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486 Cards in this Set
- Front
- Back
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upper extremity begins at
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sternoclavicular joint
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what makes up pectoral or shoulder girdle
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scapula
clavicle |
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clavicle fxn
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holds upper extremity away from trunk, allowing maximum mobility of UE
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where are fractures common on clavicle
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along curved middle third
-falling with outstretched arms |
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does the scapula have a direct attachment to axial skeleton
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no
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what type of joint is sternoclavicular
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saddle type synovial with a thick articular disc
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only bony articulation between the axial skeleton and upper limb
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sternoclavicular
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what type of joint is acromioclavicular
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plane-type synovial that allows limited motion between scapula and clavicle
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glenohumeral type of joint
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ball and socket synovial
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most freely moving joint in body
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glenohumeral at expense of stability
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motion of scapula occur primarily at
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sternoclavicular joint
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motions of the arm occur at
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glenohumeral joint
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what elevates scapula
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upper trap
levator scapulae rhomboids |
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what depresses scapula
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lower trap
pectoralis minor latissimus dorsi |
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what protracts or abducts scapula
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serratus anterior
pect minor |
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what retracts or adducts scapula
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middle trap
rhomboids |
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what upwardly rotates scapula (greater than 90 degrees)
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upper trap
lower trap serratus anterior lower half |
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what does downward rotation of scapula
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levator scapulae
rhomboids* pectoralis minor |
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motions of upper trap at scapula
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elevation
upward rotation |
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motions of middle trap at scapula
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retraction/abduction
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motions of lower trap at scapula
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depression
upward rotation |
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motions of levator scapulae at scapula
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elevation
downward rotation |
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motions of rhomboids at scapula
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elevation
retraction/adduction downward rotation |
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motions of serratus anterior at scapula
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protraction/abduction
upward rotation lower half |
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pectoralis minor actions at scapula
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depression
abduction/protraction downward rotation |
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lat dorsi action at scapula
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depression
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ex of elevation of scap
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shrugging shoulders
-also occurs during full arm abudction |
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ex of depressing scapula
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active depression is required during climbing, pull-ups, walking on crutches
-at rest gravity is prime mover |
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ex of protraction/abduction of scapula
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slides scapula away from the midline, pulling shoulder forward
-reaching forward or throwing |
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ex of retraction/adduction of scapula
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slides scapula towards midline
-pulls shoulder backward |
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ex of upward rotation of scapula
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glenoid fossa rotates to face upward
-important for extreme flexion or abduction of the arm -twisted like a wing nut by the serratus anterior and upper and lower parts of the trap m. |
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downward rotation of scapula
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glenoid fossa rotates to face downward
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parts of the arm that do flexion at glenohumeral joint
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anterior deltoid
pect major clavicular head |
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parts of the arm that do extension at glenohumeral joint
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post deltoid
teres major lat dorsi |
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parts of the arm that abduct at glenohumeral joint
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middle deltoid
supraspinatus |
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parts of the arm that do you adduction at glenohumeral joint
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post deltoid
teres major lat dorsi pect major |
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parts of the arm that do medial rotation at glenohumeral joint
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anterior deltoid
subscapularis teres major lat dorsi pectoralis major |
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parts of the arm that do lateral rotation of arm at glenohumeral joint
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post deltoid
infraspinatus teres minor |
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actions of anterior deltoid at glenohumeral joint
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flexion
medial rotation |
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actions of middle deltoid at glenohumeral joint
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abudction
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actions of posterior deltoid at glenohumeral joint
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extension
adduction lateral rotation |
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actions of subscapularis at glenohumeral joint
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medial rotation
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actions of supraspinatus at glenohumeral joint
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abudction
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actions of infraspinatus at glenohumeral joint
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lateral rotation
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actions of teres minor at glenohumeral joint
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lateral rotation
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actions of teres major at glenohumeral joint
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extension
adduction medial rotation |
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action of lat dorsi at glenohumeral joint
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extension
adduction medial rotation |
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action of pectoralis major at glenohumeral joint
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flexion at clavicular head
adduction medial rotation |
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ex of arm flexion
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swinging arm anteriorly up to 180 degrees during pushing and lifting
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ex of arm extension
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swinging arm posteriorly
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2 general defintions of hyperextension
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1. extending a limb beyond normal limit, maybe cuasing injury
2. extending a limb posterior to the plane of anatomical position |
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ex of arm abduction
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swinging arm laterally up to 180
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upward scapular rotation extends abduction range from
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120-180
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horizontal adduction/abduction occurs in what plane
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transverse
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origin of trapezius
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sup. nuchal line
ext. occip. protuberance nuchal ligament cervical and thoracic spinous processes |
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insertion of trapezius
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distal clavicle
acromion spine of scapula |
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action of trapezius
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elevates (upper part)
retracts (middle) rotates scapula upward (uppwer and lower parts) |
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innervation of trapezius
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accessory n. 11
cervical nerves |
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levator scapulae origin
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transverse processes of C1-C4
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levator scapulae insertion
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superior angle of scapula
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levator scapulae actions
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elevates and rotates scapula downward
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innervation of levator scapulae
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cervical nerves
dorsal scapular n. |
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rhomboid major and minor origin
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spinous processes of C7-T5
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rhomboid major and minor insertion
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medial border of scapula
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rhomboid major and minor actions
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elevate
retract rotate scapula downward hold scapula against thoracic wall |
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innervation of rhomboid major and minor
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dorsal scapular n
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origin of serratus anterior
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ribs 1-8
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insertion of serratus anterior
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medial border of scapula
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action of serratus anterior
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protracts and rotates scapula upward
holds scapula against throacic wall |
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innervation of serratus anterior
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long thoracic nerve
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pectoralis minor origin
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ribs 3-5
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pectoralis minor insertion
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coracoid process
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pectoralis minor action
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rotates scapula downward
stabilizes scapula by protracting and depressing it |
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pectoralis minor innervation
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lateral and medial pectoral n/
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deltoid origin
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clavicle (lateral 1/3)
acromion spine of scapula |
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deltoid insertion
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deltoid tuberosity of humerus
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deltoid actions
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abducts (middle)
flexes, medially rotates (anterior) extends, laterally rotates, adducts (posterior) |
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deltoid innervation
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axillary n
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subscapularis origin
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subscapular fossa
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subscapularis insertion
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lesser tubercle of humerus
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subscapularis actions
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medially rotates arm and rotator cuff muscle
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subscapularis innervation
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upper and lower subscapular n
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supraspinatus origin
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supraspinatus fossa of scapula
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supraspinatus insertion
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greater tubercle of humerus
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supraspinatus action
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abducts arm and rotator cuff muscle
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supraspinatus innervation
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suprascapular n
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infraspinatus origin
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infraspinous fossa of scapula
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infraspinatus insertion
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greater tubercle of humerus
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infraspinatus action
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laterally rotates arm and rotator cuff muscles
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infraspinatus innervation
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suprascapular n
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teres minor origin
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lateral border of scapula
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teres minor insertion
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greater tubercle of humerus
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teres minor action
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laterally rotates arm and rotator cuff
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teres minor innervation
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axillary n
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teres major origin
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inferior angle of scapula
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teres major insertion
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medial to intertubercular groove
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teres major action
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adducts
medially rotates extends arm (synergist of lat dorsi esp when there is resistance) |
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teres major innervation
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lower subscapular n
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latissimus dorsi origin
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spinous processes of T7-12
-thoracolumbar fascia -iliac crest -some ribs |
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latissimus dorsi insertion
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intertubercular groove
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latissimus dorsi actions
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extends
adducts medially rotates arm -can also depress scapula and retract and rotate it downward via shoulder |
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lat dorsi innervation
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thoracodorsal n.
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pectoralis major origin
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clavicular head; clavicle
sternocostal head: sternum costal cartilages 1-6 |
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pectoralis major insertion
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lateral to intertubercular groove
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pectoralis major action
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adducts
flexes (clavicular head) medially rotates arm -can also depress, protract, and rotate scapula downward via shoulder joint -sternocostal head also extends flexed arm |
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pectoralis major innervation
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lateral and medial pectoral n
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coracobrachialis origin
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coracoid process of scapula
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coracobrachialis insertion
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humerus (middle 1/3 of medial aspect)
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coracobrachialis action
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flexes
adducts arm (functionally insignificant synergist of pectoralis major) |
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coracobrachialis innervation
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musculocutaneous n
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both heads of biceps brachii cross which joint? and do what
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glenohumeral joint
can assist with arm flexion |
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long head of triceps crosses which joint and does what
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glenohumeral
assists with arm extension |
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subclavius fxn etc
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small muscle that runs from rib 1 to clavicle
-stabilizes the sternoclavicular joint by pulling the clavicle medially during violent arm movements |
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omohyoid fxn
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runs from the superior border of the scapula to the hyoid bone
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rotator cuff SITS
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order of insertion on the greater tubercle of humerus
1. Supraspinatus 2. Infraspinatus 3. Teres minor 4. Subscapularis on lesser tubercle |
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primary function of SITS on rotator cuff
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hold the head of the humerus in the glenoid cavity during all movements
-provides additionar support to a highly mobile and somewhat vulnerable joint |
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quadrangular space contains
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axillary n
posterior circumflex humeral a |
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triangular interval contains
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radial n
profunda brachii a |
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triangular space contains
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circumflex scapulae a
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suprascapular ligament...army over navy explain
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suprascapular a. passes over ligament
-suprascapular n. passes under ligament -NERVE entrapment |
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axilla definition
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pyramidal space between the arm and the thoracic wall
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most important contents of axilla
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brachial plexus
axillary artery |
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apex of axilla
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points toward the base of the neck and is formed by the convergence of the first rib, clavicle and scapula.
-neurovascular bottleneck, |
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thoracic outlet syndrome
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compression of nerves or vessels between the 1st rib and clavicle
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base of axilla
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skin and fascia of the armpit
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anterior wall of axilla
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anterior axillary fold/pectoralis muscles
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posterior wall of axilla
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posterior axillary fold
(subscapularis, teres major, latissimus dorsi) |
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medial wall of axilla
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serratus anterior
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lateral wall of axilla
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humerus, intertubercular sulcus
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contents of axilla
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brachial plexus
axillary artery axillary vein axillary lymph nodes and vessels in fat muscles (coracobrachialis and biceps brachii) |
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axillary artery is a continuation of the
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subclavian a
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where does subclavian become axillary a
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as it enters the axilla at the border of the first rib
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when does the axillary a become the brachial a
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as it leaves the axilla at the lower border of the teres major
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what divides the axillary artery into 3 parts
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pectoralis minior
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what 3 parts does the pectoralis minor break the axillary a into
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1. lies proximal to the pectoralis minor and has 1 branch
2,. lies deep to the pectoralis minor and has 2 branches 3. lies distal to the pectoralis minor and has 3 branches |
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what is in part 1 of the axillary artery and what does it supply
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superior thoracic artery
-supplies anterior chest wall |
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what is in part 2 of the axillary artery...what do they supply
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1. thoracoacromial artery: short; divides into several branches (clavicular. acromial, deltoid, pectoral) which supply pectoral and deltoid muscles.
2. lateral thoracic artery: supplies lateral chest wall (serr ant. and pectoralis_ |
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what is in part 3 of the axillary a.
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1. subscapular artery
2. anterior humeral circumflex a 3. posterior humeral circumflex a |
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parts of subscapular artery and what they supply
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largest branch of axillary artery
1. circumflex scapular a: to infraspinatus fossa, anastomoses with other scapular arteries (supra and dorsal) 2. thoracodorsal a.: supplies the lat dorsi and accompanies thoracodorsal n. |
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what does the anterior humeral circumflex a do
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passes anteriorly around the surgical head of humerus and anastomoses with posterior humeral circumflex a
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what does the posterior humeral circumflex a do
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runs posteriorly with axillary nerve through quadrangular space and supplies the shoulder joint and adjacent muscles
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brachial plexus definition
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network of nerves supplying the muscles and skin of the upper limb
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brachial plexus is formed by the...and is divided into
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union of ventral rami of C5-8 and T1
-divided into roots, trunks, divisions, cords and branches |
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supraclavicular branches of brachial plexus arise from
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arise from roots or trunks
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infraclavicular branches of brachial plexus arise from
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cords
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how many roots of brachial plexus
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5=ventral rami of C5-8 and T1
-Not the same as spinal cord roots! - |
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branches of roots of brachial plexu
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1. dorsal scapular n
2. long thoracic n -innervate upper limb muscles -other branches innervate some neck muscles and diaphragm |
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trunks of brachial plexus
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3:
-upper, middle and lower -branches: nerve to subclavius muscle suprascapular nerve |
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divisions of brachial plexus
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6:
-each of the 3 trunks splits into an anterior and posterior division -no branches |
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cords of brachial plexus
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3:
-lateral, medial, posterior -names indicate location relative to axillary a. |
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branch from lateral cord
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lateral pectoral n
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branch from medial cord
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medial pectoral nerve:
-and 2 nerves that provide sensory innervation to the skin: -medial brachial cutaneous nerve -medial antebrachial cutaneous nerve |
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branches from posterior cord
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lower subscapular nerve
upper subscapular nerve thoracodorsal nerve |
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terminal branches of brachial plexus
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five all together:
1. musculocutaneous n 2. axillary n 3. radial n 4. median n 5. ulnar n |
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musculocutaneous nerve...path, innervate etc
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passes through the coracobrachialis
-innervates the flexors in the anterior arm and continues as a sensory nerve (lateral antebrachial cutaneous) |
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axillary nerve
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passes to the back of teh arm through the quadrangular space
-innervates 2 shoulder muscles and continues as sensory nerve (lateral brachial cutaneous) |
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radial nerve
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innerates posterior muscles(mostly extensors) of teh arm, forearm, and hand and gives rise to cutaneous nerves of the posterior arm, forearm and hand
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median nerve
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innervates flexors in anterior forearm (except 1.5 muscles innervate by ulnar nerve)
-five hand muscles and some skin on the hand |
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ulnar nerve
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innervates 1.5 flexors in the anterior forearm (flexor carpi ulnaris and lateral part of flexor digitorum profundus)
-most of the hand muscles -skin of 1.5 fingers |
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most frequently fractured carpal bone
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scaphoid
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what type of joint is elbow
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archetypal hinge joint
-also a compound joint (humeroradial and humeroulnar) |
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proximal radioulnar and distal radioulnar what which joints
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pivot joints
-radius can twist over ulna |
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what type of joint is radiocarpal joint
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condyloid joint
-radius and scaphoid and lunate |
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what type of joint are intercarpal
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plane joints including midcarpal joint (between proximal and distal rows of carpals) and pisotriquetral joint
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what type of joint are intermetacarpal joints
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plane joints
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carpometacarpal joints
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1st CMC joint is a very mobile saddle joint between the thumb and the trapezium
-the rest of the CMC's (digits 2-5) are much less mobile plane joints |
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metacarpophalangeal joints are what
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MCP or MP
-condyloid joints better known as your big knuckles |
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proximal interphalangeal and distal interphalangeal joints
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PIP and DIP
-hinge joints -only one interphalangeal (IP) joint in the thumb |
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condyloid joints move in which directions
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2
-flex/extend -add/abduct |
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motions at wrist
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-flex/extend
-abudction (radial deviation_ -adduction (ulnar deviation) |
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muscles that flex elbow
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biceps brachii
brachialis brachioradialis |
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muscles that extend elbow
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triceps brachii
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muscles that pronate at radioulnar joints
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pronator teres
pronator quadratus |
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muscles that supinate at radioulnar joints
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biceps brachii
supinator |
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flexion at the elbow explain
|
3 B's Bend the elBow
-biceps brachii -brachialis -brachioradialis -strong semiprone position |
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2 motions of forearm at elbow
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flexion and extension
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motions of the forearm at radioulnar joints
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pronation and supination
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pronation of forewarm at radioulnar joint
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rotating the hand out of anatomical position
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supination at the forearm at the radioulnar joints
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rotating the hand into anatomical position
HOLDING A CUP OF SOUP -supination is stronger than pronation (think of tightening a screw) |
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what muscles flex the wrist
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flexor carpi radialis
flexor carpi ulnaris flexor digitorum superficialis flexor digitorum profundus |
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what muscles extend the wrist
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extensor carpi radialis longus/brevis
-extensor carpi ulnaris -extensor digitorum |
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what muscles abduct the wrist
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flexor carpi radialis
extensor carpi radialis longus/brevis abductor pollicis longus |
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what muscles adduct the wrist
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flexor carpi ulnaris
extensor carpi ulnaris |
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flexor carpi radialis motions at wrist
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flexion
abduction |
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flexor carpi ulnaris motions at wrist
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flexion
adduction |
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flexor digitorum superficialis actions at wrist
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flexion
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flexor digitorum profundus actions at wrist
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flexion
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extensor carpi radialis longus/brevis actions at wrist
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extension
abduction |
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extensor carpi ulnaris actions at wrist
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extension
adduction |
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extensor digitorum actions at wrist
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extension
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abductor pollicis longus actions at wrist
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abduction
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motions of the hand occur at which joints
|
radiocarpal
midcarpal |
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coracobrachialis origin
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coracoid process
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coracobrachialis insertion
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humerus
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coracobrachialis action
|
flexes and adducts arm
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coracobrachialis innervation
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musculocutaneous n
|
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biceps brachii origin
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long head: supraglenoid tubercle of scapula
short head: coracoid process |
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biceps brachii insertion
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bicipital aponeurosis and tuberosity of radius
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action of biceps brachii
|
supinates forearm
flexes it when supine or semiprone |
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innervation of biceps brachii
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musculocutaneous n
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brachialis origin
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humerus
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brachialis insertion
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coronoid process
tuberosity of ulna |
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action of brachialis
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chief flexor of forearm..can do in any position
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innervation of brachialis
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musculocutaneous n
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what muscle of anterior forearm is functionally insignic
|
coracobrachialis
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bicipital aponeurosis of biceps brachii covers
|
cubital fossa protecting the median n and brachial n and other deep structures
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brachioradialis origin
|
humerus on lateral supracondylar ridge
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brachiradialis insertion
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radius
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brachioradialis action
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flexes forearm
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brachioradialis innervation
|
radial n
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brachioradialis mnemonic
|
Beer Raising muscle
-strongest when wrist is oriented like holding mug (forearm is semiprone and elbow flexed) -Breaks Rule, flexor muscle But Radial n |
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important relation ship with brachioradialis BR
|
Behind it is teh Radial nerve in the cubital fossa
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anterior arm muscles
|
biceps brachii
coracobrachialis brachialis |
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posterior arm muscles
|
triceps brachii
anconeus |
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origin of triceps brachii
|
long head; infraglenoid tubercle of scapula
lateral: humerus medial: humerus |
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insertion of triceps brachii
|
olecranon
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action of triceps brachii
|
chief extensor of forearm
|
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innervation of triceps brachii
|
radial n
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anconeus origin
|
lateral epicondyle
|
|
|
anconeus insertion
|
olecranon and body of ulna
|
|
|
anconeus action
|
extends forearm
|
|
|
innervation of anconeus
|
radial n
|
|
|
course of radial nerve makes it...
|
vulnerable to injry in humeral fractures
|
|
|
pronator teres origin
|
humeral head: medial epicondyle
ulnar head; coronoid process of ulna |
|
|
pronator teres insertion
|
radius
|
|
|
pronator teres action
|
pronate forearm
flex it too |
|
|
pronator teres innervation
|
median n
|
|
|
flexor carpi radialis origin
|
medial epicondyle
|
|
|
flexor carpi radialis insertion
|
base of 2nd metacarpal
|
|
|
flexor carpi radialis action
|
flexes and abducts wrist
|
|
|
flexor carpi radialis innervation
|
median n
|
|
|
flexor carpi ulnaris origin
|
humeral head: medial epicondyle
ulnar head: olecranon |
|
|
flexor carpi ulnaris insertion
|
base of 5th metacarpal, pisiform and hook of hamate
|
|
|
flexor carpi ulnaris action
|
flexes and addcuts wrist
|
|
|
innervation of flexor carpi ulnaris
|
ulnar n
|
|
|
palmaris longus origin
|
medial epicondyle
|
|
|
palmaris longus inertion
|
palmar aponeurosis
|
|
|
palmaris longus action
|
flexes wrist
|
|
|
palmaris longus innervation
|
median n
|
|
|
flexor digitorum superficialis origin
|
humeroulnar head: medial epicondyle and adjacent ulna
radial head: radius |
|
|
flexor digitorum superficialis insertion
|
middle phalanges (digits 2-5_
|
|
|
flexor digitorum superficialis action
|
flexes fingers at PIP
flexes fingers at MCP and flexes wrist |
|
|
flexor digitorum superficialis innervation
|
median n
|
|
|
elbow tendinitis/golfers elbow
|
repetitive foreceful use of anterior forearm muscles can strain the common flexor tendon, causing pain on the medial side of the elbow from the inflammation of the medial epicondyle
|
|
|
median n normallly travels...
|
between 2 heads of the pronator teres
|
|
|
pronator syndrome
|
entrapment or compression of the median n near the elbow from trauma, muscular hypertrophy or fibrous bands
|
|
|
what 1.5 muscles does the ulnar n innervate
|
flexor carpi ulnaris
medial half of felxor digitorum profundus |
|
|
palmaris longus significance
|
weak wrist flexor
absent in one or both sides often nerve like tendon travels next to median nerve |
|
|
intermediate layer of anteror forearm muscles
|
flexor digitorum superficialis
|
|
|
flexor digitorum profundus origin
|
anterior ulna and interosseus membrane
|
|
|
flexor digitorum profundus insertion
|
distal phalanges (2-5)
|
|
|
flexor digitorum profundus action
|
flexes fingers at DIP, MCP and PIP
|
|
|
flexor digitorum profundus innervation
|
medial part: ulnar n
lateral part: median n |
|
|
flexor pollicis longus origin
|
anterior radius and interosseus membrane
|
|
|
flexor pollicis longus insertion
|
distal phalanx of thumb
|
|
|
flexor pollicis longus action
|
flexes thumb at IP, MCP and CMC
|
|
|
flexor pollicis longus innervation
|
median n
|
|
|
pronator quadratus origin
|
distal ulna
|
|
|
pronator quadratus insertion
|
distal radius
|
|
|
pronator quadratus action
|
chief pronator of forearm
|
|
|
pronator quadratus innervation
|
median n
|
|
|
only muscle that can flex fingers at DIP
|
flexor digitorum profundus
|
|
|
only muscle that can flex the thumb at the IP
|
flexor pollicis longus
|
|
|
boundaries of cubital fossa
|
medial boundary: pronator teres m
lateral boundary: brachioradialis m floor: brachialis m and supinator m roof: deep fascia including the bicipital aponeurosis |
|
|
superficial veins in cubital fossa
|
median cubital
cephalic basilic -lie over deep fascia |
|
|
contents of cubital fossa
|
-biceps tendon
-brachial a which its terminal branches: radial a and ulnar a. -median n -radial n |
|
|
where does brachial a bifurcate and into what
|
in the cubital fossa to the;
radial a ulnar a |
|
|
branches of brachial artery in the arm
|
deep brachial a that travels with radial n in posterior arm
-superior ulnar collateral a and inferior ulnar collateral a |
|
|
radial artery gives off a proximal branch in forearm...
|
radial recurrent a. that heads back toward elbow
|
|
|
path of radial artery
|
in the forearm, it runs under the brachioradialis m. until it comes in contact with the distal end of the radius (pulse) then winds laterally around radius passing through the anatomical snuffbox and making the major contribution to deep palmar arch
|
|
|
TAN
|
tendon
brachial a median n |
|
|
ulnar a gives off braches...
|
common interosseus a which divides almost immediately to anterior interosseous and posterior
|
|
|
posterior interosseus a gives rise to
|
recurrent interosseus a
|
|
|
other ulnar branches near elbow minus common interosseus
|
anterior ulnar recurrent a
posterior too |
|
|
ulnar a terminates in the hadn by ...
|
making the major contribution to the superficial palmar arch
|
|
|
collateral circulation around elbow
|
functionally significant anastomosis but diff to see
|
|
|
flexor digitorum superficialis action
|
flexion at MCP/PIP
|
|
|
flexor digitorum profundus action
|
flexion at MCP/ PIP/DIP
|
|
|
extensor digitorum action
|
extension at MCP/PIP/DIP
|
|
|
extensor indicis action
|
2: MCP/PIP/DIP extension here
|
|
|
extensor digiti minimi action
|
5: extension at MCP/PIP/DIP
|
|
|
abductor digiti minimi action
|
abduction at 5, MCP
|
|
|
flexor digiti minimi brevis action
|
flexion at 5 MCP
|
|
|
opponens digiti minimi action
|
oppoistion at 5 CMC
|
|
|
palmar interossei action
|
flexion of 2/4/5 at MCP
extension at 2/4/5 PIP and DIP adduction at 2/4/5 at MCP |
|
|
dorsal interossei actions
|
flexion at 2/3/4 MCP
extension at 2/3/4 PIP and DIP abduction at 2/3/4 at MCP |
|
|
lumbricals actions
|
flexion at MCP
extension at PIP and DIP |
|
|
flexion and extension of fingers
|
closing and opening fingers
-occurs at all finger joints : MCP. PIP and DIP |
|
|
axis of hand
|
middle finger
|
|
|
ab or adduction of hand
|
away or toward middle finger
|
|
|
adduction and abduction occur at which joints
|
MCP
|
|
|
all adductor and abductors of the fingers are what type of hand muscles
|
intrinsic
|
|
|
opposition of digit 5
|
flexing, adducting and laterally rotating the pinky at the CMC to bring the palmar surface in contact with the palmar surface of the oppositing thumb
-grasping |
|
|
flexor pollicis longus actions
|
flexion at CMC/MCP/IP
|
|
|
abductor pollicis longus action
|
abduction at CMC
|
|
|
extensor pollicis brevis action
|
extension at CMC and MCP
|
|
|
extensor pollicis longus action
|
extension at CMC/MCP/IP
|
|
|
abductor pollicis brevis action
|
abduction at CMC
|
|
|
flexor pollicis brevis action
|
flexion at CMC/MCP
|
|
|
extensor indicis action
|
2: MCP/PIP/DIP extension here
|
|
|
extensor digiti minimi action
|
5: extension at MCP/PIP/DIP
|
|
|
abductor digiti minimi action
|
abduction at 5, MCP
|
|
|
flexor digiti minimi brevis action
|
flexion at 5 MCP
|
|
|
opponens digiti minimi action
|
oppoistion at 5 CMC
|
|
|
palmar interossei action
|
flexion of 2/4/5 at MCP
extension at 2/4/5 PIP and DIP adduction at 2/4/5 at MCP |
|
|
dorsal interossei actions
|
flexion at 2/3/4 MCP
extension at 2/3/4 PIP and DIP abduction at 2/3/4 at MCP |
|
|
lumbricals actions
|
flexion at MCP
extension at PIP and DIP |
|
|
flexion and extension of fingers
|
closing and opening fingers
-occurs at all finger joints : MCP. PIP and DIP |
|
|
axis of hand
|
middle finger
|
|
|
add and abduction of fingers only occurs at
|
MCP joints
|
|
|
all adductor and abductor of fingers are what type of hand muscles
|
intrinsic
|
|
|
opposition of digit 5
|
flexing, adducting, laterally rotating the pinky at the CmC to bring the plamar surface in contact with the palmar surface of the opposing thumb
-grasping |
|
|
action of flexor pollicis longs
|
flexion at CMC/MCP/UO
|
|
|
action of abductor pollicis longus
|
abduction at CMC
|
|
|
action of extensor pollicis brevis
|
extension at CMC/MCP
|
|
|
action of extensor pollicisi longus
|
extension at CMC/MCP/IP
|
|
|
action of abductor pollicis brevis
|
abduction at CMC
|
|
|
flexor pollicis brevis actions
|
flexion of CMC/MCP
|
|
|
action of opponens pollicis
|
oppostion at CMC
|
|
|
adductor pollicis action
|
adduction at CMC
|
|
|
compared to other digits the thumb is rotated...
|
90 degrees about its long axis
|
|
|
flexion and extension at MP and IP joints are similar to
|
fingers and are intuititve
|
|
|
adduction and abduction of thumb occurs
|
in a plane perpendicular to the palm at the CMC joint
|
|
|
opposition of thumb
|
flexing, adducting and medially rotating the thumb at the CMC to bring palmar surface of thumb in contact with palmar surface of fingers
|
|
|
reposition of thumb
|
opposite of opposition
|
|
|
thenar muscles
|
abductor pollicis brevis
flexor pollicis brevis opponens pollicis |
|
|
abductor pollicis brevis origin
|
flexor retinaculum and tubercles of scaphoid and trapezium
|
|
|
abductor pollicis brevis insertion
|
base of 1st proximal phalanx
|
|
|
abductor pollicis brevis action
|
abducts thumb
|
|
|
abductor pollicis brevis innervation
|
median n
|
|
|
flexor pollicis brevis origin
|
flexor retinaculum and tubercles of scaphoid and trapezium
|
|
|
flexor pollicis brevis insertion
|
base of 1st proximal phalanx
|
|
|
flexor pollicis brevis action
|
flexes thumb at MCP and CMC
|
|
|
innervation of flexor pollicis brevis
|
median n
|
|
|
opponens pollicis origin
|
flexor retinaculum and tubercles of scaphoid and trapezium
|
|
|
opponens pollicis insertion
|
shaft of 1st metacarpal
|
|
|
opponens pollicis action
|
opposes thumb
|
|
|
opponens pollicis innervation
|
median n
|
|
|
hypothenar muscles
|
abductor digiti minimi
flexor digiti minimi brevis opponens digiti minimi |
|
|
abductor digiti minimi origin
|
pisiform
|
|
|
abductor digiti minimi insertion
|
base of 5th proximal phalanx and extensor expansion
|
|
|
abductor digiti minimi action
|
abducts 5th finger
|
|
|
abductor digiti minimi innervation
|
ulnar n
|
|
|
flexor digiti minimi brevis origin
|
hook of hamate
flexor retinaculum |
|
|
flexor digiti minimi brevis insertion
|
base of 5th proximal phalanx
|
|
|
flexor digiti minimi brevis action
|
flexes 5th finger at MCP
|
|
|
flexor digiti minimi brevis innervation
|
ulnar n
|
|
|
opponens digiti minimi origin
|
hook of hamate
flexor retinaculum |
|
|
opponens digiti minimi insertion
|
shaft of 5th metacarpal
|
|
|
opponens digiti minimi action
|
opposes 5th finger
|
|
|
opponens digiti minimi innervation
|
ulnar n
|
|
|
palmar interossei I-III origin
|
shafts of 2nd, 4th and 5th metacarpals
|
|
|
palmar interossei insertion
|
bases of proximal phalanges and extensor expansions of digits 2,4,5
|
|
|
palmar interossei action
|
adduct fingers (PAD)
flex at MCP extend at PIP/DIP via extensor expansion |
|
|
palmar interossei innervation
|
ulnar n
|
|
|
dorsal interossei origin
|
facing sides of adjacent metacarpal bones
|
|
|
dorsal interossei insertion
|
bases of proximal phalanges and extensor expansions of digits 2, 3, both sides and 4
|
|
|
dorsal interossei action
|
abduct fingers
flex at MCP extend at PIP and DIP via extensor expansions |
|
|
dorsal interossei innervation
|
ulnar n
|
|
|
lumbricals I and II origin
|
lateral 2 tendons of flex dig profundus
|
|
|
lumbricals 1 and 2 insertion
|
lateral sides of extensor expansions of digits 2-5
|
|
|
lumbricals 1 and 2 action
|
flex fingers at MCP and extend them at PIP/DIP via extensor expansion
|
|
|
lumbricals 1 and 2 innervation
|
median n
|
|
|
lumbricals 3 and 4 origin
|
medial 3 tendons of flex dig profundus
|
|
|
lumbricals 3 and 4 insertion
|
lateral sides of extensor expansions of digits 2-5
|
|
|
lumbricals 3 and 4 action
|
flex fingers at MCP and extend them at PIP./DIP via extensor expansion
|
|
|
innervation of lumbricals 3 and 4
|
ulnar n
deep |
|
|
palmaris brevis origin
|
flexor retinaculum
palmar aponeurosis |
|
|
palmaris brevis insertion
|
skin of palm
|
|
|
palmaris brevis action
|
cups the hand
|
|
|
palmaris brevis innervation
|
ulnar n superficial
|
|
|
what appear to be critical for simultaneous extension of all three finger joints
|
interossei and lumbricals
|
|
|
what causes claw hand deformity
|
MCP joints in slight hyperextension and PIP and DIP in partial extension
-paralysis of interossei and lumbricals |
|
|
interossei and lumbricals can all...
|
flex the MCP joints and extend the PIP/DIP joints
|
|
|
palmar v dorsal interossei
|
palmar are unipennate
dorsal are bipennate and can see from both sides |
|
|
flexor retinaculum path
|
runs from the tubercles of the scaphoid and trapezium on the radial side to the pisiform and hook of hamate on the ulnar side to form the carpal tunnel
|
|
|
carpal tunnel contents
|
median n
tendons of the flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus |
|
|
carpal tunnel syndrome
|
compression of the median n, caused by inflammation of the flexor retinaculum or flexor synovial sheaths, arthritic changes, or other factors that reduce the size of the carpal tunnel
-can result in sensory and motor deficits |
|
|
flexor synovial sheaths
|
bursae formed by synovial membranes that lubricate the tendons
|
|
|
common flexor synovial sheath or ulnar bursa
|
contains all 8 tendons of the flexor digitorum superficialis and profundus and extends into the 5th digit
|
|
|
palmar aponeurosis
|
thick fascia that helps make the skin of the palm firm and unyielding
-insertion of palmaris longus |
|
|
fibrous digital sheaths
|
dense fibrous tissue surrounding the flexor synovial sheaths
-prevent bowstringing of the flexor tendons |
|
|
vincula
|
tiny tendons that provide routes for blood vessels coming from the periosteum (CT covering bone) to reach the flexor tendons
|
|
|
extensor retinaculum
|
holds down extensor tendons in the posterior forearm at the wrist
-prevents bowstringing during wrist hyperextension |
|
|
intertendinous connections
|
joint the extensor tendons in the dorsum of the hand (these connections make independent extension of the middle and ring finger difficult and unnatural because unlike the thumb, index finger and little finger the middle and ring are each served by only one extensor)
|
|
|
extensor expansion
|
formed by the aponeurotic expansoins of the extensor digitorum tendons, the tendons of the interossei and lumbricals
|
|
|
extensor expansion allows...
|
interossei and lumbricals to extend the fingers at the PIP and DIP joints
|
|
|
superficial palmar arch is mainly supplied by
|
ulnar a
|
|
|
deep palmar arch is mainly supplied by
|
radial a
|
|
|
extensor carpi radialis longus origin
|
humerus (lateral supracondylar ridge)
|
|
|
extensor carpi radialis longus insertion
|
base of 2nd metacarpal
|
|
|
extensor carpi radialis longus actions
|
extends and abducts hand
|
|
|
extensor carpi radialis longus innervation
|
radial n
|
|
|
extensor carpi radialis brevis origin
|
lateral epicondyle via common extensor tendon
|
|
|
extensor carpi radialis brevis insertion
|
base of 3rd metacarpal
|
|
|
extensor carpi radialis brevis actions
|
extends and abducts hand
|
|
|
innervation of extensor carpi radialis brevis
|
radian n. deep branch
|
|
|
extensor digitorum origin
|
lateral epicondyle via common extensor tendon
|
|
|
extensor digitorum insertion
|
extensor expansion on digits 2-5
|
|
|
extensor digitorum actions
|
extends fingers at MCP, PIP/DIP via extensor expansion
-extends hand |
|
|
extensor digitorum innvervation
|
radial n
(posterior interosseous) |
|
|
extensor digiti minimi origin
|
lateral epicondyle via common extensor tendon
|
|
|
extensor digiti minimi insertion
|
extensor expansion of digit 5
|
|
|
extensor digiti minimi action
|
extends 5th finger at MCP
and PIP/DIP via extensor expansion |
|
|
extensor digiti minimi innervation
|
radial n
posterior interosseus n |
|
|
extensor carpi ulnaris origin
|
lateral epicondyle via common extensor tendon
|
|
|
extensor carpi ulnaris insertion
|
base of 5th metacarpal
|
|
|
extensor carpi ulnaris action
|
extends and adducts hand
|
|
|
extensor carpi ulnaris innervation
|
radial n
post. interosseous n |
|
|
explain tennis elbow or lateral epicondyltisi
|
repetitive forceful use of superficial posterior forearm muscles can strain the common extensor tendon, causing pain near the lateral epicondyle
|
|
|
supinator origin
|
lateral epicondyle
proximal ulna (& radial coll lig and annular lig) |
|
|
supinator insertion
|
radius (proximal 1/3)
|
|
|
supinator action
|
supinates forearm
|
|
|
supinator innervation
|
radial n,
deep branch |
|
|
abductor pollicis longus origin
|
posterior radius
posterior ulna interosseous membrance |
|
|
abductor pollicis longus insertion
|
base of metacarpal of thumb
|
|
|
abductor pollicis longus actions
|
abducts and extends thumb at CMC
-abducts hand at wrist |
|
|
abductor pollicis longus innervation
|
radial n,.
-posterior interosseous n |
|
|
extensor pollicis brevis origin
|
posterior radius
interosseous membrane |
|
|
extensor pollicis brevis insertion
|
base of proximal phalanx of thumb
|
|
|
extensor pollicis brevis action
|
extends thumb at MCP and CMC
|
|
|
extensor pollicis brevis innervation
|
radial n
posterior interosseous |
|
|
extensor pollicis longus origin
|
posterior ulna
interosseous membrane |
|
|
extensor pollicis longus inesrtion
|
base of distal phalanx of thumb
|
|
|
extensor pollicis longus action
|
extends thumb at IP and MCP and CMC
|
|
|
extensor pollicis longus innervation
|
radial n
posterior interosseous |
|
|
extensor indicis origin
|
posterior ulna
interosseous membrane |
|
|
extensor indicis insertion
|
extensor expansion of index finger or digit 2
|
|
|
extensor indicis action
|
extends index finger at MCP. PIP and DIP via extensor expansion
|
|
|
extensor indicis innervation
|
radial n
posterior interosseous |
|
|
anatomical snuffbox is formed by
|
1. abductor pollicis longus
2. extensor pollicis brevis(laterally) 3. extensor pollicis longus (medially) **tendons of these muscles |
|
|
what passes through snuffbox
|
radial a.
|
|
|
what lie on the floor of the snuffbox
|
scaphoid
trapezium |
|
|
most frequently fractured carpal bone
|
scaphoid
|
|
|
sternoclavicular is articulation between
|
manubrium and clavicle
|
|
|
what type of joint is sternoclavicular and why
|
saddle synovial
-bc of the shape of its articular surfaces -2 bones don't fit together well and don't come into contact because of an articular disc |
|
|
articular disc in sternoclavicular joint does what
|
divides the joint cavity into two entirely separate cavities
-prevents medial displacement of clavicle -shock absorber of forces transmitted on clavicle |
|
|
what is sternoclavicular joint functionally similar to
|
ball and socket joint because it permits shoulder elevation/depression, protract/retract and rotation of clavicle on long axis
(articular disc_ |
|
|
what reinforces fibrous capsule of sternoclavicular joint
|
anterior and posterior sternoclavicular ligaments:
1. interclavicular ligament 2. costoclavicular ligament |
|
|
interclavicular ligament fxn
|
limits excessive depression of clavicle
|
|
|
costoclavicular ligament fxn
|
limits excessive elevation of clavicle
|
|
|
what type of joint is acromioclavicular
|
plane synovial that permits limited motion between scapula and clavicle
|
|
|
is articular disc present in acromioclavicular joint
|
yes but usually incomplte
|
|
|
fibrous capsule of acromioclavicular joint significance...what is it called
|
think, lax, tears easily
-acromioclavicular ligament |
|
|
strongest reinforcement of acromioclavicular joint is supplied by
|
coracoclavicular ligament with its 2 parts:
1. trapezoid ligament 2. conoid ligament |
|
|
dislocation of acromioclavicular joint (shoulder separation) AC
|
acromioclavicular joint from hard blow to the shoulder can rupture the acromioclavicular ligaments and in more serious cases the coracoclavicular ligametn
|
|
|
what type of joint is glenohumeral
|
ball and socket
|
|
|
most commonly dislocated joint in adults and why
|
glenohumeral
-ball is bigger than socket |
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describe fibrous capsule of glenohumeral joint
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thin and loose
-becomes taut in arm abduction |
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where is fibrous capsule of glenohumeral joint weakest
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on its inferior side...where dislocation usually occurs
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structures that strengthen and protect the glenohumeral joint
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1. glenohumeral ligaments
2. coracohumeral ligaments 3. coracoacromial ligaments 4. rotator cuff muscles 5. tendon of long head of biceps brachii |
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glenohumeral ligaments
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thickenings of the capsule that reinforce the joint anteriorly
(sup, mid, inf) |
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coracohumeral ligament
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thickening of the capsule that reinforces the joint superiorly
-blends with supraspinatus tendon |
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coracoacromial ligament
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joins the coracoid process and acromion
forms a coracoacromial arch |
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coracoacromial arch
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prevents superior dislocation of the humerus
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deep to coracoacromial arch
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subacromial bursa
supraspinatus tendon |
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rotator cuff muscles
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hold the head of the humerus in the glenoid cavity and strengthen the joint superiorly (supraspinatus), posteriorly (infraspinatus and teres minor) and anteriorly (subscapularis)
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tendon of long head of biceps brachii significance
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attached to teh supraglenoid tubercle
-held in the intertubercular groove by the transverse humeral ligament |
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supraspinatus outlet
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space deep to the coracoacromial arch that contains the supraspinatus tendon
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why is supraspinatus outlet significant
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site of impingement (rotator cuff impingment)
-can lead to degernation and tearing of the supraspinatus tendon -friction here is reduced by several bursae: -subacromial -subscapular -subdeltoid |
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what is the elbow joint.type and made up of
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stable hinge synovial
compound: 1. humeroulnar joint: between trochlea of humerus and trochlear notch of ulna 2. humeroradial jointL between capitulum of humerus and head of radius) |
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fibrous capsule of elbow
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encloses elbow joint and proximal radioulnar joint
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ulnar and radial collateral ligaments
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thickening of the joint capsule that strengthen the elbow medially and laterally
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significant about bursa around elbow
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common sites of infection from abrasion or inflammation from excessive friction
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proximal radioulnar joint type
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pivot synovial joint that permits pronation/supination
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what articulates in proximal radioulnar joint
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convex head of radius and concave radial notch of the ulna
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annular ligament
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encircles proximal radius and holds it in the radial notch of the ulna
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nursemaid's elbow
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partial dislocation of the radial head:
-usually kids 2-4 -lifting a kid by the arm -frequently recurs |
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distal radioulnar type of joint
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pivot synovial joint that permits pronation/supination
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distal radioulnar joint articulations
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convex head of ulna articulates with the concave ulnar notch of radius
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distal radioulnar joint articular disc
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triangular, binds the ends of the ulna and radius and separates the cavity of the distal radioulnar joint from the cavity of the wrist joint
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radiocarpal (wrist joint) is what ytpe
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condyloid synovial
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radiocarpal wrist joint articulations
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convex surfaces of the scaphoid, lunate and triquetrum articulate with the concave distal end of the radius and the articular disc of the distal radioulnar joint NOT ulna
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fibrous capsule of wrist joint
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reinforced by radial and ulnar collateral ligaments and dorsal and palmar radiocarpal ligaments
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intercarpal joints are what type
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plane synovial that contribute to the motions of the radiocarpal joint
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midcarpal joint joins
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the proximal and distal rows of carpals
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intermetacarpal joints and CMC joints are what type
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plane synovial
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cmc joint of thumb is
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a highly mobile saddle joint between the trapezium and teh saddle-shaped base of the 1st metacarpal bone
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collateral ligaments of wrist during extension
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slack
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collateral ligaments of wrist during flexion
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taut or close packed to make it most stable
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one continuous synovial cavity in hand...
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includes all intercarpal joints, intermetacarpal joints and CMC joints of all digits except the thumb
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MCP joints are
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condyloid joints
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IP joints are
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hinge
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MCP and IP joints are reinforced by
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collateral ligaments
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atrophy of thenar eminence
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cant grasp
prob with recurrent branch of median n |
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how to know whether or not its carpal tunnel by hand sensation
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carpal tunnel shouldn't lose sensation in medial palm
-median n can get trapped near pronator teres heads and can compress and cause carpal tunnel like sensation but LOSES palmar sensation |
