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EXSS 275L: Elbow, Wrist and Hand

Terms in this set (47)

Carpal Tunnel
- Borders: Radial (scaphoid and trapezium), Ulnar (pisiform and hook hamate), Top (flexor retinaculum)

- Contents: Flexor digitorum profundus ( 4 tendons), flexor digitorum superficialis (4 tendons), flexor pollicis longus, median nerve
Brachioradialis
ORIGIN: Supracondylar ridge of humerus

INSERTION: Styloid process of radius

ACTION: Elbow flexion; pronation from supinated position to neutral; supination from pronated position to neutral

INNERVATION: Radial nerve
Superficial Flexor/Pronators
- Pronator Teres
- Flexor carpi radialis
- Palmaris longus
- Flexor carpi ulnaris
Pronator Teres
ORIGIN: Humeral head: Medial epicondylar ridge and common flexor tendon; Ulnar head: coronoid process of ulna

INSERTION: Middle of lateral surface of radius

ACTION: Foreamr pronation; assists in elbow flexion

INNERVATION: Median Nerve
Flexor Carpi Radialis
ORIGIN: Medial epicondyle of humerus

INSERTION: Base of 2nd and 3rd metacarpal bones

ACTION: Wrist flexion, radial deviation, assist in elbow flexion

INNERVATION: Median Nerve
Palmaris Longus
ORIGIN: Medial epicondyle of humerus

INSERTION: Transverse carpal ligament and palmar aponuerosis

ACTION: Wrist flexion and assists in elbow flexion

INNERVATION: Median Nerve
Flexor Carpi Ulnaris
ORIGIN:
- Humeral Head: Medial epicondyle of humerus
- Ulnar Head: Olecranon
INSERTION: Pisiform, hamate, and 5th metacarpal

ACTION: Wrist flexion, ulnar deviation, assist in elbow flexion

INNERVATION: Ulnar Nerve
Deep flexor/ Pronator Muscles
- Flexor digitorum Superficialis
- Flexor digitorum profundus
- Flexor pollicis longus
- Pronator Quadratus
Flexor Digitorum Superficialis
ORIGIN:
- Humeral Head: Medial epicondyle of humerus
- Ulnar Head: Coronoid Process
- Radial Head: Oblique line of radius

INSERTION: Palmar surface of middle phalanx of medial 4 digits

ACTION: Flex middle phalanges (PIP) of medial 4 digits, aids in wrist and forearm flexion

INNERVATION: Median Nerve
Flexor Digitorum Profundus
ORIGIN: Medial and anterior surface of ulna and interosseus membrane

INSERTION: Base of distal phalanges of medial 4 digits

ACTION: MCP/PIP/DIP flexion; Wrist flexion

INNERVATION:
- Median Nerve (2nd and 3rd digit)
- Ulnar Nerve (4th and 5th digit)
Flexor Pollicis Longus
ORIGIN: Anterior surface of radius and interosseus membrane; Coronoid Process of ulna

INSERTION: Base of distal phalanx of the thumb

ACTION: Thumb CMC/MCP/IP joint flexion

INNERVATION: Median Nerve
Pronator Quadratus
ORIGIN: Distal 1/4 of the anterior surface of the ulna

INSERTION: Distal 1/4 of the anterior surface of the radius

ACTION: Forearm Pronation

INNERVATION: Median Nerve
Superficial Extensor/Supinators
- Extensor Carpi Radialis Longus
- Extensor Carpi Radialis Brevis
- Extensor Digitorum
- Extensor Carpi Ulnaris
Extensor Carpi Radialis Longus
ORIGIN: Lateral supracondylar ridge; lateral epicondyle

INSERTION: Dorsal surface of base of 2nd metacarpal

ACTION: Wrist extension, radial deviation, assist with elbow extension

INNERVATION: Radial Nerve
Extensor Carpi Radialis Brevis
ORIGIN: Lateral epicondyle of humerus

INSERTION: Dorsal surface of base of 3rd metacarpal

ACTION: Wrist extension, radial deviation, assist with elbow extension

INNERVATION: Radial Nerve
Extensor Digitorum
ORIGIN: Lateral epicondyle of humerus

INSERTION: Bases of middle and distal phalanges of medial 4 digits

ACTION: MCP extension of medial 4 digits, assists with wrist and elbow extension

INNERVATION: Radial Nerve
Extensor Carpi Ulnaris
ORIGIN: Lateral epicondyle of humerus

INSERTION: Medial side of base of 5th metacarpal

ACTION: Wrist extension, ulnar deviation, assist with elbow extension

INNERVATION: Radial Nerve
Deep Extensor/Supinators
- Supinator
- Abductor Pollicis Longus
- Extensor Pollicis Longus
- Extensor Pollicis Brevis
- Extensor Indicis
Supinator
ORIGIN: Lateral epicondyle of humerus; Lateral proximal ulna

INSERTION: Lateral surface of radius

ACTION: Forearm supinatior

INNERVATION: Radial Nerve
Abductor Pollicis Longus
ORIGIN: Posterior surface of ulna, interosseous membrane, middle 1/3 of posterior surface of radius

INSERTION: Radial side of the base of the metacarpal

ACTION: Thumb and wrist abduction

INNERVATION: Radial Nerve
Extensor Pollicis Brevis
ORIGIN: Posterior surface of radius, interosseous membrane

INSERTION: Base of proximal phalanx of thumb

ACTION: Extension of proximal phalanx of thumb

INNERVATION: Radial Nerve
Extensor Pollicis Longus
ORIGIN: Middle 3rd of posterior surface of ulna, interosseous membrane

INSERTION: Base of distal phalanx of thumb

ACTION: Extension of distal phalanx of thumb

INNERVATION: Radial Nerve
Extensor Indicis
ORIGIN: Distal posterior ulna; interosseous membrane

INSERTION: Dorsal surface of base of middle and distal phalanx of the index finger

ACTION: Index finger MCP extension; assists with wrist extension

INNERVATION: Radial Nerve
Muscles Innervated by the Radial Nerve
- Brachioradialis
- Extensor Carpi Radialis Longus
- Extensor Carpi Radial Brevis
- Extensor Digitorum
- Extensor Digiti Minimi
- Extensor Carpi Ulnaris
- Supinator
- Extensor Indicis
- Abductor Pollicis Longus
- Extensor Pollicis Longus
Muscles Innervated by the Median Nerve
- Pronator Teres
- Flexor Carpi Radialis
- Palmaris Longus
- Flexor Digitorum Superficialis
- Flexor Pollicis Longus
- Pronator Quadratus
- Abductor Pollicis Brevis
- Opponens Pollicis
- Flexor Pollicis Brevis
- Lumbricales (2 lateral)
Muscles Innervated by the Ulnar Nerve
- Flexor Carpi Ulnaris
- Flexor Digitorum Profundus
- Flexor Pollicis Longus
- Abductor Digiti Minimi
- Opponens Digiti Minimi
- Adductor Pollicis
- Lumbricales (2 medial)
- Dorsal Interossei
- Palmar Interossei
Thenar Eminence Muscles
- Abductor Pollicis Brevis
- Flexor Pollicis Brevis
- Opponens Pollicis
- Adductor Pollicis
Abductor Pollicis Brevis
ORIGIN: Transverse carpal ligament, scaphoid, and trapezium

INSERTION: Radial side of the base of the proximal phalanx of the thumb

ACTION: Thumb Abduction (at CMC)

INNERVATION: Median Nerve
Opponens Pollicis
ORIGIN: Transverse carpal ligament, trapezium

INSERTION: Lateral side of 1st metacarpal

ACTION: Thumb Opposition (at CMC)

INNERVATION: Median nerve
Flexor Pollicis Brevis
ORIGIN: Transverse carpal ligament, scaphoid, trapezium, 1st metacarpal

INSERTION: Base of the proximal phalanx of the thumb

ACTION: Flexes Proximal phalanx of the thumb

INNERVATION: Median Nerve
Adductor Pollicis
ORIGIN:
- Oblique head: base of 2nd and 3rd metacarpal, capitate, and trapezoid
- Transverse Head: Anterior surface of 3rd metacarpal

INSERTION: Ulnar side of the base of the proximal phalanx of the 1st metacarpal

ACTION: Thumb adduction (at CMC)

INNERVATION: Ulnar Nerve
Hypothenar Eminence Muscles
- Abductor Digiti Minimi
- Flexor Digiti Minimi Brevis
- Opponens Digiti Minimi
Abductor Digiti Minimi
ORIGIN: Pisiform bone, tendon of flexor carpi ulnaris

INSERTION: Base of proximal phalanx of 5th digit

ACTION: Abduction of 5th digit from 4th digit

INNERVATION: Ulnar Nerve
Opponens Digiti Minimi
ORIGIN: Transverse carpal ligament, hook of hamate

INSERTION: Medial border of the 5th metacarpal

ACTION: Opposition of the 5th digit

INNERVATION: Ulnar Nerve
Flexor Digiti Minimi
ORIGIN: Transverse carpal ligament, hook hamate

INSERTION: Medial border of the 5th metacarpal

ACTION: Flexion of proximal phalanx of the 5th digit

INNERVATION: Ulnar Nerve
Palmar Muscles
- Lumbricals
- Palmar Interossei
- Dorsal Introssei

- Let you ADD/ABDuct fingers
Lumbricals Action
- MCP flexion of medial 4 digits
- PIP/DIP extension of medial 4 digits
Palmar Interossei Action
- MCP adduction of 2nd, 4th, 5th digits
Dorsal Introssei
- MCP flexion
- MCP abduction
- PIP/DIP extension of 2nd, 3rd, 4th digits
Radial Nerve Injury
- Compression: transient paralysis
- Humeral Fracture
- Lesions
Humeral fracture
- Surgical neck or shaft
- Skin sensitivity testing may not represent injury
- Elbow extension may still be obtained
- Test with arm ABD
- Wrist extensors may be paralyzed, "wristdrop"
Lesions
- Different paralysis patterns
- Wristdrop - paralysis of extensor arm muscles, if lesion exists in nerve after it pierces the lateral intermuscular septum
- Complete deep branch lesions may cause inability to extend MCP joints, radial extensors can still extend wrist
- Surgical repair is difficult
Ulnar Nerve Injury
- Damage at wrist
- Damage at elbow
- Flexor digitorum profundus unaffected
- Hypothenar, interossei, ulnar two lumbricals, ADD pollicis become paralyzed
- MCP joint become hyperextended due to overpull of extensor digitorum
- Flexion of IP joints, due to overpull of flexor digitorum profundus
Damage at Wrist
- Flexor digitorum profundus unaffected
- Hypothenar, interossei, ulnar two lumbricals, ADD pollicis become paralyzed
- MCP joint become hyperextended due to overpull of extensor digitorum
- Flexion of IP joints, due to overpull of flexor digitorum profundus
- Muscle imbalance at the thumb results in ABD
- The transverse MC arch becomes flat, "ulnar claw hand"
- Sensation lost in area distal to lesion, skin dry & vasodilated
Damage at Elbow
- Less severe than wrist (unlike median nerve)
- Vulnerable behind medial epicondyle
- May become loose and dislocate from groove
- Results in possible neuritis, paralysis
- Supply to hand may be affected before flexor carpi ulnaris and flexor digitorum muscles
- When nerve supply to flexor digitorum is lost, muscle imbalance in the ulnar two fingers improves and the degree of "clawing" is reduced
Volkmann's Contracture
- Degeneration, contracture, fibrosis, and atrophy of muscle
- Results from injury to blood and nerve supply (brachial artery and median nerve)
- Usually seen in the hand
Carpal tunnel Syndrome
- Most common compression neuropathy of the wrist (compression of the median nerve as it passes through the carpal tunnel)
- Any sports related activity that involves wrist motion may be the cause
- Movements of fingers unaffected, thumb movements not seriously impaired
- Opponens pollicis action lost, OPP is attained by flexors, ABD provided by abductor pollicis longus (radial nerve)
- Fine, coordinated movements may become difficult due to a loss in proprioception
- Signs and symptoms of this compression injury are relieved by the division of the flexor retinaculum, "tunnel release"
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