Exam II Flashcards
Muscles that originate on the vertebral column or skull
Trapezius, Rhomboid major, rhomboid minor, levator scapula, and latissimus dorsi
What is the origin of the trapezius
External occipital protuberance, superior nuchal line, ligamentous nuchae, and spines of the thoracic vertebrae
What is the insertion of the trapezius?
Clavicle and acromion process of the scapula
What are the actions of the trapezius?
Stabilizes the scapula. Upper portion elevates the scapula. The middle and lower portions adduct the scapula
What is the nerve supply of the trapezius?
Motor: spinal accessory nerve
Sensory: C4 and C5
What is the clinical condition characterized by a deepening of the shoulder on the affected side?
Trapezius Palsy
This type of injury frequently occurs during an auto accident and most often injures the superior portion of the trapezius.
Whiplash injury
What is the clinical test for the spinal accessory nerve?
Have the patient shrug their shoulders against resistance and see if there is any weakness on a particular side
What is the origin of the rhomboid major?
Spines of the upper thoracic vertebrae
What is the insertion of the rhomboid major?
Vertebral border of the scapula
This muscle is rhomboid in shape and lies deep to the trapezius
Rhomboid major
This muscle lies superior and parallel to the rhomboid major
Rhomboid minor
What is the origin of the rhomboid minor?
Spines of the lower cervicals and first thoracic vertebrae
What is the insertion of the rhomboid minor?
Vertebral border of the scapula
This muscle is found on the side of the neck, deep to the superior portion of the trapezius
Levator scapula
What is the origin of the levator scapula?
Transverse processes of the upper cervical vertebrae
What is the insertion of the levator scapula?
Superior angle of the scapula
What are the actions of the rhomboids and levator scapula?
Elevation, adduction, and stabilization of the scapula
What nerve innervates the rhomboids and levator scapula?
Dorsal scapular nerve
What complications arise when you have damage to the dorsal scapular nerve?
Difficulty in completely adducting the scapula. The scapula is also further from the midline on the affected side
This muscle is found over the lower posterior thoracic and lumbar region and is the widest muscle of the back region
Latissimus Dorsi
What is the origin of the latissimus dorsi?
Spines of the lower thoracic and lumbar vertebrae, thoracodorsal fascia, crest of the ilium, and lower ribs
What is the insertion of the latissimus dorsi?
The intertubecular groove (lesser tubercle) of the humerus
What is the action of the latissimus dorsi?
Extends, adducts, and medially rotates the humerus. Also involved with forced expiration
What is the nerve supply of the latissimus dorsi?
Thoracodorsal nerve (C6, C7, and C8)
What complications arise when there is a weakness or damage to the latissimus dorsi?
It results in forward displacement of the shoulder
This feature is a depression found at the lower portion of the latissimus dorsi and bounded by the latissimus dorsi, crest of the ilium and the external oblique muscle. Clinical significance: hernia of the posterior abdominal wall may develop here.
Lumbar triangle
This feature is a depression found at the superior border of the latissimus dorsi and bounded by the latissimus dorsi, trapezius, and vertebral border of the scapula. Clinical significance: the lungs can be hear much more easily with a stethoscope in this location
Triangle of Auscultation
What is the origin of the serratus anterior?
Upper ribs
What is the insertion of the serratus anterior?
Vertebral border of the scapula
What are the actions of the serratus anterior?
Abducts the scapula (prime mover), stabilizes the scapula, and is involved with forced inspiration when the humerus is abducted
What is the nerve supply of the serratus anterior?
Long thoracic (C5, C6, and C7)
What muscle is affected in long thoracic nerve palsy (winged scapula)?
Serratus anterior
This is a condition in which the serratus anterior muscle is weakened due to damage to the long thoracic nerve or its segmental innervation.
Long thoracic nerve palsy (Winged scapula)
What are some common causes for long thoracic nerve palsy (winged scapula)?
Trauma (subluxation), traction injuries involving the shoulder joint, and recumbence for a long period of time
What muscles compose the scapular muscles?
Deltoid, supraspinatus, infraspinatus, subscapularis, teres major, and teres minor
The suprasinatus, infraspinatus, subscapularis, and teres minor muscles compose what structure?
Rotator cuff muscles
What is the origin for the three portions of the deltoid?
Anterior portion: clavicle
Middle portion: acromion process
Posterior portion: spine of the scapula
What is the insertion of the deltoid?
Deltoid tuberosity of the humerus
What are the actions of the deltoid?
Anterior portion: flexes and medially rotates the humerus
Middle portion: abducts the humerus
Posterior portion: extends and laterally rotates the humerus
What is the nerve supply of the deltoid?
Axillary nerve (C5-C6)
This clinical condition can occur through an injury to the axillary nerve through a fracture of the surgical neck of the humerus, dislocation of the shoulder joint, or pressure of a crutch in the axilla.
Crutch paralysis or atrophy of the deltoid
What are some physical manifestations of crutch paralysis?
Atrophy of the deltoid gives the shoulder a flattened appearance, loss of sensation may occur over the lateral aspect of the arm, and abduction of the arm is greatly impaired
The tendon of insertion for the supraspinatus is separated from the acromion process by what structures?
Subacromial and subdeltoid bursa
What is the origin of the supraspinatus?
Supraspinatus fossa of the scapula
What is the insertion of the supraspinatus?
Greater tuberosity of the humerus
What are the actions of the supraspinatus?
Initiates abduction of the humerus, laterally rotates the humerus, and stabilizes the shoulder joint
What is the nerve supply of the supraspinatus?
Suprascapular nerve (C5-C6)
What are some clinical aspects of the supraspinatus?
Rotator cuff tendonitis, rotator cuff tears, and bursitis
It is the most common cause of shoulder pain, also known as shoulder impingement syndrome, and is characterized by an irritation and inflammation of the supraspinatus tendon. It can be caused by calcium deposits, trauma/injury, excess stress and repetition, weakness around the rotator cuff or genetics.
Rotator cuff tendonitis
What is the drop test and what is it testing?
It is used to test a rotator cuff tear. The patient is asked to lower their fully abducted arm slowly and if it drops suddenly in an uncontrolled manner, their tendon is torn
This condition is due to an inflammation of a bursa.
Bursitis
What is the origin of the infraspinatus?
Infraspinatus fossa of the scapula
What is the insertion of the infraspinatus?
Greater tuberosity of the humerus
What is the action of the infraspinatus?
Laterally rotates the humers and stabilizes the shoulder joint
What is the nerve supply to the infraspinatus?
Suprascapular (C5-C6)
What is the origin of the subscapularis?
Subscapular fossa of the scapula
What is the insertion of the subscapularis?
Lesser tuberosity of the humerus
What is the action of the subscapularis?
Medially rotates the humerus and stabilizes the shoulder joint
What is the nerve supply of the subscapularis?
Upper and lower subscapular nerves (C5-C6)
What is the origin of the teres minor?
The axillary border of the scapula
What is the insertion of the teres minor?
Greater tuberosity of the humerus
What is the action of the teres minor?
Adducts and medially rotates the humerus and stabilizes the shoulder joint
What is the nerve supply of the teres minor?
Axillary nerve (C5-C6)
What is the origin of the teres major?
Inferior angle of the scapula
What is the insertion of the teres major?
medial lip of the intertubercular groove of the humerus
What is the action of the teres major?
Adducts and medially rotates the humerus. Also stabilizes the shoulder joint
What is the nerve supply of the teres major?
Lower subscapular nerve (C6)
What is the quadrilateral space?
This space is more lateral than the triangular space and contains the axillary nerve and humeral circumflex blood vessels (artery and vein)
What is the triangular space?
This space is more medial than the quadrilateral space and contains the circumflex scapular branch of the subscapular artery
What are the two classifications of ligaments?
Extrinsic (found superficial to the capsular ligament) and Intrinsic (found deep to the capsular ligament)
What two things can ligaments act as?
A rope or a wall
This joint by which the upper limb articulates with the axial skeleton and is the most stable joint.
Sternoclavicular joint
What are the articulations of the sternoclavicular joint?
Sternal end of the clavicle, clavicular and costal notches of the sternum (manubrium) and the medial end of the first rib
What is an articular disc of the sternoclavicular disc and what does it do?
It is a piece of cartilage that is found in the middle of the joint cavity. It prevents the clavicle from being displaced at its articulation with the sternum and acts as a shock absorber for forces being transmitted along the clavicle
What type of joint is the sternoclavicular joint classified as?
Plane gliding joint
What is the nerve supply of the sternoclavicular joint?
Supraclavicular and nerve to the subclavius
What are the ligaments associated with the sternoclavicular joint?
Anterior and posterior sternoclavicular, interclavicular, costoclavicular ligaments
What do the anterior and posterior sternoclavicular ligaments do? What type of ligament is it?
Reinforce the capsular ligament, prevent excessive forward and bacward movement of the joint. It is an extrinsic ligament and acts as a wall.
What does the interclavicular ligament do? What type of ligament is it?
Functions to prevent displacement of the clavicle when one is carrying a heavy object. It is extrinsic and acts like a rope
What does the costoclavicular ligament do? What type of ligament is it?
Reinforces the capsular ligament and limits the elevation at the medial end of the clavicle. It is extrinsic and acts like a rope
What usually causes a sternoclavicular joint dislocation?
Direct trauma to the anterior aspect of the sternal end of the clavicle. This injury is rare, but can be life threatening due to compression of the trachea and blood vessels
What are the articulations of the acromioclavicular joint?
The acromion process of the scapula and the lateral end of the clavicle
What type of joint is the acromioclavicular joint classified as?
A plane gliding joint
What is the nerve supply of the acromioclavicular joint?
Suprascapular and axillary nerves
What ligaments are associated with the acromioclavicular joint?
Superior and inferior acromioclavicular ligaments and the coracoclavicular ligament
What is the function of the superior and inferior acromioclavicular ligaments? What type of ligaments are they?
Reinforces the capsular ligament, prevents the clavicle from losing contact with the acromion process. It is extrinsic and acts like a rope
What is the function of the coracoclavicular ligament? What type of ligament is it?
It is largely responsible for holding and suspending the weight of the scapula from the clavicle. Also limits protraction, elevation, and rotation of the scapula. It is extrinsic and acts like a rope
How does a dislocation of the acromioclavicular joint occur? What is it typically characterized by?
It usually occurs through a severe blow to the shoulder, known as a shoulder pointer. When a grade III dislocation occurs both the acromioclavicular and coracoclavicular ligaments rupture and the clavicle will separate from the scapula.
What are the articulations of the shoulder or glenohumeral joint?
Head of the humerus with the glenoid cavity of the scapula.
What is the glenoid labrum?
It is a fibrocartilage rim that that deepens the glenoid cavity for the head of the humerus.
What type of joint is the glenohumeral joint?
Ball and socket joint
What is the nerve supply of the glenohumeral joint?
Axillary and suprascapular
What are the ligaments of the glenohumeral joint?
Capsular ligament, Glenohumeral, transverse humeral, coracohumeral coracoacromial, and the suprascapular
What muscle passes through the capsular ligament of the glenohumeral joint?
The long head of the biceps brachii
What does the glenohumeral ligament do? What type of ligament is it?
It strengthens the anterior aspect of the capsule, helps prevent lateral rotation of the humerus at the shoulder joint. It is intrinsic and acts like a rope
What does the transverse humeral ligament do?
It keeps the long head of the biceps brachii in place
What does the coracohumeral ligmanet do? What type of ligament is it?
Strengthens the capsule from above, limits lateral rotation of the humerus. It is extrinsic and acts like a rope
What does the coracoacromial ligament do? What type of ligament is it?
It prevents upward displacement of the humerus. It is extrinsic and acts like a wall
What is the suprascapular ligament?
It is a small ligament that spans the scapular notch
What type of dislocations can occur with the glenohumeral joint?
Anterior dislocation and Subcoracoid dislocation
What nerves can be damaged with a shoulder dislocation?
Musculocutaneous and axillary nerves
What is the origin of the biceps brachii?
Long head: supraglenoid tubercle of the scapula
Short head: Coracoid process of the scapula
What is the insertion of the biceps brahii?
Radial tuberosity and the shaft of the ulna
What are the actions of the biceps brachii?
Flexion of the forearm at the elbow joint, supinator of the forearm, and adduction (short head)/abduction (long head) of the humerus
What is the innervation of the biceps brachii?
Musculocutaneous nerve
This clinical condition occurs when the biceps tendon moves back and forth in the intertubecular groove to the point that wear and tear can inflame it and cause pain.
Biceps tendonitis
This clinical condition occurs when the long head of the biceps tendon ruptures.
Popeye Deformity
What segmental innervations are being tested with the biciptial reflex?
C5 and C6
What is the origin of the coracobrachialis?
Coracoid process of the scapula
What is the insertion of the coracobrachialis?
Shaft of the humerus
What are the actions of the coracobrachialis?
Flexion and weak adduction of the humerus. Helps to stabilize the shoulder joint
What is the innervation of the coracobrachialis?
Musculocutaneous nerve
What is the origin of the brachialis?
Shaft of the humerus
What is the insertion of the brachialis?
Coronoid process of the ulna
What is the action of the brachialis?
Flexion of the forearm at the elbow joint
What is the innervation of the brachialis?
Musculocutaneous nerve
What is the origin of the triceps brachii?
Long head: infraglenoid tubercle of the humerus
Lateral and medial heads: shaft of the humerus
What is the insertion of the triceps brachii?
Olecranon process of the ulna
What is the action of the triceps brachii?
Extension of the forearm at the elbow joint
What is the segmental innervation being tested by tapping the triceps brachii’s tendon of insertion?
C7 and C8
If the triceps brachii is atrophied, passive extension can be produced through what?
Gravity
What is the origin of the anconeus?
Lateral epicondyle of the humerus
What is the insertion of the anconeus?
Olecranon process and proximal posterior shaft of the ulna
What is the action of the anconeus?
To assist (weakly) in the extension of the forearm
This artery is the continuation of the axillary and splits into the ulnar and radial arteries.
Brachial artery
Where can a pulse of the brachial artery be taken?
Bicipital furrow
What are the branches of the brachial artery?
Deep brachial (brachial profundus), superior and inferior ulnar collaterals
Why is blood pressure taken at the location of the brachial artery?
It is 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 vessels
What tool do you use to take blood pressure?
Sphygomomanometer
When taking blood pressure, the point at which blood flow resumes and is audible through a stethoscope is known as what?
Systolic pressure
When taking blood pressure, the point at which the sound can no longer be heard is what?
Diastolic pressure
What are the veins that compose the cutaneous (superficial) veins of the upper extremity?
Dorsal venous arch, cephalic vein (terminates in the axillary veins), basilic vein (joins with the brachial veins to form the axillary vein, median cubital vein.
Where is blood sampling commonly performed?
At the median cubital vein of the upper extremity
Which nerve is injured with direct wounds to the axilla, aneurysm of the axillary artery, or a dislocation of the shoulder joint?
Musculocutaneous nerve
What occurs when there is injury to the musculocutaneous nerve?
Atrophy of the weak anterior arm muscles and loss of sensation along the lateral aspect of the forearm, since the lateral antebrachial cutaneous nerve is a branch of the musculocutaneous nerve
What are the boundaries of the cubital fossa?
Lateral: brachioradialis muscle
Medial: pronator teres muscle
Proximal: Level of the epicondyles of the humerus
What are some important structures found in teh cubital fossa?
Deepest to most superficial:
Median nerve, brachial artery, tendon of the biceps brachii, and median cubital vein
What are the functions of the elbow complex?
Provides the mobility for the hand in space, by being able to shorten and lengthen the upper extremity. Allows the hands to be brought close to the face for eating fr placed at a distance from the body.
What is the elbow complex composed of?
The elbow joint and the proximal radio-ulnar joint
What are the articulations for the elbow joint?
Trochlea of the humerus with the trochlear notch of the ulna and the capitulum o f the humerus with the head of the radius
What type of joint is the elbow joint?
Hinge/ginglymus joint
What is the nerve supply of the elbow joint?
Musculocutaneous and radial nerves
What are the ligaments of the elbow joint?
Capsular, lateral or radial collateral, medial or ulnar collateral, and annular
What does the lateral or radial collateral ligament of the elbow joint do? What type of ligament is it?
It prevents adduction at the joint. It is extrinsic and acts like a rope
What does the medial or ulnar collateral ligament do? What type of ligament is it?
It prevents abduction at the joint. It is extrinsic and acts like a rope
What does the annular ligament do? What type of ligament is it?
It keeps the head of the radius in place. It is extrinsic and acts like a wall
What types of dislocations are common with the elbow joint? What can these injuries be accompanied by?
Posterior dislocations are the most common and can be accompanied by fractures (head of the radius, coronoid process and/or olecranon process of the ulna), torn ligaments (ulnar collateral), and or injury to the ulnar nerve
How can the ulnar nerve be injured during an elbow dislocation?
It can be stretched or lacerated at the time of the dislocation, it may be entrapped in scar tissue as the torn ligament heals, or it may become entrapped in new bone formation
What is the carrying angle?
In full extension of the upper extremity, the forearm and arm are not exactly aligned. In females their carrying angle is typically 15 degrees with males being 5-10 degrees.
What is an increase in the carrying angle called?
Cubitus valgus
What is the function of the olecranon bursa?
It dissipates the pressure produced when one leans on their elbow
What is bursitis?
It is an inflammation or infection of the bursa
What are the articulations of the proximal (superior) radio-ulnar joint?
Head of the radius with the radial notch of the ulna
What type of joint is the proximal (superior) radio-ulnar joint?
Pivot/trochoid joint. Only rotational movement is possible
What is the function of the interosseous membrane and the oblique cord of the proximal (superior) radio-ulnar joint?
They limit supination beyond anatomical position, are extrinsic, and act like ropes
What is nursemaid’s elbow?
It is a subluxation of the head of the radius. Common in preschool children when a child is suddenly lifeted by the hand or forearm. It may tear the annular ligament or subluxate the head of the radius.
What are some signs or symptoms of nursemaid’s elbow?
Very painful, extremity is held limply at the side (forearm is flexed and pronated), supination of the forearm causes increased pain
What are the characteristics of a radial or ulnar fracture?
They are typically due to severe and direct trauma and produce a transverse fracture to the shaft of both bones. Fractures may be comminuted (broken in pieces). Pronation and supination may be impaired
What is a Colles fracture?
A fracture at the distal end of the radius. It occurs when an individual falls on an outstretched hand with the forearm pronated.
What is a typically sign of a Colles fracture?
Dinner fork deformity, which describes the posterior angulation that occurs in forearm, just proximal to the wrist and there is a prominent indentation at the anterior lateral aspect of the wrist.
What is a Smith’s fracture?
A reverse colles fracture, with the distal fragment of the radius displaced anteriorly. It occurs due to a fall on the back of the hand
What are the bones of the hand?
Scaphoid, Lunate, triquetral, pisiform, trapezium, trapezoid, capitate, and hamate
What are sesamoid bones?
They are a varying number of bones embedded in some of the flexor tendon of the hand.
What is the function of sesamoid bones?
To protect and stabilize tendons. Also to change the angle of the tendons as they pass to their insertion (increases leverage)
Which bone is the most commonly fractured in the hand?
Scaphoid
A fracture of the hamate bone may lead to an injury in this nerve?
Ulnar nerve
What is a Boxer’s fracture?
It usually occurs when an individual punches someone with a closed fist and leads to the 5th metacarpal fracturing.
What type of injury usually causes phalanges to fracture?
Crushing injuries
What types of movements can be carried out by the hand at the wrist joint?
Flexion, extension, hyperextension, abduction, and adduction
What types of movements can be carried out by the digits?
Flexion, extension, abduction, and adduction
What is the origin of the pronator teres?
Medial epicondyle of the humerus and the coronoid process of the ulna
What is the insertion of the pronator teres?
Pronator ridge of the radius
What are the actions of the pronator teres?
Pronation of the forearm at the superior radioulnar joint. Assists in flexion at the forearm
What is the innervation of the pronator teres?
Median nerve
What is pronator teres syndrome characterized by?
Compression of the median nerve in the proximal forearm. This caused by direct trauma or excessive pronation/supination
What is the origin of the flexor carpi radialis?
Medial epicondyle of the humerus
What is the insertion of the flexor carpi radialis?
Second metacarpal (with a small slip to the 3rd metacarpal)
What are the actions of the flexor carpi radialis?
Equal prime mover for flexion at the wrist joint and abduction of the hand
What is the nerve supply of the flexor carpi radialis?
Median nerve
Weakness of the flexor carpi radialis can lead to an abnormal type of flexion of the hand at the wrist joint known as what?
Ulnar deviation
What is the origin of the palmaris longus?
Medial epicondyle of the humerus
What is the insertion of the palmaris longus?
Palmar aponeurosis
What are the actions of the palmaris longus?
Weak flexion of the wrist and tightens the fascia of the palm
What is the nerve supply of the palmaris longus?
Median nerve
What is the origin of the flexor carpi ulnaris?
Medial epicondyle of the humerus and the olecranon process of the humerus
What is the insertion of the flexor carpi ulnaris?
Pisiform, hamate, and the 5th metacarpal
What are the actions of the flexor carpi ulnaris?
Equal prime mover for flexion at the wrist joint and adduction of the hand
What is the innervation of the flexor carpi ulnaris?
Ulnar nerve
Weakness of the flexor carpi ulnaris can lead to an abnormal type of flexion of the hand at the wrist joint known as what?
Radial deviation
What is the origin of the flexor digitorum superficialis?
Medial epicondyle of the humerus
What is the insertion of the flexor digitorum superficialis?
Middle phalanges of digits 2-5
What is the action of the flexor digitorum superficialis?
Flexes PIP joints of 2-5 and assists in flexion at the wrist joint
What is the innervation of the flexor digitorum superficialis?
Median nerve
What is the origin of the flexor digitorum profundus?
Shaft of the ulna
What is the insertion of the flexor digitorum profundus?
Distal phalanges of digits 2-5
What is the action of the flexor digitorum profundus?
Flexes DIP joints of digits 2-5 and flexion of the wrist joint
What is the innervation of the flexor digitorum profundus?
Median and ulnar nerves
What is the origin of the flexor pollicis longus?
Shaft of the radius
What is the insertion of the flexor pollicis longus?
distal phalanx of digit one
What is the action of the flexor pollicis longus?
Flexes digit one at the IP joint
What is the nerve supply of the flexor pollicis longus?
Median nerve
What is the origin of the pronator quadratus?
Shaft of the ulna
What is the insertion of the pronator quadratus?
Shaft of the radius
What is the action of the pronator quadratus?
Pronates the forearm at the distal radioulnar joint and helps to stabilize the distal radioulnar joint
What is the innervation of the pronator quadratus?
Median nerve
Median nerve damage can occur at the proximal part or distal part of the forearm resulting in which two conditions?
Pronator teres syndrome (proximal) and carpal tunnel syndrome (distal)
What symptoms can occur with damage to the median nerve?
Loss or weakened pronation, abnormal and weak flexion at the wrist joint, and weak abduction of the hand. Ape hand (atrophy of the thenar muscles) and sensory loss over the lateral 2/3 of the palmar surface of the hand can also occur
What symptoms can occur with damage to the ulnar nerve?
Impaired or weakened adduction of the hand, weakened or abnormal flexion of the hand, atrophy of hypothenar muscles, and difficulty in making a fist (claw hand)
This condition is used to indicate compromise or damage of the ulnar nerve at the wrist joint, where it passes between the pisiform and hood of the hamate. The individual shows a loss of sensation in teh medial one and a half digits and may show atrophy of the hypothenar muscles.
Guyon tunnel or canal syndrome. Also called cyclists or handlebar neuropathy
What is the origin of the brachioradialis?
Lateral supracondylar ridge of the humerus
What is the insertion of the brachioradialis?
Styloid process of the radius
What is the action of the brachioradialis?
Flexes the forearm. It can also act as a pronator/supinator depending on the position of the forearm
What nerve supplies all the muscles of the posterior forearm?
Radial nerve
What is the origin of the extensor carpi radialis longus?
Lateral epicondyle of the humerus
What is the insertion of the extensor carpi radialis longus?
Second metacarpal
What is the origin of the extensor carpi radialis brevis?
Laterial epicondyle of the humerus
What is the insertion of the extensor carpi radialis brevis?
Third metacarpal
What is the action of the extensor carpi radialis brevis?
Extends the hand and abducts the hand
What is the origin of the extensor digitorum (maximus)?
Lateral epicondyle of the humerus
What is the insertion of the extensor digitorum (maximus)?
Middle and distal phalanges of digits 2-5
What is the action of the extensor digitorum (maximus)?
Extends digits 2-5, extends the hand at the wrist joint, and abducts digits 2, 4, and 5
What is the origin of the extensor digiti minimi?
Lateral epicondyle of the humerus
What is the insertion of the extensor digiti minimi?
Proximal phalanx of digit 5
What is the action of the extensor digiti minimi?
Extends digit 5
What is the origin of the extensor carpi ulnaris?
Lateral epicondyle of the humerus
What is the insertion of the extensor carpi ulnaris?
Fifth metacarpal
What is the action of the extensor carpi ulnaris?
Extends the hand and adducts the hand
This is a painful condition of the elbow, which involves repetitive use of the superficial posterior forearm muscles, which all have a common origin off of the lateral epicondyle of the humerus. There is generally an inflammation and possible degeneration of the common tendon of origin. Typically arises as a result of injury or overuse of the posterior forearm muscles. Inflammation or subluxation of C5 may also cause pain in the region of the lateral epicondyle.
Lateral epicondylitis or tennis elbow
What type of movement aggravates lateral epicondylitis (tennis elbow)?
Full extension of the wrist joint
This is a condition in which there is a sudden, severe tension on one of the long extensor tendons where is may avulse at its attachment at the distal phalanx. It is typically caused from the distal IP joint being forced into extreme flexion. Extension of the DIP joint at the affected digit becomes very painful.
Mallet or baseball finger
What is the origin of the supinator?
Lateral epicondyle of the humerus and supinator crest of the ulna
What is the insertion of the supinator?
Shaft of the radius
What is the action of the supinator?
Supinates the forearm
What is the origin of the abductor pollicis longus?
Shaft of the ulna and radius
What is the insertion of the abductor pollicis longus?
First metacarpal
What is the action of the abductor pollicis longus?
Abducts digit one at the CM joint
What is the origin of the extensor pollicis brevis?
Shaft of the radius
What is the insertion of the extensor pollicis brevis?
Proximal phalanx of digit one
What is the action of the extensor pollicis brevis?
Extends digit 1
What muscles compose the anatomical snuffbox?
Abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus
Tenderness and swelling in the anatomical snuffbox may indicate a fracture of which bone?
Scaphoid bone
This is a condition in which there is inflammation of then tendons of the abductor pollicis longus and the extensor pollicis brevis within their common fibrous sheath. This can be due to repetitive hand wrist movements, which cause friction between the tendons.
DeQuervain’s disease or tenosynovitis stenosans
What is the origin of the extensor indicis?
Shaft of the ulna
What is the insertion of the extensor indicis?
Proximal phalanx of digit 2
What is the action of extensor indicis?
Extends digit 2
What injury is the most common cause of radial nerve damage?
Fracture of the humerus
What are the arteries of the forearm?
Radial and ulnar arteries
What are the branches of the radial artery?
Recurrent, unnamed muscular branches, and superficial and deep palmar. Superficial and deep palmar join with smaller branches from the ulnar artery to form the superficial and deep palmar arches of the hand
What are the branches of the ulnar artery?
Anterior and posterior recurrent, common interosseous, and the superficial and deep palmar (palmar arches). The common interosseous divides into an anterior and posterior interosseous arteries.
What are the articulations of the distal or inferior radio-ulnar joint?
Head of the ulna and ulnar notch of the radius
What kind of joint is the distal or inferior radio-ulnar joint?
Pivot or trochoid
What is the nerve supply of the distal or inferior radio-ulnar joint?
Radial nerve
What ligaments are associated with the distal/inferior radio-ulnar joint?
Capsular ligament, anterior and posterior transverse ligaments, articular disc, and the interosseous membrane
What is the function of the anterior and posterior transverse ligaments of the distal radioulnar joint? What type are they?
To unite the distal ends of the radius and ulna, strengthens the capsular ligament, and prevents supination. They are extrinsic and act as ropes
What is the function of the articular disc of the distal radioulnar joint?
It helps to firmly unite the distal end of the two bones and is considered the chief uniting structure of the joint.
What is the function of the interosseus membrane in the distal radioulnar joint?
It provides considerable strength and stability between the radius and ulna, limits supination, and increases the surface attachmet of muscles in both the anterior and posterior forearm.
What movements are carried out by the radioulnar joints?
Pronation and supination
Why is pronation/supination important?
It provides a wide range motion for the palm of the hand. Supination would seem to be more important since bringing things closer to your eyes and mouth are primarily carried out by supination
What are the articulations of the radiocarpal (wrist) joint?
Distal end of the radius, articular disc with the scaphoid, lunate, and triquetral.
What type of joint is the radiocarpal joint?
Condyloid
What is the nerve supply to the radiocarpal joint?
Median, radial, and ulnar
What are the ligaments of the radiocarpal joint?
Capsular ligament, dorsal and palmar radiocarpals, palmer ulnocarpal, ulnar and radial collaterals.
What is the function of the dorsal and palmar radiocarpal ligaments of the radiocarpal joint? What type of ligament are they?
Attaches superiorly to the radius and inferiorly to the scaphoid and lunate bones. It is an extrinsic ligament and acts like a rope
What is the function of the palmar ulnocarparl ligaments of the radiocarpal joint? What type of ligament are they?
It attaches the ulna to the scaphoid and lunate. They are extrinsic and act like ropes
What is the function of the ulnar and radial collaterals of the radiocarpal joint? What type of ligament are they?
They attach from the styloid process of the ulna and radius to the carpal bones on their respective sides. They are extrinsic and act like ropes
What are the movements of the wrist joint?
Flexion, extension, addduction, and abduction.
Within the wrist joint, what two movements do not occur here?
Medial and lateral rotation
Within the wrist joint, what limits flexion?
Extensor tendons and dorsal radiocarpal ligaments
Within the wrist joint, what limits extension?
Bone hitting bone, flexor tendons, and the palmar radiocarpal and ulnocarpal ligaments
Within the wrist joint, what limits adduction?
Radial collateral ligament
Within the wrist joint, what limits abduction?
Ulnar collateral ligament and the styloid process of the radius making contact with the trapezium bone
What is manual dexterity?
The ability of our hands to manipulate objects in the environment and is recognized as one of the major distinguishing characteristics of the human species
This is a strong thick band of connective tissue that spans the concave palmar aspect of the wrist and forms an osseofibrous carpal tunnel through which pass the median nerve and the long flexor tendons to the digits
Flexor retinaculum
This is a fairly common condition, which is usually caused by the compression of the median nerve in the carpal tunnel. Common causes: edema, fractures, tumors, oral contraceptives, repetitive flexion and extension of the wrist, and misalignment of the bones
Carpal tunnel syndrome
What are some common symptoms of carpal tunnel syndrome?
Paresthesia in the area of the median nerve’s cutaneous distribution, decreased skin moisture in teh area of the nerve’s distribution, pain that awakens the patient in the middle of the night, atrophy of the thenar muscles.
This is a sensation of “pins and needles” when one taps over the site of the median nerve at the anterior aspect of the wrist. It can be indicative of carpal tunnel syndrome
Tinel’s sign
This test is used to reproduce the symptoms of carpal tunnel syndrome by having the patient flex their hands to maximum and holding in that position for several minutes
Phalen’s test
This is a strong fibrous band of deep fascia extending across the posterior aspect of the wrist.
Extensor retinaculum
This structure is a triangular shaped piece of deep fascia which occupies the central area of the palm and it is continuous with the fascia that covers the thenar and hypothenar muscles and with the flexor retinaculum
Palmar aponeurosis
What is the function of the palmar aponeurosis?
Gives firm attachment to the overlying skin to improve grip and it protects underlying tendons
This is a condition in which there is a shortening and hypertrophy of the palmar aponeurosis
Dupuytren’s contracture
What is brachiation?
It is a form of locomotion utilized by primates (other than humans) characterized by swinging through trees with their arms
What is the origin of the abductor pollicis brevis?
Trapezium and scaphoid
What is the insertion of the abductor pollicis brevis?
Proximal phalanx of digit one
What is the action of the abductor pollicis brevis?
Abducts digit one at the MP joint
What is the nerve supply of the abductor pollicis brevis?
Median nerve
What is the origin of the opponens pollicis?
Trapezium
What is the insertion of the opponens pollicis?
First metacarpal
What is the action of the opponens pollicis?
Medial rotation of the first metacarpal
What is the nerve supply of the opponens pollicis?
Median nerve
What is the origin of the flexor pollicis brevis?
Trapezium, trapezoid, and capitate
What is the insertion of the flexor pollicis brevis?
Proximal phalanx of digit one
What is the action of the flexor pollicis brevis?
Flexes the thumb at the MP joint
What is the nerve supply of the flexor pollicis brevis?
Median and ulnar nerves
What is the origin of the adductor pollicis?
Trapezoid, capitate, 2nd and 3rd metacarpals (oblique head) and the 3rd metacarpal (transverse head)
What is the insertion of the adductor pollicis?
Proximal phalanx of digit one
What is the action of the adductor pollicis?
Adducts digit 1
What is the nerve supply of the adductor pollicis
Ulnar nerve
All of the hypothenar muscles are supplied by which nerve?
Ulnar nerve
What is the origin of the abductor digiti minimi?
Pisiform
What is the insertion of the abductor digiti minimi?
Proximal phalanx of digit 5
What is the function of the abductor digiti minimi?
Abducts digit 5
What is the origin of the flexor digiti minimi?
Hamate
What is the insertion of the flexor digiti minimi?
Proximal phalanx of digit 5
What is the action of the flexor digiti minimi?
Flexes digit 5 at the MP joint
What is the origin of the opponens digiti minimi?
Hamate
What is the insertion of the opponens digiti minimi?
Fifth metacarpal
What is the action of the opponens digiti minimi?
Laterally rotates the 5th metacarpal
What is the origin of the lumbricales?
Tendons of the flexor digitorum profundus
What is the insertion of the lumbricales?
Tendons of the extensor digitorum maximus
What is the action of the lumbricales?
Flexes the MP joint and extends the IP joint
What is the nerve supply of the lumbricales?
Median nerve (first and second lumbricales). Ulnar nerve (thrid and fourth lumbricales)
What is the origin of the palmar interossei?
Metacarpal bones of the digit it moves
What is the insertion of the palmar interossei?
Proximal phalanx of the second, fourth, and fifth digits
What is the action of the palmar interossei?
Adducts digits 2, 4, and 5, flexes the MP joints, and extends the IP joints
What is the nerve supply of the palmar interossei?
Ulnar nerve
What is the origin of the dorsal interossei?
From the adjacent metacarpals between them
What is the insertion of the dorsal interossei?
Proximal phalanx of digits two, three, and four
What is the action of the dorsal interossei?
Abducts digits 2, 3, and 4, flexes the MP joints, and extends the IP joints
What is the nerve supply of the dorsal interossei?
Ulnar nerve
What is the origin of the palmaris brevis?
Flexor retinaculum
What is the insertion of the palmaris brevis?
Skin of the hypothenar eminence
What is the action of the palmaris brevis?
Prevents the skin of the palm from flattening during a palmar grip
What is the nerve supply of the palmaris brevis?
Ulnar nerve
What is the cutaneous supply of the lateral part of the palmar surface of the hand?
Median nerve
What is the cutaneous supply of the medial aspect of the hand (both palmar and dorsal aspects)?
Ulnar nerve
What is the cutaneous supply of the lateral aspect of the dorsum of the hand and the dorsal portion of the first, second, third, and fourth digits?
Radial nerve
Which vessels supply blood to the hand?
Radial and ulnar arteries, which split into superficial and deep branches that then fuse to form the superficial and deep palmar arches
What type of joints are the intercarpal joints?
Plane gliding joints
What type of joints are the carpometacarpal joints?
Irregular synovial joints
What type of joint is the carpometacarpal joint of digit one?
Universal joint
What movements compose oppostion of the thumb?
Flexion, abduction and rotation of digit 1
What does opposition allow us to do?
It allows the palmar surface of the thumb to meet the palmar surface of the other digits and it greatly expand the opportunity to use the upper extremity for grasping and manipulation of obects
What type of joints are the intermetacarpal joints?
Plane gliding joints between the bases of the second through fifth metacarpals
What type of joints are the interphalangeal joints?
Ginglymus joints
This is a condition of the MP joint of digit one. The injury involves a rupture or laxity of the collateral ligaments of the joint and is usually the result of hyperabduction at the MP joint of digit one. Can result in an avulstion fracture of the first metacarpal
Skier’s thumb
