Upper Extremity - Shoulder Girdle Flashcards

1
Q

What are the bone landmarks on the scapula and where are they?

A

Superior angle: top pointy part of the scapula
Inferior angle: bottom pointy part of the scapula
Medial/Vertebral border: side of the scapula that is closest to the vertebral column
Lateral border: ends at the top, ends with the glenoid fossa
Glenoid fossa: shallow socket where the humerus rests
Supraspinous fossa: above the spine of the scapula
Infraspinous fossa: below the spine of the scapula
**Acromion process: ** extension of the spine of the scapula on the posterior side, very large (you can feel it)
Coracoid process: finger-like projection on the anterior side of the scapula (finger points forward and lateral), just superior and medial to the glenoid fossa

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2
Q

What are the actions performed by the shoulder girdle?

A

Protraction: medial sides of scapula move further apart, lateral end of the shoulder girdle moves forward, lateral end of the clavicle rotates around the SC joint and moves forwards (the medial side of the clavicle is attached)
Retraction: the medial sides of the scapula move closer together, the lateral sides of the shoulder girdle move backwards
Elevation: bringing shoulders up to ears motion, lateral point of the shoulder girdle moves up (medial side does not move because it is anchored so it pivots)
Depression: bringing shoulder back to neutral (only a small amount of depression pact neutral), lateral point of the shoulder girdle moves down (medial side does not move because it is anchored so it pivots)

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3
Q

How can the scapula move in the shoulder girdle?

A

Superior Rotation: glenoid fossa moves up, caused by elevation
Inferior Rotation: glenoid fossa moves down, caused by depression
Anterior Tilt: scapula moves up along the ribcage, the top of the scapula tilts forward slightly, caused by elevation
Posterior Tilt: scapula moves down along the ribcage, bottom of the scapula starts to tuck down, caused by depression

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4
Q

What is winging of the scapula, how does it happen and what prevents it from happening?

A

Wining of the scapula is when there is movement in the medial border and inferior angle of the scapula.

Winging can happen because the scapula and ribcage are not held together with ligaments, just muscles to allow for movement. Sometimes the muscles are not strong enough the hold the scapula down and part of the scapula can move away from the ribs (most noticeable in the medial border and inferior angle). Winging can be happen when the pectoralis minor muscle is too tight (causes too much anterior tilt) and the inferior angle of the scapula can pop off the ribcage.

Winging should be stopped by the inferior aspect of the trapezius.
Muscles that are attached to the medial border of the scapula: serratus anterior, rhomboid major and rhomboid minor

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5
Q

The Sternoclavicular (SC) Joint

A

Where the medial side of the clavicle fits into a concave surface on the manubrium of the sternum.

Made of the Anterior Sternoclavicular Ligament, Posterior Sternoclavicular Ligament and Costoclavicular Ligament.

This is the pivot point for all shoulder girdle movements - it needs to be very stable

Articular Disk: between the clavicle and the manubrium - prevents compressive and friction movements from causing damage.

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6
Q

Anterior Sternoclavicular (ASC) Ligament

A

Origin: anterior point of the manubrium
Runs: superiorly and laterally
Insertion: medial end of the clavicle
Limits: retraction of the shoulder girdle and superior movement of the medial end of the clavicle - gravity wants to pull the lateral side of the clavicle and the scapula down so the SC ligaments hold them up

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7
Q

Posterior Sternoclavicular (PSC) Ligament

A

Origin: posterior point of the manubrium
Runs: superiorly and laterally
Insertion: medial end of the clavicle
Limits: deep protraction of the shoulder girdle, and superior movement of the medial end of the clavicle - gravity wants to pull the lateral side of the clavicle and the scapula down so the SC ligaments hold them up

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8
Q

Costoclavicular Ligament

A

Origin: superior aspect of the costal cartilage of the first rib
Runs: superiorly
Insertion: inferior side of the medial end of the clavicle
Limits: superior movement of the medial end of the clavicle

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9
Q

Acromioclavicular (AC) Joint

A

The point where the acromion process of the scapula meets up the lateral end of the clavicle.

This often gets injured often. Results in a separated shoulder (step deformity) - the acromion process has separated away from the lateral end of the clavicle - lateral end is higher.

The joint surfaces are very small and shallow where the lateral end of the clavicle meets the acromion process - because there is not a lot of joint movement the main purpose is to hold them together.

Articular disk between the ends of the clavicle and acromion process

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10
Q

Acromioclavicular (AC) Ligament

A

Re-enforces the joint capsule. Thickest on the superior side of the joint.
Surrounds the AC joint.
Separated in to superior and inferior AC ligaments.
Attaches the lateral end of the clavicle to the medial side of the acromion.

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11
Q

Coracoclavicular Ligaments

A

In the coracoid process.
Pair of muscles: conoid and trapezoid ligaments.

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12
Q

Conoid Ligament

A

Part of the coracoclavicular ligaments (medial side)
Origin: coracoid process
Insertion: conoid tubercle on the inferior aspect of the clavicle
Limits: superior translation of the lateral end of the clavicle (relative to scapula) and dropping of the scapula - gravity is trying to pull the scapula down but the conoid ligament holds it up

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13
Q

Trapezoid Ligament

A

Origin: coracoid process
Insertion: conoid tubercle on the inferior aspect of the clavicle
Limits: superior translation of the lateral end of the clavicle (relative to scapula) and dropping of the scapula - gravity is trying to pull the scapula down but the conoid ligament holds it up

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14
Q

Coracoacromial Ligament

A

Origin: tip of the coracoid process
Insertion: acromion process

This does not support the AC joint because it’s origin and insertion are on the same bone

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15
Q

Trapezius Muscle

A

On the posterior side of the body.
Origin: external occipital protuberance, superior nuchal line, and down the nuchal ligament
Runs: from T1-T12 (has attachments to each spinous process it crosses)
Insertion: shoulder girdle
Function is separated into 3 separate groups because the muscle is so large and has so many functions - UFT, MFT and LFT

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16
Q

Nuchal Ligament

A

Part of the origin for the trapezius.
Origin: external occipital protuberance
Runs: vertically down the midline of the spine - connections to spinous processes from C1-C7
Insertion: C7
Limits: flexion of the cervical spine

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17
Q

Upper/Descending Fibers of Trapezius (UFT)

A

Origin: the skull and cervical spine
Fiber Direction: down
Insertion: superior aspect of the lateral 1/3 of the clavicle - stops around the AC joint
Actions: elevation of the shoulder girdle

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18
Q

Middle Fibers of Trapezius (MFT)

A

Origin: T1-T3
Fiber direction: horizontal
Insertion: AC joint to the superior aspect of the acromion process to the superior aspect of the spine of the scapula
Actions: retraction of the shoulder girdle

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19
Q

Lower/Ascending Fibers of Trapezius (AFT)

A

Origin: T3-T12
Fiber direction: up
Insertion: superior aspect of the spine of the scapula
Actions: superior rotation of the scapula (by pulling the medial side of the scapula down), depression of the shoulder girdle (if arms are raised), and posterior tilt of the scapula (caused by depression)

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20
Q

Levator Scapulae

A

Deep to Trapezius.
Origin: transverse process from C1-C4
Insertion: superior angle of the scapula and medial border of the scapula (above the spine of the scapula) - mostly the superior angle
Actions: inferior rotation of the scapula (caused by elevation of the superior angle of the scapula)

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21
Q

Rhomboid Major

A

Below Rhomboid Minor, deep to Trapezius
Origin: Spinous processes from T2-T5
Runs: Inferiorly and Laterally
Insertion: medial border of the scapula - distal to the spine of the scapula
Actions: retraction of the shoulder girdle and inferior rotation of the scapula

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22
Q

Rhomboid Minor

A

Above Rhomboid Major, deep to Trapezius.
Origin: spinous processes of C7 and T1
Runs: inferiorly and laterally
Insertion: medial border of the scapula - the root of the spine of the scapula
Actions: retraction of the shoulder girdle, and inferior rotation of the scapula

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23
Q

Serratus Anterior

A

Between the ribs and the scapula
Origin: lateral aspects of the upper 8 ribs
Runs: back (as 1 muscle belly) along the medial border of the scapula
Insertion: anterior surface of the scapula
Actions: protraction of the shoulder girdle (upper fibers pull horizontally) and superior rotation of the scapula (lower fibers pull obliquely)

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24
Q

Pectorialis Minor

A

Small, triangle shaped muscle, deep to pectoralis minor.
Origin: anterior aspect of ribs 3-5
Runs: superiorly and slightly posteriorly
Insertion: medial side of the coracoid process
Actions: protraction of the shoulder girdle, depression of the shoulder girdle, anterior tilt of the scapula

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25
Q

Flexion in the Sagittal Plane

A

Brining your arm up with the thumb pointing back, fingers pointing up

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26
Q

Extension in the Sagittal Plane

A

Bringing your arm behind you as far as it can go

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27
Q

Adduction in the frontal plane

A

Moving the arm back towards the midline of the body

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28
Q

Abduction in the Frontal Plane

A

Moving the arm away from the midline of the body

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29
Q

Cross flexion in the Horizontal Plane

A

Start Position: shoulder abducted at 90 degrees
Bring the arm as far across the front of the body as possible

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30
Q

Cross Extension in the Horizontal Plane

A

Start Position: shoulder abducted at 90 degrees
Bring the arm as far back across the body as possible

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31
Q

External Rotation of the GH Joint in Adduction

A

Start Position: elbow flexed at 90 degrees, resting at side, thumb up
Spin the humerus so it points away from the body (hand points laterally)

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32
Q

Internal Rotation of the GH joint in Adduction

A

Start Position: elbow flexed at 90 degrees, resting at side, thumb up
Spin the humerus so it points towards the body (hand points medially)

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33
Q

External Rotation of the GH joint in abduction

A

Starting Position: elbow bent at 90 degrees, abduct shoulder 90 degrees, fingers point forwards
Rotate the humerus so the fingers point up

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34
Q

Internal Rotation of the GH Joint in Abduction

A

Starting Position: elbow bent at 90 degrees, abduct shoulder 90 degrees, fingers point forwards
Rotate the humerus so the fingers point down

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35
Q

What are the Fossa of the Scapula?

A

Supraspinous Fossa - on posterior side, above the spine of the scapula
Infraspinous Fossa - on posterior side, below the spine of the scapula
Glenoid Fossa - on lateral side, attachment point for the humerus
Subscapular Fossa - on anterior side, under the scapula (next to the ribcage)

36
Q

Parts of the Glenoid Fossa

A

2 roughened areas: supraglenoid tubercle and infraglenoid tubercle (attachment point for ligaments and muscles)
Glenoid Labrum: goes around the circumference of the glenoid fossa, acts as a seal, made of fibrocartilage, often torn with dislocation

37
Q

Features on the Humerus

A

Head: fits into the glenoid fossa
Anatomical Neck: just below the head, slightly narrower
Lesser Tuberosity: distal to the neck, on medial and anterior side
Greater Tuberosity: dital to the neck, lateral and posterior side
Bicipital Groove: between the lesser and greater tubercle - has a medial crest and lateral crest
Surgical Neck: narrower, smaller cross sectional area, easier to fracture
Deltoid Tuberosity: more distal, roughened area, indertion point of the deltoids

38
Q

What are the Glenohumeral Ligaments?

A

Superior Glenohumeral Ligament (SGHL), Middle Glenohumeral Ligament (MGHL), and Inferior Glenohumeral Ligament Complex (IGHL)

39
Q

The Superior Glenohumeral Ligament

A

Origin: 1:00 position on the glenoid rim
Insertion: lesser tuberosity of the humerus
Limits: external rotation of the GH joint (in slight abduction) and anterior translation of the humerus

40
Q

The Middle Glenohumeral Ligament

A

Origin: 2:00 position on the glenoid rim
Insertion: lesser tuberosity and the anatomical neck of the humerus
Limits: external rotation of the GH joint (in slight abduction) and anterior translation of the humerus

41
Q

The Inferior Glenohumeral Ligament Complex

A

3 Parts: Anterior band, axillary pouch (not really a ligament), and posterior band
Origin: 3:00 - 8:00 position on the glenoid rim
Runs: front to back
Insertion: anatomical neck of the humerus
Limits: external rotation of the joint (in full abduction) and anterior translation of the humerus

42
Q

The Rotator Cuff

A

Does not completly wrap around the head of the humerus
Made of 4 muscles: subscapularis, teres minor, infraspinatus, and supraspinatus
Teres minor, infraspinatus and supraspinatus have tendons that are continuous with each other - they are seperated from the subscpularis because of the rotator interval

43
Q

The Subscapularis

A

On the anterior side of the joint - largest of the 4 rotator cuff muscles
Origin: subscapular fossa
Runs: superiorlly and laterally across the front of the GH joint capsule
Insertion: lesser tuberosity
Action: internal rotation of the humerus and compression of the head of the humerus into the glenoid fossa

44
Q

The Supraspinatus

A

On posterior side
Origin: supraspinous fossa
Runs: across the top of the GH joint (shoulder)
Insertion: superior part of the greater tuberosity
Action: abduction of the GH joint, compression of the head of the humerus into the glenoid fossa

45
Q

The Infraspinatus

A

On posterior side
Origin: infraspinous fossa
Insertion: posterior aspect of the greater tuberosity
Action: external rotation of the GH joint, compression of the head of th humerus into the glenoid fossa

46
Q

The Teres Minor

A

On posterior side
Origin: lateral border of the scapula
Insertion: posterior and inferior aspect of the greater tubersoity
Action: external rotation of the GH joint, compression of the head of the humerus into the glenoid fossa

47
Q

The Deltoid

A

Triangle shaped muscle with wide origins and 1 common, narrow insertion
3 Parts: clavicular/anterior, acromial/middle and spinal/posterior
The Delto-pectoral triangle: small triangle shaped space between the anterior head of the deltoid and the pectoralis major

48
Q

The Calvicular/Anterior part of the Deltoid

A

Origin: lateral 1/3 of the clavicle on the inferior border (until the AC joint)
Runs: inferiorly and laterally
Insertion: deltoid tuberosity on the lateral side of the humerus
Action: abduction of the GH joint, flexion of the GH joint (both planes) and internal rotation of the shoulder

49
Q

The Acromial/Middle part of the Deltoid

A

Origin: lateral edge of the acromion process
Runs: inferiorly
Insertion: deltoid tuberosity on the lateral side of the humerus
Action: abduction of the GH joint

50
Q

The Spinal/Posterior part of the Deltoid

A

Origin: the spine of the scapula
Runs: inferiorlly and laterally (superior to infraspinatus and teres minor)
Insertion: deltoid tuberosity on the lateral side of the humerus
Action: abduction of the GH joint, extension of the GH joint and external rotation of the shoulder

51
Q

The Anterior Wall of the Axilla

A

Pectoralis Major + Coracobracialis

52
Q

Posterior wall of the Axilla

A

Latissimus Dorsi + Teres Major

53
Q

The Pectoralis Major

A

Origin: medial 1/2 of the inferior border of the clavicle (stop at AC joint), the length of the sternum, ribs 1-6, and some connective tissue in the abdomen
Runs: clavicular fibers = inferiorly and laterally, sternal fibers = horizontal, distal part of the sternum and abdomen = superiorly and laterally
Insertion: lateral lip of the bicipital groove of the humerus (clavicular fibers insert lower, distal part of the sternum and abdominal fibers insert higher)
Actions: flexion of the GH joint (both planes), adduction of the GH joint, internal rotation of the GH joint

54
Q

The Coracobrachialis

A

Origin: tip of the coracoid process
Runs: inferiorly and laterally (anterior to posterior)
Insertion: 1/2 down the shaft of the humerus, slightly medial
Actions: flextion of the GH joint (both planes), adduction of the GH joint

55
Q

The Latissimus Dorsi

A

Origin: T7-L5, posterior portion of the iliac crest, and ribs 10-12
Runs: superiorly - travels through the bottom of the armpit and wraps around to the front of the humerus (posterior to anterior)
Insertion: the bicipital groove of the humerus
Action: ectension of the GH joint (both planes), adduction of the GH joint, internal rotation of the GH joint

56
Q

The Teres Major

A

Origin: lateral border of the scapula (close to inferior angle)
Runs: superiorly and laterally - travels through the bottom of the armpit and wraps around to the front of the humerus (posterior to anterior)
Insertion: the medial lip of the bicipital groove of the humerus
Actions: extension of the GH joint (both planes), adduction of the GH joint, internal rotation of the GH joint

57
Q

Annular Ligament

A

Allows the radius to move while still being close to the ulna - what allows for pronation and supination

58
Q

Superior Radial Ulnar Joint

A

The annular ligament and the read of the radius resting against the lateral side of the notch of the ulna

59
Q

Humero-radial Joint

A

The head of the radius connects with the capitulum of the humerus
Held by the Radial Collateral Ligament

60
Q

Radial Collateral Ligament

A

2 bands - anterior and posterior
Origin: lateral epicondyle of the humerus
Insertion: annular ligament (and for posterior) the supinator crest of the ulna
Limits: Varus movement

61
Q

Humero-ulnar Joint

A

The ulna connects with the humerus - olecranon process (ice cream scoop)
The coracoid and olecranon processes on the ulna arap around the olecranon fossa of the humerus
Held by the Ulnar Collateral Ligament

62
Q

Ulnar Collateral Ligament

A

3 bands - anterior, posterior, transverse
Origin: medial epicondyle of the humerus
Insertions: anterior-coronoid process, posterior-olecranon process, transverse- olecranon
Limits: valgus movement

63
Q

Biceps Brachii

A

Origin: short head-corocoid process, long head-supraglenoid tubercle
Runs: down the humerus (as 1 muscle belly), the long head crosses the top of the shoulder
Insertion: radial tuberosity and bicipital aponeurosis
Actions: flexion of the elbow and supination

64
Q

Brachialis

A

Deep to Biceps Brachii
Origin: anterior aspect of the humerus
Insertion: ulnar tuberosity
Actions: flexion of the elbow

65
Q

Triceps Brachii

A

3 heads (long, medial and lateral)
Origin: long head-infraglenoid tubercle of the scpula, medial head-posterior side of the humerus, lateral head-posterior side of the humerus
Insertion: olecranon process of the ulna
Actions: extension of the elbow and extension and adduction of the GH joint

66
Q

Carpal Bones

A

The head of the ulna connects to the carpals on the pinky side
Promimal Row: scaphoid, lunate, triquetreum, pisiform
Distal Row: trapezium, trapezoid, capitate, hamate

67
Q

Movements of the Wrist and Hand

A

Flexion: closing the hand
Extension: opening the hand
Ulnar Deviation: tilting the wrist to the pinky side
Radial Deviation: tilting the wrist to the thumb side
Pronation: turning the pam down
Supination: turning the palm up
Adduction: bringing the fingers together
Abduction: seperating the fingers
Protraction: bringing the thumb and pinky together
Retraction: seperating the thumb and pinky

68
Q

Pronator Teres

A

Anterior - superficial
Origin: medial epicondyle of the humerus
Insertion: 1/3 of the way down the radius
Action: pronation

69
Q

Flexor Carpi Radialis

A

Anterior - superficial
Origin: medial epicondyle of the humerus
Insertion: base of the 2nd and 3rd metacarpals
Action: flexion of the wrist and radial deviatoin

70
Q

Flexor Carpi Ulnaris

A

Anterior - superficial
Origin: medial epicondyle of the humerus
Insertion: pisiform, hook of hamate, base of 5th metacarpal
Action: flexion of the wrist and ulnar deviation

71
Q

Palmaris Longus

A

Anterior - superficial
Origin: medial epicondyle of the humerus
Insertion: Palmar Aponeurosis (middle of the wrist)
Action: flexion of the wrist

72
Q

Flexor Digitorum Superficialis

A

Anterior - deep
Origin: medial epicondyle of the humerus, ulna, shaft of the radius
Runs: splits into 4 tendons
Insertion: base of the middle phalanges (2-5)
Action: flexion of the wrist, MCP joints and PIP joints

73
Q

Flexor Digitorum Profundus

A

Anterior - deep
Origin: ulna
Runs: splits into 4 tendons
Insertion: base of the distal phalanges (2-5)
Actions: flexion of the wrist, MCP, PIP and DIP joints

74
Q

Flexor Retinaculum

A

bridge over the carpal tunnel that holds the tendons in place - on the palmar side of the wrist

75
Q

Brachioradiais

A

Lateral aspect of the forearm - most superficial
Origin: lateral supracondylar ridge of the humerus
Insertion: distal end of the radius (crosses the elbow)
Actions: flexion of the elbow

76
Q

Extensor Carpi Radialis Brevis

A

Lateral aspect of the forearm - most deep
Origin: lateral epicondyle of the humerus
Insertion: base of 3rd metacarpal
Actions: extension of the wrist and radial deviation

77
Q

Extensor Carpi Radialis Longus

A

Lateral aspect of the forearm - middle
Origin: lateral supracondylar ridge of the humerus
Insertion: base of 2ns metacarpal
Actions: extension of the wrist, radial deviation

78
Q

Extensor Carpi Ulnaris

A

Posterior aspect of the forearm
Origin: lateral epicondyle of the humerus
Insertion: base of the 5th metacarpal
Actions: ulnar deviation, extension of the wrist

79
Q

Extensor Digitorum

A

Posterior aspect of the forearm
Origin: lateral epicondyle of the humerus
Runs: breaks into 4 tendons
Insertion: distal and middle phalanges
Actions: extension of phalanges 2-5 and extension of the wrist

80
Q

Extensor Digiti Minimi

A

Posterior aspect of the forearm
Origin: lateral epicondyle of the humerus
Insertion: 5th metacarpal
Actions: extension of the 5th phalange and extension of the wrist

81
Q

Supinator

A

Posterior aspect of the forearm
Origin: lateral epicondyle of the humerus and supinator crest of the ulna
Runs: around the radius
Insertion: proximal 1/3 of the radius
Action: supination

82
Q

Muscles of the Hand - Thenar Muscles

A

Thumb side - 4 muscles - for opposition and gripping

83
Q

Muscles of the Hand - Hypothenar Muscles

A

Pinky side - 4 msucles - opposition and gripping

84
Q

Muscles of the Hand - Interossi

A

Attached to the metacarpals and proximal phalanges of each finger (between the fingers) - abduction and adduction of the fingers

85
Q

Power Grips

A

Cylinder Grip: fingers and thumb wrap around but do not overlap - eg. holding a mug
Spherical Grip: grasping a spherical object in the palm - eg. holding a baseball
Hook Grip: fingers flex with no thumb movement - eg. holding grocery bags
Fist Grip: like a cylinder but with thumb overtop of fingers - eg. holding a bar to do a chinup

86
Q

Prehensile Grips

A

Tip to Tip Pinch: tips of your fingers touching - eg. holding thread when trying to thread a needle
Lateral Pinch: thumb presses the object against the side of the finger - eg. holding a pencil
Pad Pinch: hold the object between the pads of your fingers - eg. pinch of salt

87
Q
A