p55-75 Flashcards
Inflammation of common flexor tendon resulting from overuse of flexors–activities that require a lot of gripping is called
Medial Epicondylitis (Golfer’s elbow)
Name the injury that results in: Loss of flexion to PIPs in 1st-3rd digits, Weakened flexion to PIPs in 4th and 5th digits, Loss of flexion to DIPs in 2nd-3rd digits BUT no issues with 4th and 5th digits. Ability to flex MPs of 2nd and 3rd digits is affected.
(What is this injury also known as)
Injury to Median n, (C6-T1) at elbow/forearm
Hand of Benediction
How do you decipher between an injury to the Median n. or A.I.N.?
Attempt to make the “okay” sign– if it results in a “pinch” posture it is the Median n.
What is the deepest muscle in the anterior forearm that covers distal radius, ulna, and interosseous membrane?
What passes deep to this muscle?
What innervated it?
Pronator Quadratus
A.I.A. and A.I.N.
A.I.N
What is the origin and insertion of the Pronator Quadratus m.?
O: Distal 1/4 of anterior surface of ulna
I: Distal 1/4 of anterior surface of radius
What muscle lies lateral to Flexor Digitorum Profundus and covers aspect of radius distal to supinator?
Does it pass through the carpal tunnel?
Flexor Pollicis Longus
It DOES pass through the carpal tunnel and has its own synovial tendon sheath (radial bursa)–> lateral to common flexor sheath.
What is the origin and insertion and innervation of Flexor Pollicis Longus?
At which joint does this m. flex the thumb?
O: Anterior surface of radius and adjacent interosseous membrane
I: Base of distal phalanx of thumb
N: A.I.N. (C8, T1)
ONLY muscle that flexes thumb at interphalangeal joint. Secondarily flexes proximal phalanx, 1st MP and CM joints respectively
In the flexor compartment, what four muscles comprise the superficial layer?
Superficial Layer:
- ) Pronator teres m
- ) Flexor carpi radialis m.
- ) Palmaris longus m.
- ) Flexor carpi ulnaris m.
In the flexor compartment, what muscle comprise the intermediate layer and what three comprise the deep layer?
Intermediate layer:
Flexor digitorum superficialis m.
Deep layer:
- ) Flexor digitorum profundus m.
- ) Flexor pollicis longus m.
- ) Pronator quadratus m.
**Superficial and intermediate groups cross elbow AND wrist joints. Deep group ONLY crosses wrist.
What is the only muscle to flex distal interphalangeal joints (DIPs) and covers anterior aspect of ulna?
Flexor Digitorum Profundus
- Gives rise to 4 tendons at wrist.
- Has 2 innervations
What is the Origin, Insertion and Innervation of Flexor Digitorum Profundus?
*Hint: Lateral and medial halves share an origin but not I/A/N
O: Medial and lateral halves – Proximal ¾ medial and anterior surfaces of ulna and
interosseous membrane
I: Medial half – Bases of distal phalanges of 4th and 5th digits
Lateral half – Bases of distal phalanges of 2nd and 3rd digits
What is the action and innervation of the medial and lateral halves of Flexor Digitorum Profundus?
A: Medial half – Flexes DIPs of 4th and 5th digits
Lateral half – Flexes DIPs of 2nd and 3rd digits
N: Medial half – Ulnar n. (C8, T1)
Lateral half – A.I.N. (C8, T1)
Assists in making a fist, Can only flex pointer finger independently.
Flexor Digitorum Profundus
Testing these muscles of the flexor compartment tests the integrity of the Median nerve:
Pronator teres Flexor Carpi Radialis Flexor Digitorum Superficialis Flexor Digitorum Profundus (by way of index finger--> Why?) Flexor Pollicis Longus
Gives Rise to four tendons at wrist and shares a common flexor sheath with FDP:
Flexor Digitorum Superficialis
Which four muscles originate from the medial epicondyle via a common flexor tendon?
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris (humeral head only)
Flexor Digitorum Superficialis (along with the coronoid process)
Which muscles pass through the carpal tunnel?
Flexor Digitorum Superficialis
Flexor Digitorum Profundus
Flexor Pollicis Longus
What is the Origin (of the two heads) and Insertion of Flexor Digitorum Superficialis?
O: Humeroulnar head – ME via common flexor tendon and coronoid process
Radial head – Superior ½ anterior border
I: Shafts of middle phalanges of medial 4 digits via split tendon
What is the Action and Innervation of Flexor Digitorum Superficialis?
A: Flexion of PIPs; strong flexion of MPs
N: Median n. (C7, C8, T1)
Flexion of the wrist is produced when which two muscles act together?
Flexor Carpi Radialis and Ulnaris
Ulnar n. enters forearm by passing between humeral and ulnar heads through what is called…
this is a potential site of:
The Cubital Tunnel
Inpingement
When Flexor Carpi ulnaris acts alone what action is produced?
Alone, it produces a combination of flexion and ulnar deviation
o Moves hand anteromedially
stabilize shoulder / prevent dislocation:
subscapularis supraspinatus infraspinatus teres minor biceps brachii (short head) triceps brachii (long head)
aDduct humerus:
subscapularis
teres major
coracobrachialis
aBduct humerus:
deltoid (middle)
supraspinatus
laterally rotate humerus
deltoid (posterior)
infraspinatus
teres minor
medially rotate humerus
deltoid (anterior)
subscapularis
teres major
extend humerus
deltoid (posterior)
flex humerus
deltoid (anterior)
biceps brachii
coracobrachialis
flex forearm (elbow)
biceps brachii (when supinated) brachialis pronator teres flexor carpi radialis palmaris longus flexor carpi ulnaris flexor digitorum superficialis brachioradialis
extend forearm (elbow)
triceps brachii
anconeus
stabilize elbow
anconeus
supinate forearm
biceps brachii
supinator
pronate forearm
pronator teres
pronator quadratus
flex wrist
flexor carpi radialis palmaris longus flexor carpi ulnaris flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus
extend wrist
extensor carpi radialis longus extensor carpi radialis brevis extensor digitorum extensor carpi ulnaris extensor indicis
aBduct hand (radial flexion)
flexor carpi radialis extensor carpi radialis longus extensor carpi radialis brevis abductor pollicis longus extensor pollicis longus extensor pollicis brevis
aDduct hand (ulnar flexion)
flexor carpi ulnaris
extensor carpi ulnaris
flex metacarpals/proximal/intermediate/distal phalanges
flexor digitorum superficialis (P/I, 2-5) flexor digitorum profundus (P/I/D, 2-5) flexor pollicis longus (M/P/D, 1) flexor pollicis brevis (M/P, 1) flexor digiti minimi brevis (P, 5) lumbricals (P, 2-5) dorsal interossei (P, 2-4) palmar interossei (P, 2,4,5)
extend metacarpals/proximal/intermediate/distal phalanges
extensor digitorum (M/P/I/D, 2-5) extensor digiti minimi (M/P/D, 5) extensor indicis (2) extensor pollicis longus (M/P/D, 1) extensor pollicis brevis (M/P, 1) lumbricals (I/D, 2-5) dorsal interossei (I/D, 2-4) palmar interossei (I/D, 2,4,5)
aBduct digits
flexor pollicis longus (1) (c-m joint) abductor pollicis longus (1) (c-m joint) abductor pollicis brevis (1) abductor digiti minimi (5) dorsal interossei (2-4)
aDduct digits
adductor pollicis (1) palmar interossei (2,4,5)
oppose digits
abductor pollicis brevis
opponens pollicis
opponens digiti minimi
What is the most medial of the superficial flexors?
Flexor Carpi Ulnaris
What Action is produced when Flexor carpi ulnaris acts with Flexor carpi radialis? Extensor Carpi Ulnaris?
Flexion is produced when acting with FCR
Ulnar deviation is produced when acting with ECU
Which muscle is absent in one or both sides of around 14% of people?
Palmaris Longus
Which flexor muscle does not pass through carpal tunnel and lies medial to Pronator Teres m?
Flexor Carpi Radialis
What action is produced when Flexor Carpi Radialis is acting with Extensors carpi radialis longus and brevis?
Radial deviation is produced when acting with ECRL and ECRB
What action does Flexor Carpi Radialis produce when acting alone?
When acting alone, it produces a combination of flexion and radial deviation
o Hand moves anterolaterally
Median n. passes between two heads of this muscle
o Common site of impingement
Pronator Teres m.
Most lateral of superficial forearm flexors
Pronator Teres m.
A: Pronation (when more speed and power is needed) and flexion of forearm
Pronator Teres m.
What compartments are the muscles of the forearm broken into?
Divided into anterior (flexor) and posterior (extensor) compartments
Lateral epicondyle and supracondylar ridge provide attachment for (hint: group)
Extensors
*Proximal parts of extensor compartment lie posterolaterally
Medial epicondyle and supracondylar ridge provide attachment for
Flexors
*Proximal parts of flexor compartment lie anteromedially
Information ONLY:
Flexors and pronators are in anterior compartment
o Served by median n.
o One and a half exceptions innervated by ulnar n.
o Supplied by radial and ulnar aa.
Information ONLY:
Extensors and supinators are in the posterior compartment
o Innervated by radial n.
Directly or its deep branch
o Supplied by radial and ulnar aa.
T/F: Antebrachial fascia is continuous with Brachial fascia superiorly?
True
Antebrachial fascia divides forearm into:
Anterior (flexor) compartment
Posterior (extensor) compartment
Compartments are separated by interosseous membrane
Demarcated by subcutaneous border of ulna and the radial a.
What is Antebrachial fascia continuous with distally?
Extensor and flexor retinaculums
*Flexor retinaculum converts anterior concavity into carpal tunnel
In the distal radio-ulnar joing, which bone moves?
Radius
Where are the heads of the ulna and radius located?
Head of ulna is distal
Head of radius is proximal
Radius and ulna are united by
interosseous membrane
What overlies the cubital fossa
o Median cubital v.
Anterior to brachial a.
o Medial and lateral antebrachial cutaneous nn.
What are the contents of the cubital fossa?
Terminal part of brachial a. Deep accompanying vv. Biceps brachii t. Median n. Radial n.
What are the boundaries of the cubital fossa? (Lateral, medial, base (superior), floor, roof)
o Lateral – brachioradialis m.
o Medial – pronator teres m.
o Base (superior) – line between medial and lateral epicondyles
o Floor – supinator and brachialis mm.
o Roof – skin, fascia and bicipital aponeurosis
What is the most commonly injured nerve?
Radial n. (C5-8) in Arm
Injury to the radial n. superior to the origin of its branches to the triceps brachii m. results in paralysis of:
Triceps brachii, brachioradialis, supinator mm. and extensors of wrist and fingers
Injury to which nerve is known as “Saturday night palsy?” and it’s characteristic disability is the “wrist drop’
Injury to the Radial n. (C5-8) in Arm
Injury to which nerve can be caused by:
Improper use of crutches
Falling asleep with arm over chair
Posterior dislocation of glenohumeral joint (rare)
Injury to the Radial n. (C5-8) in Arm
Injury to the radial n. in the radial groove would weaken which muscle and paralyze which muscles?
Can be caused by?
weaken triceps brachii. All other posterior compartment forearm mm. would be paralyzed
Fracture to humeral shaft
Musculocutaneous n. supplies:
biceps brachii M
brachialis M
coracobrachilalis M (pierces it)
skin of lateral forearm (as lateral antebrachial cutaneous n)
What n. emerges lateral to biceps tendon as lateral antebrachial cutaneous n?
Musculocutaneous n.
Terminal branches of posterior cord of brachial plexus
Axillary n.
Radial n.
What does the Radial n. run with in the radial groove?
What branch arises here?
profunda brachii a.
Branch to lateral head of triceps arises here
What nerve continues between brachialis and brachioradialis mm. to level of lateral epicondyle
Radial n.
What type of joints are the distal and proximal radio-ulnar joints?
Synovial, Pivot. (pronation, supination)
The radio-ulnar joint has an articular disc that is what shape?
Triangular. It is called the Triangular ligament clinically/
Where is the ulnar notch located?
On the distal end of the radius
There are five ligaments associated with the radio-ulnar joints: Annular l, Anterior l, Posterior l, Oblique cord, and Interosseous membrane– Where are they located: proximal or distal radio-ulnar joint?
Anterior and posterior ll= Distal radio-ulnar joint
The rest= Proximal “ jt
What is found overlying the cubital fossa? (NAV?)
o Median cubital v.
Anterior to brachial a.
o Medial and lateral antebrachial cutaneous nn.
Which cord of the brachial plexus can Musculocutaneous nerve be traced to?
Lateral cord
T/F: Venae comitantes are unpaired
False
Name the superficial veins of the arm and forearm (4)
Basilic
Median Cubital
Cephalic
Intermediate Antebrachial
Cephalic v can be found in what structure of the arm?
deltopectoral groove
Intermediate antebrachial v divides into:
(A clear M is formed)
Median Cephalic and Basilic vv.
The Brachial artery terminates in the cubital fossa as what structure/s
Radial and Ulnar aa.
Aconeus m is nicknamed what?
Point to where it is located
The homeless guy? (IDK)
I hope you’re pointing at the postero-lateral portion of your elbow
What is the main extensor of the forearm?
Triceps brachii m
Rupture of what leads to “Popeye Deformity”?
Rupture of tendon of long head of biceps brachii
Associated with a snap or a pop
Injury to musculocutaneous nerve usually occurs due to
Knife fight
Point to where your coracobrachialis is located
What runs deep to it and can be compressed by it?
Superomedially on upper arm
Medial N and/or Brachial artery
What is the main flexor muscle of the forearm?
Brachialis
Bicipital aponeurosis covers what structures?
Brachial artery and Median N.
T/F Flexors are twice as strong as extensors
T (Better pullers than pushers)
Deep
Breath.
Everything is going to be alllll right
Name a few ways an elbow joint can be dislocated posteriorly
o From a fall to the hands when the elbow is flex
o Hyperextension
o Blow that drives ulna posterior and posterolateral
What nerve can be injured due to elbow dislocation?
Ulnar N
The real name for “student’s elbow”
Subcutaneous Olecranon Bursitis
During flexion, head of radius contacts
radial fossa of humerus
The capitulum of the humerus contacts what part of the radius?
The head.
What type of joint is the humeroradial joint?
What type of joint is the humeroulnar joint?
Limited ball-and-socket, hinge type joint
Flexion/extension and supination/pronation permitted
Hinge joint
During flexion what contacts the coronoid fossa of humerus
The coronoid process of Ulna
During extension, olecranon process of ulna contacts
olecranon fossa of humerus
The elbow is what type of joint?
Synovial
How often do lower brachial plexus injuries occur? How do they occur?
Not too common
Injuries occur here when upper limb is suddenly pulled superiorly
o e.g. grasping something to break a fall or baby’s upper limb being pulled during delivery
What is another name for lower brachial plexus injuries? What does it look like?
Klumpke’s palsy, claw hand (Unopposed action of extensors and flexor digitorum profundus m.)
Erb-Duchenne palsy is what type of injury?
Injury to upper brachial pexus
What causes Erb Duchenne palsy and what does it look like?
Injuries occur here with excessive increase in angle between neck and shoulder
e.g. thrown from horse or baby with shoulder dystocia
Waiter’s tip position/ Flintstones men.
What nerves are associated with the lateral cord of the brachial plexus?
Lateral pectoral n.
Musculocutaneous n. (terminal branch)
Lateral root of median n. (terminal branch)
What nerves are associated with the mediaL cord of the brachial plexus?
Medial root of median n. (terminal branch) Medial pectoral n. Medial brachial cutaneous n. Medial antebrachial cutaneous n. Ulnar n. (terminal branch)
What nerves are associated with the posterior cord of the brachial plexus?
Upper subscapular n. Thoracodorsal n. Lower subscapular n. Axillary n. (terminal branch) Radial n. (terminal branch)
Cords are named for their relationship to
2nd part of the axillary a.
INFORMATION:
o C5-6 – primarily innervate mm. that act at shoulder or flex elbow
o C7-8 – innervate mm. that extend elbow or are part of forearm
o T1 – primarily innervates intrinsic mm. of hand
Which parts of the brachial plexus can we see in lab?
Cords and branches
How many groups of lymph nodes are located in the axillary region?
Five.
Axillary artery begins where? ends?
Lateral border of the first rib. It ends at the inferior border of teres major m.(becomes brachial a).
Name the branch of the first part of the axillary artery
Superior (Supreme) Thoracic a.
What are the two branches from the second part of the axillary artery?
Thoracoacromial trunk (CAPD) Lateral Thoracic a.
What are the three branches from the third part of the axillary artery?
o Subscapular a.
Terminates as circumflex scapular and thoracodorsal aa.
o Anterior humeral circumflex a.
o Posterior humeral circumflex a. - found in quadrangular space
Where does each section of the axillary artery begin? (Boundaries of 1st-3rd parts)
1: From lateral border of 1st rib to medial border of pectoralis minor m.
2: Posterior to pectoralis minor
3: From lateral border of pectoralis minor to inferior border of teres major
