contents of the anatomical snuff box
Superficial radial nerve (cutaneous) and radial artery
A patient is experiencing acute tenderness with palpation of snuffbox after a fall, how did they fall and what is the potential injury
On an outstretched hand/wrist. The scaphoid is potentially fractured.
What is at risk with a fracture of the scaphoid
Radial artery
Extensor retinaculum function
Holds extensor muscles tendons in place at wrist
Intricinsic muscles of the hand
Palmaris brevis, thenar muscles, hypothenar muscles, dorsal interosseous, palmar interosseous, adductor pollicis, lumbricals
Deep palmar structures
Deep transverse metacarpal ligament, FDS,FDP fibrous flexor digital sheath
Inter carpal joint
Articulations between the two rows of carpal bones. Increases range of wrist movement.
Carpal bones
scaphoid, lunate, pisiform, triquetral, hamate, capitate, trapezoid, trapezium
Palmaris brevis PA, DA, innervation
PA-medial aspect of palmar aponeurosis
DA-Skin of palm of hand
Ulnar nerve innervation.
