Upper Extremity Anatomy Quiz 2

Front 1

Biceps Brachii

Back 1

O=
Short Head =
Tip of coracoid proc.
Long Head =
Supraglenoid tubercle (and superior labrum)
I = Radial tuberosity AND aponeurosis
N = Musculocutaneous n. (C5-6)
A = Flex humerus and elbow, supinate forearm

Front 2

Brachialis

Back 2

O = Lower ½ ant. Humerus
I = Tuberosity of ulna
N = Musculocutaneous n. (C5-6)
A = Flex elbow

Front 3

Triceps Brachii

Back 3

O
Long Head = infraglenoid tubercle
Lateral Head = post humerus above radial groove
Medial Head = Post humerus below radial groove
I = Olecranon proc.
N = Radial n. (C6-8) (passes under triceps and goes to anterior compartment of forearm)
A = ExtendS shoulder and elbow

Front 4

Anconeous

Back 4

O = Lat epicondyle of humerus
I = Lat olecranon proc.
N = Radial n. (C7-8, T1)
A = Extension of forearm, thought to pull posterior capsule to prevent impingement

Front 5

Proximal row of carpal bones

Back 5

Scaphoid
Lunate
Triquetrum
Pisiform - attached only to triquetrum

Front 6

Distal row of carpal bones

Back 6

Trapezium
Trapezoid
Capitate
Hamate

Front 7

Superficial Flexors of the forearm
6

Back 7

Brachioradialis
Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris
Flexor Digitorum Superficialis

Front 8

Deep Flexors of the forearm

Back 8

Flexor Digitorum Profundus

Flexor Pollicis Longus

Pronator Quadratus*** (not actually a deep forearm flexor?)

Front 9

Brachioradialis

Back 9

O = Lat supracondylar ridge
I = Lat distal radius
N = Radial n. (C5-7)
A = Flex of elbow

Front 10

How to remember Orientation of Superficial Forearm Muscles

Back 10

Use your fingers!
with right fingers 2-5 on left forearm
pointer = pronator teres
middle = flexor carpi radialis
ring = palmaris longus
pinky = flexor carpi ulnaris

Flexor Digitorum Superficialis Just deep to these
Represented by Thumb

Front 11

Pronator Teres

Back 11

O
Lateral Head = medial epicondyle of humerus
Medial Head = coronoid proc
I = Lateral shaft of radius
N = Median n. (C6-7)
A = Flexes elbow and pronates forearm

Front 12

Flexor Carpi Radialis

Back 12

O = Common flexor tendon, med epicondyle of humerus
I = Base of metacarpals 2 & 3
N = Median n. (C6-7)
A =
Flex wrist
Radially deviate wrist

Front 13

Common flexor Tendon

Back 13

located on medial epicondyle of humerus

origin for flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis

Front 14

Palmaris Longus

Back 14

O = Common flexor tendon, med. epicondyle of humerus
I = Palmar aponeurosis
N = Median n. (C7-8)
A = Flex wrist, tense the palmar aponeurosis (for gripping objects)
10-15% don't have it

Front 15

Flexor Carpi Ulnaris

Back 15

O = Common flexor tendon, med epicondyle of humerus, post surface of ulna
I = Pisiform, hook of hamate, base of MC 5
N = Ulnar n. (C7-8)
A = Flex wrist; Ulnar deviation of wrist

Front 16

Flexor Digitorum Superficialis

Back 16

O = Common flexor tendon, Med epicondyle of humerus, proximal radius
I = Middle phalanx of fingers 2-5
N = Median n. (C7-8, T1)
A =
Flex middle phalanx (PIP jts) 2-5
Flex wrist

Front 17

Flexor Digitorum Profundus

Back 17

O = Ant and Med Ulna
I = Distal phalanx of fingers 2-5
N =
Radial half
Ant. Interosseous branch of Median (C8,T1)
Ulnar half
Ulnar n. (C8,T1)
A = Flex of distal phalanx (DIP jts) of fingers 2-5; Flexes wrist

Front 18

Flexor Pollicis Longus

Back 18

O = Ant. radius, and Interosseous membrane
I = Distal phalanx of thumb
N = Ant. Interosseous branch of Median N. (C8,T1)
A = Flex distal phalanx of thumb

Front 19

Pronator Quadratus

Back 19

O = Distal ant. Ulna
I = Distal anterior Radius
N = Ant. Interosseous branch of Median N. (C8, T1)
A = Pronate the forearm

Front 20

Innervation of
Flexor Muscles of the Forearm

Back 20

all innervated by Median Nerve except
Brachioradialis - radial nerve
and
flexor carpi ulnaris and half of flexor digitorum profundus (both by ulnar nerve)

Front 21

Superficial Forearm Extensors

Back 21

Extensor Carpi Radialis Longus

Extensor Carpi Radialis Brevis

Extensor Carpi Ulnaris

Extensor Digiti Minimi

Extensor Digitorum

Front 22

Common Extensor Tendon

Back 22

Common insertion site at lateral epicondyle

Front 23

Extensor Carpi Radialis Longus

Back 23

O = Lat. Epicondyle of humerus (common extensor tendon)
I = Base of 2nd metacarpal
N = Radial n. (C6,7)
A =
Ext of wrist
Radial deviation of wrist

Front 24

Extensor Carpi Radialis Brevis

Back 24

O = Common extensor tendon
I = Base of 3rd metacarpal
N = Radial n. (C7,8)
A = Ext of wrist, Radially deviates wrist

Front 25

Extensor Carpi Ulnaris

Back 25

O = Common extensor tendon, prox. post. Ulna

I = Base of 5th metacarpal

N = Radial n. (C7,8)

A =
Ext of wrist
Ulnar deviation of wrist

Front 26

Extensor Digitorum

Back 26

O = Common extensor tendon

I = Middle and distal phalanx of fingers 2-5

N = Radial n. (C7,8)

A = Extension of fingers 2-5

Front 27

Extensor Digiti Minimi

Back 27

O = Common extensor tendon

I = Middle phalanx of 5th finger, distal phalanx via Ext Dig tendon

N = Radial n. (C7,8)

A = Ext of 5th finger

Front 28

Deep Extensors of the Forearm

Back 28

Abductor Pollicis Longus

Extensor Indicis

Extensor Pollicis Brevis

Extensor Pollicis Longus

Supinator

Front 29

Review movements of the thumb

Back 29

flexion and extension are in the plane of the palm
abduction comes out at 90 degrees
opposition

Front 30

Abductor Pollicis Longus

Back 30

O = Posterior ulna and radius

I = Base of 1st metacarpal

N = Radial n. (C7,8)

A = Abd of thumb, Ext of thumb

Front 31

Extensor Pollicis Brevis

Back 31

O = Posterior radius

I = Proximal phalanx of thumb

N = Radial n. (C7-8)

A = Extension of prox phalanx of thumb

Front 32

Extensor Pollicis Longus

Back 32

O = Posterior middle 1/3 of ulna

I = Distal phalanx of thumb

N = Radial n. (C7-8)

A = Extension of distal phalanx of thumb

Front 33

Anatomical Snuff Box

Back 33

Made up of Abductor Pollicis Longus and Extensor Pollicis Brevis
big one is Extensor Pollicis Longus

Front 34

Extensor Indicis

Back 34

O = Posterior ulna

I = Extensor Digitorum tendon to index finger

N = Radial n. (C7-8)

A = Extension of index finger

Front 35

Supinator

Back 35

O = Common extensor tendon, annular ligament

I = Proximal shaft of radius

N = Radial n. (C5-6) (can have entrapment)

A = Supination of forearm

Front 36

Innervation of the Extensor Muscles of the Forearm

Back 36

Superficial:
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris
Extensor Digiti Minimi
Extensor Digitorum
Deep:
Abductor Pollicis Longus
Extensor Indicis
Extensor Pollicis Brevis
Extensor Pollicis Longus
Supinator

All innervated by Radial nerve

Front 37

What passes between the two head of the Pronator Teres

Back 37

Anterior Interosseous branch of the Median nerve passes between the two head of the Pronator Teres

Entrapment
Pronator Teres Syndrome

Front 38

Common Synovial Flexor Sheath

Back 38

Houses tendons of both Flexor Digitorum Superificialis and Flexor Digitorum Profundus

Depicted as “SS” in this figure

Front 39

Finger Flexor Tendon Structure

Back 39

Tendons of Flexor digitorum superficialis tendon
Split and attach to either side of middle phallanx

Flexor digitorum profundus tendon
Runs underneath split
Attaches to both middle and distal phallanx

Both tendons
Attach to phallanges via connective tissue structures known as “vincula”

Front 40

What nerve goes under the supinator?

Back 40

the radial nerve

Front 41

Do you understand the tendonous insertions on the fingers?

Back 41

not really,
look at some pictures!

Front 42

Humeroulnar joint

Back 42

Humeroulnar

Hourglass shaped Trochlea of Humerus

Trochlear Notch of Ulna

Front 43

Humeroradial joint

Back 43

Humeroradial

Round Capitulum of Humerus

Cup shaped concave head of Radius

Front 44

Elbow Complex Joint Capsule

Back 44

Encloses:
Humeroradial jt
Humeroulnar jt
Superior Radioulnar jt

Characteristics:
Large and fairly loose
Weak anteriorly and posteriorly
Reinforced medially & laterally by collateral ligaments & muscles

Front 45

Medial (ulnar) collateral ligament

Back 45

Medial (Ulnar) Collateral
Anterior Fibers
Primary valgus restraint
Reinforced by FCU, PT & FDS
Posterior Fibers
Less valgus restraint
Limits elbow extension
Transverse or Oblique Fibers
Assists in valgus restraint
Helps keep the joint surfaces approximated

Front 46

Lateral Collateral ligaments of the elbow

Back 46

Lateral Collateral:
Lateral Radial Collateral - attaches to radius and annular ligament
Resists varus stress
Resists longitudinal distraction

Lateral Ulnar Collateral - attaches to ulna
Resists varus stress

Front 47

Annular Ligament

Back 47

Wraps around head of radius


Provides stability during pronation/supination

Front 48

Olecranon Bursa

Back 48

Main bursa of the elbow complex

Lies posteriorly between the skin and the olecranon process

Superficial location puts it at high risk for injury from direct trauma to the elbow

gets "boggy"

Front 49

Elbow Complex Motions

Back 49

Axis thru middle of Trochlea
Uniaxial, Biplanar
Flexion / Adduction
As elbow flexes → Slight forearm adduction
Extension / Abduction
As elbow extends → Slight forearm abduction

Accessory Motions of sliding throughout ROM

Front 50

Carrying Angle

Back 50

medial aspect of the trochlea extends more distally
“Cubitus Valgus”

Normal:
Males = 5 degrees
Females = 10-15 degrees
Slight differences with dominance

Front 51

Elbow ROM

Back 51

Normal: 0 – 145o
Influenced by:
Bulk of contracting flexors
BMI (Obesity)
Position of the forearm (greatest in supination)
Passive insufficiency of Long Head of Biceps

Front 52

Activity of Elbow Flexors

Back 52

Brachialis
“Work Horse”

Biceps Brachii
Active with light flexion movements if supination required
Active with heavy flexion resistance regardless of supination requirement

Brachioradialis
Recruited with rapid movements and heavy resistance in pronated (or partially pronated) position

Weak elbow flexors
Pronator Teres
Extensor Carpi Radialis Longus & Brevis

Front 53

Superior Radioulnar joint

Back 53

Superior Radioulnar

Convex Head of Radius

Concave Radial Notch of Ulna

Front 54

Superior Radioulnar Ligaments

Back 54

Annular Ligament
Binds Radial Head to the Ulna
Quadrate
Reinforces the inferior capsule
Oblique Cord
Interosseous Membrane

Front 55

Inferior Radioulnar Joint

Back 55

Inferior Radioulnar
Convex Head of Ulna
Concave Ulnar Notch on Radius

Front 56

Inferior radioulnar ligaments

Back 56

Anterior Radioulnar Ligament
Posterior Radioulnar Ligament

Interosseous Membrane
Binds bones together
Allows transmission of forces

Front 57

Articular disc in wrist

Back 57

Triangular Fibrocartilage (TFC)
Attached to inferior edge of ulnar notch (of radius) and styloid process of ulna
Central area is avascular

Helps to level articular surface of the ulna and radius

Front 58

Radioulnar Motions

Back 58

Axis is from Radial Head to Ulnar Head
Pronation
Radius crosses over Ulna

Supination
Supinator
Biceps Brachii

Pronation:
Pronator Teres
Helps stabilize superior radioulnar joint
Pronator Quadratus
Helps stabilize inferior radioulnar joint

Front 59

Injuries to the elbow

Back 59

Radial Head Dislocation
“Nursemaid’s Elbow”
Distraction injury

Fractures (“FOOSH”)

Compression Injury

Sprains