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
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)
