Exam 2 (2)

Question 1

Trapezius Origin, Insertion, Innervation, Action

identify the bone attachments, innervation and action of the muscles of the scapulohumeral
region included in the class PowerPoint

Answer 1

Origin= medial third of superior nuchal line, external occipital protucerence, nuchal ligament
Insertion= Lateral third of clavicle; acromion and spine of scap
Innervation= Spinal acessory nerve CN XI
Action= superior part elevates; inferior part depresses, middle part retracts scapula

Question 2

Levator scapulae Origin, Insertion, Innervation, Action

Answer 2

Origin= c1 and c4 vertebrae
Insertion= scapula
Innervation= dorsal scapular nerve (c4, c5)
Action= elevates scapula, downward rotation of scapula

Question 3

Rhomboids major and minor origin, insertion, innervation, action

Answer 3

Origin= rhomboid minor:spinous process c7-t1
Rhomboid major: spinous process t2-t5
Insertion= medial borders of scapulae
Innervation= dorsal scapular nerve c5
Action= retraction of scapula, downaward rotation of scapula

Question 4

Serratus anterior origin, insertion, action, innervation

Answer 4

Origin= external surface of ribs 1-8
Insertion= anterior surface, medial border of scapula
Innervation= long thoracic nerve (c5-7)
Action= protraction of scpula, upward rotation of scapula

Question 5

Pectoralis minor origin, insertion, innervation, action

Answer 5

Origin= ribs 3-5
Insertion= coracoid process of scapula
Innervation= medial pectoral nerve (c8,t1)
Action= protracts, depresses downward rotation of scapula

Question 6

Detloid origin, insertion, innervation, action

Answer 6

origin= acromion, clavicle, spine of scapula
Insertion= deltoid tuberosity
Innervation= axillary nerve (c5,6)
Action=
Anterior: flexion, medial rotation of humerus
Middle: abduction of humerus
Posterior: extension, lateral rotation of humerus

Question 7

Pectoralis major origin, insertion, innervation, action

Answer 7

Origin= clavicular heads origin is medial half of clavicle. sternocostal heads origin is the sternum
Insertion= lateral lip of intertubercular groove of humerus
Innervation= medial and lateral pectoral nerve
Action= adducts humerus. medially rotates humerus.

Clavicular head flexes humerus, sternocostal head will extend humerus from the flexed position

Question 8

Latissimus dorsi origin, insertion, action, innervation

Answer 8

origin= spinous processes of inferior 6 thoracic vertebrae,
Insertion= floor of intertubercular groove of humerus
Action= extends, adduts, medially rottates humerus
Innervation= thoracodorsal nerve (c6-8)

Question 9

Teres major origin, insertion, action, innervation

Answer 9

origin= posterior surface, inferior angle of scapula
insertion= medial lip of intertubercular groove
innervation= lower subscapular nerve
action= adducts humerus. medially rotates humerus

Question 10

Supraspinatus

dentify the muscles of the rotator cuff; their bone attachment sites, innervation and action. Note
their role in maintaining the integrity of the shoulder joint

Answer 10

origin= supraspinous fossa
Inserts= on greater tubercle of humerus
action= initiates abduction of the humerus– abducts the humerus to about 15 degrees; allowing the deltoid to continue the abduction movement.
innervation= suprascapular nerve

Question 11

Infraspinatus

dentify the muscles of the rotator cuff; their bone attachment sites, innervation and action. Note
their role in maintaining the integrity of the shoulder joint

Answer 11

Origin= infraspinous fossa
Insertion= greater tubercle
action= Acts to laterally rotate the humerus (also called external rotation)
inneration= suprascapular nerve

Question 12

Teres Minor

Answer 12

origin= infraspinous fossa
Insertion= Greater tubercle
action= Acts to laterally rotate the humerus (also called external rotation)
innervation= axillary nerve

Question 13

Subscapularis

Answer 13

origin= subscapular fossa
Insert= lesser tubercle
action= : Acts to medially rotate the humerus (also called internal rotation)
innervation= upper and lower subscapularis nerves

Question 14

Rotator cuffs role in maintaing the integrity of the shoulder joint?

Answer 14

The ligaments supporting the shoulder joint are not known for their strength— so the shoulder joint relies on the rotator cuff muscles/tendons to maintain the integrity of the joint

All four muscles act to hold and support the head of the humerus in the glenoid fossa at the shoulder joint

The rotator cuff tendons do not support (or cover) the inferior aspect of the shoulder joint very well—so the humeral head can easily dislocate inferiorly

The rotator cuff muscles form a musculotendinous “cuff” around the head of the humerus at the shoulder joint (hence the name “rotator cuff”); as such, they act to hold the head of the humerus in place at the shoulder joint

Question 15

Subclavian, axillary, brachial arteries

identify the major blood vessels supplying this region (subclavian, axillary, brachial arteries

Answer 15

Subclavius can cover the subclavian artery and vein to protect them in case of a clavicle fracture; otherwise, one could bleed to death

axillary artery= begins at lateral border of the 1st rib continuation of the subclavian artery ends at inferior border of the teres major. The axillary nerve is at risk when the humerus dislocates inferiorly

brachial artery= provides main arterial supply to the arm,contuiation of axillar artery

Question 16

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Winged scapula

Be able to identify the anatomical structures associated with common pathologies seen in this
area; and explain how the anatomical structures contribute to the condition (e.g. clavicle fracture,
winged scapula)

Answer 16

damage to serratus anterior and or long thoracic nerve.
medial border of scapula moves latearlly and upper limb wont be able to elevate normally above the horizontal posiiton

Question 17

Subclavius Origin, insertion, action, innervation

Answer 17

origin= junction of 1st rib and costal cartilage
insertion= inferior surface, middle third of clavicle
Innervation= Nerve to subclavius
action= depress scapula

Question 18

Injury to spinal acessory nerve

Answer 18

Drop shoulder, trapezius innervates here

Question 19

injury to axillary nerve

Answer 19

detloid and teres minor will atrophy. axillary nerve is usually injured during fracture of surgical neck of humerus

Question 20

injury to dorsal scapular nerve

Answer 20

rhomboid and levator scapulae muscles are effected.

Question 21

injury to thoracodorsal

Answer 21

latismuss dorsi is effected.

Question 22

Describe the formation of the brachial plexus (roots-trunks-divisions-cords-terminal branches)
pg. 195-206

Answer 22

Roots= C5-T1
Trunks: superior trunk (union of c5 and c6 roots), middle trunk (continuation of c7), inferior trunk (union of c8 and t1 roots)
Divisions= anterior divisons (supply anterior compartments), posterior divisions supply posterior compartments
Cords= Lateral cord (anterior division of superior and middle trunk form it)
Medial cord (anterior divison of inferior trunk continues as it)
Posterior cord (the three posterior divisions unite to form it)
Axillary and radial nerve from posterior cord
musculocutaneous nerve and median nerve from lateral cord
ulnar and median nerve from medial cord

Question 23

Identify the major landmarks used to locate portions of the brachial plexus (anterior, middle
scalenes, first rib, borders of pectoralis minor

Answer 23

Roots of the brachial plexus emerge between the anterior and middle scalene
first rib= roots and inferior trunk
pectoralis minor= cords

Question 24

Identify the location of the subclavian and axillary arteries and their relationship to the nerves of
the brachial plexus

Answer 24

sublcavian artery and roots of brachial plexus both emerge between anterior and middle scalene
Parts of the Brachial Plexus are named according to their relationship to the axillary artery

Question 25

Collateral branches of brachial plexus ## Footnote identify the collateral branches of the brachial plexus and note where they emerge from the plexus (roots, trunks, cords). Be able to identify the muscles they innervate

Answer 25

>Nerves that arise from the brachial plexus prior to the terminal branches are called collateral branches (of the brachial plexus),Collateral branches arise from the roots, trunks, and cords of the plexus,Collateral branches innervate muscles of the scapular region DSSLLMMMUTL Denzel Sings Songs Loudly and Lovely Mary Might Make Uggs tomorrow loudly Dorsal scapular nerve= innervate rhomboids, occasionaly levator scapulae. originates from c5 suprascapular nerve= innervations supraspinatus and infraspiantus, originates from c5,c6 subclavian nerve= subclavius and SCM, superior trunk long thoracic nerve= serratus anterior, c5,c6,c7 lateral pectoral nerve= pectoralis major, side branch of lateral cord medial pectoral nerve= pectoralis minor and sternal part of pec major, side branches ofmedial cord medial cutaneous nerve of arm= skin of medial side of arm, side branches of medial cord medial cutaneous nerves of forearm= skin on medila side of forearm, side branches of medial cord upper subscapular nerve= superior portion of subscapularis and teres major, side branch of posterior cord thoracodorsal nreve= latissiumus dorsi, side branch of posterior cord lower subscapular= inferior portion of subscapularis and teres major, side branch of posterior cord

Question 26

## Footnote Identify the terminal branches of the cords of the brachial plexus (Musculocutaneous, Axillary, Radial, Median, Ulnar). Be able to identify the region of the upper extremity supplied by each terminal nerve.

Answer 26

Muscolocutaenous= muscles of anterior compartment of arm (coracobrachialis, biceps brachii, and brachialis), lateral cord Axillary= glenohumeral jont; teres minor and deltoid muscles, posterior cord radial= all muscles of posterior compartments of arm and forearm, posterior cord median= muscles of anterior forearm compartments except flexor carpi ulnaris and ulnar half of flexor digitorum profundus, lateral root of median nerve and medial root of median nerve ulnar= flexor carpi ulnaris and ulnar half of flexor digitorum profundus, medial cord

Question 27

Upper brachial plexus injuries ## Footnote pg. 205-206 identify some pathological conditions involving the brachial plexus, and explain the involvement of the nerves of the plexus and the symptoms/presentation:

Answer 27

c5 and c6 are injured in upper brachial plexus injuries depress shoulder= happens from an excessive increase in the angle between the neck and shoulder, often from someone who is thrown from a motorcycle or horse and land on their shoulder. Stretches or ruptures the the superior parts of the brachial plexus erbs palsy= Described as the “waiter’s tip position”—arm adducted, elbow extended, wrist flexed-- loss of muscles supplied by C5 and C6—deltoid, biceps brachii, brachialis

Question 27

## Footnote compression syndromes: Costoclavicular, Hyperabduction syndromes

Answer 27

costoclavicular syndrome= Depression of the shoulders (as in carrying a heavy backpack) may compress the brachial plexus/and or subclavian artery between the clavicle and first rib hyperabduction syndrome= Prolonged hyperabduction of the arm may compress the cords of the brachial plexus between the coracoid process and the tendon of pectoralis minor

Question 27

lower brachial plexus injuries ## Footnote pg. 205-206 Lower brachial plexus injuries: Klumpke’s palsy—claw hand

Answer 27

c8 and t1 are injured claw hand= paralysis appearance of hand, loss of ulnar nerve

Question 28

## Footnote Thoracic outlet syndrome: Compression between scalenes, pectoralis minor; cervical rib

Answer 28

Thoracic outlet syndrome= A general term that describes several situations where the brachial plexus or subclavian artery and/or vein is compressed pectoralis minor or anterior and medial scalenes can compress it cervical rib can compress emerging from c7 (birth defect)

Question 29

## Footnote pg. 204 Define the spinal nerve ventral rami associated with the typical brachial plexus (C5-T1); a prefixed brachial plexus (C4-C8); a post-fixed brachial plexus (C6-T2

Answer 29

Remember that the typical brachial plexus is formed from the ventral rami of C5-T1 Pre-fixed brachial plexus: ventral rami of C4-C8 -when superiormost root of the plexus is c4 and inferiormost root is c8 Post-fixed brachial plexus: ventral rami of C6-T2 when superior root is c6 and inferior root is t2

Question 30

what runs through the quadrangulra space?

Answer 30

## Footnote Identify the structures running through the quadrangular space: axillary nerve, posterior circumflex humeral arteries and veins Fig 3.52; pg. 211

Question 31

## Footnote Identify the sites on the humerus where nerves run close to bone (surgical neck-axillary nerve; radial groove on the mid-shaft- radial nerve; medial epicondyle-ulnar nerve). Identify the consequences of damage to the nerve in instances of bone fracture: identify the muscles that may be affected and the movements impaired

Answer 31

Note the close contact of nerves to bone in the humerus: the axillary nerve wraps around the surgical neck of the humerus; the radial nerve runs in the radial groove in the mid-shaft of the humerus. Ulnar posterior to the medial epicondlye in the ulnar groove Fracture of the humerus at sites where nerves run close to bone may result in nerve injury if sharp edges of bone contact the nerve Fracture of the surgical neck of the humerus may injure the axillary nerve: results in denervation of the deltoid—loss of humeral abduction Fracture of the mid-shaft of the humerus may injure the radial nerve; results in loss of wrist extension—commonly called “wrist drop”

Question 32

Biceps Brachi ## Footnote Identify the muscles on the anterior arm (biceps brachii, coracobrachialis, brachialis)—their bone attachment site, innervation (musculocutaneous nerve) and action

Answer 32

Origin= Short head: coracoid process long head: supraglenoid tubercle of scapula Insertion= radial tuberosity and fascia of forearm via bicipital apneurosis Innervation= Musculocotuaneous nerve (c5,c6,c7) Action= flexes humerus at shoulder (long head), flexes forearm at elbow, supiantes forearm

Question 33

Brachialis

Answer 33

Origin= distal humerus insertion= coronoid proces and tuberosity of ulna Innervation= muscolcutaneous action= flexes forearm in all positions

Question 34

brachioradialis

Answer 34

orgiin= supracondylar ridge of humerus Insertion= distal radius Innervation= radial nerve Action= flexes elbow when forearm is in neutral posiiton "drinking muscle"

Question 35

Bicipital aponeurosis and its role in supporting median cubital vein for peripheral blood draw? Superfcical veins? ## Footnote Identify the bicipital aponeurosis and its role in supporting the median cubital vein for a peripheral blood draw. Identify the cephalic vein and the basilic vein as examples of superficial veins

Answer 35

The median cubital vein is a common site for a peripheral blood draw—the vein is separated from deeper structures by the bicipital aponeurosis in the cubital fossa The bicipital aponeurosis protects deeper structures in a peripheral blood draw cephalic vein can be located popping out at the deltopectoral groove cephaliv vein and basilic veins are the superficial veins of the upper limb

Question 36

Triceps brachii ## Footnote identify the muscles of the posterior arm (triceps brachii, anconeus)—their bone attachment sites, innervation (radial nerve) and action

Answer 36

O: Long head: Infraglenoid tubercle of scapula; Lateral head: posterior shaft of humerus superior to radial groove; Medial head: posterior shaft of humerus, inferior to radial groove I: Olecranon process of ulna Innervation= radial nerve action= extend elbow, long head extends shoulder

Question 37

Anconeus

Answer 37

O: Lateral epicondyle of humerus I: Superior ulna, lateral surface of olecranon inNervation: Radial Action= assists triceps brachii in elbow extension

Question 38

(superficial)Pronator teres

Answer 38

Origin: Ulnar head= coronoid process of ulnda humeral head= medial epicondyle of humerus insertion= lateral surface of radius middle of the convexity Innervation= median nerve action= pronates and flexes forearm

Question 39

Flexor carpi radialis(superficial)

Answer 39

origin= medial epicondyle insertion= base of 2nd metacarpal innervation= median nerve action= flexes hand at wrist, abducts

Question 40

(superficial)palmaris longus

Answer 40

origin= medial epicondyle insertion= dital half of flexor retinaculum innervation= median nerve action= flexes hand at wrist and tenses palmar aponeurosis

Question 41

(superfical)flexor carpi ulnaris

Answer 41

Origin: humeral head= medial epicondyle ulnar head= olecranon and posterior border of ulna insertion= pisiform, hook of hammate, 5th metacarpal innervation= ulnar nerve action= felxes and adducts hand at wrist

Question 42

flexor digitorum superficialis (intermediate layer)

Answer 42

Origin: Humero-ulnar haed: medial epicondle Radial head= anterior border of radius, superior half insertion= shafts of middle phalanges of medial four digits action= flexes PIP and MP joints innervatiion= medial nerve

Question 43

flexor digitourm profundus (dep layer)

Answer 43

Origin= ulna and interosseuous membrane Insertion= distal phalanges (2,3,4,5) Innervation: medial part (digits 4 and 5)= ulnar nerve lateral part(digists 2 and 3)= median nerve from anterior interosseuous branch action= flexes DIP

Question 44

flexor pollicis longus (deep)

Answer 44

origin= anterior radius and interosseuous membrane insertion= base of distal phalanx of thumb innervaiton= median nerve (anterior interosseous branch) action= flexes phalanges of 1st digit

Question 45

pronator quadratus (deep)

Answer 45

origin= distal ulna insertion= distal radius innervation= anterior interosseuous action= pronates forearm

Question 46

Whats the deep branch of the median nerve? ## Footnote -Identify the anterior interosseous nerve as the deep branch of the median nerve

Answer 46

The deep branch of the median nerve is called the anterior interosseus nerve supplies the deep forearm flexors besdies the ulnar part of the FDP. supplies pronator quadratus

Question 47

Relationship between FDS and FDP ## Footnote Describe the relationship of the tendons of the flexor digitorum profundus and flexor digitorum superficialis over the anterior surface of the digits (tendon of flexor digitorum longus pierces the tendon of flexor digitorum superficialis

Answer 47

flexor digitorum profundus flexes digits in slow actions, flexes the middle and distal phalanges flexor digitorum superficials= flexes middld phalanges

Question 48

What forms the roof of the carpall tunnel? What does it do? ## Footnote -Identify the flexor retinaculum as the roof of the carpal tunnel and identify the contents of the carpal tunnel (in the hand powerpoint

Answer 48

The flexor retinaculum holds the tendons of the anterior forearm muscles in place in the carpal tunnel—prevents “bowstringing” Flexor retinaculum: forms the “roof” of the carpal tunnel: runs from scaphoid and trapezium—to—pisiform and hamate Nine tendons and the median nerve run through the carpal tunnel (4 tendons of Flexor Digitorum Superficialis,4 tendons of Flexor Digitorum Profundus and tendon of flexor pollicis longus)

Question 49

Identify the blood supply of the forearm (radial and ulnar artery) Fig. 3.68; pg. 234

Answer 49

ulnar artery= larger terminal branch of brachial artery in cubital fossa radial artery= smaller terminal branch of brachial artery in cubital fossa

Question 50

(superficial)extensor carpi radialis longus

Answer 50

origin= lateral epicondle + supracondylar ridge insertion= 2nd metacarpal posterior innervation= radial nerve action= extend and abudct hand at wrist joint

Question 51

(superfiical)extensor carpi radialis brevis

Answer 51

origin= lateral epicondyle inseriton= 3rd metacarpal, posterior side innervation= deep branch of radial nerve aciton= extend and abduct, active during fist clenching

Question 52

(superfical)extensor digit minimi

Answer 52

origin= lateral epicondyle insertion= extensor expansion of 5th digit innervation= deep branch of radial nerve action= extends 5th finger at metacarpolhalagneal joint

Question 53

(superficial) extensor carpi ulnaris

Answer 53

origin= lateral epicondle, posterior border of ulna insertion= 5th metacarpal, posterior side innervation= deep branch of radial nerve aciton= extends and abducts hand at wrist joint

Question 54

extensor digitorum (superfical)

Answer 54

orgigin= lateral epicondyle insertion= extensor expansion of medial 4 digits inneraiton= deep branch of radial nerve action= extends medial four digits

Question 55

supiantor (deep)

Answer 55

origin= lateral epicondyle insertion= proximal third of humerus, lataeral posterior innervation= deep branch of radila nerve action= supinates forearm

Question 56

extensor indicis

Answer 56

origin= distal third of ulna insertion= extensor expansion of 2nd digit innervation= posterior interosseous nerve action= extends 2nd digit

Question 57

abductor pollicis longus

Answer 57

origin= proximal ulna insertion= 1st meta carpal innervation= posterior interosseous nerve (branch of radial nerve) action= abduct thumb at CMC joint

Question 58

extensor pollicis longus

Answer 58

origin= middle third of ulna insertion= distal phalanx of thumb innervation= posterior interosseous nerve (branch of radial nerve) action= extends distal phalanx atIP joints

Question 59

extensor pollicis brevis

Answer 59

origin= distal third of radius insertion= proximal phalanx of thumb innervation= posterior interosseous nerve action= extends proximal phalanx of thumb at MCP joints

Question 60

Identify the muscles that make up the anatomical snuffbox. Identify the scaphoid bone located deep in the anatomical snuffbox. Identify the radial artery running through the anatomical snuffbox pg. 233 Identify the symptom of a scaphoid fracture

Answer 60

radial artery on floor of anatomical snuff box Tenderness in the anatomical snuffbox is a symptom of a scaphoid fracture,The scaphoid is often fractured in fall on the wrist area Healing of the fracture can be poor or incomplete The tendon of extensor pollicis longus travels medially around Lister’s tubercle, using it as pulley before making a 45 degree turn on its way to the insertion on the distal phalange of the thumb, fritction on the tendon (EPL)can damage it

Question 61

Describe the function of the extensor retinaculum. Identify the muscle tendons in each compartment of the extensor expansion. Fig. 3.64; pg. 230

Answer 61

The extensor retinaculum is divided into compartments. The extensor retinaculum prevents tendon “bowstringing” Compartment 1= APL, EPB Compartment 2= ECRB, ECRL Compatment 3= EPL compartment 4= ED, EI Compartment 5= EDM Compartment 6= ECU

Question 62

Identify the cause of DeQuervain’s tenosynovitis . Identify the tendons that are involved and the action that produces pain Identify the simple screening test test for DeQuervain’s (Finkelstein test) and describe how the test is done. Pg. 265

Answer 62

Cause of DeQuervain= Compression of tendons in Compartment 1 of the extensor retinaculum Tendons that are involved= (abductor pollicis longus and extensor pollicis brevis Action that produces pain=(abduction of the thumb). finklestein test=A quick test to screen for deQuervain’s –grasp thumb with other fingers—then ulnar deviate (adduct) the wrist: pain at the base of the thumb suggests that further evaluation should be done for a conclusive diagnosis

Question 63

what muscles produce radial deviation? ulnar deivaiton? ## Footnote dentify the muscles that are used to produce pure radial deviation (flexor carpi radialis and extensor carpi radialis longus and brevis) and pure ulnar deviation (flexor carpi ulnaris and extensor carpi ulnaris)

Answer 63

radial deviation=(flexor carpi radialis and extensor carpi radialis longus and brevis) ulnar deviation=(flexor carpi ulnaris and extensor carpi ulnaris)

Question 64

## Footnote Predict the consequences of lesions or compression of the median and/or ulnar nerve on the muscle activity and areas of sensory loss on the forearm and hand.

Question 65

Abductor pollicis brevis (thenar muscle) ## Footnote Pg, 249-255 Identify the muscles of the hand: Thenar muscles (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis); Adductor pollicis, Hypothenar muscles (abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi), Lumbricals, Palmar and Dorsal Interossei.

Answer 65

origin= flexor retinaculum insertino= proximal phalanx of thumb, lateral side innervatiin= median nerve action= abduct thumb

Question 66

flexor pollicis brevis

Answer 66

origin= flexor retinaculum insertion= lateral side of proximal phalanx of thumb innervation= median nerve action= flex thumb

Question 67

opponens pollicics

Answer 67

origin= flexor retinaculum insertion= lateral side of 1st metacarpal innervation= median nerve action= oppose thumb, draw 1st metacarpal medially and rotate it medially

Question 68

adductor pollicis

Answer 68

origin: oblique head= base of 2nd and 3rd metacarpals transverse head= 3rd metacarpals anterior shaft Insertion= phalanx of thumb, medial side innervaiton= ulnar nerve action=adducts thumb

Question 69

abductor digiti minimi

Answer 69

origin= pisiform inseriton= proximal phalanx of 5th figer, medial side innervation= ulnar nerve action= abducts 5th finger

Question 70

flexor digiti minimi brevis

Answer 70

origin= hook of hamate and flexor retinaculum insertion= 5th metacarpal medial border innervaiton= ulnar nerve action= flexes phalanx of 5th finger

Question 71

opponens digiti minimi

Answer 71

origin= hook of hammate and flexor retinaculum insertion= 5th metacarpal, medial border innervation= ulnar nerve action= draws 5th metacarpal

Question 72

Lumbricals

Answer 72

Origin: 1 and 2= lateral two tendons of flexor digitorum profundos 3 and 4= medial three tendons of flexor digitorum profundus insertion= lateral sides of extensor expansions of 2nd-5th fingers innervation= median nerve first fingers 1-2, ulnar fingers 3-4 aciton= flex MCP, extend IP of 2-5 digits bye bye muscle, mp flexion, ip extension

Question 73

Dosal interossei 1-4

Answer 73

origin= adjacent sides of two metacarpals insertion= proximal phalanges,extensor expansions of 2-4 fingers innervation- ulnar nerve action= abduct 2-4 fingers from axial line

Question 74

palmar interossei 1-3

Answer 74

origin= palmar surfaces of 2-5 metacarpals insertion= proximal phalanges, extensor expansions of 2-5 fingers innervation= ulnar nerve action= adduct 2-5th fingers

Question 75

## Footnote Be able to name the carpal bones. Know the ones in the proximal row and those in the distal row. Pg. 150-152 .

Answer 75

Proximal- Scaphoid Lunnate Triqutrum, Pisiform Distal- Trapezium, trapezoid, capitate, hammate

Question 76

## Footnote Describe the location and function of the palmar aponeurosis. Note that the tendon of palmaris longus inserts into the palmar aponeurosis. Identify the palmar aponeurosis as the structure involved in Dupuytren’s contracture. Pg. 264-265

Answer 76

When you remove the skin of the palm, the first structure you see is the palmar aponeurosis—which protects the muscles located on the palmar side of the hand Note: the tendon of palmaris longus inserts into the palmar aponeurosis A progressive shortening of the fibers of the palmar aponeurosis leads to a condition called Dupuytren’s Contracture

Question 77

What muscles would be weakened or lost in carpal tunnel syyndrome? ## Footnote - -Identify the muscles whose function may be weakened or lost in cases of carpal tunnel syndrome (muscles of the thenar emininence: abductor pollicis brevis, flexor pollicis brevis, opponens pollicis; also lumbricals 1 and 2. These are muscles of the hand innervated by the median nerve). Muscle losses (weakness or atrophy) occur distal to the lesion or compression—forearm muscles are not affected in early stages of carpal tunnel—the median nerve innervation to forearm muscles is intact in carpal tunnel syndrome. Pg. 266. Note that the flexor retinaculum (transverse carpal ligament) forms the roof of the carpal tunnel.

Answer 77

all muscles in hand innervates by median nerve would be effected. muscles of the thenar emininence: abductor pollicis brevis, flexor pollicis brevis, opponens pollicis; also lumbricals 1 and 2 Muscle losses (weakness or atrophy) occur distal to the lesion or compression—forearm muscles are not affected in early stages of carpal tunnel—the median nerve innervation to forearm muscles is intact in carpal tunnel syndrome. .

Question 78

Thumb action that can be lost in carpal tunnel syndrome? ## Footnote -Identify the thumb action that may be lost in carpal tunnel syndrome: opposition—due to loss of opponens pollicis. Abduction may be weakened due to loss of abductor pollicis brevis, but abductor pollicis longus in the anatomical snuffbox will be intact to provide abduction of the thumb—it is located in the forearm (anatomical snuffbox) and innervated by the radial nerve. Flexion of the thumb may be weakened due to loss of flexor pollicis brevis, but flexor pollicis longus (deep muscle in the forearm) is still active—the median nerve (anterior interosseous branch) is still intact. There is no other muscle providing opposition of the thumb, so the loss of opponens pollicis results in loss of opposition of the thumb.

Answer 78

opposition of thumb—due to loss of opponens pollicis. Abduction may be weakened due to loss of abductor pollicis brevis, but abductor pollicis longus in the anatomical snuffbox will be intact to provide abduction of the thumb—it is located in the forearm (anatomical snuffbox) and innervated by the radial nerve. Flexion of the thumb may be weakened due to loss of flexor pollicis brevis, but flexor pollicis longus (deep muscle in the forearm) is still active—the median nerve (anterior interosseous branch) is still intact. There is no other muscle providing opposition of the thumb, so the loss of opponens pollicis results in loss of opposition of the thumb.

Question 79

## Footnote Identify the muscle that provides a substitution for opposition of the thumb:

Answer 79

Adductor pollicis— adduction of the thumb can assist with grip in the absence of opposition. It is innervated by the ulnar nerve, which is not involved in carpal tunnel syndrome

Question 80

Describe the areas of skin innervated by the median, ulnar and radial nerves (cutaneous innervation). Fig. 3.28; pg. 168

Answer 80

Question 81

Note the areas of skin that would exhibit sensory symptoms in cases of carpal tunnel syndrome . Be able to describe this area. ## Footnote Note the areas of skin that would exhibit sensory symptoms in cases of carpal tunnel syndrome (area supplied by the median nerve). Be able to describe this area.

Answer 81

muscles supplied by the median nerve muscles of the thenar emininence: abductor pollicis brevis, flexor pollicis brevis, opponens pollicis; also lumbricals 1 and 2

Question 82

-Identify two simple screening tests for carpal tunnel syndrome and describe how these tests are done

Answer 82

phalens test= wrists flexed against each other tinel sign= tapping finger or object along nerve

Question 83

-Describe how loss of the small hand intrinsic muscles result in “claw hand”— loss of MP flexion, IP extension provided by these muscles results in the appearance of “claw hand” Fig. B3.28; pg. 245.

Answer 83

when trying to make a fist they cant flex the 4 and 5th digits at the DIPs. Cant etend IPs when trying to straighten fingers hand muscles- interossei and lumbricals loss of MP flexion, IP extension provided by these muscles results in the appearance of “claw hand claw hand= ulnar nerve injury deformity is caused by loss of interosseuious muscles supplied by the ulnar nerve

Question 84

Note the consequences of median nerve injury (“hand of benediction”) and ulnar nerve injury (“claw hand”). Pg. 244-24

Answer 84

hand of benediction= when makign a fist 2nd and 3rd fingers remain partially extended. Flexion of DIPS of 2-3 is lost, 4th and 5th DIPS not effected because they are innervated by ulnar nerve from FDP. flexion of PIPs of 1-3 digits is lost and weakaned in 4th and 5th PIPs

Question 85

Identify the bone fracture involved in a Colles, and Smith’s fracture. Distinguish between the two examples of distal radius fractures

Answer 85

When the distal fragment of the fractured radius is displaced toward the palmar surface of the wrist, the injury is called a Smith’s Fracture Fracture of the distal radius is called a Colles Fracture

Question 86

Explain what a FOOSH injury is, and provide examples (Colles fracture, scaphoid fracture, etc). Pg. 157

Answer 86

FOOSH” injury Fall On an OutStretched Hand

Question 87

Pg. 284-288 -Identify the articulating bones at the wrist joint, the ligaments that support the wrist joint, and actions possible at the wrist joint. radiocarpal

Answer 87

wrist joint (radiocarpal)= condyloid synovial joint, articulating bones= proximal row of carpal bones with the distal end of the radius and articular disc of distal radio-ulnar joint. ulna dosent participate in articulation ligaments: palmar radiocarpal ligament=pass from radius to the two rows of carpals, strong and directed so hand follows radius during supination dorsal radiocarpal=directed so hand follows radius during pronation ulnar collateral ligament= attaches to ulnar styloid process and triqutrum, strentetnges joint capsule medially radial colalteral ligament= strengtehns joint capsule laterally, attaches to radius styloid process and scaphoid movements= flexion- extension, abduction-adduction(radial and ulnar deviaiton) and circumduction

Question 88

midcarpal joint ## Footnote -Identify the joints of the hand, the ligaments that support these joints, and actions seen at these joints

Answer 88

mid carpal joint=between proximal and distal rwos of carpal bones. carpals united by anterior, posterior, and interosseous ligaments. flexion extension initiated at mid carpal joint

Question 89

carpometacarpal joint ## Footnote dentify the joints of the hand, the ligaments that support these joints, and actions seen at these joints

Answer 89

The carpometacarpal joint of the thumb is a saddle (sellar) joint Movements allowed = flexion/extension, abduction/adduction, opposition. ligaments= palmar and dorsal CMC and IM ligaments and interosseous IM ligaments. transverse metacarpal ligaments Movement allowed at CMC joints 2-5 = slight dorsal and palmar displacement This movement is greatest at CMC joints 4 and 5

Question 90

metacarpophalangeal joint ## Footnote dentify the joints of the hand, the ligaments that support these joints, and actions seen at these joints

Answer 90

movement= flexion-extension,abduction-adduciton Collateral ligaments are lax (loose) when the digits are extended at MP joints; taut (tight) when digits are flexed at MP joints This allows the metacarpal heads to abduct fully when digits are extended; but limits abduction of the metacarpal heads when digits are flexed. This allows a more secure grip

Question 91

Interphalangeal joints

Answer 91

movement= flexion/extension collateral ligaments

Question 92

Describe the structure of the extensor expansion. Pg. 230-232

Answer 92

Question 93

## Footnote Explain how the extensor expansion is damaged in the case of mallet finger, boutonniere injury. Pg. 242

Answer 93

mallet finger= The lateral bands tear away form the distal phalange— common in trauma to the dorsal side of the digit boutonniere injury=Common in cases of arthritis—the joint swelling tears the lateral bands of the extensor expansion away from the central band

Question 94

Describe the location and role of the annular pulleys in the phalanges. Pg. 255-256.

Answer 94

Annular pulleys prevent “bowstringing” of flexor tendons located on phalanges, A1-A5

Question 95

# What is the ulnary artery the source of? radial artery? Describe the blood supply of the hand (ulnar, radial arteries). Identify the ulnar artery as the source of the superficial palmar arch, and the radial artery as the source of the deep palmar arch. Pg. 257-258. ## Footnote Describe the blood supply of the hand (ulnar, radial arteries). Identify the ulnar artery as the source of the superficial palmar arch, and the radial artery as the source of the deep palmar arch. Pg. 257-258.

Answer 95

Identify the ulnar artery as the source of the superficial palmar arch, and the radial artery as the source of the deep palmar arch. The radial and ulnar arteries lead to the blood vessels that supply the hand

Question 96

Describe the path of the median and ulnar nerves entering the hand. . Pg. 237-240; 258-262

Answer 96

(median n. travels through carpal tunnel; ulnar nerve through canal of guyon. Identify these sites as potential sites for compression or lesions of these nerves). the ulnar nerve may be compressed in the Canal of Guyon (ulnar canal syndrome) Leads to sensory loss over the area of skin supplied by the ulnar nerve, and weakness or atrophy of muscles supplied by the ulnar nerve

Question 97

# **** describe the areas of skin innervated by the median, ulnar and radial nerves (cutaneous innervation). Fig. 3.20, pg. 168 what nerves for what digits of hand, palm, dorsal side

Answer 97

Question 98

Describe the differences between a precision and power grip—regarding joint position, object use, and the muscle groups and individual muscles used for each type of grip. Pg. 247-248

Answer 98

Characteristics of a Power Grip -Features strong IP flexion by flexor digitorum superficialis and profundus -The object is held firmly in the hand, with extensive palmar contact. -Adduction of the thumb (adductor pollicis) stabilizes the object in the hand -The object is often moved in space by the large arm, forearm and shoulder muscles Characteristics of a Precision Grip -The object is held lightly between the pads of the fingers and manipulated in the hand; minimal palmar contact -IP flexion and extension is adjusted as needed by the digit flexors and lumbricals and interossei - Opposition of the thumb is common (opponens pollicis) There are many variations of power and precision grips: For example: Hook grip (power) Pinch grip (precision)

Question 99

Compare the pattern of cutaneous innervation represented by the dermatome map to that represented by cutaneous branches of peripheral nerves. Identify the some of the cutaneous nerves supplying the skin of the arm and forearm (superior lateral cutaneous, medial brachial cutaneous, medial antebrachial cutaneous, lateral antebrachial cutaneous nerves). Compare the dermatome pattern on the hand to the pattern of cutaneous innervation by the median, ulnar, and radial nerves.

Answer 99

cutaneous nerves- superior Lateral Cutaneous Nerve (C5,6) Lateral Cutaneous Nerve of the Forearm (C6,7) Radial Nerve (C6-8) Median Nerve (C6-8) Ulnar Nerve (C8,T1) Fig 3.19

Question 100

identify the articulating surfaces of the elbow and proximal and distal radioulnar joint

Answer 100

elbow articulation=trochlea and capitulum ofhumerus articulate with trochlear notch of ulna and head of radius proximal radioulnar joint=head of radius articulates with radial notch of the ulna distal radioulnar notch= head of ulna articulates with ulnar notch on medial side of the distal radius

Question 101

Identify the ligaments of the elbow and proximal radioulnar joint

Answer 101

radial collateral ligament ulnar collateral ligament

Question 102

Identify the movements possible at the elbow, proximal and distal radioulnar joint

Answer 102

elbow= flexion extension proximal radioulnar joint-supination pronation distal radiolnar joint= supination pronaiton

Question 103

Explain the role of the annular ligament in support of the head of the radius. Identify the role ofthe interosseous membrane in maintaining the alignment of the radius and ulna

Answer 103

annular ligament surrounds the artiucalating surfaces and forms a collar that with the radial notch creates a ring that completly encircles the head of the radius. allows the radius to rotate within the annular liggament without tearing the synbovial membrane.

Question 104

What is a slipped elbow (nursemaid’s elbow) and why is it common in young children?

Answer 104

In small children, the head of the radius is smaller and more flexible because it still contains some cartilage When a pulling force is applied to an extended elbow, the head of the radius may “slip out” of the annular ligament

Question 105

Locate the subcutaneous olecranon bursa—inflammation of this bursa commonly called “student’s elbow

Answer 105

Inflammation of the subcutaneous olecranon bursa is known as “student’s elbow”

Question 106

Describe the location of the triangular fibrocartilage complex (TFCC) and its role to separate the ulnar head from the proximal row of carpal bones at the distal radioulnar joint