Upper Limb 4

Front 1

Ulna: osteology

Back 1

Proximal: coronoid process; ulnar tuberosity (attachment of brachialis); olecranon process (posterior)

Distal: head; styloid process

Front 2

Radius: osteology

Back 2

Proximal: head; radial tuberosity (attachment of biceps)

Distal: styloid process

Front 3

Osteology of hand

Back 3

5 metacarpal bones
14 phalanges (proximal, middle, distal phalanx), thumb just has proximal and distal
Scaphoid and lunate are small carpal bones that articulate with distal radius

Front 4

PIPJ

Back 4

Proximal interphalangeal joint

Front 5

DIPJ

Back 5

Distal interphalangeal joint

Front 6

Forearm

Back 6

AKA antebrachium
Bordered by cubital fossa and carpal tunnel
Anterior and posterior compartments

Front 7

Cubital fossa

Back 7

Bordered by:
Superior: imaginary line connecting medial and lateral epicondyles of humerus
Medial: Pronator teres
Lateral: Brachioradialis

Contents:
1. Tendon of biceps brachii
2. Brachial artery and terminal branches (radial and ulnar arteries)
3. Median nerve
Partially covered by bicipital aponeurosis

Front 8

Anterior compartment muscles (action)

Back 8

Flexor-pronators

Flex the digits and wrist
and pronate the hand

Innervated by median and ulnar nerves

Front 9

Posterior compartment muscles (action)

Back 9

Extensor-supinators

Extend the wrist and digits and
Supinate the hand

Innervated by radial nerves

Front 10

Interosseous membrane

Back 10

Fibrous membrane connecting ulna and radius

Attachment for muscles and compartmentalizes the forearm

Fibers travel downward from radius to ulna; transfer force from radius to ulna

Front 11

Colles' Fracture

Back 11

Distal radial fractures

Breaking a fall (extending the wrist)

"Dinner fork deformity"

Front 12

Antebrachial fascia

Back 12

Deep fascia of forearm
Posterior aspect of wrist: extensor retinaculum
Anterior aspect of wrist: palmar carpal ligament, flexor retinaculum

Thickenings of fascia prevent bowstringing

Front 13

Flexor retinaculum

Back 13

Thickening of antebrachial fascia on anterior side

Front 14

Extensor retinaculum

Back 14

Thickening of antebrachial fascia on posterior side of wrist

Front 15

Palmar carpal ligament

Back 15

Thickening of antebrachial fascia holding ligaments on anterior surface of wrist

Front 16

Superficial muscles of forearm

Back 16

1. Pronator teres
2. Flexor carpi radialis
3. Palmar longus
4. Flexor carpi ulnaris
5. Flexor digitorum superficialis

(Brachioradialis considered posterior)

Common origin on medial epicondyle
All innervated by median nerve except flexor carpi ulnaris, which is innervated by the ulnar nerve

Front 17

Deep muscles of the forearm

Back 17

1. Flexor digitorum profundus
2. Pronator quadratus
3. Flexor pollicis longus

Innervated by anterior interosseous nerve (branch of median nerve) except medial half of the FDP, which is innrevated by the ulnar nerve

Front 18

Pronators and mechanism

Back 18

1. Pronator teres (superficial)
2. Pronator quadratus (deep)

Pronator quadratus initiates pronation of the forearm at radioulnar joints, pulls distal radius over the ulna

Pronator teres assists quadratus when more speed/power are required

Front 19

Flexor digitorum superficialis

Back 19

"Intermediate" between superficial and deep groups (but part of superficial group)

Heads of origin: humeroulnar and radial

Gives rise to four tendons which pass beneath flexor retinaculum

Inserts in middle phalanx digits 2-5 and flexes at at PIPJ

Innervated by median nerve

Front 20

Flexor digitorum profundus

Back 20

Originates from anterior surface of ulna and interosseous membrane

Divides into four tendons which pass beneath flexor retinaculum and insert in base of distal phalanx of digits 2-5 (passes through split tendons of FDS)

Innervated more laterally by anterior interosseous nerve (branch of median nerve) and more medially by ulnar nerve

Front 21

Functional groups of the extensors

Back 21

1. Extensors of the wrist
2. Extensors of the digits
3. Extensors/abductors of the thumb

All innervated by radial nerve or its branches

Many originate on lateral epicondyle

Front 22

Extensors of the wrist

Back 22

1. Extensor carpi radialis longus
2. Extensor carpi radialis brevis
3. Extensor carpi ulnaris

Arise from extensor tendon and insert on metacarpal bases

Extend and stabilize the wrist

Front 23

Extensors of the digits

Back 23

1. Extensor digitorum
2. Extensor indicis (deeper muscle belly)- two long tendons
3. Extensor digiti minimi

Front 24

Extensor expansion

Back 24

AKA "hood"
Extensor tendons divide into central band which insert in middle phalanx
Two lateral bands insert in distal phalanx
Small intrinsic hand muscles merge to form "extensor hood" on dorsum of fingers

Front 25

Extensors/abductors of the thumb

Back 25

Deeper in the forearm, AKA "outcropping muscles"

1. Abductor pollicis longus (most lateral)
2. Extensor pollicis brevis
3. Extensor pollicis longus

Assist with intricate and precise movements of the thumbs

Front 26

Extensor tendons

Back 26

Secured at the wrist by the extensor retinaculum- thickening of the antebrachial fascia

Compartmentalized into fibro-osseous tunnels within retinaculum; surrounded by synovial sheaths that aid in movement

Front 27

Ganglion/synovial cyst

Back 27

Thin walled cyst containing mucinous/synovial fluid on dorsum of wrist

AKA "bible cysts"

Commonly found in extensor carpi radialis longus/brevis

Can cause pain and nerve compression

Front 28

Anatomical snuff box

Back 28

Bounded by the three posterior pollicis muscles:
1. Abductor pollicis longus
2. Extensor pollicis longus
3. Extensor pollicis brevis

Radial artery passes through; scaphoid bone and styloid process of radius can be palpated

Front 29

Brachioradialis

Back 29

Flexor of the forearm but considered in the posterior compartment because innervated by radial nerve

Front 30

Supinator

Back 30

Supinates forearm and hand

Unique appearance; inserts in proximal radius

Innervated by deep radial nerve

Front 31

De Quervian's Tenosynovitis

Back 31

Inflammation of tendons and synovial sheaths of extensor pollicis brevis and abductor pollicis longus

Often seen in mothers picking up children a lot

Pain on movement of thumb and anatomical snuff box

Treatment: brace, anti-inflammatories, sometimes steroidal injection

Front 32

Radial nerve

Back 32

Leaves posterior compartment by crossing anterior to lateral epicondyle

Divides into superficial branch (cutaneous/sensory to hand) and deep branch (motor)

Front 33

Superficial branch of radial nerve

Back 33

Runs under brachioradialis and supplies sensation to the thumb and hand

Front 34

Deep branch of radial nerve

Back 34

Pierces supinator and enters extensor compartment where continues as posterior interosseus nerve, innervating many of forearm extensors

Front 35

Ulnar nerve

Back 35

Passes posterior to medial epicondyle (common impingement)

Innervates flexor carpi ulnaris, half of the flexor digitorum profundus and the majority of intrinsic muscles of the hand

Cutaneous branches that supply the skin and medial aspect of the hand

Passes through "canal of Guyon" at wrist (common impingement) to innervate hand

Front 36

Median nerve

Back 36

Principle innervator of the flexors (anterior compartment) of the forearm

Passes between flexor digitorum superficialis and profundus

Muscular branches and anterior interosseous nerve innervate forearm (except for 1.5)

Passes beneath flexor retinaculum and enters hand

Small cutaneous palmar branch courses superficially to retinaculum and supplies the skin on the lateral palm

Front 37

Ulnar artery

Back 37

Branch of brachial artery (larger of the two branches)

Courses through anterior compartment alongside ulnar nerve to the hand

Main branches: anterior and posterior interosseus arteries

Front 38

Radial artery

Back 38

Smaller of the two brachial artery branches

Courses beneath the brachioradialis then enters anatomical snuff box

Front 39

Elbow joint

Back 39

Hinge-type synovial joint
Movements are flexion and extension

Trochlea and capitulum of humerus articulate with trochlear notch and head of radius

Surrounded by articular capsule lined with synovial membrane; radial and ulnar collateral ligaments; annular ligament of the radius

Front 40

Ligaments of the elbow joint

Back 40

Radial and ulnar collateral ligaments- provide strength to the joint

Radial collateral blends with: annular ligament of the radius

Front 41

Proximal radioulnar joint

Back 41

Pivot-type synovial joint between head of the radius and ulna

Annular ligament forms a collar around the head of the radius, lined with synovial membrane

Front 42

Annular ligament

Back 42

Elbow ligament

Forms collar around head of the radius

Lined with synovial membrane, allowing rotation of radius (supination and pronation)

Front 43

Nursemaid's Elbow

Back 43

Dislocation of the radial head in toddlers aged 1-4 due to pulling or lifting a child by the arm

Subluxation out of annular ligament

Front 44

Radiocarpal (wrist) joint

Back 44

Condyloid-type synovial joint

Distal radius articulates with scaphoid and lunate (triquetrum in severe adduction)

Radial and ulnar collateral ligaments help strengthen and stabilize the joint

Palmar intercarpal ligament

Front 45

Metacarpophalyngeal joints (MCP)

Back 45

Condyloid type synovial joints

Palmar ligament (palmar plates) strengthen the anterior aspect of the joint

Deep transverse metacarpal ligament spans the heads and holds knuckles in place

Front 46

Game Keeper's thumb

Back 46

Rupture of the ulnar collateral ligament of the thumb, often associated with fracture of the base of the proximal phalanx of the thumb

AKA "Skier's Thumb"

Front 47

Radial nerve "BEST"

Back 47

Innervates "BEST"
Brachioradialis
Extensors
Supinators
Triceps