Upper Extremity Flashcards
Upper fibres of trapezius
Innervation:
– Motor supply CN11- accessory nerve
– sensor supply- ventral rami of cervical nerves (C2-C4)
Attachment:
– occiput, C1-C7 and lateral clavicle, acromion
– head straight, resist lateral flexion of head above the ear and resist shoulder elevation as well
Trapezius- middle
Attachment-
- C2 to T12, Nuchal Line, Superior Angle of the scapula, Distal Clavicle, Acromion
Supine-
- arm extended to the side 90 degrees
- place hand on the posterior forearm of pt
- resist downward movement
Prone-
- arm extended to side 90 degrees
- place hand on anterior forearm
- place other hand on posterior forearm
- resist upward movement gently
Trapezius- lower
Supine:
- humerus abducted to 135 degrees with elbow locked
- place band on posterior forearm superior to the wrist
- resist downward motion
Prone:
- humerus abducted 135 degrees with elbow locked
- place one hand on anterior forearm and other on posterior forearm
- resist upward motion, gently
Latissimus dorsi- straight arm
Innervation:
– thoracodorsal nerve (C6-C8), from the posterior cord of the brachial plexus
Attachment-
- T7-T12, Thoracolumbar Fascia, Iliac Crest, Last 3-4 ribs, bicipital groove
Supine or prone:
- humerus addicted and medically rotated against body, elbow locked
- place hand on posterior forearm
- resist adduction
Latissimus dorsi- bent elbow
Supine or prone:
- Abducted 90 to side, elbow bent 90 degrees
- shoulder externally rotated
- resist adduction to elbow
Levator Scapula
Innervation:
– cervical C3, C4 and dorsal scapula C4, C5
Attachment-
- C1-C4, superior angle of the scapula
Supine or prone:
- rotate pt head slightly to side
- resist side ending of neck above ear with 1 hand, and resist shoulder elevation with the other hand
Teres major
Innervation:
– lower sub scapular nerve (C5, C6), arises from the posterior cord of the brachial plexus
Movement:
– internal rotation of shoulder
– extension of shoulder
Attachment:
– inferior angle of scapula
– bicipital groove of humerus
Supine:
– chicken wing arm
– back of pts hand underneath their waistline
– resist downwards movement
Prone:
– same but the movement will be upwards
Rhomboids
Innervation:
– dorsal scapula (C4, C5)
Attachment-
- C7-T5, medial border of the scapula
Supine:
- humerus abducted 45 degrees, elbow bent 90 degrees
- palm facing in
- resist adduction at elbow
Prone:
- elbow bent and slightly abducted
- resist adduction at elbow
Teres Minor
Innervation:
– axillary nerve (C5, C6)
Attachment-
- Upper axillary border of the scapula, Greater tubercle of the humerus
Supine and prone:
- Elbow bent 90 degrees, humerus abducted 45 degrees
- Resist lateral rotation with hand superior to wrist stabilising medial elbow
Infraspinatus
Innervation:
– supra scapular nerve (C5, C6), from the upper trunk of the brachial plexus
Attachment-
- Infraspinatus fossa of scapula, Greater tubercle of humerus
Supine and Prone:
- Elbow bent 90 degrees, humerus abducted 90 degrees
- Resist lateral rotation, supporting medial elbow
Supraspinatus
Innervation:
– supra scapular nerve (C5, C6) from the upper trunk of the brachial plexus
Attachment-
- Supraspinatus fossa of scapula, Greater tubercle of humerus
Supine:
- Humerus abducted 10-15 degrees and lifted slightly off the table
- Resist abduction
Prone:
- Arm at side
- Resist first 15 degrees of abduction
Subscapularis
Innervation:
– Upper and lower subscapular nerves (C5-C7), from the posterior cord of the brachial plexus
Attachment-
- Subscapular fossa of scapula, Lesser tubercle of humerus
Supine and Prone:
- Humerus abducted between 45 and 90 degrees
- Elbow flexed 90 degrees
- Resist medial rotation of elbow, stabilising lateral elbow
Biceps- long head
Innervation:
– musculocutaneous nerve (C5, C6)
Attachment-
- Supraglenoid tubercle of the scapula, Radial Tuberosity
Supine:
- Humerus abducted 45 degrees
- Resist elbow flexion holding superior to wrist
Prone:
- Clients elbow bent 90 degrees
- Grasp forearm superior to elbow, and resist movement of hand to shoulder
Biceps short head
Innervation:
– musculocutaneous nerve (C5, C6)
Attachment:
– coracoid process
– radial tuberosity
Action:
– flexion of humerus, flexion of elbow
– supination of forearm
– adduction of humerus
Supine:
– humerus adducted, elbow bent 90 degrees
– resist elbow flexion superior to wrist
Brachialis
Innervation:
– musculocutaneous nerve (C5, C6)
Attachment:
– lower half of the anterior shaft of the humerus
– ulnar tuberosity and coronoid process of ulnar
Action:
– flexion of elbow
Supine:
– humerus abducted, elbow bent 90 degrees
– thumb facing pts head (hammer curl)
– resist flexion
Pronator Teres
Innervation:
– median nerve (C5, T1)
Attachment-
- Medial epicondyle of humerus, Middle of lateral shaft of radius
- Clients elbow bent
- Grasp thumb with one hand, and place back of other hand against back of pt hand
- Resist pronation
Supinator
Innervation:
– Radial nerve (C5-T1)
Attachment-
- Lateral epicondyle of humerus, Lateral surface of proximal third of radius
- Pt elbow bent
- One hand behind pt thumb and index finger, other hand on hypothenar eminence
- Resist supination
This also tests biceps supination action
Longus colli
Innervation:
– C2-6
Attachment:
– anterior C1 and C2
– anterior C3 and C4
– Support pts head an inch or 2 off the bed with hand under occiput
– get pt to chin tuck, while you gently try to tip the forehead back, as if to undo the nod.
Medial scalene
Innervation:
– C4-8
Action:
- neck flexion and SB raises first rib
Attachment:
- C3-C7 and anterior ribs 1-2
Deltoid anterior
Innervation:
– axillary (C5, 6)
Attachment:
– lateral third of the clavicle
– deltoid tuberosity
Supine:
– elbow bent:
—- humures abducted 90 degrees
—- resist horizontal adduction (across body)
—- with one hand on bicep and other grasping the pt’s hand
elbow straight:
– abduct the humerus slightly
– resist humeral flexion with hand on posterior forearm superior to the wrist
Prone:
– pts elbow bent and shoulder abducted 90 degrees so arm is hanging off the bed
– top hand place above elbow for stability and one underneath to resist the downward motion
Deltoid middle
Innervation:
– axillary C5, 6
Attachment:
– lateral acromion and deltoid tuberosity
Action:
– abduction of shoulder to 90 degrees
Supine:
– pts elbow bent 90 degrees
– pts shoulder abducted 90 degrees
– hold arm and hand on superior shoulder
– resist further abduction
Prone:
– same as supine
– arm hanging off the bed
Posterior deltoid
Innervation:
– Axillary (C5, C6)
Attachment:
– lateral acromion and deltoid tuberosity
Action:
– extension, horizontal abduction and lateral rotation of the humerus
Supine:
– shoulder abducted 90 degrees and elbow flexed 90 degrees
– resist backwards motion of the shoulder
Prone:
– same as supine but resist upward motion
Coracobrachialis
Innervation:
– musculocutaneous nerve (C5, C6, C7)
Attachment:
– coracoid process and middle third of medial surface of humeral shaft
Action:
– flexion of humerus
– adduction of humerus
Supine:
– humerus abducted slightly
— arms lifted up slightly
– elbow bent 90 degrees
– place hand on bicep while grasping pts hand
– resist flexion of the shoulder
Pectoralis major clavicular fibres
Innervation:
– upper fibres:
—- lateral pectoral nerve (C5, C6)
– lower fibres:
—- lateral and medial pectoral nerves (C6-C8, T1)
Attachment:
– medial half of the clavicle and bicipital groove
Supine:
– pt arm straight up with posterior arm facing their opposite shoulder and palm of hand facing you
– resist movement of shoulder across body
Prone:
– pt arm straight out with palm facing the floor
– resist downward movement towards the floor
Pectoralis major sternal fibres
Attachment:
– sternal cartilage of ribs 1-6 and bicipital groove
Supine:
– client arm straight up with their palm facing practitioner and thumb facing opposite hip
– traction the arm
– resist movement across body
Prone:
– arm abducted 135 degrees
– place hand superior to the wrist
– palm facing practitioner
– resist downward movement
Pectoralis minor
Innervation:
– medial pectoral nerve with fibres from the communicating branch of the lateral pectoral nerve (C6-C8, T1)
Attachment:
– ribs 3-5 and coracoid process
Action:
– protraction, depression, downward rotation of scapula
supine:
– pt lifts shoulder up
– resist the protraction of the shoulder over the ball and socket
Prone:
– humerus abducted 90 degrees with elbow bent
– place hand under clients fist
– resist downward movement
– tests both pec minor and major
Serratus anterior
Innervation:
– long thoracic (C5-8)
Attachment:
– outer surface of upper 8 ribs
– anterior surface of vertebral border of scapula
Action:
– protraction and upward rotation of the scapula
– stabilises scapula versus the chest wall
Upper fibres:
– pt supine
– humerus flexed 90 degrees and slightly abducted
– elbow locked
– resist downward movement of the arm (caudal)
Lower fibres:
– pt supine
– humerus flexed 90 degrees and slightly abducted
– elbow locked
– resist upwards movement by holding the wrist
Triceps long head
Innervation:
– radial nerve (C6-T1)
Attachment:
– infraglenoid tubercle of scapula
– olecranon
Action:
– extension of humerus
– extension of elbow
Supine:
– humerus adducted with palm facing upwards, with elbow locked out
– resist extension
Triceps brachii as a whole
Attachment:
– long head- infraglenoid tubercle of scapula
– lateral head- posterior humerus
– medial head (deep)- posterior humerus
– all insert at the olecranon
Action:
– extension of elbow
Supine:
– supine or seated, shoulder flexed 90 degrees
– elbow slightly flexed
– push wrist to cause flexion at the elbow and get pt to resist
– stabilise by holding pts elbow
Brachioradialis
Attachment:
– lateral supracondylar ridge of humerus
– styloid process of radius
Action:
– flexion of elbow in neutral position
Supine:
– arm abducted 45 degrees
– elbow bent 90 degrees
– thumb pointing upwards
– resist flexion (pull arm into extension and get pt to resist)
– stabilise at pts elbow
Flexor carpi radialis
Attachment:
– medial epicondyle of humerus
– 2nd and 3rd metacarpals
Action:
– flexion and abduction of wrist (radial deviation)
Supine:
– clients wrist flexed 45 degrees
– place your hand on medial wrist in line with the thumb
– resist flexion of the wrist
Extensor carpi radialis brevis
Attachment:
– lateral epicondyle
– third metacarpal
Action:
– extension of the wrist
Supine:
– clients wrist extended 45 degrees
– place hand on medial wrist in line with thumb
– resist extension
Flexor carpi ulnaris
Attachment:
– humeral and ulnar head, make up the cubital tunnel, can be affected by golfers elbow
Action:
– flexion of wrist
– ulnar deviation
Supine:
– clients wrist flexed 45 degrees
– resist on medial wrist in like with little finger
– resist flexion
Extensor carpi ulnaris
Attachment:
– lateral epicondyle
– fifth metatarsal
Action:
– extension of wrist
– ulnar deviation
Supine:
– clients wrist extended 45 degrees
– place hand over wrist in line with little finger
– resist extension
Flexor digitorum superficialis
- humeroulnar head- medial epicondyle
- radial head- anterior border of the radius
- Attaches onto the middle phalanges of the 4 fingers (PIP)
Action:
– flexion of PIP joints
Supine:
– clients wrist flexed 45 degrees
– place fingers across each PIP joint from 2-5
– resist flexion of PIP joints
Flexor digitorum profundus
Attachment:
– ulna
– interosseous membrane
– base of distal phalanges of four fingers
Action:
– flexion of DIP’s
Supine:
– Clients wrist flexed 45 degrees
– place fingers over DIP joints 2-5
– resist flexion off DIP’s
Extensor digitorum
Attachment:
– lateral epicondyle
– extensor expansion of the 4 fingers
Action:
– extension of MCP joints
Supine:
– clients wrist extended 45 degrees
– place fingers across back of fingers 2-5
– resist extension of the MCP’s
Flexor pollicis longus
Attachment:
– anterior radius
– interosseous membrane
– DIP of thumb
Action:
– flexion of DIP of thumb
Supine:
– clients elbow bent 90 degrees
– fingers curled into palm apart from thumb
– place index finger onto thumb
– resist flexion of the thumb
Extensor pollicis longus
Attachment:
– posterior ulna
– interosseous membrane
– Distal phalanx of thumb
Action:
– extension of distal phalanx of thumb
Supine:
– elbow bent 90 degrees
– fingers curled into palm apart from thumb
– index finger on the posterior thumb
– resist extension
Flexor pollicis brevis
Attachment:
– flexor retinaculum and carpal bones
– PIP of thumb
Action:
– flexion of pip of thumb
Supine:
– elbow flexed
– fingers curled into palm of hand other than thumb
– thumb curled slightly, place finger on the tip
– resist further flexion
Extensor pollicis brevis
Attachment:
– posterior radius
– interosseous membrane
– PIP of thumb
Action:
– extension of PIP of thumb
Supine:
– elbow bent
– fingers curled into palm of hand apart from thumb
– thumb already bent, place index finger behind it
– resist extension
Adductor pollicis
Attachment:
– capitate, 2nd and 3rd metacarpals
– PIP of thumb
Action:
– adduction of the first metacarpal of the thumb at CM joint (carpometacarpal)
Supine:
– place clients thumb against their index finger
– pull thumb away from index finger, they have to stop you
Adductor pollicis longus
Attachment:
– posterior radius and ulna
– interosseous membrane
– base of 1st metacarpal
Action:
– abduct the thumb
– extends the thumb
– assists with wrist abduction
Supine:
– place clients thumb against their index finger and then move slightly apart
– place index finger on the posterior of their thumb
– resist abduction
Thumb to finger opposition
Opponens pollicis and opponens digiti minimi are involved
Get pt to put thumb and little finger together, see if they can hold it there while you slowly try to pull them away from each other