038 Foundations: Upper Quarter Functional Anatomy

Front 1

What type of joint is SC joint?

Back 1

Saddle Synovial with INTRA-ARTICULAR DISC

Front 2

When does SC joint move?

When is SC joint injured?

Back 2

ED

-moves into Elevation and Depression during shoulder ELEVATION/DEPRESSION;

-injured AFTER the AC joint and CLAVICLE

*Think of this in alphabetical order AC joint, clavicle, then SC joint are injured

Front 3

What type of joint is the AC joint?

Back 3

Plane Synovial

Front 4

What ligaments are associated with the AC joint

Back 4

1) Coracoclavicular ligament (Trapezoid [L] and Conoid [M])

2) Acromioclavicular ligament

Front 5

What is the function of the coracoclavicular ligament

Back 5

1) Trapezoid (lateral) and Conoid (medial) portions: STABILIZE AC joint and PREVENT UPWARD DISPLACEMENT of HH

2) PREVENT SEPARATION of scapula from clavicle

Front 6

Where is the coracoclavicular ligament positioned relative to other structures?

Back 6

Covers the Supraspinatus

can be involved in impingement syndrome

Front 7

When is the AC joint injured?

Back 7

during SHOULDER SEPARATION which leads to injury to ligaments of AC joint and unstable AC joint causing pain and dysfuncition of shoulder joint

Front 8

What type of joint is the glenohumeral joint?

Back 8

multi-axial ball and socket (HH and glenoid cavity of scapula

Front 9

What stabilizes the GH joint?

Back 9

mobility > stability but stabilized by A and P JOINT CAPSULE, glenoid LABRUM, and long head of BICEPS mm (continuous with the labrum)

Front 10

What is the glenoid labrum

Back 10

FIBRO-CARTILAGINOUS rim that deepens glenoid cavity and stabilizes GH joint

-long head of biceps mm is continuous with labrum

Front 11

What is the ligamentous support of the GH joint?

Back 11

SIM

SUPERIOR, INFERIOR, AND MIDDLE GH ligaments = static restraint to excessive anterior translation

Front 12

What are the rotator cuff muscles?

Back 12

SITS

Supraspinatus,

Infraspinatus,

Teres MINOR, Subscapularis

Front 13

What provides tendon support to GH joint?

Back 13

Rotator cuff mms that insert INTO joint capsule

-dynamic support provided by muscles contracting and pulling head of humerus down into lower and wider portion of glenoid cavity and allowing full overhead elevation of arm

Front 14

What happens when static support of GH joint is compromised?

Back 14

ASYNCHRONOUS firing of the rotator cuff mm may cause subacromial IMPINGEMENT

Front 15

What joints are involved to raise arm overhead?

Back 15

4 joints: GASS

GH joint

AC joint

SC joint

Scapulothoracic articulation

Front 16

How many degrees of elevation occur at GH joint? How many at Scapulothoracic articulation?

Back 16

120 deg at GH

60 deg at Scapthoracic

GS - 2:1

Front 17

What motion of clavicle occur during arm elevation?

Back 17

ERB Elevates: Elevates, Retracts, Backward rotation

-during first 90 deg shoulder abd, clavicle elevates 35-45 deg at SC joint

-full scapular UR requires 45-50 deg clavicle posterior/backward rotation (at SC joint)

Front 18

What is the scapulohumeral rhythm?

Back 18

ratio of scapular to humeral motion for elevation is 1:2 (or humeral to scapular ratio 2:1)

Front 19

Describe the muscular stabilizers of the shoulder

Back 19

RC work as group to hold HH in glenoid cavity esp during ABD

-supraspinatus and coracoacromial arch guard shoulder superiorly

-subscapularis stabilizes anteriorly

-infraspinatus and teres minor stabilize posteriorly

Front 20

Muscles for UR of scapula during elevation

Back 20

URSUL (like URSULA)

SERRATUS ANTERIOR and (trapezius) UPPER and LOWER trapezius

Front 21

muscles for downward rot (esp with purposeful shoulder extension i.e. wood chopping)

Back 21

DRRLP

Rhomboids, Levator scapula, Pec minor

Front 22

what muscles contribute to protraction?

Back 22

PPS

PS: Pec minor and SA

Front 23

what mm contribute to retraction?

Back 23

ReTraction-RT

RT: Rhomboids and middle & lower Traps

Front 24

what mm contribute to scapular elevation?

Back 24

UL

Upper traps and Levator scapula

Front 25

what mm contribute to scapular depression?

Back 25

pec minor and lats

Front 26

what bursa is at shoulder?

Back 26

SUBACROMIAL bursa which is fused with subdeltoid bursa

-palpable by extending humerus

-located over bicipital groove under the deltoid mm

-separates deltoid from RC

-injury=bursitis & shoulder tenderness and restriction of movement

Front 27

Describe circulation into the axilla

Back 27

AXILLARY ARTERY is palpable in lateral wall of inferior part of axilla

-injury occurs when inferior part pressed against humerus (e.g. resting on crutches)

Front 28

what is crutch palsy?

Back 28

compression of RADIAL nn in axilla due to resting on crutches (also can press the axillary aa against humerus) = WRIST DROP

Front 29

Draw Brachial Plexus

Back 29

Front 30

what nerves branch off before trunks form? i.e. off rami

Back 30

dorsal scapular

long thoracic nn

Front 31

what does dorsal scapular nn innervate and results of injury to the nerve?

Back 31

LEVATOR SCAPULA and RHOMBOIDS

-injury effects scapular retraction and downward rotation

Front 32

when do the TRUNKS form?

Back 32

superior, middle, and inf

-as they pass over the first rib

C8 and T1 pass on either side of the first rib

Front 33

where does the suprascapular nn arise and travel to?

Back 33

from superior trunk and passes beneath trapezius through scapular notch to innervate the supraspinatus and infraspinatus

Front 34

what does injury to the suprascapular nerve cause and when does it happen?

Back 34

injury to nerve from IMPINGEMENT by the SUPERIOR TRANSVERSE SCAPULAR LIGAMENT causes pain and DECREASED AB and ER of the shoulder

Front 35

where do trunks DIVIDE?

Back 35

into divisions (3 ant and 3 post) BENEATH THE CLAVICLE

Front 36

where are lateral, posterior and medial CORDS formed?

Back 36

BENEATH PEC MINOR

Front 37

what is the MOI for cord injuries?

Back 37

postural dysfunction or traumatic injury due to impingement of the brachial plexus beneath the clavicle or pectoralis minor

Front 38

when do the brachial plexus BRANCHES form?

Back 38

as the cords pass under the pectoralis minor

Front 39

what is the most frequent fracture site of the proximal humerus?

Back 39

surgical neck (where bone narrows to become the shaft)

Front 40

what brachial branches are injured with fractures of humerus

Back 40

URA

ulnar

radial,

axillary

*Ura fractured his humerus

Front 41

what type of joint is the ulnohumeral joint

Back 41

uniaxial HINGE between ulnar trochlear notch and the trochlea of the humerus (anterior/inferior)

Front 42

what ligament is at the ulnohumeral joint?

Back 42

ULNAR COLLATERAL (AKA: LCL) ligament stabilizes joint

-carrying angle:

-10-15 deg in men

-20-25 deg in women with arm at the side

Front 43

What happens with movement at the ulnohumeral joint?

Back 43

gaps medially in full extension, laterally in full flexion and glides side to side in supination/pronation

*Look at your arm extended and picture the joint to help with this

Front 44

what type of joint is the radiohumeral joint?

Back 44

uniaxial hinge between radial head and the capitulum of the humerus

Front 45

What ligament is associated with the radiohumeral joint?

Back 45

RADIAL COLLATERAL ligament: provides lateral stablity

injury may interfere with elbow flexion and extension

Front 46

what type of joint is the superior radioulnar joint?

Back 46

uniaxial pivot joint between the radial proximal head and the medial portion of the proximal ulna

Front 47

what motion occurs at superior radioulnar joint?

Back 47

spherical radial head allows ROTATION needed for supination/pronation

Front 48

what ligament is at the superior radioulnar joint?

Back 48

ANNULAR ligament provides stability by surrounding the radial head

Front 49

what can injury of the superior radioulnar joint cause?

Back 49

limitation in ability to control the position of the hand

Front 50

What makes up the middle radioulnar joint?

Back 50

interosseous membrane and the oblique cord

-interosseous membrane stabilizes the elbow during pushing movements

-oblique cord resists distal displacement of the radius during pulling movements

Front 51

How many joints make up the elbow?

Back 51

3 joints:

1. ulnohumeral joint

2. radiohumeral joint

3. radioulnar joints

Front 52

How many groups of muscles control movements at the elbow?

How many total muscles?

Back 52

-4 groups that synergistically control elbow flexion/ext and supination/pronation

-8 muscles exert force to move the elbow

Front 53

What muscles contribute to elbow flexion?

Back 53

B3: brachialis, biceps brachii, & brachioradialis

(flexor carpi ulnaris and pronator teres may contribute)

Front 54

What is the main elbow flexor?

Back 54

**BRACHIALIS**

(NOT biceps brachii)

Front 55

In what elbow/forearm positions does the brachialis flex the elbow?

Back 55

acts in shoulder flexion or extension & forearm supination or pronation

Front 56

In what elbow/forearm positions does the biceps brachii act on the elbow?

Back 56

when in supination, flexes the forearm

or

flexes the forearm when lifting >2 lb

Front 57

What movement does brachioradialis cause?

Back 57

flexes the elbow

and

STABILIZES supination and pronation during strong resistance

Front 58

Besides the main elbow flexors, what other muscles may contribute to elbow flexion?

Back 58

Flexor carpi ulnaris

Pronator teres

Front 59

What are the main elbow extension muscles?

Back 59

TRICEPS brachii is the main extensor

with ANCONEUS assisting and providing STABILITY during supination and pronation

Front 60

Besides triceps and anconeus, what other muscles may contribute to elbow extension?

Back 60

PEC MAJOR and ANT DELT facilitate elbow extension in closed chain movements such as push-ups or pushing heavy objects

(Think of doing push ups)

Front 61

What muscles produce supination?

Back 61

supinator and biceps brachii

Front 62

when does the supinator act?

Back 62

with LOW loads and with SLOW movements

Front 63

when does the biceps brachii cause supination?

Back 63

when elbow is flexed to 90 deg

Front 64

what muscles produce pronation?

Back 64

pronator teres, pronator quadratus, and FLEXOR CARPI RADIALIS

Front 65

when is the pronator quadratus active for pronation?

Back 65

during low loads

(similar to the supinator)

Front 66

Describe coordination between muscle antagonist during the action of pulling objects

Back 66

elbow flexion by biceps brachii

triceps aids shoulder extension and controls elbow flexion

Front 67

Describe coordination between muscle antagonist during the action of pushing an object away from body

Back 67

triceps extends elbow

biceps controls extension and helps with shoulder flexion

Front 68

Describe coordination between muscle antagonist during the action of turning door knobs or screwdrivers clockwise

Back 68

biceps supinates

TRICEPS counters flexion action

Front 69

Describe coordination between muscle antagonist during the action of using a fork

Back 69

biceps supinates and flexes elbow to bring fork to mouth

biceps contracts eccentrically to control putting down fork

Front 70

what bursae are at the elbow

Back 70

SUBCUTANEOUS and SUBTENDINOUS bursae

Front 71

where is the subcutaneous olecranon bursa and how is it injured?

Back 71

located in tissue over the olecranon

injury due to repeated excessive friction (="student's elbow")

Front 72

Where is the subtendinous olecranon bursa located? and when/how is it injured?

Back 72

between triceps tendon and the olecranon

injury: less common and occurs with excessive friction between triceps tendon and olecranon (e.g. during certain assembly jobs)

Front 73

What artery is associated with the elbow region and where can it be palpated?

Back 73

BRACHIAL artery which is a continuation of the axillary artery

palpated over anterior region of cubital fossa

Front 74

where is compression of the brachial artery the most effected?

Back 74

middle of the humerus

Front 75

what injury occurs with occlusion or laceration of the brachial artery

Back 75

ischemia of the flexor muscles of the forearm causing a Volkmann's ischemic contracture of the involved muscles

Front 76

what is Volkmann's ischemic contracture?

Back 76

occurs when there is ISCHEMIA TO FOREARM FLEXORS resulting in contractures of elbow flexion, forearm pronation, wrist flexion, MCP extension, and IP flexion, and thumb adduction

Front 77

where is the head of the ulna and the head of the radius?

Back 77

head of radius= at the elbow

head of ulna = at wrist

Front 78

Where are the styloid processes of the ulna and radius?

Back 78

ulna = distal end on the medial side

radial styloid process = distal end on lateral side of the bone

-radial styloid process is more distal than ulnar styloid process

Front 79

where is the radius most likely to be fractured?

Back 79

distal radial fracture = Colles' fracture

MOI = FOOSH

Front 80

what is a Colles' fracture

Back 80

distal radial fracture with MOI commonly fall on outstretched hand

(If I had a collie, I would name him Radius)

Front 81

Describe bony anatomy of ulna.

Back 81

-Trochlear notch, coronoid process, olecranon process

-Humerus has Trochlea, coronoid fossa, olecranon fossa

Front 82

where can you palpate the head of the radius?

Back 82

with elbow extended, just distal to lateral epicondyle of humerus

Front 83

where can the radial styloid process be palpated?

Back 83

on lateral aspect of wrist

Front 84

where is the ulnar nerve located at the elbow?

Back 84

posterior to the medial epicondyle

Front 85

when/where is ulnar nerve most likely to be compressed?

Back 85

in Osborn's fasica, forming the cubital tunnel, posterior to medial epicondyle

Front 86

Name the carpal bones

Back 86

Some lovers try positions that they can't handle (lateral to medial on volar surface)

proximal row: (lat to med) Scaphoid, lunate, triquetrium, pisiform,

distal row: trapezium, trapezoid, capitate, hamate

Front 87

what is the flexor retinaculum attached to?

Back 87

scaphoid and trapezium

Front 88

What is the contents of the carpal tunnel?

Back 88

median nn and 9 flexor tendons: (4) FDS, (4) FDP, (1) FPL

superficial: FDS 3 & 4, median nn

middle: FDS 2 & 5

Deep: FDP & FPL

transverse carpal ligament (aka flexor retinaculum forms roof of carpal tunnel and carpal bones form floor)

Front 89

Which carpal bone is most likely to fracture?

Back 89

SCAPHOID

poor blood supply and can frequently develop avascular necrosis

Front 90

Where are the heads of the metacarpals

Back 90

heads are distal

Front 91

how many bones and how many joints are in the wrist, hand, and fingers?

Back 91

bones: 29

joints: 31

(I think Radius and Ulna are included in this)

Front 92

What is the quantity of movement contributed by the thumb to hand function?

Back 92

40% of hand's function is contributed by thumb

-(that's almost 1/2)!

Front 93

what are the arches of the hand?

Back 93

support the hand for strength and allow prehension

1. longitudinal

2. metacarpalphalangeal transverse (distal transverse arch)

3. carpal transverse (proximal transverse)

Front 94

what type of injury limits supination/pronation

Back 94

damage to mid to distal forearm

Front 95

what type of joint is the radiocarpal and what bones make it up?

Back 95

BI-AXIAL ELLIPSOID between radius (concave) and scaphoid and lunate (convex)

Front 96

What stabilizes the radiocarpal joint?

Back 96

-RADIAL COLLATERAL LIGAMENT on lateral side

-triangular shaped disc on the ulna (part of triangular fibrocartilage complex [TFCC] that connects to triquetrium and lunate via ulnar collateral ligament medially)

Front 97

*What is TFCC?

Back 97

Triangular fibrocartilage complex

-articular disk on distal end of ulna connected via two fibrous laminae:

1. dorsal and palmar ligaments attaching to head of ulna and ulnar styloid process

2. ulnar collateral ligament which attaches to triquetrum, hamate, and base of 5th metacarpal

and ECU tendon shealth

Front 98

what is the load bearing ratio of radius to ulna

Back 98

60:40

Front 99

What are the motions of the radiocarpal joint?

Back 99

5 TOTAL: flexion, extension, radial deviation, ulnar deviation, circumduction

Front 100

What motions occur at intercarpal joint?

Back 100

small amount of gliding

-dorsal, palmar, and interosseous ligaments stabilize

-pisiform sits on triquetrum and does not participate in gliding

Front 101

*What articulations makes up the midcarpal joint?

Back 101

-medially the scaphoid, lunate, triquetrium articulate with hamate and capitate

-laterally the scaphoid articulates with the trapezoid and trapezium

-stabilized by dorsal and palmar ligaments

Front 102

What is the functional motion of the scaphoid during wrist motions?

Back 102

-functions with proximal row of carpals during flexion

-functions with distal row during extension

(* the only thing that may help with this is when you flex your wrist you can get your fingers to go more proximal than when you extend your wrist where they stay more distal)

Front 103

What dislocation is common in the carpal bones?

Back 103

anterior dislocation of the LUNATE resulting in compression of median nn against the flexor retinaculum

Front 104

*What joint does the majority of wrist flexion and wrist extension occur at?

Back 104

wrist flexion: mid carpal

wrist extension: radiocarpal

Front 105

what wrist position allows effective hand function?

Back 105

slight extension

Front 106

*What muscle is most active in grasping?

Back 106

Extensor carpi radialis brevis ECRB which holds wrist in slight extension

Front 107

*what 3 muscles of the wrist/forearm are active in both wrist flexion and extension to provide dynamic stability?

Back 107

ECU

EPB

Abd Pollicis longus

Front 108

*What are the wrist flexors and which is more effective?

Back 108

FCR and FCU

-FCR is more effective

-finger flexors can flex wrist (need to be stabilized during MMT)

Front 109

*what mm produces radial deviation

Back 109

ECRB, ECRL, FCR

Front 110

What mm do ulnar deviation?

Back 110

ECU, FCU

Front 111

what are the muscles of the anterior forearm

Back 111

8 muscles

-muscles that pronate forearm and hand: Pronator quadratus and Pronator teres

-muscles that flex hand: FCU, FCR and palmaris longus

-muscles that flex the digits (FPL, FDP, FDS)

FLEXORS:

*4-1=3

SUPERFICIAL LAYER

1. Pronator teres

2. FCR

3. Palmaris Longus

4. FCU

MIDDLE LAYER

1. FDS

DEEP LAYER

1. FDP

2. FPL

3. Pronator Quadratus

Front 112

what are the muscles of posterior forearm

Back 112

11 muscles

-Muscles that extend the wrist: ECRL, ECRB, ECU

-extend medial 4 digits: ED, EI, EDM

-extend the 1st digit (thumb): Abductor pollicus longus, EPB, EPL

EXTENSORS:

6-6

SUPERFICIAL LAYER:

1. Brachioradialis

2. ECRL

3. ECRB

4. Extensor Digitorum

5. Extensor Digiti Minimi

6. ECU

DEEP LAYER:

1. Anconeus

2. Supinator

3. AbPL

4. EPB

5. EPL

6. Extensor Indices

Front 113

what is the blood supply of the wrist?

Back 113

radial artery begins in the cubital fossa and travels medially to radial styloid process

-palpation is where radial artery lies on anterior surface of distal radius & lateral to FCR

Front 114

What injury can damage radial artery?

Back 114

supracondylar fracture of the elbow can damage radial artery in cubital fossa

Front 115

what type of joints are the 4 medial CMC joints?

What ligaments provide stability

Back 115

-Plane synovial

-Dorsal, palmar, and interosseous ligament support

Front 116

what injuries are common at the CMC joint?

Back 116

all CMC joints are susceptible to STRAINS

Front 117

what type of joint is the thumb CMC

Back 117

SADDLE with dorsal, palmar, and lateral ligament support

Front 118

Where is the intermetacarpal joints?

Back 118

between 2nd through 4th metacarpal bones

-plane joints held together by ligaments with small amount of gliding motion

Front 119

What type of joint is the MCP joints?

what ligaments provided stability

Back 119

-Condyloid joints

-Palmar, transverse and collateral ligaments (tight in flexion)

Front 120

What is unique about the 1st MCP joint?

Back 120

It can ROTATE which augments function of 1st CMC joint

Front 121

how many IP joints in each finger?

Back 121

2 except the thmb

Front 122

what type of joint are the PIP and DIP?

Back 122

uniaxial HINGE: flexion and extension

Front 123

what stabilizes DIP and PIP joints?

Back 123

PALMAR and COLLATERAL ligaments and a FIBROUS capsule

Front 124

what happens to IP ligaments in flexion?

Back 124

they DO NOT become tight (unlike MCP joint flexion in which the collaterals do become tight)

Front 125

In general what muscle performance characteristic do the hand extrinsic muscles supply vs the intrinsics?

Back 125

extrinsics provide POWER

intrinsics provide FINE CONTROL

Front 126

How much wrist extension is needed for optimal use of the hand?

Back 126

20-30 deg

Front 127

what are the 2 types of functional grasps

Back 127

POWER grip

PRECISION (prehension) grip

Front 128

What is power grip?

Back 128

exerts force on object to hold against hand

requires FINGER FLEXION and WRIST EXTENSION with ULNAR DEVIATION

Front 129

what is prehension/precision grip?

Back 129

used for accurate function with objects held between tips of fingers

Front 130

what muscles control the thumb?

Back 130

4 intrinsic (thenar) and 4 extrinsics (forearm)

intrinsic:

OP - opponens pollicis

FPB - flexor pollicis brevis

APB - abductor pollicis brevis

adductor pollicis

extrinsic:

EPL - extensor pollicis longus

EPB - extensor pollicis brevis

FPL - flexor pollicis longus

APL - abductor pollicis longus

Front 131

what are the muscles of the thenar eminence?

Back 131

1) Opponens pollicis

2) FPB: Flexor pollicis brevis

3) AbPB Abductor pollicis brevis

innervation: (except deep head of FPB) = median nn

Front 132

what are the hypothenar muscles?

Back 132

1) flexor digiti minimi

2) abductor digiti minimi

3) opponens digiti minimi

4) palmaris brevis

Front 133

what muscles extend the IPs and MCPs?

Back 133

EXTENSOR DIGITORUM

(interossei and lumbricals contribute by incr tension on extensor mechanism to allow ED to extend digits)

Front 134

What is the function of the EPL?

Back 134

extends IP and MCP of thumb

causes CMC retroposition

Front 135

what does the opponens digiti minimi do?

Back 135

hollows the palm for cupping the hand (e.g. to drink water from glass or grasp cylindrical object)

Front 136

what does radial nerve damage do to hand/wrist function?

Back 136

affects ability to maintain functional wrist position and to release an object

Front 137

what does damage to median nn do to hand/wrist function?

Back 137

effects flexion of digits on radial side and precision grip

Front 138

what does damage to ulnar nn do to hand/wrist function?

Back 138

flexion of digits on ulnar side and power grip