Upper Limb 3 Flashcards by Andrew Hay

What do the muscles in the anterior compartment of the forearm do in general compared to the posterior compartment of the forearm?

Anterior compartment = flexion and pronation

Posterior compartment = extension and supination

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Name the 3 groups of muscles of the anterior forearm

Superficial
Intermediate
Deep

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What are the 4 muscles of the superficial group of the anterior forearm?

Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris

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What is the common flexor origin of the anterior forearm?

How does this compare to the common extensor origin?

Medial epicondyle

Lateral epicondyle

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What is the action of pronator teres?

Pronation of the forearm

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What is the innervation of the pronator teres?

Median nerve

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Pronator teres = pronation

The other 3 muscles of the superficial group of the anterior forearm flex the hand at the wrist joint.

Which muscles in addition to this adduct and abduct at the wrist joint?

Adduct the wrist joint = flexor carpi ulnaris

Abduct the wrist joint = flexor carpi radialis

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What two muscles work to abduct the wrist?

Flexor carpi radialis

Extensor carpi radialis (longus and brevis)

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What two muscles work to adduct the wrist?

Flexor carpi ulnaris

Extensor carpi ulnaris

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What nerves supply the 4 muscles of the superficial group of anterior compartment of forearm?

Median supplies all apart from the flexor carpi ulnaris which is supplied by the ulnar nerve

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What is unique about the brachioradialis muscle?

Belongs to the extensor compartment and is supplies by an extensor compartment nerve even though it is a flexor of the elbow joint.

Major exception to the generalisation that the radial nerve supplies only extensor muscles and that all flexors lie in the anterior compartment

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Which nerve inervates the brachioradialis muscle?

What is the segmental value?

Radial nerve

c5, C6, c7

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What muscle is the only member of the intermediate group of muscles in the anterior compartment of the forearm?

Flexor Digitorum Superficialis (FDS)

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How many tendons does the flexor digitorum profundus give rise to?

To which fingers are these tendons attached?

4 tendons

Index finger to pinkie (2-5)

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Which phalynx does the tendons of flexor digitorum superficialis insert?

Because of this what joints does this muscle flex?

Middle

Wrist, MCP, and interphalangeal joints

(NOT distal interphalangeal joint)

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What nerve supplies the flexor digitorum superficialis?

What is the segmental value? (C7, C8, T1)

Medial nerve

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What 3 muscles make up the deep group of the anterior compartment of the forearm?

Flexor digitorum profundus (FDP)
Flexor pollicis longus
Pronator quadratus

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What joints does the flexor digitorum profundus act on?

What are its main actions?

Wrist and all joints of the fingers

Flexes wrist and distal interphalangeal

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Describe the nerve supply of the flexor digitorum profundus

Dual nerve supply

Ulnar nerve -> Medial part (c8, T1)
Median nerve -> Lateral part (C8, t1)

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What is the action and nerve supply of the plexor pollicis longus?

Long flexor of the thumb

Median nerve (C8, t1)

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Where is the origin and insertion of the pronator quadrates?

Origin = front of the ulna

Insertion into radius

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What is the action of the pronator quadratus?

What is the nerve supply?

Pronates forearm; deep fibres bind radius and ulna together

Anterior interosseous nerve, from median nerve (C8, t1)

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What is the relationship of the brachial artery with the medial nerve in the cubital fossa?

The nerve is medial to the brachial artery in the cubital fossa

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Which muscle(s) does the median nerve not supply in the forearm?

Flexor carpi ulnaris and medial half of flexor digitorum profundus

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Does the median nerve enter the hand by passing below or above the flexor retinaculum?

Below

Describe the path of the ulnar nerve as it enters the forearm

After passing posterior to the medial epicondyle of the humerus the ulnar nerve enters the forearm by passing between the heads of flexor carpi ulnas muscle

How does the ulnar nerve lie in relation to the ulnar artery in the distal forearm?

Medial

What are the two terminal branches of brachial artery?

Radial and Ulnar artery

In close relation to which part of radius does the brachial artery divides into 2 terminal branches?

Opposite neck of radius

What makes up the walls of the carpal tunnel?

Roof = flexor retinaculum Lateral side = scaphoid and trapezium Medial side = Pisiform and hamate

What is the fibrous retinaculum?

Strong fibrous band which converts the concavity of the palmar surface of the carpus (carpal bones) and convertes it into a channel, the carpal tunnel.

What are the contents of the carpal tunnel?

Median nerve 4 tendons of Flexor digitorum superficialis 4 tendons of flexor digitorum profundus 1 tendon of flexor pollicis longus

What is the most sensitive structure in the carpal tunnel that could be affected in carpal tunnel syndrome?

Median nerve

Carpal tunnel syndrome results from what?

Any lesion that significantly reduces the size of the carpal tunnel

If the median nerve is effected in carpal tunnel syndrome what symptoms may the patient experience?

Tingling Diminished sensation Abscence of tactile sensation to the area supplied by the nerve

What muscle of the forearm is continuous with the fascia of the palm called the palmar aponeurosis?

Palmaris longus tendon

The intrinsic muscles of the hand are located in 5 compartments. Name them

Thenar compartment Hypothenar compartment Adductor compartment Lumbicals and long flexor tendons - central compartment Interossei compartment

The thenar muscles from the thenar eminence on the lateral part of the palm are responsible mainly for what?

Apposition of the thumb

Name the 3 muscles which make up the thenar eminence

Flexor pollicis brevis Abductor pollicis brevis Opponens pollicis

Which nerve innervates all 3 muscles of the thinner eminence?

Recurrent Branch of Median Nerve

The nerve which innervates the thenar muscles is made up of fibres from which segmental levels?

C8 and T1

What 3 muscles make up the hypothenar eminence? | hypothenar muscles

Abductor digiti minimi Flexor Digiti Minimi Oppenens digiti minimi

Which nerve innervates all the hypothenar muscles?

Deep branch of the Ulnar Nerve

What is the segmental value of the nerve innervating the hypothenar muscles?

C8, T1

The adductor pollicis is made up of 2 heads Name them

Transverse head | Oblique head

Which nerve innervates the adductor pollicis?

Deep branch of the ulnar nerve (C8, T1)

What is the action of the adductor pollicis on the thumb?

Adducts the thumb towards the lateral border of the palm

Among the short muscles of the hand, there are 4 earth worm-like muscles forming the central compartment What are these collectively called?

Lumbricals

From which long flexor tendon do the lumbricals originate?

Tendon of flexor digitorum profundus

What is the action of the lumbrical muscles?

Flex the fingers at the metacarpophalangeal joint and simultaneously extend the interphalangeal joint of 2nd to 5th digits

How are the lumbricals innervated?

Medial two lumbricals innervated by the ulnar nerve and the lateral two are innervated by the median nerve

The interossei are present between what bones?

Metacarpal bones

How many dorsal and hor many palmar interossei are there?

4 dorsal | 3 palmar

What are the actions of the dorsal and palmar interossei muscles on the fingers?

DAB -Dorsal Interossei ABduct fingers PAD -Palmar Interossei ADduct the fingers

Which nerve innervates the dorsal and palmar interossei muscles?

Ulnar

What segmental levels provide nerve fibres to the ulnar nerve?

C8, T1

Lesion of which trunk affects these short muscles of the hand? What is the paralysis called?

Lower trunk Klumpke paralysis

What are the segmental levels involved in Klumpke paralysis (lower trunk)?

C8, T1

Describe the blood supply to the hand

The ulnar and radial arteries and their branches provide all the blood to the hand. Both arteries after entering the palm contribute to the formation of arterial arches - superficial and deep palmar arteries These arterial arches provide collateral circulation in the hand

Which artery is the main contributor of the superficial palmar arch? What about the deep palmar arch?

Ulnar = Superficial Radial = deep

What muscles do the radial nerve supply?

None Supplies skin on the dorsal aspect of the hand

The ulnar nerve innervates most of the intrinsic muscles of the hand except what?

Thenar muscles and the first and second lumbrical muscle

The wrist joint is which kind of joint?

Synovial condyloid joint

What structures make up the proximal and distal aspects of the wrist joint?

Proximal: -Distal end of radius and the articular disc Distal: -Proximal row of the carpal bones (except the pisiform)

What is the combined action of extensor and flexor carpi ulnaris on the wrist joint?

They act as adduction or cause ulnar deviation

Which muscles are responsible for the abduction of the wrist joint?

Extensor + flexor carpi radialis