Exam 2 flashcards-1
Trapezius (Origin/ Insertion)
Origin: External Occipital Protuberance (EOP), Superior Nuchal Line, Ligamentum Nuchae, Spines of the Thoracic Vertebrae, Insertion: Clavicle, Acromion Process and Spine of Scapula
Trapezius (Actions)
Actions:* Stabilizes the scapula, * Upper portion: elevates the scapula,* Middle and Lower portions: adducts the scapula
Trapezius (Nerve Supply)
Nerve Supply: Motor Innervation: Spinal Accessory Nerve (C.N. XI), Sensory Innervation: C4 and C5”
Trapezius Palsy
A deepening of the shoulder on the affected side. The shoulder drops on the affected side.
Whiplash Injuries (to Trapezius)
The superior portion of the muscle is frequently involved in neck injuries during an auto accident.
Cranial Nerve XI (Clinical Test)
The clinical test for this nerve is to ask the patient to elevate their shoulders (shrug) against resistance. Both sides should be tested at the same time, so weakness of one side can be evaluated relative to the other side.
Rhomboid Major (Origin/Insertion)
Origin: Spine of Upper Thoracic Vertebrae, Insertion: Vertebral/Medial Border of Scapula
Rhomboid Minor (Origin/ Insertion)
Origin: Spines of Lower Cervicals and T1, Insertion: Vertebral/Medial Border of Scapula
Levator Scapula (Origin/Insertion)
Origin: Transverse Processes of Upper Cervicals, Insertion: Superior Angle of Scapula
Rhomboid Major, Rhomboid Minor, and Levator Scapula (Actions )
Actions: * Elevates the scapula, * Adducts the scapula, * Stabilizes the scapula
Rhomboid Major, Rhomboid Minor, and Levator Scapula (Nerve Supply)
Nerve Supply: Dorsal Scapula Nerve (C5)
(Damage to) Dorsal Scapula Nerve or C5
Damage results in difficulty in completely adducting the scapula and the scapula on the affected side is further from the midline.
Latissimus Dorsi (Origin/Insertion)
Origin: Spines of Lower Thoracics and Lumbars, Thoracodorsal Fascia, Crest of the Ilium, Lower Ribs, Insertion: Intertubercular Groove of Humerus
Latissimus Dorsi (Actions)
Actions:* Extends, adducts, and medially rotates the humerus, * Involved with forced expiration
Latissimus Dorsi (Nerve Supply)
Nerve Supply: Thoracodorsal Nerve (C6, C7, and C8)
(Damage to) Latissimus Dorsi
Damage results in forward displacement of the shoulder.
Lumbar Triangle
A depression found at the lower portion of the latissimus dorsi and is bounded by the: latissimus dorsi, crest of the ilium, and the external oblique muscle. A hernia of the posterior wall of the abdomen may develop here.
Triangle of Auscultation
A depression found at the superior portion of the latissimus dorsi bounded by the: latissimus dorsi, trapezius, and the vertebral/medial border of the scapula. The area is a relatively thin layer of tissue allowing for lungs sounds to be more easily heard with a stethoscope. The area can be enlarged by abducting the scapula.
Serratus Anterior (Origin/Insertion)
Origin: Upper Ribs, Insertion: Vertebral/Medial Border of Scapula
Serratus Anterior (Actions)
Actions: * Abducts the scapula (prime mover), * Stabilizes the scapula, * Involved with forced inspiration but only when the humerus is abducted
Serratus Anterior (Nerve Supply)
Nerve Supply: Long Thoracic (C5, C6, and C7)
Serratus Anterior (AKA)
AKA: Boxer’s Muscle
Winged Scapula (Long Thoracic Nerve Palsy)
A condition in which the serratus anterior is weakened due to damage to the long thoracic nerve or its segmental innervation. Patient will experience difficulty abducting their scapula and thus have problems with raising their extremity over their head. The patient will have difficulty keeping the vertebral border and inferior angle of their scapula against the posterior thoracic wall, and will have shoulder pain.
Winged Scapula weakened serratus anterior (Common Causes)
- Trauma and/or subluxation, * Traction injuries involving the shoulder joint, * Recumbency for a long period of time
Rotator Cuff Muscle (Criteria)
Criteria: 1. The muscle’s tendon of insertion must contribute to forming a cuff around the proximal end of the humerus. 2. The muscle participates in either lateral or medial rotation of the humerus.
Rotator Cuff Muscles
This group of muscles is collectively known as {this}: supraspinatus, infraspinatus, subscapularis, and teres minor.
Deltoid (Origin/Insertion)
Origin: Clavicle (anterior portion), Acromion Process (middle portion), Spine of Scapula (posterior portion), Insertion: Deltoid Tuberosity of Humerus
Deltoid (Actions)
Actions: * Anterior portion: flexes and medially rotates the humerus, * Middle portion: abducts the humerus, * Posterior portion: extends and laterally rotates the humerus
Deltoid (Nerve Supply)
Nerve Supply: Axillary Nerve (C5 and C6)
Atrophy of Deltoid (Crutch Paralysis)
Injury due to the axillary nerve. Caused by: * Fracture of the surgical neck of the humerus (injury to nerve may be immediate or occur during healing), * Dislocation of the shoulder joint, * Pressure of a crutch in the axilla
Atrophy of Deltoid (Problems)
Problems: * The shoulder has a flattened appearance; the rounded contours of the shoulder disappear, * Loss of sensation may occur over the lateral aspect of the arm, * Abduction of the arm is greatly impaired
Deltoid
Common site for intramuscular injection of drugs.
Supraspinatus (Origin/Insertion)
Origin: Supraspinous Fossa of Scapula, Insertion: Greater Tuberosity of Humerus
Supraspinatus (Actions)
Actions: * Initiates abduction of the humerus, * Laterally rotates the humerus, * Stabilizes the shoulder joint
Supraspinatus (Nerve Supply)
Nerve Supply: Suprascapular (C5 and C6)
Rotator Cuff Tendinitis
An irritation and inflammation of the supraspinatus tendon and one of the most common causes of shoulder pain. Also known as shoulder impingement syndrome. * Pain may be sharp or aching and usually occurs in the anterior and/or lateral aspects of the shoulder,* At first it may feel like a “twinge” in your shoulder but can progress to pain during and after activity, * Usually the result of overuse due to repetitive motions which cause microtrauma to the tendon’s collagen fibers, * In elderly individuals it may be due to calcium deposits in the tendon
Rotator Cuff Tears
If the tendon is weakened by a combination of multifactorial it may lead to {this}. * The tendon usually ruptures at or near its insertion and the tear may be partial or complete, * A complete tear in younger individuals are almost always from trauma or after a shoulder dislocation, * Small tears can result from repetitive microtrauma or from a severe case of tendinitis, but large or complete tears are from a single episode of trauma, * Over the age of 50, tears can occur with only minor trauma, * Symptoms are similar to tendinitis, but with a significant tear patient will have difficulty carrying out abduction of the arm
Drop Test
Test used to evaluate rotator cuff tears or for degenerative tendinitis. The patient is asked to lower the fully abducted limb slowly, the limb will fall suddenly to the side in an uncontrolled manner if the tendon is torn or diseased.
Shoulder Bursitis
Shoulder pain and discomfort may be due to inflammation of the subacromial and deltoid brusae. This may in fact be more common than rotator cuff tendinitis, but is difficult to distinguish one from the other. Commonly seen in swimmers, tennis players, and gymnasts.
Subacromial and Deltoid (Bursae)
The supraspinatus tendon is separated from the acromion process by these bursae.
Infraspinatus (Origin/Insertion)
Origin: Infraspinous Fossa of Scapula, Insertion: Greater Tuberosity of Humerus
Infraspinatus (Actions)
Actions: * Laterally rotates the humerus, * Stabilizes the shoulder joint
Infraspinatus (Nerve Supply)
Nerve Supply: Suprascapular (C5 and C6)
Subscapularis (Origin/Insertion)
Origin: Subscapular Fossa of Scapula, Insertion: Lesser Tuberosity of Humerus
Subscapularis (Actions)
Actions: * Medially rotates the humerus, * Stabilizes the shoulder joint
Subscapularis (Nerve Supply)
Nerve Supply: Upper and Lower Subscapular Nerves (C5 and C6)
Teres Minor (Origin/Insertion)
Origin: Axillary/Lateral Border of Scapula, Insertion: Greater Tuberosity of Humerus
Teres Minor (Actions)
Actions: * Laterally rotates the humerus, * Stabilizes the shoulder joint
Supraspinatus, Infraspinatus, and Teres Minor (SIT) Muscles
The rotator cuff muscles that attach to the greater tuberosity of the humerus.
Teres Major (Origin/Insertion)
Origin: Inferior Angle of Scapula, Insertion: Intertubercular Groove (Medial Lip) of Humerus
Teres Major (Actions)
Actions: * Adducts and medially rotates the humerus* Stabilizes the shoulder joint
Teres Major (Nerve Supply)
Nerve Supply: Lower Subscapular (C6)
Quadrilateral Space
The more lateral space between the teres major and teres minor where the axillary nerve and humeral circumflex arteries are found.
Triangular Space
The more medial space between the teres major and teres minor where the circumflex scapular branch of the subscapular artery is found.
Sternoclavicular Joint
The joint by which the upper limb articulates with the axial skeleton. Most stable joint in the upper extremity. Articulations: sternal end of the clavicle, clavicular notch of the sternum, and the cartilage of the first rib. The articulating surfaces are poorly adapted to one another overcome by a piece of cartilage called the articular disc.
Articular Disc (of Sternoclavicular Joint)
Divides the sternoclavicular joint into separate cavities and functions to: prevent the clavicle from being displaced at its articulation with the sternum, and as a shock absorber of forces being transmitted along the clavicle.
Plane Gliding (Sternoclavicular Joint Classification)
Sternoclavicular joint classification.
Sternoclavicular Joint (Capsular Ligament)
Very strong ligament that completely surrounds the joint.
Anterior and Posterior Sternoclavicular Ligaments
These ligaments reinforce the capsular ligament and prevent excessive forward (protraction) and backward (retraction) displacement of the clavicle. Extrinsic/Wall
Interclavicular Ligament
This ligament is attached to the sternal ends of both clavicles across the jugular notch of the sternum. It functions to prevent displacement of the clavicle, as when one is carrying a heavy object. Extrinsic/Rope
Costoclavicular Ligament
A strong ligament which is attached from the costal tubercle of the clavicle to the first rib. The ligament reinforces the joint capsule and limits elevation of the medial end of the clavicle. Extrinsic/Rope
Sternoclavicular Joint (Nerve Supply)
Joint Nerve Supply: Supraclavicular and Nerve to the Subclavius
Sternoclavicular Joint (Movements)
Although the joint is very strong and stable it is mobile enough to allow movements of the pectoral girdle and upper limb. Elevation, depression, protraction and retraction occur at the joint but much of the movement is passive and occurs when the scapula moves.
Acromioclavicular Joint (Articulations)
Articulations: Acromion process of the scapula and the lateral end of the clavicle.
Plane Gliding (Acromioclavicular Joint Classification)
Acromioclavicular joint classification.
Acromioclavicular Joint (Capsular Ligament)
A thin, weak capsular ligament that cannot maintain the integrity of the joint without reinforcing ligaments.
Superior and Inferior Acromioclavicular Ligaments
Ligaments that reinforce the capsule and prevent the clavicle from losing contact with the acromion process. Extrinsic/Rope
Coracoclavicular Ligament
Ligament which connects the clavicle with the coracoid process of the scapula. The ligament is divided into a conoid and trapezoid portion, which are attached respectively to the conoid tubercle and trapezoid line of the clavicle. The ligament is largely responsible for holding and suspending the weight of the scapula from the clavicle and also limits protraction, elevation, and rotation at the joint. Extrinsic/Rope
Acromioclavicular Joint (Nerve Supply)
Joint Nerve Supply: Suprascapular and Axillary Nerves
Acromioclavicular Joint (Movements)
At this joint the acromion of the scapula rotates on the acromial end of the clavicle, but no muscles attach to either bones to carry out this movement. all movement at the joint occurs by movements of the scapula which than cause it to move upon the clavicle.
Dislocation of the Acromioclavicular Joint (Shoulder Separation)
Although a very strong ligament, it is very vulnerable to injury in contact sports (e.g. football, rugby, and hockey). Injuries often occur by a severe blow to the shoulder which is known as a shoulder pointer. Both the acromioclavicular and coracoclavicular ligaments are damaged and the scapula will separate from the clavicle and falls because of the weight of the upper limb. The lateral end of the clavicle is displaced and easily palpable and the acromion process is more prominent than normal. This type of dislocation may compress the subclavian artery indicated by a diminished brachial or radial pulse.
Glenohumeral (Shoulder) Joint (Articulations)
Articulations: Head of Humerus with the Glenoid Cavity of the Scapula
Glenoid Labrum
The fibrocartilage rim that deepens the glenoid cavity of the scapula.
Ball and Socket (Glenohumeral (Shoulder) Joint Classification)
Glenohumeral (Shoulder) joint classification.
Glenohumeral (Shoulder) Joint (Capsular Ligament)
Capsular ligament surrounds the joint and is thin and lax. The long head of the biceps brachii passes out of the joint cavity. The capsule is not strong enough to keep the two bones in contact with each other allowing for tremendous freedom of movement.
Glenohumeral Ligament
A ligament which is found within the shoulder joint cavity. It strengthens the anterior aspect of the capsule and helps prevent lateral rotation of the humerus. Intrinsic/Rope
Transverse Humeral Ligament
A ligament that spans the intertubercular groove, converting it into a canal. The long head of the biceps is held in place by the ligament.
Coracohumeral Ligament
A ligament that strengthens the capsule from above and limits lateral rotation of the humerus. Extrinsic/Rope
Coracoacromial Ligament
A ligament that attaches the coracoid process to the acromion process. It prevents upward displacement of the head of the humerus. Extrinsic/Wall
Suprascapular Ligament
A small ligament which spans the scapular notch and may ossify.
Glenohumeral (Shoulder) Joint (Nerve Supply)
Joint Nerve Supply: Axillary and Suprascapular Nerves
Glenohumeral (Shoulder) Joint (Dislocation)
Dislocation due to the general weakness of the ligaments, it is primarily muscles which keep the joint from dislocating. Because of its freedom of movement and instability the joint can be dislocated either directly or indirectly.
Glenohumeral (Shoulder) Joint (Anterior Dislocations)
Most common dislocation of the joint and usually seen in young adults, particularly athletes, and take place at the inferior aspect of the capsular ligament caused by excessive extension and lateral rotation of the humerus. The head of the humerus is forced through the capsule and ends up lying below the coracoid process. The shoulder loses its rounded appearance and the greater tuberosity cannot be palpated by pressing through the deltoid. Numbness along the lateral aspect of arm and forearm due to injury of the musculocutaneous and axillary nerves.
Flexion (at Elbow Joint)
Bending at the elbow joint by bringing the anterior aspect of the forearm closer to the anterior aspect of the arm. There is a decrease in the angle of the joint.
Extension (at Elbow Joint)
A return movement from flexion at the elbow joint, with an increase in the angle between the forearm and arm.
Hyperextension (at Elbow Joint)
Movement at elbow joint past extension which some individuals can do due to the size of the olecranon process and fossa, rather than a laxity in ligaments.
Supination (of Forearm)
Lateral rotation of the forearm (palms up position).
Pronation (of Forearm)
Medial rotation of the forearm (palms down position).
Anconeus (Action)
Action: Weakly assists in extension of the forearm
Anconeus (Nerve Supply)
Nerve Supply (week forearm extensor muscle): Radial Nerve
Brachial Artery
Main arterial supply to the arm and is the continuation of the axillary artery. At the cubital fossa, the vessel divides into its two terminal branches - the ulnar and radial arteries.
Deep Brachial (Brachial Profundus)
First major branch of brachial artery arises just distal to the teres major. The artery accompanies the radial nerve and supplies the posterior aspect of the arm. The vessel brings the axillary artery into communication with the radial and ulnar arteries.
Superior and Inferior Ulnar Collaterals
These arteries are given off at the distal medial end of the brachial artery and take part in the arterial anastomosis around the medial aspect of the elbow joint.
Blood Pressure
The brachial artery is commonly used to measure {this} using a sphygmomanometer. The brachial artery is used because it lies approximately at the level of the heart and the muscle mass of the arm can effectively transmit the pressure in the cuff to the blood vessel.
Cutaneous (Superficial) Veins (of the Upper Extremity)
Dorsal Venous Arch, Cephalic Vein, Basilic Vein, Median Cubital Vein are {these} of the upper extremity.
Dorsal Venous Arch
The veins of the hand form a prominent arch on the back of the hand and from which the respective cutaneous veins arise.
Cephalic Vein
The vein that comes off of the lateral aspect of the dorsal venous arch and continues proximally in the lateral aspect of the forearm and arm. It terminates and drains into the axillary vein.
Basilic Vein
The vein that comes off of the medial aspect of the dorsal venous arch and continues proximally in the medial aspect of the forearm and arm. It joins with the brachial veins to form the axillary vein.
Median Cubital Vein
The main linkage between the cephalic and basilic veins in the cubital fossa. This is usually the most prominent cutaneous vein of the body and is visible and palpable when all others may be hidden in fat or collapsed by shock. Blood is usually taken from here.
Musculocutaneous Nerve
Nerve that innervates biceps brachii, coracobrachialis, and brachialis. Rarely injured directly because of its protected position beneath the biceps brachii muscle. Injury to the nerve is typically due to a direct wound in the axilla, aneurysm of the axillary artery, or possibly a dislocation of the shoulder joint.
Musculocutaneous Nerve (Damage)
When {this} nerve is damaged the anterior arm muscles will atrophy but weak flexion of the forearm at the elbow joint is still possible because of secondary actions of the pronator teres and brachioradialis muscles. There may also be a loss of sensation along the lateral aspect of the forearm since the lateral antebrachial cutaneous nerve is a branch.
Cubital Fossa
The depression found a the anterior aspect of the elbow. It is triangular in shape and marks the point where many of the nerves and vessels of the arm enter the forearm. Boundaries: lateral - brachioradialis muscle, medial - pronator teres muscle, proximal - level of the epicondyles of the humerus.
Ginglymus (Hinge) (Elbow Joint Classification)
Elbow joint classification.
Elbow Joint (Capsular Ligament)
This type of joint demands that the capsular ligament be loose anterior and posterior to permit flexion and extension and have strong collateral ligaments to prevent medial and lateral movements. The capsular ligament has attachments to the humerus and ulna but does not have any direct attachments with the radius.
Lateral or Radial Collateral Ligaments
{These} ligaments run from the lateral epicondyle of the humerus to the annular ligament below. Independent rotation of the radius is not impeded. They prevent adduction (medial) movement at the joint. Extrinsic/Rope
Medial or Ulnar Collateral Ligaments
{These} ligaments run from the medial epicondyle to the proximal part of the ulna. They prevent abduction (lateral movement). Extrinsic/Rope
Annular Ligament
{This} ligament is attached to the margins of the radial notch of the ulna encompassing, but not attaching to the head and neck of the radius. Extrinsic/Wall
Elbow Joint (Nerve Supply)
Joint Nerve Supply: Musculocutaneous and Radial Nerves
Elbow Joint (Dislocations)
Posterior dislocations of {this} joint are common, especially when children fall on their hands with their forearms flexed. The proximal end of the ulna will become dislocated from the trochlea of the humerus. These types of dislocation may be accompanied by fractures (head of radius, coronoid or olecranon processes of the ulna), torn ligaments (ulnar collateral) or injury to the ulnar nerve.
Ulnar Nerve (Damage)
{This} nerve becomes compressed or lacerated in dislocations or fracture dislocations of the elbow joint. The injury may occur at the time of the injury or weeks or even months later. The patient will complain of numbness in the area of their little finger and notice weakened flexion and adduction of the hand at the wrist joint.
Carrying Angle
In full extension of the upper extremity, the forearm and arm are not exactly aligned. In females the forearm deviates laterally between 12° and 15°, in males the angle is about 5°.
Cubitus Valgus
An increase in the carrying angle.
Olecranon Bursa
A large bursa between the olecranon process and the skin, which functions to dissipate the pressure produced when one leans on their elbow. This bursa is exposed to injury during falls on the elbow and to infections from abrasions of the skin. Repeated excessive pressure on the bursa may cause it to become inflamed producing a friction type of bursitis.
Sexual Dimorphism
Differences between males and females in size and appearance.
Proximal (Superior) Radioulnar Joint (Articulation)
Articulation: Head of the Radius with the Radial Notch of the Ulna
Pivot or Trochoid (Proximal (Superior) Radioulnar Joint Classification)
Proximal (superior) radioulnar joint classification.
Proximal (Superior) Radioulnar Joint (Capsular Ligament)
{This} capsular ligament encloses the joint and is continuous with that of the elbow joint.
Interosseous Membrane and Oblique Cord
{These} ligaments of the elbow joint limit supination beyond anatomical position. Extrinsic/Rope
Subluxation of the Head of the Radius (Pulled/Slipped Elbow; Nursemaid’s Elbow)
One of the most common musculoskeletal injuries seen in preschool children. Usually caused when the child is suddenly lifted by the hand or forearm which tears or pulls the head of the radius from under the annular ligament.
Radius
Lateral bone of the forearm. It articulates proximally with the humerus at the elbow joint and with the ulna at the proximal radioulnar joint. Its distal end articulates with the scaphoid and lunate bones at the wrist joint and with the distal end of the ulna at the distal radioulnar joint. Pivot bone which carries the hand during pronation and supination.
Ulna
Medial bone of the forearm. Proximal end articulates with the humerus at the elbow joint and with the head of the radius at the proximal radioulnar joint. Distally the bone articulates with the radius at the distal radioulnar joint but is excluded from taking part in the wrist joint by a piece of cartilage known as the articular disc of the wrist. Stabilizing bone of the forearm and hand.
Colles Fracture
A fracture at the distal end of the radius and one of the most common fractures in adults, especially women over the age of 50 (osteoporosis). Occurs when an individual falls on an outstretched hand with the forearm pronated. The force of the trauma moves through the carpal bones to the distal end of the radius. The distal fragment is displaced posteriorly producing a shortening of the radius. These fragments may often be comminuted (broken in pieces). Tend to heal well since the bone has a good vascular supply. Failure to restore the normal articulation between the radius and carpal bones can lead to severe limitations on flexion and extension at the wrist.
Dinner Fork Deformity
A typical sign of Colles Fracture is often clinically referred to as {this} because a posterior angulation occurs in the forearm just proximal to the wrist and the normal anterior curvature of the hand.
Smith’s Fractures
Fracture that occurs at the distal end of the radius due to a fall on the back of the hand. The distal fragment displaced anteriorly.
Carpal Bones (Lateral to Medial, Proximal to Distal)
Scaphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
(Carpal Bone(s) that Ossify in) First Year of Life
Capitate and Hamate ossify when?
(Carpal Bone(s) that Ossify between) Second and Third Year of Life
Triquetral ossifies when?
(Carpal Bone(s) that Ossify in) Third Year of Life
Lunate ossifies when?
(Carpal Bone(s) that Ossify between) Fourth and Fifth Year of Life
Trapezium, trapezoid, and scaphoid ossify when?
(Carpal Bone(s) that Ossify between) Ninth and Tenth Year of Life
Pisiform ossifies when?
Sesamoid Bones
Bones embedded in tendons. They protect and stabilize the tendons and change the angle as the tendons pass to their insertion increasing leverage.
(Fractures of the) Scaphoid
The most commonly fractured carpal bone. Often results from a fall on the palm with the hand hyperextended. It takes a great deal of force to fracture this bone (twice as much force as is needed to fracture the radius).
(Fractures of the) Hamate
Fractures of this carpal may result in a nonunion of the fractured bone parts because of traction produced by the attached muscles. The ulnar nerve may be injured in these types of fractures due to its proximity to the hook.
(Fractures of the) Metacarpals
Since the 2nd to 5th of these are held closely by ligaments, fractures tend to be stable, they have good blood supply and heal quickly, a severe crushing injury may fracture several at once.
Boxer’s Fracture
A fracture of the 5th metacarpal occurs when an individual punches someone are something with a closed fist.
(Fractures of the) Phalanges
Fractures of {these} usually due to crushing injuries. Because of the highly developed sensation in this area these injuries are extremely painful.
Flexion (of Hand at Wrist Joint)
The act of bending the palm of the hand toward the forearm.
Extension (of Hand at Wrist Joint)
The movement of straightening the flexed hand to anatomical position.
Abduction (of Hand at Wrist Joint)
Movement of the hand laterally away from the body.
Adduction (of Hand at Wrist Joint)
Movement of the hand medially toward the body.
Flexion (of Digits)
Bending the digits toward the palm.
Extension (of Digits)
Straightening the flexed digits.
Abduction (of Digits)
Movement of digits 1, 2, 4, and 5 away from the midline of the hand.
Adduction (of Digits)
Movement of digits 1, 2, 4, and 5 towards the midline of the hand.
Flexor Carpi Radialis (Nerve Supply)
Nerve Supply: Median Nerve
Ulnar Deviation
Weakness to the flexor carpi radialis can cause an abnormal type of flexion at the hand known as {this} due to median nerve damage.
Ape Hand
{This} term is often used for median nerve damage when the thenar muscles have atrophied and the thumb is held close to the second metacarpal.
Median Nerve Damage (Motor Test)
Ask the patient to make a circle with their thumb and index finger, the examiner attempts to pull the thumb away by applying force to the proximal phalanx of the thumb. This tests the strength of the thenar muscles.
Median Nerve Damage (Sensory Test)
Assess cutaneous sensation at the tip of the second digit. This is the part of cutaneous distribution least susceptible to variation.
Ulnar Nerve Damage
{This} nerve can be compressed or injured at the proximal or distal aspect of the forearm. More than 25% of nerve problems in the upper extremity affect this nerve. Most common area of compression or injury is at or just distal to the elbow joint. Injury here will cause atrophy of the flexor carpi ulnaris and half of the flexor digitorum profundus.
Claw Hand
{This} term is often used for ulnar never damage due to the difficulty in making a fist (cannot fully flex digits four and five).
Guyon Tunnel (or Canal) Syndrome
Term used to indicate compression or damage to the ulnar nerve at the wrist where it passes between the pisiform and the hook of the hamate. The individual will show loss of sensation in the medial one and half digits and may show atrophy of the hypothenar muscles.
Cyclists (or Handlebar) Neuropathy
Term used for individuals who ride long distances on bicycles with their hands in an extended position against the hand grips putting pressure on the hook of the hamate and compressing the ulnar nerve. This results in sensory loss on the medial side of the hand and weakness of the hypothenar muscles.
All Muscles in both the Superficial and Deep Posterior Forearm (Nerve Supply)
Nerve Supply: Radial Nerve
Extensor Indicis (Action)
Action: Extends digit two
Radial Nerve (Damage)
The degree of motor paralysis will depend upon the level at which {this} nerve is injured. The most common cause of injury is a fracture of the shaft of the humerus. At this level the triceps may be spared paralysis but the posterior forearm muscles will be affected as well as sensation in areas of skin supplied by the nerve. Patient will be unable to: extend the wrist or the digits, hands drop into passive flexion, loss of sensation on the dorsum of the forearm and hand.
Wrist Drop
Term describing the passive flexion of the hand due to radial nerve damage.
Radial Artery
More lateral branch of the brachial artery. Descends along the lateral side of the forearm, where it is mostly covered by just skin and fascia. Branches: recurrent (takes part in an arterial anastomosis around the elbow), unnamed muscular branches, superficial and deep palmar which help from the palmar arches.
Ulnar Artery
Medial branch of the brachial artery. Passes along the medial side of the forearm, where it is deep to the flexor carpi ulnaris muscle. The artery then crosses the retinaculum and sends branches to form the superficial and deep palmar arches. It is accompanied by the ulnar nerve as it descends down the forearm. Branches: anterior and posterior recurrent (take part in the arterial anastomosis around the elbow), common interosseous (arises from the proximal part of the vessels and divides into an anterior and posterior interosseous artery).
Distal (Inferior) Radioulnar Joint (Articulation)
Articulation: Head of the Ulnar and Ulnar Notch of the Radius
Pivot or Trochoid (Distal (Inferior) Radioulnar Joint Classification)
Distal (inferior) radioulnar joint classification.
Distal (Inferior) Joint (Capsular Ligament)
Capsular ligament encloses the joint but rather weak and some deficient superiorly.
Anterior and Posterior Transverse Ligaments
Ligaments which serve to unite the distal ends of the radius and ulna, strengthen the capsular ligament and prevent supination. Extrinsic/Rope
Articular Disc (Distal Radioulnar Joint)
A unique feature of this joint and the wrist joint. A triangular piece of fibrocartilage which attaches to the ulnar notch and the styloid process of the ulna. Helps to firmly unite the distal end of the two bones and is the chief uniting structure of the Distal (Inferior) Radioulnar Joint.
Interosseous Membrane
Membrane provides considerable strength and stability between the radius and ulna, limits supination, increases the surface for attachment of muscles in both the anterior and posterior compartments of the forearm.
Radiocarpal (Wrist) Joint (Articulation)
Articulation: Distal end of the Radius and Articular Disc with the Scaphoid, Lunate, and Triquetral
Condyloid (Radiocarpal (Wrist) Joint Classification)
Radiocarpal (wrist) joint classification.
Radiocarpal (Wrist) Joint (Capsular Ligament)
Capsular ligament is rather thin and unremarkable.
Dorsal and Palmar Radiocarpal Ligaments
Ligaments that attach superiorly to the radius and inferiorly to the scaphoid and lunate carpals. They strengthen the capsule. Extrinsic/Rope
Palmar Ulnocarpal Ligament
Ligament that attaches the ulna to the carpal bones. Extrinsic/Rope
Ulnar and Radial Collateral Ligaments
Ligaments that attach from the styloid process of the ulna and radius to the carpal bones on their respective sides. Relatively strong ligaments. Extrinsic/Rope
Radiocarpal (Wrist) Joint (Nerve Supply)
Nerve Supply: Median, Ulnar, and Radial Nerves
Flexion (at Wrist Joint)
Movement limited by the extensor tendons and dorsal radiocarpal ligaments.
Extension (at Wrist Joint)
Movement limited by bone hitting bone, flexor tendons and the palmar radiocarpal and ulnocarpal ligaments.
Adduction (at Wrist Joint)
Movement limited by the radial collateral ligament.
Abduction (at Wrist Joint)
Movement limited by the ulnar collateral ligament and the styloid process making contact with the trapezium.
Tinel’s Sign
A sensation of “pins and needles” when one taps over the site of the median nerve distribution at the anterior aspect of the wrist.
Phalen’s Test
Test used to reproduce the symptoms of carpal tunnel syndrome by having the patient flex their hands to maximum and holding in the position for several minutes.
Palmar Aponeurosis
Triangular shaped piece of deep fascia which occupies the central area of the palm. It is continuous with the fascia that covers the thenar and hypothenar muscles and with the flexor retinaculum. Functions: gives firm attachment to the overlying skin to improve grip, protects the underlying structures.
Dupuytren’s Contracture
A condition in which there is a shortening and hypertrophy of the palmar aponeurosis. The condition usually begins with one or more mildly painful nodules involving the fascia, usually at the base of the fourth and fifth digits. This condition causes a thickening as well as a shortening of the aponeurosis and results in the contracture of muscles affecting the digits. Starts near the base of the fourth digit and draws the digit into the palm because of flexion at the MP joint, later may involve the firth digit in the same manner.
Biceps Brachii, Coracobrachialis, and Brachialis (Nerve Supply)
Nerve Supply: Musculocutaneous Nerve
Biceps Tendinitis
The long head of the biceps is enclosed in a synovial sheath and moves back and forth in the intertubercular groove, wear and tear can inflame the tendon and cause pain in the shoulder region. Occurs in sports where there is a lot of throwing or the use of a racquet.
Crepitus
A grating sound or sensation produced by friction between bone and cartilage.
Sternoclavicular Joint (Dislocation)
This joint rarely dislocates due to the strength of the ligaments, the articular disc, and how forces are transmitted along the clavicle. When a dislocation occurs it is due to direct trauma (e.g. automobile accident). * Injuries can run from a mild sprain to a complete dislocation, * Most common in individuals under 25 (epiphyseal plate at the sternal end has not yet closed), * May be life threatening due to damage or compression of the trachea or blood vessels in the neck
Biceps Brachii Short Head (more medial head) (Origin/Insertion)
Origin: Coracoid Process of the Scapula, Insertion: Tuberosity of Radius, and Shaft of Ulna
Biceps Brachii Long Head (more lateral head) (Origin)
Origin: Supraglenoid Tubercles of Scapula, Insertion: Tuberosity of Radius, and Shaft of Ulna
Biceps Brachii (Actions)
Actions: * Flexion of the forearm at elbow joint, * Supinator of the forearm (prime mover), * Short head: adducts humerus, * Long head: abducts humerus
Biceps Brachii Long Head (Rupture)
Rupture that results from wear and tear on a chronically inflamed tendon. * Tendon is usually torn or ruptured near its attachment on the supraglenoid tubercle, * Rupture is commonly dramatic and associated with a pop or snap, * Ruptured belly forms a ball near the center of the distal anterior aspect of the arm (Popeye Deformity), * Common causes: chronic tendinitis, forceful flexion of the arm against excessive weight
Bicipital Reflex
The tendon of the biceps tendon is tapped looking for a simple reflex that tests the segmental innervation of the muscle (C5 and C6).
Coracobrachialis (Origin/Insertion)
Origin: Coracoid Process of Scapula, Insertion: Midpoint on Shaft of Humerus
Coracobrachialis (Actions)
Actions: * Flexion and weak adduction of the humerus, * Helps to stabilize the shoulder joint
Brachialis (Origin/Insertion)
Origin: Shaft of the Humerus, Insertion: Coronoid Process of Ulna
Brachialis (Action)
Action: flexion of the forearm at the elbow joint
Triceps Brachii Long Head (Origin/Insertion)
Origin: Infraglenoid Tubercle of Scapula, Insertion: Olecranon Process of Ulna
Triceps Brachii Lateral and Medial Heads (Origin/Insertion)
Origin: Shaft of the Humerus, Insertion: Olecranon Process of Ulna
Triceps Brachii (Actions)
Actions: * Extension of the forearm at the elbow joint, * Medial head: works all of the time, * Lateral and Long head: work only for extra force
Triceps Brachii (Nerve Supply)
Nerve Supply (posterior arm): Radial Nerve
Anconeus (Origin/Insertion)
Origin: Lateral Epicondyle of Humerus, Insertion: Olecranon Process of Ulna
Cubital Fossa (Structures)
Structures found in {this}: * Median nerve, * Brachial artery (branching into ulnar and radial arteries), * Tendon of the biceps brachii, * Median cubital vein
Elbow Complex
The complex that includes the elbow joint and the proximal radioulnar joint. The two joints are included in the complex because: * The radius and ulna are common articulating surfaces, * The synovial cavity of the elbow joint is continuous with the synovial cavity of the proximal radioulnar joint, * the ligaments of the elbow are continuous with the ligaments of the proximal radioulnar joint
