Muscles And Fasciae Of The Upper Limb part 3 Flashcards by Adrian Tiglao

SUPERFICIAL LAYER (POSTERIOR COMPARTMENT)
All extend as tendons into the hand except:

Brachioradialis

* Anconeus

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BRACHIORADIALIS Origin:

proximal part of the supraepicondylar ridge of the humerus

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BRACHIORADIALIS Insertion:

lateral side of the distal end of the radius just proximal to the radial styloid process

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BRACHIORADIALIS Innervation::

radial nerve

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BRACHIORADIALIS Origin:

accessory flexor of elbow joint

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forms the lateral boundary of the cubital fossa.

BRACHIORADIALIS

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EXTENSOR CARPI RADIALIS LONGUS

Origin:

o distal part of the supraepicondylar ridge

o lateral epicondyle of the humerus

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EXTENSOR CARPI RADIALIS LONGUS

Insertion:

dorsal surface of the base of metacarpal II

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EXTENSOR CARPI RADIALIS LONGUS

Innervation:

deep branch of the radial nerve

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EXTENSOR CARPI RADIALIS LONGUS

Action:

extends and abducts the wrist

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EXTENSOR CARPI RADIALIS BREVIS Origin:

lateral epicondyle of the humerus

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EXTENSOR CARPI RADIALIS BREVIS Insertion:

adjacent dorsal surfaces of the bases of metacarpals II and III

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EXTENSOR CARPI RADIALIS BREVIS Innervation:

deep branch of the radial nerve

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EXTENSOR CARPI RADIALIS BREVIS Action:

extends and abducts the wrist

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EXTENSOR DIGITORUM Origin:

lateral epicondyle of the humerus

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EXTENSOR DIGITORUM Insertion:

via the triangular-shaped
connective tissue
aponeurosis (extensor hood) into
the base of the dorsal surfaces of
the middle and distal phalanges

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EXTENSOR DIGITORUM Innervation:

posterior interosseous nerve

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EXTENSOR DIGITORUM Action:

Major extensor of the 4 fingers (index, middle, ring, and little fingers

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EXTENSOR DIGITORUM
o It results from the distal interphalangeal joint suddenly being forced into extreme flexion
o Sudden severe tension on a long extensor tendon, avulse attachment to the phalanx
o Treatment: use of finger splint to approximate the edges of the torn tendon

Mallet or baseball finger:

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EXTENSOR DIGITI MINIMI Origin:

medial to extensor digitorum in the forearm arising from lateral epicondyle of the humerus

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EXTENSOR DIGITI MINIMI Insertion:

together with the tendon of extensor digitorum into the dorsal digital expansion of the little finger

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EXTENSOR DIGITI MINIMI Innervation:

posterior interosseous nerve

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EXTENSOR DIGITI MINIMI Action:

accessory extensor of the small finger

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EXTENSOR CARPI ULNARIS Location:

medial to the extensor digiti minimi

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EXTENSOR CARPI ULNARIS Location:

lateral epicondyle of the humerus

EXTENSOR CARPI ULNARIS Origin:

medial side of the base of metacarpal V

EXTENSOR CARPI ULNARIS Insertion:

posterior interosseous nerve

EXTENSOR CARPI ULNARIS Innervation:

extends and adducts the wrist

ANCONEUS Location:

most medial | of the superficial extensors

ANCONEUS Shape:

triangular

ANCONEUS Origin:

lateral | epicondyle of the humerus

ANCONEUS Insertion:

o Posterolateral surface of the olecranon o Posterior surface of the ulna

ANCONEUS Innervation:

branch of the radial nerve

ANCONEUS Action:

abducts the ulna during pronation & accessory extensor of the elbow joint

5 muscles in the DEEP LAYER (POSTERIOR COMPARTMENT)

``` o Supinator o Abductor pollicis longus o Extensor pollicis brevis o Extensor pollicis longus o Extensor indicis ```

All deep layer muscles originate from the posterior surfaces of the radius, ulna, interosseous membrane, and pass into the thumb & fingers except: __

supinator muscle

3 muscles that emerge from between extensor digitorum and extensor carpi radialis brevis tendons of the superficial layer and pass into the thumb:

o Abductor pollicis longus o Extensor pollicis brevis o Extensor pollicis longus

2 of the three outcropping muscles that form a distinct muscular bulge in the distal posterolateral surface of the forearm:

o Abductor pollicis longus | o Extensor pollicis brevis

All muscles of the deep layer are innervated by the __ (continuation of radial nerve deep branch)

posterior interosseous nerve

SUPINATOR | Has 2 heads of origin:

o Superficial humeral head | o Deep ulnar head

SUPINATOR Insertion:

proximal aspect of radius

SUPINATOR Innervation:

posterior interosseous nerve that innervates the medial head of the triceps brachii

SUPINATOR Action:

supinates forearm

ABDUCTOR POLLICIS LONGUS Origin:

o Proximal posterior surfaces of the radius & ulna | o Interosseous membrane

ABDUCTOR POLLICIS LONGUS Insertion:

lateral side of the base of metacarpal I

ABDUCTOR POLLICIS LONGUS Innervation:

posterior interosseous nerve (C7 and C8)

ABDUCTOR POLLICIS LONGUS Action:

abduct the thumb at the joint between metacarpal I and trapezium bones

It contributes to the lateral border of the anatomical snuffbox

Abductor pollicis longus tendon

EXTENSOR POLLICIS BREVIS Origin:

distal to the origin of abductor pollicis longus from the posterior surface of the radius and interosseous membrane

EXTENSOR POLLICIS BREVIS Insertion:

dorsal surface of the base of the proximal phalanx

EXTENSOR POLLICIS BREVIS Innervation:

Posterior interosseous nerve

EXTENSOR POLLICIS BREVIS Action:

extends the MCP and carpometacarpal joints of the thumb

contributes as well to the lateral border of the anatomical snuffbox

Extensor pollicis brevis tendon

* Occurs when the tendons around the base of thumb (APL and EPB) are irritated or constricted * Noticeable when forming a fist; grasping; gripping; turning the wrist * Characterized by tendon swelling and causes pain and tenderness along the thumb side of the wrist

De Quervain’s Tenosynovitis

De Quervain’s Tenosynovitis Dx: placing thumb against your hand. Making a fist with your fingers closed over your thumb and then bending wrist toward little finger

Finkelstein test

EXTENSOR POLLICIS LONGUS Origin:

posterior surface of the ulna & adjacent interosseous membrane

EXTENSOR POLLICIS LONGUS Insertion:

long tendon into the dorsal surface of distal phalanx of the thumb

EXTENSOR POLLICIS LONGUS Action:

Extension of all joints of the thumb

EXTENSOR POLLICIS LONGUS Innervation:

posterior interosseous nerve (C7 and C8)

``` Extensor pollicis longus (EPL) and Extensor pollicis brevis (EPB) tendon ```

EXTENSOR INDICIS Origin:

adjacent interosseous membrane & distal to extensor pollicis longus from the posterior surface of the ulna

EXTENSOR INDICIS Insertion:

extensor hood of the index finger with the tendon of extensor digitorum

EXTENSOR INDICIS Innervation:

posterior interosseous nerve (C7 and C8)

EXTENSOR INDICIS Action:

accessory extensor of the index finger

SURFACE ANATOMY OF THE FOREARM

▪ Medial part: flexor muscles | ▪ Lateral part: extensor muscles

FUNCTIONAL POSITIONS OF THE HAND

``` Power Grip Hook Grip Precision Handling Grip Pinching Position of Rest ```

▪ forcible motions of the digits acting against the palm. ▪ the fingers are wrapped around an object with counter pressure from the thumb like when grasping a cylindrical structure. ▪ it involves the: • long flexors of the fingers • intrinsic muscles in the palm • extensors of the wrist.

Power Grip

▪ posture of the hand used when carrying a briefcase. ▪ consumes less energy, involving mainly the long flexors of the fingers, which are flexed to a varying degree, depending on the size of the object that is grasped.

Hook Grip

▪ involves a change in the position of a handled object that requires fine control of the movements of the fingers and thumb ▪ for example: holding a pencil, manipulating a coin, threading a needle, buttoning a shirt. ▪ Wrist and fingers are held firmly by the long flexor and extensor muscles, and the intrinsic hand muscles perform fine movements of the digits.

Precision Handling Grip

▪ compression of something between the thumb and the index finger ▪ for example, handling a teacup or holding a coin on edge.

Pinching

is assumed by an inactive hand ▪ for example, when the forearm and hand are laid on the table. ▪ is often used when it is necessary to immobilize the wrist and hand in a cast to stabilize a fracture.

Position of Rest

are located entirely in the hand and mainly execute precision movements (‘precision grip’) with the fingers and thumb.

INTRINSIC MUSCLES OF THE HAND

The intrinsic muscles are the:

* Palmaris brevis * Interossei (Dorsal and Palmar) * Adductor pollicis * Thenar muscles * Hypothenar muscles * Lumbrical muscles

All of the intrinsic muscles of the hand are innervated by the

deep branch of the ulnar nerve

All of the intrinsic muscles of the hand are innervated by the deep branch of the ulnar nerve except:

3 thenar and 2 lateral lumbrical muscles

3 thenar and 2 lateral lumbrical muscles which are innervated by the

median nerve.

PALMARIS BREVIS Origin:

tendinous fasciculi from the transverse carpal ligament and palmar aponeurosis.

PALMARIS BREVIS Insertion:

skin on the ulnar border of the palm of the hand, occasionally on the pisiform

PALMARIS BREVIS Actions:

tenses the skin of the palm on the ulnar side during a grip action, deepens the hollow of the palm

PALMARIS BREVIS Innervation:

only | muscle innervated by the superficial branch of the ulnar nerve (C8, T1)

INTEROSSEI MUSCLES Divided into two groups

* dorsal interossei, | * palmar interossei

are muscles between and attached to the metacarpals.

INTEROSSEI MUSCLES

INTEROSSEI MUSCLES Insertion:

proximal phalanx of each digit and into the extensor hood.

INTEROSSEI MUSCLES Innervation:

All are innervated by the deep branch of the ulnar nerve

INTEROSSEI MUSCLES actions

o abduct and adduct the digits | o contribute to the complex flexion and extension movements generated by the extensor hoods.

They are unipennate muscles originating from the metacarpals of the digits with which is associated.

Palmar Interossei

o Origin: medial side of the palmar surface of metacarpal I | o Insertion: base of the proximal phalanx of the thumb, extensor hood

First palmar interosseous muscle

o Origin: medial side of metacarpal II | o Insertion: medial side of the dorsal expansion of the index finger

Second palmar interosseous muscle

o Origin: lateral surfaces of metacarpals IV and V o Insertion: lateral sides of the respective dorsal hoods o actions: • adduct the thumb, index, ring, and little fingers • flexion of the MCP joints • extension of the PIP & DIP joints of the fingers through their attachments to the dorsal hoods

Fourth & Fifth palmar of interosseous muscle

LUMBRICAL MUSCLES Origin:

tendons of flexor digitorum profundus

The 1st and 2nd lumbricals are __ muscles associated with index and middle fingers.

unipennate

The 3rd and 4th lumbricals are __ associated with the ring and little fingers.

bipennate

1st and 2nd lumbricals Insertions:

digital branches of the median nerve

3rd and 4th lumbricals Insertions:

deep branch of the ulnar nerve

Large triangular muscle anterior to the plane of the interossei that crosses the palm

ADDUCTOR POLLICIS

ADDUCTOR POLLICIS Origins:

o Transverse head – anterior aspect of the shaft of metacarpal III o Oblique head – capitate, bases of metacarpals II and III

ADDUCTOR POLLICIS Insertions:

o medial side of the base of the proximal phalanx of the thumb o extensor hood

ADDUCTOR POLLICIS Actions

o powerful adductor of the thumb and opposes the thumb to the rest of the digits in gripping

THUMB MOVEMENTS

▪ rotated 90 degrees to the other digits. ▪ Abduction and adduction occur in a sagittal plane ▪ Flexion and Extension occur in a coronal plane ▪ Opposition is the most complex movement.

Responsible for the prominent swelling on the lateral side of the palm at the base of the thumb.

(thenar eminence)

▪ Largest of the thenar muscles

OPPONENS POLLICIS

▪ Distal to the abductor policis brevis

FLEXOR POLLICIS BREVIS

▪ There are 3 hypothenar muscles:

o Opponens digiti minimi o Abductor digiti minimi o Flexor digiti minimi brevis

lies deep to the other two hypothenar muscles.

OPPONENS DIGITI MINIMI

overlies the opponens digiti minimi.

ABDUCTOR DIGITI MINIMI

Fascia deep surface, which occasionally serves to extend the surface area available for muscular origin, is attached directly or via __

intermuscular septa to the enclosed bones.

Deep fascia which forms the floor of the axilla

AXILLARY FASCIA

Deep fascia which forms a tubular investment of the arm

BRACHIAL FASCIA

BRACHIAL FASCIA Attached to the __ via medial and lateral intermuscular septae

humerus

Deep fascia which form a tubular investment of the forearm muscles

ANTEBRACHIAL FASCIA

ANTEBRACHIAL FASCIA Attached to the __ via the lateral intermuscular septum

radius

divides the forearm into volar and dorsal muscular compartments.

Intermuscular septum together with the radius

o formed by the carpal arch and the flexor retinaculum | o a rigid and confining space that contains the long flexor tendons of the fingers and the thumb and the median nerve

Carpal tunnel

The median nerve is the most sensitive structure in the carpal tunnel and therefore is the most affected.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome has 2 terminal sensory branches that supply the skin of the hand

* paresthesia (tingling) | * hyposthesia (diminished sensation)

Carpal Tunnel Syndrome may occur in the

lateral 3 ½ digits

Individuals with carpal tunnel syndrome are unable to

oppose the thumb and have difficulty buttoning shirt or blouse as well as gripping things such as a comb.

refers to a deformity in which thumb movements are limited to flexion and extension of the thumb in the plane of the palm • caused by the inability to oppose and by limited abduction of the thumb

Ape hand

To relieve both the compression and the resulting symptoms, complete surgical division of the flexor retinaculum, a procedure called

carpal tunnel release,

The incision for carpal tunnel release is made toward the medial side of the wrist and flexor retinaculum to avoid possible injury to the

recurrent branch of the median nerve

o thickening of the deep fascia covering the palm of the hand o composed of very dense connective tissue that extends out into each of the fingers

Palmar Aponeurosis

Dapuytren’s Contracture o a disease of the palmar fascia resulting in progressive shortening, thickening, and fibrosis of the palmar fascia and aponeurosis

Dapuytren’s Contracture

Dapuytren’s Contracture cause

fibrous degeneration of the longitudinal bands of the palmar aponeurosis

stenosing tenosynovitis

Trigger Finger

a condition in which one of your fingers gets stuck in a bent position.

Trigger Finger

▪ covering the thenar muscle group ▪ blends with the palmar aponeurosis and attaches to the third metacarpal bone as the lateral fibrous septum ▪ defines the thenar compartment of the hand

THENAR FASCIA

▪ covers the hypothenar muscle group ▪ blends with the palmar aponeurosis and attaches to the fifth metacarpal bone as the medial fibrous septum ▪ defines the hypothenar compartment of the hand

HYPOTHENAR FASCIA

CENTRAL COMPARTMENT | In between thenar and hypothenar compartments are:

o Flexor tendons and sheaths o Lumbricals o Superficial palmar arterial arch o Digital vessels and nerves

ADDUCTOR COMPARTMENT ▪ Deepest muscular plane of the palm ▪ Contains:

adductor pollicis

o is responsible for the smooth contour of the lateral side of the neck and over the superior aspect of the shoulder.

Trapezius

o forms much of the muscle mass underlying the posterior axillary fold extending obliquely upward from the trunk to the arm.

Latissimus dorsi

o passes from the inferior angle of the scapula to the upper humerus and contributes to the fold laterally.

Teres major

The rounded curve of the shoulder is formed by the thick __, which is a frequent site for intramuscular injections.

deltoid muscle

The __ forms the fleshy anterior axillary fold, which acts as the anterior border of the axilla.

pectoralis major

The __ and __ form the fleshy posterior axillary fold, which is the posterior border of the axilla.

latissimus dorsi and teres major muscles

becomes prominent | when the elbow is flexed.

Biceps brachii muscle

Cubital fossa

o biceps brachii tendon o brachial artery o median nerve

``` It is a depression within which the median cubital vein connects the basilic and cephalic veins. ▪ is a common site for venipuncture. ```

Cubital fossa

formed by the bulk of | the posterior surface of the brachium.

Triceps brachii muscles

The __ is a rounded lateral projection at the distal end of the humerus.

lateral epicondyle of the humerus

The __ is palpated easily | along the posterior aspect of the elbow.

olecranon of the ulna

located approximately at the junction between the lateral and middle thirds of an imaginary line drawn transversely across the distal forearm.

tendon of flexor carpi radialis

immediately lateral to this tendon and this site is used for taking a radial pulse.

radial artery

Muscles And Fasciae Of The Upper Limb part 3 Flashcards

(143 cards)