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1294 Cards in this Set
- Front
- Back
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Question
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Answer
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Splenius: Origin
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Nuchal ligament and spinous process of C7-T3/4
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Splenius: Insertion
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Mastoid process; superior nuchal line of occipital bone - splenius capitis
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Splenius: Nerve Supply
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posterior rami of spinal nerves
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Splenius: Function
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laterally flex neck and rotate head to side; extend head and neck
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Erector Spinae: Iliocostalis:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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Erector Spinae: Iliocostalis:Insertion
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Ribs and transverse processes of cervical vertebrae
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Erector Spinae: Longissimus:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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Erector Spinae: Longissimus:Insertion
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Ribs and transverse processes of cervical and thoracic vertebrae and mastoid process of temporal bone
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Erector Spinae: Spinalis:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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Erector Spinae: Spinalis:Insertion
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Spinous processes of upper thoracic and cervical vertebrae and skull
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Erector Spinae: Iliocostalis, Longissimus, Spinalis:Nerve Supply
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posterior rami of spinal nerves
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Erector Spinae: Iliocostalis, Longissimus, Spinalis:Function
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extend vertebral column and head; as back is flexed, control movement via eccentric contraction; laterally flex vertebral column
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Semispinalis: Capitis, Cervicis, and Thoracis:Origin
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Transverse processes of C4-T12
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Semispinalis: Capitis, Cervicis, and Thoracis:Insertion
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Occipital bone, spinous processes of Cervical and thoracic vertebrae
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Rotatores:Origin
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Transverse processes (primarily thoracic)
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Rotatores:Insertion
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Junction lamina and transverse process or spinous process 2 segments superior
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Multifidus:Origin
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Sacrum, erector spinae ligament, transverse and articulate processes of cervical and thoracic vertebrae
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Multifidus:Insertion
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Spinous processes of vertebrae 2-4 superior
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Transversospinalis:Semispinalis, Multifidus, Rotatores (brevis and longus):Nerve Supply
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posterior rami of spinal nerves
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Semispinalis:Function
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extends head and thoracic and cervical regions of vertebral column and rotates them contralaterally
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Multifidus: Function
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stabilizes vertebrae during local movements of vertebral column
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Rotatores: Function
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stabilize vertebrae and assist with local extension and rotatory movements of vertebral column; proprioception
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Rectus Capitis Posterior Minor:Origin
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Posterior tubercle of posterior arch of C1
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Rectus Capitis Posterior Major: Origin
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Spinous proccess of C2
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Rectus Capitis Posterior Minor:Insertion
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Medial part of inferior nuchal line of occipital bone
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Rectus Capitis Posterior Major:Insertion
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Lateral part of inferior nuchal line of occipital bone
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Obliquus Capitis Superior: Origin
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transverse process of C1
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Obliquus Capitis Superior: Insertion
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Occipital bone between superior and inferior nuchal lines
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Obliquus Capitis Inferior: Origin
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Posterior tubercle of posterior arch of C2
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Obliquus Capitis Inferior: Insertion
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Transverse process of C1
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Suboccipital nerve (posterior ramus C1):insertion
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runs between cranium and C1 to reach muscles of suboccipital triangle
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Greater occipital nerve (posterior ramus C2):Insertion
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Emerges inferior to obliquus capitis inferior and ascends to Skin over neck and occipital bone
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Posterior rami of C3-C7: Insertion
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Pass segmentally to intrinsic muscles of back and overlying skin (adjacent to vertebral column)
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Lesser occipital nerve (anterior rami of C2-C3): Insertion
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Passes directly to skin of superior posterolateral neck and scalp posterior to external ear
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Vertebral artery:Origin
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Transverse foramina of cervical vertebrae
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Vertebral artery:Insertion
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Foramen magnum to brain
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Trapezius:Origin
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Spinus processes and nuchal ligament
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Trapezius:Insertion
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Upper limb (spine of scapula as well as the bump on your shoulder) and wraps around to clavicle
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Trapezius: innervation
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Spinal accessory nerve (CN XI) (motor fibers) and C3, C4 spinal nerves (pain and proprioception)
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Trapezius: function
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descending elevates; ascending depresses; middle retracts scapula; descending and ascending together rotate glenoid cavity superiorly
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Triangle of auscultation
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latissimus dorsi, medial scapula, inferolateral trapezius
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Latissimus Dorsi:Origin
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Spinous processes of lumbar levels as well as thoraco something fascia?
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Latissimus Dorsi:Insertion
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humerus
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Latissimus Dorsi:Innervation
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Thoracodorsal nerve (C6, C7, C8)
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Latissimus Dorsi:function
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extends, adducts, and medially rotates humerus; raises body toward arms during climbing
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Levator Scapulae:origin
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posterior tubercles of transverse processes of C1-C4
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Levator Scapulae:insertion
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medial border of scapula superior to root of scapular spine
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Levator Scapulae:innervation
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dorsal scapular (C5) and cervical C3-C4 nerves
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Levator Scapulae:function
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elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula
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Rhomboid minor:Origin
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Spinous processes
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Rhomboid minor:Insertion
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Spine of scapula
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Rhomboid major/minor:Innervation
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dorsal scapular nerve (C4, C5)
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Rhomboid major/minor:function
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retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall
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Rhomboid major:Origin
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Spinous processes
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Rhomboid major:Insertion
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Below spine of scapula
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Serratus posterior superior:Origin
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Spinous processes
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Serratus posterior superior:Insertion
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ribs
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Serratus posterior inferior:Origin
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Spinous processes
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Serratus posterior inferior:Insertion
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ribs
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C3-C5 Spinous Processes:Characteristics
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Short
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C3-C6 Spinous Processes:Characteristics
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bifid
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C6 Spinous Process:Characterisitc
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long
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C7 Spinous Process:called
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vertebra prominens
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Vertebral Body Osteoporosis: Most affected areas
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Most affected areas are the neck of the femur and bodies of vertebrae, metacarpals, and radius
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Vertebral Body Osteoporosis:Radiographical signs
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diminished radiodensity of trabecular (spongy) bone of vertebral bodies, cuasing thinned cortical bone to appear prominent (vertical striping); also kyphosis
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Laminectomy
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excision of spinous processes and laminae to gain access to vertebral canal (spinal cord) or roots of specific spinal nerves; or relieve pressure from a tumor etc
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Dislocation of Cervical Vertebrae
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cervical vertebrae are less tightly locked; if the dislocation does not result in "facet jumping" it may self-reduce (slip back into place) so you can't tell if there's been spinal cord injury on MRI
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Fracture and Dislocation of Atlas
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Occipital condyle can transmit force on lateral masses of C1 which are wedge shaped and push them out (Jefferson or burst fracture) actually increases size of foramen
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Fracture and Dislocation of Atlas
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common, usually at pars interarticularis; traumatic spondylolysis of C2 usually from hyperextension of the head ON the neck (hangman's fracture); quadriplegia or death
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Fractures of the dens
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also common axis injury from horizontal blow to the head or complication of osteopenia; results in avascular necrosis of dens
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Lumbar Spinal Stenosis
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cause compression of spinal nerve roots occupying the inferior vertebral canal; requires decompressive laminectomy
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Cervical Ribs
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common anomaly 1-2% of people; may cause thoracic outlet syndrome when supernumerary rib places pressure on structures that emerge from the superior thoracic aperture
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Caudal Epidural Anethsesia
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local anesthetic injected into fat of sacral canal surrounding proximal sacral nerves; acts on S2-Co1; height of ascension of anesthetic controlled by amt injected and position of patient
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Injury of Coccyx
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coccygodynia often follows coccygeal trauma
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abnormal fusion of vertebrae
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Sacralization of L5:L5 fuses to Sacrum, L4-L5 degenerates=pain; lumbarization of the S1:if S1 doesn't fuse, no biggie
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Effect of aging on vertebrae
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bowing; osteophytes (bony spurs) commonly develop around the margins of the vertebral body
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anomalies of vertebrae
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spina bifida occulta: neural arches of L5-S1 fail to develop; spina bifida cystica: herniation of meninges (meningocele) or spinal cord (meningomyelocele)
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herniation of nucleus pulposus
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extend posterolaterally where anulus fibrosus is thin and does not receive support from posterior or anterior longitudinal ligaments; usually L4-L5 or L5-S1
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Rupture of Transverse Ligament of Atlas
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dens set free: atlanto-axial subluxation; can compress spinal cord - quadriplegia or into medulla - death
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Rupture of Alar Ligaments
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weaker than transverse ligament of atlas so combined flexion and rotation of the head may tear resulting in a 30% increase in ROM to the contralateral side
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Fractures and Dislocations of Vertebrae
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See others cards, but spondylolysis of L5 results from a failure of the centrum of L5 to unite with neural arches at neurocentral joint
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Spondylolisthesis
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at the L5-S1 IV joint may result in pressure on spinal cord and low back/limb pain
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Injury and disease of Zygapophysial joints
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joints that are close to IV foramina through which spinal nerves emerge, so they can be linked to pain of a dermatome and spasm in a myotome
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Interspinales: Origin
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superior surfaces of spinous processes of cervical and lumbar vertebrae
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Interspinales: Insertion
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Inferior surfaces of spinous processes of vertebra superior to vertebra of proximal attachment
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Interspinales: Nerve Supply
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Posterior rami of spinal nerves
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Interspinales: Function
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Aid in extension and rotation of vertebral column
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Intertransversarii: Origin
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Transverse processes of cervical and lumbar vertebrae
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Intertransversarii: Insertion
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Transverse processes of adjacent vertebrae
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Intertransversarii: Nerve Supply
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Posterior and anterior rami of spinal nerves
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Intertransversarii: Function
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aid in lateral flexion of vertebral column; stabilize vertebral column
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Levatores costarum: Origin
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Tips of transverse processes of C7 and T1-T11 vertebrae
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Levatores costarum: Insertion
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Pass inferolaterally and insert on rib between tubercle and angle
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Levatores costarum: Nerve supply
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posterior rami of C8-T11 spinal nerves
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Levatores costarum: function
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elevate ribs, assisting respiration; assist with lateral flexion of vertebral column
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Flexion of cervical intervertebral joints
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Longus Coli, Scalene, Sternocleidomastoid
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Extension of cervical intervertebral joints
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Deep neck muscles: semispinalis cervicis, iliocostalis cervicis, splenius cervicis, levator scapulae, splenius capitis, multifidus, longissimus capitis, semispinalis capitis, trapezius
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Lateral bending of cervical intervertebral joints
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unilateral action of: rotatores, semispinalis capitis and cervicis, multifidus, splenius cervicis
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Flexion of thoracic and lumbar IV joints
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Bilateral action of rectus abdominis, psoas major, gravity
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Extension of thoracic and lumbar IV joints
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bilateral action of erector spinae, multifidus, semispinalis thoracis
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Lateral bending of thoracic and lumbar IV joints
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unilateral action of iliocostalis thoracis and lumborum, longissimus thoracis, multifidus, external and internal oblique, quadratus lumborum, rhomboids, serratus anterior
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rotation of thoracic and lumbar IV joints
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unilateral rotatores, multifidus, iliocostalis, longissimus, external oblique opposite internal oblique, splenius thoracis
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Suboccipital triangle: superomedial boundary
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rectus capitis posterior major
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Suboccipital triangle: superolateral boundary
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obliquus capitis superior
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Suboccipital triangle: inferolateral bondary
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obliquus capitis inferior
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Suboccipital triangle: floor
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posterior atlanto-occipital membrane and posterior arch of vertebra C1
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Suboccipital triangle: roof
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semispinalis capitis
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Suboccipital triangle: contents
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vertebral artery and suboccipital nerve
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Flexion of atlanto-occipital joints
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longus capitis, rectus capitis anterior, anterior fibers of sternocleidomastoid, suprahyoid and infrahyoid mm.
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Extension of atlanto-occipital joints
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Rectus capitis posterior (major and minor), obliquus capitis superior, splenius capitis, longissimus capitis, trapezius
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Lateral flexion of atlanto-occipital joints
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sternocleidomastoid, obliquus capitis superior, rectus capitis lateralis, longissimus capitis, splenius capitis
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Leptomeninges: Development
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single layer from mesenchyme surrounding embryonic spinal cord
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avulsion fracture of the greater tubercle of humerus
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fall on acromion or hand when arm is abducted; subscapularis rotates limb medially
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transverse fracture of teh shaft of humerus
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direct blow to arm; deltoid caries proximal fragment laterally
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Colles fracture
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complete transverse fracture of distal 2cm of radius; distal fragment comminuted (broken into peices); from forced dorsiflexion of the hand (trying to ease a fall)
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Fracture of scaphoid
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just looks like sprained wrist until 10-14 days later reveal bone resorption; can lead to avascular necrosis and degenerative joint disease
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fracture of hamate
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can involve ulnar nerve, decreasing grip strength
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fracture of metacarpals
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held together and good blood supply, so heal quickly
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fracture of phalanges
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bone fragments must be carefully realigned to restore normal function because of flexor tendons
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dermatomes C3, C4
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region at base of neck, extending laterally over shoulder
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dermatome C5
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Lateral aspect of arm (i.e., superior aspect of abducted arm)
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dermatome C6
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lateral forearm and thumb
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dermatome C7
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middle and ring fingers and center of posterior aspect of forearm
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dermatome C8
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little finger, medial side of hand and forearm (i.e., inferior aspect of abducted arm)
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dermatome T1
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medial aspect of forearm and inferior arm
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dermatome T2
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medial aspect of superior arm and skin of axilla
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Supraclavicular nerve from C3, C4 cervical plexus
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pass anterior to clavicle, immediately deep to platysma, and supply skin over clavicle and superolateral aspect of pectoralis major
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superior lateral cutaneous nerve of arm C5, C6 terminal branch of axillary nerve
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emerges from beneath posterior margin of deltoid and supplies skin over lower part of this muscle and on lateral side of midarm
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inferior lateral cutaneous nerve of arm C5, C6 radial nerve (or posterior cutaneous nerve of arm)
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Perforates lateral head of triceps, passing close to cephalic vein to supply skin over inferolateral aspect of arm
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posterior cutaneous nerve of arm C5-C8 radial nerve (in axilla)
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Crosses posterior to and communicates with intercostobracheal nerve and supplies skin on posterior arm as far as olecranon
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posterior cutaneous nerve of forearm C5-C8 radial nerve (with inferior lateral cutaneous nerve of arm)
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perforates lateral head of triceps, descends laterally in arm, then runs along and supplies posterior forearm to wrist
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Lateral cutaneous nerve of forearm C6-C7 Musculocutaneous nerve (terminal branch)
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Emerges lateral to biceps tendon deep to cephalic vein, supplying skin of anterolateral forearm to wrist
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Medial cutaneous nerve of forearm C8, T1 Medial cord of brachial plexus (in axilla)
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Descends medial to brachial artery, pierces deep fascia with basilic vein in midarm, dividing into anterior and posterior branches that enter forearm and suppply skin of anteromedial aspect to wrist
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Medial cutaneous nerve of arm C8-T2 Medial cord of brachial plexus (in axilla)
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Communicates with intercostobrachial nerve, continuing to supply skin of medial aspect of distal arm
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Intercostobrachial Nerve T2 Second intercostal nerve (as its lateral cutaneous branch)
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Extends laterally, communicating with posterior and medial cutaneous nerves of arm, supplying skin of axilla and medial aspect of proximal arm
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Pectoralis Major: origin
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Clavicular head: anterior surface of medial half of clavicle; Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle
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Pectoralis major: Insertion
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Lateral lip of intertubercular sulcus of humerus
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Pectoralis Major: Innervation
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Lateral and medial pectoral nerves; clavicular head (C5, C6), sternocostal head (C7, C8, T1)
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Pectoralis Major: function
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adducts and medially rotates humerus; draws scapula anteriorly and inferiorly; clavicular head flexes humerus and sternocostal head extends it from the flexed position
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Pectoralis Minor: origin
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3-5th ribs near their costal cartilages
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Pectoralis Minor: insertion
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medial border and superior surface of coracoid process of scapula
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Pectoralis minor: innervation
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Medial pectoral nerve (C8, T1)
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Pectoralis Minor: function
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stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall
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subclavius: origin
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junction of 1st rib and its costal cartilage
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subclavius: insertion
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inferior surface of middle third of clavicle
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subclavius: innervation
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nerve to subclavius (C5, C6)
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subclavius: function
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anchors and depresses clavicle
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serratus anterior: origin
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external surfaces of lateral parts of 1-8th ribs
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serratus anterior: insertion
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anterior surface of medial border of scapula
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serratus anterior: innervation
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Long thoracic nerve (C5, C6, C7)
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Serratus anterior: function
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protracts scapula and holds it against thoracic wall; rotates scapula
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Elevate scapula
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Trapezius (descending part)(main), levator scapulae, rhomboids
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depress scapula
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gravity(main), pectoralis major, inferior sternocostal head; latissimus dorsi; trapezius, ascending part; serratus anterior, inferior part; pectoralis minor
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Protract scapula
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serratus anterior (main), pectoralis major/minor
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rotate scapula upward
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trapezius (descending part)(main), trapezius ascending; serratus anterior (inferior part) (main as well)
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rotate scapula downward
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gravity, levator scapulae, rhomboids, latissimus dorsi (main), pec minor, pec major, inferior sternocostal head
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deltoid: origin
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lateral third of clavicle; acromion and spine of scapula
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deltoid: insertion
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deltoid tuberosity of humerus
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deltoid: innervation
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axillary nerve (C5, c6)
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deltoid: function
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clavicular: flexes and medially rotates arm; acromial: abducts arm; spinal:extends and laterally rotates arm
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supraspinatus: origin
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supraspinous fossa of scapula
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supraspinatus: insertion
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superior facet of greater tubercle of humerus
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supraspinatus: innervation
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suprascapular nerve (c4, C5, c6)
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supraspinatus: function
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initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles
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infraspinatus: origin
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infraspinous fossa of scapula
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infraspinatus: insertion
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middle facet of greater tubercle of humerus
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infraspinatus: innervation
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suprascapular nerve (C5, c6)
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infraspinatus: function
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laterally rotates arm; acts with rotator cuff muscles
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teres minor: origin
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middle part of lateral border of scapula
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teres minor: insertion
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inferior facet of greater tubercle of humerus
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teres minor: innervation
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axillary nerve (C5, c6)
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teres minor: function
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laterally rotates arm; acts with rotator cuff muscles
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teres major:origin
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posterior surface of inferior angle of scapula
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teres major: insertion
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medial lip of intertubercular sulcus of humerus
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teres major: innervation
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lower subscapular nerve (c5, C6)
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teres major: function
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adducts and medially rotates arm
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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:innervation
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upper and lower subscapular nerves (c5, C6, c7)
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subscapularis: function
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medially rotates arm; as part of rotator cuff, helps hold head of humerus in glenoid cavity
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winged scapula
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injury to long thoracic nerve causes paralysis of serratus anterior, so scapula isn't held tightly to wall
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Injury of spinal accessory nerve (CN XI)
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ipsilateral weakness when shoulders elevated (shrugged) against resistance
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Injury of thoracodorsal nerve
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latissimus dorsi paralysis, unable to climb; can't use axillary crutch
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Injury to dorsal scapular nerve
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rhomboids, scapula not retracted so close to midline
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Injury to axillary nerve
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deltoid; humerus fracture; flattened shoulder appearance
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Fracture-dislocation of proximal humeral epiphysis
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can cause premature cessation of growth
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rotator cuff injuries
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SITS; degenerative tendonitis common
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Dorsal Scapular Nerve: Origin
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posterior aspect of anterior ramus of C5 with a frequent contribution from c4
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Dorsal scapular Nerve: course
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pierces middle scalene; descends deep to levator scapulae and rhomboids
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Dorsal scapular nerve: innervates
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rhomboids
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long thoracic nerve: origin
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posterior aspect of anterior rami of C5, C6, c7
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Long thoracic nerve: course
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passes through cervico-axillary canal, descending posterior to C8 and T1 roots of plexus (anterior rami); runs inferiorly on superficial surface of serratus anterior
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long thoracic nerve: invervates
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serratus anterior (main), pectoralis major/minor
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suprascapular nerve (origin)
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superior trunk, receiving fibers from C5, c6, and often c4
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suprascapular nerve: course
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passes laterally across lateral cervical region, superior to brachial plexus; then through scapular notch inferior to superior transverse scapular ligament
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suprascapular nerve: innervates
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supraspinatus and infraspinatus mm. glenohumeral (shoulder) joint
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subclavian nerve: origin
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superior trunk, receiving fibers from c5, C6, and often c4
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subclavian nerve: course
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descends posterior to clavicle and anterior to brachial plexus and subclavian artery; often giving an accessory root to phrenic nerve
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subclavian nerve: innervates
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subclavius and sternoclavicular joint (accessory phrenic root innervates diaphragm)
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lateral pectoral nerve: orgin
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side branch of lateral cord, receiving fibers from c5, C6, c7
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lateral pectoral nerve: course
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pierces costocoracoid membrane to reach deep surface of pectoral muscles; a communicating branch to the medial pectoral nerve passes anterior to axillary artery and vein
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lateral pectoral nerve: innervates
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primaryily pec major
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musculocutaneous nerve: origin
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terminal branches of lateral cord (C5-7)
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musculocutaneous nerve: course
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exits axilla by piercing coracobrachialis; descends between biceps brachii and brachialis, supplying both; continues as lateral cutaneous nerve of forearm
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musculocutaneous nerve: innervates
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anterior compartment of arm (coracobrachialis, biceps brachii, and brachialis); skin of lateral aspect of forearm
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median nerve: origin
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Lateral root: terminal branch of lateral cord (C6, C7); Medial root:terminal branch of median cord (C8, T1)
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median nerve: course
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lateral and medial roots merge to form median nerve lateral to axillary artery; descends through arm adjacent to brachial artery, with nerve gradually crossing anterior to artery to lie medial to artery in cubital fossa
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median nerve: innervates
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anterior forearm (except flexor carpi ulnaris and ulnar half of flexor digitorum profundus), five intrinsic mm. in thenar half of palm and palmar skin
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Medial pectoral, medial cutaneous nerve of arm, and median cutaneous nerve of forearm:origin
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side branches of medial cord, receiving fibers from C8, T1
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medial pectoral nerve: course
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passes between axillary artery and vein; then pierces pectoralis minor and enters deep surface of pectoralis major; although it is called medial for its origin from medial cord, it lies lateral to lateral pectoral nerve
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medial pectoral nerve: innervates
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pec minor and sternocostal part of pec major
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medial cutaneous nerve of arm: course
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smalles nerve of plexus; runs along medial side of axillary and brachial veins; communicates with intercostobrachial nerve
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medial cutaneous nerve of arm: innervatews
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skin of medial side of arm, as far distal as medial epicondyle of humerus and elecranon of ulna
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median cutaneous nerve of forearm: course
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starts with ulnar nerve (with which it may be confused) but pierces deep fascia with basilic vein and enters subcutaneous tissue, dividing into anterior and posterior branches
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median cutaneous nerve of forearm: innervates
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skin of medial side of forearm, as far distal as wrist
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ulnar nerve: origin
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larger terminal branch of medial cord, receiving fibers from C8, T1, and often C7
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Question
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Answer
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Splenius: Origin
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Nuchal ligament and spinous process of C7-T3/4
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ulnar nerve: course
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descends medial arm; passes posterior to medial epicondyle of humerus; then descends ulnar aspect of forearm to hand
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Splenius: Insertion
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Mastoid process; superior nuchal line of occipital bone - splenius capitis
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ulnar nerve: innervates
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flexor carpi ulnaris and ulnar half of flexor digitorum profundus (forearm); most intrinsic muscles of hand; skin of hand medial to axial line of digit 4
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Splenius: Nerve Supply
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posterior rami of spinal nerves
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upper subscapular nerve: origin
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side branch of posterior cord receiving fibers from C5
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Splenius: Function
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laterally flex neck and rotate head to side; extend head and neck
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upper subscapular nerve: course
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passes posteriorly, entering subscapularis directly
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upper subscapular nerve: innervates
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superior portion of subscapularis
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Erector Spinae: Iliocostalis:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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lower subscapular nerve: origin
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side branch of posterior cord, receiving fibers from C6
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Erector Spinae: Iliocostalis:Insertion
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Ribs and transverse processes of cervical vertebrae
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lower subscapular nerve: course
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passes inferolaterally, deep to subscapular artery and vein
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Erector Spinae: Longissimus:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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lower subscapular nerve: innervates
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inferior portion of subscapularis and teres major
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Erector Spinae: Longissimus:Insertion
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Ribs and transverse processes of cervical and thoracic vertebrae and mastoid process of temporal bone
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thoracodorsal nerve: origin
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side branch of posterior cord, receiving fibers from c6, C7, c8
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Erector Spinae: Spinalis:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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thoracodorsal nerve: course
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arises between upper and lower subscapular nerves and runs inferolaterally along posterior axillary wall to apical part of latissimus dorsi
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Erector Spinae: Spinalis:Insertion
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Spinous processes of upper thoracic and cervical vertebrae and skull
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Erector Spinae: Iliocostalis, Longissimus, Spinalis:Nerve Supply
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posterior rami of spinal nerves
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thoracodorsal nerve: innervates
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latissimus dorsi
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axillary nerve: origin
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terminal branch of posterior cord, receiving fibers from C5, c6
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Erector Spinae: Iliocostalis, Longissimus, Spinalis:Function
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extend vertebral column and head; as back is flexed, control movement via eccentric contraction; laterally flex vertebral column
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Semispinalis: Capitis, Cervicis, and Thoracis:Origin
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Transverse processes of C4-T12
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axillary nerve: course
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exits axillary fossa posteriorly, passing through quadrangular space with posterior circumflex humeral artery; gives rise to superior lateral brachial cutaneous nerve; then winds around surgical neck of humerus deep to deltoid
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axillary nerve: innervates
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glenohumeral (shoulder) joint; teres minor and deltoid muscles; skin of superolateral arm (over inferior part of deltoid)
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Semispinalis: Capitis, Cervicis, and Thoracis:Insertion
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Occipital bone, spinous processes of Cervical and thoracic vertebrae
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Rotatores:Origin
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Transverse processes (primarily thoracic)
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radial nerve: origin
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larger terminal branch of posterior cord (largest branch of plexus), receiving fibers from C5-T1
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radial nerve: course
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exits axillary fossa posterior to axillary artery; passes posterior to humerus in radial groove with deep brachial artery, between lateral and medial heads of triceps; perforates lateral intermuscular septum; enters cubital fossa, dividing into superficial (cutaneous) and deep (motor) radial nerves
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Rotatores:Insertion
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Junction lamina and transverse process or spinous process 2 segments superior
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radial nerve: innervates
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all muscles of posterior compartments of arm and forearm; skin of posterior and inferloateral arm, posterior forearm, and dorusm of hand lateral to axial line of digit 4
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Multifidus:Origin
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Sacrum, erector spinae ligament, transverse and articulate processes of cervical and thoracic vertebrae
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biceps brachii: origin
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short head:tip of coracoid process of scapula; long head: supraglenoid tubercle of scapula
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Multifidus:Insertion
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Spinous processes of vertebrae 2-4 superior
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biceps brachii: insertion
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tuberosity of radius and fascia of forearm via bicipital aponeurosis
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Transversospinalis:Semispinalis, Multifidus, Rotatores (brevis and longus):Nerve Supply
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posterior rami of spinal nerves
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biceps brachii & coracobrachialis: innervation
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musculocutaneous nerve (c5, C6, c7)
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Semispinalis:Function
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extends head and thoracic and cervical regions of vertebral column and rotates them contralaterally
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biceps brachii: function
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supinates forearm and when it is supine, flexes forearm; short head resists dislocation of shoulder
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Multifidus: Function
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stabilizes vertebrae during local movements of vertebral column
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coracobrachialis: origin
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tip of coracoid process of scapula
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Rotatores: Function
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stabilize vertebrae and assist with local extension and rotatory movements of vertebral column; proprioception
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Rectus Capitis Posterior Minor:Origin
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Posterior tubercle of posterior arch of C1
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coracobrachialis: insertion
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middle thir of medial surface of humerus
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Rectus Capitis Posterior Major: Origin
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Spinous proccess of C2
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coracobrachialis: function
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helps flex and adduct arm; resists dislocation of shoulder
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brachialis: origin
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distal half of anterior surface of humerus
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Rectus Capitis Posterior Minor:Insertion
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Medial part of inferior nuchal line of occipital bone
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brachialis: insertion
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coronoid process of tuberosity ulna
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Rectus Capitis Posterior Major:Insertion
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Lateral part of inferior nuchal line of occipital bone
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brachialis: innervation
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musculocutaneous nerve (c5, c6) and radial nerve (c5, c7)
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Obliquus Capitis Superior: Origin
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transverse process of C1
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Obliquus Capitis Superior: Insertion
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Occipital bone between superior and inferior nuchal lines
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brachialis: function
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flexes forearm in all positions
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triceps brachii: origin
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long head: infraglenoid tubercle of scapula; lateral head: posterior surface of humerus, superior to radial groove; medial head: posterior surface of humerus, inferior to radial groove
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Obliquus Capitis Inferior: Origin
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Posterior tubercle of posterior arch of C2
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Obliquus Capitis Inferior: Insertion
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Transverse process of C1
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triceps brachii: insertion
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proximal end of olecranon of ulna and fascia of forearm
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triceps brachii: innervation
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radial nerve (c6, C7, C8)
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Suboccipital nerve (posterior ramus C1):insertion
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runs between cranium and C1 to reach muscles of suboccipital triangle
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Greater occipital nerve (posterior ramus C2):Insertion
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Emerges inferior to obliquus capitis inferior and ascends to Skin over neck and occipital bone
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triceps brachii: function
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chief extensor of forearm; long head resists dislocation of humerus; especially important during adduction
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Posterior rami of C3-C7: Insertion
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Pass segmentally to intrinsic muscles of back and overlying skin (adjacent to vertebral column)
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anconeus: origin
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lateral epicondyle of humerus
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anconeus: insertion
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lateral surface of elecranon and superior part of posterior surface of ulna
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Lesser occipital nerve (anterior rami of C2-C3): Insertion
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Passes directly to skin of superior posterolateral neck and scalp posterior to external ear
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Vertebral artery:Origin
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Transverse foramina of cervical vertebrae
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anconeus: innervation
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Radial nerve (c7, c8, t1)
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Vertebral artery:Insertion
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Foramen magnum to brain
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anconeus: function
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assists triceps in extending forearm; stabilizes elbow joint; may abduct ulna during pronation
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Pronator teres:ulnar head: origin
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coronoid process
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Trapezius:Origin
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Spinus processes and nuchal ligament
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Pronator teres:ulnar head: insertion
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middle of convexity of lateral surface of radius
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Trapezius:Insertion
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Upper limb (spine of scapula as well as the bump on your shoulder) and wraps around to clavicle
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Pronator teres:ulnar head: innervation
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Median nerve (c6, C7)
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Trapezius: innervation
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Spinal accessory nerve (CN XI) (motor fibers) and C3, C4 spinal nerves (pain and proprioception)
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Pronator teres:ulnar head: function
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pronates and flexes forearm (at elbow)
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Trapezius: function
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descending elevates; ascending depresses; middle retracts scapula; descending and ascending together rotate glenoid cavity superiorly
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Triangle of auscultation
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latissimus dorsi, medial scapula, inferolateral trapezius
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Pronator teres:humeral head: origin
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Medial epicondyle of humerus (common flexor origin)
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Pronator teres:humeral head: insertion
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middle of convexity of lateral surface of radius
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Latissimus Dorsi:Origin
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Spinous processes of lumbar levels as well as thoraco something fascia?
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Pronator teres:humeral head: innervation
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Median nerve (c6, C7)
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Latissimus Dorsi:Insertion
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humerus
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Pronator teres:humeral head: function
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pronates and flexes forearm (at elbow)
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Latissimus Dorsi:Innervation
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Thoracodorsal nerve (C6, C7, C8)
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Latissimus Dorsi:function
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extends, adducts, and medially rotates humerus; raises body toward arms during climbing
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Flexor carpi radialis (FCR): origin
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Medial epicondyle of humerus (common flexor origin)
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Levator Scapulae:origin
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posterior tubercles of transverse processes of C1-C4
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Flexor carpi radialis (FCR): insertion
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base of 2nd metacarpal
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Flexor carpi radialis (FCR): innervation
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Median nerve (c6, C7)
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Levator Scapulae:insertion
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medial border of scapula superior to root of scapular spine
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Flexor carpi radialis (FCR): function
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flexes and abducts hand (at wrist)
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Levator Scapulae:innervation
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dorsal scapular (C5) and cervical C3-C4 nerves
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Levator Scapulae:function
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elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula
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Palmaris Longus: Origin
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Medial epicondyle of humerus (common flexor origin)
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Rhomboid minor:Origin
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Spinous processes
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Palmaris Longus: Insertion
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distal half of flexor retinaculum and apex of palmar aponeurosis
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Rhomboid minor:Insertion
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Spine of scapula
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Palmaris Longus: Innervation
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Median nerve (c7, c8)
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Rhomboid major/minor:Innervation
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dorsal scapular nerve (C4, C5)
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Palmaris Longus: Function
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Flexes hand (at wrist) and tenses palmar aponeurosis
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Flexor carpi ulnaris (FCU):Humeral head: origin
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Medial epicondyle of humerus (common flexor origin)
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Rhomboid major/minor:function
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retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall
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Flexor carpi ulnaris (FCU):Humeral head: insertion
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Pisiform, hook of hamate, 5th metacarpal
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Rhomboid major:Origin
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Spinous processes
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Flexor carpi ulnaris (FCU):Humeral head: innervation
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ulnar nerve (c7, C8)
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Rhomboid major:Insertion
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Below spine of scapula
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Serratus posterior superior:Origin
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Spinous processes
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Flexor carpi ulnaris (FCU):Humeral head: function
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flexes and adducts hand (at wrist)
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Flexor carpi ulnaris (FCU):Ulnar head: origin
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Olecranon and posterior border (via aponeurosis)
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Serratus posterior superior:Insertion
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ribs
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Serratus posterior inferior:Origin
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Spinous processes
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Flexor carpi ulnaris (FCU):Ulnar head: insertion
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Pisiform, hook of hamate, 5th metacarpal
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Serratus posterior inferior:Insertion
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ribs
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Flexor carpi ulnaris (FCU):Ulnar head: innervation
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ulnar nerve (c7, C8)
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C3-C5 Spinous Processes:Characteristics
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Short
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Flexor carpi ulnaris (FCU):Ulnar head: function
|
flexes and adducts hand (at wrist)
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C3-C6 Spinous Processes:Characteristics
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bifid
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Flexor digitorum superficialis (FDS):humeroulnar head: origin
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medial epicondyle (common flexor origin and coronoid process)
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C6 Spinous Process:Characterisitc
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long
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Flexor digitorum superficialis (FDS):humeroulnar head: insertion
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shafts of middle phalanges of medial four digits
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C7 Spinous Process:called
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vertebra prominens
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Flexor digitorum superficialis (FDS):humeroulnar head: innervation
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Median nerve (c7, c8, t1)
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Vertebral Body Osteoporosis: Most affected areas
|
Most affected areas are the neck of the femur and bodies of vertebrae, metacarpals, and radius
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Flexor digitorum superficialis (FDS):humeroulnar head: function
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flexes middle phalanges at proximal interphalangeal joints of middle four digits; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints
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Vertebral Body Osteoporosis:Radiographical signs
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diminished radiodensity of trabecular (spongy) bone of vertebral bodies, cuasing thinned cortical bone to appear prominent (vertical striping); also kyphosis
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Flexor digitorum superficialis (FDS):radial head: origin
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superior half of anterior border
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Laminectomy
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excision of spinous processes and laminae to gain access to vertebral canal (spinal cord) or roots of specific spinal nerves; or relieve pressure from a tumor etc
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Flexor digitorum superficialis (FDS):radial head: insertion
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shafts of middle phalanges of medial four digits
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Dislocation of Cervical Vertebrae
|
cervical vertebrae are less tightly locked; if the dislocation does not result in "facet jumping" it may self-reduce (slip back into place) so you can't tell if there's been spinal cord injury on MRI
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Flexor digitorum superficialis (FDS):radial head: innervation
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Median nerve (c7, c8, t1)
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Fracture and Dislocation of Atlas
|
Occipital condyle can transmit force on lateral masses of C1 which are wedge shaped and push them out (Jefferson or burst fracture) actually increases size of foramen
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Flexor digitorum superficialis (FDS):radial head: function
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flexes middle phalanges at proximal interphalangeal joints of middle four digits; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints
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Fracture and Dislocation of Atlas
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common, usually at pars interarticularis; traumatic spondylolysis of C2 usually from hyperextension of the head ON the neck (hangman's fracture); quadriplegia or death
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Flexor digitorum profundus (FDP): medial part: origin
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proximal three quarters of medial and anterior surfaces of ulna and interosseous membrane
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Fractures of the dens
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also common axis injury from horizontal blow to the head or complication of osteopenia; results in avascular necrosis of dens
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Flexor digitorum profundus (FDP): medial part: insertion
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bases of distal phalanges of 4th and 5th digits
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Lumbar Spinal Stenosis
|
cause compression of spinal nerve roots occupying the inferior vertebral canal; requires decompressive laminectomy
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Cervical Ribs
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common anomaly 1-2% of people; may cause thoracic outlet syndrome when supernumerary rib places pressure on structures that emerge from the superior thoracic aperture
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Flexor digitorum profundus (FDP): medial part: innervation
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ulnar nerve (c8, T1)
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Flexor digitorum profundus (FDP): medial part: function
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flexes distal phalanges 4 and 5 at distal interphalangeal joints
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Caudal Epidural Anethsesia
|
local anesthetic injected into fat of sacral canal surrounding proximal sacral nerves; acts on S2-Co1; height of ascension of anesthetic controlled by amt injected and position of patient
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Flexor digitorum profundus (FDP): lateral part: origin
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proximal three quarters of medial and anterior surfaces of ulna and interosseous membrane
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Injury of Coccyx
|
coccygodynia often follows coccygeal trauma
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Flexor digitorum profundus (FDP): lateral part: insertion
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bases of distal phalanges of 2nd and 3rd digits
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abnormal fusion of vertebrae
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Sacralization of L5:L5 fuses to Sacrum, L4-L5 degenerates=pain; lumbarization of the S1:if S1 doesn't fuse, no biggie
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Flexor digitorum profundus (FDP): lateral part: innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Effect of aging on vertebrae
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bowing; osteophytes (bony spurs) commonly develop around the margins of the vertebral body
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Flexor digitorum profundus (FDP): lateral part: function
|
flexes distal phalanges 2 and 3 at distal interphalangeal joints
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anomalies of vertebrae
|
spina bifida occulta: neural arches of L5-S1 fail to develop; spina bifida cystica: herniation of meninges (meningocele) or spinal cord (meningomyelocele)
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Flexor pollicis longus (FPL): origin
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anterior surface of radius and adjacent interosseous membrane
|
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herniation of nucleus pulposus
|
extend posterolaterally where anulus fibrosus is thin and does not receive support from posterior or anterior longitudinal ligaments; usually L4-L5 or L5-S1
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Flexor pollicis longus (FPL): insertion
|
base of distal phalanx of thumb
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Rupture of Transverse Ligament of Atlas
|
dens set free: atlanto-axial subluxation; can compress spinal cord - quadriplegia or into medulla - death
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Flexor pollicis longus (FPL): innervation
|
anterior interosseous nerve, from median nerve (C8, t1)
|
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Rupture of Alar Ligaments
|
weaker than transverse ligament of atlas so combined flexion and rotation of the head may tear resulting in a 30% increase in ROM to the contralateral side
|
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Flexor pollicis longus (FPL): function
|
flexes phalanges of 1st digit (thumb)
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Fractures and Dislocations of Vertebrae
|
See others cards, but spondylolysis of L5 results from a failure of the centrum of L5 to unite with neural arches at neurocentral joint
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Pronator quadratus: origin
|
distal quarter of anterior surface of ulna
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Spondylolisthesis
|
at the L5-S1 IV joint may result in pressure on spinal cord and low back/limb pain
|
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Pronator quadratus: insertion
|
distal quarter of anterior surface of radius
|
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Injury and disease of Zygapophysial joints
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joints that are close to IV foramina through which spinal nerves emerge, so they can be linked to pain of a dermatome and spasm in a myotome
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Pronator quadratus: innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Interspinales: Origin
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superior surfaces of spinous processes of cervical and lumbar vertebrae
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Pronator quadratus: function
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pronates forearm; deep fibers bind radius and ulna together
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Interspinales: Insertion
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Inferior surfaces of spinous processes of vertebra superior to vertebra of proximal attachment
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Brachioradialis: origin
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proximal two thirds of fupraepicondylar ridge of humerus
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Brachioradialis: insertion
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lateral surface of distal end of radius proximal to styloid process
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Interspinales: Nerve Supply
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Posterior rami of spinal nerves
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Interspinales: Function
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Aid in extension and rotation of vertebral column
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Brachioradialis: innervation
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radial nerve (c5, C6, c7)
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Brachioradialis: function
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relatively weak flexion of forearm; maximal when forearm is in midpronated position
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Intertransversarii: Origin
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Transverse processes of cervical and lumbar vertebrae
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Extensor carpi radialis longus (ECRL): origin
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lateral supraepicondylar ridge of humerus
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Intertransversarii: Insertion
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Transverse processes of adjacent vertebrae
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Intertransversarii: Nerve Supply
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Posterior and anterior rami of spinal nerves
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Extensor carpi radialis longus: insertion
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dorsal aspect of base of 2nd metacarpal
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Intertransversarii: Function
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aid in lateral flexion of vertebral column; stabilize vertebral column
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Extensor carpi radialis longus: innervation
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radial nerve (c6, c7)
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Levatores costarum: Origin
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Tips of transverse processes of C7 and T1-T11 vertebrae
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Extensor carpi radialis longus: function
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extend and abduct hand at the wrist joint; active during fist clenching
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Levatores costarum: Insertion
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Pass inferolaterally and insert on rib between tubercle and angle
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Extensor carpi radialis brevis (ECRB): origin
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lateral epicondyle of humerus (common extensor origin)
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Levatores costarum: Nerve supply
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posterior rami of C8-T11 spinal nerves
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Extensor carpi radialis brevis: insertion
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dorsal aspect of base of 3rd metacarpal
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Levatores costarum: function
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elevate ribs, assisting respiration; assist with lateral flexion of vertebral column
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Extensor carpi radialis brevis: innervation
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deep branch of radial nerve (C7, c8)
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Extensor carpi radialis brevis: function
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extend and abduct hand at the wrist joint
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Flexion of cervical intervertebral joints
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Longus Coli, Scalene, Sternocleidomastoid
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Extensor digitorum: origin
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lateral epicondyle of humerus (common extensor origin)
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Extension of cervical intervertebral joints
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Deep neck muscles: semispinalis cervicis, iliocostalis cervicis, splenius cervicis, levator scapulae, splenius capitis, multifidus, longissimus capitis, semispinalis capitis, trapezius
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Lateral bending of cervical intervertebral joints
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unilateral action of: rotatores, semispinalis capitis and cervicis, multifidus, splenius cervicis
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Extensor digitorum: insertion
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extensor expansion of medial four digits
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Extensor digitorum: innervation
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deep branch of radial nerve (C7, c8)
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Flexion of thoracic and lumbar IV joints
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Bilateral action of rectus abdominis, psoas major, gravity
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Extension of thoracic and lumbar IV joints
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bilateral action of erector spinae, multifidus, semispinalis thoracis
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Extensor digitorum: function
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extends medial four digits primarily at metacarpophalangeal joints, secondarily at interphalangeal joints
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Lateral bending of thoracic and lumbar IV joints
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unilateral action of iliocostalis thoracis and lumborum, longissimus thoracis, multifidus, external and internal oblique, quadratus lumborum, rhomboids, serratus anterior
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Extensor digit minimi (EDM): origin
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lateral epicondyle of humerus (common extensor origin)
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rotation of thoracic and lumbar IV joints
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unilateral rotatores, multifidus, iliocostalis, longissimus, external oblique opposite internal oblique, splenius thoracis
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Extensor digit minimi (EDM): insertion
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extensor expansion of 5th digit
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Suboccipital triangle: superomedial boundary
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rectus capitis posterior major
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Extensor digit minimi (EDM): innervation
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deep branch of radial nerve (C7, c8)
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Suboccipital triangle: superolateral boundary
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obliquus capitis superior
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Extensor digit minimi (EDM): function
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Extends 5th digit primarily at metacarpophalangeal joint, secondarily at interphalangeal joint
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Suboccipital triangle: inferolateral bondary
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obliquus capitis inferior
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Extensor carpi ulnaris (ECU): origin
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lateral epicondyle of humerus; posterior border of ulna via a shared aponeurosis
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Suboccipital triangle: floor
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posterior atlanto-occipital membrane and posterior arch of vertebra C1
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Extensor carpi ulnaris (ECU): insertion
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dorsal aspect of base of 5th metacarpal
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Suboccipital triangle: roof
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semispinalis capitis
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Extensor carpi ulnaris (ECU): innervation
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deep branch of radial nerve (C7, c8)
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Suboccipital triangle: contents
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vertebral artery and suboccipital nerve
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Extensor carpi ulnaris (ECU): function
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extends and adducts hand at wrist joint (also active during fist clenching)
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Flexion of atlanto-occipital joints
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longus capitis, rectus capitis anterior, anterior fibers of sternocleidomastoid, suprahyoid and infrahyoid mm.
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Supinator: origin
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lateral epicondyle of humerus; radial collateral and anular ligaments; supinator fossa; crest of ulna
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Extension of atlanto-occipital joints
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Rectus capitis posterior (major and minor), obliquus capitis superior, splenius capitis, longissimus capitis, trapezius
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Supinator: insertion
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lateral, posterior, and anterior surfaces of proximal third of radius
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Lateral flexion of atlanto-occipital joints
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sternocleidomastoid, obliquus capitis superior, rectus capitis lateralis, longissimus capitis, splenius capitis
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Supinator: innervation
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deep branch of radial nerve (c7, C8)
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Leptomeninges: Development
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single layer from mesenchyme surrounding embryonic spinal cord
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Supinator: function
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supinates forearm; rotates radius to turn palm anteriorly or superiorly (if elbow is flexed)
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avulsion fracture of the greater tubercle of humerus
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fall on acromion or hand when arm is abducted; subscapularis rotates limb medially
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Extensor indicis: origin
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posterior surface of distal thihrd of ulna and interosseous membrane
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transverse fracture of teh shaft of humerus
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direct blow to arm; deltoid caries proximal fragment laterally
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Extensor indicis: insertion
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extensor expansion of 2nd digit
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Colles fracture
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complete transverse fracture of distal 2cm of radius; distal fragment comminuted (broken into peices); from forced dorsiflexion of the hand (trying to ease a fall)
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Extensor indicis: innervation
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posterior interosseous nerve (C7, c8), continuation of deep branch of radial nerve
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Fracture of scaphoid
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just looks like sprained wrist until 10-14 days later reveal bone resorption; can lead to avascular necrosis and degenerative joint disease
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Extensor indicis: function
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extends 2nd digit (enabling its independent extension); helps extend hand at wrist
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fracture of hamate
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can involve ulnar nerve, decreasing grip strength
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Abductor pollicis longus (APL): origin
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posterior surface of proximal halves of ulna, radius, and interosseous membrane
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fracture of metacarpals
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held together and good blood supply, so heal quickly
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Abductor pollicis longus (APL): insertion
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base of 1st metacarpal
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fracture of phalanges
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bone fragments must be carefully realigned to restore normal function because of flexor tendons
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Abductor pollicis longus (APL): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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dermatomes C3, C4
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region at base of neck, extending laterally over shoulder
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Abductor pollicis longus (APL): function
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abducts thumb and extends it at carpometacarpal joint
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dermatome C5
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Lateral aspect of arm (i.e., superior aspect of abducted arm)
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Extensor pollicis longus (EPL): origin
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posterior surface of middle third of ulna and interosseous membrane
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dermatome C6
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lateral forearm and thumb
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Extensor pollicis longus (EPL): insertion
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dorsal aspect of base of distal phalanx of thumb
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Extensor pollicis longus (EPL): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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dermatome C7
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middle and ring fingers and center of posterior aspect of forearm
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Extensor pollicis longus (EPL): function
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extends distal phalanx of thumb at interphalangeal joint; extends metacarpophalangeal and carpometacarpal joints
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dermatome C8
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little finger, medial side of hand and forearm (i.e., inferior aspect of abducted arm)
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Extensor pollicis brevis (EPB): origin
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posterior surface of distal third of radius and interosseous membrane
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dermatome T1
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medial aspect of forearm and inferior arm
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Extensor pollicis brevis (EPB): insertion
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dorsal aspect of base of proximal phalanx of thumb
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dermatome T2
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medial aspect of superior arm and skin of axilla
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Supraclavicular nerve from C3, C4 cervical plexus
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pass anterior to clavicle, immediately deep to platysma, and supply skin over clavicle and superolateral aspect of pectoralis major
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Extensor pollicis brevis (EPB): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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superior lateral cutaneous nerve of arm C5, C6 terminal branch of axillary nerve
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emerges from beneath posterior margin of deltoid and supplies skin over lower part of this muscle and on lateral side of midarm
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Extensor pollicis brevis (EPB): function
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extends proximal phalanx of thumb at metacarpophalangeal joint; extends carpometacarpal joint
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Opponens pollicis: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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inferior lateral cutaneous nerve of arm C5, C6 radial nerve (or posterior cutaneous nerve of arm)
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Perforates lateral head of triceps, passing close to cephalic vein to supply skin over inferolateral aspect of arm
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Opponens pollicis: insertion
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lateral side of 1st metacarpal
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posterior cutaneous nerve of arm C5-C8 radial nerve (in axilla)
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Crosses posterior to and communicates with intercostobracheal nerve and supplies skin on posterior arm as far as olecranon
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Opponens pollicis: innervation
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recurrent branch of median nerve (C8, t1)
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posterior cutaneous nerve of forearm C5-C8 radial nerve (with inferior lateral cutaneous nerve of arm)
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perforates lateral head of triceps, descends laterally in arm, then runs along and supplies posterior forearm to wrist
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Opponens pollicis: function
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to oppose thumb, it draws 1st metacarpal medially to center of palm and rotates it medially
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Lateral cutaneous nerve of forearm C6-C7 Musculocutaneous nerve (terminal branch)
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Emerges lateral to biceps tendon deep to cephalic vein, supplying skin of anterolateral forearm to wrist
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Abductor pollicis: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Medial cutaneous nerve of forearm C8, T1 Medial cord of brachial plexus (in axilla)
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Descends medial to brachial artery, pierces deep fascia with basilic vein in midarm, dividing into anterior and posterior branches that enter forearm and suppply skin of anteromedial aspect to wrist
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Abductor pollicis: insertion
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lateral side of base of proximal phalanx of thumb
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Medial cutaneous nerve of arm C8-T2 Medial cord of brachial plexus (in axilla)
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Communicates with intercostobrachial nerve, continuing to supply skin of medial aspect of distal arm
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Intercostobrachial Nerve T2 Second intercostal nerve (as its lateral cutaneous branch)
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Extends laterally, communicating with posterior and medial cutaneous nerves of arm, supplying skin of axilla and medial aspect of proximal arm
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Abductor pollicis: innervation
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recurrent branch of median nerve (C8, t1)
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Abductor pollicis: function
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abducts thumb; helps op[pose it
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Pectoralis Major: origin
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Clavicular head: anterior surface of medial half of clavicle; Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle
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Flexor pollicis brevis: superficial head: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Pectoralis major: Insertion
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Lateral lip of intertubercular sulcus of humerus
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Pectoralis Major: Innervation
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Lateral and medial pectoral nerves; clavicular head (C5, C6), sternocostal head (C7, C8, T1)
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Flexor pollicis brevis: superficial head: insertion
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lateral side of base of proximal phalanx of thumb
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Flexor pollicis brevis: superficial head: innervation
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recurrent branch of median nerve (C8, t1)
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Pectoralis Major: function
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adducts and medially rotates humerus; draws scapula anteriorly and inferiorly; clavicular head flexes humerus and sternocostal head extends it from the flexed position
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Flexor pollicis brevis: superficial head: function
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flexes thumb
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Pectoralis Minor: origin
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3-5th ribs near their costal cartilages
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Flexor pollicis brevis: deep head: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Pectoralis Minor: insertion
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medial border and superior surface of coracoid process of scapula
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Flexor pollicis brevis: deep head: insertion
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lateral side of base of proximal phalanx of thumb
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Pectoralis minor: innervation
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Medial pectoral nerve (C8, T1)
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Flexor pollicis brevis: deep head: innervation
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deep branch of ulnar nerve (c8, T1)
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Pectoralis Minor: function
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stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall
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Flexor pollicis brevis: deep head: function
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adducts thumb toward lateral border of palm
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subclavius: origin
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junction of 1st rib and its costal cartilage
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subclavius: insertion
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inferior surface of middle third of clavicle
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Adductor pollicis: Oblique head: origin
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bases of 2nd and 3rd metacarpals, capitate, and adjacent carpals
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Adductor pollicis: Oblique head: insertion
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medial side of base of proximal phalanx of thumb
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subclavius: innervation
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nerve to subclavius (C5, C6)
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Adductor pollicis: Oblique head: innervation
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deep branch of ulnar nerve (c8, T1)
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subclavius: function
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anchors and depresses clavicle
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Adductor pollicis: Oblique head: function
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adducts thumb toward lateral border of palm
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serratus anterior: origin
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external surfaces of lateral parts of 1-8th ribs
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Adductor pollicis: Transverse head: origin
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anterior surface of shaft of 3rd metacarpal
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serratus anterior: insertion
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anterior surface of medial border of scapula
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Adductor pollicis: Transverse head: insertion
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medial side of base of proximal phalanx of thumb
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serratus anterior: innervation
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Long thoracic nerve (C5, C6, C7)
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Adductor pollicis: Transverse head: innervation
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deep branch of ulnar nerve (c8, T1)
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Serratus anterior: function
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protracts scapula and holds it against thoracic wall; rotates scapula
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Adductor pollicis: Transverse head: function
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adducts thumb toward lateral border of palm
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Elevate scapula
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Trapezius (descending part)(main), levator scapulae, rhomboids
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abductor digit minimi: origin
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pisiform
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depress scapula
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gravity(main), pectoralis major, inferior sternocostal head; latissimus dorsi; trapezius, ascending part; serratus anterior, inferior part; pectoralis minor
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abductor digit minimi: insertion
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medial side of base of proximal phalanx of 5th digit
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Protract scapula
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serratus anterior (main), pectoralis major/minor
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abductor digit minimi: innervation
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deep branch of ulnar nerve (c8, T1)
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rotate scapula upward
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trapezius (descending part)(main), trapezius ascending; serratus anterior (inferior part) (main as well)
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rotate scapula downward
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gravity, levator scapulae, rhomboids, latissimus dorsi (main), pec minor, pec major, inferior sternocostal head
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abductor digit minimi: function
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abducts 5th digit; assists in flexion of its proximal phalanx
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deltoid: origin
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lateral third of clavicle; acromion and spine of scapula
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Flexor digiti minimi brevis: origin
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Hook of hamate and flexor retinaculum
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deltoid: insertion
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deltoid tuberosity of humerus
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Flexor digiti minimi brevis: insertion
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medial side of base of proximal phalanx of 5th digit
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deltoid: innervation
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axillary nerve (C5, c6)
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Flexor digiti minimi brevis: innervation
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deep branch of ulnar nerve (c8, T1)
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deltoid: function
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clavicular: flexes and medially rotates arm; acromial: abducts arm; spinal:extends and laterally rotates arm
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Flexor digiti minimi brevis: function
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flexes proximal phalanx of 5th digit
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supraspinatus: origin
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supraspinous fossa of scapula
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Opponens digiti: origin
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Hook of hamate and flexor retinaculum
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Opponens digiti: insertion
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medial border of 5th metacarpal
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supraspinatus: insertion
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superior facet of greater tubercle of humerus
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Opponens digiti: innervation
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deep branch of ulnar nerve (c8, T1)
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supraspinatus: innervation
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suprascapular nerve (c4, C5, c6)
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supraspinatus: function
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initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles
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Opponens digiti: function
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draws 5th metacarpal anterior and rotates it, bringing 5th digit into opposition with thumb
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infraspinatus: origin
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infraspinous fossa of scapula
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Lumbricals: 1st and 2nd: origin
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lateral two tendons of flexor digitorum profundus (as unipennate muscles)
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infraspinatus: insertion
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middle facet of greater tubercle of humerus
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Lumbricals: 1st and 2nd: insertion
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lateral sides of extensor expansions of 2-5th digits
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infraspinatus: innervation
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suprascapular nerve (C5, c6)
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Lumbricals: 1st and 2nd: innervation
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Median nerve (c8, T1)
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infraspinatus: function
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laterally rotates arm; acts with rotator cuff muscles
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Lumbricals: 1st and 2nd: function
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Flex metacarpophalangeal joints; extend interphalangeal joints of 2-5th dights
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teres minor: origin
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middle part of lateral border of scapula
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Lumbricals: 3rd and 4th: origin
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medial three tendons of flexor digitorum profundus (as bipennate muscles)
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teres minor: insertion
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inferior facet of greater tubercle of humerus
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Lumbricals: 3rd and 4th: insertion
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lateral sides of extensor expansions of 2-5th digits
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Lumbricals: 3rd and 4th: innervation
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deep branch of ulnar nerve (c8, T1)
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teres minor: innervation
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axillary nerve (C5, c6)
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Lumbricals: 3rd and 4th: function
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Flex metacarpophalangeal joints; extend interphalangeal joints of 2-5th dights
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teres minor: function
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laterally rotates arm; acts with rotator cuff muscles
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Dorsal interossei, 1-4th: origin
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adjacent sides of two metacarpals (as bipennate muscles)
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teres major:origin
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posterior surface of inferior angle of scapula
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Dorsal interossei, 1-4th: insertion
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bases of proximal phalanges; extensor expansions of 2-4th digits
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teres major: insertion
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medial lip of intertubercular sulcus of humerus
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Dorsal interossei, 1-4th: innervation
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deep branch of ulnar nerve (c8, T1)
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teres major: innervation
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lower subscapular nerve (c5, C6)
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Dorsal interossei, 1-4th: function
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abduct 2-4th digits from axial line; act with lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints
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teres major: function
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adducts and medially rotates arm
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Palmar interossei, 1-3rd: origin
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palmar surfaces of 2nd, 4th, and 5th metacarpals (as unipennate muscles)
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subscapularis:origin
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subscapular fossa
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Palmar interossei, 1-3rd: insertion
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bases of proximal phalanges; extensor expansions of 2nd, 4th, and 5th digits
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subscapularis:insertion
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lesser tubercle of humerus
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subscapularis:innervation
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upper and lower subscapular nerves (c5, C6, c7)
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Palmar interossei, 1-3rd: innervation
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deep branch of ulnar nerve (c8, T1)
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Palmar interossei, 1-3rd: function
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adduct 2nd, 4th, and 5th digits toward axial line; assist lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints; extensor expansions of 2nd-4th digits
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subscapularis: function
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medially rotates arm; as part of rotator cuff, helps hold head of humerus in glenoid cavity
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Glenohumeral Joint: Flexion:
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PEC MAJOR (clavicular head); DELTOID (clavicular and anterior acromial parts); coracobrachialis
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winged scapula
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injury to long thoracic nerve causes paralysis of serratus anterior, so scapula isn't held tightly to wall
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Injury of spinal accessory nerve (CN XI)
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ipsilateral weakness when shoulders elevated (shrugged) against resistance
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Glenohumeral Joint: Extension:
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DELTOID (spinal part); teres major; latissimus dorsi; long head of triceps brachii
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Glenohumeral Joint: Abduction:
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DELTOID (whole, but especially acromial part); supraspinatus
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Injury of thoracodorsal nerve
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latissimus dorsi paralysis, unable to climb; can't use axillary crutch
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Glenohumeral Joint: Adduction:
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PEC MAJOR; LATISSIMUS DORSI; teres major; long head of triceps brachii
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Injury to dorsal scapular nerve
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rhomboids, scapula not retracted so close to midline
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Glenohumeral Joint: Medial rotation:
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SUBSCAPULARIS; pec major; deltoid (clavicular part); latissimus dorsi; teres major
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Injury to axillary nerve
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deltoid; humerus fracture; flattened shoulder appearance
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Glenohumeral Joint: Lateral rotation:
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INFRASPINATUS; teres minor; deltoid (spinal part)
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Fracture-dislocation of proximal humeral epiphysis
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can cause premature cessation of growth
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Glenohumeral Joint: Tensors of articular capsule (to hold head of humerus against the glenoid cavity):
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SUBSCAPULARIS; INFRASPINATUS(simultaneously); supraspinatus; teres minor
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rotator cuff injuries
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SITS; degenerative tendonitis common
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Glenohumeral Joint: Resisiting downard dislocation (shunt muscles):
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DELTOID (whole); long head of triceps brachii; coracobrachialis; short head of biceps brachii
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Dorsal Scapular Nerve: Origin
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posterior aspect of anterior ramus of C5 with a frequent contribution from c4
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Ankylosis of sternoclavicular joint
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(stiffening or fixation) surgery necessary to restore movement of shoulder
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Dorsal scapular Nerve: course
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pierces middle scalene; descends deep to levator scapulae and rhomboids
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Dorsal scapular nerve: innervates
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rhomboids
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Dislocation of sternoclavicular joint
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rare; fall on outstretched hand
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long thoracic nerve: origin
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posterior aspect of anterior rami of C5, C6, c7
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Dislocation of acromioclavicular joint
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fall on shoulder or outstretched upper limb; hockey;
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Calcific supraspinatus tendinitis
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inflammation and calcification of subacromial bursa=pain during 50-130 degree of abduction (painful arc syndrome)
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Long thoracic nerve: course
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passes through cervico-axillary canal, descending posterior to C8 and T1 roots of plexus (anterior rami); runs inferiorly on superficial surface of serratus anterior
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Rotator cuff injurying
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baseball pitchers; lifting a stuck window; use gravity for 15 degrees of abduction, then deltoid can take over
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long thoracic nerve: invervates
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serratus anterior (main), pectoralis major/minor
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Dislocation of glenohumeral joint
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head of humerus driven inferoanteriorly; hard blow to humerus; support arm with other hand
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suprascapular nerve (origin)
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superior trunk, receiving fibers from C5, c6, and often c4
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Axillary nerve injury
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paralysis of deltoid; inability to abduct arm
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Glenoid labrum tears
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pain while throwing during acceleration phase; popping during abduction and lateral rotation
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suprascapular nerve: course
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passes laterally across lateral cervical region, superior to brachial plexus; then through scapular notch inferior to superior transverse scapular ligament
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Adhesive capsulitis of glenohumeral joint
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difficulty abducting arm; strain placed on AC joint, painful
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suprascapular nerve: innervates
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supraspinatus and infraspinatus mm. glenohumeral (shoulder) joint
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Bursitis of elbow
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dart thrower's elbow and miner's elbow; pain when forearm pronated
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subclavian nerve: origin
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superior trunk, receiving fibers from c5, C6, and often c4
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avulsion of medial epicondyle
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traction injury of the ulnar nerve is a frequent complication
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subclavian nerve: course
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descends posterior to clavicle and anterior to brachial plexus and subclavian artery; often giving an accessory root to phrenic nerve
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Ulnar collateral ligament reconstruction
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(UCL); athletic throwing; autologous transplant of palmaris longus or plantaris tendon of contralateral forearm or leg
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subclavian nerve: innervates
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subclavius and sternoclavicular joint (accessory phrenic root innervates diaphragm)
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Dislocation of elbow joint
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hyperextension or a blow that drives the ulna posterior; injury to the ulnar nerve may occur
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lateral pectoral nerve: orgin
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side branch of lateral cord, receiving fibers from c5, C6, c7
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subluxation and dislocation of radial head
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preschool, picking up kid with their arms fully extended; jerked; pinched anular ligament; Tx - supination of forearm while elbow is flexed; 2 weeks in sling
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lateral pectoral nerve: course
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pierces costocoracoid membrane to reach deep surface of pectoral muscles; a communicating branch to the medial pectoral nerve passes anterior to axillary artery and vein
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wrist fractures and dislocations
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surgical fusion of carpals (arthrodesis) may be necessary to relive severe pain
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lateral pectoral nerve: innervates
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primaryily pec major
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musculocutaneous nerve: origin
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terminal branches of lateral cord (C5-7)
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Bull rider's thumb
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avulsion fracture of lateral part of the proximal phalanx of the thumb
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Skier's thumb
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hyperabduction of MP joint of thumb
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musculocutaneous nerve: course
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exits axilla by piercing coracobrachialis; descends between biceps brachii and brachialis, supplying both; continues as lateral cutaneous nerve of forearm
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musculocutaneous nerve: innervates
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anterior compartment of arm (coracobrachialis, biceps brachii, and brachialis); skin of lateral aspect of forearm
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median nerve: origin
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Lateral root: terminal branch of lateral cord (C6, C7); Medial root:terminal branch of median cord (C8, T1)
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median nerve: course
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lateral and medial roots merge to form median nerve lateral to axillary artery; descends through arm adjacent to brachial artery, with nerve gradually crossing anterior to artery to lie medial to artery in cubital fossa
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median nerve: innervates
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anterior forearm (except flexor carpi ulnaris and ulnar half of flexor digitorum profundus), five intrinsic mm. in thenar half of palm and palmar skin
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Medial pectoral, medial cutaneous nerve of arm, and median cutaneous nerve of forearm:origin
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side branches of medial cord, receiving fibers from C8, T1
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medial pectoral nerve: course
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passes between axillary artery and vein; then pierces pectoralis minor and enters deep surface of pectoralis major; although it is called medial for its origin from medial cord, it lies lateral to lateral pectoral nerve
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medial pectoral nerve: innervates
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pec minor and sternocostal part of pec major
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medial cutaneous nerve of arm: course
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smalles nerve of plexus; runs along medial side of axillary and brachial veins; communicates with intercostobrachial nerve
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medial cutaneous nerve of arm: innervatews
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skin of medial side of arm, as far distal as medial epicondyle of humerus and elecranon of ulna
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median cutaneous nerve of forearm: course
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starts with ulnar nerve (with which it may be confused) but pierces deep fascia with basilic vein and enters subcutaneous tissue, dividing into anterior and posterior branches
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median cutaneous nerve of forearm: innervates
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skin of medial side of forearm, as far distal as wrist
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ulnar nerve: origin
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larger terminal branch of medial cord, receiving fibers from C8, T1, and often C7
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ulnar nerve: course
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descends medial arm; passes posterior to medial epicondyle of humerus; then descends ulnar aspect of forearm to hand
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ulnar nerve: innervates
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flexor carpi ulnaris and ulnar half of flexor digitorum profundus (forearm); most intrinsic muscles of hand; skin of hand medial to axial line of digit 4
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upper subscapular nerve: origin
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side branch of posterior cord receiving fibers from C5
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upper subscapular nerve: course
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passes posteriorly, entering subscapularis directly
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upper subscapular nerve: innervates
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superior portion of subscapularis
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lower subscapular nerve: origin
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side branch of posterior cord, receiving fibers from C6
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lower subscapular nerve: course
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passes inferolaterally, deep to subscapular artery and vein
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lower subscapular nerve: innervates
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inferior portion of subscapularis and teres major
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thoracodorsal nerve: origin
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side branch of posterior cord, receiving fibers from c6, C7, c8
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thoracodorsal nerve: course
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arises between upper and lower subscapular nerves and runs inferolaterally along posterior axillary wall to apical part of latissimus dorsi
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thoracodorsal nerve: innervates
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latissimus dorsi
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axillary nerve: origin
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terminal branch of posterior cord, receiving fibers from C5, c6
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axillary nerve: course
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exits axillary fossa posteriorly, passing through quadrangular space with posterior circumflex humeral artery; gives rise to superior lateral brachial cutaneous nerve; then winds around surgical neck of humerus deep to deltoid
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axillary nerve: innervates
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glenohumeral (shoulder) joint; teres minor and deltoid muscles; skin of superolateral arm (over inferior part of deltoid)
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radial nerve: origin
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larger terminal branch of posterior cord (largest branch of plexus), receiving fibers from C5-T1
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radial nerve: course
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exits axillary fossa posterior to axillary artery; passes posterior to humerus in radial groove with deep brachial artery, between lateral and medial heads of triceps; perforates lateral intermuscular septum; enters cubital fossa, dividing into superficial (cutaneous) and deep (motor) radial nerves
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radial nerve: innervates
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all muscles of posterior compartments of arm and forearm; skin of posterior and inferloateral arm, posterior forearm, and dorusm of hand lateral to axial line of digit 4
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biceps brachii: origin
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short head:tip of coracoid process of scapula; long head: supraglenoid tubercle of scapula
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biceps brachii: insertion
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tuberosity of radius and fascia of forearm via bicipital aponeurosis
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biceps brachii & coracobrachialis: innervation
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musculocutaneous nerve (c5, C6, c7)
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biceps brachii: function
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supinates forearm and when it is supine, flexes forearm; short head resists dislocation of shoulder
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coracobrachialis: origin
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tip of coracoid process of scapula
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coracobrachialis: insertion
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middle thir of medial surface of humerus
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coracobrachialis: function
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helps flex and adduct arm; resists dislocation of shoulder
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brachialis: origin
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distal half of anterior surface of humerus
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brachialis: insertion
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coronoid process of tuberosity ulna
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brachialis: innervation
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musculocutaneous nerve (c5, c6) and radial nerve (c5, c7)
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brachialis: function
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flexes forearm in all positions
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triceps brachii: origin
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long head: infraglenoid tubercle of scapula; lateral head: posterior surface of humerus, superior to radial groove; medial head: posterior surface of humerus, inferior to radial groove
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triceps brachii: insertion
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proximal end of olecranon of ulna and fascia of forearm
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triceps brachii: innervation
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radial nerve (c6, C7, C8)
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triceps brachii: function
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chief extensor of forearm; long head resists dislocation of humerus; especially important during adduction
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anconeus: origin
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lateral epicondyle of humerus
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anconeus: insertion
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lateral surface of elecranon and superior part of posterior surface of ulna
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anconeus: innervation
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Radial nerve (c7, c8, t1)
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anconeus: function
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assists triceps in extending forearm; stabilizes elbow joint; may abduct ulna during pronation
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Pronator teres:ulnar head: origin
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coronoid process
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Pronator teres:ulnar head: insertion
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middle of convexity of lateral surface of radius
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Pronator teres:ulnar head: innervation
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Median nerve (c6, C7)
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Pronator teres:ulnar head: function
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pronates and flexes forearm (at elbow)
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Pronator teres:humeral head: origin
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Medial epicondyle of humerus (common flexor origin)
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Pronator teres:humeral head: insertion
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middle of convexity of lateral surface of radius
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Pronator teres:humeral head: innervation
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Median nerve (c6, C7)
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Pronator teres:humeral head: function
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pronates and flexes forearm (at elbow)
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Flexor carpi radialis (FCR): origin
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Medial epicondyle of humerus (common flexor origin)
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Flexor carpi radialis (FCR): insertion
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base of 2nd metacarpal
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Flexor carpi radialis (FCR): innervation
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Median nerve (c6, C7)
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Flexor carpi radialis (FCR): function
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flexes and abducts hand (at wrist)
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Palmaris Longus: Origin
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Medial epicondyle of humerus (common flexor origin)
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Palmaris Longus: Insertion
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distal half of flexor retinaculum and apex of palmar aponeurosis
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Palmaris Longus: Innervation
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Median nerve (c7, c8)
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Palmaris Longus: Function
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Flexes hand (at wrist) and tenses palmar aponeurosis
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Flexor carpi ulnaris (FCU):Humeral head: origin
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Medial epicondyle of humerus (common flexor origin)
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Flexor carpi ulnaris (FCU):Humeral head: insertion
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Pisiform, hook of hamate, 5th metacarpal
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Flexor carpi ulnaris (FCU):Humeral head: innervation
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ulnar nerve (c7, C8)
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Flexor carpi ulnaris (FCU):Humeral head: function
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flexes and adducts hand (at wrist)
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Flexor carpi ulnaris (FCU):Ulnar head: origin
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Olecranon and posterior border (via aponeurosis)
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Flexor carpi ulnaris (FCU):Ulnar head: insertion
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Pisiform, hook of hamate, 5th metacarpal
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Flexor carpi ulnaris (FCU):Ulnar head: innervation
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ulnar nerve (c7, C8)
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Flexor carpi ulnaris (FCU):Ulnar head: function
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flexes and adducts hand (at wrist)
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Flexor digitorum superficialis (FDS):humeroulnar head: origin
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medial epicondyle (common flexor origin and coronoid process)
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Flexor digitorum superficialis (FDS):humeroulnar head: insertion
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shafts of middle phalanges of medial four digits
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Flexor digitorum superficialis (FDS):humeroulnar head: innervation
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Median nerve (c7, c8, t1)
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Flexor digitorum superficialis (FDS):humeroulnar head: function
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flexes middle phalanges at proximal interphalangeal joints of middle four digits; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints
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Flexor digitorum superficialis (FDS):radial head: origin
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superior half of anterior border
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Flexor digitorum superficialis (FDS):radial head: insertion
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shafts of middle phalanges of medial four digits
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Flexor digitorum superficialis (FDS):radial head: innervation
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Median nerve (c7, c8, t1)
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Flexor digitorum superficialis (FDS):radial head: function
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flexes middle phalanges at proximal interphalangeal joints of middle four digits; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints
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Flexor digitorum profundus (FDP): medial part: origin
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proximal three quarters of medial and anterior surfaces of ulna and interosseous membrane
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Flexor digitorum profundus (FDP): medial part: insertion
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bases of distal phalanges of 4th and 5th digits
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Flexor digitorum profundus (FDP): medial part: innervation
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ulnar nerve (c8, T1)
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Flexor digitorum profundus (FDP): medial part: function
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flexes distal phalanges 4 and 5 at distal interphalangeal joints
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Flexor digitorum profundus (FDP): lateral part: origin
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proximal three quarters of medial and anterior surfaces of ulna and interosseous membrane
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Flexor digitorum profundus (FDP): lateral part: insertion
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bases of distal phalanges of 2nd and 3rd digits
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Flexor digitorum profundus (FDP): lateral part: innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Flexor digitorum profundus (FDP): lateral part: function
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flexes distal phalanges 2 and 3 at distal interphalangeal joints
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Flexor pollicis longus (FPL): origin
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anterior surface of radius and adjacent interosseous membrane
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Flexor pollicis longus (FPL): insertion
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base of distal phalanx of thumb
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Flexor pollicis longus (FPL): innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Flexor pollicis longus (FPL): function
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flexes phalanges of 1st digit (thumb)
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Pronator quadratus: origin
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distal quarter of anterior surface of ulna
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Pronator quadratus: insertion
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distal quarter of anterior surface of radius
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Pronator quadratus: innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Pronator quadratus: function
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pronates forearm; deep fibers bind radius and ulna together
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Brachioradialis: origin
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proximal two thirds of fupraepicondylar ridge of humerus
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Brachioradialis: insertion
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lateral surface of distal end of radius proximal to styloid process
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Brachioradialis: innervation
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radial nerve (c5, C6, c7)
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Brachioradialis: function
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relatively weak flexion of forearm; maximal when forearm is in midpronated position
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Extensor carpi radialis longus (ECRL): origin
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lateral supraepicondylar ridge of humerus
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Extensor carpi radialis longus: insertion
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dorsal aspect of base of 2nd metacarpal
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Extensor carpi radialis longus: innervation
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radial nerve (c6, c7)
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Extensor carpi radialis longus: function
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extend and abduct hand at the wrist joint; active during fist clenching
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Extensor carpi radialis brevis (ECRB): origin
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lateral epicondyle of humerus (common extensor origin)
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Extensor carpi radialis brevis: insertion
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dorsal aspect of base of 3rd metacarpal
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Extensor carpi radialis brevis: innervation
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deep branch of radial nerve (C7, c8)
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Extensor carpi radialis brevis: function
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extend and abduct hand at the wrist joint
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Extensor digitorum: origin
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lateral epicondyle of humerus (common extensor origin)
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Extensor digitorum: insertion
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extensor expansion of medial four digits
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Extensor digitorum: innervation
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deep branch of radial nerve (C7, c8)
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Extensor digitorum: function
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extends medial four digits primarily at metacarpophalangeal joints, secondarily at interphalangeal joints
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Extensor digit minimi (EDM): origin
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lateral epicondyle of humerus (common extensor origin)
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Extensor digit minimi (EDM): insertion
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extensor expansion of 5th digit
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Extensor digit minimi (EDM): innervation
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deep branch of radial nerve (C7, c8)
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Extensor digit minimi (EDM): function
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Extends 5th digit primarily at metacarpophalangeal joint, secondarily at interphalangeal joint
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Extensor carpi ulnaris (ECU): origin
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lateral epicondyle of humerus; posterior border of ulna via a shared aponeurosis
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Extensor carpi ulnaris (ECU): insertion
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dorsal aspect of base of 5th metacarpal
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Extensor carpi ulnaris (ECU): innervation
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deep branch of radial nerve (C7, c8)
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Extensor carpi ulnaris (ECU): function
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extends and adducts hand at wrist joint (also active during fist clenching)
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Supinator: origin
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lateral epicondyle of humerus; radial collateral and anular ligaments; supinator fossa; crest of ulna
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Supinator: insertion
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lateral, posterior, and anterior surfaces of proximal third of radius
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Supinator: innervation
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deep branch of radial nerve (c7, C8)
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Supinator: function
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supinates forearm; rotates radius to turn palm anteriorly or superiorly (if elbow is flexed)
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Extensor indicis: origin
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posterior surface of distal thihrd of ulna and interosseous membrane
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Extensor indicis: insertion
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extensor expansion of 2nd digit
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Extensor indicis: innervation
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posterior interosseous nerve (C7, c8), continuation of deep branch of radial nerve
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Extensor indicis: function
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extends 2nd digit (enabling its independent extension); helps extend hand at wrist
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Abductor pollicis longus (APL): origin
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posterior surface of proximal halves of ulna, radius, and interosseous membrane
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Abductor pollicis longus (APL): insertion
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base of 1st metacarpal
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Abductor pollicis longus (APL): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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Abductor pollicis longus (APL): function
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abducts thumb and extends it at carpometacarpal joint
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Extensor pollicis longus (EPL): origin
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posterior surface of middle third of ulna and interosseous membrane
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Extensor pollicis longus (EPL): insertion
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dorsal aspect of base of distal phalanx of thumb
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Extensor pollicis longus (EPL): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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Extensor pollicis longus (EPL): function
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extends distal phalanx of thumb at interphalangeal joint; extends metacarpophalangeal and carpometacarpal joints
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Extensor pollicis brevis (EPB): origin
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posterior surface of distal third of radius and interosseous membrane
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Extensor pollicis brevis (EPB): insertion
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dorsal aspect of base of proximal phalanx of thumb
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Extensor pollicis brevis (EPB): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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Extensor pollicis brevis (EPB): function
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extends proximal phalanx of thumb at metacarpophalangeal joint; extends carpometacarpal joint
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Opponens pollicis: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Opponens pollicis: insertion
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lateral side of 1st metacarpal
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Opponens pollicis: innervation
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recurrent branch of median nerve (C8, t1)
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Opponens pollicis: function
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to oppose thumb, it draws 1st metacarpal medially to center of palm and rotates it medially
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Abductor pollicis: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Abductor pollicis: insertion
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lateral side of base of proximal phalanx of thumb
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Abductor pollicis: innervation
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recurrent branch of median nerve (C8, t1)
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Abductor pollicis: function
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abducts thumb; helps op[pose it
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Flexor pollicis brevis: superficial head: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Flexor pollicis brevis: superficial head: insertion
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lateral side of base of proximal phalanx of thumb
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Flexor pollicis brevis: superficial head: innervation
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recurrent branch of median nerve (C8, t1)
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Flexor pollicis brevis: superficial head: function
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flexes thumb
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Flexor pollicis brevis: deep head: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Flexor pollicis brevis: deep head: insertion
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lateral side of base of proximal phalanx of thumb
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Flexor pollicis brevis: deep head: innervation
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deep branch of ulnar nerve (c8, T1)
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Flexor pollicis brevis: deep head: function
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adducts thumb toward lateral border of palm
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Adductor pollicis: Oblique head: origin
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bases of 2nd and 3rd metacarpals, capitate, and adjacent carpals
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Adductor pollicis: Oblique head: insertion
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medial side of base of proximal phalanx of thumb
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Adductor pollicis: Oblique head: innervation
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deep branch of ulnar nerve (c8, T1)
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Adductor pollicis: Oblique head: function
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adducts thumb toward lateral border of palm
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Adductor pollicis: Transverse head: origin
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anterior surface of shaft of 3rd metacarpal
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Adductor pollicis: Transverse head: insertion
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medial side of base of proximal phalanx of thumb
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Adductor pollicis: Transverse head: innervation
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deep branch of ulnar nerve (c8, T1)
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Adductor pollicis: Transverse head: function
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adducts thumb toward lateral border of palm
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abductor digit minimi: origin
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pisiform
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abductor digit minimi: insertion
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medial side of base of proximal phalanx of 5th digit
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abductor digit minimi: innervation
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deep branch of ulnar nerve (c8, T1)
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abductor digit minimi: function
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abducts 5th digit; assists in flexion of its proximal phalanx
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Flexor digiti minimi brevis: origin
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Hook of hamate and flexor retinaculum
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Flexor digiti minimi brevis: insertion
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medial side of base of proximal phalanx of 5th digit
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Flexor digiti minimi brevis: innervation
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deep branch of ulnar nerve (c8, T1)
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Flexor digiti minimi brevis: function
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flexes proximal phalanx of 5th digit
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Opponens digiti: origin
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Hook of hamate and flexor retinaculum
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Opponens digiti: insertion
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medial border of 5th metacarpal
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Opponens digiti: innervation
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deep branch of ulnar nerve (c8, T1)
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Opponens digiti: function
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draws 5th metacarpal anterior and rotates it, bringing 5th digit into opposition with thumb
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Lumbricals: 1st and 2nd: origin
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lateral two tendons of flexor digitorum profundus (as unipennate muscles)
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Lumbricals: 1st and 2nd: insertion
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lateral sides of extensor expansions of 2-5th digits
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Lumbricals: 1st and 2nd: innervation
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Median nerve (c8, T1)
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Lumbricals: 1st and 2nd: function
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Flex metacarpophalangeal joints; extend interphalangeal joints of 2-5th dights
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Lumbricals: 3rd and 4th: origin
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medial three tendons of flexor digitorum profundus (as bipennate muscles)
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Lumbricals: 3rd and 4th: insertion
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lateral sides of extensor expansions of 2-5th digits
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Lumbricals: 3rd and 4th: innervation
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deep branch of ulnar nerve (c8, T1)
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Lumbricals: 3rd and 4th: function
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Flex metacarpophalangeal joints; extend interphalangeal joints of 2-5th dights
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Dorsal interossei, 1-4th: origin
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adjacent sides of two metacarpals (as bipennate muscles)
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Dorsal interossei, 1-4th: insertion
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bases of proximal phalanges; extensor expansions of 2-4th digits
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Dorsal interossei, 1-4th: innervation
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deep branch of ulnar nerve (c8, T1)
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Dorsal interossei, 1-4th: function
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abduct 2-4th digits from axial line; act with lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints
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Palmar interossei, 1-3rd: origin
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palmar surfaces of 2nd, 4th, and 5th metacarpals (as unipennate muscles)
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Palmar interossei, 1-3rd: insertion
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bases of proximal phalanges; extensor expansions of 2nd, 4th, and 5th digits
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Palmar interossei, 1-3rd: innervation
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deep branch of ulnar nerve (c8, T1)
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Palmar interossei, 1-3rd: function
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adduct 2nd, 4th, and 5th digits toward axial line; assist lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints; extensor expansions of 2nd-4th digits
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Glenohumeral Joint: Flexion:
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PEC MAJOR (clavicular head); DELTOID (clavicular and anterior acromial parts); coracobrachialis
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Glenohumeral Joint: Extension:
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DELTOID (spinal part); teres major; latissimus dorsi; long head of triceps brachii
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Glenohumeral Joint: Abduction:
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DELTOID (whole, but especially acromial part); supraspinatus
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Glenohumeral Joint: Adduction:
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PEC MAJOR; LATISSIMUS DORSI; teres major; long head of triceps brachii
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Glenohumeral Joint: Medial rotation:
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SUBSCAPULARIS; pec major; deltoid (clavicular part); latissimus dorsi; teres major
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Glenohumeral Joint: Lateral rotation:
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INFRASPINATUS; teres minor; deltoid (spinal part)
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Glenohumeral Joint: Tensors of articular capsule (to hold head of humerus against the glenoid cavity):
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SUBSCAPULARIS; INFRASPINATUS(simultaneously); supraspinatus; teres minor
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Glenohumeral Joint: Resisiting downard dislocation (shunt muscles):
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DELTOID (whole); long head of triceps brachii; coracobrachialis; short head of biceps brachii
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Ankylosis of sternoclavicular joint
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(stiffening or fixation) surgery necessary to restore movement of shoulder
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Dislocation of sternoclavicular joint
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rare; fall on outstretched hand
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Dislocation of acromioclavicular joint
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fall on shoulder or outstretched upper limb; hockey;
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Calcific supraspinatus tendinitis
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inflammation and calcification of subacromial bursa=pain during 50-130 degree of abduction (painful arc syndrome)
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Rotator cuff injurying
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baseball pitchers; lifting a stuck window; use gravity for 15 degrees of abduction, then deltoid can take over
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Dislocation of glenohumeral joint
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head of humerus driven inferoanteriorly; hard blow to humerus; support arm with other hand
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Axillary nerve injury
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paralysis of deltoid; inability to abduct arm
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Glenoid labrum tears
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pain while throwing during acceleration phase; popping during abduction and lateral rotation
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Adhesive capsulitis of glenohumeral joint
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difficulty abducting arm; strain placed on AC joint, painful
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Bursitis of elbow
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dart thrower's elbow and miner's elbow; pain when forearm pronated
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avulsion of medial epicondyle
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traction injury of the ulnar nerve is a frequent complication
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Ulnar collateral ligament reconstruction
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(UCL); athletic throwing; autologous transplant of palmaris longus or plantaris tendon of contralateral forearm or leg
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Dislocation of elbow joint
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hyperextension or a blow that drives the ulna posterior; injury to the ulnar nerve may occur
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subluxation and dislocation of radial head
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preschool, picking up kid with their arms fully extended; jerked; pinched anular ligament; Tx - supination of forearm while elbow is flexed; 2 weeks in sling
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wrist fractures and dislocations
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surgical fusion of carpals (arthrodesis) may be necessary to relive severe pain
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Bull rider's thumb
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avulsion fracture of lateral part of the proximal phalanx of the thumb
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Skier's thumb
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hyperabduction of MP joint of thumb
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Question
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Answer
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Splenius: Origin
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Nuchal ligament and spinous process of C7-T3/4
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Splenius: Insertion
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Mastoid process; superior nuchal line of occipital bone - splenius capitis
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Splenius: Nerve Supply
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posterior rami of spinal nerves
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Splenius: Function
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laterally flex neck and rotate head to side; extend head and neck
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Erector Spinae: Iliocostalis:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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Erector Spinae: Iliocostalis:Insertion
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Ribs and transverse processes of cervical vertebrae
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Erector Spinae: Longissimus:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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Erector Spinae: Longissimus:Insertion
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Ribs and transverse processes of cervical and thoracic vertebrae and mastoid process of temporal bone
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Erector Spinae: Spinalis:Origin
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A broad tendon along sacrum, ilium and spinous processes of lumbar vertebrae
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Erector Spinae: Spinalis:Insertion
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Spinous processes of upper thoracic and cervical vertebrae and skull
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Erector Spinae: Iliocostalis, Longissimus, Spinalis:Nerve Supply
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posterior rami of spinal nerves
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Erector Spinae: Iliocostalis, Longissimus, Spinalis:Function
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extend vertebral column and head; as back is flexed, control movement via eccentric contraction; laterally flex vertebral column
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Semispinalis: Capitis, Cervicis, and Thoracis:Origin
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Transverse processes of C4-T12
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Semispinalis: Capitis, Cervicis, and Thoracis:Insertion
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Occipital bone, spinous processes of Cervical and thoracic vertebrae
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Rotatores:Origin
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Transverse processes (primarily thoracic)
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Rotatores:Insertion
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Junction lamina and transverse process or spinous process 2 segments superior
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Multifidus:Origin
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Sacrum, erector spinae ligament, transverse and articulate processes of cervical and thoracic vertebrae
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Multifidus:Insertion
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Spinous processes of vertebrae 2-4 superior
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Transversospinalis:Semispinalis, Multifidus, Rotatores (brevis and longus):Nerve Supply
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posterior rami of spinal nerves
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Semispinalis:Function
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extends head and thoracic and cervical regions of vertebral column and rotates them contralaterally
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Multifidus: Function
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stabilizes vertebrae during local movements of vertebral column
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Rotatores: Function
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stabilize vertebrae and assist with local extension and rotatory movements of vertebral column; proprioception
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Rectus Capitis Posterior Minor:Origin
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Posterior tubercle of posterior arch of C1
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Rectus Capitis Posterior Major: Origin
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Spinous proccess of C2
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Rectus Capitis Posterior Minor:Insertion
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Medial part of inferior nuchal line of occipital bone
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Rectus Capitis Posterior Major:Insertion
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Lateral part of inferior nuchal line of occipital bone
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Obliquus Capitis Superior: Origin
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transverse process of C1
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Obliquus Capitis Superior: Insertion
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Occipital bone between superior and inferior nuchal lines
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Obliquus Capitis Inferior: Origin
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Posterior tubercle of posterior arch of C2
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Obliquus Capitis Inferior: Insertion
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Transverse process of C1
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Suboccipital nerve (posterior ramus C1):insertion
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runs between cranium and C1 to reach muscles of suboccipital triangle
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Greater occipital nerve (posterior ramus C2):Insertion
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Emerges inferior to obliquus capitis inferior and ascends to Skin over neck and occipital bone
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Posterior rami of C3-C7: Insertion
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Pass segmentally to intrinsic muscles of back and overlying skin (adjacent to vertebral column)
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Lesser occipital nerve (anterior rami of C2-C3): Insertion
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Passes directly to skin of superior posterolateral neck and scalp posterior to external ear
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Vertebral artery:Origin
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Transverse foramina of cervical vertebrae
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Vertebral artery:Insertion
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Foramen magnum to brain
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Trapezius:Origin
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Spinus processes and nuchal ligament
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Trapezius:Insertion
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Upper limb (spine of scapula as well as the bump on your shoulder) and wraps around to clavicle
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Trapezius: innervation
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Spinal accessory nerve (CN XI) (motor fibers) and C3, C4 spinal nerves (pain and proprioception)
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Trapezius: function
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descending elevates; ascending depresses; middle retracts scapula; descending and ascending together rotate glenoid cavity superiorly
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Triangle of auscultation
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latissimus dorsi, medial scapula, inferolateral trapezius
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Latissimus Dorsi:Origin
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Spinous processes of lumbar levels as well as thoraco something fascia?
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Latissimus Dorsi:Insertion
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humerus
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Latissimus Dorsi:Innervation
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Thoracodorsal nerve (C6, C7, C8)
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Latissimus Dorsi:function
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extends, adducts, and medially rotates humerus; raises body toward arms during climbing
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Levator Scapulae:origin
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posterior tubercles of transverse processes of C1-C4
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Levator Scapulae:insertion
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medial border of scapula superior to root of scapular spine
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Levator Scapulae:innervation
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dorsal scapular (C5) and cervical C3-C4 nerves
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Levator Scapulae:function
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elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula
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Rhomboid minor:Origin
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Spinous processes
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Rhomboid minor:Insertion
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Spine of scapula
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Rhomboid major/minor:Innervation
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dorsal scapular nerve (C4, C5)
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Rhomboid major/minor:function
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retract scapula and rotate it to depress glenoid cavity; fix scapula to thoracic wall
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Rhomboid major:Origin
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Spinous processes
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Rhomboid major:Insertion
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Below spine of scapula
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Serratus posterior superior:Origin
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Spinous processes
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Serratus posterior superior:Insertion
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ribs
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Serratus posterior inferior:Origin
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Spinous processes
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Serratus posterior inferior:Insertion
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ribs
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C3-C5 Spinous Processes:Characteristics
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Short
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C3-C6 Spinous Processes:Characteristics
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bifid
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C6 Spinous Process:Characterisitc
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long
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C7 Spinous Process:called
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vertebra prominens
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Vertebral Body Osteoporosis: Most affected areas
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Most affected areas are the neck of the femur and bodies of vertebrae, metacarpals, and radius
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Vertebral Body Osteoporosis:Radiographical signs
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diminished radiodensity of trabecular (spongy) bone of vertebral bodies, cuasing thinned cortical bone to appear prominent (vertical striping); also kyphosis
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Laminectomy
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excision of spinous processes and laminae to gain access to vertebral canal (spinal cord) or roots of specific spinal nerves; or relieve pressure from a tumor etc
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Dislocation of Cervical Vertebrae
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cervical vertebrae are less tightly locked; if the dislocation does not result in "facet jumping" it may self-reduce (slip back into place) so you can't tell if there's been spinal cord injury on MRI
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Fracture and Dislocation of Atlas
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Occipital condyle can transmit force on lateral masses of C1 which are wedge shaped and push them out (Jefferson or burst fracture) actually increases size of foramen
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Fracture and Dislocation of Atlas
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common, usually at pars interarticularis; traumatic spondylolysis of C2 usually from hyperextension of the head ON the neck (hangman's fracture); quadriplegia or death
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Fractures of the dens
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also common axis injury from horizontal blow to the head or complication of osteopenia; results in avascular necrosis of dens
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Lumbar Spinal Stenosis
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cause compression of spinal nerve roots occupying the inferior vertebral canal; requires decompressive laminectomy
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Cervical Ribs
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common anomaly 1-2% of people; may cause thoracic outlet syndrome when supernumerary rib places pressure on structures that emerge from the superior thoracic aperture
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Caudal Epidural Anethsesia
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local anesthetic injected into fat of sacral canal surrounding proximal sacral nerves; acts on S2-Co1; height of ascension of anesthetic controlled by amt injected and position of patient
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Injury of Coccyx
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coccygodynia often follows coccygeal trauma
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abnormal fusion of vertebrae
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Sacralization of L5:L5 fuses to Sacrum, L4-L5 degenerates=pain; lumbarization of the S1:if S1 doesn't fuse, no biggie
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Effect of aging on vertebrae
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bowing; osteophytes (bony spurs) commonly develop around the margins of the vertebral body
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anomalies of vertebrae
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spina bifida occulta: neural arches of L5-S1 fail to develop; spina bifida cystica: herniation of meninges (meningocele) or spinal cord (meningomyelocele)
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herniation of nucleus pulposus
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extend posterolaterally where anulus fibrosus is thin and does not receive support from posterior or anterior longitudinal ligaments; usually L4-L5 or L5-S1
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Rupture of Transverse Ligament of Atlas
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dens set free: atlanto-axial subluxation; can compress spinal cord - quadriplegia or into medulla - death
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Rupture of Alar Ligaments
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weaker than transverse ligament of atlas so combined flexion and rotation of the head may tear resulting in a 30% increase in ROM to the contralateral side
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Fractures and Dislocations of Vertebrae
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See others cards, but spondylolysis of L5 results from a failure of the centrum of L5 to unite with neural arches at neurocentral joint
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Spondylolisthesis
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at the L5-S1 IV joint may result in pressure on spinal cord and low back/limb pain
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Injury and disease of Zygapophysial joints
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joints that are close to IV foramina through which spinal nerves emerge, so they can be linked to pain of a dermatome and spasm in a myotome
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Interspinales: Origin
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superior surfaces of spinous processes of cervical and lumbar vertebrae
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Interspinales: Insertion
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Inferior surfaces of spinous processes of vertebra superior to vertebra of proximal attachment
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Interspinales: Nerve Supply
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Posterior rami of spinal nerves
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Interspinales: Function
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Aid in extension and rotation of vertebral column
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Intertransversarii: Origin
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Transverse processes of cervical and lumbar vertebrae
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Intertransversarii: Insertion
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Transverse processes of adjacent vertebrae
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Intertransversarii: Nerve Supply
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Posterior and anterior rami of spinal nerves
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Intertransversarii: Function
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aid in lateral flexion of vertebral column; stabilize vertebral column
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Levatores costarum: Origin
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Tips of transverse processes of C7 and T1-T11 vertebrae
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Levatores costarum: Insertion
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Pass inferolaterally and insert on rib between tubercle and angle
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Levatores costarum: Nerve supply
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posterior rami of C8-T11 spinal nerves
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Levatores costarum: function
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elevate ribs, assisting respiration; assist with lateral flexion of vertebral column
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Flexion of cervical intervertebral joints
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Longus Coli, Scalene, Sternocleidomastoid
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Extension of cervical intervertebral joints
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Deep neck muscles: semispinalis cervicis, iliocostalis cervicis, splenius cervicis, levator scapulae, splenius capitis, multifidus, longissimus capitis, semispinalis capitis, trapezius
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Lateral bending of cervical intervertebral joints
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unilateral action of: rotatores, semispinalis capitis and cervicis, multifidus, splenius cervicis
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Flexion of thoracic and lumbar IV joints
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Bilateral action of rectus abdominis, psoas major, gravity
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Extension of thoracic and lumbar IV joints
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bilateral action of erector spinae, multifidus, semispinalis thoracis
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Lateral bending of thoracic and lumbar IV joints
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unilateral action of iliocostalis thoracis and lumborum, longissimus thoracis, multifidus, external and internal oblique, quadratus lumborum, rhomboids, serratus anterior
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rotation of thoracic and lumbar IV joints
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unilateral rotatores, multifidus, iliocostalis, longissimus, external oblique opposite internal oblique, splenius thoracis
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Suboccipital triangle: superomedial boundary
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rectus capitis posterior major
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Suboccipital triangle: superolateral boundary
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obliquus capitis superior
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Suboccipital triangle: inferolateral bondary
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obliquus capitis inferior
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Suboccipital triangle: floor
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posterior atlanto-occipital membrane and posterior arch of vertebra C1
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Suboccipital triangle: roof
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semispinalis capitis
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Suboccipital triangle: contents
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vertebral artery and suboccipital nerve
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Flexion of atlanto-occipital joints
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longus capitis, rectus capitis anterior, anterior fibers of sternocleidomastoid, suprahyoid and infrahyoid mm.
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Extension of atlanto-occipital joints
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Rectus capitis posterior (major and minor), obliquus capitis superior, splenius capitis, longissimus capitis, trapezius
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Lateral flexion of atlanto-occipital joints
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sternocleidomastoid, obliquus capitis superior, rectus capitis lateralis, longissimus capitis, splenius capitis
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Leptomeninges: Development
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single layer from mesenchyme surrounding embryonic spinal cord
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avulsion fracture of the greater tubercle of humerus
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fall on acromion or hand when arm is abducted; subscapularis rotates limb medially
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transverse fracture of teh shaft of humerus
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direct blow to arm; deltoid caries proximal fragment laterally
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Colles fracture
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complete transverse fracture of distal 2cm of radius; distal fragment comminuted (broken into peices); from forced dorsiflexion of the hand (trying to ease a fall)
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Fracture of scaphoid
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just looks like sprained wrist until 10-14 days later reveal bone resorption; can lead to avascular necrosis and degenerative joint disease
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fracture of hamate
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can involve ulnar nerve, decreasing grip strength
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fracture of metacarpals
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held together and good blood supply, so heal quickly
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fracture of phalanges
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bone fragments must be carefully realigned to restore normal function because of flexor tendons
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dermatomes C3, C4
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region at base of neck, extending laterally over shoulder
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dermatome C5
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Lateral aspect of arm (i.e., superior aspect of abducted arm)
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dermatome C6
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lateral forearm and thumb
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dermatome C7
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middle and ring fingers and center of posterior aspect of forearm
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dermatome C8
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little finger, medial side of hand and forearm (i.e., inferior aspect of abducted arm)
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dermatome T1
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medial aspect of forearm and inferior arm
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dermatome T2
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medial aspect of superior arm and skin of axilla
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Supraclavicular nerve from C3, C4 cervical plexus
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pass anterior to clavicle, immediately deep to platysma, and supply skin over clavicle and superolateral aspect of pectoralis major
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superior lateral cutaneous nerve of arm C5, C6 terminal branch of axillary nerve
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emerges from beneath posterior margin of deltoid and supplies skin over lower part of this muscle and on lateral side of midarm
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inferior lateral cutaneous nerve of arm C5, C6 radial nerve (or posterior cutaneous nerve of arm)
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Perforates lateral head of triceps, passing close to cephalic vein to supply skin over inferolateral aspect of arm
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posterior cutaneous nerve of arm C5-C8 radial nerve (in axilla)
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Crosses posterior to and communicates with intercostobracheal nerve and supplies skin on posterior arm as far as olecranon
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posterior cutaneous nerve of forearm C5-C8 radial nerve (with inferior lateral cutaneous nerve of arm)
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perforates lateral head of triceps, descends laterally in arm, then runs along and supplies posterior forearm to wrist
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Lateral cutaneous nerve of forearm C6-C7 Musculocutaneous nerve (terminal branch)
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Emerges lateral to biceps tendon deep to cephalic vein, supplying skin of anterolateral forearm to wrist
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Medial cutaneous nerve of forearm C8, T1 Medial cord of brachial plexus (in axilla)
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Descends medial to brachial artery, pierces deep fascia with basilic vein in midarm, dividing into anterior and posterior branches that enter forearm and suppply skin of anteromedial aspect to wrist
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Medial cutaneous nerve of arm C8-T2 Medial cord of brachial plexus (in axilla)
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Communicates with intercostobrachial nerve, continuing to supply skin of medial aspect of distal arm
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Intercostobrachial Nerve T2 Second intercostal nerve (as its lateral cutaneous branch)
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Extends laterally, communicating with posterior and medial cutaneous nerves of arm, supplying skin of axilla and medial aspect of proximal arm
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Pectoralis Major: origin
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Clavicular head: anterior surface of medial half of clavicle; Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle
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Pectoralis major: Insertion
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Lateral lip of intertubercular sulcus of humerus
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Pectoralis Major: Innervation
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Lateral and medial pectoral nerves; clavicular head (C5, C6), sternocostal head (C7, C8, T1)
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Pectoralis Major: function
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adducts and medially rotates humerus; draws scapula anteriorly and inferiorly; clavicular head flexes humerus and sternocostal head extends it from the flexed position
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Pectoralis Minor: origin
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3-5th ribs near their costal cartilages
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Pectoralis Minor: insertion
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medial border and superior surface of coracoid process of scapula
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Pectoralis minor: innervation
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Medial pectoral nerve (C8, T1)
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Pectoralis Minor: function
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stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall
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subclavius: origin
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junction of 1st rib and its costal cartilage
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subclavius: insertion
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inferior surface of middle third of clavicle
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subclavius: innervation
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nerve to subclavius (C5, C6)
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subclavius: function
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anchors and depresses clavicle
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serratus anterior: origin
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external surfaces of lateral parts of 1-8th ribs
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serratus anterior: insertion
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anterior surface of medial border of scapula
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serratus anterior: innervation
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Long thoracic nerve (C5, C6, C7)
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Serratus anterior: function
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protracts scapula and holds it against thoracic wall; rotates scapula
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Elevate scapula
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Trapezius (descending part)(main), levator scapulae, rhomboids
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depress scapula
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gravity(main), pectoralis major, inferior sternocostal head; latissimus dorsi; trapezius, ascending part; serratus anterior, inferior part; pectoralis minor
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Protract scapula
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serratus anterior (main), pectoralis major/minor
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rotate scapula upward
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trapezius (descending part)(main), trapezius ascending; serratus anterior (inferior part) (main as well)
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rotate scapula downward
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gravity, levator scapulae, rhomboids, latissimus dorsi (main), pec minor, pec major, inferior sternocostal head
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deltoid: origin
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lateral third of clavicle; acromion and spine of scapula
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deltoid: insertion
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deltoid tuberosity of humerus
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deltoid: innervation
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axillary nerve (C5, c6)
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deltoid: function
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clavicular: flexes and medially rotates arm; acromial: abducts arm; spinal:extends and laterally rotates arm
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supraspinatus: origin
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supraspinous fossa of scapula
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supraspinatus: insertion
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superior facet of greater tubercle of humerus
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supraspinatus: innervation
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suprascapular nerve (c4, C5, c6)
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supraspinatus: function
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initiates and assists deltoid in abduction of arm and acts with rotator cuff muscles
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infraspinatus: origin
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infraspinous fossa of scapula
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infraspinatus: insertion
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middle facet of greater tubercle of humerus
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infraspinatus: innervation
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suprascapular nerve (C5, c6)
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infraspinatus: function
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laterally rotates arm; acts with rotator cuff muscles
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teres minor: origin
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middle part of lateral border of scapula
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teres minor: insertion
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inferior facet of greater tubercle of humerus
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teres minor: innervation
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axillary nerve (C5, c6)
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teres minor: function
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laterally rotates arm; acts with rotator cuff muscles
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teres major:origin
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posterior surface of inferior angle of scapula
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teres major: insertion
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medial lip of intertubercular sulcus of humerus
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teres major: innervation
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lower subscapular nerve (c5, C6)
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teres major: function
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adducts and medially rotates arm
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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:innervation
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upper and lower subscapular nerves (c5, C6, c7)
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subscapularis: function
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medially rotates arm; as part of rotator cuff, helps hold head of humerus in glenoid cavity
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winged scapula
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injury to long thoracic nerve causes paralysis of serratus anterior, so scapula isn't held tightly to wall
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Injury of spinal accessory nerve (CN XI)
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ipsilateral weakness when shoulders elevated (shrugged) against resistance
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Injury of thoracodorsal nerve
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latissimus dorsi paralysis, unable to climb; can't use axillary crutch
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Injury to dorsal scapular nerve
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rhomboids, scapula not retracted so close to midline
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Injury to axillary nerve
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deltoid; humerus fracture; flattened shoulder appearance
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Fracture-dislocation of proximal humeral epiphysis
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can cause premature cessation of growth
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rotator cuff injuries
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SITS; degenerative tendonitis common
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Dorsal Scapular Nerve: Origin
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posterior aspect of anterior ramus of C5 with a frequent contribution from c4
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Dorsal scapular Nerve: course
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pierces middle scalene; descends deep to levator scapulae and rhomboids
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Dorsal scapular nerve: innervates
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rhomboids
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long thoracic nerve: origin
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posterior aspect of anterior rami of C5, C6, c7
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Long thoracic nerve: course
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passes through cervico-axillary canal, descending posterior to C8 and T1 roots of plexus (anterior rami); runs inferiorly on superficial surface of serratus anterior
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long thoracic nerve: invervates
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serratus anterior (main), pectoralis major/minor
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suprascapular nerve (origin)
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superior trunk, receiving fibers from C5, c6, and often c4
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suprascapular nerve: course
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passes laterally across lateral cervical region, superior to brachial plexus; then through scapular notch inferior to superior transverse scapular ligament
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suprascapular nerve: innervates
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supraspinatus and infraspinatus mm. glenohumeral (shoulder) joint
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subclavian nerve: origin
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superior trunk, receiving fibers from c5, C6, and often c4
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subclavian nerve: course
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descends posterior to clavicle and anterior to brachial plexus and subclavian artery; often giving an accessory root to phrenic nerve
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subclavian nerve: innervates
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subclavius and sternoclavicular joint (accessory phrenic root innervates diaphragm)
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lateral pectoral nerve: orgin
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side branch of lateral cord, receiving fibers from c5, C6, c7
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lateral pectoral nerve: course
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pierces costocoracoid membrane to reach deep surface of pectoral muscles; a communicating branch to the medial pectoral nerve passes anterior to axillary artery and vein
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lateral pectoral nerve: innervates
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primaryily pec major
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musculocutaneous nerve: origin
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terminal branches of lateral cord (C5-7)
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musculocutaneous nerve: course
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exits axilla by piercing coracobrachialis; descends between biceps brachii and brachialis, supplying both; continues as lateral cutaneous nerve of forearm
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musculocutaneous nerve: innervates
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anterior compartment of arm (coracobrachialis, biceps brachii, and brachialis); skin of lateral aspect of forearm
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median nerve: origin
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Lateral root: terminal branch of lateral cord (C6, C7); Medial root:terminal branch of median cord (C8, T1)
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median nerve: course
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lateral and medial roots merge to form median nerve lateral to axillary artery; descends through arm adjacent to brachial artery, with nerve gradually crossing anterior to artery to lie medial to artery in cubital fossa
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median nerve: innervates
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anterior forearm (except flexor carpi ulnaris and ulnar half of flexor digitorum profundus), five intrinsic mm. in thenar half of palm and palmar skin
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Medial pectoral, medial cutaneous nerve of arm, and median cutaneous nerve of forearm:origin
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side branches of medial cord, receiving fibers from C8, T1
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medial pectoral nerve: course
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passes between axillary artery and vein; then pierces pectoralis minor and enters deep surface of pectoralis major; although it is called medial for its origin from medial cord, it lies lateral to lateral pectoral nerve
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medial pectoral nerve: innervates
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pec minor and sternocostal part of pec major
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medial cutaneous nerve of arm: course
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smalles nerve of plexus; runs along medial side of axillary and brachial veins; communicates with intercostobrachial nerve
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medial cutaneous nerve of arm: innervatews
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skin of medial side of arm, as far distal as medial epicondyle of humerus and elecranon of ulna
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median cutaneous nerve of forearm: course
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starts with ulnar nerve (with which it may be confused) but pierces deep fascia with basilic vein and enters subcutaneous tissue, dividing into anterior and posterior branches
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median cutaneous nerve of forearm: innervates
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skin of medial side of forearm, as far distal as wrist
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ulnar nerve: origin
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larger terminal branch of medial cord, receiving fibers from C8, T1, and often C7
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ulnar nerve: course
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descends medial arm; passes posterior to medial epicondyle of humerus; then descends ulnar aspect of forearm to hand
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ulnar nerve: innervates
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flexor carpi ulnaris and ulnar half of flexor digitorum profundus (forearm); most intrinsic muscles of hand; skin of hand medial to axial line of digit 4
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upper subscapular nerve: origin
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side branch of posterior cord receiving fibers from C5
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upper subscapular nerve: course
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passes posteriorly, entering subscapularis directly
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upper subscapular nerve: innervates
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superior portion of subscapularis
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lower subscapular nerve: origin
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side branch of posterior cord, receiving fibers from C6
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lower subscapular nerve: course
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passes inferolaterally, deep to subscapular artery and vein
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lower subscapular nerve: innervates
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inferior portion of subscapularis and teres major
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thoracodorsal nerve: origin
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side branch of posterior cord, receiving fibers from c6, C7, c8
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thoracodorsal nerve: course
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arises between upper and lower subscapular nerves and runs inferolaterally along posterior axillary wall to apical part of latissimus dorsi
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thoracodorsal nerve: innervates
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latissimus dorsi
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axillary nerve: origin
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terminal branch of posterior cord, receiving fibers from C5, c6
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axillary nerve: course
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exits axillary fossa posteriorly, passing through quadrangular space with posterior circumflex humeral artery; gives rise to superior lateral brachial cutaneous nerve; then winds around surgical neck of humerus deep to deltoid
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axillary nerve: innervates
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glenohumeral (shoulder) joint; teres minor and deltoid muscles; skin of superolateral arm (over inferior part of deltoid)
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radial nerve: origin
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larger terminal branch of posterior cord (largest branch of plexus), receiving fibers from C5-T1
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radial nerve: course
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exits axillary fossa posterior to axillary artery; passes posterior to humerus in radial groove with deep brachial artery, between lateral and medial heads of triceps; perforates lateral intermuscular septum; enters cubital fossa, dividing into superficial (cutaneous) and deep (motor) radial nerves
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radial nerve: innervates
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all muscles of posterior compartments of arm and forearm; skin of posterior and inferloateral arm, posterior forearm, and dorusm of hand lateral to axial line of digit 4
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biceps brachii: origin
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short head:tip of coracoid process of scapula; long head: supraglenoid tubercle of scapula
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biceps brachii: insertion
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tuberosity of radius and fascia of forearm via bicipital aponeurosis
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biceps brachii & coracobrachialis: innervation
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musculocutaneous nerve (c5, C6, c7)
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biceps brachii: function
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supinates forearm and when it is supine, flexes forearm; short head resists dislocation of shoulder
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coracobrachialis: origin
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tip of coracoid process of scapula
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coracobrachialis: insertion
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middle thir of medial surface of humerus
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coracobrachialis: function
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helps flex and adduct arm; resists dislocation of shoulder
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brachialis: origin
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distal half of anterior surface of humerus
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brachialis: insertion
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coronoid process of tuberosity ulna
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brachialis: innervation
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musculocutaneous nerve (c5, c6) and radial nerve (c5, c7)
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brachialis: function
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flexes forearm in all positions
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triceps brachii: origin
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long head: infraglenoid tubercle of scapula; lateral head: posterior surface of humerus, superior to radial groove; medial head: posterior surface of humerus, inferior to radial groove
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triceps brachii: insertion
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proximal end of olecranon of ulna and fascia of forearm
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triceps brachii: innervation
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radial nerve (c6, C7, C8)
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triceps brachii: function
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chief extensor of forearm; long head resists dislocation of humerus; especially important during adduction
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anconeus: origin
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lateral epicondyle of humerus
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anconeus: insertion
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lateral surface of elecranon and superior part of posterior surface of ulna
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anconeus: innervation
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Radial nerve (c7, c8, t1)
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anconeus: function
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assists triceps in extending forearm; stabilizes elbow joint; may abduct ulna during pronation
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Pronator teres:ulnar head: origin
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coronoid process
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Pronator teres:ulnar head: insertion
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middle of convexity of lateral surface of radius
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Pronator teres:ulnar head: innervation
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Median nerve (c6, C7)
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Pronator teres:ulnar head: function
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pronates and flexes forearm (at elbow)
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Pronator teres:humeral head: origin
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Medial epicondyle of humerus (common flexor origin)
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Pronator teres:humeral head: insertion
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middle of convexity of lateral surface of radius
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Pronator teres:humeral head: innervation
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Median nerve (c6, C7)
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Pronator teres:humeral head: function
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pronates and flexes forearm (at elbow)
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Flexor carpi radialis (FCR): origin
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Medial epicondyle of humerus (common flexor origin)
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Flexor carpi radialis (FCR): insertion
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base of 2nd metacarpal
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Flexor carpi radialis (FCR): innervation
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Median nerve (c6, C7)
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Flexor carpi radialis (FCR): function
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flexes and abducts hand (at wrist)
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Palmaris Longus: Origin
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Medial epicondyle of humerus (common flexor origin)
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Palmaris Longus: Insertion
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distal half of flexor retinaculum and apex of palmar aponeurosis
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Palmaris Longus: Innervation
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Median nerve (c7, c8)
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Palmaris Longus: Function
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Flexes hand (at wrist) and tenses palmar aponeurosis
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Flexor carpi ulnaris (FCU):Humeral head: origin
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Medial epicondyle of humerus (common flexor origin)
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Flexor carpi ulnaris (FCU):Humeral head: insertion
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Pisiform, hook of hamate, 5th metacarpal
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Flexor carpi ulnaris (FCU):Humeral head: innervation
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ulnar nerve (c7, C8)
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Flexor carpi ulnaris (FCU):Humeral head: function
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flexes and adducts hand (at wrist)
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Flexor carpi ulnaris (FCU):Ulnar head: origin
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Olecranon and posterior border (via aponeurosis)
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Flexor carpi ulnaris (FCU):Ulnar head: insertion
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Pisiform, hook of hamate, 5th metacarpal
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Flexor carpi ulnaris (FCU):Ulnar head: innervation
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ulnar nerve (c7, C8)
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Flexor carpi ulnaris (FCU):Ulnar head: function
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flexes and adducts hand (at wrist)
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Flexor digitorum superficialis (FDS):humeroulnar head: origin
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medial epicondyle (common flexor origin and coronoid process)
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Flexor digitorum superficialis (FDS):humeroulnar head: insertion
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shafts of middle phalanges of medial four digits
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Flexor digitorum superficialis (FDS):humeroulnar head: innervation
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Median nerve (c7, c8, t1)
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Flexor digitorum superficialis (FDS):humeroulnar head: function
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flexes middle phalanges at proximal interphalangeal joints of middle four digits; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints
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Flexor digitorum superficialis (FDS):radial head: origin
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superior half of anterior border
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Flexor digitorum superficialis (FDS):radial head: insertion
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shafts of middle phalanges of medial four digits
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Flexor digitorum superficialis (FDS):radial head: innervation
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Median nerve (c7, c8, t1)
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Flexor digitorum superficialis (FDS):radial head: function
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flexes middle phalanges at proximal interphalangeal joints of middle four digits; acting more strongly, it also flexes proximal phalanges at metacarpophalangeal joints
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Flexor digitorum profundus (FDP): medial part: origin
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proximal three quarters of medial and anterior surfaces of ulna and interosseous membrane
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Flexor digitorum profundus (FDP): medial part: insertion
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bases of distal phalanges of 4th and 5th digits
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Flexor digitorum profundus (FDP): medial part: innervation
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ulnar nerve (c8, T1)
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Flexor digitorum profundus (FDP): medial part: function
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flexes distal phalanges 4 and 5 at distal interphalangeal joints
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Flexor digitorum profundus (FDP): lateral part: origin
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proximal three quarters of medial and anterior surfaces of ulna and interosseous membrane
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Flexor digitorum profundus (FDP): lateral part: insertion
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bases of distal phalanges of 2nd and 3rd digits
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Flexor digitorum profundus (FDP): lateral part: innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Flexor digitorum profundus (FDP): lateral part: function
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flexes distal phalanges 2 and 3 at distal interphalangeal joints
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Flexor pollicis longus (FPL): origin
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anterior surface of radius and adjacent interosseous membrane
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Flexor pollicis longus (FPL): insertion
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base of distal phalanx of thumb
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Flexor pollicis longus (FPL): innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Flexor pollicis longus (FPL): function
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flexes phalanges of 1st digit (thumb)
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Pronator quadratus: origin
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distal quarter of anterior surface of ulna
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Pronator quadratus: insertion
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distal quarter of anterior surface of radius
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Pronator quadratus: innervation
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anterior interosseous nerve, from median nerve (C8, t1)
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Pronator quadratus: function
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pronates forearm; deep fibers bind radius and ulna together
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Brachioradialis: origin
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proximal two thirds of fupraepicondylar ridge of humerus
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Brachioradialis: insertion
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lateral surface of distal end of radius proximal to styloid process
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Brachioradialis: innervation
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radial nerve (c5, C6, c7)
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Brachioradialis: function
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relatively weak flexion of forearm; maximal when forearm is in midpronated position
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Extensor carpi radialis longus (ECRL): origin
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lateral supraepicondylar ridge of humerus
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Extensor carpi radialis longus: insertion
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dorsal aspect of base of 2nd metacarpal
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Extensor carpi radialis longus: innervation
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radial nerve (c6, c7)
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Extensor carpi radialis longus: function
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extend and abduct hand at the wrist joint; active during fist clenching
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Extensor carpi radialis brevis (ECRB): origin
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lateral epicondyle of humerus (common extensor origin)
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Extensor carpi radialis brevis: insertion
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dorsal aspect of base of 3rd metacarpal
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Extensor carpi radialis brevis: innervation
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deep branch of radial nerve (C7, c8)
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Extensor carpi radialis brevis: function
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extend and abduct hand at the wrist joint
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Extensor digitorum: origin
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lateral epicondyle of humerus (common extensor origin)
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Extensor digitorum: insertion
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extensor expansion of medial four digits
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Extensor digitorum: innervation
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deep branch of radial nerve (C7, c8)
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Extensor digitorum: function
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extends medial four digits primarily at metacarpophalangeal joints, secondarily at interphalangeal joints
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Extensor digit minimi (EDM): origin
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lateral epicondyle of humerus (common extensor origin)
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Extensor digit minimi (EDM): insertion
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extensor expansion of 5th digit
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Extensor digit minimi (EDM): innervation
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deep branch of radial nerve (C7, c8)
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Extensor digit minimi (EDM): function
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Extends 5th digit primarily at metacarpophalangeal joint, secondarily at interphalangeal joint
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Extensor carpi ulnaris (ECU): origin
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lateral epicondyle of humerus; posterior border of ulna via a shared aponeurosis
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Extensor carpi ulnaris (ECU): insertion
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dorsal aspect of base of 5th metacarpal
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Extensor carpi ulnaris (ECU): innervation
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deep branch of radial nerve (C7, c8)
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Extensor carpi ulnaris (ECU): function
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extends and adducts hand at wrist joint (also active during fist clenching)
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Supinator: origin
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lateral epicondyle of humerus; radial collateral and anular ligaments; supinator fossa; crest of ulna
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Supinator: insertion
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lateral, posterior, and anterior surfaces of proximal third of radius
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Supinator: innervation
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deep branch of radial nerve (c7, C8)
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Supinator: function
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supinates forearm; rotates radius to turn palm anteriorly or superiorly (if elbow is flexed)
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Extensor indicis: origin
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posterior surface of distal thihrd of ulna and interosseous membrane
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Extensor indicis: insertion
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extensor expansion of 2nd digit
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Extensor indicis: innervation
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posterior interosseous nerve (C7, c8), continuation of deep branch of radial nerve
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Extensor indicis: function
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extends 2nd digit (enabling its independent extension); helps extend hand at wrist
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Abductor pollicis longus (APL): origin
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posterior surface of proximal halves of ulna, radius, and interosseous membrane
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Abductor pollicis longus (APL): insertion
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base of 1st metacarpal
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Abductor pollicis longus (APL): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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Abductor pollicis longus (APL): function
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abducts thumb and extends it at carpometacarpal joint
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Extensor pollicis longus (EPL): origin
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posterior surface of middle third of ulna and interosseous membrane
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Extensor pollicis longus (EPL): insertion
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dorsal aspect of base of distal phalanx of thumb
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Extensor pollicis longus (EPL): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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Extensor pollicis longus (EPL): function
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extends distal phalanx of thumb at interphalangeal joint; extends metacarpophalangeal and carpometacarpal joints
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Extensor pollicis brevis (EPB): origin
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posterior surface of distal third of radius and interosseous membrane
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Extensor pollicis brevis (EPB): insertion
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dorsal aspect of base of proximal phalanx of thumb
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Extensor pollicis brevis (EPB): innervation
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posterior interosseous nerve (c7, C8), continuation of deep branch of radial nerve
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Extensor pollicis brevis (EPB): function
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extends proximal phalanx of thumb at metacarpophalangeal joint; extends carpometacarpal joint
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Opponens pollicis: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Opponens pollicis: insertion
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lateral side of 1st metacarpal
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Opponens pollicis: innervation
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recurrent branch of median nerve (C8, t1)
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Opponens pollicis: function
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to oppose thumb, it draws 1st metacarpal medially to center of palm and rotates it medially
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Abductor pollicis: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Abductor pollicis: insertion
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lateral side of base of proximal phalanx of thumb
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Abductor pollicis: innervation
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recurrent branch of median nerve (C8, t1)
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Abductor pollicis: function
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abducts thumb; helps op[pose it
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Flexor pollicis brevis: superficial head: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Flexor pollicis brevis: superficial head: insertion
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lateral side of base of proximal phalanx of thumb
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Flexor pollicis brevis: superficial head: innervation
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recurrent branch of median nerve (C8, t1)
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Flexor pollicis brevis: superficial head: function
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flexes thumb
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Flexor pollicis brevis: deep head: origin
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flexor retinaculum and tubercles of scaphoid and trapezium
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Flexor pollicis brevis: deep head: insertion
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lateral side of base of proximal phalanx of thumb
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Flexor pollicis brevis: deep head: innervation
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deep branch of ulnar nerve (c8, T1)
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Flexor pollicis brevis: deep head: function
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adducts thumb toward lateral border of palm
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Adductor pollicis: Oblique head: origin
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bases of 2nd and 3rd metacarpals, capitate, and adjacent carpals
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Adductor pollicis: Oblique head: insertion
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medial side of base of proximal phalanx of thumb
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Adductor pollicis: Oblique head: innervation
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deep branch of ulnar nerve (c8, T1)
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Adductor pollicis: Oblique head: function
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adducts thumb toward lateral border of palm
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Adductor pollicis: Transverse head: origin
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anterior surface of shaft of 3rd metacarpal
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Adductor pollicis: Transverse head: insertion
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medial side of base of proximal phalanx of thumb
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Adductor pollicis: Transverse head: innervation
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deep branch of ulnar nerve (c8, T1)
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Adductor pollicis: Transverse head: function
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adducts thumb toward lateral border of palm
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abductor digit minimi: origin
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pisiform
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abductor digit minimi: insertion
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medial side of base of proximal phalanx of 5th digit
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abductor digit minimi: innervation
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deep branch of ulnar nerve (c8, T1)
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abductor digit minimi: function
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abducts 5th digit; assists in flexion of its proximal phalanx
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Flexor digiti minimi brevis: origin
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Hook of hamate and flexor retinaculum
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Flexor digiti minimi brevis: insertion
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medial side of base of proximal phalanx of 5th digit
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Flexor digiti minimi brevis: innervation
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deep branch of ulnar nerve (c8, T1)
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Flexor digiti minimi brevis: function
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flexes proximal phalanx of 5th digit
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Opponens digiti: origin
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Hook of hamate and flexor retinaculum
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Opponens digiti: insertion
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medial border of 5th metacarpal
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Opponens digiti: innervation
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deep branch of ulnar nerve (c8, T1)
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Opponens digiti: function
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draws 5th metacarpal anterior and rotates it, bringing 5th digit into opposition with thumb
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Lumbricals: 1st and 2nd: origin
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lateral two tendons of flexor digitorum profundus (as unipennate muscles)
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Lumbricals: 1st and 2nd: insertion
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lateral sides of extensor expansions of 2-5th digits
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Lumbricals: 1st and 2nd: innervation
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Median nerve (c8, T1)
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Lumbricals: 1st and 2nd: function
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Flex metacarpophalangeal joints; extend interphalangeal joints of 2-5th dights
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Lumbricals: 3rd and 4th: origin
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medial three tendons of flexor digitorum profundus (as bipennate muscles)
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Lumbricals: 3rd and 4th: insertion
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lateral sides of extensor expansions of 2-5th digits
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Lumbricals: 3rd and 4th: innervation
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deep branch of ulnar nerve (c8, T1)
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Lumbricals: 3rd and 4th: function
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Flex metacarpophalangeal joints; extend interphalangeal joints of 2-5th dights
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Dorsal interossei, 1-4th: origin
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adjacent sides of two metacarpals (as bipennate muscles)
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Dorsal interossei, 1-4th: insertion
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bases of proximal phalanges; extensor expansions of 2-4th digits
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Dorsal interossei, 1-4th: innervation
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deep branch of ulnar nerve (c8, T1)
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Dorsal interossei, 1-4th: function
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abduct 2-4th digits from axial line; act with lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints
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Palmar interossei, 1-3rd: origin
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palmar surfaces of 2nd, 4th, and 5th metacarpals (as unipennate muscles)
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Palmar interossei, 1-3rd: insertion
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bases of proximal phalanges; extensor expansions of 2nd, 4th, and 5th digits
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Palmar interossei, 1-3rd: innervation
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deep branch of ulnar nerve (c8, T1)
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Palmar interossei, 1-3rd: function
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adduct 2nd, 4th, and 5th digits toward axial line; assist lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints; extensor expansions of 2nd-4th digits
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Glenohumeral Joint: Flexion:
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PEC MAJOR (clavicular head); DELTOID (clavicular and anterior acromial parts); coracobrachialis
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Glenohumeral Joint: Extension:
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DELTOID (spinal part); teres major; latissimus dorsi; long head of triceps brachii
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Glenohumeral Joint: Abduction:
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DELTOID (whole, but especially acromial part); supraspinatus
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Glenohumeral Joint: Adduction:
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PEC MAJOR; LATISSIMUS DORSI; teres major; long head of triceps brachii
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Glenohumeral Joint: Medial rotation:
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SUBSCAPULARIS; pec major; deltoid (clavicular part); latissimus dorsi; teres major
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Glenohumeral Joint: Lateral rotation:
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INFRASPINATUS; teres minor; deltoid (spinal part)
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Glenohumeral Joint: Tensors of articular capsule (to hold head of humerus against the glenoid cavity):
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SUBSCAPULARIS; INFRASPINATUS(simultaneously); supraspinatus; teres minor
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Glenohumeral Joint: Resisiting downard dislocation (shunt muscles):
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DELTOID (whole); long head of triceps brachii; coracobrachialis; short head of biceps brachii
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Ankylosis of sternoclavicular joint
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(stiffening or fixation) surgery necessary to restore movement of shoulder
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Dislocation of sternoclavicular joint
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rare; fall on outstretched hand
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Dislocation of acromioclavicular joint
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fall on shoulder or outstretched upper limb; hockey;
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Calcific supraspinatus tendinitis
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inflammation and calcification of subacromial bursa=pain during 50-130 degree of abduction (painful arc syndrome)
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Rotator cuff injurying
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baseball pitchers; lifting a stuck window; use gravity for 15 degrees of abduction, then deltoid can take over
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Dislocation of glenohumeral joint
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head of humerus driven inferoanteriorly; hard blow to humerus; support arm with other hand
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Axillary nerve injury
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paralysis of deltoid; inability to abduct arm
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Glenoid labrum tears
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pain while throwing during acceleration phase; popping during abduction and lateral rotation
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Adhesive capsulitis of glenohumeral joint
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difficulty abducting arm; strain placed on AC joint, painful
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Bursitis of elbow
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dart thrower's elbow and miner's elbow; pain when forearm pronated
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avulsion of medial epicondyle
|
traction injury of the ulnar nerve is a frequent complication
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Ulnar collateral ligament reconstruction
|
(UCL); athletic throwing; autologous transplant of palmaris longus or plantaris tendon of contralateral forearm or leg
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Dislocation of elbow joint
|
hyperextension or a blow that drives the ulna posterior; injury to the ulnar nerve may occur
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subluxation and dislocation of radial head
|
preschool, picking up kid with their arms fully extended; jerked; pinched anular ligament; Tx - supination of forearm while elbow is flexed; 2 weeks in sling
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wrist fractures and dislocations
|
surgical fusion of carpals (arthrodesis) may be necessary to relive severe pain
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Bull rider's thumb
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avulsion fracture of lateral part of the proximal phalanx of the thumb
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Skier's thumb
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hyperabduction of MP joint of thumb
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