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271 Cards in this Set

  • Front
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Appendicular skeleton
Bones of upper and lower limb + supporting elements called girdles that connect limbs to trunk.

Provides control of external environment, changes in position and mobility
Pectoral girdle is made up of
Clavicle (collar bone) + scapula (shoulder blade)
Which bone provides the only direct connection between pectoral girdle and axial skeleton?
Clavicle
Scapula is supported and positioned by?
Skeletal muscles; there is no direct bony or ligamentous connection between scapula and thoracic cage.
Function of Pectoral Girdle
Movements of clavicle and scapula
-position the shoulder joint
-provide a base for arm movement
-help maximize range of motion of the humerus
Where do muscles that move the arm originate?
Pectoral girdle
Clavicle (function)
-Braces the shoulder
-transfers some of the weight of upper limb to axial skeleton
The clavicle originates in
Manubrium of sternum
What are the two ends of the clavicle
Sternal end & acromial end
Where do the ligaments of the shoulder attach on the clavicle?
Conoid tubercle (acromial end) and Costal tuberosity (Sternal end)
Tubercle
A small rounded projection
Tuberosity
A rough projection
Three sides of the scapular triangle
superior border
medial border
lateral border
Muscles that position the scapula attach at these edges
Corners of the scapular triangle
Superior angle (medial angle)
Inferior angle
Lateral angle
Glenoid cavity
Formed by lateral angle
Scapula articulates with humerus at glenoid cavity
Joint between humerus and scapula
Glenohumeral or shoulder joint (Scapulohumerol joint )
What is the fossa on the anterior surface of the scapula?
subscapular fossa
What are two large scapular processes?
Coracoid process and acromion
Coracoid process
Smaller anterior process of scapula; projects anteriorly and slightly laterally and serves as attachment point for biceps brachii muscles
Acromion
Larger posterior process of scapula; projects anteriorly; located on lateral end of scapular spine.
Serves as attachment point for trapezium muscles of the back.
Joint between clavilce and scapula
acromioclavicular joint (between acromion process of scapula and acromial end of clavicle)
The two surface markings above and below the glenoid cavity
Supraglenoid tubercle: attachment point for biceps brachii muscles

Infraglenoid tubercles: attachment point for triceps brachii muscles
Scapular spine
Crosses the scapular body from acromion to end at medial border.

Serves as attachment point for deltoid and trapezius muscles.
What two regions does the scapular spine divide the posterior surface of scapula into?
Supraspinous Fossa: an attachment for supraspinatus muscle

Infraspinous fossa: attachment for infraspinatus muscle.
What is indentation medial to the base of the coracoid process called?
suprascapular notch
Fossa
A shallow depression
Process
Any projection or bump
Bones of the upper limb
Humerus, ulna, radius, carpal bones (wrist), metacarpals and phalanges of the hand.
Where is the greater tubercle located and what muscles attach to it?
Location: Proximal lateral margin of humerus.

Four scapular muscles attach to the greater tubercle: pectoralis major, supraspinatus muscle, infraspinatus muscle and teres minor muscle
Where is the lesser tubercle located and what muscles attach to it?
Location: Anterior, medial surface on proximal end of humerus

The subscapularis, a scapular muscle attaches to it.
What is the groove between the lesser and greater tubercle on the humerus called? What runs through it?
Intertuberculer sulcus or groove (Bicipital groove)

A tendon of the biceps brachii runs through it from its origin at the supraglenoid tubercle of the scapula.
Where do fractures often occur in the humerus?
The surgical neck.
What is the body of the humerus called?
Shaft
Location of deltoid tuberosity and what muscle attaches to it?
Location: lateral border of shaft of humerus

Muscle: deltoid muscle
What is the distal articular surface of the humerus called and what are its two regions?
Condyle.

The two regions are trochlea and capitulum.
Trochlea of the humerus articulates with what bone and runs between which two depressions?
Trochlea articulates with ulna.

Runs from the anterior coronoid fossa to the posterior olecranon fossa.
The capitulum of the humerus articulates with what bone?
Radius
What are the three depressions on the distal end of the humerus and what projections do they accept?
Coronoid fossa and olecranon fossa accept projections from ulna as the elbow flexes and extends.

Radial fossa accomadate small part of the radial head.
Radial groove location and what nerve runs through it?
Location: runs along posterior margin of deltoid tuberosity.

The radial nerve runs through it.
Function of radial nerve
Provides sensory information from back of hand and motor control over large muscles that extend (straighten) the elbow.
What are epicondyles?
Processes that develop proximal to an articulation and provide additional surface area for muscle attachment.
What nerve crosses the medial epicondyle of the humerus?
Ulnar nerve
What location is called the funny bone?
The humeral side of the elbow joint. Bumping it can strike the ulnar nerve which produced temporary numbness and paralysis of some muscles in the forearm.
Relative position of ulna and radius to each other
Ulna lies medial to radius in anatomical position.
What forms the point of the elbow?
Olecranon (olecranon process) of the ulna
What feature of the ulna interlocks with the tochlea on the humerus?
Trochlear notch
What two markings for the superior and inferior border of the trochlear notch?
Olecranon and Coronoid process.

Olecranon projects into the olecranon fossa when the elbox extends.

The coronoid process projects into the coronoid fossa of humerus when elbow flexes.
What marking accommodates the head of the radius on the ulna?

What is the joint called.
Radial notch

Proximal radioulnar joint
What shape is the shaft of the ulna?
Triangle, with base on medial side and apex of triangle on lateral side.
What fibrous sheet connects the ulna and radius? What is its function
Interosseous membrane: provides additional surface area for muscle attachment.
What are the two bone features at the distal end of the ulna?
Ulnar head and styloid process. A cartilage attaches to the styloid process and separates ulnar head from wrist bones.

Ulnar head is part of distal radioulnar joint.
What two joints is the elbow joint made of?
Humeroulnar joint and humeroradial joint.
Where is the head of the ulna located?

Where is the head of the radius located?
Distal end of ulna.

Proximal end of radius
Where does the biceps brachii muscle attach on the radius?
Radial tuberosity. The muscle flexes the elbow.
What is the distal end of the radius called?
Distal extremity
Do both the distal extremity and ulnar head participate in the wrist joint.
No only the distal extremit does. Cartilage separates ulna from wrist.
What feature of the radius articulates with the ulnar head?
Ulnar notch of radius. This forms the distal radioulnar joint.
Describe rotation of medial and lateral rotation at radioulnar joint.
The proximal radioulnar joint permits medial or lateral rotation of ulnar head. When medial rotation occurs at the proximal radioulnar joint, the ulnar notch of the radius rolls across the rounded surface of the ulnar head. Medial rotation at the radioulnar joints in turn rotates the wrist and hand medially, from the anatomical position. The medial rotation is called pronation and the lateral rotation is called supination.
What is the function of the styloid process of radius
Stabilizes the wrist
How many bones in the wrist?
Eight. Four proximal carpal bone and four distal carpal bones.
What is the phrase to help you remember the names of the carpal bones?
Sam likes to push the toy card hard
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
What two carpal bones articulate with the radius?
Scaphoid and lunate
What carpal bone articulates with the cartilage that separates the ulna from the wrist?
Triquetrum
What carpal bone extends further medially than any other carpal bone?
Pisiform
What distal carpal bones articulate with the scaphoid?
Trapezium and trapezoid
Which is the largest carpal bone?
Capitate
What are the palm bones called? How many are there and how are they numbered?
Metacarpals; there are five metacarpal numbered I-V beginning with the lateral metacarpal.
Three portions of the metacarpals
Proximal base, small body and distal head
What are the bones in the fingers called? How many are there?
Phalanges; there are fourteen, two in the thumb or pollex and three in each finger.
What carpal bone fractures most frequently?
The scaphoid usually from falling onto an outstretched hand. It heals poorly in older people due to decreased blood supply.
Why would a broken clavicle affect the mobility of the scapula?
The clavicle attaches to the sternum and thus restricts the scapulas range of movement. If the clavicle is broken, the scapula will have a greater range of movement and will be less stable
Which antebrachial bone is lateral in the anatomical position?
Radius
What is the function of the olecranon
The olecranon is the point of the elbow. During the extension of the elbow the olecranon swings into the olecranon fossa on the posterior surface of the humerus to prevent overextension.
Function of appendicular musculature
To stabilize the pectoral and pelvic girdles and for moving the upper and lower limbs.
What are the two groups of appendicular muscles?
Muscles of the pectoral girdle and upper limbs.

Muscles of the pelvic girlde and lower limbs
How are muscular connections between pectoral girdle and axial skeleton different from muscular connections between pelvic girdle and axial skeleton?
Muscular connections between pectoral girdle and the axial skeleton increase upper limb mobility since since skeletal elements are not locked in position relative to the axial skeleton. Emphasis on versatility.

In contrast the pelvic girdle has a strong skeletal connection to transfer weights from axial to appendicular skeleton. Emphasis on strength.
The action produced by a muscle at a joint depends on what?
Structure of joint.

Location of insertion of muscle relative to the axis of movement at the joint.
What is the action line of the muscle?
Imagine a string running from point of origin to point of insertion on the muscle. The string would follow the direction of the applied tension which is called the action line of the muscle.
What rules can be applied to action lines to determine action of muscle produced at a joint?
1. At joints that permit flexion and extension, muscles whose action lines cross the anterior aspect of a joint are the flexors of that joint and muscles who action lines cross the posterior aspect of a joint are extensors of that joint.

2. At joints that permit adduction and abduction, muscles whose action lines cross the medial aspect of a joint are adductors of that joint and muscles whose action lines cross the lateral aspect of a joint are abductors of that joint.

3. At joints that permit rotation, muscles whose action lines cross on the medial aspect of a joint may produce medial rotation at that joint, whereas muscles whose action lines pass on the lateral aspect of a joint produce lateral rotation at that joint.
Function of spurt and shunt muscles.
Spurt muscles insert close to the joint and mainly produce movement at the joint.

Shunt muscles insert farther from the joint help stabilize the joint by pulling the articulating surfaces closer together in addition to producing motion at that joint.
Four groups of muscles of the pectoral girdle and upper limbs
1. muscles that position the pectoral girdle
2. muscles that more the arm
3. muscles that move the forearm and hand
4. muscles that move the hand and fingers
List the muscles that position the pectoral girdle. What nerves innervate them?
Seven total.
Trapezius
Levator scapulae
Rhomboid minor
Rhomboid major
Serratus anterior
Subclavius muscle
Pectoralis minor

Nerves: cervical, dorsal scapular, medial pectoral, long thoracic, nerve to subclavius, accessory nerve
Levator scapulae (origin, insertion, action, innervation)
Origin: cervical vertebrae
Insertion: Vertebral (medial) border of scapula near superior angle
Action: elevates scapula
Innervation: cervical nerves (C3 - C4) and dorsal scapular nerve (C5)
Pectoralis minor (origin, insertion, action, innervation)
Origin: anterior and superior margins of ribs
Insertion: coracoid process
Action: depresses and protracts shoulder; rotates scapula; elevates ribs if scapula is stationary
Innervation: Medial pectoral nerve (C8, T1)
Rhomboid major (origin, insertion, action, innervation)
Origin: vertebrae T2 to T5
Insertion: vertebral (medial) border of scapula from spine to the inferior angle
Action: Adducts and performs downward motion of the scapula
Innervation: Dorsal scapular nerve
Rhomboid minor (origin, insertion, action, innervation)
Origin: Vertebrae C7-T1
Insertion: Vertebral (medial) border of scapula
Action: Adducts and performs downward motion of the scapula
Innervation: Dorsal scapular nerve
Serratus anterior (origin, insertion, action, innervation)
Origin: Ribs (anterior and superior margins) 1-8, 1-9 or 1-10
Insertion: Anterior surface of vertebral border of scapula
Action: protracts shoulder; rotates scapula so glenodi cavitry moves superiorly
Innervation: Long thoracic nerve (C5-C7)
Subclavius (origin, insertion, action, innervation)
Origin: First rib
Insertion: clavicle (inferior border of middle 1/3)
Action: depresses and protracts border
Innervation: Nerve to subclavius (C5-C6)
Trapezius (origin, insertion, action, innervation)
Origin: occipital bone and thoracic vertebrae
Insertion: clavicle and scapula (acromion and scapular spine)
Action: depends on active region and state of other muscles; may elevate, retract, depress or rotate scapula upward and/or clavicle; can also extend neck when the position of the shoulder is fixed
Innervation: Accessory nerve (N XI)
Major abductor (muscle) of arm
deltoid muscle
supraspinatus muscles assists at the start of the movement
What muscles rotate the arm medially?
subscapularis and teres major muscle
What muscles rotate the arm laterally?
infrapinatus and teres minor muscle
The scapular muscles that flexes and adducts the arm is?
coracobrachialis and pectoralis major
What muscles flex and extend the shoulder
Pectoralis major (flex)
Latissimus dorsi (extends)
What muscles form the rotator cuff?
supraspinatus, infraspinatus, subscapularis, teres minor merge with connective tissue of the shoulder joint capsule to form the rotator cuff
Coracobrachialis (origin, insertion, action, innervation)
Origin: Coracoid process
Insertion: medial margin of shaft of humerous
Action: Adduction and flexion at shoulder
Innervation: Musculocutaneous nerve
Deltoid (origin, insertion, action, innervation)
Origin: Clavical and scapula (acromion and scapular spine)
Insertion: Deltoid tuberosity of humerus
Action: abduction at shoulder (whole muscle); flexion and medial rotation of humerus (anterior part); extension and lateral rotation of shoulder (posterior part)
Innervation: Axillary nerve
Supraspinatous (origin, insertion, action, innervation)
Origin: Supraspinous fossa of scapula
Insertion: Greater tubercle of humerus
Action: Abduction at shoulder
Innervation: suprascapular nerve (C5)
Infraspinatous (origin, insertion, action, innervation)
Origin: Infraspinous fossa of scapula
Insertion: Greater tubercle of humerus
Action: Lateral rotation at shoulder
Innervation: Suprascapular nerve (C5 - C6)
Subscapularis (origin, insertion, action, innervation)
Origin: subscapular fossa of scapula
Insertion: Lesser tubercle of humerus
Action: Medial rotation at shoulder
Innervation: Subscapular nerve (C5 - C6)
Teres major (origin, insertion, action, innervation)
Origin: Inferior angle of scapula
Insertion: Medial lip of intertuberculer sulcus of humerus
Action: Extension and medial rotation at shoulder
Innervation: Lower subscapular nerve (C5 - C6)
Teres minor (origin, insertion, action, innervation)
Origin: Lateral Border of Scapula
Insertion: Greater Tubercle of humerus
Action: Lateral rotation and adduction at shoulder
Innervation: Axillary nerve (C5)
Latissimus dorsi (origin, insertion, action, innervation)
Origin: Spinous processes of inferior thoracic and all lumbar and sacral vertebrae, ribs 8-12, and thoracolumbar fascia
Insertion: Floor of intertubercular sulcus of the humerus
Action: Extension, adduction, and medial rotation at shoulder
Innervation: Thoracodorsalnerve (C6-C8)
Pectoralis major (origin, insertion, action, innervation)
Origin: Cartilage of ribs 2-6, body of sternum, and inferior and medial portion of clavicle
Insertion: Crest of greater tubercle and lateral lip of intertubercular sulcus of humerus
Action: Flexion, adduction, and medial rotation of shoulder
Innervation: pectoral nerve
What muscles move the arm?
Coracobrachialis
Deltoid
Supraspinatus
Infraspinatus
Subscapularis
Teres major
Teres minor
Triceps brachii (long head)
Biceps brachii
Latissimus dorsi
Pectoralis major
Pronation
Moves the wrist and hand from palm-facing-front to palm-facing-back.
Supination
Moves the wrist and hand from palm-facing-back to palm -facing-forward.
Where do most of the muscles that move the forearm and hand originate? What are the two exceptions
Originate on the humerus and insert upon the forearm and wrist.
The two exceptions are the triceps brachii and biceps brachii which originate on the scapula.
In which position of the forearm (supinated or pronated) can the biceps brachii muscle NOT function properly?
Pronated
In general, where are the extensors and flexors of the forearm and wrist located?
Extensors: posterior and lateral surfaces of the forearm

Flexors: anterior and medial surfaces of the forearm
What muscles (flexors) flex the elbow? What nerves innervate them?
Biceps brachii
Brachialis
Brachioradialis

Nerves: musculocutaneous and radial
What muscles extend (extensors) the elbow? What nerves innervate them?
Anconeus
Triceps brachii

Nerves: radial
What muscles (pronators) pronate the forearm and wrist? What nerves innervate them?
Pronator quadratus
Pronator teres

Nerves: median nerve
What muscles (supinators) supinate the forearm and wrist? What nerves innervate them?
Supinator

Nerves: deep radial
What muscles (flexors) flex the wrist? What nerves innervate them?
Flexor carpi radialis
Flexor carpi ulnaris
Palmaras longus

Nerves: Median and ulnar
What muscles (extensors) extend the wrist? What nerves innervate them?
Extensor carpi radialis longus
Extensor carpi radialus brevis
Extensor carpi ulnaris

Nerves: radial and deep radial
Biceps brachii (origin, insertion, action, innervation)
Origin: Short head from the coracoid process; long head from the supraglenoid tubercle (both on scapula)
Insertion: Radial tuberosity
Action: Flexion at the elbow and shoulder; supination
Innervation: Musculocutaneous nerve (C5-C6)
Brachialis (origin, insertion, action, innervation)
Origin: Distal half of the anterior surface of the humerus
Insertion: Ulnar tuberosity and cornoid process
Action: flexion at the elbow
Innervation: Musculocutaneous nerve (C5-C6) and radial nerve (C7-C8)
Brachioradialis (origin, insertion, action, innervation)
Origin: Ridge superior to the lateral epicondyl of the humerus
Insertion: Lateral aspect of styloid process of radius
Action: Flexion at elbow
Innervation: Radial nerve (C6-C8)
Anconeus (origin, insertion, action, innervation)
Origin: Posterior surface of lateral epicondyl of humerus
Insertion: Lateral margin of olecranon and ulnar shaft
Action: Extension at elbow
Innervation: Radial nerve (C6-C8)
Triceps brachii (origin, insertion, action, innervation)
lateral head
long head
medial head
Origin: superior, lateral margin of humerus (lateral head); infraglenoid tubercle of scapula (long head); posterior surface of humerus, inferior to radial groove (medial head)
Insertion: olecranon of ulna (all)
Action: Extension at elbow (all), extension and adduction at shoulder (long head)
Innervation: radial nerve
Pronator quadratus (origin, insertion, action, innervation)
Origin: Anterior and medial surface of distal ulna
Insertion: anterolateral surface of distal portion of radius
Action: Pronates forearm and hand by medial rotation of radius at radioulnar joint
Innervation: Median nerve (C8 - T1)
Pronator teres (origin, insertion, action, innervation)
Origin: Medial epicondyl of humerus and cornoid process of ulna
Insertion: Middle of lateral surface of radius
Action: rotates forearm and hand by medial rotation of radius at radioulnar joint, plus flexion at elbow
Innervation: Median nerve (C6 - C7)
Supinator (origin, insertion, action, innervation)
Origin: Lateral epicondyl of humerus and ridge near radial notch of ulna
Insertion: Anterolateral surface of radius distal to the radial tuberosity
Action: Supinates forearm and hand by lateral rotation of radius at the radioulnar joint
Innervation: deep radial nerve
Flexor carpi radialis (origin, insertion, action, innervation)
Origin: medial epicondyle of humerus
Insertion: bases of second and third metacarpal bones
Action: flexion and abduction at wrist
Innervation: median nerve (C6-C7)
Flexor carpi ulnaris (origin, insertion, action, innervation)
Origin: Medial epicondyle of humerus; adjacent medial surface of olecranon and anteromedial portion of ulna
Insertion: Pisiform, hamate, and base of fifth metacarpal bone
Action: flexion and adduction at wrist
Innervation: ulnar nerve (C8 - T1)
Palmaris longus (origin, insertion, action, innervation)
Origin: Medial epicondyle of humerus
Insertion: palmar aponeurosis and flexor retinaculum
Action: Flexion at wrist
Innervation: Median nerve (C6-C7)
Extensor carpi radialis longus (origin, insertion, action, innervation)
Origin: lateral suprcondylar ridge of humerus
Insertion: base of second metacarpal bone
Action: extension and abduction at wrist
Innervation: radial nerve (C6 - C7)
Extensor carpi radialis brevis (origin, insertion, action, innervation)
Origin: Lateral epicondyl of humerus
Insertion: base of third metacarpal bone
Action: extension and abduction at wrist
Innervation: radial nerve (C6 - C7)
Extensor carpi ulnaris (origin, insertion, action, innervation)
Origin: Lateral epicondyl of humerus; adjacent dorsal surface of ulna
Insertion: base of fifth metacarpal bone
Action: extension and adduction at wrist
Innervation: deep radial nerve (C6-C8)
What muscles provide strength and crude control of the hands and fingers?
Extrinsic muscles of the hand
Do extrinsic muscles cross the wrist joint?
No, only their tendons cross the wrist joint.
What prevents friction at the tendons that pass the dorsal and ventral surfaces of the wrist?
Elongated bursae called synovial tendon sheaths.
What holds the tendons of the extrinsic muscles of the hand in place at the wrist?
Two wide bands of connective tissue called extensor retinaculum and flexor retinaculum.
What causes carpal tunnel syndrome?
Inflammation of the retinacula and tendon sheaths at the wrist which restricts movement and irritate the median nerve, a sensory and motor nerve that innervates the hand.
What muscles provide fine control of the hand?
Intrinsic muscles of the hand that originate on the carpal and metacarpal bones
What is the function of the intrinsic muscles of the hand?
1. flexion and extension of the fingers at the metacarpophalangeal joints
2. abduction and aduction fo the fingers at the metcarpophalangeal joints
3. opposition and reposition of the thumb
Do any muscles originate on the phalanges?
No. And only tendons extend across the distal joints of the fingers.
What is the opposition of the thumb?
Starting from the anatomical position, the thumb is flexed and medially rotated at the carpometacarpal joint. This movement brings the tip of the thumb in contact with the tip of any other finger.
What are the abductor extrinsic muscles of hand?
Abductor pollicis longus
What are the extensor extrinsic muscles of hand?
Extensor digitorum
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
Extensor digiti minimi
What are the flexor extrinsic muscles of hand?
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
Adductor pollicis (origin, insertion, action and innervation)
Origin: metacarpal and carpal bones
Insertion: proximal phalanx of thumb
Action: Adduction of thumb
Innervation: Ulnar nerve, deep branch (C8 - T1)
Opponens pollicis (origin, insertion, action and innervation)
Origin: Trapezium and flexor retinaculum
Insertion: First metacarpal bone
Action: Opposition of thumb
Innervation: Median nerve (C6 - C7)
Palmaris brevis (origin, insertion, action and innervation)
Origin: Palmar aponeurosis
Insertion: Skin of medial border of hand
Action: Moves skin on medial border toward midline border toward midline of palm
Innervation: Ulnar nerve, superficial branch (C8)
Abductor digiti minimi (origin, insertion, action and innervation)
Origin: pisiform
Insertion: proximal phalanx of little finger
Action: abduction of little finger and flexion at its metacarpophalangeal joint
Innervation: ulnar nerve, deep branch (C8-T1)
Abductor pollicis brevis (origin, insertion, action and innervation)
Origin: transverse carpal ligament, scaphoid and trapezium
Insertion: radial side of base of proximal phalanx of thumb
Action: abduction of thumb
Innervation: median nerve (C6 -C7)
Flexor pollicis brevis (origin, insertion, action and innervation)
Origin: flexor retinaculum, trapezium, capitate, palmar ligaments of distal row of carpal bones and ulnar side of first metacarpal
Insertion: radial and ulnar sides of proximal phalanx of thumb
Action: flexion and adduction of thumb
Innervation: Branches of median and ulnar nerve
Flexor digiti minimi brevis (origin, insertion, action and innervation)
Origin: hook of the hamate and flexor retinaculum
Insertion: proximal phalanx of little finger
Action: flexion at fifth metacarpophalangeal joint
Innervation: ulnar nerve, deep branch (C8-T1)
Opponens digiti minimi (origin, insertion, action and innervation)
Origin: hook of the hamate and flexor retinaculum
Insertion: fifth metacarpal bone
Action: flexion at metacarpophalangeal joint; brings digit into opposition with thumb
Innervation: Ulnar nerve, deep branch (C8-T1)
Lumbirical (4) (origin, insertion, action and innervation)
Origin: the four tendons of flexor digitorum profundus
Insertion: tendons of extensor digitorum to digits 2-5
Action: flexion at metacarpophalangeal joints; extension at proximal and distal interphalangeal joints
Innervation: No 1 and 2 by median nerve; no. 3 and no. 4 by ulnar nerve, deep branch
Dorsal interosseous (4) (origin, insertion, action and innervation)
Origin: each originates from oppsoing faces of two metacarpal bones (I and II, II and III, III and IV, IV and V)
Insertion: bases of proximal phalanges of digits 2-4
Action: abduction at metacarpophalangeal joints of digits 2-4; flexion at metacarpophalangeal joints; extension at interphalangeal joints
Innervation: ulnar nerve, deep branch (C8-T1)
Palmar interosseous (4) (origin, insertion, action and innervation)
Origin: sides of metacarpal bones II, IV and V
Insertion: bases of proximal phalanges of digits 2, 4 and 5
Action: adduction at metacarpophalangeal joints of digits 2, 4 and 5; flexion at metacarpophalangeal joints; extension at interphalangeal joints
Innervation: ulnar nerve, deep branch (C8-T1)
How many and what are intrinsic muscles of the hand control the thumb?
Four.

Adductor pollicis
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Name three intrinsic hand muscles that control the small finger.
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi
Major extendor of arm
Latissimus dorsi
Flexors of arm
Pectoralis major and coracobrachialis
What pectoral girdle and upper limb muscles does the musculocutaneous nerve innervate?
Coracobrachialis, biceps brachii, brachialis
What pectoral girdle and upper limb muscles does the axillary nerve innervate?
Deltoid and teres minor
What pectoral girdle and upper limb muscles does the subscapular and lower subscapular nerve innervate?
subscapularis (subscapular) and Teres major (lower subscapular nerve)
What pectoral girdle and upper limb muscles does the suprascapular nerve innervate?
Supraspinatus and infraspinatus
What pectoral girdle and upper limb muscles does the thoracodorsal nerve innervate?
Latissimus dorsi
What pectoral girdle and upper limb muscles does the pectoral and medial pectoral nerves innervate?
Pectoralis major and pectoralis minor (medial nerve)
What are the abductor extrinsic hand muscles?
Abductor pollicis longus
What are the Extensor extrinsic hand muscles?
(hint: think all, thumb, index finger and small finger)
Extensor digitorum
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
Extensor digiti minimu
What are the Flexor extrinsic hand muscles?
(hint: think all and thumb)
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
What functions do the extrinsic hand muscles and intrinsic hand muscles perform for the thumb?
What nerves innervate these muscles?
All thumb actions: abduction, adduction, extend, flex, opposition
Extrinsic: Abduct, extend, flex; deep radial and median nerves
Intrinsic: Abduct, adduct, opposition, flex; median and ulnar nerves

extend: only extrinsic
opposition and adduct: only intrinsic
hint: thumb flexors and extensors have brevis and longus; opponens, adduct and abduct do not.
What are the intrinsic hand muscles for thumb?
Adductor pollicis
Flexor pollicis brevis
Opponens pollicis
Abductor pollicis
What intrinsic hand muscles control the little finger? What nerve innervate them?
Abductor digiti minimu
Flexor digiti minimi brevis
Opponens digiti minimi

Nerve: Ulnar nerve
What intrinsic hand muscles control most fingers and what are their major functions? What nerves innervate them?
Lumbiricals; flexion at metacarpophalangeal joints
Dorsal interosseus: abduction at metacarpophalnageal joints
Palmar interosseus: adduction at metacarpophalangeal joints

All of them cause extension at interphalangeal joints
Nerves: median and ulnar nerves
Difference between Palmaris longus and palmaris brevis
Palamris longus is a muscle that moves the hand. It flexes the wrist.
Palmaris brevis is an intrinsic hand muscle that moves skin on the medial border of hand to midline of palm.
What nerves innervate the extrinsic and intrinsic hand muscles?
Extrinsic: Deep radial and median; one by ulnar nerve

Intrinsic: ulnar and median
Major adductors of arm
Pectoralis major
Latissimus dorsi
General location where flexor muscles of wrist joint originate
Medial epicondyl of humerus
General location where extensor muscles of wrist joint originate
Lateral epicondyl of humerus
What are metatarsals?
Five long bones that form the distal portion (metatarsus) of the foot.
What are carpometacarpal joints?
Five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones.
Intercondylar fossa
Depression between the medial and lateral condyles on distal end of femur, on the posterior surface.
Spine
A pointed process
Epiphysis pg. 118
Diaphysis pg. 118
Metaphysis pg. 118
Epiphysis - ends of compact bone
Diaphysis - shaft/body of compact bone
Metaphysis - narrow zone where diaphysis connects to epiphysis
Fibula
Lateral bone of leg; lateral to tibia
Entepicondylar foramen
An opening in the distal (far) end of the humerus (upper arm bone) present in some mammals
Lateral malleolus
A process at distal end of Fibula that provides stability to the ankle joint
Linea aspera
A prominent elevation that run along the center of the posterior surface of the femoral shaft.
What compartments does the deep fascia divide the arm and forearm into?
Anterior and Posterior compartments. Most muscles within a compartment are innervated by the same nerve and supplied by the same vascular element.

Deep fascia envelopes the muscles and all deeper tissue and divides each region into well defined, physically separate spaces.
What are two other divisions of the upper extremity besides anterior and posterior compartments?
Axilla (around armpit)
Cubital Fossa (in elbow area)
What nerves innervate the anterior (flexor) and posterior (extensor) compartments of the arm?
Anterior: musculocutaneous nerve (a branch of brachial plexus)
Posterior: radial nerve (a branch of brachial plexus)
What nerves innervate the anterior (flexor) and posterior (extensor) compartments of the forearm?
Anterior: median nerve (a branch of brachial plexus)
Posterior: radial nerve (a branch of brachial plexus)
What defines the anterior and posterior compartments of arm and forearm?
Arm: Deep fascia + intermuscular septa (joins deep fascia to humerus)

Forearm: Deep fascia + intemuscular septa + interosseous membrane
What forms the floor and roof of the carpal tunnel passage way?
floor: carpal bones
roof: flexor retinaculum

Carpal tunnel connects anterior forearm compartment to palm.
1. What nerves innervate the skin and subcutaneous tissue of the upper extremity?

2. What are the surface areas innervated by these nerves called?
1. Cutaneous branches of the nerves of the brachial plexus.

2. Dermatomes. Each ventral rami of the brachial plexus supplies a specific dermatome.
List arteries that supply upper extremity starting from aorta
Right extremity: Aorta -> Brachiocephalic trunk -> Subclavian artery -> Axillary artery -> Brachial Artery -> Ulnar and Radial arteries (branch from brachial artery)

Left extremity: Aorta -> Subclavian artery -> Axillary artery -> Brachial Artery -> Ulnar and Radial arteries (branch from brachial artery)

The difference between left and right upper extremity arteries is that the left subclavian artery arises directly from the aorta.
Discuss upper extremity veins
-have both deep and superficial veins.
-deep veins accompany the arteries, sharing their names and relative distribution
-one or two deep veins accompany artery but eventually there is a single axillary vein
-Axillary vein -> Subclavian vein -> Brachiocephalic vein
-superficial veins lie outside the deep facia of the compartments and are often visible through the skin
Discuss upper extremity lymphatics
There are both deep and superficial lymphatics that evential drain into either the right lymphatic duct or the thoracic duct.
Discuss upper extremity nerves
-nerve supply from brachial plexus
-ventral rami of spinal nerves C5, C6, C7, C8 and T1 come together and divide, come together, divide again yielding branches of the brachial plexus.
-Branches of brachial plexus: musculocutaneous, median, ulnar and radial nerves
What joint has the greatest range of motion of any joint in the body?
Glenohumeral joint
1. What four ligaments hold the clavicle in place?

2. What other features secure clavicle to sternum?
1. interclavicular ligament
sternoclavicular ligament
costoclavicular ligament
acromioclavicular ligament

2. intracapsular disc and fibrocartilagenous disc.
Is trauma to clavicle more likely to result in fracture or disruption of ligaments?
Fracture
Two presentation of fracture of lateral aspect of clavicle?
- inferomedial displacement of the shoulder secondary to the weight of the limb
-contraction of pectoralis major and latissimus dorsi
What kind of joint is the glenohumeral joint?
Synovial, ball and socket joint
1. What is the fibrcartilagenous ring attached along the outer margin of the glenoid fossa?

2. What happens to it in "throwers shoulder" or SLAP (Superior Labrum Anterior to Posterior) lesion injury?
1. Glenoid labrum; serves to mitigate shallow nature of glenohumeral joint.

2. labrum tears away from glenoid
What forms the coracoacromial arch?
Coracoid process and the acromion. The subacromial bursa lies with the arch superior to the supraspinatus.
What provides the bulk of stability to the shoulder?
Rotator cuff muscles and their common tendinous attachment.
What is the significance of bone markings?
Every marking provides a purpose such as muscle attachment or pathway for tendons, nerves or blood vessels.
What muscles overlies all of the main muscles that control the arm muscles?
Deltoid muscle. Is responsible for the outward smoothly contoured appearance of the shoulder.
What is the function of the muscles passing from trunk to the scapula?
Hold scapula in place and move it in relation to the trunk.
What is the most superficial posterior trunk to scapula muscle?
Trapezius

upper fibers elevate scapula
middle fibers retract scapula
lower fibers depress scapula
What three trunk to scapula muscles lie underneath the trapezius?
Levator scapulae
Rhomboid major
Rhomboid minor
What muscles define the axilla?
latissimus dorsi, teres major and subscapularis (posteriorly), pectoralis major (anteriorly), serratus anterior (medially)
What vein lies in the deltopectoral groove?
cephalic vein (a major tributary of the axillary vein)
What nerve can get damaged during dislocation of the glenohumeral joint?
Axillary nerve; damage to nerve would lead to deltoid muscle atrophy.
What is the axilla?
The space between the root of the upper limb and the chest wall. Major nerves and vessels pass through the axilla as the extend distally from the next to the upper extremity.
What is the axial bound by?
clavicle, superior border of scapula and the first rib. The floor is bound by fascia passing between anterior and posterior walls.
Where does part of the brachial plexus lie?
Axilla; rest of brachial plexus lies proximal to axilla
What are vanae comitantes?
small, often paired veins lying alongside smaller arteries, particularly in extremities.
What are the five nerve roots of the brachial plexus?
C5 - C8 and T1
How many lymph node groups in axilla?
Three.

Pectoral group (drain lateral and anterior aspects of body wall)
humeral group (drains most of upper extremity)
Subscapular group (drains posterior aspects of body wall)
What are the three nerves in anterior compartment of arm?
Median, ulnar and musculocutaneous.

Only musculocutaneous innervates the biceps brachii, brachialis and corocobrachialis.
Fundamental consideration of biomechanics
-in order for a muscle to have effect over a joint, it must cross the joint
-the closer the joint to the proximal muscular attachment, the less leverage, and therefor, the less influence it can exert over the joint e.g. biceps brachii on glenohumeral joint.
-the closer the joint to the distal muscular attachment, the greater the leverage and therefore, the greater the influence it can exert over the joint e.g. biceps brachii at elbow joint.
List the ligaments of the sternoclavicular joint
Accessory ligaments:
anterior sternoclavicular ligament
posterior sternoclavicular ligament

Extracapsular ligaments
-Interclavicular ligament
-costoclavicular ligament
Interclavicular ligament (insertions + function)
Insertions
-Interconnects the clavicles
-firmly attached to the superior border of the manubrium.

Functions:
-reinforces superior portions of the adjacent articular capsules
-prevents dislocation when shoulder is depressed
Costoclavicular ligament (insertions + function)
Insertions
-costal tuberosity of clavicle
-inferior margin of articular capsule
-superior and medial portions of the first rib and the first costal cartilages

Function: prevents dislocation of shoulder when shoulder is elevated.
Does the sternoclavicular joint have an articular disc?
Yes. The articular disc divides the sternoclavicular joint and separates two synovial cavities.
What joint permits the greatest range of motion of any joint in the body?
The shoulder joint
What is the most frequently dislocated joint?
The shoulder joint

Note: strength and stability must be sacrificed to obtain mobility
What is the glenoid labrum? What is its function?
Glenoid labrus is a ring of dense, irregular connective tissue that is attached to the margin of the glenoid cavity by fibrous cartilage.

Functions:
-enlarges joint cavity
-serves as attachment site for glenohumeral ligaments and the long head o biceps brachii muscle
Articular capsule of shoulder joint (insertion + weakness)
Extends from the scapular neck to the humerus.

Weakest at its inferior surface.
What provides most of the stability at the shoulder joint?
1. Ligaments

2. Surrounding skeletal muscles and their associated tendons.
What are the major ligaments of the shoulder joint?
1. Glenohumeral ligaments
2. Coracohumeral ligament
3. Coracoacromial ligament
4. Acromioclavicular ligament
5. Coracoclavicular ligaments
6. Transverse ligaments
Glenohumeral ligaments (insertions and function)
Insertions: shoulder joint capsule

Function: joint stabilization when humerus approaches or exceeds normal motion
Coracohumeral ligament (insertions and function)
Insertions: coracoid process and head of humerus

Function: strengthens superior part of articular capsule and helps support weight of upper limb.
Coracoacromial ligament (insertions and function)
Insertions: coracoid process and acromion, superior to joint capsule

Function: additional support to the superior surface of the capsule.
Acromioclavicular ligament (insertions and function)
Insertions: acromion to the clavicle

Functions: restricts clavicular movement at acromial end.
Describe shoulder separation
-A relatively common injury involving partial or complete dislocation of the acromioclavicular joint.
-Can result from a blow to the superior surface of the shoulder.
-the acromion is forcibly depressed, bit the clavicle is held back by strong muscles.
-can tear the inferior capsular wall and the glenoid labrum
-the ligament involved is acromioclavicular ligament
Coracoclavicular ligaments (insertions and function)
Insertions: clavicle to the coracoid process

Functions: limit the relative motion between the clavicle and scapula
Transverse humeral ligament (insertions and function)
Insertion: extends between greater and lesser tubercles

Function: holds don tend of the long head of the biceps brachii in the intertubercular groove of the humerus.
Which contribute more to shoulder joint stability: ligaments and capsular fibers or muscles?
Muscles. Do more to stabilize glenohumeral joint than ligaments and capsular fibers combined.
Bursitis
Painful inflammation of bursae that can restrict motion.
Important bursae of the shoulder joint
Subacromial and subcoracoid bursa: prevent contact between the acromion and coracoid process and the capsule.

Subdeltoid and subscapular bursa: lie between large muscles and the capsular wall.
How many joints if the elbow joint composed of?
Composed of two joints between the
(1) humerus and ulna (humeroulnar joint)
(2) the humerus and the radius (humeroradial joint)
What is the largest and strongest articulation of the elbow joint?
Humeroulnar joint
What contributes to stability at the elbow joint?
1. the bony surfaces of the humerus and ulna interlock to prevent lateral motion
2. the articular capsule is very thick
3. the capsule is reinforced by strong ligaments
Ligaments of the shoulder joint
1. Ulnar collateral ligament
2. Radial collateral ligament
3. Annular ligament
Ulnar collateral ligament (insertions and function)
Insertions: medial epicondyle of the humerus to the coronoid process of the ulna and to olecranon

Function: stabilize medial surface of joint.
Radial collateral ligament (insertions and function)
Insertions: between lateral epicondyle and annular ligament

Function: stabilizes lateral surface of the joint
Annular ligament
Insertions: Annular ligament binds the proximal radial head to the ulna.

Function: holds head of radius in place.
What are the two radioulnar joints?
1. Proximal radioulnar joint
2. Distal radioulnar joint
What is the largest muscle that causes movement a the radioulnar joints?
Biceps brachii muscles. Contraction produces flexion at the elbow and supination of the forearm.
What are the articulating surfaces of the radioulnar joints?
1. Ulnar notch of radius
2. Radial notch of ulna
3. Articular disc (piece of hyaline cartilage)
What holds together the radioulnar joints?
1. A series of radioulnar ligaments
2. Antebrachial interosseous membrane
What are the two joints that make up the elbow joint?
Radiocarpal joint and intercarpal joint
What bones are part of the radiocarpal joint?
Distal articular surface of radius and three proximal carpal bones: scaphoid, lunate, triquetrum
What major ligaments surround the wrist and stabilize the position of the individual carpal bones?
-Palmar radiocarpal ligament: connect radius to anterior surface of scaphoid, lunate and triquetrum
-Dorsal radiocarpal ligament: connects radius to posterior surface of scaphoid, lunate and triquetrum
-Ulnar collateral ligament: from styloid process of ulna to medial surface of triquetrum
-Radial Collateral ligament: from styloid process of the radius to the lateral surface of the scaphoid.
What ligaments interconnect the carpal bones and connect the distal carpal bones to the metacarpal bones.
Intercarpal ligaments and digitocarpal ligaments.
1. What type of articulation is the carpometacarpal joint of the thumb?

2. What type of articulation are the other carpometacarpal joints?
1. Saddle-type articulation.

2. Plane joints.
What are the articulations between the carpal bones called?
Intercarpal joints
1. What are the the articulations between the metacarpal bones and the proximal phalanges called?

2. What type of articulations are they?
1. Metacarpophalangeal joints.

2. Condylar joints.
1. What are the the articulations between the phalanges called?

2. What type of articulations are they?
1. Interphalangeal joints.

2. Hinge joints
Mary falls on the pals of her hand with her elbows slightly flexed. After the fall, she can't move her left arm at the elbow. If a fracture exists, what bone is most likely broken?
Ulna
Sternoclavicular (elements, type of articulation, movements)
Elements: Sternum/clavicle
Type of articulation: Planar diarthrosis (a double "plane joint," with two joint cavities separated by an articular cartilage)
Movements: Protraction/retraction, depression/elevation, slight rotation
Acromioclavicular (elements, type of articulation, movements)
Elements: Scapula/clavicle
Type of articulation: Planar diarthrosis
Movements: slight gliding movement
Glenohumeral/shoulder (elements, type of articulation, movements)
Elements: Scapula/humerus
Type of articulation: Ball-and-socket diarthrosis
Movements: Flexion/extension, adduction/abduction, circumduction, rotation
Elbow/humeroulnar and humeroradial (elements, type of articulation, movements)
Elements: Humerus/ulna and humerus/radius
Type of articulation: Hinge diarthrosis
Movements: Flexion/extension
Proximal radioulnar (elements, type of articulation, movements)
Elements: radius/ulna
Type of articulation: pivot diarthrosis
Movements: rotation
Distal radioulnar (elements, type of articulation, movements)
Elements: radius/ulna
Type of articulation: pivot diarthrosis
Movements: pronation/supination
Radiocarpal (elements, type of articulation, movements)
Elements: radius/carpal bones
Type of articulation: condylar diarthrosis
Movements: flexion/extension, adduction/abduction, circumduction, rotation
Intercarpal (elements, type of articulation, movements)
Elements: Carpal bone/carpal bone
Type of articulation: planar diarthrosis
Movements: slight gliding movement
Carpometacarpal of thumb (elements, type of articulation, movements)
Elements: carpal bone/first metacarpal bone
Type of articulation: saddle diarthrosis
Movements: flexion/extension, adduction/abduction, circumduction, opposition
Carpometacarpal (elements, type of articulation, movements)
Elements: carpal bones/metacarpal bones II-V
Type of articulation: planar diarthrosis
Movements: slight flexion/extension, adduction/abduction
Metacarpophalangeal (elements, type of articulation, movements)
Elements: metacarpal bones/phalanges
Type of articulation: condylar diarthrosis
Movements: flexion/extension, adduction/abduction, circumduction
Interphalangeal (elements, type of articulation, movements)
Elements: phalanx/phalanx
Type of articulation: hinge diarthrosis
Movements: flexion/extension