Upper Extremity Flashcards
Levator Scapulae
Action: elevates scapula, downward rotation of scapula
Sup/prox: Posterior tubercle of transverse processes, CV1-CV4
Inf/dist: superior aspect of medial border of scapula
Innervations: Dorsal scapular n. C5; C3-C4 ventral rami(sensory)
Upper Trapezius
Action: upwardly rotate with lower trapezius (inferior angle lateral) elevate and retract scapula
Sup/prox: Medial 1/3 superior nuchal line (on back of head); occipital protuberance to CV7, (ligamentum nuchlae- large median ligament composed of tendons and fascia located between posterior muscle of the neck (C1-C6)
Inf/dist: Lateral 1/3 clavicle
Innervation: CN XI (motor); ventral rami C3-C4 (sensory)
Middle Trapezius
Action: retract scapula
Sup/prox: CV7 to TV4 spinous process
Inf/dist: acromion and crest of spine of scapula
Innervation: CN XI (motor); ventral rami C3-C4 (sensory)
Lower Trapezius
Action: upwardly rotate scapula with upper trap, depress, retract scapula
Sup/prox: TV4-TV12 spinous process
Inf/dist: spine of scapula
Innervation: CN XI (motor), C3, C4 ventral rami (sensory)
Serratus Anterior
Action: protract scapula and holds it against thoracic wall; upward rotation of scapula
Sup/prox: exterior lateral surface of ribs 1-8
-digitations on anterior side, lateral to ribs, inferior to scapula laterally
Inf/dist: anterior surface of medial border of scapula
Innervation: Long thoracic N. C5, *C6*, C7
Pectoralis Major
Action: adduction and internal rotation of humerus
-clavicular head alone: flexes humerus
-SC (sternocostal) head alone: extends humerus from overhead position
-horizontal adduction at g/h joint
Sup/prox: clavicular head-anterior surface of medial 1/2 of clavicle
-sternocostal heads-anterior surface of sternum, upper 6 costal cartilages, and aponeurosis (sheet of peraly white fibrous tissue that takes place of tendon ins heetlike muscles having wide area of attachment)
Inf/dist: lateral lip of intertubercular groove of humerus
Innervation: Lateral and medial pectoral n., Clavicular C5-C6, SC C7, C8, T1
Pectoralis Minor
Action: stabilizes scapula by drawing it inferiorly and anteriorly against the thoracic wall
Sup/prox: 3rd to 5th ribs near costal cartilages
Inf/dist: medial border and superior surface of coracoid process of scapula
Innervation: Medial and lateral pectoral n. C6, C7, C8
Anterior Deltoid
Action: abduction, flexion, internal rotation of humerus
Sup/prox: Lateral 1/3 of the clavicle, anterior surface
Inf/dist: deltoid tuberosity of the humerus (posterior)
Innervation: axillary n. C5, C6
Middle Deltoid
Action: abduct the humerus
Sup/prox: lateral aspect of the acromion
Inf/dist: deltoid tuberosity (post)
Innervation: axillary N. C5, C6
Posterior Deltoid
Action: extend, externally rotate, abduct humerus
Sup/prox: inferior lip of crest of spine of scapula
Inf/dist: deltoid tuberosity
Innervation: axillary n. C5, C6
Supraspinatus
Action: Initiates and assists deltoid in abduction of humerus
-holds head in glenoid cavity (rotator cuff)
sup/prox: supraspinous fossa (medial 2/3) of scapula
inf/dist: superior facet on greater tubercle
Innervation: suprascapular n. C4, C5, C6
Infraspinatus
Action: external rotation of humerus
-holds humeral head in glenoid (rotator cuff)
Sup/prox: infraspinous fossa of scapula
inf/dist:middle facet of greater tubercle of humerus
Innervation: suprascapular n. C5, C6
Teres Minor
Action: external rotation of humerus
-holds humeral head in glenoid (rotator cuff)
Sup/prox: middle part of lateral border of scapula
inf/dist:inferior facet on greater tubercle of humerus
Innervation: axillary n. C5, C6
Subscapularis
Action: internal rotation and adduction of humerus
-holds head of humerus in glenoid (rotator cuff)
Sup/prox: subscapular fossa
inf/dist: lesser tubercle of humerus
Innervation: upper and lower subscapular n. C5, C6, C7
Teres Major
Action: extension, adduction, internal rotation of humerus
Sup/prox: dorsal surface of inferior angle of scapula
inf/dist: medial lip of intertubercular groove (anterior aka bicipital groove)
Innervation: lower subscapular n. C5, C6
Rhomboids Major
Action: retract scapula, downward rotation of scapula, fix scapula against thoracic wall
Sup/prox: spinous process TV2-TV5
inf/dist: medial border of scapula from spine to inferior angle
Innervation: dorsal scapular N. C4-C5
Rhomboids Minor
Action: retract scapula, elevate scapula, downward rotation scapula, fix scapula against thoracic wall
Sup/prox: nuchal ligament and spinous process CV7 +TV1
Inf/dist: medial border of scapula at level of spine
Innervation: Dorsal scapular n. C4-C5
Latissmus Dorsi
Action: extension, adduction, internal rotation of humerus
sup/prox: thoracolumbar fascia (aponeurosis), spinous process TV6-TV12, inferior 3 or 4 ribs, iliac crest
Inf/Dist: floor of intertubercular (bicipital) groove of humerus (posterior)
Innervation: Thoracodorsal N. C6, C7, C8
Coracobrachialis
Action: flexion with adduction of humerus
sup/prox: tip or apex of coracoid process of scapula (anterior)
inf/dist: middle 1/3, medial humerus
Innervation: musculocutaneous n. C5, C6, C7
Biceps Brachii
Action: Long- weak shoulder flexion
-weak abduction of humerus externally rotates
*both heads- elbow flexion with forearm supination
sup/prox:
short head-coracoid process of scapula
long head- supraglenoid tubercle of scapula
Inf/dist: Radial tuberosity and fascia of forearm via bicipital aponeurosis
Innervation: musculocutaneous n. C5, C6
Brachialis
Action: elbow flexion regardless of position
sup/prox: distal half humerus, anterior surface (from elbow)
inf/dist: ulnar tuberosity and anterior aspect of coronoid process of ulna
Innervation: musculocutaneous n. C5, C6
Brachioradialis
Action: elbow flexion (midpronation most effective)
sup/prox: proximal 2/3 of lateral supracondylar ridge of humerus
Inf/dist: lateral surface of distal end of radius
Innervation: radial n. C5, C6, C7
Triceps
Action: (all heads) elbow extension
-(long head) steadies head of abducted humerus
sup/prox: (long head) infraglenoid tubercle of scapula
(lateral head) posterior surface of humerus, superior to radial groove
(medial head) posterior surface humerus, inferior to radial groove
inf/dist: proximal end of olecranon process of the ulna and fascia of forearm
Innervation: Radial n. C6, C7, C8
Aconeus
Action: assists in elbow extension
sup/prox: lateral epicondyle of humerus (posterior surface)
inf/dist: olecranon process of ulna (lateral surface)
Innervation: radial n. C7, C8, T1
Pronator Teres
Action: pronates forearm, flexes elbow
Sup/prox: (humeral head) medial epicondyle of humerus
(ulnar head) coranoid process of the ulna
Inf/dist: middle of lateral surface of radius
Innervation: median n. C6, C7
Pronator Quadratus
Action: pronates forearm
sup/prox: distal 1/4 of anterior surface of the ulna
inf/dist: distal 1/4 of anterior surface of radius
Innervation: anterior interosseus n. (from median n.) C8-T1
Supinator
Action: supinates forearm
Sup/prox: lateral epicondyle of humerus, radial collateral and annular ligaments, supinator fossa and crest of ulna
inf/dist: proximal radius, anterior, lateral, posterior surfaces
innervation: deep branch radial n. C7,C8
Triangular Space
Circumflex scapular artery
Borders:
Inferior: superior border of the teres major (inf. margin)
Lateral: the long head of the triceps
Superior: Teres minor of subscapularis
Quadrangular Space
Axillary nerve and posterior circumflex humeral artery
Borders:
Above/superior: the teres minor (inf. margin)
Below/inferior: the teres major (sup. margin)
Medially: the long head of the triceps brachii (lat. margin)
Laterally: the surgical neck of the humerus
Anteriorly: the subscapularis
Rotator Cuff (SITS)
Hold head of humerus in the glenoid cavity
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
Upward rotation of scapula
- upper and lower traps working together
- serratus anterior
Downward rotators of scapula
- rhomboid major
- rhomboid minor
- levator scapulae
Retractors of Scapula
- Rhomboid major
- Rhomboid minor
- Upper, middle, lower trapezius
Protractors of Scapula
-Serratus Anterior
Internal Rotation of Humerus
- Pectoralis major
- Anterior deltoid
- Subscapularis
- Teres major
- Latissmus Dorsi
External Rotation
- posterior deltoid
- infraspinatus
- teres minor
Adduction of humerus
-Pectoralis major (entire)
*SC head of pec major-horizontal add @ g/h joint
- subscapularis
- teres major
- latissmus dorsi
Abduction of humerus
- anterior,middle, posterior deltoid
- supraspinatus (assists deltoids)
- long head of triceps (steadies humerus)
Extension of humerus
- sternocostal head of pec major (from overhead position)
- posterior deltoid
- teres major
- latissmus dorsi
Flexion of humerus
- clavicular head of pec major
- anterior deltoid
- coracobrachialis (with adduction)
Muscles that fix scapula against thoracic wall
- rhomboid major
- rhombod minor
- serratus anterior
- pectoralis minor
Elevation of scapula
- Rhomboid major
- Rhomboid minor
- Levator scapulae
- upper trapezius
Depress Scapula
lower trapezius
Elbow flexion
- brachialis
- brachioradialis (most effective in midpronation)
- pronator teres
- biceps brachii (both heads)
Forearm pronators
- pronator teres
- pronator quadratus
Flexor carpi radialis
Action: Flexion and abduction of hand at the wrist
*SUPERFICIAL*
Sup/prox: medial epicondyle of the humerus
Inf/dist: base of 2nd metacarpal
Innervation: Median n. C6-C7
Flexor carpi ulnaris
Action: flexes and adducts hand at the wrist
*SUPERFICIAL*
sup/prox:
- humeral head: medial epicondyle of humerus
- ulnar head: olecranon and posterior border of ulna
Inf/dist: pisiform, hook of hamate and base of 5th metacarpal
Innervation: Ulnar n. C7-C8
Palmaris Longus
Action: assist wrist flexion; tense palmar aponeurosis
*SUPERFICIAL*
Sup/prox: medical epicondyle from the common flexor origin
Inf/dist: distal 1/2 of the flexor retinaculum and palmar aponeurosis
Innervation: Median N. (C7, C8)
Flexor Digitorum Superficialis
Action: flexes PIP joints of medial four digits: also flexes MCP joints; assist wrist flexion
*SUPERFICIAL*
Sup/prox:
Humeroulnar head: medial epicondyle of humerus, ulnar collateral ligament, coronoid process of ulna;
Radial head: sup 1/2 of ant border of radius
Inf/dist: Bodies of middle of phalanges of medial 4 digits
Innervation: Median N. C7-T1
Flexor digitorum profundus
Action: DIP flexion of medial four digits; also flexes PIP and MCP; assist wrist flexion
*DEEP*
sup/prox: proximal 3/4 of medial and anterior surface of ulna and interosseous membrane
inf/dist: bases of distal phalanges of medial 4 digits
Innervation: Anterior interosseous n. (from median n.) C8-T1 to lateral 2 FDP
-ulnar n. C8-T1 to medial 2 FDP
Flexor Pollicis Longus
Action: flexes IP, MCP, CMC of thumb
*DEEP*
Sup/prox: anterior surface of radius adj interosseous membrane
Inf/dist: base of distal phalanx of thumb
Innervation: Ant. interosseous n. (from median n. C8-T1)
Extensor Carpi Radiais Longus
Action: extension and abduction of hand at wrist joint
Sup/prox: lateral supracondylar ridge of humerus
Inf/dist: base of 2nd metacarpal bone
Innervation: Radial n. C6, C7
Extensor carpi radial brevis
Action: extension and abduction of hand at wrist joint
Sup/prox: lateral epicondyle of humerus
Inf/dist: Base of 3rd metacarpal
Innervation: Deep branch of radial n. C7-C8
Extensor Digitorum
Action: Extend medial 4 digits at MCP, PIP, DIP, CMC joints
Sup/prox:lateral epicondyle of humerus
Inf/dist: Base of middle phalanges of fingers of medial 4 digits via extensor expansion (hood mechanism)
Innervation:Post interosseous n. C7-C8 (continuation of deep branch of radial n.)
Extensor Digiti Minimi
Action: Extension of 5th digit at CMC, MCP and IP (PIP,DIP) joints
Sup/prox: lateral epicondyle of humerus
Inf/dist: extensor expansion of 5th digit
Innervation: PIN C7-C8
Extensor Carpi Ulnaris
Action: extension and adduction of hand at wrist
Sup/prox: lateral epicondyle of humerus and posterior border of ulna
Inf/dist: Base of 5th metacarpal
Innervation: PIN C7-C8
Abductor Pollicis Longus
Action: abduction of thumb and extends it at CMC joint
Sup/prox: posterior surface of proximal halves of ulna, radius, and interosseous membrane
Inf/dist: Base of 1st metacarpal
Innervation: PIN C7-C8
Extensor Pollicis Brevis
Action: extends proximal phalanx of thumb at MCP; extension at CMC
Sup/prox: posterior surface of radius and interosseous membrane
Inf/dist: dorsal aspect base of proximal phalanx of thumb
Innervation: PIN
Extensor pollicis longus
action: extension of distal phalanx of thumb at IP; extension of MCP and CMC joints
sup/prox: posterior surface of middle 1/3 of ulna and interosseous membrane
Inf/dist: base of distal phalanx of thumb
Innervation: PIN C7-C8
Extensor Indicis
Action: extension of 2nd digit; assists with wrist extension
Sup/prox: posterior surface of distal 1/3 of ulna and interosseous membrane
Inf/dist: extensor expansion of 2nd digit
Innervation: PIN C7-C8
Abductor Pollicis Brevis
Action: abduction of thumb; assist thumb opposition
Sup/prox: Flexor retinaculum and tubercles of scaphoid and trapezium
Inf/dist: lateral side of base of proximal phalanx of thumb and extensor expansion
Innervation: Recurrent branch Median N. (C8,T1)
Flexor Pollicis Brevis
Action: (2 heads), flexion of thumb
Sup/prox: flexor retinaculum and tubercles of scaphoid and trapezium
Inf/dist: lateral side of base of proximal phalanx of thumb
Innervation:
- Superficial head: Recurrent branch of median n. (C8,T1)
- Deep head: Deep branch of ulnar n. (C8, T1)
Opponens Pollicis
Action: oppose thumb
Sup/prox: flexor retinaculum and tubercles of scaphoid and trapezium
Inf/dist: lateral aspect of 1st MC
Innervation: Recurrent branch of median n. (C8, T1)
Adductor Pollicis
Action: (2 heads), adducts thumb
Sup/prox:
- oblique: base of 2nd and 3rd MC, capitate and adj carpals
- transverse: anterior surface of shaft of 3rd MC
Inf/dist: medial side of base of proximal phalanx of thumb
Innervation: Deep branch ulnar n. (C8, T1)
Abductor Digiti Minimi
Action: abduct 5th digit; assist MCP flexion of 5th proximal phalanx
Sup/prox: pisiform
Inf/dist: medial side of base of proximal phalanx of 5th digit
Innervation: Deep branch of ulnar n. (C8, T1)
Flexor digiti minimi brevis
Action: flexes proximal phalanx (MCP) of 5th digit
Sup/prox: hook of the hamate and flexor retinaculum
Inf/dist: medial side base of proximal phalanx of 5th digit
Innervation: Deep branch of ulnar n. (C8, T1)
Opponens Digiti Minimi
Action: draws 5th MC anteriorly to oppose the thumb
Sup/prox: hook of the hamate and flexor retinaculum
Inf/dist: medial border of 5th MC
Innervation: Deep branch of ulnar n. (C8, T1)
Lumbricals 1 and 2
Action: flex MC joints and extend IP joints
Sup/prox: lateral tendons of FDP
Inf/dist: lateral sides of extensor expansion of digits 2-5
Innervation: Median nerve (C8, T1)
Lumbricals 3 and 4
Action: flex MC joints and extend IP joints
Sup/prox: bipennate from medial 3 tendons of FDP
Inf/dist: lateral sides of extensor expansion of digits 2-5
Innervation: Deep branch of ulnar n. (C8, T1)
Palmar Interossei
Action: adduct 2nd, 4th, and 5th digit toward midline: assist with MCP flexion, IP extension
Sup/prox: palmar surfaces of 2nd, 4th, and 5th MC
Inf/dist: base of proximal phalanges and extension expansion of 2nd, 4th, and 5th digits
Innervation: Deep branch of ulnar n. (C8, T1)
Dorsal Interossei
Action: abduct digits 2-4 away from midline; assist with MCP flexion; IP extension
Sup/prox: bipennate adjacent sides of metacarpals
Inf/dist: base of proximal phalanges and extension expansions of 2nd, 3rd (bilaterally), and 4th digits
Innervation: Deep branch of ulnar n. (C8, T1)
Thenar Muscles
opponens pollicis
flexor pollicis brevis
abductor pollicis brevis
*flex and abd brevis both originate at flexor retinaculum and insert at lateral base of proximal phalanx
*opponens pollicis is deep to abd poll brevis
Hypothenar muscles
abductor digiti minimi, opponens digiti minimi, flexor digiti minimi brevis
*flexor digiti minimi and opponens digiti minimi both originate at hook of hamate and flexor retinaculum
*opponens digiti minimi is deep to flexor digiti minimi
*all insert onto proximal phalanxe of 5th digit
Elbow Flexors
Biceps Brachii
Brachialis
Brachioradialis (midpronation)
Pronator Teres
Elbow Extensors
Tricpes
Anconeus
Abductors of Wrist
Extensor Carpi radialis longus
Extensor Carpi Radialis Brevis
Flexor carpi radialis
Adductors of Wrist
Flexor Carpi Ulnaris
Extensor Carpi Ulnaris
Abductors (hand)
abductor pollicis brevis
abductor pollicis longus
abductor digiti minimi
dorsal interossei
Adductors (hand)
Palmar Interossei
adductor pollicis
Opposers
opponens pollicis
abductor pollicis brevis
opponens digiti minimi
