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Flashcards in Gross Anatomy Exam 2 Deck (130)
1

Upper Limb four major compartments

Shoulder - includes pectoral, scapular, and deltoid region and lateral part of cervical
Arm (brachium) - connects shoulder and elbow
Forearm (antebrachium) - connects elbow to wrist
Hand (manus) - formed around carpal, metacarpals and phalanges, consists of wrist, palm and dorsum of hand and digits

2

Clavicle

also know as collar bone, connects upper limb to trunk
functions: serve as a moveable strut that suspends scapula and free limb, one of the boundaries of the cervical-axillary canal, transmits shock to axial skeleton

3

Parts of the clavicle

shaft
sternal end,
acromial end
superior surface
inferior surface - conoid tubercle, trapezoid tubercle, subclavian groove, impression for costoclavicular ligament

4

Scapula

also know as the shoulder blade, triangular flat bone, lies posterior aspect of ribs 2-7, convex post. and concave ant surfaces

5

Parts of the scapula

spine - deltoid tubercle, acromion, spinoglenoid notch
supraspinous fossa, infraspinous fossa, subscapular fossa, body, glenoid fossa - supraglenoid fossa and infraglenoid fossa, coracoid process, superior border having the suprascapular notch, medial border, lateral border, superior angle and inferior angle

6

Humerus

largest bone in the upper limb, articulates with the glenoid fossa proximal and the radius and ulna distally

7

Parts of the humerus

head, anatomical neck, surgical neck, greater tubercle with 3 facets (superior, middle and inferior), lesser tubercle, intertubercular groove, shaft with deltoid tuberosity and radial groove, supracondylar ridges, medial and lateral edpicondyles

8

Condyles of the forearm are formed by

Capitulum - lateral articular surface that articulates with head of radius
Trochlea - medial articular surface that articulates with trochlear notch of ulna
Coronoid fossa - anterior hollow that receives the coronoid fossa of ulna during flexion
Radial fossa - anterior depression superior to capitulum and receives the head of the radius during flexion
Olecranon fossa - posterior hollow that receives the olecranon of ulna during extension

9

Ulna

stabalize bone of forearm, medial and longer than radius, massive proximal end specialized for articulation with humerus and radius laterally
DOES NOT PARTICIPATE IN WRIST JOINT

10

Parts of the Ulna

Olecranon, coronoid process, trochlear notch, tuberosity of ulna, radial notch, shaft and head with the ulnar styloid process
the head is the distal part of the bone

11

Radius

lateral forearm bone, crosses over ulna in pronation
PARTICIPATES IN WRIST JOINT

12

Parts of the radius

head, neck, radial tuberosity, shaft, ulnar notch, radial styloid process and dorsal tubercle of radius

13

Which styloid process is larger and why

The radial styloid process is bigger because it limits more radial deviation than the ulna does in ulnar deviation

14

Carpal bones

makes up the wrist, 8 bones total, give flexibility to wrist, convex from side to side and concave anteriorly

15

Proximal row of carpal bones (lateral to medial)

Scaphoid - boat shaped bone that articulates with radius
Lunate - moon shaped bone that articulates with the radius
Triquetrum - pyramidal bone on medial side of wrist
Pisiform - pea-shaped sesamoid bone on palmer surface of triquetrum

16

Distal row of carpal bones (lateral to medial

Trapezium - four sided bone lateral side of wrist articulating with 1st and 2nd metacarpals
Trapezoid - wedge-shaped bone articulating with the 2nd metacarpal
Capitate - head-shaped bone articulating with 3rd metacarpal
Hamate - wedge-shaped bone on medial side articulating with 4th and 5th metacarpals

17

Metacarpals

form skeleton for palm of hand, b/w carpals and phalanges, 5 metacarpals numbered from lateral to medial 1-5, 1st metacarpal is the thumb

18

Scapulohumeral Joint

Physiological (muscular) joint where there are no bone articulations, represents scapular movment on the thoracic wall b/w ant scapula and post ribs, provides base for which upper limb operates

19

Sternoclavicular Joint

only articulation b/w upper limb and axial skeleton, synovial joint
features: saddle type joint b/w manubrium and clavicle but functions as a ball and socket, divided into 2 compartments by disc, strong joint

20

Ligaments of the sternoclavicular joint

Costoclavicular ligament - anchors inferior surface of sternal end of clavicle to rib 1 and its costal cartilage
Anterior sternoclavicular ligmanet - reinforces capsule anteriorly
Posterior sternoclavicular ligament - reinforces capsule posteriorly
BOTH THESE LIGAMENTS ARTICULATE WITH DISC
interclavicular ligament - strengthens capsule superiorly, extends b/w sternal end of clavicle, attaches to superior border of manubrium

21

Acromioclavicular ligament

also know as AC joint, located 2-3cm from point of shoulder and is a synovial joint
features: plane joint b/w clavicle and acromion, separated by incomplete wedge shaped articular disc

22

Ligaments of AC Joint

Coracoclavicular ligament - from coracoid process to underside of clavicle, strong pair of bands, provides means by which scapula and free limb are passively suspended
composed of 2 ligaments: trapezoid l. - nearly horizontal
conoid l. - inverted traingle with base being at conoid tubercle
Acromoiclavicular ligmanet - from clavicle to acromion, strengthens the AC joint superiorly, integrity of joint mainly by extrinsic ligaments distal from the joint itself

23

Glenehumeral Joint

provides wide range of motion which makes the joint unstable, synovial joint
features: ball and socket joint b/w head of humerus and glenoid fossa, held in fossa by rotator cuff muscles, glenoid fossa deepens by glenoid labrum, joint capsule in 2 apertures: b/w tubercles to allow for tendon of long head of biceps brachii m. and anteriorly that allows communication b/w subscapular bur sae and synovial cavity, inferior part of joint is weak

24

Ligaments of Glenohumeral joint

Gloenhumeral ligaments Coracohumeral ligament Coracoacromial LigamentTransverse humeral ligament

25

Gloenhumeral ligaments

sup. middle and int. ligaments, strengthen the capsule ANTERIORLY, can only been seen from interior of capsule

26

Coracohumeral ligament

from coracoid process to greater tubercle of humerus, intrinsic, strengthens joint superiorly and supports the weight of hanging arm

27

Coracoacromial Ligament

from coracoid process to acromion, along with the inferior aspects of the acromion and coracoid process it forms the coracoacromial arch, prevents superior displacement of humeral head

28

Transverse humeral ligament

passes obliquely from lesser tubercle to greater tubercle of humerus, converts IT groove into a canal, holds synovial sheath and tendon of long head of biceps in the groove

29

Deep Fascia of the scapular region

Deltoid Fascia
Supraspinous fascia

30

Deltoid Fascia

covers deltoid from clavicle, acromion and scapular spine
inferiorly, fascia is continuous with pectoral fascia anteriorly and infraspinous fascia posteriorly

31

Supraspinous Fascia

overlie supraspinatus and infraspinatus muscles, very dense and must be removes to view muscles

32

Scapulhumeral Muscles

Also known as intrinsic shoulder muscles
Deltoid, Supraspinatus, Infraspinatus, Teres Minor, Teres Major, and Subscapularis

33

Muscular Spaces of the shoulder

Quadrangular space
Triangular space
Triangular interval

34

Quadrangular space

Borders: SUperiorly - teres minor muscle
Inferiorly - teres major muscle
Lateral - surgical neck of the humerus
Medial - long head of triceps brachii
Contains: axiallary nerve and the posterior humeral circumflex artery

35

Triangular space

Borders: Superiorly - teres minor muscle
Inferiorly - teres major muscle
Base - long head of triceps brachii muscle
Contains: circumflex scapular artery and no nerve

36

Triangular Interval

Borders: Base - teres major muscle
Lateral - lateral head of triceps brachii muscle
Medial - long head of triceps brachii muscle
Contains - radianl nerve and the profunda brachiallis artery

37

Deep Fascia of Pectoral region

-attaches to clavicle and sternum
-there is the pectoral fascia and the clavipectoral fascia

38

Pectoral Fascia

-invests pectoralis major muscle
-continuous inferiorly with anterior abdominal wall fascia and with brachial fascia
-leaves lateral border of pectoralis major muscle to become the axillary fascia

39

Clavipecotral Fascia

-deep to pectoral fascia and pectoralis major muscle
-descends from clavicle and encloses the subclavius muscle and pectoralis minor muscle
-continuous inferiorly with axillary fascia
-this fascia is divided into 2 parts:
costocoracoid membrane - part of clavipectoral fascia b/w pectoralis minor muscle and subclavis muscle, it is pierced by lateral pectornal nerve, cephallic vein and thoracoacromial trunk
suspensory ligament of the axilla - part of clavipectoral fascia inferior to pectoralis minor muscle, supports the axillary fascia and pulls the skin inferiorly when ABD creating the axillary fossa

40

Anterior Axioappendicular Muscles

-muscles that move the pectoral girdle
-also known as thoracoappendicular or pectoral muscles
Pectoralis Major muscle, Pectoralis minor muscle, Subclavius muscle and Serratus Anterior muscle

41

Injury to Long Thoracic Nerve (C5,C6,C7)

-nerve takes superfisclal course and lies superfiscial to serratus anterior muscle
-when limb is elevated it is at risk for injury (knife fight)
-may also be injured during a mastectomy or by weapon into thorax
-Effects are the medial border of the scapula moves laterally and posteriorly away from thoracic wall exspecially when hand is pressed against a wall
This is known as a winged scapula!
-Upper limb will now be able to ABD past 90 degrees b/c they cannot upward rotate scapula
-NO SENSORY LOSS WOULD BE NOTICED

42

Axilla

-pyramidal space b/w upper arm and the thoracic wall, superior to axillary fossa and juntion of arm
-provides a passageway for neurovascular structures of upper limb which are protected by adducted limb
-size and shape of axilla depend on the position of the arm
-it has an apex, base and 4 walls (3 are muscular)

43

Apex of axilla

cervico-axillary canal
bounded by the 1st rib, clavicle and superior border of scapula

44

Base of Axilla

-formed by concave skin, subcutaneous tissue and axillary fascia
-extends from arm to thoracic wall, forms the axiallry fossa
-bounded by anterior and posterior axillary folds, thoracic wall and medial aspect of arm

45

Anterior Wall of Axilla

-formed by pectoralis major muscle and minor muscle and the deep fascias
-anterior axillary fold is the interiormost part of anterior wall that can be grasped, formed by pectoralis major muscle and the overlying skin

46

Posterior Wall of Axilla

-formed by scapula, subscapularis, teres major and lattisimus dorsi muscle
-posterior axillary fold is the inferior most part of the posterior wall that may be grasped, extends further interior than anterior wall and is formed by the latissimus dorsi, teres major muscle and skin

47

Medial wall of Axilla

formed by the thoracic wall, 1st - 4th ribs and intercostal muscles and the serratus anterior muscle

48

Lateral Wall of Axilla

-formed by the IT groove of humerus and is a narrow wall

49

What doe this axilla area contain

axiallry blood vessels
lymphatic vessels and nodes
axillary fat
cords and braches of brachial plexus

50

Axillary sheath

sleeve like extension of the cervical fascia that covers proximal parts of neuromuscular structures

51

Axillary Artery

continuation of subclavian a.
begins at lateral border of 1st rib, is divided into 3 parts and becomes the brachial a. after teres major

52

1st part of Axillary A.

from lat border of 1st rib to the medial pec minor m.
encloses the axillary sheath and has 1 branch coming off of it: Superior Thoracic A.

53

2nd Part of Axillary A.

posterior to pectoralis minor m. and had 2 branches: Thoracoacromial Trunk and the Lateral Thoracic

54

3rd Part of Axillary A

from the lat border of pec minor m. to inferior border of trees major and has 3 branches:
Subscapular A.
Anterior Humeral Cicumflex A.
Posterior Humeral Circumflex A.

55

Scapular Anastomoses

Involves 3 arteries: Dorsal scapular, Suprascapular and Circumflex scapular.
important if ligation or a slow occlusion (stenosis) of subclavian or proximal axillary so it can still supply the upper limb
Circumflex scapular is the key player
Ligation b/w subscapular a. and profunda brachii will cut off supply to arm

56

Axillary Vein

lies on anteromedial aspect of axillary a.
formed by a union of the brachial vv. and the basilica v.
ends at 1st rib and becomes subclavian v.
receives the cephalic v.

57

Axillary Lymph Nodes

Arranged in 5 principle groups, are arranged in a manner that reflect pyramidal shape of axilla
Pectoral (Anterior) Nodes
Subscapular (Posterior) Nodes
Humeral (Lateral) Nodes
Central Nodes
Apical Nodes

58

Pectoral Nodes

lie along the medial wall of axilla
receive lymph mainly from the anterior thoracic wall and breast

59

Subscapular Nodes

lie along the posterior axillary fold
receive lymph from the posterior thoracic wall and scapular region

60

Humeral Nodes

lie along the lateral wall of axilla
receives nearly all lymph from upper limb

61

Central Nodes

lie deep to pectorals minor
receives lymph from the pectoral, sub scapular and humeral lymph nodes

62

Apical Nodes

located at apex of axilla
receive lymph from all groups pf axillar nodes as well as those accompanying cephalic v.
vessels from here traverse to crevice-axillary canal, some nodes drain to clavicle nodes
Efferent vessels unite to form subclavian lymphatic trunk and these drin to right lymphatic duct or thoracic duct

63

Brachial Plexus

begins at neck and extends to axilla
formed by union of the VPR of C5-C8 and T1
often C4 an T2 will contribute
divided into supraclavicular and infraclavicular parts: Roots and trunks are in the neck, Divisions are deep to the clavicle and the Cord and Branches are in the axilla

64

Roots

pass thru gap b/w anterior and middle scalene mm. and found with subclavian a.
roots unite to form 3 trunks

65

Trunks

Superior Trunk - formed by union of C5,C6 and sometime C4
Middle trunk - continuation of C7 nerve
Inferior Trunk - formed by union of C8 and T1 and sometime T2
Each trunk is divide into a posterior and anterior division which is all done posterior to the clavicle

66

Divisions

Anterior Division - supply the flexor compartments of the upper limb
Posterior Division - supply extensor compartments of upper limb
Divisions of trunk unite to form 3 cords

67

Cords

Lateral Cord - forms by anterior divisions of superior and middle trunks
Medial Cord - formed by the anterior division of the inferior trunk
Posterior Cord - formed by the posterior divisions of all 3 trunks
Cords are named for their relationship to 2nd part of the axillary artery

68

Branches

most branch from cord
a few from roots and trunks
Roots - dorsal scapular and long thoracic
Trunks - Suprascapular and nerve to subclavian

69

Lateral Cord

Lateral Pectoral nerve
Musculocutaneous Nerve
Lateral root of median nerve

70

Medial Cord

Median root of median nerve
Medial pectoral nerve
Medial brachial cutaneous nerve
Medial Antebrachial nerve
Ulnar nerve

71

Posterior Cord

Radial Nerve
Axillary Nerve
Upper Subscapular nerve
Thoracodorsal Nerve
Lower Subscapular nerve

72

Brachial Plexus Lesions

can be cause by pathology, trauma or compression
can occur as far up as roots or trunks
complete lesion of all parts is rare, partial lesion are more common
lesion to upper part will affect proximal muscles
lesion to lower parts will affect more distal muscles
Injuries results in Complete paralysis, Incomplete paralysis or Ability to feel pain

73

Arm

extends from shoulder to elbow
two movements can occur at elbow joint: flex/ext and supination/pronation
muscles are broken into 2 compartments with most action happening at the elbow

74

Elbow Joint

located 2-3 cm inferior to epicondyles of humerus
weak anteriorly and posteriorly, strengthened by the collateral ll.
synovial joint
composed of 2 articulations: humeroulnar and humeroradial

75

Humeraoulnar joint

throclea of humerus contacts throchlear notch of ulna
Ligamements
Ulnar collateral - triangular tape of 3 parts
Anterior Band- cord like band from medial epicondyle to tubercle on coronoid process, strongest
Posterior band - fan like band from medial epicondyle and spanning trochlear notch, weakest
Inferior band - spans medial aspect of trochlear notch, deepens the socket of the joint

76

Humeroradial Joint

capitulum of humerus contacts the head of radius
limited ball and socket hinge type joint
Ligaments
Radial collateral l. - fan like band from the lateral epicondyle to annular l of radius
Anular lig encircles the radial head

77

Bursae around the elbow joint

Subtendinous olecranon bursa - b/w the olecranon and triceps tendon
Intratendinous olecranon bursa - sometimes present in triceps tendon
Subcutaneous olecranon bursa - in subcutaneous tissue over olecranon

78

Brahcial Fascia

encloses arm like a sleeve
continuous superiorly with deltoid, pectoral, axially and infraspinous fossa
attaches inferiorly to humeral epicondyle and olecranon of ulna
continuous inferiorly with ante brachial fascia
has a medial and lateral intermuscular septa that divides arm into ant. and post. compartments

79

Cubital Fossa

triangular shaped depression on anterior aspect of elbow
filled with variable amount of fat
Boundaries are: Lateral - bracioradialis m
Medial - pronator teres m.
Base (superior) - line connecting medial and lat epicondyles
Floor - supinator and brachioradialis
Roof - skin, fascia and bicipital aponeurosis
Contains: terminal part of brachial a.
deep accompanying vv.
biceps brachii tendon
median n and radial n
Overlying the fossa is the median cubital v. and the medial and lateral ante brachial cutaneous nerves

80

Forearm

extends from the wrist to the elbow
contains the radius and ulna that are united by the interosseous membrane

81

Proximal radio Ulanr Ligament

synovial joint
fibrous layer of joint capsule is continuous with that of the elbow joint
radius moves around the ulna
- features: head of radius contacts the radial notch of the ulna, it is a pivot joint
-Ligaments of this joint: anular ligament, oblique cord, and interosseous membrane

82

Anualr LIgament

encircles radial head

83

oblique cord

from the coronoid process to the radial shaft
limits rotation
also limits distal movement of radius (pulling)

84

Interosseous membrane

connects shaft of radius and ulnalimits proximal displacement of radius (pushing)

85

Distal-radio-ulnar joint

synovial joint
radius moves around fixed ulna
-features: head of ulna articulates with ulnar notch of distal radius, pivot joint doing supination and pronation, has an articular disc that is a fibrocartilage complex triangular shaped and bind the end of ulna and radius together and is why the ulna does not participate in the wrist joint

86

Antebrachial Fascia

continuous superiorly with brachial fascia
divides the forearm into anterior (flexor) and posterior (extensor) compartments
compartments are separated by interosseuous membrane
thinkens posteriorly over the distal ends of radius and ulna forming a transverse band known as the extensor retinaculum
also forms the anterior thickening that is continuous with the extensor retinaculum called the palmar carpal ligament
distal and deeper to this ligament is the flexor retinaculum (transverse ligament), this is the carpal tunnel

87

Muscles of the forearm

flexors and pronators are in the anterior compartment
served by the median nerve and branches
1 and a 1/2 exceptions innervated by the ulnar nerve
extensors and supinators are in the posterior compartment innervated by the radial n and its branches

88

Pronator Teres

most lateral superficial forearm flexor
median nerve passes thru the two heads of this muscle and is a common site of impingment

89

Flexor Carpi Radialis

medial to the pronator teres m.
tendon does not pass thru the carpal tunnel
radial artery lies just lateral to this tendon

90

Palmaris Longus

absent in one or both sides in 14%
passes superficial to flexor retinaculum
tendon lies deep and slightly medial to median nerve at the wrist

91

Flexor Carpi Ulnaris

most medial and superficial flexor
tendon is guide to ulnar nerve and artery on the lateral side of the wrist
this muscle has 2 heads as well which has the ulnar nerve passing thru them, this is the cubital tunnel and is a potential site for impingement

92

Flexor Digitorum Superficialis

median and ulnar nerveenter forearm by passing between it 2 heads
gives rise to 4 tendons at the wrist that pass thru the carpal tunnel
chares a common flexor sheath with the FDP

93

Flexor Digitum Profundus

only muscle that flexes the DIPs!
4 tendons pass thru the carpal tunnel in the common flexor sheath with the FDS

94

Flexor Pollicis Longus

lies lateral to the FDP
passes thru the carpal tunnel in its own sheath known as the radial bursa
it the most lateral flexor sheath

95

Pronator Quadratus

deepest muscle in the anterior forearm
cannot be palpated but only observed in dissection
covers distal radius, ulna and interosseous membrane
A.I.N and A.I.A. pass deep to this muscle so they are found just proximal to this muscle in dissection

96

Medial Epicondylitis

inflammation of common tendon "golfers elbow"
results from over use of flexors, activities that require using lots of gripping
pitchers, golfers and rock climbers

97

Superficial Extensor muscles

Bracioradialis
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Digitorum
Extensor Digiti Minimi
Extensor Carpi Ulnaris

98

Deep Extensor Muscles

Supinator
Extensor Indicis

99

Outcropping Extensor Muscles

Abductor Pollicis Longus
Extensor Pollicis Longus
Extensor Policis Brevis

100

Extensor Muscle

tendons are held in place at wrist by extensor retinaculum
passes thru tunnel in extensor retinaculum and these tendons are covered by synovial sheaths

101

Bracioradialis

lies on the anterolateral surface of forearm
forms lateral border of cubital fossa
functionally a flexor but is innervated by radial nerve
overlies the radial nerve and artery proximally
TENDON IS OVERLAPPED DISTALLY BY APL AND EPB
does not cross the wrist joint
expecially active during quick movements and in the presence of resistance

102

Extensor Carip Radialis Longus

partly overlapped by bracioradialis muscle
distal tendon is crossed voer by ApL and EPB
indispensable when clenching a fist

103

Extensor Carpi Radialis Brevis

shorter than the ECRL because it starts distally on the humerus condyle
acts as synergist to ECRL

104

Extensor Digitorum

principal extensor of medial 4 digits
tendons spread on dorsum of hand as the pass digits
linked proximally at the MPs by the intertendenous connections
at distal ends of the metacarpals tendons flatten forming the extensor expansion
Hood is formed by extensor expansion

105

Extensor Digiti Minimi

partially detached part of ED
tendon located medial to ED on dorsum of han

106

Extensor Carpi Ulnaris

located medial border of forearm
has a humeral head and an ulnar head

107

Supinator

part of deep extensor group
helops form the cubital fossa
deep branch of radial nerve passes b/w its fibers, as it exits this muscle and joins the posterior interosseous artey it become the PI Nerve

108

Extensor Indicis

part of the deep extensor group
lies medial and alongside the EPL
confers independance to the index finger to point at people
tendon lies deep and medial to ED tendon on the dorsum of the hand

109

Abductor Lollicis Longus

lies just distal to supinator
tendon and belly may be split into 2, part may attach to trapezium instead of usual insertion
forms one border of the anatomical snuffbox

110

Extensor Pollicis Brevis

lies distal to APL
tendon lies parallel and immediately medial to APL
forms one border of the anatomical snuffbox

111

Extensor Pollicis Longus

larger and longer tendon than that of EPB
tendon passes medial to dorsal tubercle of radius

112

Anatomical Snuffbox

borders: posteromedial - EPL tendon
Anterolateral - EPB and EPL tendons
Floor - scaphoid and trapezium
Contents: radial artery
-superficial branch of radial nerve runs over the roof
-tenderness over the snuffbox may indicate a scaphoid fracture

113

Ulnar Artery

larger terminal branch of brachial artery
has unnamed muscular branches
Give rise to the Anterior Unlar Recurrent Artery which anastamoses with the Inferior Ulnar Collateral
Gives rise to the Posterior Ulnar Reccurent Artery which anastomoses with the Superior Ulnar Colalteral
Gives rise to the Common interosseous Artery which gives rise to the Anterior and Posterior Interosseous Arteries and the Recurrent Interosseous Artery which anastomoses with the Middle Collateral Artery
Palmar Carpal branch, anastamoses with palmar carpal branch of radial artery
Dorsal Carpal Branch, anastamoses with dorsal carpal branch of radial artery

114

Radial Artery

smaller terminal branch of brachial artery
has unnamed muscular branches
Gives rise to the Radial Recurrent Artery which anastamoses with the Radial Collateral Artery
Gives rises to the Dorsal and Palmar carpal branches

115

Deep Veins

arise from the deep venous palmar arch
gives rise to paired radial veins accompanied by radial artery
also gives rise to paired radial veins accompany ulnar arteries
In the cubital fossa join the median cubital veins and form the brachial veins

116

Median Nerve at forearm

supplies all anterior compartment muscles except FCU and 1/2 FDP
formed by union of lateral root of lateral cord and medial root of medial cord
C6, C7, C8
enters cubital fossa medial to brachial artery
passes b/w heads of pronator trees muscle and turns into the anterior interosseous nerve
median nerve found in facial plane between FDS and FDP
gives rise to the Palmar cutaneous branch which arises at the distal forearm and proximal to the flexor retinaculum

117

Ulnar Nerve at the Forearm

supplies FCU and medial 1/2 FDP
terminal branches of medial cord of brachial plexus
C8, T1
Gives rise to the Palmar cutaneous branch which arises at mid forearm and supplies the skin medial to axis of 4th digit
Gives rise to Dorsal cutaneous branch which arise at distal forearm and supplies forum of hand medial to 4th digit

118

Radial Nerve at the Forearm

Supplies the posterior compartment of forearm
terminal branch of posterior cord of brachial plexus
C5,C6,C7,C8
Gives rise to the postior antebrachial branch supplies skin of posterior aspect of forearm to wrist
Gives rise to Deep branch which supplies ECRB, ED, EDM, ECU, and supinator, pieces that supinator muscle and becomes the P.I.N.
Gives rise to the P.I.N. and supplies the out grouping muscles
Superficial branch emerges lateral to tendon of bracioradialis and runs over the roof of anatomical snuffbox and supplies the skin on the dorsum of hand lateral to axis of 4th digit.

119

Lateral Antebrachial Cutaneous Nerve

direct communication of musculocutaneous nerve
supplies the lateral aspect of forearm

120

Medial Antebrachial cutaneous nerve

from the medial cord of brachial plexus
supplies medial aspect of forearm

121

Wrist and Hand

wrist is located at junction of forearm and hand
movements at the wrist adjust position of the hand
consists of carpals, metacarpals and phalanges
Palmer features separates into 2 eminences:
-Thenar Eminence, lateral larger and more prominent at base of thumb
-Hypothenar eminence, medial smaller proximal to 5th digit

122

Radio carpal Joint

also know as the wrist joint
synovial joint
position of joint indicated by: line joining ulnar and radial styloid processes and proximal wrist crease
ulnar does not participate in this joint
Features: articulation b/w distal end of radius, articular disc and proximal row of carpals
condyloid type joint
permits flex/ext, radial and ulnar dev. and circumduction
Ligaments: Ulnar collateral, radial collateral, Palmar radiocarpal, Palmer Ulnocarpal, Dorsal radiocarpal

123

Carpometacarpal Joint

promote hollowing of hand
1 digits is different than 2-5 digits
synovial joint
Features: distal row of carpals articulate with bases of MC
Plane type joint for 2-5 digits
Saddle type joint at thumb
Ligaments: Dorsal Carpometacarpal, Palmar carpometacarpal and Superficial and deep transverse metacarpal.

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Metacarpophalangeal Joint

synovial joints
Features: heads of metacarpals articulate with bases f proximal phalanges
COndyloid joints
LIgaments: Medial Collateral and Lateral Collateral
Deep transverse metacarpal

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Interphalangeal Joints

synovial joint
have the PIP and the DIP
FeaturesL artculation b/w heads of phalanges with bases of more distal phalanges
Hinge type joint
flex and ext
Ligaments: Medial Collateral
Lateral COllateral

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Fascia of the Palm

continuous with ante brachial fascia and the fascia of dorsum of hand
thin over thenar and hypothenar eminences
thick centrally where it forms the fibrous palmar aponeurosis

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Palamr Aponeurosis

cover soft tissues, overlies flexor tendons, proximal end is continuous with flexor retinaculum and palmaris longs.
distally formes 4 longitudinal bands that radiate from the apex and attach distally at bases of proximal phalanges, becomes continuous with fibrous digital sheaths
has 2 fibrous septa that extend deeply, medial fibrous septum that attaches to 5th MC and the lateral fibrous septum that attaches to the 2nd MC
Creates 2 potential spaces in the deep hand

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Two potential Spaces created by Fibrous Septa

Thenar space - underlies thenar compartment, distally related to synovial tendon sheath of index finger
proximally related to common flexor sheath distal to carpal tunnel
Midpalmar space - underlies the central compartment, distally related to synovial tendon sheaths of digits 3-5 and proximally to common flexor sheath as it emerges from carpal tunnel
It is continuous with the anterior compartment of forearm via carpal tunnel

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Carpal Tunnel

passageway from anterior forearm to hand
formed by the anterior concavity of carpals and the flexor retinaculum (transverse ligament)
Contains the tendons of FDS, FDP, and FPL and their associated sheaths, and the median nerve b/w the FDS and FPL tendons

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Guyon Canal (Tunnel)

also known as ulnar canal
created by the depression between pisiform and hook of hamate, covered by pisohamate ligament and forms osseofibrous tunnel, contains the ulnar nerve and artery