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165 Cards in this Set
- Front
- Back
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cuboidal fossa |
triangular space, on anterior side of elbow superior border: imaginary line between lateral and medial epicondyle lateral border: brachialradalis medial border: pronator teres floor: supinator inside is median nerve and brachial artery |
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little league elbow |
valgus stress on medial epicondyle, ligament pulls off because epiphyseal plate has not fully formed, caused by overuse
symptoms: elbow pain, restricted ROM, locking of elbow joint |
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avulsion fraction |
overuse of throwing arm in adults, bone pulls off because ligament is stronger, have tommy john surgery |
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tommy john surgery |
drill into ulna and base of humerus, thread ligament from palmaris longus into figure 8 to function as ulnar collateral ligament |
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carrying angle |
cubitis valgus at rest 10-15 degrees in males, more in females |
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radial and ulnar collateral ligaments |
extend from medial epicondyle and lateral epicondyle to radius and ulna respectively |
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annular ligament |
wraps around head of radius, often torn in pulled elbow, important in joint strength |
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quadrate ligament |
holds head of radius to ulna, con be torn when falling on flexed elbow, restricts excessive supination |
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subcutaneous olecranon bursa |
beneath skin on olecranon, "student's elbow" inflammation due to resting on elbows |
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subtendinous olecranon bursa |
under tendon of tricep where it inserts on olecranon, bursitis can occur with repeated flexion and extension |
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bicipitoradial bursa |
under bicep tendon near radial tuberosity, repeated supination and flexion will cause bursitis, for test pronate and extend wrist |
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11 muscles on posterior side of forearm |
3 extensors of the wrist: extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis bravis 3 finger extensors: extensor digitorum, extensor digiti minimi, extensor indicis 3 movers of the thumb: extensor pollicis longus, extensor pollicis brevis, abductor pollicis brevis 2 left over: supinator, brachioradialis |
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muscles innervated by radial nerve |
triceps, brachialis, brachialradialis, extensor carpi radialis longus, anconeus |
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muscles innervated by deep branch of radial nerve |
goes through arcade of fronse through supinator, extensor carpi radialis brevis, supinator |
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muscles innervated by posterior interosseus |
after supinator on other side of tunnel ES, EDM, ECU, AbPL, EPL, EPB, EI |
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origin of brachialradialis |
proximal 2/3 of lateral supracondylar ridge of humerus |
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insertion of brachialradialis |
lateral side of base of styloid process radius |
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action of brachialradialis |
flexes the elbow |
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innervation of the brachialradialis |
radial nerve C5, C6, *C7 |
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origin of extensor carpi radialis longus |
lower 1/3 of lateral supracondylar ridge of humerus |
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insertion of extensor carpi radialis longus |
dorsal surface of base of second metacarpal (pointer) |
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action of extensor carpi radialis longus |
extends wrist and synergistically abducts hand with flexor carpi radialis |
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innervation of extensor carpi radialis longus |
radial nerve *C6, C7 |
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origin of extensor carpi radialis brevis |
lateral epicondyle of humerus and radial collateral ligament |
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insertion of extensor carpi radialis brevis |
dorsal surface of base of third metacarpal |
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action of extensor carpi radialis brevis |
extends wrist, assists in abduction of hand w/ flexor carpi radialis
primary muscle affected by tennis elbow |
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innervation of extensor carpi radialis brevis |
deep branch of radial nerve C7, C8 |
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origin of extensor carpi ulnaris |
common tendon from lateral epicondyle of humerus |
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insertion of extensor carpi ulnaris |
dorsal surface of base of 5th metacarpal |
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action of extensor carpi ulnaris |
extends the wrist and adducts the hand synergistically with flexor carpi ulnaris |
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innervation of extensor carpi ulnaris |
interosseus branch of radial nerve C6, *C7, C8 |
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origin of extensor digitorum |
common extensor tendon of lateral epicondyle of humerus |
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insertion of extensor digitorum |
splits into 4 tendons which go to lateral and dorsal surface of all phalanges of digits 2-5 |
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action of extensor digitorum |
extends fingers and wrist |
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innervation of extensor digitorum |
posterior interosseus *C7, C8 |
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expansion hood |
tendons of extensor digitorum: lateral slip goes sideways ending at DIP, medial slip goes down middle and ends at PIP, actively insufficient |
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origin of extensor digiti minimi |
common tendon from lateral epicondyle of humerus |
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insertion of extensor digiti minimi |
dorsal surface of base of proximal phalanx of 5th digit |
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action of extensor extensor digiti minimi |
extends 5th digit |
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innervation of extensor digiti minimi |
posterior interosseus *C7, C8 |
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origin of supinator |
lateral epicondyle of humerus, annular and radial collateral ligaments, superior crest of ulna |
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insertion of supinator |
lateral surface of upper 1/3 of of body of radius |
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action of supinator |
supinates |
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innervation of supinator |
deep branch of radial nerve C5, *C6
can impinge deep branch of radial nerve causing wrist drop and thumb motion problems |
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origin of extensor indicis |
interosseus membrane and posterior surface of ulna |
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insertion of extensor indicis |
ction of aon dorsal surface of proximal phalanx of index finger |
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action of extensor indicis |
extends index finger at MCP joint |
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innervation of extensor indicis |
posterior interosseous C6, C7, *C8 |
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Muscles of the Forearm |
3 wrist flexors: FCU, FCR, PL 3 Digit Flexors: FDP, FDS, FPL 3 Pronators: PQ, PT |
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borders of the snuffbox |
abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus
inside is ECRB, ECRL and radial artery |
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extensor retinaculum |
fibrous sheath that holds tendons in place, synovial sheath under to keep from wearing away - compartment 1: EPB and AbPL - compartment 3: EPL |
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de Quervain's disease |
tenosynvoistis, painful inflammation of tendons in compartments 1 that go to wrist |
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finkelstein test |
test for de Quervain's disease, thumb in fist and passively ulnar deviate, test uninvolved side first because always a bit painful |
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lateral epicondylitis |
"tennis elbow", overuse injury (grasping, extensors), most ECRB |
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tests for tennis elbow |
1. stabilize elbow, pt makes fist and resists clinician flexing 2. clinician passively extends elbow and flexes wrist while hand in fist 3. push down on middle finger |
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muscles on forearm not innervated by median nerve |
1/2 profundus, FCU |
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median nerve supplies |
all muscles on anterior forearm (except 1.5) and LOAF in hand |
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origin of pronator teres |
humeral head: just above medial epicondyle
ulnar head: medial side of coranoid process |
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insertion of pronator teres |
middle of lateral side of radius |
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action of pronator teres |
pronates, very weak elbow flexor but can prevent extension if tight |
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innervation of pronator teres |
median nerve C6, *C7 |
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origin of flexor carpi radialis |
medial epicondyle |
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insertion of flexor carpi radialis |
base of 2nd and 3rd metacarpals |
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action of flexor carpi radialis |
flexes wrist, adducts hand w/ ECRL/ECRB
DOES NOT GO THROUGH CARPAL TUNNEL |
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innervation of flexor carpi radialis |
median nerve C6, *C7 |
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origin on palmaris longus |
medial epicondyle and common flexor tendon |
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insertion of palmaris longus |
front of flexor retinaculum and apex of palmar apopneurosis |
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action of palmaris longus |
tenses palmar fascia and flexes wrist |
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innervation of palmaris longus |
median nerve C6-C8 |
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origin of flexor carpi ulnaris |
humeral head: common tendon from medial epicondyle
ulnar head: olecranon process and proximal 2/3 of posterior bordder |
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insertion of flexor carpi ulnaris |
pisiform bone, hook of hamate, base of 5th metacarpal |
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action of flexor carpi ulnaris |
flexes the wrist, abducts with ECU |
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innervation of flexor carpi ulnaris |
ulnar nerve C7, *C8
does not go through carpal tunnel, has own "guyon" tunnel |
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flexor carpi ulnaris syndrome |
impingement of ulnar nerve between the two heads of the FCU |
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origin of flexor digitorum superficialis |
horse-shoe shaped humeral head: medial epicondyle, common tendon, medial margin
radial head: anterior surface of shaft of radius |
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insertion of flexor digitorum superficialis |
divides into 4 tendons, which each divide into two slips on sides of middle phalanx of 4 fingers |
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action of flexor digitorum superficialis |
flexes CMC, MCP and PIP (mainly) also weakly flexes wrist |
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innervation of flexor digitorum superficialis |
median nerve C7, *C8, T1 |
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origin of flexor digitorum profundus |
medial and anterior surfaces of proximal 3/4 of ulna and interosseus membrane |
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insertion of flexor digitorum profundus |
divides into 4 tendons, insert on anterior surface of distal phalanges of 4 fingers (through expansion hood) |
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action of flexor digitorum profundus |
flexes DIP, PIP, MCP, CMC, assists in adduction of ring, little and index finger, assists in wrist flexino |
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innervation of flexor digitorum profundus |
ulnar nerve and interosseus branch of median nerve |
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origin of flexor pollicis longus |
middle of anterior shaft of radius, interosseus membrane and coranoid process |
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insertion of flexor pollicis longus |
palmar surface of base of the distal phalanx of thumb |
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action of flexor pollicis longus |
flexes thumb |
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innervation of flexor pollicis longus |
anterior interosseus branch of median nerve *C8, T1 |
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origin of pronator quadratus |
medial side of anterior surface of distal 1/4 of ulna |
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insertion of pronator quadratus |
lateral side of anterior surface of distal 1/2 of radiu |
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action pronator quadratus |
pronation |
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innervation of pronator quadratus |
anterior interosseus branch of median nerve *C8, T1 |
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carpal tunnel |
9 tendons in 2 groups coming from 3 muscles, FDS, FDP, FPL |
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ligament of struthers |
most people don't have but can go from medial epicondyle across humerus and impinge median nerve |
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kiloh nevin syndrome |
anterior interosseus impinged; test by making an Okay sign if they use the pads of their fingers it is positive for KNS |
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froment's syndrome |
missing ulnar nerve, cannot adduct thumb, when trying to hold paper will use tips of fingers |
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pronator teres syndrome |
can impinge median nerve, test by pronation and elbow flexion, will exacerbate symptoms |
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carpal tunnel syndrome |
impingement of median nerve, lose LOAF, cases ape hand over time (thenar atrophy, thumb in line w/ other fingers)
Phalens Test: flex wrist and push dorsal side of hands together Reverse Phalen's : prayer hands tinel's test: tap nerve |
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median nerve sights of impingement |
neck, ligament of struthers, pronator teres, carpal tunnel |
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cubital tunnel impingement |
impinges ulnar nerve, under ulnar collateral ligament, common place of inflammation, nerve can migrate out of tunnel
use Tinel's, can't ulnar deviate, can't flex DIP pinky or ring, interosseus atrophy (claw hand), pinky tingles, ring finger and LOAF okay, can't make Fromment's sign |
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Arcade of Frohse |
place of radial nerve impingement, right before supinator near radial head, afterwards is posterior interosseus (does not affect posterior interosseus at this point) |
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arteries that supply the hand |
radial (goes around back through snuffbox then back to front) and ulnar (supplies most of the front of the hand) |
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allen's test |
palpate both arteries, pump fist, hold arteries, open fist and release arteries to watch for blood reentering, repeat w/ individual arteries to see effect |
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Volkmann's iscemia contracture |
due to lack of radial and ulnar blood flow, wrist flexes, fingers extend at CMC and slight flexion at other finger joints |
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sesamoid bones |
bones within tendon of muscle, two in distal portion of first metacarpal, also may be one in distal portion of second metacarpal |
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first carpometacarpal joint |
saddle joint for thumb |
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metacarpalphalangeal joints |
condyloid joints for ab/adduction, flexion/extension or circumduction |
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palmar plate |
strong thickening of ligament to resist extension of PIP |
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deep transverse metacarpal ligatment |
on four fingers, holds heads of metacarpals bones together |
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camper's chiasm |
profundus tendon goes through superficialis tendon (makes X) |
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flexor sheath |
5 annular ligaments hold tendons to bones |
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crucifer ligaments |
"x" shaped and also hold flexor tendons to bone |
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trigger finger |
nodule develops and gets temporarily held back by crucifer ligaments until eventually popping back w/ rapid extension |
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dorsal radiocarpal ligament |
links radius with hand, strong so hand can be well controlled, mostly scaphoid and lunate on radius, allows for extension and adduction |
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triangular fibrocartilage |
connects ulna to carpals because they do not directly connect, forms wedge for shock absorption, and radial movement around ulna |
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palmar aponeurosis |
usually where palmaris longus attaches, covers floor of palm |
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Dupuytren's contracture |
shrinking of palmar aponeurosis, pulls fingers into flexion (typically ring and pinky), usually painless, can split but probably need surgery |
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Abductor pollicis brevis origin |
flexor retinaculum, tubercle of trapezium bone, tubercle of scaphoid bone
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insertion of abductor pollicis brevis |
radial side of base of proximal phalanx of thumb |
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action of abductor pollicis brevis |
abducts and assists in thumb opposition |
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innervation of abductor pollicis brevis |
recurrent branch of median nerve *C8, T1 |
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opponens pollicis origin |
flexor retinaculum and trapezium |
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insertion of opponens pollicis |
anterior surface of radial side of first metacarpal |
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action of opponens pollicis |
rotates thumb into opposition |
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innervation of opponens pollicis |
recurrent branch of median nerve C8 |
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origin of flexor pollicis brevis |
flexor retinaculum (deep head) and trapezium (superficial head) |
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insertion of flexor pollicis brevis |
radial side of base of proximal phalanx of thumb |
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action of flexor pollicis brevis |
flexes proximal phalanx of thumb |
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innevation of flexor pollicis brevis |
deep head: ulnar nerve superficial head: recurrent branch of median nerve C8 |
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origin of adductor pollicis |
oblique head: anterior surfaces of 2nd and 3rd metacarpals, capitate and trapezium
transverse head: anterior surface of 3rd metacarpal |
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insertion of adductor pollicis |
medial side of base of proximal phalanx of thumb |
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action of adductor pollicis |
adducts and flexes thumb |
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innervation of adductor pollicis |
ulnar nerve C8, T1 |
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origin of palmaris brevis |
palmar aponerosis |
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insertion of palmaris brevis |
skin of palm of hand (medial side, near hypothenar eminence) |
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action of palmaris brevis |
corrugates the skin of palm (cups hand)i |
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innervation of palmaris brevis |
ulnar nerve C8 |
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palmaris brevis sign |
cannot cup hand, suggests ulnar nerve damage |
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hypothenar eminence |
abductor digiti minimi, flexor digiti minimi, opponens digiti minimi (Test for T1 myotome) |
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Thenar eminence |
abductor pollicis brevis, flexor pollicis brevis and opponens pollicis (C8 myotome) |
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origin of lumbricals |
tendons of flexor digitorum profundus |
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insertion of lumbricals |
lateral side of corresponding tendon of extensor digitorum on digits |
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action of lumbricals |
extend PIP joint, weakly flexes MCP joint |
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innervation of lumbricals |
lateral side (unipennate): median n. C8, T1 medial side (bipennate): ulnar n. C8 T1 |
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dorsal interossei origin |
bipennate 1st: proximal 1/2 of ulnar border of 1st MC and radial border of 2nd MC
2nd-4th: adjacent sides of MC bones in each interspace |
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insertion of dorsal interossei |
1st - radial side of 2nd proximal phalanx 2rd - radial side of 3rd proximal phalanx 3rd - ulnar side of 3rd proximal phalanx 4th - ulnar side of 4th proximal phalanx |
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action of dorsal interossei |
abducts fingers toward middle finger, help the lumbricals |
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innervation of the dorsal interossei |
deep branch of ulnar nerve C8, T1 |
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palmar interossei origin |
unipennate 1st- 3rd: anterior surfaces of 2nd, 4th and 5th metacarpal bones |
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palmar interossei insertion |
1st: ulnar side of base of proximal phalanx of 2nd finger 2nd: radial side of base of proximal phalanx 4th finger 3rd: radial side of base of proximal phalanx of 5th finger |
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action of palmar interossei |
adducts fingers toward middle and weakly assists in flexion at MCP joint |
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tendon sheaths of hand |
little finger sheath connects to wrist, thumb typically has own, some people's thumb sheath connects to wrist and can communicate infection |
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ulnar artery |
supplies most of the superficial blood through superifical palmar arch |
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radial artery |
goes to back of hand through snuffbox and back to front via web space then forms deep palmar arch
little bit anastomoes and joins superifical palmar arch |
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bishops hand |
MCP of pink and ring is extended and PIP are flexed, if position is passive than ulnar nerve damage, if position happens when contracting than median nerve damage because missing lumbricals and interossei so cannot flex MCP and extend PIP |
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Swan's neck deformity |
palmar plate snaps (usually stops PIP extension), "M", DIP flexed, PIP hyperextended, also can lack flexor digitorum superificialis (no PIP flexion)
usually need surgery |
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Boutonniere's Deformity |
"W", DIP hyperextension, PIP flexion, happens when central slip of expansion hood had ruptured so lateral slip causes extension of DIP and PIP flexion, can be caused by trauma or RA, usually responds to splinting |
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Mallet finger |
distal tip of dorsal expansion hood breaks due to forced DIP flexion from extended position, responds to splinting |
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sweater/jersey finger |
make fist and one DIP won't flex, happens with an avulsion fracture of profundus tendon, often ring finger |
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gamekeeper's/skiers thumb |
sprain/lax of ulnar collateral ligament, caused by forced avulsion of repeated force to collateral ligament |
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bowler's thumb |
constant pressing on nerves along outside of thumb, causes pain and numbness |
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ulnar drift |
common in RA, fingers drift toward ulnar side at MCP joint |
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chauffer's fracture |
radial styloid breaks, caused by either forced ulnar deviation (avulsion fracture) or compressive force in radial deviation |
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Bennett's Fracture/ Boxer's fracture |
base of 1st metacarpal is shattered due to compressive loading force straight down the bone (axial loading) |
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kienbock's disease |
avascular necrosis of lunate, can also happen to the scaphoid, hand therapy doesn't work, Pt. usually thinks sprained wrist, usually caused by trauma or ideopathic |
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adison's maneuver |
Test of TOS: Ipsilateral rotation and extension of the arm and hold. Test radial pulse and if it is abnormal than there is impingmenet |
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Roos Test |
test for TOS, Abduct shoulder to 90 degrees, lateral rotation, and elbows slightly flexed in frontal plane and open and close hands |
