Upper Limb Final Practical Structures Flashcards
greater tuberosity of the humerus
sitting
shake hands and find acromion
move hand inward
slide inferior and lateral about an inch
lesser tuberosity of the humerus
seated
find the greater tubercle and rotate the arm laterally shaking hands
the slender ditch should be felt then as you continue to laterally rotates, the lesser tuberosity should pop out
intertubercular groove of the humerus
seated
find the greater tubercle and rotate laterally to feel the ditch
deltoid tubercle
seated
locate the acromion and slide off and lateral
halfway between shoulder and elbow will be the small mound on the lateral side
shaft of the humerus
feel distal of acromion
teres major
origin: inferior angle and lower 1/3 of lateral border of the scapula
insertion: crest of lesser tubercle of humerus
prone with arm off the table
grasp lats fibers near axilla
move fingers and thumb medially to feel the scapula lateral border; the fibers medial to the lats
follow the fibers toward axilla
resist shoulder extension
supraspinatus
origin: supraspinatus fossa of the scapula
insertion: greater tubercle of the humerus
prone
locate the spine of the scap and slide into the supraspinous fossa
fibers run parallel to spine of scap
follow the belly laterally
abduct arm against resistance
infraspinatus
origin: infraspinous fossa
insertion: greater tubercle of humerus
prone with forearm off side of table
locate the spine of scap, medial border, lateral border and lay a finger along each landmark to make a triangle around it
palpate in the triangle and laterally
lift elbow up to the ceiling
teres minor
origin: upper 2/3 of lateral border of scap
insertion: greater tubercle of humerus
prone with arm off side of table
locate superior lateral border of scap
slide laterally off the border and compress
slide thumb up into axilla and grasp the belly
ask partner to swing hand up toward head
subscapularis
origin: subscap fossa of the scap
insertion: lesser tubercle of the humerus
in side lying, flex the shoulder and pull the arm as anteriorly as possible
hold arm with one hand and locate lateral border of scap with thumb
slide thumb under lats and curl thumb onto subscap fossa
pec minor
origin: 3rd, 4th, 5th ribs
insertion: medial surface of coracoid process of scap
supine
abduct arm and place finger pads at lateral edge of pec major
slide under pec major along ribs and fingers will eventually contact pec minor
depress scap
subclavius
origin: first rib and cartilage
insertion: inferior surface of middle 1/3 of clavicle
side lying
pull arm into flexed position and pull it anteriorly allowing thumb to curl under clavicle
grab clavicle and curl thumb into underside to palpate
biceps brachii
origin: short head from coracoid process, long head from supraglenoid tubercle
insertion: tuberosity of radius and aponeurosis of biceps brachii
supine or seated
flex elbow against resistance
on the anterior surface locate the hard round belly
follow the belly distally to the elbow
triceps brachii
origin: long head from infraglenoid, lateral head from posterior surface of proximal half of humerus, medial head from posterior surface of distal half of humerus
insertion: olecranon process of ulna
prone with arm off side of table
palpate posterior arm off of deltoids down to olecranon process
ask partner to extend arm back against your resistance
coracobrachialis
origin: coracoid process
insertion: medial surface of mid-humeral shaft
supine
laterally rotate and abduct shoulder to 45 degrees
put one hand on medial side of arm and move fingers into armpit
adduct against your resistance
deltoids
origin: lateral 1/3 of clavicle, acromion, and spine of scap
insertion: deltoid tuberosity
seated
locate spine of scap, acromion, and lateral clavicle
locate deltoid tuberosity
palpate b/w these landmarks
resist abduction
subacromial bursa
seated
stand behind partner
find acromion and drop fingers off anterior edge
extend the shoulder by pulling the elbow posteriorly
palpate gently
brachial pulse
feel in medial arm between biceps and triceps
medial supracondylar ridge
seated, skake hands and locate the medial epicondyle
move proximally from medial epicondyle and the bony ridge which extends from the epicondyle is medial supracondylar ridge
lateral supracondylar ridge
seated, shake hands and locate the lateral epicondyle
move proximally and feel for bony ridge extending from the epicondyle
medial epicondyle
seated, shake hands and locate the olecranon process
slide medially off into a ditch and up onto the bony projection
lateral epicondyle
seated, shake hands and locate the olecranon process
slide laterally off into a ditch and up onto the bony projection
olecranon fossa
flex elbow and locate olecranon process
roll fingers proximally and press into the fossa (only a small crescent-shaped ditch will be accessible)
radial head
shake hands and locate the lateral epicondyle
slide distally into the small ditch b/w the humerus and radius
radial tuberosity
radial shaft
flex elbow 90 degrees and put forearm in neutral handshake position
locate the head of the radius and slide distally down the radius length near the wrist
radial styloid process
grasp the distal radius shaft b/w thumb and finger and slide distally to the age of the styloid process
listers tubercle
find the dorsal surface of the radial styloid process with your thumb
slide thumb slightly across the top toward ulna head to feel
ulnar olecranon process
ulnar head
slide fingers just distally off the ulnar shaft and just proximal to the wrist the shaft will bulge to become the head of the ulna
styloid process of the ulna
shake hands and passively adduct the wrist
use the thumb to locate posterior aspect
slide distally off the head
brachialis
origin: distal half of anterior surface of humerus
insertion: tuberosity and coronoid process of ulna
seated
shake hands and flex elbow to 90 degrees against your resistance and isolate the edges of the biceps belly
relaxing, slide lateral half an inch off the distal biceps
brachioradialis
origin: proximal 2/3 of lateral supracondylar ridge of humerus
insertion: styloid process of radius
shake hands and flex elbow to 90 degrees with forearm in neutral flex against resistance
bulges out of lateral elbow, but if not, slide distal off the lateral supracondylar ridge of the humerus
pinch belly with fingers and feel as far down as possible
anconeus
origin: lateral epicondyle of humerus
insertion: olecranon process and posterior proximal surface of ulna
locate olecranon process, proximal shaft of ulna, and lateral epicondyle
lay index finger along proximal ulna and tip of middle finger upon lateral epicondyle to form a v outline of the muscles
supinator
origin: lateral epicondyle of humerus, radial collateral ligament, annular ligament, and supinator crest of ulna
insertion: anterior, lateral surface of proximal 1/3 of radial shaft
shake hands and flex elbow to 90 degrees
locate the lateral epicondyle and proximal shaft of radius and place fingerpads b/w the two and palpate deep to extensor fibers
ask to alternately supinate and relax against your resistance
common flexor tendon
on medial epicondyle
pronator teres
origin: common flexor tendon from medial epicondyle of humerus and coronoid process of ulna
insertion: middle of lateral surface of radius
shake hands and flex elbow to 90 degrees and find the distal tendon of the biceps (can resist flexion to find this)
slide distally of the tendon and b/w brachioradialis and flexors, move thumb into this valley
follow line b/w medial epicondyle and middle radius
palmaris longus
origin: common flexor tendon from medial epicondyle of humerus
insertion: flexor retinaculum and palmar aponeurosis
flex elbow to 90 degrees and supinate
ask partner to flex wrist against your resistance
if present, it will be the most medial one to pop out
flexor carpi ulnaris
origin: common flexor tendon from medial epicondyle of humerus and posterior surface of proximal 2/3 of ulna
insertion: pisiform, hook of hamate, and base of 5th metacarpal
shake hands, flex elbow to 90 degrees, and supinate
locate the distal tendon at the pisiform
slide proximally to slide off distal tendon and move up towards medial epicondyle while partner adducts wrist against your resistance
flexor digitorum superficialis
origin: common flexor tendon from medial epicondyle of humerus, ulnar collateral ligament, coronoid process of ulna, interosseous membrane, and proximal shaft of radius
insertion: sides of middle phalanges of 2-5 fingers
flex elbow and wrist to 90 degrees
slide just off ulnar shaft into flexors
squeeze tips of pinky and thumb together then relax to feel contraction
pronator quadratus
origin: medial, anterior surface of distal ulna
insertion: lateral, anterior surface of distal radius
shake hands and find the radial styloid process
feel with thumb b/w radius and tendons
pronate ever so slightly to elicit small contraction
common extensor tendon
origin: distal 1/3 of lateral supracondylar ridge of humerus (longus) and common extensor tendon from lateral epicondyle of humerus (brevis)
insertion: base of 2nd metacarpal (longus) and base of 3rd metacarpal (brevis)
extensor carpi radialis longus and brevis
origin: distal 1/3 of the lateral supracondylar ridge of humerus (longus) and common extensor tendon from the lateral epicondyle of humerus (brevis)
insertion: base of 2nd metacarpal (longus) and base of 3rd metacarpal (brevis)
shake hands and flex elbow to 90 degrees
slide laterally off the brachioradialis
ask partner to abduct and relax wrist against your resistance
follow fibers distally
extensor carpi ulnaris
origin: common extensor tendon from the lateral epicondyle of humerus
insertion: base of 5th metacarpal
shake hands and flex elbow 90 degrees and find the shaft of the ulna to slide off laterally
ask partner to adduct wrist against your resistance
follow to the tendon distally past the ulna head
extensor digitorum
origin: common extensor tendon from the lateral epicondyle of humerus
insertion: bases of middle and distal phalanges of 2-5 fingers
shake hands and flex elbow to 90 degrees
extend wrist and fingers and follow distally
radial collateral ligament
lateral epicondyle of humerus to annular ligament and lateral side of ulna
shake hands and locate the lateral epicondyle of humerus and head of radius, there will be a ditch b/w these structures
place finger in the ditch and roll over ligament
ulnar collateral ligament
medial epicondyle of humerus to coronoid process of ulna and olecranon process
with elbow flexed find the medial epicondyle and olecranon process and place thumb b/w them
radial pulse
on thumb side
ulnar nerve
between olecranon process and medial epicondyle
annular ligament
wraps around head and neck of radius
elbow flexed, put thumb pad on head of radius
passively pronate and supinate
scaphoid
locate the radial styloid process and slide thumb distally into the ditch where the scaphoid will be
adduct-protrudes
abduct-disappear
lunate
locate lister’s tubercle and base of 3rd metacarpal
at the proximal end by listers tubercle
flex wrist and the lunate will press into your finger
triquetrum
palm facing away from you, locate the ulnar styloid process
slide distally into ditch and back up onto its surface
abduct=protrude
adduct=disappear
pisiform
locate the flexor crease and slide slightly distal to feel thick tissue of palm for the nugget-like pisiform
hamate
locate the pisiform and picture a line to the index finger and slide off pisiform following this line about half an inch
capitate
locate lister’s tubercle and base of 3rd metacarpal
at the distal end near the base of the 3rd metacarpal
passively flex wrist for capitate to roll into your finger filling its own cavity
trapezoid
trapezium
on the dorsal radial side find the scaphoid and slide distally
metacarpal head
distal portion of the metacarpals
metacarpal base
proximal portion of the metacarpals
metacarpal shaft
length of the metacarpals
phalange base
proximal portion
phalange shaft
length of phalange
phalange head
distal portion
abductor pollicis longus
origin: posterior surface of radius and ulna, and interosseous membrane
insertion: base of 1st metacarpal
extensor pollicis longus
origin: posterior surface of ulna and interosseous membrane
insertion: base of distal phalynx of thumb
extensor pollicis brevis
origin: posterior surface of radius and interosseus membrane
insertion: base of proximal phalynx of thumb
extensor indicis
origin: posterior surface of distal shaft of ulna and interosseous membrane
insertion: tendon of extensor digitorum at the level of the 2nd metacarpal
adductor pollicis
origin: capitate, 2nd and 3rd metacarpals
insertion: base of proximal phalynx of thumb
anatomical snuff box
extensor pollicis brevis and abductor pollicus longus tendons laterally
extensor pollicus longus tendon medially
extend thumb out and the tendons form a trough
flexor retinaculum/transverse carpal ligament
put thumbpad on partner’s flexor crease of wrist and slide half an inch distally to feel the thick tissues of the heel of the hand
flex and extend the hand to feel
thenar eminence
tissue on the thumb side palm
hypothenar eminence
tissue on pinky side palm
posterior joint line of the shoulder
slide off the posterior side of the acromion before the humerus
anterior joint line of the shoulder
slide off the anterior side of the acromion b4 the humerus
transverse humeral ligament
medial rotate the arm to get to the lesser tub and it’s the lig that connect greater and lesser
small palpation horizontally driven
coracoclavicular ligament
seated
abduct and medially rotate the shoulder
find the coracoid process and shaft of clavicle and palpate b/w the 2
AC ligament
