Upper Extremities (Muscles) Flashcards
How are the Muscle Compartments of the Upper Extremities divided from each other?
- Bones
2. Enclosements of Deep Fascia
What is the common action of most of the muscles in the Anterior Compartment of the Arm?
- Flex Elbow
- Flex Arm
- Forearm Supination
What is the common action of most of the muscles in the Posterior Compartment of the Arm?
Extend Elbow (only one muscle there)
What is the common action of most of the muscles in the Anterior Compartment of the Forearm?
- Flex Wrist and FIngers
2. Pronation
What is the common action of most of the muscles in the Posterior Compartment of the Forearm?
- Extend Wrist and Fingers
2. Supination
What area of the Upper Limb has the most muscles?
Forearm (about 24) split into 4 muscle groups:
- Anterior Superficial Compartment
- Anterior Deep Compartment
- Posterior Superficial Compartment
- Posterior Deep Compartment
How are the muscles of the Hand divided?
- Extrinsic Muscles (Muscle bellies in Forearm, but Tendons extend to hand)
- Intrinsic Muscles (Muscle bellies and tendons in Hand)
What are the muscles of the Anterior Compartment of the Arm?
“3 Brachi’s”
1. Coracobrachialis
- Brachialis
- Biceps Brachii
What nerve innervates the muscles of the Anterior (Flexor) Compartment of the Arm?
Musculotaneous Nerve (Part of the Brachial Plexus)
NOTE: Also does Lateral Cutaneous Forearm innervation
Coracobrachialis:
- Origin
- Insertion
- Action
- Innervation
- Coracoid Process of the Scapula
- Medial Surface on Shaft of the Humerus
- Flexion of the Shoulder
- Musculotaneous Nerve
Brachialis:
- Origin
- Insertion
- Action
- Innervation
- Humerus
- Ulna
- Flexion of the Forearm
- Musculotaneous Nerve
Biceps Brachii:
- Origin(s)
- Insertion
- Action
- Innervation
“2-Headed muscle”-noted from the name “bi”cep
- Coracoid Process (short head) and top of Glenoid Cavity AKA Supraglenoid Tubercle (long head)
- Radial Tuberosity of the Radius
- Flexion AND Supination of the Forearm
- Musculotaneous Nerve
When do Biceps Brachii perform Supination more effectively?
When Supination and Flexion are in conjuction
For Example: It is easier to open a lid when your elbow is bent
What are the muscle(s) of the Posterior (Extensor) Compartment of the Arm?
Triceps Brachii
“the 3 Headed muscle”
Triceps Brachii:
- Origin(s)
- Insertion
- Action
- Innervation
- 3 Origins:
A. Bottom of Glenoid Cavity AKA Infraglenoid Tubercle (Long Head)
B. Humerus (Medial Head)
C. Humerus (Lateral Head) - Olecranon Process of the Ulna
- Extension of Forearm
- Radial Nerve (arises from Posterior Cord)
Describe the pathway of the Radial Nerve
The Radial Nerve passes through the Triangular Interval to the back of the Humerus where it travels down in the “Spiral Groove” between the Medial and Lateral Heads of the Triceps with the artery that supplies the posterior part of the upper limb called the Deep Brachial Artery (Profunda)
What are the two spaces formed between the muscles of the upper limb through which nerves travel?
- Quadrangular Space (more superior)
2. Triangular Interval
What muscles form the borders of the Quadrangular Space?
- Teres Major
- Teres Minor
- Long Head of the Triceps Brachii
What vessels pass through the Quadrangular Space?
- Axillary Nerve (innervates Deltoid and Teres Minor)
2. Posterior Circumflex Humoral Artery (branch of Axillary Artery that goes around the Humerus)
What is the Cubital Fossa?
“An Anatomical Space on the Anterior Side of the Elbow Joint”
Palpable depression on the front of your elbow
What are the borders of the Cubital Fossa?
Superior Border- Imaginary Line between the Epicondyles of the Humerus
Lateral Border- Brachiaoradialis Muscle (Forearm)
Medial Border- Pronator Teres Muscle (Forearm)
What are the contents of the Cubital Fossa?
- Tendon of the Biceps muscle (Distal attachment going towards the Radius)
- Median Nerve (middle nerve from the Brachial Plexus “M”)
- Brachial Artery (Pulse can be felt medial to Biceps tendon)
Order from Medial to Lateral is “NAT” for Nerve, Artery, Tendon
Describe pathways of the Terminal Nerves of the Brachial Plexus:
- Median Nerve “middle of the M” (got contributions from lateral and medial cords) travels anterior to the Elbow Joint through the Cubital Fossa medial to the Biceps Tendon
- Musculocutaneous Nerve “Lateral side of the M” innervates the Anterior Compartment of the Arm and travels to the forearm superficially to innervate Lateral Cutaneous Forearm
- Ulnar Nerve “Medial side of the M” travels behind Medial Epicondyle in a groove
- Radial Nerve “Posterior to the M” to innervate Posterior Arm and Ultimately Forearm
What happens when you “hit your funny bone”?
The Ulnar Nerve that travels behind the Medial Epicondyle is stimulated and specific cutaneous sensation is felt
What is the only nerve to travel through the Cubital Fossa?
Median Nerve
What is the anterior cover of the Cubital Fossa? (Deep to Superficial)
- Bicipital Aponeurosis
- Subcutaneous Tissue
- Skin
What is the Median Cubital Vein and where does it travel?
- Travels anteriorly across the Bicipital Aponeurosis of the Median Cubital Vein
- Connects the two superficial veins of the upper limb (Cephalic and Basilic Veins)
- Fairly prominent and can be used for blood withdrawal
Matching column for Wrist Movement:
- Radial Deviation
- Ulnar Deviation
A. aBduction
B. aDduction
Radial Deviation=aBduction
Ulnar Deviation=aDduction
In terms of the Digits 2-5, what is Flexion?
“2 Fs”
Flexion is making a fist
In terms of the Digits 2-5, what is aDduction?
Fingers all together and touching (meeting at the midline)
In terms of the Digits 2-5, what is aBduction?
Fingers all spread apart (away from midline)
In terms of the Thumb, what is Flexion?
“Hiding your thumb” (moving thumb towards the pinky)
In terms of the Thumb, what is Extension?
Hitch-hiker’s thumb
In terms of the Thumb, what is aBduction?
Position of your thumb if you throw up “The U” for U Miami and your palms are facing each other (moving the thumb away from the midline)
What are the Superficial Muscles of the Forearm Anterior Compartment?
- Flexor Carpi Ulnaris
- Flexor Carpi Radialis
- Palmaris Longus
- Pronator Teres
What Nerves innervate the Superficial Muscles of the Forearm Anterior Compartment?
- Median Nerve (more)
- Ulnar Nerve
MEDIAN DOES MORE
Where is the common origin of the Superficial Muscles of the Forearm Anterior Compartment?
Medial Epicondyle of the Humerus
Flexor Carpi Ulnaris:
- Origin
- Insertion
- Action
- Innervation
- Medial Epicondyle of Humerus
- Ulnar (Medial) side Carpals of Wrist
- Flexion and aDduction of the Wrist
- ULNAR NERVE!!!!
Flexor Carpi Radialis:
- Origin
- Insertion
- Action
- Innervation
- Medial Epicondyle of Humerus
- Radial (Lateral) side Carpals of Wrist
- Flexion and aBduction
- Median Nerve
Palmaris Longus:
- Origin
- Insertion
- Action
- Innervation
NOT PRESENT IN ALL PEOPLE
- Medial Epicondyle of Humerus
- Palmar Aponeurosis
- Flexion of Wrist
- Median Nerve
Travels between Flexor Carpi Radialis and Ulnaris
Pronator Teres:
- Origin
- Insertion
- Action
- Innervation
Most Lateral of the Superficial Muscles of the Forearm Anterior Compartment
- Medial Epicondyle of Humerus
- Midshaft on Lateral Side of the RADIUS
- Pronates Forearm (in its name)
- Median Nerve
What is the Palmar Aponeurosis?
- Triangular Deep Fascia over the palm that extends to the digits
- Insertion point of Palmaris Longus (if present), Palmaris Brevis
What is the only Superficial Muscle of the Forearm Anterior Compartment that is NOT innervated by the Median Nerve?
Flexor Carpi Ulnaris
Innervated by Ulnar Nerve, It’s even in the name
What is the only Superficial Muscle of the Forearm Anterior Compartment that does NOT cause Wrist activity?
Pronator Teres
Never crosses wrist
Choose the correct bone:
ALL Pronator and Supinator Muscles of the Forearm Anterior Compartment must insert on the ULNA or RADIUS
ALL Pronator and Supinator Muscles of the Forearm Anterior Compartment must insert on the RADIUS
What is the Intermediate (sometimes Superficial) Muscle of the Forearm Anterior Compartment?
Flexor Digitorum Superficialis
The one with Superficial in its name is really INTERMEDIATE
Flexor Digitorum Superficialis:
- Origin
- Insertion
- Action
- Innervation
- Medial Humerus and Radius (kind of broad)
- Splits and inserts on Middle Phalanges of Digits 2-5 (Middle 1/3 of your digit)
- Flexes digits at Metacarpal-Phalangeal Joint and Proximal Interphalangeal Joint (PIP)
- Median Nerve
What are the Deep Muscles of the Forearm Anterior Compartment?
- Flexor Digitorum Profundus
- Flexor Pollicis Longus
- Pronator Quadratus
What nerves innervate the Deep Muscles of the Forearm Anterior Compartment?
- Median Nerve (again Median does the Most)
2. Ulnar Nerve
Flexor Digitorum Profundus:
- Origin
- Insertion
- Action
- Innervation
- Medial Humerus and Radius (kind of broad)
- Inserts on Distal Phalanges of Digits 2-5 (Top 1/3 of Digit) after passing through the split tendons of the FD Superficialis
- Flexion of Wrist and ENTIRE DIGITS 2-5 (Distal Interphalangeal Joint (DIP), Proximal Interphalangeal Joint (PIP), Metacarpal-Phalangeal Joint)
- HALF Median Nerve and HALF Ulnar Nerve
Flexor Pollicis Longus:
- Origin
- Insertion
- Action
- Innervation
- Radius
- Distal Phalanx of Thumb
- Flexion of the Interphalangeal and Metacarpal-Phalangeal Joints of the Thumb
- Median Nerve
Pronator Quadratus:
- Origin
- Insertion
- Action
- Innervation
- Ulna
- Radius
- Pronation of Forearm
- Median Nerve
What is the only muscle located in the Forearm Anterior Compartment (Superficial or Deep) that is innervated by both the Ulnar and Median Nerve?
Flexor Digitorum Profundus is innervated 50/50 by the Ulnar and Median Nerves
What are the only muscles located in the Forearm Anterior Compartment (Superficial or Deep) that are innervated by the Ulnar Nerve?
- Flexor Carpi Ulnaris
2. Flexor Digitorum Profundus (only 50%)
The Forearm Anterior Compartment is also called what?
“Flexor Compartment” since all the muscles perform Flexion
What are the Superficial Muscles of the Forearm Posterior Compartment?
- Extensor Carpi Radialis Longus
- Extensor Carpi Radialis Brevis
- Extensor Carpi Ulnaris
- Extensor Digitorum
- Extensor Digiti Minimi
- Anconeus
- Brachioradialis
The Forearm Posterior Compartment is also called what?
“Extensor Compartment” because all but one muscle (Brachioradialis) perform Extension
What nerve innervates the Superficial Muscles of the Forearm Posterior Compartment?
Radial Nerve
What is the lone muscle that performs Flexion in the group of Superficial Muscles of the Forearm Posterior Compartment? Why is it considered Posterior?
- Brachioradialis
- Innervated by Radial Nerve
NOTE: It is considered to be posterior, BUT it is located very laterally between the anterior and posterior compartments
Extensor Carpi Radialis Longus:
- Origin
- Insertion
- Action
- Innervation
- Lateral Supracondylar Ridge (Right above Lateral Epicondyle) of the Humerus
- Base of Second Metacarpal (Index Finger)
- Wrist Extension and aBduction
- Radial Nerve
Extensor Carpi Radialis Brevis:
- Origin
- Insertion
- Action
- Innervation
- Lateral Epicondyle of Humerus
- Base of Third Metacarpal (Middle Finger)
- Wrist Extension and aBduction
- Radial Nerve
Extensor Carpi Ulnaris:
- Origin
- Insertion
- Action
- Innervation
- Lateral Epicondyle of Humerus AND Posterior Border of Ulna
- Base of the Fifth Metacarpal (Pinky)
- Wrist Extension and aDduction
- Radial Nerve
Extensor Digitorum:
- Origin
- Insertion
- Action
- Innervation
- Lateral Epicondyle of the Humerus
- Inserts on Middle and Distal Phalanges of Digits 2-5
- Extension of Digits 2-5
- Radial Nerve
Extensor Digiti Minimi:
- Origin
- Insertion
- Action
- Innervation
- Lateral Epicondyle of the Humerus
- Phalynx of Digit 5 (Pinky)
- Extension of Pinky
- Radial Nerve
Anconeus:
- Origin
- Insertion
- Action
- Innervation
- Lateral Epicondyle of Humerus
- Lateral aspect of Olecranon on Ulna
- Accessory to Extension of the Elbow
- Radial Nerve
Brachioradialis:
- Origin
- Insertion
- Action
- Innervation
- Lateral Supracondylar Ridge (Right above Lateral Epicondyle) of the Humerus
- Radius (Lateral side of Distal end)
- Accessory to Flexion of the Elbow
- Radial Nerve
What are the Deep Muscles of the Forearm Posterior Compartment?
- Abductor Pollicis Longus
- Extensor Pollicis Longus
- Extensor Pollicis Brevis
- Extensor Indicis
- Supinator
What nerve innervates the Deep Muscles of the Forearm Posterior Compartment?
Radial Nerve
Abductor Pollicis Longus:
- Origin
- Insertion
- Action
- Innervation
- Posterior of Radius and Ulna
- Base of Thumb Metacarpal and Trapezium
- Extension and aBduction of Thumb
- Radial Nerve
Extensor Pollicis Brevis:
- Origin
- Insertion
- Action
- Innervation
- Radius and Ulna (Dorsally)
- Proximal Phalynx of Thumb
- Extends Thumb (hitchhiking)
- Radial Nerve
Extensor Pollicis Longus:
- Origin
- Insertion
- Action
- Innervation
- Radius and Ulna (Dorsally)
- Distal Phalynx of Thumb
- Extends Thumb (hitchhiking)
- Radial Nerve
Extensor Indicis:
- Origin
- Insertion
- Action
- Innervation
- Ulna (Distally)
- Second Digit Phalanges (Index)
- Extension of the Index Finger
- Radial Nerve
Supinator:
- Origin
- Insertion
- Action
- Innervation
- Lateral Epicondyle of Humerus AND Ulna (Proximally)
- Radius (Proximally)
- Supination of the Forearm
- Radial Nerve
What is the difference in orientation of the Superficial and Deep Muscles of the Forearm Posterior Compartment?
“FaDDDy” (in Forearm Dorsal Deep run Diagonally):
- Deep Muscles run Diagonally
- Superficial Muscles run Vertically
How is the Carpal Tunnel formed?
Flexor Retinaculum (tough connective tissue) runs across the top of the Carpal Arch closing it off
What are the contents of the Carpal Tunnel?
- Tendons of Flexor Digitorum Profundus (Flex wrist and digits 2-5)
- Tendons of Flexor Digitorum Superficialis (flex wrist and proximal 2/3 of digit 2-5)
- Tendon of Flexor Pollicis Longus (flexes thumb)
- Median Nerve
What is the only nerve to pass through the Carpal Tunnel?
Median Nerve
What is the cause of Carpal Tunnel Syndrome?
Compression of the Median Nerve causes suppression of innervations in the hand located distally to the Carpal Tunnel
What is the Anatomical Snuffbox?
- “Little dip” between the Tendons of the Extensor Pollicis Longus and the Extensor Pollicis Brevis
- Contains the Radial Artery
- Floor formed by Scaphoid and Trapezium bones (most lateral bones of each row of Carpals)
What are some basic characteristics of Extrinsic Hand Muscles?
- Muscles that originate in the Forearm and have tendons that extend into the hand
- Innervated by Median, Ulnar, and Radial Nerves
- Involved in “Power Grip”
List the Extrinsic Muscles of the Hand:
All Forearm muscles:
- Flexor Carpi Ulnaris
- Flexor Carpi Radialis
- Palmaris Longus
- Flexor Digitorum Superficialis
- Flexor Digitorum Profundus
- Flexor Pollicis Longus
- Pronator Quadratus
- Extensor Carpi Radialis Longus
- Extensor Carpi Radialis Brevis
- Extensor Carpi Ulnaris
- Extensor Digitorum
- Extensor Digiti Minimi
- Abductor Pollicis Longus
- Extensor Pollicis Longus
- Extensor Pollicis Brevis
- Extensor Indicis
Matching Column:
- Extrinsic Hand Muscles
- Intrinsic Hand Muscles
A. Powerful Actions
B. Precision Actions
Extrinsic Hand Muscles perform Powerful Actions
Intrinsic Hand Muscles perform Precision Actions
What are some basic characteristics of Intrinsic Hand Muscles?
- Originate in the hand
- “Precision Grip” (fine movement)
- Innervated by Ulnar and Median Nerves
List the Intrinsic Muscles of the Hand:
- Palmar Brevis
- Palmar Interossei
- Dorsal Interossei
- Adductor Pollicis
- Thenar Groups
- Hypothenar Groups
- Lumbricals
Choose the correct answer:
In the Anterior Forearm, ULNAR/MEDIAN Nerve does most of the innervation while the ULNAR/MEDIAN Nerve only innervates 1.5 muscles.
In the Anterior Forearm, MEDIAN Nerve does most of the innervation (6.5 muscles) while the ULNAR Nerve only innervates 1.5 muscles.
Choose the correct answer:
In the Hand, ULNAR/MEDIAN Nerve does most of the innervation while the ULNAR/MEDIAN Nerve only innervates some.
In the Hand, ULNAR Nerve does most of the innervation while the MEDIAN Nerve only innervates some.
Palmaris Brevis:
- Origin
- Insertion
- Action
- Innervation
Small Superficial “Quadrangular Muscle” on the medial side of the Palm that works with the Palmaris Longus IF it exists
- Medial Side of the Hand
- Palmaris Aponeurosis (midline)
- Improves Grip
- Ulnar Nerve
Adductor Pollicis:
- Origin
- Insertion
- Action
- Innervation
“Triangular muscle”
- Midline of the Hand
- Proximal Phalanx of the Thumb
- Adduction of Thumb
- Ulnar Nerve
What are the Interossei, what are their names?
- Interrosei are 7 muscles that run between the Metacarpals to perform aDduction and aBduction of digits 2-5
- Dorsal (4) and Palmar (3) Interossei
Dorsal Interossei pneumonic
“DABB”:
- “D” for Dorsal
- 4 muscles (4 letters)
- “ABB” for aBduction of Digits 2-4
- Ulnar Nerve Innervation
Palmar Interossei pneumonic
“PAD”:
- “P” for Palmar
- 3 muscles (3 letters)
- “AD” for aDuction of Digits 2,4,5
- Ulnar Nerve Innervation
Lumbricals:
- Origin
- Insertion
- Action
- Innervation
4 muscles that “wrap around” Phalanges
- Between the Tendons of Flexor Digitorum Profundus
- Phalanges
- Flex Metacarpal Phalangeal Joint BUT Extend PIP and DIP joints of Digits 2-5 (like holding a pen)
- Medial 2 (Ulnar side) are innervated by the Ulnar Nerve BUT Lateral 2 (Radial Side) innervated by Median Nerve
What is the Thenar Group?
3 Muscles that form the bulge of tissue over the Lateral Palm near the Thumb called the Thenar Eminence
What are the muscles of the Thenar Group?
- Opponens Pollicis
- Flexor Pollicis Brevis
- Abductor Pollicis Brevis
ALL INNERVATED BY MEDIAN NERVE
What are the only Intrinsic Hand Muscles innervated by the Median Nerve?
- Thenar Group (Opponens Pollicis, Flexor Pollicis Brevis, Abductor Pollicis Brevis)
- Lateral 2 Lumbricals (Thumb side)
Opponens Pollicis:
- Action
- Innervation
- Opposition of Thumb
2. Median Nerve
Flexor Pollicis Brevis:
- Action
- Innervation
- Flexes Thumb at Metacarpal Phalangeal Joint
2. Median Nerve
Abductor Pollicis Brevis:
- Action
- Innervation
- aBducts Thumb at Metacarpal Phalangeal Joint
2. Median Nerve
What is the Hypothenar Group?
3 muscles that form the bluge over the Medial Palm near the Pinky called the Hypothenar Eminence
What are the muscles of the Hypothenar Group?
- Opponens Digiti Minimi
- Flexor Digiti Minimi Brevis
- aBductor Digiti Minimi
ALL INNERVATED BY THE ULNAR NERVE
Describe the Pathway of blood supply to the hand
- Axillary Artery
- Brachial Artery (Name changes after Axilla)
- Radial and Ulnar Arteries (branches of Brachial Artery in the forearm)
- Superficial and Deep Palmar Arches (2 interconnected arterial arches formed by the Radial and Ulnar arteries in the hand)
- Common Digital Arteries (branch from Superficial and Deep Palmar Arches)
- Proper Digital Arteries provide Digits with blood (Branch from Common Digital Arteries and are on either side of the Digit)
- Venous Drainage by Superficial and Deep Veins
What is the Allen’s Test for Adequate Contribution?
Test to measure contribution of blood to the hand by both the Ulnar and Radial Arteries:
- Shake blood out of hand
- Cut off blood supply to hand by pinching anterior side of wrist
- Stop occluding one side and check if blood has rushed into the hand (turns pink)
Cutaneous Innervation of the Hand’s Palm:
- Median Nerve- Digits 1-3 and 1/2 of 4
2. Ulnar Nerve- Pinky and 1/2 Ring Finger (Medial Palm)
Cutaneous Innervation of the Hand’s Dorsum:
- Median Nerve- tips of Digits 1-3 and 1/2 of 4
- Ulnar Nerve- Pinky and 1/2 of Ring finger (Medial Dorsum)
- Radial Nerve- Digits 1-3 and 1/2 of 4 (not including tips)
Where in your hand do you feel tingling if you hit your elbow and why?
Ulnar Nerve travels underneath the Medial Epicondyle of the Humerus so if you hit your elbow you feel it in the Medial 1.5 digits (Pinky and 1/2 Ring Finger)
Which nerve has ONLY Cutaneous Innervation in the Hand and NO Muscular Innervation?
Radial Nerve
Dorsal Cutaneous innervation of the Lateral 3.5 digits (not including the tips)
Musculocutaneous Nerve:
- Origin
- What does it Innervate?
- Lateral Side of the Brachial Plexus “M”
2. Motor Innervation in Anterior Arm AND Cutaneous Innervation of Lateral Forearm
Median Nerve:
- Origin
- What does it Innervate?
- Middle of the Brachial Plexus “M”
- Travels through Cubital Fossa and innervates most of Anterior Forearm Muscles
2A. Travels through Carpal Tunnel to innervate Thenar Group and 2 Lateral Lumbricals
2B. Cutaneous Innervation of Palm (Digits 1-3 and 1/2 of 4) and Dorsum (TIPS of Digits 1-3 and 1/2 of 4)
Ulnar Nerve:
- Origin
- What does it Innervate?
- Medial side of the Brachial Plexus “M”
- Passes behind Medial Epicondyle of the Humerus and does 1.5 muscles of the Anterior Forearm
2A. Innervates most of the Intrinsic Muscles of the Hand
2B. Cutaneous Innervation of the Medial 1.5 Digits (Pinky and 1/2 Ring)
Radial Nerve:
- Origin
- What does it Innervate?
- Posterior to Brachial Plexus “M” and passes through Triangular Interval
- Travels down Posterior of the Arm and goes into Forearm under Brachioradialis (lateral) and innervates all of the Forearm Posterior Compartment
2A. Dorsal Hand Cutaneous Innervation of the Lateral 3.5 digits (not including the tips)
Where are the Pulse Points?
- Axillary (in Axilla)
- Brachial (Cubital Fossa Medial to Biceps Tendon)
- Radial (Anterior Wrist and Anatomical Snuff Box)
- Ulnar (Anterior Wrist)