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What are the components of the pectoral girdle (AKA shoulder girdles)?
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What holds the pectoral girdles in place?
Muscle attachments
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What is the main purpose of the pectoral girdles?
They attach bones of the upper limbs to the axial skeleton.
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Where does the clavicle (collar bone) attach to the sternum relative to the first rib?
Superior to the first rib.
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Where is the clavicle most commonly broken?
At the junction of the curves
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What are the names of the two ends of the clavicle?
- Acromial extremity
- Sternal extremity
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What are the muscles/ligaments that attach to the coracoid process (crow's beak) of the scapula?
- Muscles: pectoralis minor, coracobrachialis, biceps brachii
- Ligaments: coracoacromial, conoid, trapezoid
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What are the muscles/ligaments that attach to the infraspinous fossa of the scapula?
Infraspinatus muscle
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What are the muscles/ligaments that attach to the supraspinous fossa of the of scapula?
Supraspinatus muscle
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What are the muscles/ligaments that attach to the subscapular fossa of the scapula?
Subscapularis muscle
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What are the muscles/ligaments that attach to the medial border of the scapula?
- Rhomboid major
- Rhomboid minor
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What muscle of the anterior neck attaches either near the scapular notch or on the superior transverse scapular ligament?
Omohyoid
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Where is the superior transverse scapular ligament located? What structure runs under the ligament? What structure runs over the ligament?
- Bridges the suprascapular notch.
- The suprascapular nerve travels under the ligament.
- The suprascapular artery goes over the ligament.
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What causes suprascapular neuritis (form of entrapment neuropathy)?
Compression of the suprascauplar nerve at the back of the shoulder.
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What are the clinical findings of suprascapular neuritis regarding: pain, reproduction of the pain by the examiner, effect on muscles due to prolonged entrapment?
- Neuralgic pain, radiates to C5 and C6 dermatomes (can be vague).
- Direct pressure over nerve in the notch.
- Visble wasting of supraspinatus and infraspinatus muscles.
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What landmark of the scapula is the lateral end of the spine and high point of the shoulder?
Acromion
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What landmark of the scapula accepts the head of the humerus to for the glenohumeral joint?
Glenoid cavity
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What landmark of the scapula is the thin edge closer to the vertebral column? What is it also known as?
- Medial border
- Vertebral border
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Where do the medial and lateral borders join on the scapula?
Inferior angle
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Where do the superior and medial borders join on the scapula?
Superior angle
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What landmark of the scapula joins the medial border at the superior angle?
Superior border
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What landmark of the scapula is an indentation along the superior border through which the suprascapular nerve passes?
Suprascapular notch
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What landmark of the scapula is a projection at the lateral end of the superior border to which tendons of muscles and ligaments attach?
Coracoid process (like a crow's beak)
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What landmark of the scapula is a surface for attachment of the infraspinatus muscle of the shoulder?
Infraspinous fossa
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What landmark of the scapula is a surface for attachment of the supraspinatus muscle?
Supraspinous fossa
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What landmark of the scapula is on the anterior surface (of scapula) and is a surface of the attachment for the subscapularis muscle?
Subscapular fossa
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Where is the acromioclavicular joint located?
- Where lateral (acromial) end of clavicle articulates with acromion process of the scapula.
- Site of shoulder separations.
-
Where is the sternoclavicular joint located?
- Where the sternal end of clavicle articulates with manubrium of sternum and 1st costal cartilage.
- Only true synovial joint that connects pectoral girdle with ribcage.
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What feature of the humerus is located between the tubercles and the head and is the site of attachment of the articular space?
Anatomical neck
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What feature of the humerus contains the long head of the biceps brachii muscle?
Intertubercular sulcus (bicipital groove/intertubercular groove)
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What feature of the humerus is rounded and near the lateral epicondyle?
Capitulum
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What feature of the humerus is a deep fossa located above the trochlea? What does it receive?
- Coronoid fossa
- Receives ulnar coronoid process
-
What feature of the humerus is in the middle of the shaft and is the site of attachment for the deltoid muscle?
Deltoid tuberosity
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What feature of the humerus are sites of insertion for some of the muscles that move the humerus at the shoulder joint?
- Greater tubercle
- Lesser tubercle
-
What feature of the humerus is where the sharp lateral supracondylar ridge on the shaft of the bone ends?
Lateral epicondyle
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What feature of the humerus is the termination of the medial supracondylar ridge?
Medial epicondyle
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What feature of the humerus is a large depression of the posterior humerus? What does it receive when the forearm is extended?
- Olecranon fossa
- Receives olecranon process of the ulna.
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What feature of the humerus is a shallow fossa that lies above the capitulum? What does it contain during flexion?
- Radial fossa
- Contains part of the radius.
-
What feature of the humerus is distal to the tubercles, and is a site where the humerus is frequently broken?
Surgical neck
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What feature of the humerus with its indentation, is more medial in position from the lateral epicondyle and capitulum?
Trochlea
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What muscle attaches to the deltoid tuberosity?
Deltoid muscle
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What muscles attach to the greater and lesser tubercles?
- Greater: supraspinatus, infraspinatus, teres minor
- Lesser: subscapularis
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What are the relative sizes of the lateral and medial epicondyles of the humerus? What is the reason for this?
- Medial epicondyle is larger than the lateral epicondyle.
- Size is relative to the size/number of muscle that attaches to it.
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How are avulsion fractures typically repaired?
By open reduction and fixation with a screw(s).
-
What is an avulsion fracture/how does it occur?
- Occurs when a ligament or tendon attached to a bone pulls away part of the bone.
- May result from a fall onto the point of the shoulder (acromion) in middle aged and elderly, or hand in younger people-relatively common.
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State the nerve that be affected accompanying damage to the humerus at each of the following locations: distal end, medial epicondyle, shaft, surgical neck.
- Distal end: median nerve
- Medial epicondyle: ulnar nerve
- Shaft (radial groove): radial nerve
- Surgical neck: axillary nerve
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What are the relative positions (medial/lateral) of the radius and ulna?
- Ulna: forms medial border of forearm (stabilizing bone)
- Radius: forms lateral border of forearm (moveable bone)
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What feature of the ulna is an anterior projection at the proximal end?
coronoid process
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What feature of the ulna is at its distal end and is separated from the wrist by a disc of fibrocartilage?
head of the ulna
-
What feature of the ulna is at the proximal end and forms the prominence of the elbow?
olecranon process (olecranon)
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What feature of the ulna is at the distal end and is an attachment point for the ulnar collateral ligament to the wrist?
styloid process
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What feature of the ulna is a large curved area that is formed by contribution from the olcecranon and coronoid process, and in turn forms part of the elbow joint?
trochlear notch
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What feature of the ulna is located just inferior to the coronoid process and is the attachment site for the brachialis muscles?
ulnar tuberosity
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What feature of the radius has a disc-shape and articulates with both the capitulum of the humerus and radial notch of the ulna?
Head
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What feature of the radius is located inferior to the disc-shaped head (of radius)?
Constricted neck
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What feature of the radius is a roughened area inferior to the neck that serves as a point of attachment for tendons of the biceps brachii muscle?
Radial tuberosity
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What feature of the radius is on the lateral side and can be felt proximal to the thumb?
Styloid process
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What individual muscles attach to the ulnar tuberosity (ulna)?
Brachialis muscle
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What individual muscles attach to the radial tuberosity (radius)?
Tendons of the biceps brachii muscle.
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What individual muscles attach to the styloid process of the radius?
- Brachioradialis muscle.
- Radial collateral ligament to the wrist.
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What are the wrist bones (carpals) of the proximal row and what are their shapes (from lateral to medial)?
- Scaphoid (boat shaped)
- Lunate (moon shaped)
- Triquetrum (3 corners)
- Pisiform (pea shaped)
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What are the wrist bones (carpals) of the distal row and what are their shapes (from lateral to medial)?
- Trapezium (four sided)
- Trapezoid (four sided)
- Capitate (large head)
- Hamate (hooked process)
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Surface anatomy: what does the border of the pectoralis major form?
anterior axillary fold
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Surface anatomy: what vein is located superiorly (anterior surface), and its course can be traced between the deltoid and pectoralis major muscles?
cephalic vein
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Surface anatomy: what muscle contributes to the rounded shape of the shoulder?
deltoid (muscle)
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Surface anatomy: what is the depression between the two sternal ends of the clavicles?
jugular notch
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Surface anatomy: what muscle is inferior to the trapezius and forms the posterior axillary fold?
latissimus dorsi (muscle)
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Surface anatomy: what muscle is the most superficial muscle of the anterior thoracic wall and forms the anterior axillary fold?
pectoralis major (muscle)
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Surface anatomy: what is formed from the lateral border of the latissimus dorsi and teres major?
posterior axillary fold
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Surface anatomy: what muscle is on the anterolateral side of the thorax?
serratus anterior (muscle)
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Surface anatomy: what muscle contributes to the posterior axillary fold, inserts into the arm, and is located near the inferior angle of the scapula?
teres major (muscle)
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Surface anatomy: what muscle is a large and triangular shaped muscle of the upper and middle back?
trapezius (muscle)
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Surface anatomy: what is the feature of the back that lies lateral to the vertebral furrow?
vertebral border of scapula
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Surface anatomy: what feature of the back is located between the vertebral borders of the scapulae?
vertebral furrow
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What vein is commonly used for routine venipuncture?
Median cubital vein
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What are the names of the anterior thoracoappendicular muscles?
- Pectoralis major
- Pectoralis minor
- Serratus anterior
- Subclavius
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What is the name of the posterior thoracoappendicular muscle?
Latissimus dorsi
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State the origin, insertion, action, innervation and arterial supply of the latissimus dorsi muscle.
- Origin: spinous processes of T7-L5, crests of sacrum and ilium
- Insertion: intertubercular sulcus (groove) of humerus
- Action: extend, adduct, medially rotate humerus at shoulder join, draw arm inferiorly & posteriorly, raises body toward arms (climbing)
- Innervation: thoracodorsal nerve
- Arterial supply: thoracodorsal artery
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State the origin, insertion, action, innervation and arterial supply of the levator scapulae.
- Origin: superior 4 or 5 cervical vertebrae
- Insertion: superior vertebral border of scapula
- Action: elevates scapula
- Innervation: dorsal scapular nerve
- Arterial supply: dorsal scapular artery
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State the origin, insertion, action, innervation, and arterial supply of the pectoralis major.
- Origin: clavicle (head), sternum, costal cartilages (sternocostal head)
- Insertion: intertubercular sulcus (groove) of humerus
- Action: adducts and medially rotates humerus at shoulder joint
- Innervation: lateral and medial pectoral nerves
- Arterial supply: pectoral branch of the thoracoacromial artery
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State the origin, insertion, action, innervation, and arterial supply of the pectoralis minor.
- Origin: ribs 2-5, or 3-5, or 2-4 (near costal cartilages)
- Insertion: coracoid process (of scapula)
- Action: abduct (protract) scapula, rotate it downward; elevates ribs (forced inhalation) when scapula is fixed
- Innervation: medial pectoral nerve
- Arterial suppy: lateral thoracic artery
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State the origin, insertion, action, innervation, and arterial supply of the rhomboid major.
- Origin: spinous processes of T2-T5
- Insertion: medial (vertebral) border of scapula inferior to spine
- Action: elevates and adducts (retracts) scapula; stabilizes scapula (fixes it to thoracic wall)
- Innvervation: dorsal scapular nerve
- Arterial supply: dorsal scapular artery
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State the origin, insertion, action, innervation, and arterial supply of the rhomboid minor.
- Origin: spinous processes of C7 and T1 and nuchal ligament
- Insertion: medial (vertebral) border of scapula superior to spine
- Action: elevates and adducts (retracts) scapula; stabilzes scapula (fixes it to thoracic wall)
- Innervation: dorsal scapular nerve
- Arterial supply: dorsal scapular artery
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State the origin, insertion, action, innervation and arterial supply of the serratus anterior.
- Origin: superior eight or nine ribs
- Insertion: vertebral border and inferior angle of scapula
- Action: abducts scapula and rotates it upward. "Boxer's muscle" because it is important in horizontal arm movements such as punching and pushing.
- Intervation: long thoracic nerve
- Arterial supply: lateral thoracic artery
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State the origin, insertion, action, innervation and arterial supply of the subclavius.
- Origin: 1st rib
- Insertion: clavicle
- Action: depresses clavicle and moves it anteriorly
- Innervation: subclavian nerve
- Arterial supply: clavicular branch of the thoracoacromial artery
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State the origin, insertion, action, innervation, and arterial supply of the trapezius.
- Origin: external occipital protuberance, superior nuchal line (occipital bone), nuchal ligament (ligamentum nuchae), and spinous processes of C7-T12
- Insertion: clavicle, acromion and spine of scapula
- Action: superior fibers elevate scapula and extend head, middle fibers adduct (retract) scapula, inferior fibers depress scapula
- Innervation: accessory nerve (CN XI)(motor) and cervical nerves (sensory)
- Arterial supply: transverse cervical artery
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What movement at the shoulder joint is a combination of flexion, extension, abduction, and adduction?
Circumduction
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What movement at the shoulder joint is a circular movement around the long axis of the bone at the joint?
Rotation
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What are the scapulohumeral muscles?
- Deltoid
- Supraspinatus
- Infraspinatus
- Teres minor
- Teres major
- Subscapularis
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State the origin, insertion, action, innervation, and arterial supply of the deltoid.
- Origin: acromial extremity of the clavicle, acromion and spine of scapula
- Insertion: deltoid tuberosity of humerus
- Action: entire muscle abducts arm at shoulder joint, anterior fibers flex and medially rotate arm, posterior fibers extend and laterally rotate arm
- Innervation: axillary nerve
- Arterial supply: thoracoacromial artery, deltoid branch
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State the origin, insertion, action, innervation, and arterial supply of the infraspinatus.
- Origin: infraspinous fossa of scapula
- Insertion: greater tubercle of humerus
- Action: laterally rotates arm at shoulder joint
- Innervation: suprascapular nerve
- Arterial supply: suprascapular artery
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State the origin, insertion, action, innervation, and arterial supply of the subscapularis.
- Origin: subscapular fossa of scapula
- Insertion: lesser tubercle of humerus
- Action: medially rotates arm at shoulder joint
- Innervation: upper and lower subscapular nerves
- Arterial supply: subscapular artery
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State the origin, insertion, action, innervation, and arterial supply for the supraspinatus.
- Origin: supraspinous fossa of scapula
- Insertion: greater tubercle (greater tuberosity) of humerus
- Action: assists deltoid with initial stages of abducting arm at shoulder joint, and continues to act throughout abduction
- Innervation: suprascapular nerve
- Arterial supply: suprascapular artery
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State the origin, insertion, action, innervation, and arterial supply of the teres major.
- Origin: inferior lateral border (angle) of scapula
- Insertion: intertubercular sulcus (groove) of humerus
- Action: adducts, medially rotates, and extends arm (dorsally) at shoulder joint
- Innervation: lower subscapular nerve
- Arterial supply: subscapular artery
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State the origin, insertion, action, innervation, and arterial supply of the teres minor.
- Origin: middle lateral border of scapula
- Insertion: greater tubercle of humerus
- Action: laterally rotates and adducts arm at shoulder joint
- Innervation: axillary nerve
- Arterial supply: subscapular artery (lateral circumflex scapular artery)
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What are the names of the muscles that comprise the rotator cuff?
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres minor
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What is the function of the rotator cuff?
Helps to life and rotate the arm, and to stabilize the ball of the shoulder within the joint.
-
Where do the majority of the muscles of the rotator cuff insert?
- Greater tuberosity of the humerus.
- Subscapularis inserts on the lesser tuberosity.
-
What feature marks the beginning of the axillary artery?
It begins at the lateral border of the 1st rib as the continuation of the subclavian artery.
-
What feature marks the termination of the axillary artery?
When it passes the inferior border of the teres major and reaches the humerus, it becomes the brachial artery.
-
What is the sequence of vessels that branch off the axillary artery?
- Superior thoracic artery
- Thoracoacromial artery
- Lateral thoracic artery
- Subscapular artery
- Anterior circumflex humeral artery
- Posterior circumflex humeral artery
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What nerve innervates most or all of the muscles in the anterior arm?
Musculocutaneous nerve
-
What nerve innervates most or all of the muscles in the anterior forearm?
Median nerve
-
What nerve innervates most or all of the muscles in the posterior arm?
Radial nerve
-
What nerve innervates most or all of the muscles in the posterior forearm?
Deep radial nerve (posterior interosseous nerve)
-
What does the motor portion of the musculocutaneous nerve innervate?
Flexors of the arm (biceps brachii and brachialis muscles)
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What is the terminus of the musculocutaneous nerve?
Lateral antebrachial cutaneous nerve (cutaneous part)
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Which nerve of the brachial plexus is the smaller branch of the posterior division, travels with the posterior circumflex artery, and distributes to the deltoid and teres minor muscles?
Axillary nerve
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Which nerve of the brachial plexus innervates the pectoralis major muscle, originates from the lateral cord, and is an infraclavicular nerve?
Lateral pectoral nerve
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Which nerve of the brachial plexus innervates the pectoralis minor and part of the pectoralis major, originates from the medial cord, and is an infraclavicular nerve?
Medial pectoral nerve
-
Which nerve of the brachial plexus is formed by contributions from the lateral and medial cords?
Median nerve
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Which nerve of the brachial plexus supplies all the muscles of the posterior compartment of the arm (triceps brachii, anconeus, brachioradialis, extensor muscles)?
Radial nerve
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Which nerve of the brachial plexus supplies the latissimus dorsi, and is an infraclavicular nerve?
Thoracodorsal nerve
-
Which nerves of the brachial plexus are supraclavicular nerves?
- Dorsal scapular nerve
- Long thoracic nerve
- Nerve to the subclavius
- Suprascapular nerve
-
Which nerves of the brachial plexus are infraclavicular nerves?
- Medial & lateral pectoral nerves
- Medial brachial & medial antebrachial cutaneous nerves
- Subscapular nerves (three)
-
What is the cutaneous terminus of the axillary nerve (brachial plexus)?
Superior lateral cutaneous nerve (axillary cutaneous branch)
-
What is the cutaneous terminus of the musculocutaneous nerve (brachial plexus)?
Lateral antebrachial cutaneous nerve
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What is the cutaneous terminus of the radial nerve (brachial plexus)?
- Posterior brachial cutaneous nerve
- Posterior antebrachial cutaneous nerve
- Inferior lateral brachial cutaneous nerve
-
Where is the quadrangular space located?
Posterior axilla
-
What are the contents of the quadrangular space?
- Axillary nerve
- Posterior circumflex humeral artery
- Posterior circumflex humeral vein
-
What nerves pass through the arm without innervating any muscles of the arm?
-
Name the muscles in the anterior compartment of the arm. Name the nerve that supplies them.
- Biceps brachii
- Brachialis
- Coracobrachialis
- Innervated by the musculocutaneous nerve.
-
Name the muscles in the posterior compartment of the arm. Name the nerve that supplies them.
- Triceps brachii
- Anconeus
- Innervated by the radial nerve.
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State the origin, insertion, action, innervation, and arterial supply of the anconeus muscle.
- Origin: lateral epicondyle of humerus
- Insertion: olecranon of ulna
- Action: extends forearm at elbow joint (assists triceps and stabilizes elbow joint)
- Innervation: radial nerve
- Arterial supply: deep brachial artery
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State the origin, insertion, action, innervation, and arterial supply of the brachialis (anterior compartment).
- Origin: humerus
- Insertion: ulnar tuberosity and coronoid process of ulna
- Action: flexes forearm at elbow joint (major flexor of elbow)
- Innervation: musculocutaneous nerve
- Arterial supply: brachial artery
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State the origin, insertion, action, innervation, and arterial supply of the biceps brachii (anterior compartment).
- Origin: long head-supraglenoid tubercle of scapula, short head-coracoid process of scapula
- Insertion: tuberosity of radius (radial tuberosity) and bicipital aponeurosis
- Action: flexes forearm at elbow joint, supinates forearm (@ radioulnar joint), and flexes arm at shoulder joint (also powerful supinator)
- Innervation: musculocutaneous nerve
- Arterial supply: brachial artery
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State the origin, insertion, action, innervation, and arterial supply of the coracobrachialis (anterior compartment).
- Origin: coracoid process of scapula
- Insertion: shaft of humerus
- Action: flexes and adducts arm at the shoulder joint
- Innervation: musculocutaneous nerve
- Arterial supply: brachial artery
-
State the origin, insertion, action, innervation, and arterial supply of the triceps brachii (posterior compartment).
- Origin: long head-infraglenoid tubercle of scapula, lateral head-humerus (lateral & posterior surface, inferior to radial groove), medial head-humerus (posterior surface of humerus inferior to radial groove)
- Insertion: olecranon of ulna
- Action: extends forearm at elbow joint, extends arm at shoulder joint
- Innervation: radial nerve
- Arterial supply: brachial artery (also deep brachial artery)
-
What muscle of the arm is located posteriorly, originates on the lateral epicondyle, inserts on the upper posterior surface of the ulna, and assists the triceps brachii in extension of the forearm at the elbow joint?
Anconeus (posterior compartment)
-
Which muscles, or heads of muscles, have action at the shoulder joint?
- Pectoralis major
- Latissimus dorsi
- Deltoid
- Supraspinatus
- Infraspinatus
- Teres minor
- Teres major
- Subscapularis
-
Which muscles, or heads of muscles, have action at the elbow joint?
- Biceps brachii
- Brachialis
- Triceps brachii
- Anconeus
- Brachioradialis
- Pronator teres
-
What term is used to describe an incomplete or partial dislocation of a joint or organ?
Subluxation
-
What injury is commonly encountered in the pediatric population, peaks in age range of 2-3 years, is more common in girls than boys, and affects the left side more than the right?
Nursemaid's elbow (subluxation of radial head)
-
How does subluxation of the radial head (aka Nursemaid's elbow) occur/what is the mechanism of injury?
- Sudden longitudinal traction on the arm with the elbow extended (child is suddenly lifted and swing by arms in play, child lifts legs while holding parent's hands).
- Radial head moves distally, partially out of the anular ligament and sudden pain is caused by the pinched anular ligament.
-
What are the general functions of muscles that are in the anterior compartment of the forearm?
flexors and pronators
-
What are the general functions of muscles that are in the posterior compartment of the forearm?
extensors and supinators
-
What muscles are part of the deep anterior (flexor) compartment of the forearm?
- Flexor pollicis longus
- Flexor digitorum profundus
- Pronator quadratus
-
What muscles are part of the deep posterior (extensor) compartment of the forearm?
- Supinator
- Abductor pollicis longus
- Extensor pollicis brevis
- Extensor pollicis longus
- Extensor indicis
-
What muscles are part of the superficial anterior (flexor) compartment of the forearm?
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor carpi ulnaris
- Flexor digitorum superficialis
-
What muscles are part of the superficial posterior (extensor) compartment of the forearm?
- Brachioradialis
- Extensor carpi radialis longus
- Extensor carpi radialis brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
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State the origin, insertion, action, innervation and arterial supply of the abductor pollicis longus.
- Origin: posterior radius and ulna (interosseous membrane)
- Insertion: base of thumb (1st metacarpal)
- Action: abducts and extends thumb
- Innervation: deep radial nerve
- Arterial supply: posterior interosseous artery
-
State the origin, insertion, action, innervation and arterial supply of the brachioradialis.
- Origin: humerus
- Insertion: radius (styloid process)
- Action: flexes forearm at elbow; supinates and pronates forearm (back to neutral) "beer drinker muscle"
- Innervation: radial nerve
- Arterial supply: radial artery (recurrent)
-
State the origin, insertion, action, innervation and arterial supply of the extensor carpi radialis brevis.
- Origin: lateral epicondyle of humerus via common extensor tendon
- Insertion: radial posterior hand (posterior side of base of 3rd metacarpal)
- Action: extends and abducts hand at wrist joint (radial deviation)
- Innervation: deep radial nerve
- Arterial supply: radial artery
-
State the origin, insertion, action, innervation and arterial supply of the extensor carpi radialis longus.
- Origin: distal humerus
- Insertion: radial posterior hand (posterior side of base of 2nd metacarpal)
- Action: extends and abducts hand at wrist joint (radial deviation)
- Innervation: radial nerve
- Arterial supply: radial artery
-
State the origin, insertion, action, innervation and arterial supply of the extensor carpi ulnaris.
- Origin: lateral epicondyle of humerus via common extensor tendon
- Insertion: ulnar posterior hand (posterior side of base of 5th metacarpal)
- Action: extends and adducts hand at wrist joint (ulnar deviation)
- Innervation: deep radial nerve
- Arterial supply: ulnar artery
-
State the origin, insertion, action, innervation and arterial supply of the extensor digiti minimi.
- Origin: lateral epicondyle of humerus via common extensor tendon
- Insertion: phalanx of little finger (extensor expansion of 5th digit)
- Action: extends 5th digit
- Innervation: deep radial nerve
- Arterial supply: interosseous recurrent artery
-
State the origin, insertion, action, innervation and arterial supply of the extensor digitorum.
- Origin: lateral epicondyle of humerus via common extensor tendon
- Insertion: phalanges of digits 2-4 or 2-5 (extensor expansions of medial four digits)
- Action: extends digits 2-4 or 2-5
- Innervation: deep radial nerve
- Arterial supply: anterior and posterior interosseous arteries
-
State the origin, insertion, action, innervation and arterial supply of the extensor indicis.
- Origin: ulna (and interosseous membrane)
- Insertion: index finger (extensor expansion of 2nd digit)
- Action: extends 2nd digit (helps extend hand)
- Innervation: deep radial nerve
- Arterial supply: posterior interosseous artery
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State the origin, insertion, action, innervation and arterial supply of the extensor pollicis brevis.
- Origin: posterior radius (and interosseous membrane)
- Insertion: proximal phalanx of thumb
- Action: extends thumb
- Innervation: deep radial nerve
- Arterial supply: posterior interosseous artery
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State the origin, insertion, action, innervation and arterial supply of the extensor pollicis longus.
- Origin: posterior ulna (and interosseous membrane)
- Insertion: distal phalanx of thumb
- Action: extends thumb
- Innervation: deep radial nerve
- Arterial supply: posterior interosseous artery
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State the origin, insertion, action, innervation and arterial supply of the flexor carpi radialis.
- Origin: medial epicondyle of humerus
- Insertion: radial anterior hand (anterior side of bases of 2nd and 3rd metacarpals)
- Action: flexes and abducts hand at wrist (radial deviation)
- Innervation: median nerve
- Arterial supply: ulnar artery, radial artery
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State the origin, insertion, action, innervation and arterial supply of the flexor carpi ulnaris.
- Origin: humeral head-medial epicondyle of humerus via common flexor tendon, ulnar head-olecranon and posterior border of ulna
- Insertion: ulnar anterior hand carpals (pisiform, hook of hamate, base of 5th metacarpal)
- Action: flexes and adducts hand at wrist (ulnar deviation)
- Innervation: ulnar nerve
- Arterial supply: ulnar artery
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State the origin, insertion, action, innervation and arterial supply of the flexor digitorum profundus.
- Origin: ulna and interosseous membrane
- Insertion: anterior surface of digits 2-5 (distal phalanx)
- Action: flexes fingers at distal phalanges and assists with flexion of hand
- Innervation: median and ulnar nerves
- Arterial supply: ulnar artery (also anterior interosseous artery)
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State the origin, insertion, action, innervation and arterial supply of the flexor digitorum superficialis.
- Origin: medial epicondyle of humerus via common flexor tendon (and also the upper radius and upper ulna)
- Insertion: anterior surface of the middle phalanges or the fingers (digits 2-5)
- Action: flexes fingers, flexes hand at wrist
- Innervation: median nerve
- Arterial supply: ulnar artery, radial artery
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State the origin, insertion, action, innervation and arterial supply of the flexor pollicis longus.
- Origin: radius and interosseous membrane
- Insertion: distal phalanx of thumb
- Action: flexes distal phalanx of thumb
- Innervation: median nerve
- Arterial supply: anterior interosseous artery <??
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State the origin, insertion, action, innervation and arterial supply of the palmaris longus.
- Origin: medial epicondyle of humerus via the common flexor tendon
- Insertion: flexor retinaculum and palmar aponeurosis
- Action: flexes hand at wrist and tightens palmar aponeurosis
- Innervation: median nerve
- Arterial supply: ulnar artery
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In what compartment are pronators found? In what compartment are supinators found?
- Pronators: anterior
- Supinators: posterior
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State the origin, insertion, action, innervation and arterial supply of the pronator quadratus.
- Origin: ulna (distal shaft)
- Insertion: radius (distal shaft)
- Action: pronates forearm (at radioulnar joint)
- Innervation: median nerve
- Arterial supply: <<>>
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State the origin, insertion, action, innervation and arterial supply of the supinator.
- Origin: humerus (lateral epicondyle) and ulna (proximal portion)
- Insertion: proximal radius
- Action: supinates forearm
- Innervation: deep radial nerve
- Arterial supply: <<>>
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Describe the test for ability to flex the distal interphalangeal joint. What muscle does this test? What nerve does this test when applied to the second and third digits? What nerve does this test when applied to the fourth and fifth digits?
- Examiner holds middle phalanx in full extension, which isolates the flexor digitorum profundus, and patient actively flexes the distal phalanx.
- Assesses for muscle function and median nerve function.
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What tendon is found within the Y-shaped split of the flexor retinaculum?
Tendon of the flexor carpi radialis
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What structure forms the anterior wall of the carpal tunnel? What forms the posterior wall of the carpal tunnel?
- Anterior: flexor retinaculum
- Posterior: carpal bones (scaphoid, trapezium bones, hamate and pisiform)
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List the structures within the carpal tunnel.
- Tendons of the flexor pollicis longus, flexor digitorum superficialis, flexor digitorum profundus muscles.
- Median nerve.
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Which digits of the hand are supplied by the terminal sensory branches of the median nerve?
2-4 (M)
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What causes carpal tunnel syndrome? What nerve is involved?
Results from any lesion that significantly reduces the size of the carpal tunnel (fluid retention, infection, excessive exercise of fingers).
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What specific portion of the nerve that is generally involved with carpal tunnel syndrome is in fact not involved, and why is it not?
The palmar cutaneous branch of the median nerve remains unaffected because it arises proximal to the carpal tunnel and does not pass through it.
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Which digits of the hand exhibit hypoesthesia or anesthesia with carpal tunnel syndrome? Which digits do not?
- Lateral three and one half digits (thumb and fingers in the middle).
- Medial one and one half digits will be unaffected.
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Does the palm of the hand exhibit hypoesthesia or anesthesia with carpal tunnel syndrome?
NO
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What nerve running through the wrist is not involved with carpal tunnel syndrome?
Palmar cutaneous branch of the median nerve.
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Name the muscles of the thenar compartment.
- Abductor pollicis brevis
- Flexor pollicis brevis
- Opponens pollicis
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Name the muscles of the hypothenar compartment.
- Abductor digiti minimi
- Flexor digiti minimi brevis
- Opponens digiti minimi
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State the origin, insertion, action, innervation and arterial supply of the abductor pollicis brevis.
- Origin: flexor retinaculum, scaphoid, and trapezium
- Insertion: lateral side of proximal phalanx of thumb
- Action: abducts thumb (helps oppose it)
- Innervation: median nerve
- Arterial supply: radial artery
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State the origin, insertion, action, innervation and arterial supply of the flexor pollicis brevis.
- Origin: flexor retinaculum, scaphoid, and trapezium
- Insertion: lateral side of proximal phalanx of thumb
- Action: flexes thumb
- Innervation: median and ulnar nerves
- Arterial supply: radial artery
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State the origin, insertion, action, innervation and arterial supply of the opponens pollicis.
- Origin: flexor retinaculum, scaphoid, and trapezium
- Insertion: lateral 1st metacarpal
- Action: draws 1st metacarpal medially to oppose little finger toward center of palm
- Innervation: median nerve
- Arterial supply: radial artery
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State the origin, insertion, action, innervation and arterial supply of the adductor pollicis.
- Origin: 2nd and 3rd metacarpals
- Insertion: medial side of proximal phalanx of thumb
- Action: draws 1st metacarpal medially toward center of palm (adducts thumb)
- Innervation: ulnar nerve
- Arterial supply: radial artery
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What muscle of the thumb is deeply placed, fan-shaped, moves the thumb to the palm of the hand giving power to the grip?
Adductor pollicis (located in adductor compartment NOT thenar)
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State the origin, insertion, action, innervation and arterial supply of the abductor digiti minimi.
- Origin: pisiform
- Insertion: medial side of proximal phalanx of little finger
- Action: abducts (and flexes) little (5th) finger
- Innervation: ulnar nerve
- Arterial supply: ulnar artery
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State the origin, insertion, action, innervation and arterial supply of the flexor digiti minimi brevis.
- Origin: flexor retinaculum and hamate (hook of hamate)
- Insertion: medial side of proximal phalanx of little finger
- Action: flexes little (5th) finger
- Innervation: ulnar nerve
- Arterial supply: ulnar artery
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State the origin, insertion, action, innervation and arterial supply of the opponens digiti minimi.
- Origin: flexor retinaculum and hamate (hook of hamate)
- Insertion: medial 5th metacarpal
- Action: draws 5th metacarpal anteriorly, bringing little finger (5th digit) into opposition with thumb
- Innervation: ulnar nerve
- Arterial supply: ulnar artery
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State the origin, insertion, action, innervation and arterial supply of the dorsal interossei.
- Origin: adjacent sides of two metacarpals (bipennate muscles)
- Insertion: proximal phalanges of digits 2-4
- Action: abduct digits; extend fingers (acting with lumbricals)
- Innervation: ulnar nerve
- Arterial supply: ulnar artery
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State the origin, insertion, action, and innervation of the lumbrical muscles.
- Origin: distal portion of flexor digitorum profundus tendons
- Insertion: distal portion of extensor digitorum tendons
- Action: flexes and extends fingers
- Innervation: median and ulnar nerves
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State the origin, insertion, action, innervation and arterial supply of the palmar interossei.
- Origin: palmar surfaces of metacarpals
- Insertion: digits 2,4 and 5
- Action: adducts and flexes fingers (acting with lumbricals)
- Innervation: ulnar nerve
- Arterial supply: palmar metacarpal arteries
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What is the general location of the anatomical snuff box?
Posterior lateral on the hand just superior to the thumb.
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What specific tendons mark the boundaries for the anatomical snuff box?
- Abductor pollicis longus tendon
- Extensor pollicis brevis tendon
- Extensor pollicis longus tendon
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What are the contents of the anatomical snuff box?
- Radial artery (floor)
- Radial styloid process, base of 1st metacarpal
- Scaphoid and trapezium (floor)
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What arteries furnish blood supply to the hand? What arteries form the superficial palmar arch? What arteries form the deep palmar arch?
- Radial and ulnar arteries
- Superficial branch of the ulnar artery
- Deep branch of the ulnar artery
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