Gross Lecture Exam 2 Flashcards
Three groups of shoulder muscles
- Originate from vertebral column or skull and insert on shoulder girdle or humerus
- Originate thoracic wall insert shoulder girdle or humerus
- originate scapula insert on humerus
Trapezius Origin (4)
EOP
Superior Nuchal line
Ligamentous Nuchae
Spines of thoracic vertebrae
Trapezius Insertion (2)
Clavicle
acromion process and spine of scapula
Trapezius Action (3)
Stabilize Scap
Elevates scapula
adducts scapula
Trapezius nerve supply (sensory and motor)
Sensory: C4 and C5
Motor: Spinal accessory nerve
Characteristics of Trapezius Palsy
deepening of shoulder on affected side
shoulder drops on affected side
Describe clinical test for XI cranial nerve
Spinal Accessory
Shrug shoulder against resistance. Test both sides at same time to check for weakness on one.
Rhomboid Major origin and insertion
Origin: Spine of upper thoracic vertebrae
Insertion: Vertebral border of scapula
Rhomboid Minor origin and insertion
Origin: Spines of lower cervicals and first thoracic
Insertion: Vertebral border of scapula
Levator Scapula Origin and Insertion
O: transverse processes of upper cervicals
I: superior angle of scap
Levator Scapula actions (3)
Elevate scapua
adduct scapula
stabilize scapula
Levator Scapula Nerve Supply and Nerve root
Dorsal scapular nerve (C5)
Describe affects of damage to C5 or levator scapula nerve
Complete adduct scapula difficulty
Scap is slightly further from midline on affected side
Latissimus Dorsi Origin (4)
Spines of lower thoracic and lumbar vertebrae
thoracodorsal fascia
crest of ilium
lower ribs
Latissimus Dorsi Insertion
Intertubercular groove (lesser tubercle) of humerus
Latissimus Dorsi Actions (2)
extends, adducts, and medially rotates humerus
forced expiration
Latissimus Dorsi nerve supply
Thoracodorsal (C6, C7, and C8)
Describe affect of weakness of Latissimus Dorsi
forward displacement of the shoulder
What makes up the lumbar triangle and what is its clinical significance?
Latissimus dorisi, crest of ilium, and external oblique musle.
hernia of posterior abdominal wall may develop here
What makes up the triangle of auscultation?
Latissimus dorsi, Trapezius, and Vertebral border of scap
Serratus anterior origin and insertion
O: Upper ribs
I: Vertebral border of Scapula
Serratus Anterior Actions (3) and Nerve Supply
Prime mover abduction of Scapula
Stabilizes Scap
Forced inspiration only when humerus is abducted
Long Thoracic (C5, C6, and C7)
Describe Long Thoracic Nerve Pulsy
Winging of the Scapula
Difficulty abducting scap and raising arm over head
may have pain around shoulder region
Causes of Long Thoracic Nerve Paulsy (3)
Trauma/Subluxation
Shoulder joint traction injuries
Recumbency for long period time
Two criteria of rotator cuff muscles
Tendon of insertion contributes to cuff formation around proximal humerus
Participate in lateral or medial rotation of humerus
Deltoid Origin (4) and insertion
O: Clavicle (anterior portion) Acromion process (middle) and Spine of scapula (posterior)
I: Deltoid tuberosity of humerus
Deltoid actions (3) and innervation
Anterior - Flexes and medially rotates humerus
Middle - Abducts humerus
Posterior - Extends and laterally rotates humerus
Axillary nerve (C5 and C6)
Name and causes for Atrophy of Deltoid
Crutch Paralysis
Fracture of surgical neck humerus
Dislocation of shoulder joint
Pressure of crutch in axilla
Deltoid atrophy problems
flattened shoulder appearance
loss of sensation (lateral brachial cutaneous branch of axillary nerve)
abduction of arm impaired
Which two bursae separate the acromion process and tendon of supraspinatous?
Subacromial and subdeltoid Bursae. This bursitis may be as common as tendonitis but hard to distinguish.
Supraspinatous Origin and Insertion
O: Supraspinous fossa
I: Greater tuberosity of humerus
Supraspinatous actions (3) and Innervation
Initiates abduction of humerus
laterally rotates humerus
stabilizes shoulder joint
Suprascapular (C5 and C6)
Describe Rotator Cuff Tendonitis
inflammation of the supraspinatous tendon
very common cause of shoulder pain
“shoulder impingement syndrome”
Sharp or aching anterior and or lateral aspect
weak shoulder movements
hard to sleep on that side
possible radiation
Causes of shoulder impingement syndrome
“rotator cuff tendonitis”
Genetic, born with hooked acromion
excess stress and repetition (athletes)
calcium deposits in tendon (old ppl)
Trauma
Clinical test for rotator cuff tear
Drop test - lower the fully abducted limb slowly…then it will DROP suddenly if tendon is torn.
Infraspinatous origin and insertion
O: infraspinous fossa
I: Greater tuberosiy of humerus
Infraspinatous actions (2) and innervation
Laterally rotates the humerus
Stabilizes shoulder joint
Suprascapular (C5 and C6)
Subscapularis O and I
O - Subscapular fossa
I - lesser tuberosity of humerus
Subscapularis Actions (2) and Innervation
Medially rotates humerus (ONLY rotator cuff muscle that does this)
Stabilizes shoulder joint
Upper and Lower subscapular nerve (C5 and C6)
Teres Minor O I A2 and N
O: axilarry border of scap
I: Greater tuberosity of humerus
A: laterally rotates humerus and stabalizes AC joint
N: axillary nerve (C5 and C6
Teres Major O I A2 and N
O - Inferior angle of scap
I - Medial lip of intertubercular grove
A - medially rotate humerus, stabalize ac joint
N - lower subscapular (C6)
Name the two divisions of the space between teres minor and major that is divided by the long head of triceps.
Quadrilateral space - lateral of two, axillary nerve and humeral circumflex vessels here
Triangular space - medial of two, circumflex scapular branch of subscapular artery here
What is the most stable joint of the upper extremity? What are its articulations?
Sternoclavicular joint
Sternal end of the clavicle
Clavicular notch and costal notches of the manubrium
Medial end of the first rib
The articular disc of the sternoclavicular joint is divided into two separate cavaties. What are their functions?
prevent clavicle from displacement with sternum
act as shock absorber for forces transmitted along clavicle
Sternocalvicular joint:
Classification
Capsular ligament characteristic
Plane gliding (kinda ball and socket a little)
very strong and completely surround joint
Extrinsic/extracapsular ligaments vs. intrinsic/intracapsular
Ex - superficial to capsular ligament
IN - deep to capsular ligament
What are the 4 ligaments of the sternoclavicular joint?
Anterior/Posterior Sternoclavicular
Interclavicular
Costoclavicular
Anterior/Posterior sternoclavicular characteristics
reinforce capsular ligament
prevents excessive protractions and retractions
Extrinsic acts like a wall
Interclavicular Characteristics
attached to both clavicles
prevent displacement when carrying heavy thing
extrinsic acts like a rope
Costoclavicular characteristics
strong attached to costal impression and rib 1
reinforces capsular ligament
limits elevation at medial end of clavicle
Extrinsic acts like a rope
Nerve supply and movement pf sternclavicular joint
Supraclavicular and nerve to subclavius
elevation,depression,pro/retraction and rotation passively when scap moves
Dislocation info for sternoclavicular
rarely happens cuz of strength
usually result of direct trauma to anterior aspect of sternal end clavicle. car crash or pile on football
mild sprain to complete dislocation
life threatening if compression of trachea or blood vessels in neck
Acromioclavicular joint
Articulations, Classification, Capsular lig. character
acromion process and lateral end of clavicle
plane gliding
think and week needs reinforce ligaments
What re the 3 ligaments of the A/C joint? Their nerve supply?
Superior/Inferior Acromioclavicular
Coracoclavicular
Suprascapular and axillary
Superior/Inferior Acromioclavicular ligament characteristics
Reinforce capsule
prevent clavicle from contact loss with acromion
extrinsic acts like a rope
Coracoclavicular ligament characteristics
Connects clavicle with coracoid process
divided into conoid and trapezoid portions which attach to respective clavicle locations
Suspends weight of scapula from clavicle
Extrinsic acts like a rope
Describe dislocation of the AcromioClavicular joint. (Shoulder Separation)
Often occur after severe blow to shoulder (Shoulder pointer)
when grade three, clavicle separates from scap
Lateral end of clavicle displaced and palpable
more prominent acromion
Subclavian artery may be compressed so diminished brachial pulse
Glenohumeral joint Articulation, classification, capsule character,
Head of humerus with glenoid cavity of scap
glenoid cavity much smaller so glenoid labrum
Ball and socket
thin and lax, opening inferior lateral part so long biceps passes out of cavity
Glenohumeral joint ligaments (5) and nerve supply
Glenohumeral Tranverse Humeral Coracohumeral Coracoacromial Suprascapular
axillary and suprascapular n
Glenohumeral ligament character
inside joint cavity
helps prevent lateral rotation of humerus
intrinsic acts like a rope
Transverse Humeral ligament
spans intertubercular groove
keeps long head of biceps in place
Coracohumeral Lig
limits lateral rotation of huerus
extrinsic like a rope
Coracoacromial ligament
attaches coracoid and acromion
prevents upward displacement of humerus head
extrinsic acts like a wall
Suprascapular ligament
small ligament spans the scapular notch
Dislocation of the Glenohumeral joint describe
Most common is an Anterior Dislocation at the lateral aspect of the capsular ligament
Caused by excessive extension and lateral rotation of humerus which goes through anterior part of capsular ligament and ends up below coracoid. (subcoracoid dislocation)
possible loss of sensation along lateral arm and forearm cuz musculocutaneous and axilarry nerve damage
What are the three anterior arm muscles and which nerve supplies them
Biceps Brachii
Coracobrachialis
Brachialis
Musculocutaneous nerve
What is unique about the biceps brachii?
it has no attachment to the humerus and is known as a “three joint muscle” cuz it can cause movement at the shoulder, elbow, and superior radiulnar joints.
Biceps Brachii O I A and INN
Coracoid process and Supraglenoid tubercle
tuberosity of the radius and ulna shaft
Flexion of forearm at elbow joint
Supinator of forearm
Short adducts the humerus
long abducts the humerus
Describe Biceps Tendonitis
Long head moves back and forth in the intertubercular groove
usually activities with flexion at elbow joint resistance
some individuals have rougher/narrow groove that can irritate tendon and cause cracking sound (Crepitus)
Rupture of Long head Biceps tendon describe
usually torn at attachment of supraglenoid tubercle
audible pop or snap
rupture belly forms near center aspect of arm (popye deformity)
Chronic tendonitis and forceful flexion cause rupture
Bicipital reflex describe
tap the biceps insertion to look for flexion at elbow
tests for segmental innervation at c5 and c6
Coracobrachialis O I A
O - Coracoid process
I - shaft humerus
A - Flexion and weak adduction of humerus
Helps stabilize shoulder joint
Brachialis O I A
O Shaft humerus
I coronoid process
A Flexion of forearm at elbow
What is unique about triceps action
Only medial head works all the time, lateral and long head only for extra force!
List the important branches of the Brachial artery and where they are located
Deep Brachial (brachial profundus)
First major branch, distal to teres major
Superior and inferior Ulnar Collateral arteries
off distal medial end of brachial and take part in arterial anastomosis around medial aspect of elbow joint
Differences between Systolic and Diastolic pressure
As pressure in cuff is released blood flow resumes and you hear Systolic
Point when sound not heard any more is Diastolic
What are the cutaneous veins of the upper extremity?
Dorsal Venous Arch
Cephalic Vein
Basilic Vein
Median Cubital Vein
Characteristics of the Musculocutaneous nerve
rarely inured because beneath biceps
usually due to direct wound in axilla or dislocation of shoulder joint
Effects if Musculocutaneous nerve is damaged
Anterior arm muscles will atrophy but weak flexion still possible due to pronator teres and brachioradialis
possible loss of sensation along lateral forearm cuz lateral antebrachial cutaneous nerve
What are the three boundaries of the cubital fossa
Lateral - brachioradialis muscle
Medial - pronator teres muscle
Proximal - level of the epicondyles of humerus
4 important structures in cubital fossa
Median nerve
Brachial artery (branches to ulnar and radial)
Tendon of biceps brachii
Median cubital vein
Which two joints make up the elbow complex?
Elbow joint and proximal (superior) radioulnar joint
Elbow Joint articulations, classification, capsular ligament character and innervation
Trochlea of the humerus with trochelar notch of ulna and capitulum of humerus with head of radius
hinge joint/ginglymus
loose anterior/posterior to permit maximum flexion and extension
strong colatteral to prevent movement
Capsule attaches to humerus and ulna but not radius
Musculocutaneous and Radial
Elbow joint ligaments 3
Lateral or Radial Collateral
Medial or Ulnar Collateral
Annular Ligament
Lateral/Radial Collateral ligament attachments and function
lateral epicondyle to annular ligament
prevents adduction at the joint
extrinsic acts like a rope
Medial/Unlar Collateral attachment and function
medial epicondyle to proximal ulna
prevents abduction
Extrinsic acts like a rope
Annular ligament attachment and function
margins of radial notch and encompasses but not attach to head and neck of radius
keeps head of radius in place
extrinsic acts like a wall
Describe dislocation of elbow joint
Posterior are most common, olecranon process will dislocate from trochlea
caused by fractures, torn ligaments, or ulnar nerve injury
Ulnar nerve damage causes
Stretched or lacerated during dislocation
entrapped in scar tissue after ligament healing
Entrapped in new bone formation
Name for increased Carrying angle of elbow joint
Cubitus valgus
Describe the Olecranon bursae
it sits between olecranon process and skin to dissipate pressure when leaning on elbow
repeated pressure cause friction type bursitis
injury or fall could cause bacterial infection of bursae
Proximal (Superior) Radioulnar joint Articulation, Classification, Capsule characteristic
Head of radius with radial notch of ulna
pivot or trochoid joint (only rotational)
encloses the joint and continuous with elbow joint
Ligaments of the Proximal Radioulnar Joint and describe them
Interosseous membrane (ligament) and Oblique chord
both limit supination
extrinsic and at like ropes
What is the common name of a subluxation of the Head of the Radius? Describe it.
Pulled/Slipped elbow, Nursemaids Elbow
most common preschool injuries happens when child is suddenly jerked by hand or forearm
tear or pulls head of radius from under the annual ligament.
painful, extremity limp and forearm held flexed and pronated
supination hurts
Does the ulna articulate with wrist joint?
No cuz the articular disc of the wrist is between it and the carpal bones
Describe a Colles Fracture
fracture at distal end of radius, most common in adults esp 50+ women
individual falls on outstretched hand
distal fragment displaced posterior so radius shortens
Typical sign of Colles fracture? does it heal well?
Dinner fork deformity - posterior angulation occurs in the forearm proximal to the wrist
heal well usually cuz good vascular supply
Describe a Smith’s Fracture
fracture at distal end of radius
fall on back of hand, reverse colles fracture so displaced fragment anterior
List the order of the ossification of the Carpal bones
Capitate and Hamate Triquetral Lunate Trapezium, Trapezoid, Scaphoid Pisiform
Around what age is the ossification of carpal bones complete? Does ossification start before or after birth?
14 to 16
Usually after
What are Sesamoid bones? What are their functions?
bones embedded in some flexor tendons of the hand. usually over MP joints on digits 1 2 5 and IP1
protect and stabilize tendons
change the angle of the tendons (increase leverage)
Describe a Scaphoid fracture
most common carpal fracture
fall on the palm of the hyperextended hand
twice as much force to break this as radius
appears as a sprained wrist, tenderness and swelling in snuffbox
Describe a hammate fracture
may lead to a nonunion of fractured parts cuz pull of muscles attached to bone. Ulnar nerve is close to the hook of hamate andmay be inured
Describe metacarpal fractures
held closely by ligaments so fractures tend to be stable and heal quickly cuz good blood supply
Boxers Fracture is that of the 5th metacarpal from a punch
Describe Phalange fracture
usually crushing injuries (slam in door)
very painful! may result in hematomas
avulsion fractures with extensor tendons common
Pronator Teres O I A Inn
Origin - medial epicondyle and coranoid process
Insertion - pronator ridge radius
Action - pronation and helps flexion
Innervation - median nerve
What is pronator teres syndrome and what causes it?
Compression of median nerve at proximal forearm between head of muscle
Direct trauma or excessive pronation/supination
Flexor carpi radialis OIAI
Medial epicondyle
Second metacarpal and little bit of 3rd
Flexion and abduction of hand
Median nerve
Ulnar vs radial deviation
Know it?
Flexor Carpi Ulnaris OIAI
Medial epicondyle and olecrandon process
Pisaform hammate and 5th metacarpal
Flexes andadducts hand
Ulnar nerve
Flexor digatorum superficialias
medial epicondyle
middle phalanges of digits 2-5
flexes digit proximal IP joints, helps flexion hand
Median nerve
Flexor digatorum profundus
Ulna shaft
distal phalanges 2-5
median and ulnar nerve
flexes dip joints and helps flex hand`
Flexor pollicis longus
shaft of radius
distal phalanx of digit 1
flexes ip joint of thumb
median
Pronator Quadratus
shaft of ulna
shaft or radius
pronates lower forearm, helps stabilize joint
median nerve
Describe Carpal Tunnel Syndrome
Compression of the Median nerve at the distal radialulnar joint.
atrophy of the thenar muscles may occur “ape hand”
Sensory loss over lateral 2/3 palm
What tests are done to identify carpal tunnel?
Make circle with thumb and pointer finger and doctor trys to pull first digit away
Also assess the sensivity of tip of digit 2
Describe effects of Ulnar nerve damage
difficulty making a fist (Claw Hand)
Guyon Tunnel or Canal Syndrome
comprimised ulnar nerve as it passes between hook of the hamate and the pisiform
sensation loss in medial one and half digits
Cyclists or Handlebar Neuropathy
ppl who develop Guyon cannal due to biking a lot with a hyperextened grip
Brachioradialis
Lateral supracondylar ridge
styloid process of the radius
Flexes forearm, pronates AND supinates depending
Radial nerve
Extensor carpi radialis longus and brevis
Lateral Epicondyle
second and third metacarpals
Extends and abducts hand
Radial
Extensor Digitorum
lateral epicondyle
middle and distal phalanges 2-5
extends digits, extends hand, abducts digits 2,4, and 5
Radial
Extensor digiti minimi
Lateral epicondyle
proximal phalanx digit 5
extend digit 5
Extensor Carpi Ulnaris
lateral epicondyle
fifth metacarpal
extends hand and adducts hand
Describe Lateral Epicondylitis (Tennis Elbow)
painful due to excessive use of superficial posterior forearm muscles
pain at lateral epicondye run down their forearm laterally
any activity with full extension aggervates this
Test for Tennis elbow
.stabilization of the patient’s forearm and having the patient make a fist and hyperextend their hand .applying pressure to the patient’s hand and attempting to force the patient’s hand into flexion, while the patient resists - pain if there
Describe Mallet or Baseball finger
Sudden severe tension of one of the long extensor tendons may avulse at attachment to distal phalanx
result is poor extension at joint
Supinator
Lateral epicondyle and supinator crest of ulna
Shaft of radius
supinates forearm
radial
Abductor Pollicis Longus
shaft of ulna and radius
first metacarpal
adducts digit one at CM joint
Extensor Pollicis Brevis
Shaft radius
Proximal phalanx thumb
Extends thumb
Extensor Pollicis Longus
Shaft Ulna
Distal Phalanx digit one
extends digit
What is in the floor of the Anatomical Snuffbox?
Styloid of radius, scaphoid and trapezium
Describe DeQuervains Disease or Tenosynovitis Stenosans
Innflamation of tendons of abductor pollicis longus and extensor pollicis brevis within their common fibrous sheath
more common in old women menopause
Extensor Indicis
Shaft of Ulna
Proximal phalanx digit two
extends digit two
Describe damage to the radial nerve
most common cause is the fracture to humerus
triceps may be spared, but posterior forearm muscles and sensation affected
hand will drop to passive flexion Wrist Drop
Differences between damages to superficial or deep branches of radial nerve
penetrating wounds will affect the deep branch and the patient will have difficulty carrying our extension of the hand and/or digits. Sensory loss is not seen, unless the superficial branch has been damaged
.damage to the superficial branch, always shows sensory loss but not motor loss
What are the two major arteries of the forearm and their branches
Radial Artery
Recurrent artery
Unnamed muscular branches
superficial and deep palmar
Ulnar Artery
Anterior and posterior recurrent
Common Interosseous
anterior and posterior interosseous
Superficial and Deep Palmar
***Superfical and deep branches from both ulnar and radial form superficial and deep arches
Distal or Inferior Radioulnar Joint
Articulation, Classicfication, and Capsule character Innervation
Head of ulna and ulnar notch of radius
pivot or trochoid
encloses but weak, may be deficient superiorly
Radial
Distal or Inferior Radioulnar joint ligaments
Anterior and Posterior transverse ligaments - unite radius and ulna, strengthen capsule and prevent supination. Extrinsic acts like a rope
Articular disc (ligament) -small piece of fibrocartilage which attaches to the ulnar notch and the styloid process of the ulna. Chief uniting structure of joint
Functions of the Interosseous Membrane
Provide strength and stability between radius and ulna
limit supination
increase surface area for muscle attachment
What is more powerful pronation of forearm or supination?
Why easier to screwdrive with bend in elbow?
Supination
Biceps help
Radiocarpal (Wrist) Joint
Articulation, Classification, Capsule, innervation
distal end of radius and articular disc with the Scaphoid, lunate and triquetral
condyloid
Rather thin and unremarkable
Median, Radial, and Ulnar
Radiocarpal joint ligaments
Dorsal and Palmar radiocarpals
attach superiorly to radius and inferiorly to
scaphoid and lunate. Extrinsic Ropes
Palmar ulnocarpal
attach ulna to scaphoid/lunate Extrinsic Rope
Ulnar and Radial Collaterals
attach styloid process of ulna and radius to their respective sides carpal bones. Extrinsic Ropes
Does medial and lateral rotation occur at the wrist joint?
NO!!!!!!! only flexion, extension, adduction and abdution
LOOK AT CROSS SECTION DIAGRAMS!!!
LOOK AT CROSS SECTION DIAGRAMS!!!!
The ability of our hands to manipulate objects in the environment
Manual dexterity
What important structures are held within the carpal tunnel? outside of it?
median nerve and long flexor tendons to the digits
tendon of insertion of the palmaris longus and the cutaneous branches of ulnar nerve
Carpal Tunnel Syndrome other name
Distal Median Nerve Neuropathy
6 common causes of Carpal Tunnel
Edema caused by trauma, obesity, or pregnant
fractures, smiths fracture example
Tumors, ganglionic cyst for example
Oral Contraceptives
Repetitive flexion and extension of wrist
misalignment of bones
Signs and Symptoms of Carpal Tunnel
paresthesia in median nerve cuteneous area
decreased skin moisture in nerve cutenaous area
pain awakening in the middle of night
atrophy of thenar muscles
symptoms intensified by activity flexion extension
Carpal Tunnel Tests
Tinel’s Sign
Phalen’s Test
TS - sensation of “pins and needles” when doc taps over median nerve site at anterior wrist
PT - reproduce symptoms by having patient flex hands to maximum and hold for several minutes
Main function of the extensor retinaculum
prevent “bowstringing” of extensor forearm tendons when hand is hyperextended.
Structures NOT within the extensor retinaculum
Dorsal venous arch
Cephalic and Basilic Veins
Cutaneous branches of radial and ulnar nerve
Two functions of Palmar Apenouriosis
Gives attachment to overlying skin to improve grip
protects underlying tendons
Describe Dupuytren’s Contracture
shortening and hypertrophy of palmar aponeurosis
begins with one or more mild painful nodules involving the fascia at usually base of digit 4 5
causes contracture of muscles affeciting MP joints of digits 4 5 leading to flexion
genetic but no knowns cause
Common in men over 50
higher incidence in alocholics and epileptics
What makes up the Thenar muscle?
Abductor pollicis brevis
Opponens pollicis
Flexor pollicis brevis
Adductor pollicis
Abductor Pollicis Brevis OIAINN
Trapexium and Scaphoid
Proximal phalanx digit one
Abducts digit one at MP
median nerve
Opponens Pollicis OIAN
Trapezium
First metacarpal
Medially rotates first metacarpal
median nerve
Flexor Pollicis Brevis OIAN
Trapezium, trapezoid and capitate
proximal phalanx digit one
flexes digit one at MP joint
median and ulnar
Adductor Pollicis OIAN
trapezoid, capitate, 2nd and 3rd metacarpals (oblique head 3rd metacarpal)
proximal phalanx digit one
Adducts digit one
Ulnar
Hypothenar muscles list
Abductor digiti minimi
Flexor digiti minimi
opponens digiti minimi
Abductor Digiti minimi OIAN
pisiform
proximal phalanx digit 5
abducts digit 5
ulnar
Flexor digiti minimi
hamate
proximal phalanx digit 5
flexes digit 5 at MP joint
ulnar
Opponens Digiti minimi
hamate
fifth metacarpal
laterally rotates 5th metacarpal
Lumbricales OIAN
tendons of flexor digitorum profundus
tendons of extensor digitorum maximus
flexes MP joints and Extends IP joints
median and ulnar (first two and second two lumbricals)
Dorsal Interossei OIAN
From adjacent metacarpals between them
proximal phalanx digits 2,3,4
Abducts 234, flexes MP, Extends IP
Ulnar nerve
Palmaris Brevis OIAN
Flexor retinaculum
skin of hypothenar eminence
prevents skin of the palm from flattening during palmar grip
Ulnar
Cutaneous supplied by Median nerve
lateral part of palmar surface of hand
Cutaneous supplied by Ulnar
Medial aspect of hand both sides
Cutaneous of radial nerve
lateral aspect of hand dorsum and dorsum portion of 1234 digits
Two important carpal and metacarpal branches coming off the superci=fical and deep palmar arches
Princeps pollicis (to digit 1)
Radialis indicis artery
Describe intermetacarpal joints
joints between bases of 2nd through fifth metacarpals…not between 1 and 2
Skiers thumb (gamekeepers thumb) describe
rupture or laxity of collateral ligament at the MP joint of digit one
usually result of hyperabduction of MP joint
In severe injuries there may be avulsion fractures of head of first metacarpal
