Forearm and hand Flashcards
Brachioradialis
Proximal: Lateral supracondylar ridge
Distal: Styloid process of radius
Innervation: Radial nerve
Action: flexes elbow, supinates and pronates radioulnar joint from midposition
palpation:- get patient to get into hammer curl position
-place hand on patient’s forearm and get patient to resist
Pronator teres
Proximal: Humeral Head: Medial epicondyle, Ulnar Head: Coranoid Process
Distal: 1/2 lateral side of radius
Innervation: Median nerve
Action: Pronates radioulnar joint
palpation: -Supinate the patient’s palm
-palpate diagonally from medial
-Get patient to slowly turn the arm
Supinator
Proximal: Lateral epicondyle of humerus
Distal: 1/3 proximal radial shaft (lateral side)
Innervation: Radial nerve
Action: Supinates radioulnar joint
palpation: -Pronate the patient’s arm, face pam down.
-push the muscles away and sink the finger in
-Ask patient to turn the palm up gently… feel the contractions
Name the bones and joints on the forearm. (8)
Radius
Radial head
Radial Shaft
Humero-ulnar joint
Humeroradial joint
Ulna
Ulna head
Styloid process
Name the 8 bones on the hand.
Scaphoid
Lunate
Trapezium
Trapezoid
Pisiform
Hamate, Hook of hamate
Capitate
Triquetrum
Extensor indicis proprius
Proximal: Interosseous membrane, 1/3 proximal ulna
Distal:Base of proximal phalanx & dorsal expansion of 2nd digit
Innervation: Posterior interosseous
actions: PIP/DIP: extends 2nd finger
MCP: extends 2nd finger
Wrist: assists in extending wrist
Palpation: tap the index finger
Extensor carpi radialis longus
Proximal: Lateral humeral epicondyle and lateral supracondylar ridge
Distal: Base of 2nd metacarpal
Innervation: Radial nerve
actions: Wrist: extends and radially deviates
Palpation: -Palpate for Lister’s tubercle.
-Get patient to form a fist and arch it up upwards.
-When fingers are extended, ECRL is gone.
Extensor carpi radialis brevis
Proximal: Lateral humeral epicondyle
Distal: Base of 3rd metacarpal
Innervation: Radial nerve
actions: Wrist: extends
Palpation: Unlikely to be palpated
Extensor digiti minimi
Proximal: Lateral epicondyle of humerus (Common extensor tendon)
Distal: Base of proximal phalanx & dorsal expansion 5th digit
Innervation: Posterior interosseous
actions: PIP/DIP: extends 5ht finger
MCP: extends 5th finger
Wrist: assists in extending finger
Palpation: -palpate distally to the ulnar styloid process
-Tap the little finger
Extensor carpi ulnaris
Proximal:Common extensor tendon, 3/4 proximal ulna
Lateral epicondyle
Distal: Base of 5th metacarpal
Innervation: Posterior interosseous (deep radial nerve)
actions: Wrist: extends and ulnarly deviates
Palpation: - Extend the wrist and ulnar deviate
Palpate the muscle belly along ulnar side, below lateral epicondyle
Extensor digitorum communis
Proximal: Lateral epicondyle of humerus (common extensor attachment)
Distal: Base of 2nd to 5th phalanx and dorsal expansion
Innervation: Posterior interosseous (deep radial nerve)
actions: DIP/PIP: assists in extending IP joints
MCP: extend 2-5th finger
Wrist: assists in extending wrist
Palpation: - extend the fingers at the MCP joints
Flexor carpi radialis
Proximal: (medial epicondyle of humerus)
Distal: Base of 2nd metacarpals
Innervation: Median nerve
actions: Wrist: flexes and radially deviates
Palpation: Form a fist and flex.
Palpate the tendon lateral to the palmaris longus
Palmaris longus
Proximal: medial epicondyle of humerus)
Distal: Palmar aponeurosis
Innervation: Median nerve
actions: Wrist: Flexes
Palpation: Touch the tip of the pinky and thumb and flex the wrist.
Flexor digitorum superficialis
Proximal: Common flexor tendon (medial epicondyle of humerus)
Distal: Medial & lateral sides of 2nd-5th middle phalanges
Innervation: Median nerve
actions: MCP: flexes 2nd to 5th fingers
PIP: flexes 2nd to 5th fingers
Wrist: assists with flexion
Palpation: Make a fist, flex the wrist and palpate the tendon medial to the palmaris longus
Flexor digitorum profundus
Proximal: Interosseous membrane, 2/3 proximal ulna
Distal: Base of 2nd-5th distal phalanges
Innervation: MEDIAN branch of ULNAR nerve to medial FDP
RADIAL branch of MEDIAN nerve Radial branch of median nerve to lateral FD
actions: DIP: flexes 2nd to 5th finger
PIP: assist with flexion of 2nd to 5th finger
MCP: assists with flexion
Wrist: assists with flexion
Palpation: stabilize middle phalanx, get patient to flex distal phalanx
Flexor carpi ulnaris
Proximal: Common flexor tendon (medial epicondyle of humerus)
Distal: Pisiform
Innervation: Ulnar nerve
actions: Wrist: flexes and ulnarly deviates
Palpation: FCU is attached to pisiform. Palpate the tendon between styloid process of the ulna and pisiform.
Get the patient to flex and ularly deviate the wrist
Abductor pollicis brevis
Proximal: Flexor retinaculum, tubercles of scaphoid and trapezium
Distal: Base of 1st proximal phalanx
Innervation: Median nerve
actions: MCP: abducts thumb
CMC: abducts thumb and assists with opposition
Palpation: palpate the muscle from the thenar side, instruct patient to abduct the thumb
Apply some resistance on the distal end of the 1st metacarpal
Flexor pollicis brevis
Proximal: Flexor retinaculum, tubercles of scaphoid and trapezium
Distal: Base of 1st proximal phalanx
Innervation: Median nerve
actions: MCP: flexes thumb
CMC: flexes thumb
Palpation: after palpating abductor pollicis brevis, move medially on the thenar eminence, lightly flexes the thumb.
Opponens pollicis
Proximal: Flexor retinaculum, tubercles of scaphoid and trapezium
Distal: Along entire lateral aspect of 1st metacarpal
Innervation: Median nerve
actions: CMC: flexes, abducts and medially rotates 1st metarcarpal to face the palm and touch 5th finger
Palpation: difficult to palpate
Adductor pollicis - thenar
Proximal: Two heads:
Transverse head: 3rd metacarpal
Oblique head: capitate, 2nd and 3rd metacarpal
Distal: Base on 1st proximal phalanx
Innervation: Deep branch of ulnar nerve
actions: CMC: adducts thumb towards palm
Palpation: Cannot palpate the muscle belly.
But can palpate for the contraction in the web space between thumb and index finger
Abductor digiti minim- hypothenar
Proximal: Pisiform bone
Distal: Medial aspect of 5th proximal phalanx
Innervation: Deep branch of ulnar nerve
actions: CMC: abducts 5th finger
Palpation: palpate the medial aspect of 5th metacarpal.
Instruct patient to abduct the little finger away from hand
Flexor digiti minimi- hypothenar
Proximal: Hook of hamate bone and flexor retinaculum
Distal: Medial aspect of 5th proximal phalanx
Innervation: Deep branch of ulnar nerve
actions: PIP: flexes 5th finger
MCP: flexes 5th finger
Palpation: Move the palpating finger from abductor digtii minimi laterally , instruct patient to flex the little finger ,against resistance
Opponens digiti minimi- hypothenar
Proximal: Hook of hamate bone and flexor retinaculum
Distal: Medial border of 5th proximal phalanx
Innervation: Deep branch of ulnar nerve
actions: CMC: flexes, abducts and medially rotates 5th metarcarpal to face and touch thumb
Palpation: Difficult to palpate
Extensor pollicis longus
Proximal: Interosseous membrane, middle 1/3 ulna
Distal: Base of 1st distal phalanx
Innervation: Posterior interosseous
actions: IP: extends thumb
MCP: extends thumb
CMC: extends thumb
Wrist: assists with extension
Palpation: Make the “anatomical snuffbox”, observe and palpate the EPL when the patient actively extends the thumb
Extensor pollicis brevis
Proximal: Dorsal body of Radius and Interosseous membrane
Distal: Base of 1st proximal phalanx
Innervation: Posterior interosseous
actions: MCP: extends thumb
CMC: extends thumb
Wrist: assists with extension
Palpation: Palpate near the radial border, instruct patient to extend slowly without abducting the thumb
Abductor pollicis longus
Proximal: Interosseous membrane, 1/3 distal ulna & radius
Distal: Radial side of base of 1st metacarpal
Innervation: Posterior interosseous
actions: MCP: abducts and extends thumb
CMC: abducts thumb
Wrist: assists in radial deviation
Palpation: palpate the tendon at the base of the 1st metarcarpal bone on the radial side of the extensor pollicis brevis.
Flexor pollicis longus
Proximal: Middle 1/3 of radius & interosseous membrane
Distal: Base of 1st distal phalanx
Innervation: Anterior interosseous nerve aspect of median nerve
actions: IP: flexes thumb
MCP:flexes thumb
CMC: flexes thumb
Wrist: assists with flexion
Palpation: Palpate the digital crease of the thumb, instruct the patient to actively flexes the thumb.
The muscle lies deep in the forearm.
