Exam 2 Flashcards
(144 cards)
1
Q
Shoulder muscles group
A
- ) Trapezius
2) Rhomboid Major and Minor - ) Levator Scapula
- ) Latissimus Dorsi
2
Q
Trapezius Palsy (weakness of the muscle)
A
A deepening of the shoulder. The shoulder drops on the affected side
3
Q
Whiplash
A
The superior portion of the muscle (trapezius) is frequently involved in neck injuries during an auto accident.
4
Q
Cranial Nerve XI test (clinical notes with the trapezius)
A
Have the patient eleventh their shoulders (shrug) against resistance and both sides should be tested at the same time so weakness of one side can be evaluated relative to the other side.
5
Q
Damage to the Dorsal Scapular nerve or C5
A
Symptoms:
- ) Difficulty in completely adducting the scapula
- ) Scapula on the affected side is further from the midline
6
Q
Latissimus Dorsi Borders
A
The Teres major and the Latissimus Dorsi help form the posterior fold or border of the axilla.
7
Q
Weakness or damage to the Latissimus dorsi
A
Symptoms:
-Results in forward displacement of the humerus at the shoulder joint.
8
Q
Lumbar triangle
A
It’s a depression at the lower portion of the Latissimus Dorsi. It is bounded by the Latissimus Dorsi, crest of the ilium, and external oblique muscles.
Also Hernias pop up here!
9
Q
Triangle of Auscultation
A
A depression found at the superior border of the Latissimus dorsi. It’s bounded by the Latissimus dorsi, trapezius, and vertebral border of the scapula
Clinical: listening to lungs
10
Q
What is the muscle connecting the thoracic wall to the upper extremity?
A
The Serratus Anterior
11
Q
Long Thoracic Nerve Palsy (winged scapula)
A
A condition in which the serratus anterior muscle is weakened due to damage to the long thoracic nerve or its segmental innervation. The patient would have a some difficulty of keeping the vertebral border and inferior angle of the scapula against the posterior thoracic wall when carrying out abduction against resistance.
Causes of the condition include:
- ) trauma/subluxation
- ) traction injuries involving the shoulder joint
- ) recumbents for a long period of time
12
Q
Rotator cuff muscles
A
Supraspinatus, infraspinatus, subscapularis, and Teres minor
Muscles must contribute to forming a cuff around the proximal part of the humerus and that they must participate in either lateral or medial rotation of the humerus.
13
Q
Crutch Paralysis (atrophy of the deltoid)
A
This is an injury to the axillary nerve.
Causes of this conditions include:
- ) Fracture at the surgical neck of the humerus
- ) Dislocation of the shoulder joint
- ) Pressure of a crutch in the axilla
Loss of sensation may occur over the LATERAL ASPECT OF THE ARM
Abduction of the arm is greatly impaired
14
Q
Rotator Cuff Tendonitis
A
Irritation and inflammation fo the supraspinatus tendon and is one of the MOST COMMON causes of shoulder pain, which is also known as shoulder impingement syndrome.
Occurs in the anterior and/or lateral aspect of the shoulder
Common causes:
- ) Genetic (hooked acromion process)
- ) weakness around the rotator cuff which compress the tendons of the cuff
- ) Excess stress and repetition
- ) Trauma/injury
- ) Calcium deposits (COMMON in the elderly)
15
Q
Rotator Cuff Tears
A
When the tendon is weakened by a combo of multifactorial conditions:
- ) age
- ) repeated episodes of trauma
- ) steroid injections
Usually ruptures at or near its insertion and the tear may be partial or complete
Patients will have difficulty carrying out abduction of the arm
To confirm the injury you use the DROP Test
16
Q
Bursitis
A
Inflammation of the bursa that separates the tendon from the acromion process (subdeltoid and subarcomial)
Typically more common than tendonitis but can be difficult to distinguish from one another.
17
Q
Posterior wall fo the axilla
A
Latissimus Dorsi and Teres major help form this
18
Q
Quadrilateral space (Teres Major)
A
The more lateral of the two spaces contains the axillary nerve and numerical circumflex blood vessels
19
Q
Triangular space (Teres major)
A
The more medial of the spaces and contains the circumflex scapular branch of the subscapular artery
20
Q
Extrinsic Ligaments (extracapsular)
A
Are found superficial to the capsular ligament
21
Q
Intrinsic ligaments (intracapsular)
A
Are found deep to the capsular ligament
22
Q
Anterior and Posterior Sternoclavicular ligament
A
Joint: SC
Extrinsic
Wall
Function:
- ) reinforce the capsular ligament
- ) prevent excessive forward/ protraction (anterior movement)
- ) prevent excessive backward/ retraction (posterior movement)
23
Q
Interclavicular ligament
A
Joint: SC
Extrinsic
Rope
Function:
1.) Prevent displacement of the clavicle when one carrying a heavy object
Attachment:
1.) sternal ends of both clavicles
24
Q
Costoclavicular ligament
A
Joint: SC
Extrinsic
Rope
Function:
1.) reinforces the capsular ligament and limits elevation at eh medial end fo the clavicle (as when one hanger by their limbs)
Attachment:
1.) Strong ligament-attached to the costal impression of the clavicle and the first rib
25
Superior and inferior acromioclavicular ligament
Joint: AC
Extrinsic
Rope
Function:
1. ) reinforce the capsular ligament
2. ) Prevents the clavicle from losing contact with the acromion process
26
Coracoclavicular ligament
Joint: AC
Extrinsic
Rope
Function:
1. ) Divided into a confident and trapezoid portion
2. ) Largely responsible for holding and suspending the weigh of the scapula from the clavicle
3. ) Limits protraction, elevation and rotation of the scapula
Attachment:
1. ) connects the clavicle with the coracoid process fo the scapula
2. ) Attached respectively to the confidence tubercle and trapezoid line of the clavicle
27
Capsular ligament
Joint: shoulder
Function:
1.) surrounds the joint, opening for long head of the biceps brachial to pass out of the joint cavity
28
Glenohumeral ligament
Joint: shoulder
Intrinsic
Rope
Function:
1. ) Strengthens the anterior aspect of the capsule
2. ) Helps prevent lateral rotation of the humerus at the shoulder joint
Attachment:
1.) found within the shoulder joint cavity
29
Transverse humeral ligament
Joint: shoulder
(Extrinsic)
(Wall)
Function:
1.) Keeps the long head of the biceps brachii in place
Attachment:
1.) Spans the intertubercular groove, converting it into a canal
30
Coracohumeral ligament
Joint: shoulder
Extrinsic
Rope
Function:
1. ) Strengthens the capsule from above
2. ) Limits lateral rotation of the humerus
31
Coracoacromial ligament
Joint: shoulder
Extrinsic
Wall
Function:
1.) prevents upward displacement of the head of the humerus
Attachment:
1.) Attaches to the coracoid process and acromion process of the scapula
32
Suprascapular Ligament
Joint: shoulder
Accessory
Function:
1. ) Small ligament which spans the scapular notch
2. ) Converts scapular notice into a tunnel
33
Sternoclavicular joint
The most stable joint of the upper extremity
Articulations:
1. ) sternal end of the clavicle
2. ) clavicular and costal notches of the sternum (manubrium)
3. ) Medial end of the first rib
34
Acromioclavicular Joint
Classified as a plane gliding joint
The capsular ligament is thin and weak an cannot maintain the integrity of the joint without reinforcing ligaments
Nerve supply is the dorsal scapular, suprascapular and axillary nerves
35
Shoulder or Glenohumeral Joint
This joint as the greatest range of motion, which makes it very unstable
Articulations of the joint are the head of the humerus with the glenoid cavity of the scapula
Joint is classified as a ball and socket joint
Nerve supply is the axillary and suprascapular nerves
36
biceps brachii
Is considered the “three joint muscle” since it can cause movements at the elbow, shoulder and proximal radio-ulnar joints
37
Biceps Tendonitis
Irritation of the tendon through the intertubercular groove which is enclosed in the synovial sheath.
38
Rupture of the long head of the biceps tendon
The tendon is usually torn or ruptured near its attachment on the supraglenoid tubercle
No avulsion fracture
Forceful flexion of the forearm against excessive resistance can rupture the tendon
39
Bicipital reflex
Tap the biceps tendon and looks for a simple reflex of flexion at the elbow joint. This test for the segmental innervation of C5 and C6
40
Dislocation of Acromioclavicular Joint (shoulder separation)
Grade 3 dislocation occurs with both the acromioclaviular and coracoclavicular ligaments are ruptured and the clavicle will separate from the scapula.
The acromion sticks out the most during this injury.
41
Shoulder joint dislocation
The most common type is anterior dislocations and take place at the inferior aspect of the capsular ligament.
Typically caused by excessive extension and lateral rotation of the humerus.
Patients may complain of loss of sensation and numbness along the lateral aspect of the arm AND forearm, due to injury of the musculocutaneous and axillary nerves.
42
Clinical aspects of the triceps brachii
If the muscle is atrophied, passive extension can be produced by gravity, but such extension is uncontrolled and lacks stability
The segmental innervation of the muscle (C7 and C8) can be tested by tapping the muscles tendon of insertion.
43
Brachial artery
The main arterial supply to the arm
It divides at the cubical fossa into its two terminal branches
- Ulnar artery
- Radial artery
It is superficial through most of its course in the arm and a pulse of the artery can be taken in the bicipital furrow.
44
Deep brachial artery (brachial profundus)
First major branch and begins just distal to the Teres major muscle
It accompanies the radial nerve and supplies the posterior aspect of the arm.
This vessel brings the axillary artery into communication with the radial artery.
45
Superior and inferior ulnar collaterals
Vessels are given off at the distal medial aspect of the brachial artery.
They take part hint he arterial anastomoses around the medial aspect of the elbow joint.
46
What is found to take blood pressure
Brachial artery
47
Systolic pressure
As the pressure in the cuff is slowly released, blood flow resumes and is audible through a stethoscope
48
Diastolic pressure
As the pressure is released even further, the point at which the sound can no longer be heard
49
What are the main reasons why the brachial artery is used to take blood pressure?
1. ) approximately at the level of the heart
| 2. ) muscle mass of the arm can effectively transmit the pressure in the cuff to the blood vessels
50
Cutaneous (superficial) veins of the upper extremity
These are the veins which descend up the extremity and are located in the subcutaneous tissue of the extremity
They are large and easily accessible for various clinical procedures
- Dorsal venous arch
- cephalic vein
- basilic vein
- median cubical vein
51
Dorsal venous arch
The prominent venous arch on the back of the hand and from which respective cutaneous veins arise
52
Cephalic vein
Comes off the lateral aspect of the dorsal venous arch and continues proximally in the lateral aspect of the forearm and arm, where it terminates and drains into the axillary vein
53
Basilic Vein
Comes off the medial aspect of the dorsal venous arch and continues proximally in the medial aspect of the forearm and arm, where it joins the brachial veins to form the axillary vein.
54
Medial cubical vein
The most prominent cutaneous vein of the body and is formed from branches given off by both the cephalic and basilic veins
Sampling of blood is taken here
The bicipital aponeurosis of the biceps brachii muscle protects this structure.
55
Musculocutaneous Nerve
This structure is rarely injured because its protected by the biceps brachii muscle
Injury is usually due to a direct wound in the axilla or dislocation of the shoulder joint (ant. Dislocation)
If the structure is injured the ANTERIOR arm will atrophy, but weak flexion at the elbow joint is still possible
Maybe loss of sensation along the lateral aspect of the forearm SINCE the lateral antebrachial cutaneous nerve is a branch of this nerve.
56
Cubital fossa
Depression found at the anterior aspect of the elbow
This is where many nerves and vessels enter the forearm
57
Lateral border of the cubital fossa
Brachioradialis muscle
58
Medial border of the cubital fossa
Pronator Teres muscle
59
Proximal border of the cubital fossa
Level of the epicondyles of the humerus
60
Structures found in the cubital fossa include
- median nerve
- brachial artery
- tendon of the biceps brachii
- median cubital vein
61
Elbow complex
It includes the elbow joint and the proximal radio-ulnar joint
Considered to be apart of this complex because:
1. ) radius and ulna are common articulating surfaces
2. ) the joint cavity for the elbow is continuous with the joint cavity of the proximal radio-ulnar joint
3. ) the ligaments associated with the elbow joint are continuous and part of the proximal radio-ulnar joint
62
Elbow joint
Joint is classified as a hinge/ginglymus
the nerve supply to the joint is from the musculocutaneous, radial, median, and ulnar
Very stable hinge
Strengthened by strong collateral ligaments
63
Capsular ligament
Joint: Elbow
Permits maximum flexion and extension; limits medial and lateral movements
No direct attachment on the radius
64
Medial or ulnar collateral
Joint: elbow
Prevents abduction
Extrinsic
Rope
65
Lateral or radial collateral ligament
Joint: elbow
Ligament prevent adduction
Extrinsic
Rope
66
Annular ligament
Joint: elbow
Keeps head of the radius in place
Extrinsic
Wall
67
Dislocation of the elbow joint
Posterior dislocations of this joint are common
These types of dislocations may be accompanied by fractures, torn ligaments, and injury to the ulnar nerve
68
Injury to the ulnar nerve due to elbow dislocations
Patient will complain of parenthesis in the area of the 5th digit. They also may notice weakened flexion and abduction of the hand at the wrist joint.
The nerve maybe injured by:
1. ) being stretched or lacerated at time of dislocation
2. ) may become entrapped in scar tissue as the torn ligament heals
3. ) may become entrapped in new bone formation
69
Cubital Valgus
An increase in the angle that is considered abnormal
70
Proximal (superior) radio-ulnar joint
Classified as a pivot/trochoid joint, where only rotational movement is possible
Supination most limited
Only specific to the joint
- interosseous membrane
- oblique cord
71
Nursemaid’s elbow (subluxation of the head of the radius)
One of the MOST COMMON musculoskeletal injuries see in preschool children
This movement may tear the annular ligament or pull the head of the radius from under the annular ligament
Symptoms:
1. ) very painful
2. ) extremity is held limply at the side
3. ) palpation reveals tenderness at the radial head
4. ) supination of the forearm causes increased pain
72
Radius
This is a pivot bone which moves during pronation and supination
73
Ulna
This bone does not take part of articulation of the wrist joint since there is a piece of cartilage called the articular disc
It is also the stabilizing bone of the forearm
74
Ossification of the radius and ulna
3 ossification centers
```
A primary center (shaft)
Secondary centers (one for the distal and proximal end)
```
75
Radius ossification
First appears Fusion of the shaft
Distal= 1-2 years. 20-24 years
Proximal=4-7 years. 14-17 years
76
Ulna ossification
First appears. Fusion with shaft
Distal=4-7 years. 20-24 years
Proximal=9-11 years. 14-17 years
77
Fractures of the radius/ulna
Usually due to severe and direct trauma and produce a transverse fracture to the shaft or both bones
Pronation and supination may be impaired
78
Colles fracture
A fracture at the distal end of the radius and is one of the MOST COMMON fractures in adults, especially in women over the age of 50
A typical sign is referred to dinner fork deformity because a posterior angulation occurs in the forearm
79
Smith’s fracture
Occurs at the distal end of the radius
Is due to a fall on the back of the hand is basically a reverse colles fracture, with the distal fragment displaced anteriorly
80
Sequence of ossification of the carpal bones
- capitate and hamate
- triquetral
- lunate
- trapezium, trapezoid, and scaphoid
- pisiform
Ossification is completed by 14-16 years of age
The hand reveals the skeletal age
81
Seasmoid bones
Embedded in some of the flexor tendon of the hand
In the hand they are most constant over the MP joints of digit one, two, five and the IP joint of the first digit
Function:
1. ) to protect and stabilize tendons
2. ) change the angle of the tendons as they pass to their insertion (increase leverage)
82
Fractures of the scaphoid
MOST COMMONLY fractured carpal bones which often happens from a fall on the palm with the hand hyperextended
Commonly mistaken for a sprained wrist (lateral aspect)
Tenderness and swelling in the anatomical snuffbox
83
Fractures of the hamate
The ulnar nerve is close to the hook and may be injuries during this type of fracture
84
Boxer’s fracture
A fracture of the 5th metacarpal occurs when an individual punches someone with a closed fist.
85
Fractures of the phalanges
Are usually due to crushing injuries (ex: finger caught in door). Fracture of the distal phalanx may result in painful hematomas. Avulsion fractures associated with extensors and flexor tendons are common.
86
Origin is the medial epicondyle of the humerus
What they have in common:
- pronator Teres
- Palmaris longus
- flexor carpi radialis
- flexor capri ulnaris
87
Pronator Teres syndrome
Compression of the median nerve in the proximal forearm. Nerve is compressed between the head of pronator teres.
Causes:
- direct trauma
- excessive pronation and supination
88
Flexor carpi radialis
This muscle can be used as a guide for finding the radial artery.
89
Ulnar Deviation
Weakness of the flexor capri radialis can cause abnormal type of flexion of the hand at the wrist joint
90
Palmaris longus
This muscle is a useful landmark when present for identifying the median nerve
91
Radial deviation
When their is weakness of the flexor carpi ulnaris it results in abnormal type of flexion of the hand at the wrist joint known as radial deviation.
92
Flexor digitorum superficialis
This is the only muscle that is located in the intermediate layer of the anterior forearm
93
Median nerve damage
Compression or injury to the _______ nerve can occur at the proximal part of the forearm (pronator teres syndrome) or at the distal part of the forearm (carpal tunnel syndrome)
Can cause the following problems:
1. ) loss or weakened pronation
2. ) abnormal and weak flexion at the wrist joint (ulnar deviation)
3. ) weakened abduction of the hand
4. ) atrophy of the Thenar muscles (ape hand)
5. ) sensory loss over the lateral 2/3 of the palmar surface of the hand
94
Carpal tunnel syndrome
Compression or injury of the median nerve at the distal part of the forearm.
95
Ulnar nerve damage
When the nerve becomes compressed or injured at the proximal or distal aspect of the forearm.
Most common area of compression or injury is at or just distal to the elbow joint and injury here may cause atrophy of the flexor carpi ulnaris and half of the flexor digitorum profundus
May cause the following problems:
1. ) weakened adduction of the hand
2. ) radial deviation (abnormal flexion)
3. ) difficulty in making a fist (“claw hand”)
96
Guyon Tunnel or Canal syndrome
Compromise or damage of the ulnar nerve at the wrist joint, where it passes between the pisiform and hook of the hamate
Typically found in cyclists
97
Tennis elbow or lateral epicondylitis
This involves repetitive use of the superficial posterior forearm muscles. There is possible degeneration of the common tendon of origin.
Patient will point to pain at the lateral epicondyle of the humerus and may indicate that pain runs down the lateral aspect of the forearm
Inflammation or subluxation of C5 may also cause pain in this region
98
Mallet or Baseball finger
A condition in which there is a sudden, severe tension on one of the long extensor tendons, where it may avulsion at its attachment at the distal phalanx.
The deformity results from the distal IP joint being forced into extreme flexion
99
Anatomical snuffbox
when the thumb is extended and abducted, a depression appears between the tendons of the extensor pollicis longus medially and the tendons of the extensor pollicis breves and abductor pollicis longus laterally.
The floor is formed from the styloid process of the radius, scaphoid, and trapezium bones
A branch of the radial artery is found crossing this region.
100
DeQuervain’s Disease or Tenosynovitis Stenosans
A condition in which there is inflammation of the tendons of the abductor pollicis longus and the extensor pollicis breves within their common fibrous sheath
More common in women over 50
May be due to repetitive hand movements, which cause friction between the tendons
Patients will complain of pain at the lateral aspect of their wrist and may notice pain radiating.
101
Damage to the radial nerve
The _______ nerve supplies all of the muscles of the posterior aspect of the arm and forearm
Most common cause of injury is a fracture to the shaft of the humerus
The hand will drop into passive flexion, known as wrist drop
Sensory loss is not seen, UNLESS the superficial branch has been damaged
Damage to the superficial branch always shows sensory loss, BUT not motor loss
102
Radial artery
Is the more lateral terminal branch of the brachial artery
It descends along the lateral side of the forearm, where it is mostly covered by skin and fascia
103
Branches of the radial artery
It includes:
1. ) recurrent which runs proximally to the brachial profundus and takes part in collateral circulation around the lateral aspect of the elbow
2. ) unnamed muscular branch
3. ) superficial and deep palmar which join with smaller branches from the ulnar artery to form the superficial and deep palmar arches of the hand
104
Ulnar Artery
The medial branch of the brachial artery, which passes along the medial side of the forearm, where its deep to the flexor carpi ulnaris muscle
105
Branches of the ulnar artery
It includes:
1. ) Anterior and posterior recurrent which joins the ulnar collaterals of the brachial to form collateral circulation on the medial aspect of the elbow
2. ) common interosseous which arises for the proximal part of the artery. The common interosseous will than divide into an anterior and posterior interosseous artery, which descend upon the respective surfaces of the interosseous membrane
3. ) superficial and deep palmar which help form superficial and deep palmar arches
106
Radio-ulnar joint
Articulations of this joint are the head of the ulna and ulnar notch of the radius
The joint is classified as a pivot or trochoid
The nerve supply of the joint is the radial
107
Capsular ligament
Joint: radio-ulnar
Encloses the joint but is rather weak and may be deficient superiorly
108
Anterior and posterior transverse ligaments
```
joint: radio-ulnar joint
To strengthen the capsular ligament
Also prevents supination
Extrinsic
Rope
```
109
Articular Disc (ligament)
Joint: Radio-ulnar
| It is a small piece of fibrocartilage which attaches to the ulnar notch and styloid process of the ulna
110
Interosseous Membrane (ligament)
A tough piece of connective tissue that connects the ulna and radius
Function:
1. ) provide considerable strength and stability between the radius and ulna
2. ) limits supination
3. ) increase the surface attachment of muscles in both the anterior and posterior forearm
111
Movements of the radio-ulnar joint
This joint only permits pronation and supination of the forearm to occur
Also is the movement of turning a screwdriver
112
Radiocarpal (wrist) joint
This joint that unites the hand and the forearm
The articulation of the joint is the distal end of the radius, articular disc with the scaphoid, lunate and triquetral
Joint is classified as a condyloid
Nerve supply comes from the median, radial, and ulnar nerves
113
Capsular ligament
Rather thin and unremarkable in the radiocarpal joint
114
Dorsal and Palmar Radiocarpals ligaments
Attach superiorly to the radius and inferiorly to the scaphoid and lunate bones
They are extrinsic
Rope
115
Ulnar and Radial collaterals (ligaments)
Attach from the styloid process of the ulna and radius to the carpal bones on their respective sides.
It’s a strong ligament
Extrinsic
Rope
116
Movements of the wrist joint
Medial and lateral rotation DOESN’T occur here
Flexion is limited by the extensor tendons and dorsal radiocarpal ligaments
Extension is limited by bone hitting bone, flexor tendons and palmar radiocarpal and ulnocarpal ligaments
Adduction is limited by the radial collateral ligament
Abduction is limited by the ulnar collateral ligament and the styloid process of the radius making contact with the trapezium bone
117
Manual dexterity
The ability of our hands to manipulate objects in the environment and is recognized as one of the major distinguishing characteristics of the human species
118
Hand
It serves as our chief tactile organ. It provides a grasping mechanism which combines great strength with finely controlled accuracy.
119
How do we differ functionally and anatomically from other primates with our hands?
Opposability of the thumb and our intrinsic muscles of our hand
120
What thickens the wrist?
The deep fascia of the flexor retinaculum and extensor retinaculum
121
Flexor retinaculum
A strong thick band of connective tissue that spans the concave palmar aspect of the wrist.
The ulnar nerve is NOT contained by _________ __________.
122
Carpal tunnel syndrome (distal median nerve neuropathy)
Usually caused by compression of the median nerve in the ________ ___________
Causes of the condition include:
1. ) Edema caused by trauma, obesity, or pregnancy
2. ) Fractures (Ex: smith’s fracture)
3. ) Tumors (ex: ganglionic cyst)
4. ) Oral contraceptives
5. ) Repetitive flexion and extension at the wrist
6. ) Misalignment of bones
Symptoms:
1. ) paresthesia in the area of the median nerve’s cutaneous distr.
2. ) decreased skin moisture in the area of the nerve’s distr.
3. ) patient complains of pain awakening them in the middle of the night
4. ) atrophy of the thenar muscles causing weakened thumb movements
123
Tinel’s Sign
A sensation of pin and needles when one taps over the site of the median nerve at the anterior aspect of the wrist to test for carpal tunnel syndrome
124
Phalen’s Test
Used to reproduce the symptoms of carpal tunnel syndrome by having the patients flex their hands to maximum and holding in that position for several minutes.
125
Extensor Retinaculum
A strong fibrous band of deep fascia extending across the posterior aspect of the wrist
Main function is to prevent “bowstringing” when the hand is hyperextended at the wrist joint
Does not hold the dorsal venous arch, basilic and cephalic veins and the cutaneous branches of the radial and ulnar nerves
126
Palmar Aponeurosis
A triangular shaped piece of deep fascia which occupies the central area of the palm.
It’s continuous with the fascia that covers the thenar and hypothenar muscles and with the flexor retinaculum
Functions:
1. ) gives firm attachment to the overlying skin to improve grip
2. ) protects underlying tendons
127
Dupuytren’s contracture
A condition in which there is a shortening and hypertrophy of the palmar aponeurosis.
This conditions begins with one or more painful nodules involving the fascia, usually at the MP joint of Digits 4 and 5
More common in men over 50
Bilateral
128
- thenar eminence
- hypothenar eminence
- lumbricales
- interossei
- Palmaris Brevis
What are the intrinsic muscles of the hand?
129
brachiation
A form of locomotion that requires the hand to be flattened with a very strong digit flexor muscles to enable primates to get a good grip
130
Abductor Pollicis
This hand muscles has 2 heads of origins
131
Ulnar nerve
Nerve supplies all of the hypothenar muscles?
132
Ulnar nerve
What nerve supply does interosseous muscles get?
133
Median nerve
This nerve emerges from beneath the flexor retinaculum and then divides into a number of branches to supply muscles and skin of the hand
Motor supply:
- abductor pollicis brevis
- opponents digit minimi
- third and fourth lumbricales
- interossei
- Palmaris brevis
- half of the flexor pollicis brevis
Cutaneous supply is the MEDIAL aspect of the hand
134
Ulnar Nerve
Has ONLY cutaneous supply which is the LATERAL aspect of the dorsum of the hand and the dorsal portion of the first, seconded, third, and fourth digits
135
Radial and ulnar Arteries
What is the hand vascular supply?
136
Prominent metacarpal branches
Vascular supply of the hand:
- princeps pollicis (1st digit)
- radialis Indicis artery (2nd digit)
137
Intercarpal Joint
Classified as plane gliding
Each carpal bones articulates with adjacent carpal bones and small amounts of movements occurs at these joints
United by a strong dorsal, palmar and interosseous ligaments
These movements can’t be separated from movements at the wrist joint
138
Carpometacarpal joint
The medial four joint between the carpal and metacarpal bones are irregular synovial joints that allow little movement
Some flexion and extension may occur when carrying out a “power grip”
139
Carpometacarpal joint of digit one
Joint allows opposition to the digits in both a precision and power grip
Joint is more freely moveable than the other carpometacarpal joints and functions like a Universal Joint
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Oppositions of the thumb
“Movement” is a combo of thumb flexion, abduction, and rotation of the digit
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Intermetacarpal joints
Classified as plane gliding joints between the bases fo the 2nd-5th metacarpals
This joint DOESNT exist between the 1st and 2nd metacarpal
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Metacaropophalangeal Joints
Found between the heads of the metacarpals and bases fo the proximal phalanges
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Interphalangeal Joints
Similar to MP joints
Classified as gingylmus joints
2nd-5th digits have both PIP and DIP joints, while the first digit has a single IP joint
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Skier’s thumb
A condition of the MP joint of digit one
The injury involves a rupture or laxity of the collateral ligaments of the joint and is ally the result of hyperabduction at the MP joint of digit one
If severe it can cause an avulsion fracture
