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Exam #1 Upper Extremity

Terms in this set (97)

Radial groove contains
radial nerve& deep artery of the arm
Origin
more fixed and (usually) proximal
Insertion
more moveable, (usually) distal
Tendons
fibrous bands of dense tissue that attach muscles to bones (or muscles to muscles)
Pectoralis Major
O-clavicle, sternum, and upper 6 costal cartilage
I-lateral lip of inter-tubercular groove of humerus
N-medial and lateral pectoral nerves
A-adducts and medially rotates humerus; clavicular fibers flex humerus
Pectoralis Minor
O-3rd, 4th, and 5th ribs
I-coracoid process of scapula
N-medial pectoral nerve
A-stabilizes scapula by drawing it inferiorly and anteriorly
Subclavius
O-junction of 1strib and cartilage
I-inferior surface of clavicle
N-nerve to subclavius
A-not much -depresses and anchors the clavicle
Serratus Anterior
O-first 8 ribs
I-medial border of scapula
N-long thoracic nerve
A-draws scapula forward around thoracic wall; rotates glenoid fossa of scapula superiorly
Trapezius
O-external occipital protuberance, superior nuchal line, spinous processes of C7-T12
I-lateral 1/3 of clavicle, acromion, and spine of scapula
N-spinal accessory nerve
A-superior fibers elevate scapula; middle fibers retract scapula; inferior finger depress scapula
Latissimus Dorsi
O-spines of T7-T12, thoracolumbar fascia, iliac crest, ribs 9-12
I-floor of bicipital (intertubercular) groove of humerus
N-thoracodorsal nerve
A-adducts, extends, and medially rotates humerus
Levator Scapulae
O-transverse processes of C1-C4
I-superior angle of scapula
N-dorsal scapular nerve and C3-C4
A-elevates scapula and rotates glenoid fossa of scapula inferiorly
Rhomboids (major and minor)
O-nuchal ligament and spinous process of C7-T5
I-medial border of scapula
N-dorsal scapular nerve
A-retracts scapula and rotates glenoid fossa inferiorly
Deltoid
O-lateral third of clavicle, acromion, and spine of scapula
I-deltoid tuberosity of humerus
N-axillary nerve
A-abducts, flexes, extends, medially and laterally rotates humerus
Teres Major
O-dorsal surface of inferior angle of scapula
I-medial lip of bicipital groove of humerus
N-lower subscapular nerve
A-adducts and medially rotates humerus
Subscapularis- rotator cuff muscle
O-subscapular fossa
I-lesser tubercle of humerus
N-upper and lower subscapular nerve
A-medially rotates humerus
Supraspinatus- rotator cuff muscle
O-supraspinous fossa
I-greater tubercle (superior part) of humerus
N-suprascapular nerve
A-initiates abduction of humerus, lateral rotation of humerus
Infraspinatus- rotator cuff muscle
O-infraspinous fossa
I-greater tubercle (middle part) of humerus
N-suprascapular nerve
A-holds humerus in place; laterally rotates humerus
Teres minor- rotator cuff muscle
O-superior part of lateral border of scapula
I-greater tubercle (inferior part) of humerus
N-axillary nerve
A-laterally rotates humerus
Depression of glenoid fossa
•Gravity is a prime mover
•Pectoralis minor weakly rotates
•Latissimus dorsi indirectly attached, can assist with rotation
•Rhomboid major and minor are the prime movers for rotating glenoid fossa inferior
Flex/extend of Glenohumeral Joint
Flexion:Pectoralis major= Prime mover, Anterior deltoid= Synergist.
Extension:Latissimus dorsi= Prime mover. Posterior deltoid= Synergist.
Ab/adduction of Glenohumeral Joint
Abduction: supraspinatus= prime mover, deltoid= synergist.
Adduction: latissimus doris, pectoralis major= prime movers, teres minor= synergist.
Medial/lateral rotation of Glenohumeral Joint
Medial: Subscapularis, Teres major= prime movers, Pectoralis major, Anterior deltoid,Latissimus dorsi= synergists.
Lateral: Infraspinatus, Teres minor= prime movers; posterior deltoid= synergists.
Biceps Brachii
O- short head: tip of coracoid process of scapula long head:supraglenoid tubercle of scapula
I- Radial tuberosity andfascia of forearm via bicipital aponeurosis
N- musculocutaneous nerve
A- supinates forearm; flexes forearm when supine; assists in flexing arm
Brachialis
O- distal half of anterior surface of humerus
I- coronoid process and tuberosity of ulna
N- musculocutaneous nerve
A- flexes forearm
Coracobrachialis
O- tip of coracoid process of scapula
I- middle 1/3 of medial surface of humerus
N- musculocutaneous nerve
A- helps to flex and adduct arm
Upper Brachial Plexus Injuries
Lesion in fibers that form the Musculocutaneous nerve results in:•Weakened flexion of elbow•Weakened supination of forearm
Triceps Brachii
O- long head: infraglenoid tubercle of scapula
lateral head: posterior surface of humerus, superior to radial groove
medial head: posterior surface of humerus, inferior to radial groove
I- proximal end of olecranon of ulna and fascia of forearm
N- radial nerve
A- extends forearm
Anconeus
O-lateral epicondyle of humerus
I- lateral surface of olecranon and superior part of posterior surface of ulna
N- radial nerve
A- assists in extending forearm; stabilizes elbow joint
Brachial Plexus Injuries
•Fibers to radial n
•Inability to extend elbow
•However, gravity will usually pull it into an extended position
Flexion muscle actions of elbow
Prime mover: brachialis
Synergist: Biceps Brachii,Brachioradialis,Pronator Teres
Extension muscle actions of elbow
Prime mover: Triceps Brachii
Synergist: Aconeus
Supination of elbow joint
Prime mover: supinator
Synergist: biceps brachii
Pronation of elbow joint
Prime mover: Pronator Quadratus
Synergist: pronator teres
Pronator Teres
O- medial epicondyle of humerus and coronoid process of ulna
I-lateral side of middle radius
N- median nerve
A- pronates the forearm, with some flexion at elbow
Flexor Carpi Radialis
O- medial epicondyle of humerus
I-proximal 2nd metacarpal
N- median nerve
A-flexion and abduction of the hand at the wrist
Palmaris Longus
O- medial epicondyle of humerus
I-palmar aponeurosis and distal flexor retinaculum
N- median nerve
A-flexion at wrist, tightens palmar aponeurosis, retracts claws in cats
Flexor Carpi Ulnaris
O- medial epicondyle of humerus, olecranon and posterior aspect of ulna
I-proximal 5th metacarpal, pisiform bone and hamate bone
N- ulnar nerve*
A-flexion and adduction of hand at wris
Flexor Digitorum Superficialis
O- medial epicondyle of humerus, coronoid process of ulna, and anterior superior radius
I-middle phalanges of digits 2-5
N- median nerve
A-flexes:•fingers at proximal interphalangeal joints•metacarpophalangeal joints•wrist
Flexor Pollicis Longus (deep)
O- middle part of radius and interosseous membrane
I-distal phalanx of thumb
N-median nerve
A-flexes phalanges of thumb
Flexor Digitorum Profundus (deep)
O- proximal ¾ of ulna and interosseous membrane
I-distal phalanges of digits 2-5
N-medial part ulnar nerve*, lateral part median nerve
A-flexes fingers at distal interphalangeal jointsand helps flex wrist
Pronator Quadratus
O- distal anterior ulna
I-distal anterior radius
N-median nerve
A-pronates forearm
Flexion of wrist
Prime Movers: flexor carpi ulnaris, flexor carpi radialis
Synergists: Flexor Digitorum Superficialis, Flexor Pollicis Longus, Palmaris Longus, Abductor Pollicis Longus
Extension of wrist
Prime Movers: Extensor Carpi Radialis Longus &Brevis, Extensor Carpi Ulnaris
Synergist: Extensor Digitorum, Extensor Pollicis Longus & Brevis
Abduction of wrist
Prime Mover: Abductor pollicus longus
Synergist: Flex Carpi Radialis, Extensor Carpi Radialis Longus
Adduction of wrist
Extensor Carpi Ulnaris with Flexor Carpi Ulnaris
Median nerve lesion (carpal tunnel)
-Paralysis of forearm pronators
-Paralysis of long flexor mm. of wrist and finger [except FCU and ulnar half of FDP]
-Paralysis of mm. of thenar eminence [retention of adductor and extensor pollicis mm.]
Hand of Benediction
Paralysis of median n. at elbow:

•Cannot flex 2nd & 3rd digits
•Cannot flex thumb at proximal interphalangeal joint
•Can weakly flex 4th & 5th digits (medial part of FDP innervated by ulnar n.)
Anular and cruciform ligaments
-Cruciform ligaments are weak
-4 cruciform ligaments per digit (not incl. thumb)
-Anular ligaments are strong
-5 anular ligaments per digit (not incl. thumb)
-Prevents tendons of FDS & FDP from bowstringing when digit is flexedPalmar
Brachioradialis
-Superficial extensor layer
-on flexor side
O- lateral supracondylar ridge of humerus
I-lateral side of distal radius
N-radial nerve
A-flexor of the forearm(moves elbow joint)
Carpal Tunnel
tendons of:
•Flexor carpi radialis
•Flexor digitorum superficialis
•Flexor pollicis longus
•Flexor digitorum profundus
Extensor Carpi Radialis Longus
-Superficial extensor layer
-on flexor side
O- lateral supracondylar ridge of humerus
I-proximal 2nd metacarpal
N-radial nerve
A-extension and abduction at wrist
Extensor Carpi Radialis Brevis
-Superficial extensor layer
-on flexor side
O- lateral epicondyle of humerus
I-proximal end of 3rd metacarpal
N-radial nerve (deep branch)
A-extension and abduction at wrist
Extensor Digitorum
-Superficial extensor layer
O- lateral epicondyle of humerus
I-extensor expansions of 4 fingers
N-radial nerve(posterior interosseous n.)
A-extension of 4 fingers and extension of hand
Extensor expansion
Formed by the tendons of:
1.Ext. digitorum
2.Interosseus muscles
3.Lubrical muscles
Extensor Digiti Minimi
-Superficial extensor layer
O- lateral epicondyle of humerus
I-extensor expansions of little finger
N-radial nerve(posterior interosseous n.)
A-extension of little finger
Extensor Carpi Ulnaris
-Superficial extensor layer
O- lateral epicondyle of humerus and posterior surface of ulna
I-proximal end of 5th metacarpal
N-radial nerve(posterior interosseous n.)
A-extension of wrist
Supinator
-deep
O- lateral epicondyle, supinator fossa, radial collateral & anular ligaments
I-anterior, lateral and posterior surfaces of proximal radius
N-radial nerve (deep branch)
A-supination of forearm
Abductor Pollicis Longus
-deep
O-posterior ulna, radius and interosseous membrane
I-proximal end of 1st metacarpal
N-radial nerve (posterior interosseous nerve)
A-abducts and extends
Extensor Pollicis Brevis
-deep
O- posterior radius and interosseous membrane
I-base of proximal phalanx of thumb
N-radial nerve (posterior interosseous nerve)
A- synergist of wrist extension
Extensor Pollicis Longus
-deep
O- posterior ulna and interosseous membrane
I-base of distal phalanx of thumb
N-radial nerve(posterior interosseous nerve)
A-extends thumb at MP
Extensor Indicis
-deep
O- posterior ulna and interosseous membrane
I-extensor expansion of index finger
N-radial nerve(posterior interosseous nerve)
A-extends index finger
Extensor retinaculum
Prevents bowstringing of tendons when hand is extended at the wrist joint
Power Grip
Finger flexors:
•Flexor digitorum superficialis & profundus mm. cause the carpometacarpal joint to flex as well as the digits
•Flexor pollicis longus & brevis mm.

•Wrist extensor mm. (extensor carpi radialis longus & brevis mm. & extensor carpi ulnaris m.)
-Extensors of the wrist (ext. carpi radialis longus & brevis, ext. carpi ulnaris) activate:•Prevents wrist from flexing•Extends wrist, which lengthens the flexor muscles, allowing them to contract more
Radial nerve lesion
-Wrist droop
-Loss of power grip
Carpometacarpal Joints
Digits 2 - 5:
Plane joints
Not much movement

Thumb (digit 1):
Saddle joint
Connects trapezium with 1st metacarpal
Lots of movement
Metacarpophalangeal joints
Condyloid joints (digits 2-5):
Allows flexion-extension, abduction-adduction, and circumduction

Metacarpal heads united by the deep transverse metacarpal ligament
Interphalangeal joints
Allows only flexion & extension (hinge)

Palmar ligaments (plates) create a smooth surface for the digital tendons to glide upon
Palmar Aponeurosus
Insertion of the palmaris longus m.
Present even if palmaris longus is missing
Continuous with the flexor retinaculum
Little function in humans
Flexor Retinaculum
Holds flexor muscle tendons in place
May also have little function
Compartments of the Hand
Thenar (median nerve)
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis

Adductor (ulnar nerve)
adductor pollicis

Hypothenar (ulnar nerve)
abductor digiti minimi
flexor digiti minimi
opponens digiti minimi

Central (Ulnar & median nerves)
lumbricals

Interossei (ulnar)
dorsal
palmar
Abductor Pollicis Brevis
O - scaphoid, trapezium and flexor retinaculum

I - lateral base of proximal phalanx of thumb

N - median nerve

A - abducts thumb and helps oppose it
Flexor Pollicis Brevis
O - capitate, trapezium and flexor retinaculum

I - lateral base of proximal phalanx of thumb

N - median nerve

A - flexes thumb
Opponens Pollicis
O - scaphoid, trapezium and flexor retinaculum

I - lateral side of metacarpal of thumb

N - median nerve

A - opposition of the thumb; medially rotates thumb metacarpal
Adductor Pollicis
O - oblique head: capitate and bases of 2nd and 3rd metacarpals; transverse head: 3rd metacarpal

I - medial base of proximal phalanx of thumb

N - ulnar nerve

A - adduction of thumb
Abductor Digiti Minimi
O - pisiform bone

I - medial base of proximal phalanx of little finger

N - ulnar nerve

A - abducts little finger
Flexor Digiti Minimi
O - hook of hamate and flexor retinaculum

I - medial base of proximal phalanx of little finger

N - ulnar nerve

A - flexes little finger
Opponens Digit Minimi
O - hook of hamate and flexor retinaculum

I - medial side of metacarpal of little finger

N - ulnar nerve

A - rotates little finger into opposition to thumb
Palmaris Brevis
Small, thin, superficial muscle

Connects the skin to the palmer aponeurosis

Covers the ulnar nerve and artery
Lumbricals (4)
O - tendons of flexor digitorum profundus

I - lateral sides of extensor expansions of fingers

N - median nerve (digits 2 & 3); ulnar nerve (digits 4 & 5)

A - flexes fingers at MP joint; extends at IP joint

--Medial 2 lumbricals each originate from two tendons of flexor digitorum profundus
--Lateral 2 lumbricals each originate from one tendon of flexor digitorum profundus
Dorsal Interossei (4)
O - adjacent metacarpals (bipennate)

I - base of proximal phalanx and extensor expansions of digits 2-4

N - ulnar nerve

A - abduct fingers and assists lumbricals in flexion at MP joints and extension at IP joints

--Dorsal interosseous muscles ABduct
--Thumb & little finger have no dorsal interossei mm. because they already have their own abductors
Palmar Interossei (3)
O - 2nd, 4th, and 5th metacarpal bones

I - base of proximal phalanx and extensor expansions of digits 2, 4, & 5

N - ulnar nerve

A - adduct fingers and assists lumbricals in flexion at MP joints and extension at IP joints

--Palmar interosseous muscles ADduct
--Middle finger (digit 3) has no palmar interosseus m. because it is the "center line" of adduction
--Thumb has no palmar interosseous because it has the adductor pollicis
Nerves of Hand
Median - enters through carpal tunnel; innervates the thenar muscles and lumbricals 1-2

Ulnar - innervates remaining hand muscles
Ulnar Nerve Lesion
--paralysis of FCU
--paralysis of ulnar half of FDP
--paralysis of intrinsic hand mm. [except thenar mm. & first 2 lumbrical]
--Greatly weakened ability to adduct and abduct digits
--Patient cannot hold piece of paper between fingers
Sternoclavicular Joint
Saddle joint between clavicle and sternum
Functions as a ball-and-socket joint
Extremely strong, but very mobile
Sternoclavicular Joint Movement
Fibrous capsule is strong enough to support the weight of the upper limb

1°: Elevation of clavicle (and scapula)

2°: Protraction and retraction also possible

2°: Some rotation of the clavicle
Acromioclavicular Joint
--Planar joint
--Strengthened by trapezius muscle
--Reinforced primarily by coracoclavicular ligament
--Small amount of movement in superoinferior and anteroposterior axes as well as --abduction/adduction
--Translation: the joint can wiggle
Glenohumeral (Shoulder) Joint
--Most mobile joint in the body
--Enclosed by a fibrous capsule

Reinforcement:
1) Tendons of rotator cuff muscles
2) Tendon of long head of biceps brachii:
Passes through synovial cavity
Held in place by transverse ligament spanning between greater and lesser tubercles
3) Coracoacromial ligament prevents superior dislocation of humerus
4) Glenoid labrum
Fibrocartilagenous lip surrounding glenoid fossa/cavity. Deepens the socket a little
Glenohumeral (Shoulder) Joint Movement
Glenohumeral joint can abduct to about 120°
After about 90°, scapula begins to rotate
Flexion range exceeds hyperextension range
Lateral and medial rotation
Joint is "close packed" when abducted and laterally rotated
Parts of Glenohumeral (Shoulder) Joint
Superior: glenoid labrum, coracoacromial lig., long head of biceps brachii

Lateral: rotator cuff tendons, long head of biceps brachii

Anterior: glenoid labrum, long head of biceps brachii, subscapularis

Posterior: glenoid labrum, acromion proc., supraspinatus, infraspinatus, teres minor

Inferior: glenoid labrum
Proximal radioulnar joint
Pivot joint
Ulnar collateral ligament
Anterior cord-like band is strongest
Posterior fan-like band is weakest
Oblique band deepens the trochlear notch
Elbow Joint
--Hinge joint
--Elbow joint is surrounded by a fibrous joint capsule
--Radial head rotates (supinates & pronates)
--Enclosed by anular ligament & radial notch of ulna
Wrist (radiocarpal) Joint
--Joint between the radius, scaphoid, and lunate
--Ulna does not participate
--Condyloid (ellipsoid) joint
Wrist Bones
scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
Important wrist ligaments
--Ulnar and radial collateral ligaments poorly developed
--Palmar radiocarpal and palmar radioulnar ligaments absorb hyperextension stress
--Falling on outstretched hand
--Dorsal wrist ligaments are weaker than palma
Flexion & extension of wrist joint
--Flexion & extension occur simultaneously from radiocarpal joint and midcarpal joint
--Females usually have large range of motion than males
Abduction and Adduction of Wrist Joint
--Adduction is greater than abduction
--Abduction limited by styloid proc. of radius
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