Upper Extremity 2 Flashcards
Boundaries of Cubital Fossa
Superior: between medial and lateral epicondyles
medial: pronator teres
lateral: brachioradialis
floor: brachialis and supinator
roof: bicipital aponeurosis
Contents of Cubital Fossa
brachial artery, biceps tendon, bicipital aponeurosis, pronator teres, brachioradialis, median cibital vein
Anteromedial compartment
flexors & pronators
most supplied by median nerve
1 and part of 1 supplied by ulnar nerve
Posterolateral Compartment
extensors and supinators
all supplied by raidal nerve
Pronator Teres
Proximal attachments
(i) Medial epicondyle of humerus and coronoid process of ulna
Distal attachments
(i) Middle of lateral surface of the radius
Median nerve
Pronates and flexes forearm
Flexor Carpi Radialis
Proximal Attachment
Medial epicondyle of humerus
Distal attachments
Base of 2nd metacarpal
Median nerve
Flexes and abduct the handPalmaris longus
Proximal attachments
(i) Medial epicondyle of humerus
Distal attachments
(i) Distal half of the flexor retinaculum and palmer aponeurosis
Median nerve
Flexes hand and “tightens” palmer aponeurosis
Flexor Carpi Ulnaris
Proximal attachments…two heads
(i) Humeral head: medial epicondyle of humerus
(ii) Ulnar head: olecranon process and posterior border of ulna
Distal attachments
(i) Pisiform, hook of the hamate and the base of the 5th metacarpal bone
Ulnar nerve
Flexes and adducts the hand
Flexor Digitorum Superficialis
Proximal attachments – two heads
(i) Humeroulnar head: Medial epicondyle of humerus and coronoid process of ulna
(ii) Radial head: superior half of anterior border of radius
Distal attachments
(i) Bodies of middle phalanges of medial four digits (2-5)
Median nerve
Flexes PIP joint of medial four digits (2-5)…will also assist with flexion of hand and of MCP joint
Flexor Digitorum Profundus
Proximal attachments
(i) Proximal ¾ of medial and anterior surfaces of the ulna and interosseous membrane
Distal attachments
(i) Bases of distal phalanges of medial four digits (2-5)
Two nerves innervate the FDP**
(Median nerve (AIN - anterior interosseous nerve) – lateral portion
(Ulnar nerve – medial portion
Flexes DIP joint of medial four digits (2-5)…will also assist with flexion of hand
Flexor Pollicis Longus
Proximal attachments
(i) Anterior surface of the radius and interosseous membrane
Distal attachments
(i) Base of the distal phalanx of the thumb
Median nerve…AIN (anterior interosseous nerve)
Flexes phalanges of the thumb (1st digit)
Pronator Quadratus
Proximal attachments
(i) Distal ¼ of anterior surface of the ulna
Distal attachments
(i) Distal ¼ of anterior surface of the radius
Median nerve…AIN (anterior interosseous nerve)
Pronates forearm…also help stabilize radius and ulna
Brachioradoalis
Proximal attachments
(i) Proximal 2/3 of lateral supracondylar ridge of humerus
Distal attachments
(i) Lateral surface of distal radius
Radial nerve
Flexes forearm
Supinator
Proximal attachments
(i) Lateral epicondyle of humerus, supinator fossa, crest of ulna
Distal attachments
(i) Lateral, posterior and anterior surface of proximal 1/3 of the radius
Deep branch of radial nerve
Supinates forearm
Extensor Carpi radialis longus
Proximal attachments
(i) Lateral supracondylar ridge of humerus
Distal attachments
(i) Base of 2nd metacarpal
Radial nerve
Extend and abduct hand
Extensor Carpi Radialis Brevis
Proximal attachments
(i) Lateral epicondyle of humerus
Distal attachments
(i) Base of 3rd metacarpal
Deep branch of radial nerve
Extend and abduct hand
Extensor Carpi Ulnaris
Proximal attachments
(i) Lateral epicondyle of humerus and posterior border of the ulna
Distal attachments
(i) Base of 5th metacarpal
PIN (posterior interosseous nerve) – branch of radial nerve
Extend and adduct hand
Extensor Digitorum
Proximal attachments
(i) Lateral epicondyle of the humerus
Distal attachments
(i) Extensor expansion of medial four digits (2-5)
PIN (posterior interosseous nerve) – branch of radial nerve
Extend medial four digits (2-5), assist in wrist extension
Extensor Indices
Proximal attachments
(i) Posterior surface of the ulna and interosseous membrane
Distal attachments
(i) Extensor expansion of second digit
PIN (posterior interosseous nerve) – branch of radial nerve
Extend 2nd digit
Extensor Digiti Minimi
Proximal attachments
(i) Lateral epicondyle of the humerus
Distal attachments
(i) Extensor expansion of 5th digit
PIN (posterior interosseous nerve) – branch of radial nerve
Extends 5th digit
Abductor Pollicis Longus
Proximal attachments
(i) Posterior surface of ulna, radius and interosseous membrane
Distal attachments
(i) Base of 1st metacarpal
PIN (posterior interosseous nerve) – branch of radial nerve
Abducts the thumb
Extensor Pollicis Brevis
Proximal attachments
(i) Posterior surface of radius and interosseous membrane
Distal attachments
(i) Base of proximal phalanx of the thumb
PIN (posterior interosseous nerve) – branch of radial nerve
Extends proximal phalanx of thumb (at the CMC joint - carpometacarpal jt)
Extensory Pollicis Longus
Proximal attachments
(i) Posterior surface of the middle 1/3 of the ulna and the interosseous membrane
Distal attachments
(i) Base of distal phalanx of thumb
PIN (posterior interosseous nerve) – branch of radial nerve
Extends distal phalanx of the thumb (at the interphalangeal joint.)
Trochlea and humerus articulate with
trochlear notch of ulnar
capitulum of humerus articulates with
head of radius
Radial collateral ligament
lateral epicondyle to annular ligament surrounding head of humerus
Ulnar collateral ligament
medial epicondyle to cornoid process and olecranon
anterior, posterior, oblique
Proximal Radioulnar Joint (PRUJ)
head of radius articulates w/radial notch of ulna
radial head stabilized by annular ligament
sacciform reccess–> continuation of synovial joint capsule of elbow
Distal Radioulnar Joint (DRUJ)
Head of ulna articulates with ulnar notch of radius
TFCC
attaches to base of radius and styloid process of ulna
acts as pivot/articular disc during pronation and supination
Anatomical Snuff box
lateral wrist
Boarders–>
abductor pollicis longus & extensor pollicis brevis
extensor pollicis longus tendon
contents–>radial artery
Extensor retinaculum
contains extensor tendons as they pass across the posterior wrist
Palmer carpal ligament
anterior continuation of extensor retinaculum
Flexor Retinaculum
forms roof of carpal tunnel
Flexor pollicis brevis
I- median nerve
A- flexes thumb
Opponens Pollicis
I- median nerve
A- opposes thumb
Abductor Pollicis Brevis
median nerve
abducts thumb, assists with opposition
Adductor Pollicis
two heads—> oblique and transverse
I-ulnar nerve
A-adducts thumb toward midline
Abductor digiti minimi
ulnar nerve
abduction of 5th digit
Flexor digiti minimi brevis
ulnar nerve
flexion of 5th digit
Opponens digiti minimi
ulnar nerve
opposition of 5th digit
Four Dorsal Interossei’s
ABduct the digits with the midline of the hand
DAB–> Dorsal abducts digits
Three Palmer Interossei’s
ADduct’s the digits with the midline of the hand
PAD–> palmer adducts digits
Extensor Expansions of the digits
Extensor tendons (ED,EDM,EI) flatten to form extensor expansions the lumbricals and interossi attach into the lateral band of the hood
Common flexor synovial sheath
FDS and FRP are contained by the common flexor synovial sheath
pass deep to the flexor retinaculum in the carpal tunnel
Digital Synovial Sheaths
protect the long finger tendons as they pass through the digital “pulleys” (fibrous sheath)
Fibrous Digital Sheath
enclose the synovial sheaths, superficial and deep flexor tendons and tendon of flexor pollicis longus
Boarders of the carpal tunnel
Anterior–> flexor retinaculum
Posterior–> carpal bones
Medial and Lateral walls–> carpal bones
Contents of the carpal tunnel
median nerve
FDS tendon
FDP tendons
FPL tendon
