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Exam 2

Flashcards for Gross 1 exam 2, excluding the joints and arteries/ veins
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Trapezius origins (4)
1. EOP
2. superior nuchal line
3. nuchal ligament
4. spines of thoracic vertebrae
trapezius insertion (2)
1. Clavicle
2. acrominon process + spine/ scapula
trapezius actions (3)
1. stabilize the scapula
2. upper portion elevates the scapula
3. middle + lower portions adduct scapula
Trapezius Nerve supply (2)
1. motor: spinal accessory nerve
2. sensory: C4 + C5
Weakness of trapezius (Trapezius Palsy)
-deepening of muscle on affected side
-shoulder drops on affected side
-superior portion is often involved in auto accidents (whiplash)
Clinical Exam for C.N. XI
ask patient to elevate shoulders (shrug) against resistance. Do both sides to evaluate weakness of one side relative to the other side
Rhomboid Major Origin
spines of the upper thoracic vertebrae
Rhomboid Major Insertion
vertebral border of the scapula
Rhomboid Minor Origin
spines of the lower cervicles + T1
Rhomboid Minor Insertion
vertebral border of the scapula
Levatator Scapula Origin
transverse processes of the upper cervicle vertebrae
Levatator Scapula Insertion
superior angle of the scapula
Rhomboid Major, Minor, and Levatator Scapula Actions (3)
1. elevate scapula
2. adduct scapula
3. stabilize the scapula
Rhomboid Major, Minor, and Levatator Scapula Nerve Supply
Dorsal Scapular Nerve (C5)
Damage to C5 (Dorsal Scapular Nerve)
-difficulty completely adducting scapula
-scapula on affected side is further from the midline
Latissimus Dorsi Origin (4)
1. spines of the lower thoracic and lumbar vertebrae
2. thoracodorsal fascia
3. crest of the ilium
4. lower ribs
Latissimus Dorsi Insertion
intertubecular groove / humerus
Latissimus Dorsi Actions (2)
1. extends, adducts, and medially rotates humerus
2. involved with forced expiration
Latissimus Dorsi Nerve Supply
Thoracodorsal Nerve (C6, C7, C8)
Weakness/Damage to Latissimus Dorsi
results in forward displacement of the shoulder
Lumbar Triangle
-Latissimus Dorsi
-crest of ilium
- external oblique muscle
--hernia of the posterior wall of the abdomen may develop here
Triangle of Auscultation
-latissimus dorsi
-trapezius
-vertebral border of the scapula
--enlarge by abducting scapula
Serratus Anterior Origin
upper ribs
Serratus Anterior Insertion
vertebral border of the scapula
Serratus Anterior Actions (3)
1. abducts the scapula (prime mover)
2. stabilize scapula
3. involved with forced inspiration (when humerus is abducted)
Serratus Anterior Nerve Supply
Long thoracic nerve (C5, C6, C7)
Long Thoracic Nerve Palsy
(Winged Scapula)
-Serratus Anterior weaked due to damage to long thoracic nerve or its segmental innervation
-patient will have difficulty abducting scapula and thus raising hand over head
-#1 clinical sign is difficulty keeping vertebral border and superior angle of the scapula against posterior thoracic wall when preforming abduction against resistance ("winging" of the scapula)
- +/- pain
Causes of Long Thoracic Nerve Palsy (3)
1. trauma/ subluxation
2. traction injury involving shoulder joint
3. recumbency for a long period of time
Rotator Cuff Muscles (4)
1. Supraspinatus
2. Infraspinatus
3. Subscapularis
4. Teres Major
Rotator Cuff Muscle Criteria (2)
1. tendon of insertion must contribute to forming a cuff around the proximal humerus
2. they participate in either lateral or medial rotation of the humerus
Deltoid Origins (3)
1. Anterior portion: clavicle
2. Middle Portion:acromion process
3. Posterior portion: spine of the scapula
Detoid Insertion
deltoid tuberosity of the humerus
Deltoid Actions (3)
1. Anterior portion:flexes and medially rotates the humerus
2. Middle Portion: abducts the humerus
3. Posterior portion:extends and laterally rotates the humerus
Deltoid Nerve Supply
Axillary Nerve (C5, C6)
Atrophy of Deltoid
"Crutch Paralysis"
-due to injury to Axillary nerve or its segmental innervations
-atrophy gives shoulder a flattened apperance
-loss of senation may occur over lateral aspect of arm (due to lateral brachial cutaneous branch of axillary nerve)
-abduction of arm is greatly impaired
"Crutch Paralysis" Causes (3)
1. Fx of surgical neck of humerus (nerve injury immediate or during healing)
2. dislocation of shoulder joint
3. pressure of a crutch in axilla
Supraspinatus Origin
supraspinous fossa of the scapula
Supraspinatus Insertion
greater tuberosity of the humerus
Supraspinatus Actions (3)
1. initiates abduction of humerus (1st 30-45*)
2. laterally rotates the humerus
3. Stabilizes shoulder joint
Supraspinatus Nerve Supply
Suprascapular (C5 and C6)
Rotator Cuff Tendinitis
aka shoulder impingment syndrome
- pain can be sharp or aching, usually occurs in anterior +/- lateral aspects of the shoulder
-may feel like a "twinge" at first but progress to pain during and after activity
-usually result of overuse due to repetitive motion microtrauma to tendon's collagen fibers
-may be due to calcium deposits in elderly
Rotator Cuff Tears
-tearing usually a result of multifactoral conditions
--tendon usually ruptures near its insertion and can be partial or complete
- in young a complete tear is due to trauma or shoulder dislocation
- small tears can be from repetitive microtrauma or severe tendinitis
-large or complete tears from single trauma episode
-50+ years tears can occur with microtrauma
-symptoms similar to tendinitis, but with sig. tear patients will have difficulty abducting arm
Drop Test
-tests rotator cuff tears or degenerative athritis
-patient asked to lower fully abducted arm slowly
-limb will drop suddenly and uncontrolled if tendon is torn or diseased
Bursitis of Rotator Cuff
-affects deltoid or subacromial bursa
-may be more common than tendinitis, but difficult to distinguish
Subscapularis Origin
subscapular fossa/ scapula
Subscapularis Insertion
lesser tuberosity / humerus
Subscapularis Actions (2)
1. medially rotates humerus
2. stabilizes the shoulder
Subscapularis Nerve Supply
Upper and Lower Subscapular Nerve (C5, C6)
Infraspinatus Origin
infraspinous foss/ scapula
Infraspinatus Insertion
greater tuberosity / humerus
Infraspinatus Actions (2)
1. laterally rotates humerus
2. stabilizes shoulder joint
Infraspinatus Nerve Supply
Suprascapular (C5 and C6)
Teres Minor Origin
axillary border / scapula
Teres Minor Inserrtion
greater tuberosity / humerus
Teres Minor Actions (2)
1. laterally rotates humerus
2. stabilizes shoulder joint
Teres Minor Nerve Supply
Lower Subscapular Nerve (C6)
Teres Major Origin
inferior angle / scapula
Teres Major Insertion
intertubecular groove / humerus (medial lip)
Teres Major Actions (2)
1. adduct + medially rotates humerus
2. stabilizes shoulder joint
Teres Major Nerve Supply
Lower subscapular (C6)
Quadralateral Space
-space btwn teres major + minor
- more lateral
- contains axillary nerve and humeral circumflex
Triangular Space
-space btwn teres major + minor
- more medial
- contains circumflex scapular branch of the subscapular artery
Biceps Brachii Origin (2)
1. short head: coracoid process / scapula
2. Long head: supraglenoid tubercle / scapula
Biceps Brachii Insertion (2)
1. tuberosity / radius
2. shaft / ulna
Biceps Brachii Actions (4)
1. flexion of forearm at elbow joint
2. supination of forearm (prime mover)
3. short head: adducts humerus
4. long head: abducts humerus
Biceps Brachii Nerve Supply
musculocutanous nerve
Biceps Tendinitis
-long head is enclosed in snyovial sheath and moves within the intertuberclar groove
-wear and tear occurs on this tendon and cause inflammation and pain
-narrow or rough groove can cause crepitus
-occurs in sports with lots of throwing or raquet
Rupture of the Long Head of the Biceps Tendon
-tendon usually torn or ruptured near attachment on glenoid cavity
-rupture is dramatic and has pop or snap
-ruptured belly forms ball near center of the distal anterior aspect of arm (Popeye Deformity)
Causes for Rupture of the Long Head of the Biceps Tendon
-weaked by chronic tendinitis
-forceful flexion of arm against resistance (weightlifters)
Bicipital Reflex
-tests C5 and C6
-tap biceps tendon looking for reflex
Coraobracialis Origin
coracoid process / scapula
Coraobracialis Insertion
shaft / humerus
Coraobracialis Actions (2)
1. flexion and weak adduction of the humerus
2. helps stabilize shoulder joint
Coraobracialis Nerve Supply
Musculocutaneous Nerve
Brachialis Origin
shaft of the humerus
Brachialis Insertion
coronoid process of the ulna
Brachialis Action
Flexion of forearm at elbow joint
Brachialis Nerve Supply
Musculocutaneous nerve
Triceps brachii Origin
Long head: infraglenoid tubercle / humerus
Lateral + Medial heads: shaft of the humerus
Triceps brachii Insertion
olecranon process / ulna
Triceps brachii Actions
extention of forearm at elbow
(medial head always works, gravity assists, lateral and long heads if extra force needed)
Triceps brachii Nerve Supply
Radial Nerve (C6, C7, C8)
Atrophy of Triceps brachii
passive extention by gravity, but lacks control and stability
Segmental Nerve test for Triceps brachii
C7 and C8 can be tested by tapping tendon of insertion and looking for simple extension reflex
Anconeus Origin
lateral epicondyle / humerus
Anconeus Insertion
olecranon process / ulna
Anconeus Action
assists in extension of forearm
Anconeus Nerve Supply
Radial Nerve (C6, C7, C8)
Blood Pressure
-Taken at brachial artery (because it's at the level of the heart and muscle mass can transmit cuff pressure to vessel)
-sphygmomanometer occludes vessel and then releases pressure slowly
-Systolic pressure is when blood flow 1st becomes audible
-Diastolic pressure is when blood flow can no longer be heard
Musculocutaneous Nerve Damage
-rarely injured because protected by biceps brachii
-injury due to direct wound in axilla, axillary artery aneurysm, or shoulder joint dislocation
Results of Musculocutaneous Nerve Damage
-flexion still possible because pronator teres can carry out weak flexion (not supplied my musculocutaneous)
-may lose sensation along lateral forearm (lateral antebrachial cutaneous nerve is a branch)
Cubital Fossa
-depression at anterior elbow
-many nerves and arteries enter here
Cubital Fossa Boundries
Lateral: brachioradialis muscle
Medial: pronator teres
Proximal: level of the epicondyles of the humerus
Cubital Fossa structures (4)
1. median nerve
2. brachial artery (branches into ulnar and radial art.)
3. tendon of biceps brachii
4. median cubital vein
Elbow Complex
-joints and muscles of the elbow serve the hand
-includes elbow and proximal radioulnar joint
Definition of Elbow "Complex"
1. radius and ulna are common articulation surfaces
2. synovial cavities are continuous
3. ligaments are continuous
Carrying Angle
greater in females than in males, angle disappears with pronation, allows elbow to closely into waist depression
Cubitus Valgus
an increase and latereal deviation of the carrying angle
Olecranon Bursa
Btwn olecranon and skin, dissipates pressure
- infectious bursitis- injury during falls and abrasions to skin
- friction bursitis- repeated excessive pressure
Articular disc of the wrist
excludes the ulna from taking part of the wrist joint, ulna is the stabilizing joint
Ossifiation in Radius and Ulna (sequence)
1) distal radius
2) proximal radius
3) distal ulna
4) proximal ulna
Fusion with shaft of Radius and Ulna (sequence)
1) proximal radius
2) proximal ulna
3) distal ulna
4) distal radius
Fracture of Radius or Ulna
- usually a result of severe direct injury
- usually transverse fx of both, but can be just 1 bone
- fragment displacement is usually considerable, depends on the pull of attached muscles
- pronation and supination will be impaired if normal anatomical relationship of radius, ulna, and interosseous membrane are not restored
Colles Fracture
- common in women 50 +
- occurs by fall on ourstreached, pronated hand
- force travels through carpal boned to fx distal radius
Features of Colles Fracture
- distal fragment displaced posteriorly, radius shortens
- fragments often comminuted
-"dinner fork deformity" posterior angulation occurs in forearm just proximal to wrist
- heal easily due to vascular supply
- flexion and extension of wrist impaired if normal articulations not restored
Smiths Fracture
- reverse of colles fx
- due to a fall on the back of hand
- distal fragment displaced anteriorly
Carpal Ossification Sequence
1. capitate and hamate
2. triquetral
3. lunate
4. trapezium/ trapezoid/ scaphoid
5. pisiform
Carpal Ossification
- completed by 14-16 years old
- xray tells skeletal age and any growth disorders
- carpals used to tell age of unknown child
Sesamiod Bones
-varying # embedded in flexor tendons
- most consistent over MP joints of 1, 2, 5 digits and IP joint of 1st digit
Sesamoid Bone Functions
1. protect and stabilized tendons
2. change angle of tendons as they pass to insertion (increase angle)
Scaphoid Fracture
- most commonly fx carpal
- due to fall on palm- hand hyperextended
- takes twice as much force to fx scaphoid as to fx radius
Scaphoid Fracture Symptoms
- sweeling and pain in wrist, many patients think they sprained wrist
- tenderness and swelling in anatomical snuffbox
- initial rads may not reveal fx
- prolonged healing due to poor vascular supply, can result in degenerative arthritis in 1st CM joint
Fracture of Hamate
- may not fuse again due to traction of attached muscles
- ulnar nerve is close to hook of hamate and can be injured
Metacarpal Fractures
- metacarpals held by ligaments and have little displacement
- good blood supply and heal quickly
- can fx multiple metacarpals at once
Boxer's Fracture
- fx of 5th metacarpal
- occurs when you punch with closed fist
- fx to base of 1st metacarpal will cause instability to 1st CM joint
Movements of Hand at Wrist Joints (4)
1. Flexion
2. Extension
3. Abduction (radial deviation)
4. Adduction (ulnar deviation)
Movements of Digits
- occur at MP, MC, PIP, DIP, IP joints
1. Flexion
2. Extension
3. Abduction (digits 1, 2, 4, 5)
4. Adduction (digits 1, 2, 4, 5)
- 3rd digit does lateral or medial abduction
Pronator Teres Origins (2)
1. medial epicondyle / humerus
2. coronoid process / ulna
Pronator Teres Insertion
pronator ridge / ulna
Pronator Teres Actions (2)
1. pronation of forearm at superior radioulnar joint
2. assists in flexion of arm
Pronator Teres Nerve Supply
median nerve (C8, T1)
Pronator Teres Syndrome
compression of the median nerve in the proximal forearm btwn the heads of the pronator teres
Pronator Teres Syndrome Causes
1. direct trauma
2. excessive pronation/ supination
Flexor Carpi Radialis Origin
medial epicondyle / humerus
Flexor Carpi Radialis Insertion
2nd metacarpal (with slip to 3rd metacarpal)
Flexor Carpi Radialis Actions (2)
1. equal prime mover for flexion at wrist joint
2. abduct hand
Flexor Carpi Radialis Nerve Supply
Median Nerve (C8, T1)
Ulnar Deviation
abnormal flexion of Flexor Carpi Radialis due to weakness of the muscle, pulls medially
Palmaris Longus
vestigial in humans, in many species it operates the claw, missing in about 15% of humans
Palmaris Longus Origin
medial epicondyle / humerus
Palmaris Longus Insertion
palmer aponeurosis (facia, attaches to bone)
Palmaris Longus Actions (2)
1. weak flexion at wrist
2. tightens facia of palm (allows palm to "cup")
Palmaris Longus Nerve Supply
Median nerve (C8, T1)
Flexor Carpi Ulnaris Origins (2)
1. medial epicondyle / humerus
2. olecranon
Flexor Carpi Ulnaris Insertion (3)
1. pisiform
2. hamate
3. 5th metacarpal
Flexor Carpi Ulnaris Actions (2)
1. equal prime mover for flexion at wrist joint
2. adduction of hand
Flexor Carpi Ulnaris Nerve Supply
Ulnar Nerve (C7, C8)
Radial Deviation
-abnormal flexion at hand due to weakness of Flexor Carpi Ulnaris
- more lateral
Flexor Digitorum Superficialis Origin
medial epicondyle / humerus
Flexor Digitorum Superficialis Insertion
middle phalanges of digits 2-5
Flexor Digitorum Superficialis Actions (2)
1. flexes PIP joints of digits 2-5
2. assists in flexion at the wrist joint
Flexor Digitorum Superficialis Nerve Supply
Median nerve (C8, T1)
Flexor Digitorum Profundus Origin
shaft / ulna
Flexor Digitorum Profundus Insertion
distal phalanges of digits 2-5
Flexor Digitorum Profundus Actions (2)
1. flex DIP joints 2-5
2. flexion of wrist joint
Flexor Digitorum Profundus Nerve Supply
Median (C8, T1) (lateral half)
Ulnar (C7, C8) (medial half)
Flexor Pollicis Longus Origin
shaft / radius
Flexor Pollicis Longus Insertion
distal phalanx of 1st digit
Flexor Pollicis Longus Actions (2)
1. pronates forearm at distal radioulnar joint
2. helps stabilize distal radioulnar joint
Flexor Pollicis Longus Nerve Supply
Median nerve (C7, C8)
Pronator Quadratus Origin
shaft / ulna
Pronator Quadratus Insertion
shaft / radius
Pronator Quadratus Actions (2)
1. pronates forearm at distal radioulnar joint
2. helps stabilize distal radioulnar joint
Pronator Quadratus Nerve Supply
Median (C8, T1)
Median Nerve Damage
- compression or injury of the nerve
- proximal forearm compression = pronator teres syndrome
- distal forearm compression = carpal tunnel syndrome
Median Nerve Damage Symptoms
- loss or weakened pronation
- sensory loss over lateral 2/3 palmer surface of hand
- ulnar deviation
- weakened abduction
- atrophy of thenar muscles, with loss of opposition +/or weakness of 1st digit movement
Ape Hand
- due to median nerve damage
- thenar muscles atrophied and thumb is held close to the 2nd metacarpal
Median Nerve Damage Motor Test
- testing thenar muscle strength
- patient makes a circle with 1st and 2nd digit
- Dr. tries to pull proximal phalanx of thumb away
- motor damage will occur after cutaneous damage
Median Nerve Damage Sensory Test
- tested at tip of 2nd digit
- cutaneous damage will occur before motor damage
Ulnar Nerve Damage
-can be compressed at proximal or distal forearm
- more than 25% of upper extremity nerve problems are ulnar nerve
- commonly compressed at or distal to elbow
- causes atrophy of Flexor Carpi Ulnaris and 1/2 of Flexor Digitorum Profundus
Ulnar Nerve Damage Symptoms
- impaired or weakened adduction of hand
- radial deviation
- atrophy of hypothenar muscles (5th digit)
- loss of sensation of medial palmer hand
- "claw hand" - difficultly making a fist because cannot fully flex digits 4 + 5
Guyon Tunnel or Canal Syndrome
- compression/ damage of ulnar nerve btwn pisiform and hook of hamate
- loss of sensation in medial 1 1/2 digits
- atrophy of hypothenar muscles
Cyclist or Handlebar Neuropathy
- pressure put on hook of hamate + therefore ulnar nerve
- sensory loss of medial hard
- hypothenar muscle atrophy
Brachioradialis Origin
lateral supracondylar ridge / humerus
Brachioradialis Insertion
styloid process / radius
Brachioradialis Actions (2)
1. Flexes forearm
2. depending on the position of forearm, can act as a supinator (when forearm extended and pronated) or pronator (when forearm is flexed and supinated)
Brachioradialis Nerve Supply
Radial nerve (C6, C7)
Extensor Carpi Radialis Longus Origin
lateral epicondyle / humerus
Extensor Carpi Radialis Longus Insertion
2nd metacarpal
Extensor Carpi Radialis Longus Actions (2)
1. extends hand
2. abducts hand
Extensor Carpi Radialis Longus Nerve Supply
Radial nerve (C6, C7)
Extensor Carpi Radialis Brevis Insertion
Lateral epicondyle / humerus
Extensor Carpi Radialis Brevis Insertion
3rd metacarpal
Extensor Carpi Radialis Brevis Actions (2)
1. extends hand
2. abducts hand
Extensor Carpi Radialis Brevis Nerve Supply
radial nerve (C6, C7)
Extensor Digitorum Maximus Origin
lateral epicondyle / humerus
Extensor Digitorum Maximus Insertion
middle and distal phalanges of digits 2-5
Extensor Digitorum Maximus Actions (3)
1. extends digits 2-5
2. extends hand at wrist joint
3. abducts digits 2, 4, 5
Extensor Digitorum Maximus Nerve Supply
Radial nerve (C6, C7)
Extensor Digiti Minimi Origin
lateral epicondyle / humerus
Extensor Digiti Minimi Insertion
proximal phalanx of 5th digit
Extensor Digiti Minimi Action
extends digit 5
Extensor Digiti Minimi Nerve Supply
Radial nerve (C6, C7)
Extensor Carpi Ulnaris Origin
lateral epicondyle / humerus
Extensor Carpi Ulnaris Insertion
5th metacarpal
Extensor Carpi Ulnaris Actions (2)
1. extends hand
2. adducts hand
Extensor Carpi Ulnaris Nerve Supply
radial nerve (C6, C7)
Tennis Elbow aka Lateral Epicondylitis
- involves repetitive use of superficial posterior forearm muscles
- inflammation and poss. degeneration of common tendon of origin ass. with lateral epicondyle / humerus
Tennis Elbow aka Lateral Epicondylitis Signs
1. tenderness + pain around lateral epicondyle
2. radiation of pain down lateral aspect of forearm
3. pain aggravated by any activity putting tension on extensor forearm muscles
Tennis Elbow aka Lateral Epicondylitis Test
- patient makes a fist and hyperextends hand while forearm is stabilized
- dr. applies pressure to force hand into flexion while patient resists
- tennis elbow = sudden severe pain in lateral epicondyle area
Inflammation / Subluxation of C5
causes pain in the region of the lateral epicondyle (dermatome level)
Mallet or Baseball Finger
-sudden, severe tension on a long extensor muscle
- tendon avulses at attachment at phalanx
- DIP joint is forced into extreme flexion
- cannot extend DIP joint + deformity looks like a mallet
Supinator Origins (2)
1. lateral epicondlye / humerus
2. supinator crest / ulna
Supinator Insertion
shaft / radius
Supinator Action
supinates forearm
Supinator Nerve Supply
Radial Nerve
Abductor Pollicis Longus Origin
shaft of ulna and radius
Abductor Pollicis Longus Insertion
1st metacarpal
Abductor Pollicis Longus Action
abduct digit 1 at CM joint
Abductor Pollicis Longus Nerve Supply
Radial nerve
Extensor Pollicis Brevis Origin
shaft of the radius
Extensor Pollicis Brevis Insertion
proximal phalanx of 1st digit
Extensor Pollicis Brevis Action
extends digit 1
Extensor Pollicis Brevis Nerve supply
Radial nerve
Extensor Pollicis Longus Origin
shaft / ulna
Extensor Pollicis Longus Insertion
distal phalanx of 1st digit
Extensor Pollicis Longus Action
extends digit 1
Extensor Pollicis Longus Nerve Supply
radial nerve
Anatomical Snuffbox Borders
1. lateral: tendons of extensor pollicis brevis and abductor pollicis longus
2. medial: extensor pollicis longus
3. floor: styloid process / radius, scaphoid, and trapezium
Anatomical Snuffbox
- branch of the radial nerve passes through
- tenderness and swelling may indicate fx of scaphoid or styloid process of radius
DeQuevain's Dz aka Tenosynovitis Stenosans
- inflammation of tendons of abductor pollicis longus, extensor pollicis brevis, and their common fibrous sheath (tenosynovius sheath)
- may be due to repetitive hand + wrist movements which cause friction btwn tendons
DeQuevain's Dz aka Tenosynovitis Stenosans Signs
- more common in 50 +
- can lead to abnormal thinking of sheath which will restrict tendon movement and cause pain with thumb movement
- pain at lateral aspect of wrist which radiates up forearm or down thumb
Extensor Indicis Origin
shaft / ulna
Extensor Indicis Insertion
proximal phalanx of 2nd digit
Extensor Indicis Action
extends 2nd digit
Extensor Indicis Nerve Supply
Radial nerve
Radial Nerve Damage
- radial nerve supplies all posterior arm and forearm muscles
- degree of paralysis depends on where damage is
- most commonly fx to shaft of humerus- triceps ok, posterior forearm muscles and cutaneous supply affected
Radial Nerve Damage Signs
- cannot extend digits or wrist
- wrist drop- hand drops in passive flexion
- loss of sensation to dorsum of forearm and hand
Radial Nerve Damage- Deep Branch
- due to penetrating wounds
- difficulty with extension of digits
- no sensory loss (no cutaneous branches)
Radial Nerve Damage- Superficial Branch
sensory loss, especially on dorsum of hand and web space btwn 1st and 2nd digits
Radial Artery Branches (3)
1. Recurrent- takes part in arterial anastomosis around elbow
2. unnamed muscular branches
3. superficial and deep palmer- help form palmer arches
Ulnar Artery
-medial branch of brachial artery (deep to flexor carpi ulnaris)
- crosses retinaculum
- accompanied by ulnar nerve as it desends
Ulnar Artery Branches
1. anterior recurrent
2. posterior recurrent
3. common interosseous
4. anterior interosseous
5. posterior interosseous
Interosseous Membrane
- connects radius and ulna with openings for passage of posterior interosseous blood vessels
Interosseous Membrane Functions
1. provide strength and stability btwn radius and ulna
2. limit supination
3. increase surface attachment for muscles of both anterior and posterior forearm
Human Hand vs. Non-Human Hand
- grasp is strong and accurate
- chief tactile organ
- opposable thumb
- fine discriminatory movements of digits permitted by intrinsic muscles of the hand
Carpal Tunnel formed by...
-flexor retinaculum in cancave palmer wrist
- contains median nerve and long flexor tendons of digits
- does not include palmaris longus tendons or cutaneous brances of ulnar nerve
Carpal Tunnel Syndrome
- caused by compression of median nerve in carpal tunnel (entrapment neuropathy)
- mainly due to increase in pressure in the tunnel
Carpal Tunnel Syndrome Causes
1. edema due to trauma, obesity, pg
2. Fractures
3. tumors
4. oral contraceptives
5. repetitive flexion and extension of wrist
6. misalignment of bones
Carpal Tunnel Syndrome Signs
1. parathesia in median nerve's cutaneous distribution
2. dry skin in area of median nerve's distribution
3. pain awakens patient in the night
4. atrophy of thenar muscles- makes it difficult to carry out fine movements of the thumb
Tinel's Sign
"pins and needles" sensation when anterior wrist is tapped (over median nerve distribution site)
Phalen's Test
reproduces symptoms of carpal tunnel syndrome by having patient flex their hands to maximum and hold for several minutes
Extensor Retinaculum
- prevents bowstringing of tendons when hand is in extension
- does not include basilic vein, cephalic vein, and cutaneous branches of radial and ulnar nerves
Palmar Aponeurosis
- triangle deep facia in central palm
- continuous with facia covering thenar and hypothenar muscles and flexor retinaculum
- gives firm attachment to overlaying skin to improve grip
- protects underlying tendons
Duputytrens Contracture
-shortening and hypertrophy of palmar aponeurosis
- causes a thickening and shortening resulting in the contracture of muscles affecting the digits
-may be genetic
- usually in men 50+ and bilateral
Duputytrens Contracture Abnormalities
1. starts near base of 4th digit and brings it into the palm due to flexion at MP joint
2. later the condition may involve 5th digit in the same manner
Abductor Pollicis Brevis Origins (2)
1. Trapezium
2. scaphoid
Abductor Pollicis Brevis Insertion
proximal phalanx of 1st digit
Abductor Pollicis Brevis Actions
abducts 1st digit at MP joint
Abductor Pollicis Brevis Nerve Supply
median nerve
Opponens Pollicis Origin
Trapezium
Opponens Pollicis Insertion
1st metacarpal
Opponens Pollicis Action
medial rotation of 1st metacarpal
Opponens Pollicis Nerve Supply
Median nerve
Flexor Pollicis Brevis Origin (3)
1. trapezium
2. trapezoind
3. Capitate
Flexor Pollicis Brevis Insertion
proximal phalanx of digit 1
Flexor Pollicis Brevis Action
flexes thumb at MP joint
Flexor Pollicis Brevis Nerve Supply
median and ulnar nerves
Adductor Pollicis Origins (4)
1. trapezoid
2. capitate
3. 2nd + 3rd metacarpals (oblique heads)
4. 3rd metacarpal (transverse head)
Adductor Pollicis Insertion
proximal phalanx of 1st digit
Adductor Pollicis Action
adducts digit 1
Adductor Pollicis Nerve Supply
Ulnar
Abductor Digiti Minimi Origin
pisiform
Abductor Digiti Minimi Insertion
proximal phalanx of 5th digit
Abductor Digiti Minimi Action
abducts 5th digit
Abductor Digiti Minimi Nerve Supply
ulnar nerve
Opponens Digiti Minimi Origin
hamate
Opponens Digiti Minimi Insertion
5th metacarpal
Opponens Digiti Minimi Action
laterally rotates 5th metacarpal
Opponens Digiti Minimi Nerve Supply
ulnar nerve
Flexor Digiti Minimi Origin
hamate
Flexor Digiti Minimi Insertion
proximal phalanx of 5th digit
Flexor Digiti Minimi Action
flex digit 5 at MP joint
Flexor Digiti Minimi Nerve Supply
ulnar nerve
Lumbricales Origin
tendons of Flexor Digitorum Profundus
Lumbricales Insertion
tendons of Extensor Digitorum Maximus
Lumbricales Actions (2)
1. flex MP joints
2. extend IP joints
Lumbricales Nerve Supply
Median nerve (1st and 2nd lumbricales)
Ulnar nerve (3rd and 4th lumbricales)
Palmer Interossei Origin
metacarpal bone (of the digit it moves)
Palmer Interossei Insertion
proximal phalanx of digits 2, 4, 5
Palmer Interossei Actions (3)
1. adducts digits 2, 4, 5
2. flex MP joints
3. extend IP joints
Dorsal Interossei Origin
from adjacent metacarpal btwn which they lie
Dorsal Interossei Insertion
proximal phalanx or digits 2, 3, 4
Dorsal Interossei Actions (3)
1. abducts digits 2, 3, 4
2. Flex MP joints
3. Extend IP joints
Palmar Brevis Origin
flexor retinaculum
Palmar Brevis Insertion
skin of hypothenar eminance
Palmar Brevis Actions (2)
1. cups skin on hand
2. prevents skin of palm for shifting during a palmar grip
Palmar Brevis Nerve Supply
Ulnar nerve
Motor Supply of Median Nerve (4)
1. Abductor Pollicis Brevis
2. Opponens Pollicis
3. half of Flexor Pollicis Brevis
4. 1st and 2nd Lumbricales
Cutaneous Supply of Median Nerve
lateral part of palmer surface of hand
Motor Supply of Ulnar Nerve (7)
1. Abductor Digiti Minimi
2. Flexor Digiti Minimi
3. Opponens Digiti Minimi
4. 3rd and 4th Lumbricales
5. Interossei
6. Palmaris Brevis
7. half of Flexor Pollicis Brevis
Cutaneous Supply of Ulnar Nerve
medial hand (both palmar and dorsal aspects)
Cutaneous Supply of Radial Nerve
- lateral aspect of dorsum of hand
- dorsal distal portion of digits 2, 3, 4
Carpometacarpal Joints
-irregular synovial joints
- little movement
- some flexion and extension occur at 4th and 5th joint with "power grip"
Carpometacarpal Joint of Digit 1
- universal joint
- allows opposition
- flexion, extension, adduction, abduction, and rotation
- thumb movement are 50% of hand movements
Opposition of Thumb
- combo of flexion, extension, and rotation
- opposition allows thumb to meet palmar surface of other digits
- greatly expands manual dexterity
Intermetacarpal Joints
- gliding joints at bases of 2nd thru 5th metacarpals
- does not exist btwn 1st and 2nd metacarpals
Metacarpophalangeal Joints
- form knuckles of closed fist
- btwn heads of metacarpals and base of proximal phalanx
Interphalangeal Joints
- ginglymus joints
- flexion and extension
- digits 2-5 have DIP and PIP joints
- 1st digit only has IP joint
Skier's Thumb
- rupture or laxity of collateral Lig. of 1st metacarpophalageal joint
- result of hyperabduction of 1st MP joint
- can be an avulsion fx of 1st metacarpal head