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110 Cards in this Set
- Front
- Back
+ Distal Humerus Text
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Distal Humerus
a. Radial (spiral) groove • “groove” for radial nerve as it travels posterior to humerus b. Trochlea c. Capitulum d. Three fossa of the distal humerus • Olecranon fossa – posterior surface • Coronoid fossa – anterior surface • Radial fossa – anterior surface e. Medial epicondyle • Attachment site for flexor muscles of the forearm f. Lateral epicondyle • Attachment site for extensor muscles of the forearm |
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+ Ulna Text
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Ulna
a. Stabilizing bone of the forearm b. Articulations • Humeroulnar joint – articulation between trochlea of the humerus and trochlear notch of ulna • Proximal and distal radioulnar joints c. Landmarks of ulna • olecranon (i) attachment for triceps tendon • coronoid process (i) attachment sites for brachialis • trochlear notch • ulnar tuberosity (i) just inferior to coronoid process • radial notch of the ulna (i) allows head of radius to articulate with ulna • head of ulna (i) distal end of ulna • ulnar styloid process (i) distal end of ulna |
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+ Radius Text
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Radius
a. Shorter than ulna, lateral to ulna b. Articulations • Humeroradial jt – articulation between capitulum of the humerus and radial head • Proximal and distal radioulnar joints • Radiocarpal joint c. Landmarks • Radial head (i) Articulates with capitulum of humerus and radial notch of ulna (ii) Annular ligament stabilizes radial head • Neck of the radius • Radial tuberosity (i) Separate the head/neck from the body of the radius • Body of the radius • Ulnar notch of the radius (i) distal end of radius (ii) articulates with head of ulna • Radial styloid process (i) distal end of radius • Dorasl tubercle of radius (i) distal end of radius |
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+ Carpal Bones Text
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Carpal bones
1. eight carpal bones arranged in two rows of four 2. Proximal Row (lateral to medial) a. Scaphoid b. Lunate c. Triquetrium d. Pisiform 3. Distal Row (lateral to medial) a. Trapezium b. Trapezoid c. Capitate d. Hamate |
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+ Metacarpals Text
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Metacarpals
1. Base a. proximal end b. forms CMC (carpometacarpal) joint by articulation with carpals 2. Head a. distal end, forms “knuckles” of hand b. Forms MCP (metacarpal-phalangeal) joint by articulating with phalanges |
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+ Phalanges Text
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Phalanges
1. proximal, middle and distal (except thumb…proximal and distal only) 2. numbered lateral to medial a. thumb = 1st digit b. index finger = 2nd digit c. middle finger = 3rd digit d. ring finger = 4th digit e. “pinky” finger = 5th digit 3. articulations a. MCP (metacarpal-phalangeal joint) b. PIP (proximal interphalangeal joint) c. DIP (distal interphalangeal joint) |
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+ Text
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Cubital Fossa
A. Triangular hollow area – anterior elbow B. Boundaries 1. superior: line between medial and lateral epicondyles 2. medial: pronator teres 3. lateral: brachioradialis 4. roof: fascia reinforced by bicipital aponeurosis |
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+ Forearm Compartment Text
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Forearm
Anterior and posterior compartments 1. Technically not “pure” anterior/posterior divisions 2. Anteromedial compartment a. “Flexors and pronators” b. Most muscles supplied by median nerve c. 1 ½ supplied by ulnar nerve 3. Posterolateral compartment a. “extensors and supinators” b. All muscles supplied by radial nerve 4. Division between the two forearm compartments a. Interosseous membrane between the radial and ulna bones b. Subcutaneous border of the ulna • Palpate the length of the ulna c. Radial artery • Palpate the pulse along the full length of the radial artery |
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Anteromedial Compartment Hierarchy
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Anteromedial compartment of the forearm
a. In general these muscles flex the wrist/digits of the hand and pronate the forearm b. All of these are innervated by the median nerve (or it’s interosseous branch) EXCEPT 1½ muscles. c. Superficial group (Netter plate 429) • Pronator teres • Flexor carpi radialis • Palmaris longus • Flexor carpi ulnaris d. Intermediate layer (Netter plate 430) • Flexor digitorum superficialis (FDS) – often grouped with “superficial” layer • NOTE: the superficial and intermediate groups have full or partial attachment to the common flexor tendon at the medial epicondyle of humerus e. Deep group (Netter plate 431) • Flexor digitorum profundus • Flexor pollicis longus • Pronator quadratus |
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Pronator teres
• Proximal attachments (i) Medial epicondyle of humerus and coronoid process of ulna • Distal attachments (i) Middle of lateral surface of the radius • Median nerve • Pronates and flexes forearm • Misc. (i) Median nerve passes between two heads of pronator teres (ii) Medial border of cubital fossa |
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Flexor carpi radialis (FCR)
• Proximal attachments (i) Medial epicondyle of humerus • Distal attachments (i) Base of 2nd metacarpal • Median nerve • Flexes and abduct the hand • Misc. (i) Radial artery lies just lateral to the FCR tendon at the wrist (ii) Palpate “easily” if flex the wrist (iii) Median nerve located medial to FCR tendon at the wrist |
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Palmaris longus
• Proximal attachments (i) Medial epicondyle of humerus • Distal attachments (i) Distal half of the flexor retinaculum and palmer aponeurosis • Median nerve • Flexes hand and “tightens” palmer aponeurosis • Misc. (i) Absent in 10 – 20% of the population (ii) Palpate the tendon…flex wrsit and “pinch” thumb and little finger together…easily seen and palpated (iii) Median nerve located lateral to palmaris longus tendon at the wrist |
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Flexor carpi ulnaris
• Proximal attachments…two heads (i) Humeral head: medial epicondyle of humerus (ii) Ulnar head: olecranon process and posterior border of ulna • Distal attachments (i) Pisiform, hook of the hamate and the base of the 5th metacarpal bone • Ulnar nerve • Flexes and adducts the hand • Misc. (i) Ulnar nerve passes between two heads of flexor carpi ulnaris (ii) Ulnar nerve and artery just lateral to the FCU tendon at the wrist (iii) Palpate…place forearm on flat surface…flex and adduct the hand..tendon is not as easily palpated as FCR and PL |
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Flexor Digitorum Superficialis (FDS)
• Proximal attachments – two heads (i) Humeroulnar head: Medial epicondyle of humerus and coronoid process of ulna (ii) Radial head: superior half of anterior border of radius • Distal attachments (i) Bodies of middle phalanges of medial four digits (2-5) • Median nerve • Flexes PIP joint of medial four digits (2-5)…will also assist with flexion of hand and of MCP joint • Misc. (i) Largest muscle of superficial group (ii) Median nerve and ulnar artery pass between the two heads of the FDS (iii) Four tendons enclosed at the wrist in common flexor synovial sheath |
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Flexor Digitorum Profundus (FDP)
• Proximal attachments (i) Proximal ¾ of medial and anterior surfaces of the ulna and interosseous membrane • Distal attachments (i) Bases of distal phalanges of medial four digits (2-5) • *Two nerves innervate the FDP*** (i) Median nerve (AIN - anterior interosseous nerve) – lateral portion (ii) Ulnar nerve – medial portion • Flexes DIP joint of medial four digits (2-5)…will also assist with flexion of hand • Misc. (i) “curls the fingers” as it flexes DIP after PIP joint is flexed, helps make a “fist” (ii) Four tendons enclosed at the wrist in common flexor synovial sheath |
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FDP tendons
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Flexor pollicis longus (FPL)
• Proximal attachments (i) Anterior surface of the radius and interosseous membrane • Distal attachments (i) Base of the distal phalanx of the thumb • Median nerve…AIN (anterior interosseous nerve) • Flexes phalanges of the thumb (1st digit) • Misc. (i) MMT – stabilize proximal phalange and flex distal phalange against resistance |
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Pronator Quadratus
• Proximal attachments (i) Distal ¼ of anterior surface of the ulna • Distal attachments (i) Distal ¼ of anterior surface of the radius • Median nerve…AIN (anterior interosseous nerve) • Pronates forearm…also help stabilize radius and ulna • Misc. (i) Cannot be palapated (ii) MMT – test with the patient’s elbow flexed, this will shorten the pronator teres and help “isolate” the pronator quadratus |
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Posteolateral Compartment of the Forearm Hierarchy
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Posterolateral compartment of the forearm
a. In general these muscles extend the wrist/digits of the hand and supinate the forearm…in addition the brachioradialis flexes the forearm b. All muscles are innervated by the radial nerve • Brachioradialis (flexes forearm) • Supinator (supinates forearm) • Remaining muscles can be divided into three functional groups… (i) Muscles that extend and abduct/adduct the hand 1. Extensor carpi radialis longus…(ext & ABduct) 2. Extensor carpi radialis brevis…(ext & ABduct) 3. Extensor carpi ulnaris…(ext & ADduct) (ii) Muscles that extend the medial 4 digits (2-5) 1. Extensor digitorum 2. Extensor indices 3. Extensor digiti minimi (iii) Muscles that extend or abduct the thumb 1. Abductor pollicis longus 2. Extensor pollicis brevis 3. Extensor pollicis longus |
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Brachioradialis
• Proximal attachments (i) Proximal 2/3 of lateral supracondylar ridge of humerus • Distal attachments (i) Lateral surface of distal radius • Radial nerve • Flexes forearm • Misc. (i) “Exception” to posterior muscles…it is a flexor (ii) Lateral border of cubital fossa (iii) Tendon – C6 DTR |
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Supinator
• Proximal attachments (i) Lateral epicondyle of humerus, supinator fossa, crest of ulna • Distal attachments (i) Lateral, posterior and anterior surface of proximal 1/3 of the radius • Deep branch of radial nerve • Supinates forearm |
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Extensor carpi radialis longus
• Proximal attachments (i) Lateral supracondylar ridge of humerus • Distal attachments (i) Base of 2nd metacarpal • Radial nerve • Extend and abduct hand |
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Extensor carpi radialis brevis
• Proximal attachments (i) Lateral epicondyle of humerus • Distal attachments (i) Base of 3rd metacarpal • Deep branch of radial nerve • Extend and abduct hand |
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Extensor carpi ulnaris
• Proximal attachments (i) Lateral epicondyle of humerus and posterior border of the ulna • Distal attachments (i) Base of 5th metacarpal • PIN (posterior interosseous nerve) – branch of radial nerve • Extend and adduct hand |
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Extensor digitorum
• Proximal attachments (i) Lateral epicondyle of the humerus • Distal attachments (i) Extensor expansion of medial four digits (2-5) • PIN (posterior interosseous nerve) – branch of radial nerve • Extend medial four digits (2-5), assist in wrist extension |
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Extensor indices
• Proximal attachments (i) Posterior surface of the ulna and interosseous membrane • Distal attachments (i) Extensor expansion of second digit • PIN (posterior interosseous nerve) – branch of radial nerve • Extend 2nd digit |
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Extensor digiti minimi
• Proximal attachments (i) Lateral epicondyle of the humerus • Distal attachments (i) Extensor expansion of 5th digit • PIN (posterior interosseous nerve) – branch of radial nerve • Extends 5th digit |
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Abductor pollicis longus
• Proximal attachments (i) Posterior surface of ulna, radius and interosseous membrane • Distal attachments (i) Base of 1st metacarpal • PIN (posterior interosseous nerve) – branch of radial nerve • Abducts the thumb |
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Extensor pollicis brevis
• Proximal attachments (i) Posterior surface of radius and interosseous membrane • Distal attachments (i) Base of proximal phalanx of the thumb • PIN (posterior interosseous nerve) – branch of radial nerve • Extends proximal phalanx of thumb (at the CMC joint - carpometacarpal jt) |
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Extensor pollicis longus
• Proximal attachments (i) Posterior surface of the middle 1/3 of the ulna and the interosseous membrane • Distal attachments (i) Base of distal phalanx of thumb • PIN (posterior interosseous nerve) – branch of radial nerve • Extends distal phalanx of the thumb (at the interphalangeal joint.) |
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Ulnar Artery
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Ulnar artery
1. Two recurrent branches from the ulnar artery supply the elbow 2. Common interosseous artery branches off from the ulnar artery in the cubital fossa 3. The common interosseous then divides into anterior and posterior interosseous arteries a. The anterior interosseous artery • descends along anteriorly interosseous membrane • at the pronator quadratus it pierces the interosseous membrane and descends posteriorly to the wrist b. The posterior interosseous artery • pierces the interosseous membrane and descends posteriorly to the wrist 4. the ulnar artery continues to descend to the wrist where it will form anastomoses at the wrist and hand with the radial artery |
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Radial Artery
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Radial artery
1. descends deep to the brachioradialis…pulse can be palpated along the length of the artery 2. recurrent branch from the radial artery supplies the elbow 3. the radial artery descends to the wrist where it will form anastomoses at the hand and wrist with branches of the ulnar artery |
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Pathway of Median Nerve
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Pathway of Median nerve
1. enters forearm (cubital fossa) with the brachial artery 2. descends between the two heads of the pronator teres 3. gives off an branch called AIN (anterior interosseous nerve) 4. median nerve continues to descend between the FDS (flexor digitorum superficialis) and FDP (flexor digitorum profundus) 5. at the wrist…the median can be located between flexor carpi radialis and palmaris longus 6. Median nerve supplies the following muscles… a. Pronator teres b. FDS (Flexor digitorum superficialis) c. Palmaris longus d. Flexor carpi radialis e. Thenar muscles • Abductor pollicus brevis • Opponens pollicis • Flexor pollicis 7. AIN of the median nerve supplies the following muscles… a. FDP (flexor digitorum profundus) b. FPL (flexor pollicis longus) c. Pronator quadratus |
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Pathway of Ulnar Nerve
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Pathway of Ulnar nerve
1. passes posterior to medial epicondyle 2. enters forearm between two heads of flexor carpi ulnaris…”cubital tunnel” 3. descends between FCU and FDP 4. at wrist the ulnar nerve passes anterior to flexor retinaculum…(will discuss details in wrist/hand lecture) 5. the ulnar nerve supplies the following muscles… a. Flexor carpi ulnaris (FCU) b. Medial ½ flexor digitorum profundus (FDP) c. Muscles of the hand • Hypothenar muscles (i) Abductor digiti minimi (ii) Flexor digiti minimi (iii) Opponens digiti minimi • Interosseous muscles • 3rd and 4th lumbrical muscles • adductor pollicis • flexor pollicis |
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Pathway of Radial Nerve
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Pathway of Radial nerve
1. Enters forearm anterior to the lateral epicondyle 2. travels between brachialis and brachioradialis in the cubital fossa 3. divides into deep and superficial branches of radial nerve a. deep branch of radial nerve • pierces the supinator • wraps posteriorly around radius • continues as PIN (posterior interosseous nerve) b. superficial branch • continues to descend deep to brachioradialis • enters the hand to supply the skin of the lateral hand 4. Radial nerve supplies the following muscles • Triceps • Anconeous • Brachioradialis • Extensor carpi radialis longus • Deep branch of radial nerve supplies… (i) Extensor carpi radialis brevis (ii) Supinator • PIN (posterior interosseous nerve) supplies… (i) Extensor carpi ulnaris (ii) Muscles of digits 1. Extensor digitorum 2. Extensor indices 3. Extensor digiti minimi (iii) Extensor muscles of the thumb 1. Abductor pollicis longus 2. Extensor pollicis brevis 3. Extensor pollicis longus |
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Radial Nerve
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Elbow Joint
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Elbow joint
A. Bony articulations 4. trochlea of humerus articulates with trochlear notch of ulna 5. capitulum of humerus articulates with head of the radius B. Ligaments of elbow joint 4. radial collateral (lateral) a. lateral epicondyle to annular ligament surrounding head of humerus 5. ulnar collateral (medial) a. medial epicondyle to cornoid process and olecranon • three bands….anterior, posterior and oblique C. Carrying angle of the elbow 4. male – 10 –15º 5. female > 15º D. Bursae of elbow joint |
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Proximal and Distal Radioulnar Joints
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5. Two other joints of the forearm…proximal and distal radioulnar joints
A. These joints allow supination and pronation (remember the radius “rotates” around the ulna during these motions) 4. Muscles of pronation = pronator teres, pronator quadratus 5. Muscles of supination = supinator, biceps brachii (if resistance) Proximal radioulnar joint 4. Head of radius articulates with radial notch of the ulna 5. Annular ligament stabilizes radial head but “ring-like” allows rotation of radius during pronation/supination 6. Sacciform recess is a continuation of synovial joint capsule of elbow joint a. The sacciform recess is located between the annular ligament and the radial head C. Distal radioulnar joint 4. Head of ulna articulates with ulnar notch of the radius 5. Radius rotates around “fixed” ulna during pronation/supination 6. TFCC (triangular fibrocartilagenous complex) a. TFCC attaches to base of radius and styloid process of ulna b. acts as a pivot during pronation and supination c. acts as articular disc |
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Olecranon Bursa
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TFCC
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Anatomical Snuff Box
A. Triangular space along the lateral wrist B. Borders 4. abductor pollicis longus & extensor pollicis brevis tendons 5. extensor pollicis longus tendon C. Contains radial artery as it passes to the hand to form the deep palmer arch |
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+ Wrist Joint Text
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Wrist Joint
A. Articulations 4. distal radius and carpal bones 5. TFCC (see above) and the carpal bones B. Ligaments 4. medial (ulnar) and lateral (radial) collateral ligaments |
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Extensor retinaculum
4. contain extensor tendons as they pass across the posterior wrist 5. extensor tendons enclosed by extensor synovial sheaths 6. extensor tendons pass through wrist in “6” compartments (plate 427 Netter) |
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Palmer carpal ligament
4. anterior “continuation” of extensor retinaculum |
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Flexor retinaculum (Transverse Carpal Ligament)
4. forms “roof” of the carpal tunnel 5. clinical consideration a. ulnar nerve passes superficial and median nerve is deep to the flexor retinaculum |
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Palmer aponeurosis
4. apex (proximal) – continuous with flexor retinaculum and palmaris longus tendon |
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Thenar compartment
abductor pollicis brevis a. median nerve (recurrent branch) b. abducts thumb, assists with opposition flexor pollicis brevis a. median nerve (recurrent branch) b. flexes thumb opponens pollicis a. median nerve (recurrent branch) b. opposes thumb Adductor compartment 4. adductor pollicis a. two heads…oblique and transverse b. ulnar nerve*** • clinical importance when DDx between ulnar and median nerve injury c. adducts thumb toward midline of the hand Hypothenar compartment abductor digiti minimi a. ulnar nerve b. abduction of 5th digit flexor digiti minimi brevis a. ulnar nerve b. flexion of 5th digit opponens digiti minimi a. ulnar nerve b. opposition of the 5th digit |
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Adductor Pollicis
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lumbricals
a. flex MCP jt and extend IP joints b. proximal attachments: along tendons of FDP (flexor digitorum profundus) and c. distal attachments: into the extensor expansion hood of digits 2-5 d. 1 and 2 (unipennate muscles) • median nerve e. 3 & 4 (bipennate muscles) • ulnar nerve |
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Interossei muscles (located between the metacarpals)
4. all are innervated by the ulnar nerve 5. four dorsal interossei a. ABduct the digits with the midline of the hand 6. three palmer interossei a. ADduct the digits with the midline of the hand 7. so remember… a. DAB – dorsal abduct digits b. PAD – palmer adduct digits |
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Extensor expansions (aka dorsal hood or dorsal expansion) of the digits (p 743-745 of Moore)
A. Extensor tendons (ED, EDM, EI) flatten to form extensor expansions B. This aponeurosis type hood wraps around each of the digits 2-5 C. The lumbricals and interossei attach into the lateral band of the hood |
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Palmaris brevis
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4. located in subcutaneous tissue of hypothenar region (it is NOT in the hypothenar compartment)
5. “wrinkle” skin of the hypothenar eminence and deepens the hollow of the palm |
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Common Flexor Synovial Sheath
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4. FDS and FDP are contained by the common flexor synovial sheath
5. pass deep to the flexor retinaculum in the carpal tunnel |
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Digital Synovial Sheaths
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“protect” the long finger tendons as they pass through the digital “pulleys” (fibrous digital sheath)
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Fibrous Digital Sheath
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enclose the synovial sheaths, superficial and deep flexor tendons and tendon of flexor pollicis longus
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Carpal Tunnel
A. Borders 4. anterior: flexor retinaculum (transverse carpal ligament) 5. posterior: carpal bones 6. medial and lateral walls: carpal bones B. Contains… 4. median nerve 5. FDS tendons 6. FDP tendons 7. FPL tendon C. FDS and FDP tendons are enclosed in common flexor synovial sheath D. FPL has it’s own synovial sheath |
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Guyon’s Canal
A. Tunnel formed between the pisiform and the hook of the hamate B. The ulnar nerve passes through Guyon’s Canal….potential site for ulnar nerve injury |
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Median Nerve Pathway in the Hand
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Median nerve
4. prior to entering the carpal tunnel the median nerve sends of a palmer branch that supplies the lateral portion of the palm (passes superficial to the flexor retinaculum) 5. the median continues on and passes deep to the flexor retinaculum 6. it then gives off a muscular branch (recurrent branch) to supply the thenar muscles 7. after the recurrent branch the median nerve continues on to supply… a. the lumbricals b. palmer surface of digits 1 - 3½ (thumb, index, middle and half of the ring finger) c. dorsal surface of the distal digits 1 -3½ (thumb, index, middle and half of the ring fingers) |
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Ulnar Nerve Pathway in Hand
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Ulnar nerve
4. emerges from forearm deep to the flexor carpi ulnaris tendon 5. in the forearm the ulnar nerve gives off two cutaneous branches a. dorsal cutaneous branch • supplies medial half of the dorsum of the hand b. palmer cutaneous branch • supplies medial palm 6. The ulnar nerve passes through Guyon’s Canal and divides into two branches a. superficial branch…supplies skin of the medial 1½ digits (little finger and half of the ring finger) b. deep branch supplies • hypothenar muscle • medial two lumbricals • adductor pollicis *** important clinically as noted above • all of the interossei 7. ulnar nerve is critical for “fine” movement of hand |
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Radial Nerve Pathway in the Hand
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A. Radial Nerve
4. Radial nerve does not supply any hand muscles a. Superficial branch of radial nerve supplies the lateral half of the dorsum of the hand… • EXCEPT the distal portion of digits 1 -3½ (thumb, index, middle and half of the ring fingers) |
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Ulnar Artery in Hand
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Ulnar artery
4. common interosseous artery divides into anterior and posterior interosseous arteries a. each supplies the deep forearm b. the anterior interosseous artery contributes to both the dorsal and palmer carpal arches (p 723…fig 6.11) c. the posterior interosseous artery contributes to the dorsal carpal arch (p 723…fig 6.11) 5. enters the hand superficial to the flexor retinaculum 6. divides into superficial palmer arch and deep palmer arch |
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Radial Artery in Hand
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Radial artery
4. divides into superficial and deep palmer arch 5. radial nerve passes dorsal to the wrist/thumb as it forms the deep palmer arch Deep and superficial palmer arches 4. each supplies the digits of the hand of the deep palmer arch |
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Median Nerve
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Ulnar Nerve
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Radial Nerve
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Superficial and Deep Arches
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Random Slide with no outline
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