unit 1 part 2 Flashcards
(120 cards)
1
Q
cubital fissa
A
triangularly shaped space in front of the elbow with these boundaries
a. medial - pronator teres muscle
b. lateral - brachioradialis muscle
c. base - line between epicondyles of humerus
d floor - brachialis muscle
e. roof - deep fascia
2
Q
cubital fossa contents
A
a. tendon of biceps brachii muscle
b. brachial vessels and terminal branches
1) radial artery
2) ulnar artery
c. median nerve
d. radial nerve
1) superficial branch: runs into the forearm just deep to the Brachioradialis muscle
2) deep branches: runs between the two heads of the supinator muscle to access the posterior compartment of the forearm
3
Q
forarm and wrist landmarks
A
- ulna is subcutaneous throughout the forearm
- styloid processes of radius and ulna
- distal skin crease - corresponds to proximal border of the flexor retinaculum
- tendon of palmaris longus, if present
- tendon of flexor carpi radialis muscle
- tendon of flexor carpi ulnaris muscle
- radial artery pulse
- pisiform bone
4
Q
parts of the radius
A
- on lateral side of forearm
1. head
2. neck
3. radial tuberosity
4. ulnar notch
5. styloid process
6. dorsal tubercle
-
5
Q
parts of the ulna
A
-on medial side of forearm
1. olecranon process
2. trochlear notch
3. coronoid process
4. ulnar tuberosity
5. radial notch
6. styloid process
6
Q
Carpal bones proximal row (from lateral to medial)
A
scaphoid (boat-like)
b. lunate (moon-shaped)
c. triangular (or triquetrum)
d. pisiform (pea-sized sesamoid bone developed in the tendon of the flexor carpi ulnaris)
7
Q
carpal bones distal row from lateral to medial
A
trapezium (a table or counter)
b. trapezoid (geometric figure)
c. capitate (head-shaped)
d. hamate (having a hook)
8
Q
metacarpal bones
A
numbered I-V starting from the lateral/radial side, each has a head, shaft and base
9
Q
phalanges
A
two for tumb (proximal and distal) and three for each finger (proximal, middle and distal)
10
Q
antebrachial fascia
A
surrounds muscles
11
Q
palmar carpal ligament
A
thickening of antebrachial fascia just above wrist
12
Q
flexor retinaculum
A
- attached laterally to the tubercle of the scaphoid and crest of the trapezium and medially to the pisiform and hamulus of hamate
- may prevent flexor tendons from “bow-stringing”
- serves as boundaries of the carpal tunnel
13
Q
Thenar fascia
A
covers thumb muscles and forms the thenar compartment
14
Q
palmar aponeurosis
A
a very thick, stout fascia covering the central compartment of the hand, continuous with tendon of palmaris longus muscle
15
Q
what muscles of the arm have origins on the medial epicondyle of humerus?
A
pronator teres muscle, flexor carpi radialis muscle, palmaris longus muscle, flexor carpi ulnaris muscle, flexor digitorum superficialis
16
Q
pronator teres muscle origin and insertion and innervation
A
origin: medial side of coronoid process of ulna and epicondyle of humerus
insertion: radial shaft
innervation: median nerve
17
Q
pronator teres action
A
pronation
18
Q
flexor carpi radialis origin and insertion and innervation
A
origin: medial epicondyle of humerus
insertion:2nd and 3rd metacarpals
innervation: median nerve
19
Q
flexor carpi radialis action
A
flexes and abducts the hand
20
Q
palmaris longus origin, insertion and innervation
A
origin: medial epicondyle of humerus
insertion: flexor retinaculum and palmar aponeurosis
innervation: medial nerve
21
Q
palmaris longus action
A
flexes the hand
22
Q
flexor carpi ulnaris origin, insertion and innervation
A
origin: medial epicondyle of humerus and secound head on the olecranon and posterior border of ulna
insertion: pisiform
innervation: ulnar nerve
23
Q
first layer arm muscles
A
pronator teres, flexor cari radialis, palmaris longus, flexor carpi
24
Q
second layer arm muscle
A
flexor digitorum superficialis
25
flexor digitorum superficialis origin, insertion and innervation
origin: medial epicondyle of humerus and radius
insertion: middle phalanges 2-5
innervation: median nerve
26
flexor digitorum superficialis action
flexes the metacarpophalangeal joint, proximal interphalangeal joint and wrist jiont
27
third layer arm muscles
flexor pollicis longus and flexor digitorum profundus
28
flexor pollicis longus origin, insertion and innervation
origin: from anterior surface of radius and interosseous membrane
insertion: on the base of the distal phalanx of thumb
innervation: anterior interosseous nerve
29
flexor pollicis longus action
flexes interphalangeal joint and also metacarpophalangeal joint of the thumb
30
flexor digitorum profundus origin, insertion and innervation
origin: ulna and interosseous membrane
insertion: on distal phalanges of medial four fingers
innervation: medial half muscle is innervated by ulnar nerve and later half muscle is innervated by anterior interosseus nerve
31
flexor digitorum profundus muscle action
flexes wrist and distal interphalangeal joints
32
fourth layer arm muscle
pronator quadratus muscle
33
pronator quadratus origin, insertion, and innervation
origin: distal anterior surface of the ulna
insertion: distal anterior surface of the radius
innervated: anterior interosseous nerve
34
pronator quadratus action
pronates the elbow
- transversely oriented muscle just above wrist
35
Brachial artery
1. in cubital fossa lies between biceps tendon and median nerve, deep to the bicipital aponeurosis
2. bifurcates into radial and ulnar arteries at the level of the neck of the radius
36
Radial recurrent artery
2. crosses superficial to pronator teres muscle, but deep to the brachioradialis muscle
3. lies lateral to flexor carpi radialis tendon in lower forearm
4. goes to dorsal aspect of hand at lower end of radius
5. branches given off at wrist
a. palmar carpal branch
b. superficial radial artery
6. forms deep palmar arch in the hand
37
branches of radial recurrent at wrist
palmar carpal branch
superficial radial artery
- forms deep palmar arch in the hand
38
ulnar artery
1. anterior ulnar recurrent artery
2. posterior ulnar recurrent artery
3. common interosseous artery
a. short branch given off the ulnar artery near its origin
b. divides into anterior and posterior interosseous arteries
4. passes under median nerve and deep to both heads of pronator teres muscle, then deep to flexor digitorum superficialis
5. descends on surface of the flexor digitorum profundus lateral to the ulnar nerve
6. continues into the hand by passing through ulnar (Guyon’s) canal
7. branches given off at wrist
a. palmar carpal branch
b. deep palmar branch
8. forms superficial palmar arch in hand
39
collateral circulation around the elbow joint
branches of arteries proximal to the elbow joint anastomose with branches of arteries distal to the joint
40
branches of brachial artery
superior ulnar collateral artery
inferior ulnar collateral artery
41
branches of the deep brachial artery
radial collateral artery
middle collateral artery
42
branch of the radial artery
radial recurrent artery
43
branches of the ulnar artery
anterior ulnar recurrent artery
posterior ulnar recurrent artery
common interosseous artery
- anterior interosseous artery
posterior interosseous artery
-- interosseous recurrent artery
44
median nerve
1. passes between the humeral and ulnar heads of the pronator teres, then deep to the flexor digitorum superficialis where it descends to the wrist
2. at the wrist it can be located between the tendons of the palmaris longus and flexor carpi radialis muscles
3. passes through the carpal tunnel to reach the hand
4. innervates muscles of the first and second layer in forearm
5. gives off anterior interosseous nerve in the cubital fossa
a. supplies the muscles of the third and fourth layers
b. lies on the interosseous membrane
45
ulnar nerve
1. enters the forearm from behind the medial epicondyle of the humerus by
passing between the humeral and ulnar heads of the flexor carpi ulnaris muscle
2. travels on the flexor digitorum profundus muscle to the wrist
3. enters the hand by passing through ulnar (Guyon’s) canal
4. Innervates flexor carpi ulnaris muscle and ulnar half of flexor digitorum profundus muscles
46
elbow joint
formed by the humerus, radius and ulna
A. a hinge-type synovial joint between the trochlea and capitulum of the humerus with the trochlear notch of the ulna and the proximal concave surface of the head of the radius
B. proximal radioulnar joint is within the capsule of the elbow joint and shares its synovial cavity
C. main stability is maintained by the trochlea-trochlear fossa relationship
D. capsule
1. anterior and posterior portions are weak and fused with the brachialis and triceps brachii muscles
2. ulnar collateral ligament - has 3 parts.
a. posterior part - from medial epicondyle of humerus to olecranon process of ulna
b. anterior part - from medial epicondyle of humerus to coronoid process of ulna
c. intermediate part - from olecranon process to coronoid process
3. radial collateral ligament
a. from lateral epicondyle to annular ligament
47
ulnar collateral ligament parts
posterior part - from medial epicondyle of humerus to olecranon process of ulna
b. anterior part - from medial epicondyle of humerus to coronoid process of ulna
c. intermediate part - from olecranon process to coronoid process
48
radial collateral ligament
from lateral epicondyle to annular ligament
49
proximal radioulnar joint
apivot synovial joint between head of radius and radial notch of ulna
1. annular ligament - attaches to radial notch of ulna and encircles head and neck of radius
2. quadrate ligament- closes cavity of joint between radius and ulna
50
middle radioulnar joint
consists of oblique cord and interosseous membrane
1. interosseous ligament is a syndesmosis, a fibrous joint
51
distal radioulnar joint
apivot synovial joint between the head of the ulna and the ulnar notch of the radius
1. is separated from the wrist joint by a fibrocartilaginous disk which attaches to the styloid process of the ulna and the distal medial margin of the radius
2. moves in supination and pronation
3. is reinforced by palmar radioulnar and dorsal radioulnar ligaments
52
Radiocarpal joint
distal end of the radius and the fibrocartilaginous disk of the distal radioulnar joint articulate with the proximal row of carpal bones, exclusive of the pisiform bone
1. an ellipsoid synovial joint with a single joint cavity
53
dorsal radiocarpal ligament
from distal end of radius to the scaphoid, lunate, and triquetral bones
54
palmar radiocarpal ligament
same as dorsal radiocarpal ligament but on palmar surface
55
ulnar carpal collateral ligament
from styloid process of ulna to pisiform and triquetral bones
56
radial carpal collateral ligament
from styloid process of radius to scaphoid and trapezium bones
57
Carpal inter-articulation
pisiform bone articulates with the triquetral by a plane synovial joint
B. other seven carpal bones articulate with each other through the mid-carpal joint
1. a complex synovial joint
58
Carpometacarpal joints
first carpometacarpal joint
1. is a saddle-type synovial joint with trapezium
2. has flexion, extension, abduction, adduction, rotation and circumduction
B. second, third, fourth and fifth metacarpals have hinge joints with adjacent carpal bones
1. movement is limited
-
59
thenar eminence
the swelling at the base of the thumb
60
hypothenar eminence
the swelling at the base of the little finger
61
deep fascia
Thenar fasica- covers thumb muscles and forms the thenar compartment
hypothenar fascia - covers short muscles of the little finger and forms the hypothenar compartment
palmar aponeurosis - directly covers the central compartment which overlies the adductor-interosseous compartment
62
thenar compartment muscles
three muscles have origin from the lateral end of flexor retiaculum
- aductor pollicis brevis: inserts on lateral side of base of proximal phalanx
- flexor pollicis brevis: inserts on lateral side of base of proximal phalanx
- opponens pollicismuslce: inserts along shaft of first metacarpal
63
thenar compartment blood supply and innervation
blood supply: superficial palmar branch of the radial artery
innervation: recurrent branch of median nerve
64
hypothenar compartment muscles
three muscles have origin from the medial end of the flexor retinaculum
- abductor digiti minimi (quinti): inserts on medial side of base of proximal phalanx
- flexor digiti minimu brevis: inserts on abductor digiti minimi muscle
- opponens digiti minimi (quinti): inserts on medial side of entire fifth metacarpal
65
hypothenar compartment innervation and vascular supply
innervated: deep branch of ulnar nerve
blood supply: ulnar artery
66
central compartment of hand muscles lumbrical muscles
flexor tendons and their synovial sheaths
- four lumbrical muscles
* origin: from tendons of flexor digitorum profundus muscle and pass to laterla side of digit they serve
*inserts: on radial side of extensor expansion of the corresponding digit
67
central compartment of hand action, innervation, and blood supply
action: helps to flex the metacarpophalageal joints and extend the interphalangeal joints
innervated: lateral two lumbrical muscles (unipennate) are innervated by medial nerve and medial two lumbrical muscles (bipennate) are innervated by deep branch of the ulnar nerve
blood supply: superficial palmar arch
68
extensor expansion of central compartment of hand
the four tendons from the extensor digitorum muscles spread out over the metacarpophalangeal joint
69
adductor-interosseous compartment: adductor pollicis muscle origin, insertion, action
origin: transverse (from palmar surface of the third metacarpal bones) and oblique heads (from bases of second and third metacarpal bones, capitate bone)
insertion: on medial side of first phalanx of thumb
70
adductor-interosseous compartment: three palmar interossei muscles origin, insertion and action
origin: adjacent metacarpal bones
insertion: on base of proximal phalanx and extensor expansion of the digit acted upon
action: adduction of digits II, IV, and V; flex MP joints and extend IP joints
71
adductor-interosseous compartment of hand - four dorsal interossei muscles origin, insertion, and action
origin: from adjacent metacarpal bones
insertion: base of proximal phalnx and extensor expansion of the digit acted upon
action: abduction of digits II, III, and IV; flex MP joints
72
adductor-interosseous muscle compartment innervation and blood supply
innervation: deep branch of the ulnar nerve
blood supply: deep palmar arch
73
synovial sheaths
as the flexor tendons pass under the flexor retinaculum, they are enclosed in synovial sheaths to reduce friction
- for the distal tendons to the index, middle, and ring fingers are separate from the ulnar bursa
74
ulnar bursa
-complex synovial sheath for the 8 tendons of the two flex muscles of the fingers
-continues into the little finger, but NOT into the second, third, and fourth fingers
75
radial bursa
-synovial sheath for the tendon of the flexor pollicis longus muscle
- continues into thumb
76
ulnar artery
is lateral to the ulnar nerve and the pisiform bone, and branches in the hand
- deep palmar branch
- superficial palmar arch
77
superficial palmar arch
-the ulnar artery swimgs laterally across the palm and communicates with the superficial palmar branch of the radial artery
- is superficial to the long flexor tendons of the digits and deep to the palmar aponeurosis
- 3 common palmar digital arteries arise from the superficial palmar arch
- proper palmar digital arteries are bifurcation of the common palmar digital arteries and supplies the adjacent side of the 2nd-4th digits
78
radial artery
curves dorsally around the scaphoid and trapezium and crosses the floor of the anatomical snuff box and branches in the hand
- superficial palmar branch, principes pollicis artery, radialis indicis artery, deep palmar arch
79
superficial palmar branch
contributes to the superficial palmar arch
80
princeps pollicis artery
is the major blood supply to the thumb and usually a branch from the radial artery
81
radialis indicis artery
supplies the lateral side of the index finger
82
deep palmar arch
connection between radial artery and deep palmar branch of the ulnar artery
- palmar metacarpal arteries (3)
83
medial nerve
palmar cutaneous branch
recurrent muscular branch
common and proper palmar digital nerves
- 3 common palmar digital nerves which each divides into proper palmar digital nerves
84
palmar cutaneous branch
gives off in forearm
85
recurrent muscular branch
motor nerve to muscles in thenar compartment
86
common and proper palmar digital nerves
sensory to lateral 3 1/3 digits and motor to lateral two lumbrical muscles
- median nerve gives off 3 common palmar digital nerves as it emerges from beneath the flexor reticulum into the hand
- each common palmar digital nerve divides into proper palmar digital nerves which supply the cutaneous innervation to the sides of the digits and the lateral two lumbrical muscles
-
87
ulnar nerve
1. superficial branch - sensory to medial 1 ½ fingers
2. deep branch - motor to all the muscles
a. in the hypothenar and adductor-interosseous compartments
b. the medial two lumbrical muscles
88
Carpal inter-articulation
A. pisiform bone articulates with the triquetral by a plane synovial joint
B. other seven carpal bones articulate with each other through the mid-carpal joint
1. a complex synovial joint
89
Carpometacarpal joints
A. first carpometacarpal joint
1. is a saddle-type synovial joint with trapezium
2. has flexion, extension, abduction, adduction, rotation and circumduction
B. second, third, fourth and fifth metacarpals have gliding joints with adjacent carpal bones
1. movement is limited
-
90
Metacarpophalangeal joints
A. condylar joints which allow flexion, extension, abduction, adduction, circumduction and limited rotation except first one is a hinge joint
B. all have radial and ulnar collateral ligaments
C. the heads of the 4 medial metacarpal bones are joined by the deep transverse metacarpal ligament on the palmar aspect
D. dorsal aspect mainly formed by extensor tendon expansion hood
91
interphalangeal joints
The interphalangeal joints are hinge joints and have collateral ligaments similar to metacarpophalangeal joints
92
Brachioradialis origin, insertion and innervation
origin: lateral supracondylar ridge of humerus
insertion: distal radius near styloid process
innervation: main trunk of radial nerve
93
brachioradialis action
flexes forearm at elbow
94
Extensor carpi radialis longus origin, insertion and innervation
origin: lateral epicondyle or supracondylar ridge
insertion: base of 2nd metacarpal
innervation: main trunk of radial nerve
95
extensor carpi radiales longus actin and compartment
action: extends wrist
in second compartment
96
extensor carpi radialis brevis origin, insertion and innervation
origin: lateral epicondyle or supracondylar ridge
insertion: base of 3rd metacarpal
innervation: deep branch of radial nerve
97
extensor carpi radialis brevis action and compartment
action: extends wrist
2nd compartment
98
extensor digitorum origin, insertion and innervation
origin: lateral epicondyle or supracondylar ridge
insertion: extensor hood of digits 2-5... middle and distal phalanges
innervation: posterior interosseous nerve
99
extensor digitorum action and compartment
action: extends digits
part of the 4th compartment
100
extensor digiti minimi origin, insertion and innervation
origin: lateral epicondyle or supracondylar ridge
insertion: extensor hood of 5th digit
innervation: posterior interosseous nerve
101
extensor digiti minimi action and compartment
action: extends pinky
part of 5th compartment
102
extensor carpi ulnaris origin, insertion and innervation
origin: lateral epicondyle or supracondylar ridge
insertion: base of 5th metacarpal
innervation: posterior interosseous nerve
103
extensor carpi ulnaris action and compartment
action: extends and adducts wrist
part of 6th compartment
104
anconeus origin, insertion and innervation
origin: lateral epicondyle or supracondylar ridge
insertion: upper ulna
innervation: main trunk of radial nerve
105
anconeus action
helps with extension of elbow
106
supinator origin, insertion and innervation
origin: lateral epicondyle
insertion: radius
innervation: deep branch of radial nerve
107
abductor pollicis longus origin, insertion and innervation
origin: radius and ulna
insertion: base of 1s metacarpal
innervation: posterior interosseous nerve
108
extensor pollicis brevis origin, insertion and innervation
origin: radius
insertion: proximal phalanx of thumb
innervation: posterior interosseous nerve
109
extensor indicis origin, insertion and innervation
origin: ulna
insertion: extensor hood of index finger
innervation: posterior interosseous nerve
110
supinator action
supinates the forearm
111
abductor pollicis longus action and compartment
abducts and extends the thumb
part of 1st compartment
112
extensor pollicis brevis action and compartment
extends metacarpophalangeal and carpometacarpal joints of the thumb
part of the 1st compartment
113
extensor pollicis longus action and compartment
extends interphalangeal, metacarpophalangeal and carpometacarpal joints of the
thumb
part of 3rd compartment
114
extensor indicis action and compartment
action: extends the index finger
part of 4th compartment
115
anatomical snuffbox boundaries
medial: extensor pollicis longus
lateral: extensor pollicis brevis and abductor pollicis longus
116
anatomical snuffbox contents
radial artery, scaphoid, extensor carpi radialis longus and extensor carpi radialis brevis
117
dorsal carpal arch
supplied by the dorsal carpal branches of the radial and ulnar arteries
and anterior and posterior interosseous arteries
118
first dorsal metacarpal artery
directly from the radial artery before it crosses
through the two heads of the first dorsal interosseous muscle.
119
radial nerve
supplies all the muscles on the posterior forearm
he main trunk supplies anconeus,extensor carpi radialis longus and brachioradialis muscles
before it divides
C. radial nerve divides on the anterior aspect of the elbow into
1. superficial radial nerve - purely cutaneous to posterolateral surface of
the hand
2. deep radial nerve - supplies the extensor carpi radialis brevis and
supinator muscles
3. all other posterior forearm muscles are innervated by the posterior
interosseous nerve
120
dorsal branch of ulnar nerve
serves the medial aspect of the digits of the
dorsal side
