The Upper Limb Flashcards by Michelle Krebs

associated with the lateral side of the neck and thoracic wall

the upper limb

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composed of the shoulder, arm, forearm, and hand

the upper limb

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what is the upper limb attached to the body by?

by muscles and by a small skeletal attachment at the sternoclavicular joint

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significant transitions between the different parts of the limb

The axilla, cubital fossa, and carpal tunnel

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irregularly shaped triangle formed by muscles and bones of the shoulder and the lateral surface of the thoracic wall

Axilla

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triangular shaped depression formed by muscles anterior to the elbow

cubital fossa

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the gateway to the palm

- Formed by carpal bones and flexor retinaculum

carpel tunnel

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used for positioning the hand in space

the upper limb

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changes the position of the glenohumeral joint

Movement of the scapula on the thoracic wall

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protraction and retraction

sliding

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abduction and adduction

rotating

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can move in 3 axes

glenohumeral joint

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what are the movements at the glenohumeral joint?

flexion
extension
adduction
abduction
medial rotation
lateral rotation
circumduction

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major movements of the elbow

flexion and extension

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supinated or pronated by flipping the radius over the ulna at the distal end

the forearm

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what are the movements of the wrist?

abduction
adducted
flexed
extended
circumducted

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allow the hand to be put into a wide range of positions

The combined movements of the shoulder, arm, and forearm

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used to grip and manipulate objects generally by flexing fingers against the thumb

the hand

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pads of the palmer aspect of the hand have a high density of somatic sensory receptors

the hand as a sensory tool

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consist of the scapula, clavicle, and the proximal end of the humerus

bones of the shoulder

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articulates medially with the manubrium and laterally with the acromion of the scapula

the clavicle

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the bone of the arm

- the distal end forms the elbow joint (hinge joint) with the bones of the forearm

the humerus

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the bones of the forearm

- the distal ends form the wrist

The radius (lateral) and ulna (medial)

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make up the bones of the hand

The carpals, metacarpals, and phalanges

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movement between which bones is limited?

the 8 carpal bones is limited, thus they work as a unit

the primary skeletal foundation of the palm

The 5 metacarpals

has greater mobility than the other carpometacarpal joints

The joint of the thumb

saddle joint

the thumb joint

lacks a ligamentous connection to the neighboring metacarpal of the index finger

the metacarpel of the thumb

are distally connected via strong ligaments

Metacarpals II-V

biaxial condylar joints

Metacarpophalangeal joints

what are the movements of the Metacarpophalangeal joints?

- abduction - adduction - lexion - extension - circumduction

what movements do interphalangeal joints allow?

flexion and extension

what are the muscles that attach the scapula and clavicle to the trunk?

- trapezius - levator scapulae - rhomboids

what do other muscles attach?

attach the scapula, clavicle, and body wall to the proximal end of the humerus- pectoralis major and minor, latissimus dorsi, teres major, and deltoid

subscapularis, supraspinatus, infraspinatus, and teres minor connect scapula to humerus and provide support for the glenohumeral joint

the rotator cuff

what compartments are the muscles of the arm and forearm separated into?

- anterior (flexor compartment) | - posterior (extensor compartment)

separated by the humerus and medial and lateral intermuscular septa

Compartments of the arm

separated by a lateral intermuscular septum, radius, ulna, and interosseous membrane

Compartments of the forearm

formed by intrinsic muscles that move the thumb

The thenar eminence of the hand

directly related to the neck

upper limb

lies on each side of the superior thoracic aperture

axillary inlet

pass through the axillary inlet

The major artery, vein, and nerves of the arm

* *formed by: - Lateral margin of rib 1 - Posterior surface of clavicle - Superior margin of scapula - Medial surface of coracoid process of scapula

relationship of upper limb to neck

associated with the back and thoracic wall

Muscles that attach the bones of the shoulder to the trunk

what are the muscles that attach the bones of the shoulder to the trunk?

- trapezius - levator scapulae - rhomboid major rhomboid minor latissimus dorsi

overlays the pectoralis major which forms most of the anterior wall of the axilla

the breast

often extends up into the axilla

axillary process of the breast

where does the Lymphatic drainage from the lateral and superior sides of the breast drain into?

the axilla

arise from major axillary vessels

arteries and veins that supply and drain the breast

Innervation of the upper limb is by?

brachial plexus

formed by the anterior rami of cervical spinal nerves (C5 to C8 and T1)

brachial plexus

gives rise to the musculocutaneous (C5-C7), median (C6-C8, T1), radial (C5-C8, T1), and ulnar (C8-T1) nerves

the brachial plexus

often tested for sensation in order to test for cervical spinal nerve damage

Dermatomes of the upper limb

tested by joint movement in order to test for cervical spinal nerve damage

Myotomes of the upper limb

Each major muscle compartment in the arm and forearm and each intrinsic muscle of the hand is predominantly innervated by what?

1 nerve

also predominantly innervated by 1 nerve

different dermatomes

passes posteriorly around the surgical neck of the humerus

the axillary nerve

pass diagonally around the posterior side of the humerus

radial nerve

passes posteriorly to a bony protrusion on the medial side of the distal end of the humerus

the ulnar nerve

used to access a patients vascular system

Large veins in the superficial fascia of the upper limb

originate from the dorsal venous network on the back of the hand

cephalic and basilic veins

originates over the anatomical snuff box and extends proximally into the axilla by passing through the clavipectoral (deltopectoral) triangle

cephalic vein

connect at the elbow by the median cubital vein

The cephalic and basilic veins

positioned at right angles to the other fingers

the thumb

brings the thumb across the palm

flexion

moves the thumb away from the fingers at right angles

abduction

brings the thumb into opposition to the other fingers

Slight rotation of metacarpal I

vital for normal hand function

An opposing thumb

the region of upper limb attachment to the trunk

the shoulder

consists of the clavicle and scapula- making up the pectoral girdle

the shoulder

the only bony attachment between the shoulder and the trunk

clavicle

It is an S-shaped bone with an acromial end (lateral) and a sternal end (medial)

clavicle

Each end has a facet for articulation with either the acromion or the manubrium/1st rib

clavicle

has conoid tubercle and trapezoid line for coracoclavicular ligament attachment

The inferior surface of the lateral third (of clavicle)

- Large, flat, and triangular | - Has 3 angles, 3 borders, 2 surfaces, 3 processes

scapula

what are the angles of the scapula?

- lateral (marked by glenoid cavity) | - superior and inferior

what are the borders of the scapula?

- lateral - medial - superior

what are the surfaces of the scapula?

- costal and posterior - posterior - costal surface

what is the posterior surface of the scapula divided into?

supraspinous fossa and infraspinous fossa by scapula spine

what is the costal surface of the scapula characterized by?

subscapular fossa

where the head of the humerus articulates with the scapula

the glenoid cavity

attachment point of long head of triceps brachii

Infraglenoid tubercle

attachment point of long head of biceps brachii

Supraglenoid tubercle

a projection of the scapular spine that arches over glenohumeral joint

the acromion

between lateral angle and scapular spine

greater scapular notch

hook like structure

coracoid process

medial to the root of the coracoid process

Suprascapular notch

Consists of the head, anatomical neck, greater and lesser tubercles, surgical neck, and the superior half of the shaft

proximal humerus

articulates with glenoid cavity

head of proximal humerus

connects head to shaft

anatomical neck of proximal humerus

superior, middle, inferior facets

greater tubercle

supraspinous muscle attachment

superior greater tubercle

infraspinous muscle attachment

middle greater tubercle

teres minor muscle attachment

inferior greater tubercle

subscapularis muscle attachment

lesser tubercle

houses tendon of long head of biceps brachii

intertubercular sulcus

what are the points of attachment on the shaft of the proximal humerus?

lateral and medial lip and floor of intertubercular sulcus, deltoid tuberosity, attachment of coracobrachialis

what are the 3 joints of the shoulder complex?

- Sternoclavicular - acromioclavicular - glenohumeral

sternum and clavicle

sternoclavicular joint

acromion and clavicle

acromioclavicular joint

glenoid cavity and humerus head

glenohumeral joint

enable the scapula to be positioned over a wide range of positions, increasing reach

The sterno- and acromioclavicular joints

occurs between proximal end of clavicle and clavicular notch of manubrium

Sternoclavicular joint (synovial)

separates 2 compartments of shoulder joints

articular disc

reinforced by capsule and 4 ligaments

shoulder joints

what are the ligaments of the shoulder joints?

- Anterior and posterior sternoclavicular ligaments - Interclavicular ligaments - Costoclavicular ligaments

small synovial joint between distal end of clavicle and acromion process

Acromioclavicular joint

what is the acromioclavicular joint surrounded by?

joint capsule

what is the acromioclavicular joint reinforced by?

-Acromioclavicular ligament -Coracoclavicular ligament ~Trapezoid ligament ~Conoid ligament

a synovial ball and socket joint between the head of the humerus and the glenoid cavity

glenohumeral joint

a multiaxial joint with a wide range of movement at the cost of skeletal stability

glenohumeral joint

what is the glenohumeral joint supported by?

the rotator cuff, long head of biceps brachii, related bony processes, and extracapsular ligaments

deepened by the glenoid labrum (a fibrocartilagenous collar)

glenoid cavity

attaches to the margins of the articular surfaces and lines the fibrous membrane

synovial membrane

wraps around the tendon of the long head of biceps brachii

synovial sheath

protrudes through the fibrous membrane to produce bursae which lie between surrounding muscles and the fibrous membrane (subtendinous bursa of subscapularis is the most consistent)

synovial membrane

attaches to the margin of the glenoid cavity, outside the attachment of the glenoid labrum and the long head of the biceps brachii, and to the anatomical neck of the humerus

fibrous membrane

aids in adduction of shoulder joint

redundant synovial membrane

accommodates abduction in shoulder joint

redundant capsule

where is the fibrous membrane thickened?

- Superior, middle, and inferior glenohumeral ligaments - coracohumeral - transverse humeral ligaments

provided by ligaments and rotator cuff muscles

joint stability

blend with the joint capsule, forming a musculotendinous collar

Ligaments of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles

lies between the acromion (or deltoid muscle) and supraspinatus

The subacromial bursa (subdeltoid)

where does the blood supply to the glenohumeral joint come from?

the posterior circumflex and suprascapular artery

what is the glenohumeral joint innervated by?

branches from the posterior cord of brachial plexus, and from the suprascapular, axillary, and lateral pectoral nerves

The 2 most superficial muscles of the shoulder

trapezius and deltoid

attaches the scapula and clavicle to the trunk

trapezius

attaches the scapula and clavicle to the humerus

deltoid

what are the opposing surfaces and margins that the trapezius and deltoid attach to?

opposing surfaces and margins on the spine of the scapula, acromion, and clavicle

deep to the trapezius and deltoid

levator scapula, rhomboid major and minor

position the scapula on the trunk

levator scapula, rhomboid major and minor

has extensive origins on the axial skeleton- includes sites on the skull and vertebrae (CI to TXII)

trapezius

attaches to the shoulder in a U-shape (scapula spine, acromion, and clavicle)

trapezius

originates along the U-shape line of bone and inserts on the deltoid tuberosity of humerus

deltoid

originates on transverse processes of CI and CIV and inserts on medial border of scapula

levator scapula

attach medially to the vertebral column and descend laterally to attach to the medial border of the scapula inferior to levator scapula

rhomboid minor and major

**ORIGINATES AT: Superior nuchal line, external occipital protuberance, medial margin of the ligamentum nuchae, spinous processes of CVII to TXII and the related supraspinous ligaments

trapezius

**INSERTION AT: Superior edge of the crest of the spine of the scapula, acromion, posterior border and lateral 1/3 of clavicle

trapezius

**INNERVATED BY: Motor spinal part of accessory nerve (XI). Sensory (proprioception) anterior rami of C3 and C4

trapezius

**FUNCTION: Powerful elevator of the scapula; rotates the scapula during abduction of humerus above horizontal; middle fibers retract scapula; lower fibers depress scapula

trapezius

**ORIGIN: Inferior edge of the crest of the spine of the scapula, lateral margin of the acromion, anterior border of the lateral 1/3 of clavicle

deltoid

**INSERTION AT: Deltoid tuberosity of humerus

deltoid

**INNERVATED BY: Axillary nerve (C5, C6)

deltoid

**FUNCTION: Major abduction of arm (abducts arm beyond initial 15⁰ done by supraspinatus); clavicular fibers assist in flexing the arm; posterior fibers assist in extending the arm

deltoid

**ORIGIN: Transverse processes of CI and CII vertebrae and posterior tubercles of the transverse processes of CIII and CIV vertebrae

levator scapulae

**INSERTION: Posterior surface of medial border of scapula from superior angle to root of spine of the scapula

levator scapulae

**INNERVATION: Branches directly from anterior rami of C3 and C4 spinal nerves and by branches (C5) from dorsal scapular nerve

levator scapulae

**FUNCTION: elevates the scapula

levator scapulae

**ORIGIN: Lower end of ligamentum nucha and spinous processes of CVII and TI vertebrae

rhomboid minor

**INSERTION: Posterior surface of medial border of scapula to root of the spine of the scapula

rhomboid minor

**INNERVATION: Dorsal scapular nerve (C4, C5)

rhomboid minor

**FUNCTION: Elevates and retract the scapula

rhomboid minor

**ORIGIN: Spinous processes of TII-TV vertebrae and intervening supraspinpus ligaments

rhomboid major

**INSERTION: Posterior surface of medial border of scapula from the root of the spine to the inferior angle

rhomboid major

**INNERVATION: Dorsal scapular nerve (C4, C5)

rhomboid major

**FUNCTION: elevates and retracts the scapula

rhomboid major

Contains 4 muscles that extend between the scapula and proximal end of the humerus

posterior scapula region

what are the 4 muscles of the scapula region?

- Supraspinatus - infraspinatus - teres minor - teres major

originate from large fossa above and below the scapula spine respectively

Supraspinatus and infraspinatus

extends between infraglenoid tubercle and the olecranon (ulna)

Long head of triceps brachii

Gateways to the posterior scapula region

suprascapular notch from the neck for suprascapular nerve

from more anterior regions for axillary nerve and posterior circumflex humeral artery

Quadrangular space

has circumflex scapular artery

triangular space

radial nerve an profunda brachii artery (deep artery of arm)

triangular interval

2 major nerves of the posterior scapula region that both arise from the brachial plexus

axillary and suprascapular nerves

passes through the suprascapular foramen and innervates the supraspinatus and then passes through the greater scapular notch and innervate the infraspinatus

suprascapular nerve

innervates the deltoid and teres minor

axillary nerve

**ORIGIN: Medial 2/3 of the supraspinous fossa of the scapula and the deep fascia that covers the muscle

supraspinatus muscle

**INSERTION: Most superior facet on the greater tubercle of the humerus

supraspinatus muscle

**INNERVATION: Suprascapular nerve (C5, C6)

supraspinatus muscle

**FUNCTION: Rotator cuff muscle; initiation of abduction of arm to 15⁰ at glenohumeral joint

supraspinatus muscle

**ORIGIN: Medial 2/3 of the infraspinous fossa of the scapula and the deep fascia that covers the muscle

infraspinatus muscle

**INSERTION: Middle facet on posterior of the greater tubercle of the humerus

infraspinatus muscle

**INNERVATION: Suprascapular nerve (C5, C6

infraspinatus muscle

**FUNCTION: Rotator cuff muscle; lateral rotation of arm at the glenohumeral joint

infraspinatus muscle

**ORIGIN: Upper 2/3 of a flattened strip of bone on the posterior surface of the scapula immediately adjacent to the lateral border of the scapula

teres minor muscle

**INSERTION: inferior facet on the posterior surface of the greater tubercle of the humerus

teres minor muscle

**INNERVATION: Axillary nerve (C5, C6)

teres minor muscle

**FUNCTION: Rotator cuff muscle; lateral rotation of arm at the glenohumeral joint

teres minor muscle

**ORIGIN: Elongate oval area on the posterior surface of the inferior angle of the scapula

teres major muscle

**INSERTION: Medial lip of the intertubercular sulcus on the anterior surface of the humerus

teres major muscle

**INNERVATION: Inferior subscapular nerve (C5, C6, C7)

teres major muscle

**FUNCTION: Medial rotation and extension of the arm at the glenohumeral joint

teres major muscle

**ORIGIN: Infraglenoid tubercle on scapula

long head of triceps brachii muscle

**INSERTION: Common tendon of insertion with medial and lateral heads on the olecranon process of ulna

long head of triceps brachii muscle

**INNERVATION: Radial nerve (C6, C7, C8)

long head of triceps brachii muscle

**FUNCTION: Extension of the forearm at the elbow joint; accessory adductor and extensor of the arm at the glenohumeral joint

long head of triceps brachii muscle

what are the 3 major arteries of the posterior scapula region?

- suprascapular artery - posterior circumflex humeral artery - circumflex scapular artery

arises from thyrocervical trunk and usually passes superior to suprascapular notch

Suprascapular artery

originates from axillary

Posterior circumflex humeral artery

branch from subscapular artery which arises from the axillary

Circumflex scapular artery

gateway to the arm

axilla

- Formed by clavicle, scapula, upper thoracic wall, the humerus, and related muscles - It has 4 sides, an inlet, and a floor

axilla

continuous with the neck and the floor opens into the arm

axillary inlet

All structures that pass in or out of the upper limb pass through the.....

axilla

is formed by the pectoralis major, and underlying pectoralis minor and subclavius muscles, and the clavipectoral fascia

anterior wall of the axilla

- small muscle that passes between the clavicle and rib I | - part of anterior wall of axilla

subclavius

- small triangular muscle that passes from the thoracic wall to the coracoid process - part of anterior wall of axilla

pectoralis minor

-thick sheet of connective tissue that connects the clavicle to the floor of the axilla and encloses pectoralis minor and subclavius

clavipectoral fascia

**ORIGIN: Clavicular head- anterior surface of the medial ½ of clavicle; sternocostal head- anterior surface of sternum; first 7 costal cartilages; sternal end of 6th rib; aponeurosis of external oblique

pectorlis major muscle

**INSERTION: Lateral lip of intertubercular sulcus of humerus

pectoralis major muscle

**INNERVATION: Medial and lateral pectoral nerves; clavicular head (C5, C6); sternocostal part (C6, C7, C8, T1)

pectoralis major muscle

**FUNCTION: Flexion, adduction, and medial rotation of arm at the glenohumeral joint; clavicular head- flexion of extended arm; sternocostal head- extension of flexed arm

pectoralis major muscle

**ORIGIN: First rib at junction between rib and costal cartilage

subclavius muscle

**INSERTION: Grove on inferior surface of middle 1/3 of clavicle

subclavius muscle

**INNERVATION: Nerve of subclavius (C5, C6)

subclavius muscle

**FUNCTION: Pulls tip of shoulder down; pulls clavicle medially to stabilize sternoclavicular joint

subclavius muscle

**ORIGIN: Anterior surface and superior borders of ribs III to V; and from deep fascia overlying the related intercostal space

pectoralis minor muscle

**INSERTION: Coracoid process of scapula (medial border and upper surface)

pectoralis minor

**INNERVATION: Medial pectoral nerve (C5, C6, C7, C8, T1)

pectoralis minor

**FUNCTION: Pulls tip of shoulder down; protracts scapula

pectoralis minor muscle

Formed by upper thoracic wall (ribs and related intercostal muscles) and the serratus anterior

medial wall of axilla

innervated by the long thoracic nerve

serratus anterior of the medial wall of axilla

passes through the medial wall and into the axilla where it communicates with a branch from the brachial plexus

intercostobrachial nerve of medial wall of axilla

**ORIGIN: Lateral surfaces of the upper 8-9 ribs and the deep fascia overlying the related intercostal spaces

serratus anterior muscle

**INSERTION:Costal surface of medial border of scapula

serratus anterior muscle

**INNERVATION: Long thoracic nerve (C5, C6, C7)

serratus anterior muscle

**FUNCTION: Protraction and rotation of the scapula; keeps medial border and inferior angle of scapula opposed to thoracic wall

serratus anterior muscle

Narrow and formed entirely by the intertubercular sulcus of the humerus

lateral wall of axilla

inserts on the lateral lip of the sulcus

pectoralis major muscle

attach to the floor and medial lip of the sulcus respectively

latissimus dorsi and teres major

Formed by the costal surface of the scapula, subscapularis muscle, distal parts of the latissimus dorsi and teres major muscles, and proximal parts of the long head of the triceps brachii

posterior wall of axilla

allow structures to pass between the axilla, posterior scapular region and posterior compartment of the arm

Gaps between the muscles

**ORIGIN: Medial 2/3 of subscapular fossa

subscapularis muscle

**INSERTION: Lesser tubercle of humerus

subscapularis muscle

**INNERVATION: Upper and lower subscapular nerves (C5, C6, C7)

subscapularis muscle

**FUNCTION: Rotator cuff; medial rotation of the arm at the glenohumeral joint

subscapularis muscle

**ORIGIN: Elongate oval area on the posterior surface of the inferior angle of scapula

teres major muscle

**INSERTION: Medial lip of intertubercular sulcus on the anterior surface of the humerus

teres major muscle

**INNERVATION: Lower subscapular nerve (C5, C6, C7)

teres major muscle

**FUNCTION: Medial rotation and extension of the arm at the glenohumeral joint

teres major muscle

**ORIGIN: Spinous processes of lower 6 thoracic vertebrae and related interspinous ligaments; via the thoracolumbar fascia on the spinous processes of the lumbar vertebrae, related interspinous ligaments, and iliac crest, lower 3-4 ribs

latissimus dorsi muscle

**INSERTION: Floor of intertubercular sulcus

latissimus dorsi muscle

**INNERVATION: Thoracodorsal nerve (C6, C7, C8)

latissimus dorsi muscle

**FUNCTION: Adduction, medial rotation and extension of the arm at the glenohumeral joint

latissimus dorsi muscle

formed by fascia and a dome of skin

axilla floor

contains major blood vessels, nerves, and lymphatics of the arm

axillary sheath

contains the proximal parts of the biceps brachii and coracobrachialis muscles, the axillary process of the breast, and collections of lymph nodes

axilla

short head originates from the coracoid process

biceps brachii

originates as a tendon that attaches to the supraglenoid tubercle of the scapula

long head of biceps brachii

originates on the coracoid process of the scapula and inserts onto the medial aspect of humerus

coracobrachialis

supplies the walls of the axilla and related regions

axillary artery

As the subclavian passes the lateral margin of rib I it becomes the .....

axillary artery

As the axillary artery passes the inferior margin of the teres major muscle it becomes the .......

brachial artery

divides the axillary artery into 3 parts (1st, 2nd, and 3rd)

pectoralis minor muscle

how many branches arise from the axillary artery?

6 branches

1st part of axillary artery

superior thoracic artery

2nd part of axillary artery

thoraco-acromial artery and lateral thoracic artery

3rd part of axillary artery

Subscapular, anterior, and posterior circumflex arteries

Begins at the lower margin of the teres major and is a continuation of the basilic vein

axillary vein

where does the axillary vein pass?

Passes through the axilla medial to the axillary artery

which tributaries of the axillary vein do not follow the branches of the axillary artery?

the brachial veins and cephalic vein

- somatic plexus formed by anterior rami (C5-T1) | - Made up of roots, trunks, divisions, and cords

brachial plexus

originate from the brachial plexus

All major nerves of the arm

where is the brachial plexus located proximally?

Proximally it is posterior to the axillary artery

where is the brachial plexus located distally?

Distally it surrounds the axillary artery

The roots are made up of anterior rami (C5-T1)

brachial plexus

pass laterally over rib I and are formed by unions of roots

trunks of brachial plexus

what do the trunks of the brachial plexus divide into?

anterior and posterior divisions

forms from union of upper and middle anterior trunks

lateral cord of brachial plexus

forms from union of all posterior trunks

posterior cord of brachial plexus

forms from remaining anterior trunk

medial cord of brachial plexus

where do lymphatics from the upper arm drain into?

the axilla

receive drainage from regions of the: upper back and shoulder, lower neck, chest, upper anterolateral abdominal wall, and 75% of the mammary gland

axillary nodes

how are the 20-30 axillary nodes divided?

humeral (lateral), pectoral (anterior), subscapular (posterior), central, and apical

- in some cases penetrates the deep fascia and passes into the axilla - rarely reaches as high as the apex of the axilla

axillary process of the mammary gland

the region between the shoulder and the elbow joint

the arm

- Superiorly it communicates with the axilla | - inferiorly important structures pass through the cubital fossa

the arm

how are the muscles of the arm divided?

divided into posterior and anterior compartments by the humerus and the intermuscular septum

flex the elbow joint

muscles in the anterior compartment of the arm

extend the elbow joint

muscles in the posterior compartment of the arm

triangular with anterior, lateral, and medial borders and anterolateral, anteromedial, and posterior surfaces

humerus

has various markings associated with muscle attachment points

posterior surface of the humerus

houses the radial nerve and profunda brachii artery

radial groove of humerus

becomes flattened into the lateral and medial supraepicondylar ridges

distal end of humerus

- part of distal end of humerus | - has 2 parts (capitulum & trochlea)

condyle

articulates with the radius & part of condyle

capitulum

articulates with ulna & part of condyle

trochlea

lie adjacent and somewhat superior to the trochlea and capitulum

lateral and medial epicondyles

how many fossa occur superior to the condyle?

is superior to the capitulum

radial fossa

superior to the trochlea

coronoid fossa

superior to the trochlea on the posterior sides

olecranon fossa

consists of the head, neck, and radial tuberosity

proximal end of the radius

the roughened attachment point for the biceps brachii

radial tuberosity

runs across the shaft of the radius from the radial tuberosity

oblique line

consists of olecranon, coronoid process, trochlear notch, radial notch, supinator crest, tuberosity

proximal end of ulna

large projection of bone & part of proximal end of the ulna

olecranon

forms the trochlear notch along with the olecranon

coronoid process

obvious semilunar notch

trochlear notch

articulation point for the radius

radial notch

attachment site for brachialis

tuberosity of ulna

what are the muscles of the anterior compartment of the arm?

- coracobrachialis - biceps brachii - brachialis

extends from the tip of the coracoid process to the medial side of the midshaft of the humerus

Coracobrachialis

has 2 heads- short head- originates from coracoid process, long head originates as a tendon from the supraglenoid tubercle of scapula, the biceps inserts onto the radial tuberosity

biceps brachii

originates from distal half of anterior aspect of humerus, inserts onto the ulna tuberosity

brachialis

*ORIGIN: Apex of coracoid process

Coracobrachialis muscle

*INSERTION: Linear roughening on midshaft of humerus on medial side

Coracobrachialis muscle

*INNERVATION: Musculocutaneous (C5, C6, C7)

Coracobrachialis muscle

*FUNCTION: Flexor of arm at the glenohumeral joint

Coracobrachialis muscle

*ORIGIN:Long head- supragenoid tubercle of scapula; short head- apex of coracoid process

biceps brachii muscle

*INSERTION: radial tuberosity

biceps brachii muscle

*INNERVATION: Musculocutaneous (C5, C6, C7)

biceps brachii muscle

*FUNCTION: Powerful flexor of the forearm at the elbow joint and supinator of the forearm; accessory flexor of the arm at glenohumeral joint

biceps brachii muscle

*ORIGIN: Anterior aspect of humerus (medial and lateral surface) and adjacent intermuscular septum

brachialis muscle

*INSERTION: Tuberosity of the ulna

brachialis muscle

*INNERVATION: Musculocutaneous (C5, C6); small contribution from radial nerve to lateral part of muscle

brachialis muscle

*FUNCTION: Powerful flexor of the forearm at the elbow joint

brachialis muscle

what is the only muscle in the posterior compartment of the arm?

triceps brachii

what are the 3 heads of the triceps?

- long head - medial head - lateral head

originates from infraglenoid tubercle of scapula

long head of the triceps

originates from the extensive area of the posterior surface of the shaft of the humerus inferior to the radial groove

medial head of the triceps

originates from linear roughening superior to radial groove

lateral head of the triceps

where do all the triceps head insert?

insert on the superior surface of the olecranon via a large tendon

*ORIGIN: Long head- infraglenoid tubercle of scapula medial head- posterior surface of humerus lateral head- posterior surface of humerus

triceps brachii muscle

*INSERTION: olecranon

triceps brachii muscle

*INNERVATION: Radial nerve (C6, C7, C8)

triceps brachii muscle

*FUNCTION: Extension of the forearm at the elbow joint; long head can also extend and adduct the arm at the shoulder joint

triceps brachii muscle

is the major artery of the arm and is found in the anterior compartment

brachial atery

starts at the inferior margin of the teres major

brachial artery

is the largest branch of the brachial artery and poses into the posterior compartment

profunda brachii artery

- branches off the brachial artery | - passes posteriorly in the radial groove, humeral nutrient artery, and ulnar collateral arteries

profunda brachii

branches to posterior circumflex humeral artery, radial and middle collateral arteries

Branches off the profunda brachii artery

follow the brachial artery and join either the basilic or axillary vein

paired brachial veins

the 2 large subcutaneous veins located in the arm

the basilic and cephalic veins

what are the nerves of the anterior compartment of the arm?

- musculocutaneous nerve | - median and ulnar nerves

- enters the arm by passing through the coracobrachialis muscle and continues distally in the plane between the biceps brachii and brachialis muscles - provides motor innervation for the anterior muscle compartment

musculocutaneous nerve

have no major branches in the arm

median and ulnar nerves

what are the nerves of the posterior compartment of the arm?

- radial nerve | - inferior and posterior lateral cutaneous branches

arises from the posterior cord of the brachial plexus and runs along the radial groove with the profunda brachii artery into the posterior compartment

radial nerve

innervates the triceps brachii muscle (the only muscle in the posterior arm compartment) and muscles of the forearm

radial nerve

innervate skin on the posterior arm and forearm

The inferior and posterior lateral cutaneous branches of the radial nerve

a complex joint involving 3 separate articulations which share a common synovial cavity

elbow joint

form the main hinge joint of the elbow

The joints between the trochlear notch of the ulna and the trochlea of the humerus and between the radial head and capitulum of the humerus

form the radio-ulna joint

The joint between the radial head and the radial notch of the ulna

involved in supination and pronation

radio-ulnar joint

originates along the edges of the articular cartilage and lines of the radial, coronoid, and olecranon fossae

synovial membrane of elbow joint

found in the fossa and separate the fibrous and synovial membranes in these same regions

fat pads

how are fat pads moved?

moved out of the way by the brachialis and triceps brachii that are attached to the fibrous membrane in these regions

overlays the synovial membrane and encloses the elbow joint

fibrous membrane

what does the fibrous membrane attach to?

- the medial epicondyle, and the margins of the olecranon, coronoid, and radial fossae of the humerus - the coronoid and olecranon processes of ulna

thickened medially and laterally into ulnar and radial collateral ligaments

fibrous membrane

cuffs the radius and blends with the radial collateral ligament

anular ligament

allows rotation of radial head

sacciform recess

Formed by brachioradialis and pronator teres (lateral and medial boundaries) and the brachialis (floor)

cubital fossa

what are the major contents of the cubital fossa?

- tendon of biceps brachii - brachial artery - median nerve

passes along the lateral margin under the brachioradialis muscle

radial nerve of cubital fossa

lie along the roof of the cubital fossa roof

The median cubital vein, medial and lateral cutaneous nerves

extends between the elbow and wrist joints

forearm

what do most major structures go through that pass into the forearm?

pass through the cubital fossa (except ulnar nerve)

what do most major structures go through that pass into the hand?

the carpel tunnel (except radial artery)

separate the anterior and posterior muscle compartments of the forearm

The radius, ulnar, interosseous membrane, and lateral intermuscular septum

is smaller proximally and larger distally, where it forms the wrist joint

radius

triangular in cross section formed by: lateral, posterior, anterior surfaces and lateral, posterior, interosseous borders

shaft of radius

acts as a pulley for the extensor pollicis tendon

dorsal tubercle of radius

extends distally

radial styloid process

found on the distal end of the radius

two articulation facets

triangular in cross section formed by: anterior, posterior, medial surfaces and anterior, posterior, interosseous borders

ulna

has a roughening for attachment of pronator quadratus

anterior surface of ulna

extends distally

ulnar styloid process

form the radio-ulnar joint of the forearm

Distally the head of the ulnar and the end of the radius

separates the radio-ulnar from the wrist joint

articular disc of forearm

- runs between the ulnar and radius without restricting pronation and supination - allows transfer of forces from the radius to the ulnar and ultimately to the humerus

interosseous membrane

- occur entirely in the forearm | - Involves rotation of radius at elbow and movement of radius over ulnar at distal end

pronation and supination

spins on the capitulum, radial notch, and adjacent joint capsule

radial head

distally,............., slides anteriorly over the convex surface of the ulnar head

the ulnar notch of the radius

hold the bones in place during movements (pronation and supination)

anular ligament, interosseous membrane, articular disc

supination muscles

biceps brachii and supinator

pronation muscles

pronator teres and quadratus

- provides some abduction of the proximal end of the ulnar during pronation - This maintains the position of the palm over the central axis during pronation

anconeus

how are the muscles of the anterior (flexor) compartment divided?

divided into superficial, intermediate, and deep layers

what are the muscles of the anterior (flexor) compartment associated with?

movement of wrist joint, flexion of fingers and thumb, and pronation

originate on the medial epicondyle of humerus

all 4 muscles in the superficial layer

muscles of superficial layer of anterior (flexor) compartment

- pronator teres - flexor carpi radialis - palmaris longus - flexor carpi ulnaris

*ORIGIN: Humeral head- medial epicondyle of humerus; ulnar head- olecranon and posterior border of ulna

flexor carpi ulnaris muscle

*Insertion: Pisiform bone, and then via pisohamate and pisometacarpal ligaments into the hamate and base of metacarpal V

flexor carpi ulnaris muscle

*INNERVATION: Ulnar nerve (C7, C8, T1)

flexor carpi ulnaris muscle

*FUNCTION: Flexes and adducts the wrist

flexor carpi ulnaris muscle

*ORIGIN: Medial epicondyle of humerus

palmaris longus muscle

*INSERTION: Palmar aponeurosis of hand

palmaris longus muscle

*INNERVATION: Median nerve (C7, C8)

palmaris longus muscle

*FUNCTION: Flexes wrist joint and resists shearing forces when gripping

palmaris longus muscle

*ORIGIN: Medial epicondyle of humerus

flexor carpi radialis

*INSERTION: Base of metacarpal II and III

flexor carpi radialis

*INNERVATION: Median nerve (C6, C7)

flexor carpi radialis

*FUNCTION: Flexes and abducts the wrist

flexor carpi radialis

*ORIGIN: Humeral head- medial epicondyle and adjacent supra-epicondylar ridge; ulnar head- medial side of coronoid process

pronator teres

*INSERTION: Roughening on lateral surface, midshaft, of radius

pronator teres

*INNERVATION: Median nerve (C6, C7)

pronator teres

*FUNCTION: pronation

pronator teres

consists of 1 muscle (large flexor digitorum superficialis)

intermediate layer of anterior compartment

- muscle with two heads | - part of intermediate layer

large flexor digitorum superficialis

pass deep to, and between the 2 heads of the large flexor digitorum superficialis

median nerve and ulnar artery

distally, the..........forms 4 tendons which pass through the carpal tunnel onto the 4 fingers

flexor digitorum superficialis

insert on the margins of the middle phalanx

tendons that pass through carpel tunnel onto the 4 fingers

*ORIGIN: Humero-ulnar head-medial epicondyle of humerus and adjacent margin of coronoid process; radial had- oblique line of radius

flexor digitorum superficialis muscle

*INSERTION:Four tendons, which attach to the palmer surfaces of the middle phalanges of the index, middle, ring, and little fingers

flexor digitorum superficialis muscle

*INNERVATION: Median nerve (C8, T1)

flexor digitorum superficialis muscle

*FUNCTION: flexes proximal interphalangeal joints of the index, middle, ring, and little fingers; can also flex metacarpophalangeal joints of the same finger and the wrist joint

flexor digitorum superficialis muscle

what are the muscles of the deep layer of the anterior compartment?

- flexor digitorum profundus - flexor pollicis longus - pronator teres

gives rise to 4 tendons that pass through the carpal tunnel and onto the 4 fingers

flexor digitorum profundus

pass through the split in the tendons of the flexor digitorum superficialis and insert onto the base of the distal phalanges

tendons from the flexor digitorum profundus

forms a single tendon that passes through the carpal tunnel and onto the base of the distal phalanx of the thumb

flexor pollicis longus

*ORIGIN: Anterior and medial surfaces of ulna and anterior medial half of interosseous membrane

Flexor digitorum profundus muscle

*INSERTION: 4 tendons, which attach to the palmer surfaces of the distal phalanges of the index, middle, ring, and little fingers

Flexor digitorum profundus muscle

*INNERVATION: Lateral half by median nerve (anterior interosseous nerve); medial half by ulnar nerve (C8, T1)

Flexor digitorum profundus muscle

*FUNCTION: Flexes distal interphalangeal joints of the index, middle, ring, and little fingers; can also flex metacarpophalangeal joints of the same fingers and the wrist

Flexor digitorum profundus muscle

*ORIGIN: Anterior surface of radius and radial half of interosseous membrane

flexor pollicis longus muscle

*INSERTION: Palmer surface of base of distal phalanx of thumb

flexor pollicis longus muscle

*INNERVATION: Median nerve (anterior interosseous nerve)(C7, C8)

flexor pollicis longus muscle

*FUNCTION: Flexes interphalangeal joint of the thumb; can also flex metacarpophalangeal joint of the thumb

flexor pollicis longus muscle

*ORIGIN: Linear ridge on distal anterior surface of ulna

pronator quadratus muscle

*INSERTION: Distal anterior surface of radius

pronator quadratus muscle

*INNERVATION: Median nerve (anterior interosseous nerve) (C7, C8)

pronator quadratus muscle

*FUNCTION: pronation

pronator quadratus muscle

where are the largest arteries in the forearm?

in the anterior compartment and pass distally to supply the hand and give off branches to the posterior compartment

leaves the forearm and passes around the lateral side of the wrist and gives rise to: radial recurrent, superficial and deep palmar arch of the hand along the way

radial artery

passes on the medial side of the arm and into the wrist giving rise to: ulnar recurrent, common interosseous (posterior and anterior), dorsal and palmer carpal branches

ulnar artery

nerves of the anterior compartment of the forearm

the median and ulnar nerves and the superficial branch of the radial nerve

innervates most of the muscles of the anterior compartment and gives off anterior interosseous nerve and palmar branches

median nerve of forearm

innervates flexor carpi ulnaris and part of flexor digitorum profundus and gives off muscular, dorsal, and palmar branches

ulnar nerve of forearm

bifurcates into deep (mostly motor and innervates posterior compartment) and superficial (sensory) branches

radial nerve of forearm

occur in superficial and deep layers and move the wrist, extend the fingers and thumb, and supinate

muscles in posterior compartment of forearm

are innervated by the radial nerve and originate on the supraepicondylar ridge and lateral epicondyle of the humerus

7 superficial muscles of posterior compartment of forearm

which muscles extend as tendons into the hand?

all but the brachioradialis and anconeus

*ORIGIN: Proximal part of lateral supraepicondylar ridge of humerus and adjacent intermuscular septum

Brachioradialis | muscle

*INSERTION: Lateral surface of distal end of radius

Brachioradialis | muscle

*INNERVATION: Radial nerve (C5, C6)

Brachioradialis | muscle

*FUNCTION: Accessory flexor of elbow joint when forearm is midpronated

Brachioradialis | muscle

*ORIGIN: Distal part of lateral supraepicondylar ridge of humerus and adjacent intermuscular septum

Extensor carpi radialis longus muscle

*INSERTION: Dorsal surface of base of metacarpal II

Extensor carpi radialis longus muscle

*INNERVATION: Radial nerve (C6, C7)

Extensor carpi radialis longus muscle

*FUNCTION: Extends and abducts the wrist

Extensor carpi radialis longus muscle

*ORIGIN: Lateral epicondyle of humerus and adjacent intermuscular septum

Extensor carpi radialis brevis muscle

*INSERTION: Dorsal surface of base of metacarpal II and III

Extensor carpi radialis brevis muscle

*INNERVATION: Deep branch of radial nerve (C7, C8)

Extensor carpi radialis brevis muscle

*FUNCTION: Extends and abducts the wrist

Extensor carpi radialis brevis muscle

*ORIGIN: Lateral epicondyle of humerus and adjacent intermuscular septum and deep fascia

Extensor digitorum | muscle

*INSERTION: 4 tendons which insert via extensor hoods into the dorsal aspects of the base of the middle and distal phalanx of the fingers

Extensor digitorum | muscle

*INNERVATION: Posterior interosseous nerve (C7, C8)

Extensor digitorum | muscle

*FUNCTION: Extends the index, middle, ring, and little fingers; can also extend the wrist

Extensor digitorum | muscle

*ORIGIN: Lateral epicondyle of humerus and adjacent intermuscular septum together with extensor digitorum

Extensor digiti minimi muscle

*INSERTION: Extensor hood of little finger

Extensor digiti minimi muscle

*INNERVATION: Posterior interosseous (C7, C8)

Extensor digiti minimi muscle

*FUNCTION: extends little finger

Extensor digiti minimi muscle

*ORIGIN: Lateral epicondyle of humerus and posterior border of ulna

Extensor carpi ulnaris | muscle

*INSERTION: Tubercle on the base of the medial side of metacarpal V

Extensor carpi ulnaris | muscle

*INNERVATION: Posterior interosseous (C7, C8)

Extensor carpi ulnaris | muscle

*FUNCTION: Extends and adducts the wrist

Extensor carpi ulnaris | muscle

*ORIGIN: Lateral epicondyle of humerus

Anconeus muscle

*INSERTION: Olecranon and proximal posterior surface of ulna

Anconeus muscle

*INNERVATION: Radial nerve (C6, C7, C8) (via branch to medial head of triceps brachii)

Anconeus muscle

*FUNCTION: Abduction of the ulna in pronation; accessory extensor of elbow joint

Anconeus muscle

Consists of 5 muscles- all of which except for the supinator muscle originate from posterior surface of the radius, ulna, or interosseous membrane and pass into the thumb and index finger

deep layer of posterior forearm compartment

innervated by the posterior interosseous nerve (a continuation of the deep branch of the radial nerve)

deep muscles

has 2 heads- superficial and deep heads

supinator

*ORIGIN: Superficial part- lateral epicondyle of humerus, radial collateral and anular ligaments; deep part- supinator crest

supinator muscle

*INSERTION: Lateral surface of radius superior to the anterior oblique line

supinator muscle

*INNERVATION: Posterior interosseous nerve (branch of radial nerve (C6, C7)

supinator muscle

*FUNCTION: supination

supinator muscle

*ORIGIN: Posterior surfaces of ulna and radius (distal to the attachments of supinator and anconeus), and intervening interosseous membrane

Abductor pollicis longus | muscle

*INSERTION: Lateral side of base of metacarpal I

Abductor pollicis longus | muscle

*INNERVATION: Posterior interosseous nerve (branch of radial nerve (C6, C7)

Abductor pollicis longus | muscle

*FUNCTION: Abducts carpometacarpal joint of thumb; accessory extensor of the thumb

Abductor pollicis longus | muscle

*ORIGIN: Posterior surface of radius and adjacent interosseous membrane

Extensor pollicis brevis | muscle

*INSERTION: Dorsal surface of base of proximal phalanx of thumb

Extensor pollicis brevis | muscle

*INNERVATION: Posterior interosseous nerve (branch of radial nerve (C6, C7)

Extensor pollicis brevis | muscle

*FUNCTION: Extends metacarpophalangeal joint of the thumb; can also extend the carpometacarpal joint of thumb

Extensor pollicis brevis | muscle

*ORIGIN: Posterior surface of ulna (distal to abductor pollicis longus)and the adjacent interosseous membrane

Extensor pollicis longus | muscle

*INSERTION: Dorsal surface of base of proximal phalanx of thumb

Extensor pollicis longus | muscle

*INNERVATION: Posterior interosseous nerve (branch of radial nerve (C6, C7)

Extensor pollicis longus | muscle

*FUNCTION: Extends interphalangeal joint of the thumb; can also extend carpometacarpal and metacarpophalangeal joints of thumb

Extensor pollicis longus | muscle

*ORIGIN: Posterior surface of ulna (distal to abductor pollicis longus)and the adjacent interosseous membrane

Extensor indicis muscle

*INSERTION: Extensor hood of index finger

Extensor indicis muscle

*INNERVATION: Posterior interosseous nerve (branch of radial nerve (C6, C7)

Extensor indicis muscle

*FUNCTION: extends index finger

Extensor indicis muscle

supplied by the radial nerve, posterior and anterior interosseous arteries

posterior compartment of forearm

- nerve of the posterior compartment of forearm | - the deep branch innervates most muscles

radial nerve

becomes the posterior interosseous nerve after emerging into the posterior compartment

deep branch of radial nerve

made up of the wrist (carpus), the metacarpus, and the digits

the hand

fingers form an arcade

normal position

fingers are extended

anatomical position

palmer side of the hand

anterior side

dorsum of the hand

posterior side

how are the movements of the fingers described?

in relation to the long axis of the middle finger

what is the position of the long axis of the thumb in anatomical position?

perpendicular to the rest of the digits

what are the 3 groups of bones in the hand?

- carpals (wrist) - metacarpels (I to V) - phalanges (bones of digits)

tend to act as a bony unit

carpals bones and the metacarpals of the index, middle, ring, and little finger

form an arch and along with the flexor retinaculum form the so-called carpal tunnel

carpal bones

what does each metacarpel and phalange have?

has a base, shaft (body), and head

how many phalanges do digits II-V have?

how many phalanges does digit I have?

a synovial joint between: the distal end of the radius, articular discs of the distal end of the ulna, scaphoid, lunate, triquetrum

wrist joint

form a convex contour which houses the concave surfaces of the radius and articular discs

articular surfaces of the carpals

reinforce the wrist joint and form the capsule

ligaments

the saddle joint of the thumb imparts much more movement than the rest of the digits

Carpometacarpal joints-

provide flexion, extension, abduction, adduction, circumduction, and limited rotation

Metacarpophalangeal joints

reinforced by the palmar, collateral, and deep transverse metacarpal ligaments

Metacarpophalangeal joints

mainly flex and extend and are reinforced by collateral and palmar ligaments

Interphalangeal joints

what do the tendons of flexor digitorum superficialis and profundus and flexor carpi radialis pass through?

the carpal tunnel

what does the median nerve pass through?

carpal tunnel

surrounded by synovial sheaths

all tendons of carpal tunnel except palmaris longus

- formed by deep fascia that is anchored to the skin | - attached to the palmaris longus when present, otherwise it is anchored to the flexor retinaculum

palmaris aponeurosis

connect longitudinal fibers

transverse fibers

a small intrinsic muscle of the hand that deepens the cup of the palm by pulling the skin over the hypothenar eminence, which may improve grip

palmaris brevis

Formed by extensor tendons on the posterolateral side of the wrist

anatomical snuffbox

formed by tendons of abductor pollicis longus and extensor pollicis brevis

lateral side of anatomical snuffbox

formed by tendon of extensor pollicis longus

medial side of anatomical snuffbox

formed by the scaphoid and trapezium bones and tendons of extensor carpi radialis and extensor carpi radialis brevis

floor of anatomical snuffbox

associated with the snuffbox

cephalic vein and radial artery

where do the tendons of flexor digitorum superficialis and profundus go after exiting the carpal tunnel?

cross the palm and enter fibrous sheaths

begin proximally, anterior to the metacarpophalangeal joints

fibrous sheaths

what are fibrous flexor sheaths attached to proximally?

margins of phalanges and palmar ligaments of metacarpophalangeal and interphalangeal joints

prevent bowing of tendons during flexing

fibrous flexor sheaths

pass onto the dorsal side of digits and form extensor hoods or dorsal digital expansions on proximal phalanges

Tendons of extensor digitorum and extensor pollicis longus muscles

attach to free margins of the hoods on each side, providing for delicate hand movements

intrinsic hand muscles

what are the intrinsic muscles of the hand?

- palmaris brevis - interossei - adductor pollici - thenar - hypothenar - lumbricals

function to execute precision gripping with fingers and thumb

intrinsic hand muscles

all intrinsic hand muscles are innervated by the deep branch of the ulnar nerve except what?

the 3 thenar and 2 lateral lumbricals

the most dorsal and lie between the metacarpals and adduct, abduct, flex and extend (through extensor hoods) the fingers

Dorsal interossei

anterior to dorsal interossei

Palmar interos

often rudimentary

First palmar interossei

Adduct fingers and through attachment into extensor hoods also flex and extend digits

First palmar interossei

- a large triangular muscle anterior to the plane of the interossei - 2 heads converge into a tendon that contains a sesamoid bone and attaches to the medial side of base of proximal phalanx of thumb

adductor pollicis

The adductor pollicis is a powerful.........?

a powerful adductor of the thumb and opposes the thumb to the fingers

what are the 3 thenar muscles?

- opponens pollicis - abductor pollicis brevis - flexor pollicis brevis

what are the thenar muscles innervated by?

median nerve

rotates and flexes metacarpal I

Opponens pollicis

abducts the thumb

Abductor pollicis brevis

flexes the metacarpophalangal joint of thumb

Flexor pollicis brevis

what are the 3 hypothenar muscles?

- opponens digiti minimi - abductor digiti minimi - flexor digiti minimi brevis

rotates metcarpal V toward thumb

Opponens digiti minimi

principle abductor of little finger

Abductor digiti minimi

flexes metacarpophalangal joint

Flexor digiti minimi

what are the 4 lumbricals (wormlike)?

1st and 2nd are unipennate, 3rd and 4th are bipennate

- link flexor and extendor tendons by inserting into the extensor hoods - flex metacarpophalangeal joints while also extending interphalangeal joints

lumbricals

innervated by the deep ulnar nerve

medial 2 lumbricals

innervated by the median nerve

lateral 2 lumbricals

supply the hand with blood

radial and ulnar arties

contributes substantially to the thumb and lateral side of the index finger

radial artery

supply the remaining digits and medial side of the index finger

ulnar artery

gives rise to the superficial palmar arch and the deep palmar branch

ulnar artery

what are the branches of the palmar arch?

palmar digital artery, common palmar digital arteries which are joined by metacarpal arteries from the deep arch to become proper palmar digital arteries

forms the deep palmar arch

radial artery

what does the radial artery give off before penetrating the back of the hand?

gives off the dorsal carpal arch which gives off 3 dorsal metacarpal arteries

what are the branches of the radial artery?

- princeps pollicis - radialis indicis - deep palmar arch arteries

follow the same pattern as the arteries in the hand

deep veins

drain into the dorsal venous network on the back of the hand

superficial veins

drain into the lateral and medial side respectively

cephalic and basilic veins

nerves that supply the hand

ulnar, median, and radial nerves

what do the ulnar, median, and radial nerves contribute to?

cutaneous sensation

innervates most intrinsic muscles of the hand

ulnar nerve

mostly motor

deep branch of the ulnar nerve

is mostly sensory

superficial branch of ulnar nerve

most important as it innervates the skin of the thumb, index, middle fingers, and lateral side of the ring finger

median nerve

innervates the thenar muscles

recurrent branch of median nerve

innervate the skin of palm and digits on palmar side

digital nerves

what part of the radial nerve enters the hand?

superficial branch

innervates the skin of the dorsolateral aspect of the palmar side and dorsal side of the hand lateral digits

superficial branch of the radial nerve