Lecture 21 Flashcards
What is the movement of the elbow and hand relative to?
elbow- relative to arm at elbow
hand - relative to forearm at wrist
What are the intrinsic movements of the forearm?
Rotatory
-radius move medially over ulna for pronation
-radius moves laterally for supernation
Pivots = proximal and distal Radio-ulna Joints
Hinge = interosseus membrane
What is the movement of the hand?
rotated almost 360 degrees around the long axis of the limb
What muscles function in the rotatory movements in the arm?
- Pronator Teres (PT)
- Pronator Quadratus (PQ)
- Supernator
What is the exception to the forearm containing just a bulk of muscles that control the hand ?
Brachioradialis
- Inserts on Distal Radius
- Elbow Flexor
What 3x things separate the anterior flexor compartment and posterior extensor compartment in the forearm?
- Interosseus membrane
- M.I.S. Medial Intermuscular Septae
- L. I. S. Lateral Intermuscular Septae
When are the compartments of the forearm symmetrical?
at distal end
What are the 5x groups of movements created by the forearm muscles?
- Extension/Flexion of elbow
- Extension/Flexion at wrist
- Extension/Flexion at digits
- Adduction/Abduction at wrist
- Supernation/Pronation of hand
20 muscles
What starts earlier out of ulna or radius?
Ulna - has Olecranon
What are the 3x functions of the humerus and forearm and elbow?
- Distance hand from body
- Move hand
- Apply force to environment
Is it he broad triangular cross section or the round head which generates the most strength?
broad triangular base of ulna
- where most of the strength comes from in the Ulna
- Reciprocal b/w distal and proximal ends
Distally what does the round head of the Ulna help with?
Pronation and Supernation
Out of the radius and Ulna, which articulates with the wrist joint proper?
Radius’ broad articulating surface (Triangle)
-ulna doesnt articulate at wrist joint, as is barred by the TFC/Triangular Fibrocartilage Complex/Fibrous Articular Disc
Where are your strong collateral ligaments of your wrist located from?
Strong styloid processes
-sides of ends of bone
What are the 4x components of the Distal Radio-Ulna Joint?
- Ulna Notch (in radius, named by what is filling it)
- TFC/Triangular Fibrocartilage complex/ FAD Fibrous Articular Disc
- Head of Ulna
- Ulnar Styloid process
Does the ulna rotate at all?
Not AT ALL
-radius rotates over ulna allowing supernation and pronation
What si the sacciform recess?
Budlging of the synovial membrane between radius and ulna
Due to alot of movement in the wrist joint
Anular ligament
wraps around proximal radius
holds Proximal radius in place
so just rotates -doesnt roll over ulna like distal joint
-keeps the 2x bones together
What sort of movements does the ulna do?
Nothing much
No rotation
only a little bit of abduction/adduction
What are the 3x function of Interosseus membrane?
- Hinge: flexibe hinge. holds radius in relation to ulna (for most of its length) during pronation and supernation -soft to occur - cannot just rely on anular ligament and TFC.
- Muscle Attachment
- Force transmission. Most force transmitted up to small proximal circular head of radius.1. Radius moves up. 2. Oblique fibres placed unfer tension. 3. Force transmitted down into broad stronger base of ulna at same Proximal end
What is the triangular ligament?
FAD - fibrous articular disc
TFC -triangular fibrous complex
What forms the true wrist?
carpals
What is another name for the wrist joint proper?
Radio-carpal joint
(radius + TFC) + 4x proximal carpals
What is the name of the joints between the 2x rows of carpal bones?
Mid carpal joints
or Transverse Intercarpular joints
What is the name for the joints between distal 4x carpals and 4x medial digits/metacarpals?
Carpometacarpal joints
What 3x movements occur at the wrist?
flexion/extension
abduction/adduction
some rotation
What movement occurs at mid-carpal joint
flexion/extension
What movement occurs at the carpo-metacarpal joint?
very little movement -stability and strength
very mobile in thumb
What is the location of Flexor Retinaculum in the hand?
Medial 1/2-2/3 of wrist
-DOESNT extend to radial edge of wrist
Medially and lateral attachments to carpal bones
Thick Strap = retinaculum
(anterior surface, holds flexing muscles)
2x attachments form the Carpal tunnel/common synovial sheath
-contains Long Flexor tendons
–and stops their bow-stringing
-sometimes long flexor tendon of thumb has its separate synovial sheath
Palmar aponeurosis at distal end of flexor retinaculum. Palmaris tendon goes over flexor retinaculum and then inserts into flexor retinaculum
What is the use of the metacarpals?
Palmar fleshy part
used to grab things against
What is the most fractured carpal bone?
Scaphoid
What is the name of the proximal and medial carpal bone starting with t?
triquetral
What is the location of the wrist crease?
Between 2x styloid process
What is the difference between the tarsal bones of the foot and the carpal bones of the wrist?
Foot has 7x Tarsal Bones
Wrist has 8x carpal bones
-adds strength to argument of Pisiform being sesmoid bone
What does Hollex mean?
Great toe
What does Pollex mean?
thumb
What are 3x examples of paired structures?
Pronator/Supernator
Longus/Brevis
Superficial/Profundus
What is the origin of Pronator Quadratus?
Ulna
- as it moves its Distal attachment (Radius) over the ulna for Pronation
- speed and power is aided by Pronator Teres (hence the name) for pronation
What other muscle in the forearm aids pronator quadratus with speed and strength of pronation?
Pronator Teres
(hence the name)
-Lateral muscle
In the 4:1:3 categorisation of your flexor forearm muscles, what are the 4x superficial muscles?
Really 3 and 1/2 (Pass Fail Pass Fail)
- Pronator Teres
- Flexor Carpi Radialis
- Palmaris Longus
- Flexor Carpi Ulnaris
- common flexor tendon of humerus has 3 1/2 tendons originating from it (1/2 f.d.superficialis-other half from radius-Intermediate layer)
In the 4:1:3 categorisation of your flexor forearm muscles, what are the 1x intermediate muscles?
Flexor Digitorum Supericialis
In the 4:1:3 categorisation of your flexor forearm muscles, what are the 3x deep muscles?
- Flexor Pollicis Longus
- Pronator Quadratus
- Flexor Digitorum Profundus
How many muscles originate from the Common Flexor Tendon off the Medial Epicondyle of the humerus?
3 and 1/2
- Palmaris longus
- Flexor Carpi -Radialis and Ulnaris
- 1/2 F Digitorum Superficialus (other 1/2 off radial head in intermediate layer)
Pronator Teres
O: Supracondylar ridge of humerus
2x heads
I: 1/2 way down radius
Boundary of Cubital Fossa
-Median Nerve passes through Pronator Teres
-Medial branch of Ulna nerve runs underneath
-Adds speed and strength to pronation of hand -can aid pronator quadratus pronation
Flexor Carpi Radialis
Under Flexor Retinalculum
Base of 2nd MT
Radial Nerve runs down it Laterally - you squish inwardsagainst Radial Nerve and Flexor Carpi Radialis when taking wrist pusles
What structures do you feel when you’re taking someones pulse at their wrist?
Radial Artery which lies Lateral to Flexor Carpi Radialis
-squish inwards and feel both
Palmaris Longus
small muscle Blends with Palmar Aponeurosis --helps to anchor skin -so when you're grabbing or swinging something your skin doesnt move too much -remnant muscle -missing in 15-20% of people
What is the name of the remnant muscle that is missing in 15-20% of people?
Palmaris Longus
Flexor Carpi Ulnaris
Under Flexor Retinaculum
Pisiform + base of 5th MT
LAt –> MEdil = U. Artery –> U. Nerve –> F. Carpi. Ulnaris
-Have to press harder to get Ulnar Artery Pulse
Lateral to Medial, what is the relative arrangement of Ulnar Nerve, Ulnar Artery, and Flexor Carpi Ulnaris?
Lateral –> Medial
U. Artery - U. NErve - Flexor Carpi Ulnaris
NERVE IS CLOSER TO MUSCLE
-need to press harder to get ulnar pulse
Flexor Digitorum Superficialis
2x heads:
1x medial epicondyle as part of common flexor tendon)
1x radius (and ulna)
Under Flexor Retinaculum
Base of medial 4 MIDDLE phalanx
-moving INDIVIDUAL digits (Distal IPJ not really doing anything)
-moves 3x: Prox IPJ + MCP + wrist
What is the general rule for deeper muscles?
Insertions are more distal
Flexor Digitorum Profundus
Broad Origin: Interosseus membrane –> front of ulna
I: Base of Medial 4x DISTAL Phalanx(deeper muscle= more distal insertion)
FDP Flexes the Distal Phalanx
-LEss control
–normally only use ALL TOGETHER (guitar players exception as can have trained them better to use individually)
-More power (grab something with strength more powerfully)
Flexor Pollucis Longus
O:front of Radius and Interosseus Membrane
I: Distal phalanx
-thumb needs own STRONG FLEXOR as it OPPOSES all 4x of your fingers
What can be a potential problem with having alot of tendons under the flexor retinaculum?
Inflammation
