Exam 2 flashcards-2
Elbow Joint (Articulations)
Articulations: * Trochlea of the humerus with the trochlear notch of the ulna, * Capitulum of the humerus with the head of the radius
Elbow Joint (Movements)
A very stable hinge (ginglymus) joint because of the wrench shape of the trochlear notch of the ulna fitting around the trochlea of the humerus. The joint is also strengthened by strong medial and lateral ligaments. Flexion unrestricted by bone or ligaments. It stops when the soft tissue of the forearm meets that of the arm. Extension is limited by contact of the olecranon with the floor of the olecranon fossa of the humerus.
Subluxation of the Head of the Radius (Symptoms)
Symptoms: * Very painful (pinching of the annular ligament), * Extremity is held limply at the side (forearm is flexed and pronated) or supported by the opposite hand, * Palpation reveals tenderness at radial head, * Supination of the forearm causes great pain
(Fracture of the) Radius and/or Ulna
- Fractures usually result from severe injury and direct injury usually produces transverse fractures of both bones, * Isolated fractures of either bone can occur, * Displacement of the fragment is usually considerable and will depend on the pull of the attached muscles, * If the normal anatomical relationship are not restored pronation and supination may be impaired
(Fractured) Scaphoid (Symptoms)
Symptoms: * There is some swelling and pain and many patients just think they have “sprained” their wrist, * Tenderness and swelling in the anatomical snuffbox makes one suspicious of the this type of fracture, * Initial radiography may not reveal a fracture, * Because of the poor blood supply to the bone, union of the fractured parts may take several months and can produce degenerative arthritis of the first CM joint
Pronator Teres (Origin/Insertion)
Origin: Medial Epicondyle of Humerus, Coronoid Process of Ulna, Insertion: Pronator Ridge of Radius
Pronator Teres (Actions)
Actions: * Pronation of forearm at superior radioulnar joint, * Assists in flexion at the forearm
Pronator Teres (Nerve Supply)
Nerve Supply: Median Nerve
Pronator Teres Syndrome
Compression of median nerve in the proximal forearm. The nerve is compressed between the heads of {this} muscle due to direct trauma or excessive pronation/supination (hypertrophy of the muscle).
Flexor Carpi Radialis (Origin/Insertion)
Origin: Medial Epicondyle of Humerus, Insertion: Second Metacarpal (with a small slip to the third metacarpal)
Flexor Carpi Radialis (Actions)
Actions: * Equal prime mover for flexion at the wrist joint, * Abduction of the hand
Palmaris Longus (Origin/Insertion)
Origin: Medial Epicondyle of Humerus, Insertion: Palmar Aponeurosis (fascia)
Palmaris Longus (Actions)
Actions: * Weak flexion at the wrist, * Tightens fascia of palm
Palmaris Longus (Nerve Supply)
Nerve Supply: Median Nerve
Flexor Carpi Ulnaris (Origin/Insertion)
Origin: Medial Epicondyle of Humerus, Insertion: Pisiform, Hamate, and 5th metacarpal
Flexor Carpi Ulnaris (Nerve Supply)
Nerve Supply: Ulnar Nerve
Radial Deviation
Weakness of the flexor carpi ulnaris results in an abnormal type of flexion of the hand that wrist joint known as {this} due to ulnar nerve damage.
Flexor Digitorum Superficialis (Origin/Insertion)
Origin: Medial Epicondyle of Humerus, Insertion: Middle Phalanges of Digits 2-5
Flexor Digitorum Superficialis (Actions)
Actions: * Flexes proximal interphalangeal (PIP) joints of digits 2-5, * Assist in flexion at the wrist joint
Flexor Digitorum Superficialis (Nerve Supply)
Nerve Supply: Median Nerve
Flexor Digitorum Profundus (Origin/Insertion)
Origin: Shaft of the Ulna, Insertion: Distal phalanges of Digits 2-5
Flexor Digitorum Profundus (Actions)
Actions: * Flexes distal interphalangeal (DIP) joints of digits 2-5, * Assists in flexion at the wrist joint
Flexor Digitorum Profundus (Nerve Supply)
Nerve Supply: Median and Ulnar Nerve
Flexor Pollicis Longus (Origin/Insertion)
Origin: Shaft of Radius, Insertion: Distal Phalanx of Digit 1
Flexor Pollicis Longus (Action)
Action: Flexes digit one at the interphalangeal (IP) joint
Flexor Pollicis Longus (Nerve Supply)
Nerve Supply: Median Nerve
Pronator Quadratus (Origin/Insertion)
Origin: Shaft of Ulna, Insertion: Shaft of Radius
Pronator Quadratus (Actions)
Actions: * Pronates the forearm at the distal radioulnar joint, * Helps to stabilize the distal radioulnar joint
Pronator Quadratus (Nerve Supply)
Nerve Supply: Median Nerve
Median Nerve Damage
Compression or injury is common at either the proximal part of the forearm (Pronator Teres Syndrome) or in the distal part of the forearm (Carpal Tunnel Syndrome).
Median Nerve Damage (Symptoms)
Symptoms: * Loss or weakened pronation, * Sensory loss over the lateral 2/3 of the palmar surface of the hand, * Abnormal and weak flexion at the wrist joint (ulnar deviation), * Weakened abduction of the hand, * Atrophy of the thenar muscles with a loss of opposition and loss and/or weakness of other movements of the first digit
Ulnar Nerve Damage (Symptoms)
Symptoms: * Impaired or weakened adduction of the hand, * Weakened and abnormal flexion of the hand (radial deviation), * Muscles of the hand associated with the firth digit (hypothenar muscles) will undergo atrophy, * Loss of sensation over the medial part of the palmar surface of the hand (digit five and half of digit four), * Difficulty in making a fist (cannot fully flex digits four and five)
Brachioradialis (Origin/Insertion)
Origin: Lateral Supracondylar Ridge of Humerus, Insertion: Styloid Process of Radius
Brachioradialis (Actions)
Actions:* Flexes forearm, * When forearm is extended and pronated will act as a supinator, * When forearm is flexed and supinated will act as a pronator
Extensor Carpi Radialis Longus (Origin/Insertion)
Origin: Lateral Epicondyle of Humerus, Insertion: Second Metacarpal
Extensor Carpi Radialis Brevis (Origin/Insertion)
Origin: Lateral Epicondyle of Humerus, Insertion: Third Metacarpal
Extensor Carpi Radialis Longus and Brevis (Actions)
Actions: * Extends hand, * Abducts hand
Extensor Digitorum Maximus (Origin/Insertion)
Origin: Lateral Epicondyle of Humerus, Insertion: Middle and Distal Phalanges of digits 2-5
Extensor Digitorum Maximus (Actions)
Actions: * Extends digits 2-5, * Extends hand at wrist joint, * Abducts digits 2, 4, and 5
Extensor Digiti Minimi (Origin/Insertion)
Origin: Lateral Epicondyle of Humerus, Insertion: Proximal Phalanx of Digit Five
Extensor Digiti Minimi (Action)
Action: Extends digit five
Extensor Carpi Ulnaris (Origin/Insertion)
Origin: Lateral Epicondyle of Humerus, Insertion: Fifth Metacarpal
Extensor Carpi Ulnaris (Actions)
Actions: * Extends hand, * Adducts hand
Tennis Elbow (Lateral Epicondylitis)
Painful condition of the elbow which involves repetitive use of the superficial posterior forearm muscles. There is inflammation and a possible degeneration of the common tendon of origin associated with the lateral epicondyle of the humerus. Characterized by: tenderness and pain around the lateral epicondyle, radiation of pain down lateral aspect of the forearm, pain aggravated by any activity which puts tension on the extensor forearm muscles.
Tennis Elbow (Simple Test)
Test: * Stabilization of the patient’s forearm while having the patient make a fist and hyperextend their hand, * Apply pressure to the patient’s hand and attempt to force the patient’s hand into flexion, while patient resists, * If condition is present the patient will experience sudden severe pain in the area of the lateral epicondyle
Mallet (or Baseball) Finger
A condition in which there is a sudden, severe tension on one of the long extensor tendons where it may avulse at its attachment at a phalanx. The deformity results from the distal IP joint suddenly being forced into extreme flexion. As a result the individual is not able to extend the distal IP joint of the involved digit and the deformity bears some resemblance to {this}.
Supinator (Origin/Insertion)
Origin: Lateral Epicondyle of Humerus, Supinator Crest of Ulna, Insertion: Shaft of Radius
Supinator (Action)
Action: Supinates forearm
Abductor Pollicis Longus (Origin/Insertion)
Origin: Shaft of Ulna and Radius,Insertion: First Metacarpal
Abductor Pollicis Longus (Action)
Action: Abducts digit one at carpal-metacarpal (CM) joint
Extensor Pollicis Brevis (Origin/Insertion)
Origin: Shaft of Radius, Insertion: Proximal Phalanx of Digit One
Extensor Pollicis Longus (Origin/Insertion)
Origin: Shaft of Ulna, Insertion: Distal Phalanx of Digit One
Extensor Pollicis Brevis and Longus (Action)
Action: Extends digit one
Anatomical Snuffbox
Depression between the tendons of the extensor pollicis longus medially and the tendons of the extensor pollicis brevis and abductor pollicis longus laterally.
DeQuervain’s Disease (Tenosynovitis Stenosans)
A condition in which there is inflammation of the tendons of the abductor pollicis longus and the extensor pollicis brevis and their common fibrous sheath. More common in women over 50, may be caused by repetitive hand and wrist movemetns, may lead to abnormal thickening of the common fibrous sheath causing pain when certain thumb movements are carried out, patients complain of pain at the lateral aspect of the wrist which radiate up the forearm or down the thumb.
Extensor Indicis (Origin/Insertion)
Origin: Shaft of the Ulna, Insertion: Proximal Phalanx of Digit Two
Allen’s Test
Test used to determine the patency (the normal diameter) of the radial and ulnar arteries. Steps: * With patient’s hand resting in their lap compress the radial artery against the anterior surface of the radius and ask the patient to make a fist, * When the patient is asked to pen their hands, the skin of the palms is at first white in color and then normally the blood flows into the arches through the ulnar artery, causing the palm to turn pink, * This establishes the patency of the ulnar artery, * Patency of the radial can be established by repeating the test but compress the ulnar artery
Flexor and Extensor Retinaculums
Deep fascia of the wrist of strong connective tissue. Flexor forms a carpal tunnel through which passes the median nerve and the long flexor tendons to the digits. Extensor prevents “bowstringing” of the extensor tendons when the hand is hyperextended at the wrist.
Carpal Tunnel Syndrome (Distal Median Neuropathy) (Causes)
Causes: * Edema caused by trauma, obesity, or pregnancy,* Fractures (e.g. Smith’s fracture),* Tumors (e.g. ganglionic cyst),* Oral contraceptives,* Repetitive flexion and extension of wrist, * Misalignment of bones
Carpal Tunnel Syndrome (Symptoms)
Symptoms: * Paresthesia in the area of the median nerve’s cutaneous distribution, * Decreased skin moisture in the area of median nerve distribution, * Patient complains of pain awakening them in the middle of the night, * Atrophy of the thenar muscles
Intrinsic Muscles of the Hand
- Muscles of the thumb (thenar eminence), 2. Muscles of the little finger (hypothenar eminence), 3. Lumbricales, 4. Interossei Muscles, 5. Palmaris brevis
Abductor Pollicis Brevis (Origin/Insertion)
Origin: Trapezium and Scaphoid, Insertion: Proximal Phalanx of Digit One
Abductor Pollicis Brevis (Action)
Action: Abducts digit one at the MP joint
Abductor Pollicis Brevis (Nerve Supply)
Nerve Supply: Median Nerve
Opponens Pollicis (Origin/Insertion)
Origin: Trapezium, Insertion: First metacarpal
Opponens Pollicis (Action)
Action: Medial rotation of the first metacarpal
Opponens Pollicis (Nerve Supply)
Nerve Supply: Median Nerve
Flexor Pollicis Brevis (Origin/Insertion)
Origin: Trapezium, Trapezoid, and Capitate, Insertion: Proximal Phalanx of Digit One
Flexor Pollicis Brevis (Action)
Action: Flexes thumb at MP joint
Flexor Pollicis Brevis (Nerve Supply)
Nerve Supply: Median and Ulnar Nerves
Adductor Pollicis (Origin/Insertion)
Origin: Trapezoid, 2nd and 3rd Metacarpals (oblique head), 3rd Metacarpal (transverse head), Insertion: Proximal Phalanx of Digit One
Adductor Pollicis (Action)
Action: Adducts digit one
Adductor Pollicis (Nerve Supply)
Nerve Supply: Ulnar Nerve
Hypothenar Muscles (Nerve supply)
Nerve Supply: Ulnar Nerve
Abductor Digiti Minimi (Origin/Insertion)
Origin: Pisiform, Insertion: Proximal Phalanx of Digit Five
Abductor Digiti Minimi (Action)
Action: Abducts digit five
Flexor Digiti Minimi (Origin/Insertion)
Origin: Hamate, Insertion: Proximal Phalanx of Digit Five
Flexor Digiti Minimi (Action)
Action: Flexes digit five at the MP joint
Opponens Digiti Minimi (Origin/Insertion)
Origin: Hamate, Insertion: Fifth metacarpal
Opponens Digiti Minimi (Action)
Action: Lateral rotation of the fifth metacarpal
Lumbricales (Origin/Insertion)
Origin: Tendons of the flexor digitorum profundus muscle, Insertion: Tendons of the extensor digitorum maximus muscle
Lumbricales (Actions)
Actions: * Flexes the MP joints of digits 2-4, * Extends the IP joints of digits 2-4
Lumbricales (Nerve Supply)
Nerve Supply: 1-2 Median Nerve, 3-4 Ulnar Nerve
Palmar Interossei (Origin/Insertion)
Origin: Metacarpal bone of the digit it moves, Insertion: Proximal Phalanx of 2nd, 4th, and 5th Digits
Palmar Interossei (Actions)
Actions: * Adducts digits 2, 4, and 5, * Flexes the MP joints of 2, 4, and 5, * Extends the IP joints of 2, 4, and 5
Dorsal Interossei (Origin/Insertion)
Origin: From the adjacent metacarpal between which they lie, Insertion: Proximal Phalanx of Digits 2, 3, and 4
Dorsal Interossei (Actions)
Actions: * Abducts digits 2, 3, and 4, * Flexes the MP joints of 2, 3, and 4, * Extends the IP joints of 2, 3, and 4
Palmaris Brevis (Origin/Insertion)
Origin: Flexor retinaculum, Insertion: Skin of the hypothenar eminence
Palmaris Brevis (Action)
Action: Prevents skin of the palm from flattening during a palmar grip
Palmaris Brevis (Nerve Supply)
Nerve Supply: Ulnar Nerve
Skier’s Thumb (Historically Gamekeeper’s Thumb)
An injury that refers to a rupture or laxity of the collateral ligaments at the first metacarpophalangeal joint. this injury is usually the result of hyperabduction of the MP joint.
