Exam 2: Upper Extremities Flashcards
Functions of the Shoulder Girdle
Reduces and amplifies forces
Increases shoulder complex ROM
Positions the upper extremity in acceptable/optimal alignment for tasks
Steadies the proximal aspect of the upper extremity
Arthrology (Joints) of the Shoulder Girdle
Acromioclavicular (AC) Joint
Sternoclavicular (SC) Joint
Upper Trapezius
Origin: Occipital bone & the spinous processes of C vertebrae via nuchal ligament
Insertion: Lateral 1/3 of the clavicle
Actions: Contralateral rotation, Scapula Elevation, Scapula Upward Rotation
Middle Trapezius
Origin: Aponeurosis at the T1-4 spinous processes
Insertion: Acromion process& Superior Crest of the Scapular Spine
Actions: Scapula Retraction
Lower Trapezius
Origin: T5-12 spinous processes
Insertion: Medial Scapular Spine
Actions: Scapula Depression, Scapula Upward Rotation
Levator Scapula
Origin: Transverse processes of C1-4
Insertion: Superior angle of the scapula
Actions: Ipsilateral Cervical Rotation, Scapula Elevation, Retraction, Downward Rotation
Rhomboid Minor
Origin: Spinous processes of C6 & 7
Insertion: Medial border of the scapula
Actions: Scapula Elevation, Retraction, Downward Rotation, Stabilization
Rhomboid Major
Origin: Spinous processes of T1-4
Insertion: Medial border of the scapula
Actions: Scapula Elevation, Retraction, Downward Rotation, Stabilization
Serratus Anterior
Origin: Ribs 1-9
Insertion: Costal and Dorsal surfaces of the superior scapular angle, along the costal surface of the medial scapular border, and along the costal and dorsal surfaces of the inferior angle
Actions: Scapula Upward Rotation & Protraction
Innervation: Long Thoracic Nerve
Pectoralis Minor
Origin: Ribs 3-5
Insertion: Coracoid process of the scapula
Actions: Scapular Depression, Protraction, & Downward Rotation
Latissimus Dorsi
Origin:
Vertebral Part: Spinous processes of T7-12, thoracolumbar fascia of all lumbar spinous processes and the sacrum
Iliac Part: Posterior 1/3 of the iliac crest
Costal Part: Ribs 9-12
Scapular Part: Inferior angle of the scapula
Insertion: Floor of the intertubercular groove of the humerus
Actions: Internal Rotation, Adduction, Shoulder Extension
Teres Major
“The lat’s little helper”
Origin: Inferior angle of the scapula
Insertion: Crest of the lesser tubercle of the humerus
Actions: Internal Rotation, Adduction, Shoulder Extension
Pectoralis Major
Origin:
Clavicular Part: Medial 1/2 of the clavicle
Sternocostal Part: Sternum and costal cartilages 2-6
Abdominal Part: Anterior layer of the rectus sheath
Insertion: Crest of the greater tubercle of the humerus
Actions: Adduction, internal rotation, flexion (clavicular and sternocostal parts), and assists respiration
Clavicular/Anterior Deltoid
Origin: Lateral 1/3 of the clavicle
Insertion: Deltoid tuberosity of the humerus
Actions: Shoulder Flexion, Internal Rotation, Adduction, Horizontal Adduction
Innervation: C5
Acromial/Lateral Deltoid
Origin: Acromion Process of the scapula
Insertion: Deltoid tuberosity of the humerus
Actions: Abduction
Innervation: C5
Spinal/Posterior Deltoid
Origin: Scapular Spine
Insertion: Deltoid tuberosity of the humerus
Actions: Extension, External Rotation, Adduction
Innervation: C5
Coracobrachialis
Origin: Coracoid process of the scapula
Insertion: In line with the crest of the lesser tubercle on the humerus
Actions: Shoulder Flexion, Adduction, Internal Rotation
Triceps Brachii
Origin:
- Long Head: Infraglenoid tubercle of the scapula
- Medial Head: Posterior surface of the humerus, distal to the radial groove, and the medial intermuscular septum
- Lateral Head: Posterior surface of the humerus, proximal to the radial groove, and the lateral intermuscular septum
Insertion: Olecranon process of the ulna
Actions: Elbow Extension, shoulder extension, shoulder adduction
Innervation: Radial Nerve (C7)
Rotator Cuff Muscles
Posterior:
Supraspinatus
Infraspinatus
Teres Minor
Anterior:
Subscapularis
Supraspinatus
Origin: Supraspinous fossa of the scapula
Insertion: Greater tubercle of the humerus
Action: Abduction
Infraspinatus
Origin: Infraspinous fossa of the scapula
Insertion: Greater tubercle of the humerus
Actions: External Rotation & Horizonal Abduction
Teres Minor
Origin: Lateral border of the scapula
Insertion: Greater tubercle of the humerus
Actions: External Rotation, Weak Adduction, Horizontal Abduction
Subscapularis
Origin: Subscapular fossa of the scapula
Insertion: Lesser tubercle of the humerus
Actions: Internal Rotation & Weak Adduction
Arthrology of the Elbow
Humeroulnar Joint
Humeroradial Joint
Proximal Radioulnar Joint
Annular Ligament of the Radioulnar Joint
A ligament that encircles and holds the head of the radius against the ulna
Ulnar Collateral Ligament
Runs between the medial epicondyle of the humerus and ulna. Resists valgus stress
Radial Collateral Ligament
Runs between the lateral epicondyle of the humerus and the annular ligament of the radius.
Resists varus stress
Biceps Brachii
Origin:
- Long Head: Supraglenoid tubercle of the scapula
- Short Head: Coracoid process of the scapula
Insertion: Radial tuberosity and antebrachial fascia via bicipital aponeurosis
Actions: Elbow Joint flexion & supination, Shoulder joint flexion
Innervation: C6
Brachialis
Origin: Distal half of the anterior surface of the humerus, also the medial and lateral intermuscular septa
Insertion: Ulnar tuberosity
Action: Elbow joint flexion
Deep to the Biceps Brachii
Brachioradialis
Origin: Lateral surface of the distal humerus, lateral intermuscular septum
Insertion: Styloid process of the radius
Actions: Elbow joint flexion, Forearm semipronation
Pronator Teres
Origin:
- Humeral Head: Medial Epicondyle of the humerus
- Ulnar Head: Coronoid process of the ulna
Insertion: Lateral surface of the radius
Actions: Elbow joint weak flexion, Forearm pronation
Pronator Quadratus
Origin: Distal 1/4 of the anterior surface of the ulna
Insertion: Distal 1/4 of the anterior surface of the radius
Actions: Pronation, distal radioulnar stabilization
Supinator
Origin: Olecranon of the ulna, lateral epicondyle of the humerus, radial collateral ligament, annular ligament
Insertion: Between the radial tuberosity and insertion of the pronator teres
Action: Radioulnar supination
Triceps Brachii
Origin:
- Long Head: Infraglenoid tubercle of the scapula
- Medial Head: Posterior surface of the humerus, distal to the radial groove, and the medial intermuscular septum
- Lateral Head: Posterior surface of the humerus, proximal to the radial groove, and the lateral intermuscular septum
Insertion: Olecranon of the ulna
Actions: Elbow joint extension, Shoulder joint extension and adduction
Innervation: Radial Nerve (C7)
Starting at the first row of carpals on the palmar and radial aspect of the hand and working toward the ulna, what are the names of each carpal bone?
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
Flexor Retinaculum
A ligamentous/connective tissue structure that helps to restrain the tendons of the long flexors of the digits
Carpal Tunnel Syndrome typically leads to a partial removal of this tissue
Palmar Aponeurosis
A layer of connective tissue atop the tendons and muscles of the palmar aspect of the hand. Its purpose is to provide attachment for overlying skin and to protect the underlying tendons
Extrinsic Anterior Forearm Muscles
Flexor Carpi Radialis
Flexor Carpi Ulnaris
Palmaris Longus
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Flexor Pollicis Longus
Extrinsic Posterior Forearm Muscles
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris
Extensor Digitorum
Extensor Indicis
Extensor Pollicis Longus
Abductor Pollicis Longus
Which Muscles Attach to the Common Extensor Tendon/Lateral Epicondyle?
Extensor Digitorum
Extensor Carpi Radialis Brevis
Extensor Digiti Minimi
Extensor Carpi Ulnaris
Which Muscles Attach to the Common Flexor Tendon/Medial Epicondyle
Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Digitorum Superficialis
Flexor Carpi Ulnaris
Intrinsic Forearm Muscles (10)
Flexor Pollicis Brevis
Abductor Pollicis Brevis
Adductor Pollicis
Opponens Pollicis
Abductor Digiti Minimi
Opponens Digiti Minimi
Flexor Digiti Minimi Brevis
Dorsal Interossei
Palmar Interossei
Lumbricals
Lumbricals
4 muscles
Proximal Attachment: Flexor Digitorum Profundus
Distal Attachment: Extensor Mechanism
Actions: MP Joint Flexion & PIP/DIP Extension
Extensor Mechanism
Allows for anterior/palmar attachment between the MP and PIP joints for MP flexion while providing an anchor that wraps to the posterior/dorsal side for PIP and DIP extension
Palmar Interossei Adductor
Proximal Attachment: The sides of metacarpals 2, 4, & 5
Distal Attachment: Anterior Proximal Phalanx/Anterior Extensor Mechanism
Actions: Adduction & Flexion of the MP Joint (PAD), PIP & DIP Extension
Dorsal Interossei Abduction
Proximal Attachment: The sides of metacarpals 2-5
Distal Attachment: Anterior Proximal Phalanx/Anterior Extensor Mechanism
Actions: Abduction & Flexion of the MP Joint (DAB), PIP & DIP Extension
Flexor Digitorum Superficialis
Attachments: Medial Epicondyle & the Middle Phalanges of digits 2-5
Actions: Wrist Flexion, MCP & PIP Flexion
Flexor Digitorum Profundus
Proximal Attachments: Medial Epicondyle of the Humerus, the Coronoid Process of the Ulna, and the Palmar Aspect of the Radial Shaft
Distal Attachments: Distal Phalanges of digits 2-5
Actions: Wrist Flexion, MCP, PIP, & DIP Flexion
Flexor Carpi Ulnaris
Proximal Attachment: Medial Epicondyle
Distal Attachments: Metacarpal 5, Hook of the Hamate, & the Pisiform
Actions: Wrist Flexion, Ulnar Deviation
Flexor Pollicis Longus
Proximal Attachment: Midpoint of the Anterior Radius & its Interosseous Membrane
Distal Attachment: Base of the Distal Phalanx of Digit 1
Actions: Wrist Flexion, Radial Deviation, CMC, & MCP Flexion of the Thumb
Flexor Carpi Radialis
Proximal Attachment: Medial Epicondyle of the Humerus
Distal Attachment: Trapezium, Base of Metacarpal 2, & Metacarpal 3
Actions: Wrist Flexion, Radial Deviation
Palmaris Longus
Proximal Attachment: Medial Epicondyle of the Humerus
Distal Attachment: Palmar Aponeurosis
Actions: Wrist Flexion
Extensor Digitorum
Proximal Attachment: Lateral Epicondyle of the Humerus
Distal Attachment: Dorsal Aspect of the Extensor Mechanism
Actions: Wrist Extension, MCP, PIP, & DIP Extension of Digits 2-5, Finger Abduction
Extensor Carpi Radialis Longus
Proximal Attachment: Lateral Epicondyle of the Humerus
Distal Attachment: The Dorsal Base of Metacarpal 2
Actions: Wrist Extension, Radial Deviation
Extensor Carpi Ulnaris
Proximal Attachment: Lateral Epicondyle
Distal Attachment: The Medial Base of Metacarpal 5
Actions: Wrist Extension, Ulnar Deviation
Extensor Indicis
Proximal Attachment: The Posterior Surface of the Ulna
Distal Attachment: Dorsal Aspect of the Extensor Mechanism of Digit 2
Actions: Wrist Extension, MCP, DIP, & PIP Extension of Phalange 2
Extensor Pollicis Longus
Proximal Attachment: The Middle 1/3 of the Posterior Ulnar Surface
Distal Attachment: The Dorsal Base of the Distal Phalanx of the Thumb
Actions: Wrist Extension, Thumb Extension, Thumb Adduction, Radial Deviation
Extensor Digiti Minimi
Proximal Attachment: Lateral Epicondyle of the Humerus
Distal Attachment: The Extensor Mechanism of the 5th Proximal Phalange
Actions: Wrist Extension, Ulnar Deviation, MCP, PIP, & DIP Extension of Digit 5, Finger Abduction
Abductor Pollicis Longus
Proximal Attachment: Posterior Proximal Radius, Ulna, and Interosseous Membrane
Distal Attachment: Dorsal Base of 1st Metacarpal & the Trapezium
Actions: Radial Deviation, Thumb Abduction
Extensor Pollicis Brevis
Proximal Attachment: Distal 1/3 of the Posterior Radius & the Interosseous Membrane
Distal Attachment: Dorsal Base of 1st Proximal Phalanx
Actions: Radial Deviation, Thumb Extension
Abductor Digiti Minimi
Proximal Attachment: Pisiform
Distal Attachment: Outer Border of the 5th Proximal Phalanx
Actions: MCP Flexion of the 5th Phalange, Digit 5 Abduction
Flexor Digiti Minimi
Proximal Attachment: Hook of Hamate & Flexor Retinaculum
Distal Attachment: Palmar Base of the 5th Proximal Phalanx
Actions: Digit 5 Flexion
Flexor Pollicis Brevis
Proximal Attachment: Palmar Aspect of the Trapezium, Trapezoid, & Capitate
Distal Attachment: Palmar Base of the 1st Proximal Phalanx
Actions: Thumb Flexion, Thumb Opposition
Adductor Pollicis
Proximal Attachment: Palmar Base of Metacarpals 2 & 3, Capitate
Distal Attachment: Medial Base of the 1st Proximal Phalanx
Actions: Thumb Flexion, Thumb Adduction, Thumb Opposition
Abductor Pollicis Brevis
Proximal Attachment: Flexor Retinaculum, Scaphoid, & Trapezium
Distal Attachment: Lateral Base of the 1st Proximal Phalanx
Actions: Thumb Abduction
Opponens Pollicis
Proximal Attachment: Palmar Aspect of the Trapezium & the Flexor Retinaculum
Distal Attachment: Radial Border of 1st Metacarpal
Actions: Thumb Opposition
Opponens Digiti Minimi
Proximal Attachment: Palmar Aspect of the Hook of Hamate & Flexor Retinaculum
Distal Attachment: Ulnar Aspect of the 5th Metacarpal
Actions: Pinky Opposition
Precision Grips
Pinch & Key Grips
Intrinsic Muscles are more likely to be agonists
Requires Dexterity
Power Grips
Power & Hook
Extrinsic Muscles are more likely to be agonists
Lumbricals aren’t highly active
Tasks require high force or endurance
Pinch Grip Agonists
Agonists: Flexor Digitorum Profundus, Flexor Pollicis Brevis, Flexor Pollicis Longus, Adductor Pollicis, Opponens Pollicis
Key Grip
Agonists: DAB #1, Extensor Digitorum, Flexor Pollicis Brevis, Flexor Pollicis Longus, Adductor Pollicis
Power Grip
Agonists: All Finger Flexors & Adductor Pollicis
Hook Grip
Agonists: Flexor Digitorum Superficialis & All other finger flexors
The thumb is not involved
