1. Acromioclavicular Joint?.Type of joint and movements permitted
1. Plane-type, synovial joint
2. No demonstrable movement; muscles moving the scapula cause the acromion to move on the clavicle
3. Articulation between concave facet of acromion and convex facet of clavicle
2. Acromioclavicular Joint?.Coracoclavicular lig general
unites coracoid process and clavicle
3. Acromioclavicular Joint?.Coracoclavicular lig - Conoid
vertical, in shape of inverted pyramid (more medial)
horizontal, extends laterally to inferior surface of clavicle (more lateral)
5. Acromioclavicular Joint?.Superior Acromioclavicular lig
quadrilateral band, covering the superior part of the articulation that extends between the upper part of the lateral clavicle & upper surface of the acromion. Provides horizontal stability to the joint
1. bridges gap btw greater & lesser tubercle
2. holds tendon of biceps brachii in place
Rotator Cuff mm Abduction Supraspinous fossa to Greater Tuberosity Suprascapular n. C5-C6
Rotator Cuff mm External Rotation Infraspinous fossa to Greater Tuberosity Suprascapular n. C5-C6
19. Teres Minor
Rotator Cuff mm External Rotation Lateral border of Scapula to Greater Tuberosity Axillary n. C5-C6
Rotator Cuff mm Internal Rotation Subscapular Fossa Lesser Tuberosity Upper and Lower Subscapular n. C5-C7
21. Long head of Biceps Brachii
Rotator Cuff mm/Anterior Arm : Flexion, Abd, and Int Rot Forearm: Flexion and Supination when flexed. Supraglenoid Tubercle to Radial Tuberosity Musculocutaneous n. C5-C6
22. Pectoralis Minor
Downward Rotation of Scapula Ribs 3-5 to Coracoid Process Medial and Lateral Pectoral nn C6-T1
Anterior Arm Arm flexion, ADD, and Int Rot Coracoid Process of Scapula to middle 1/3 of medial humerus Musculocutaneous C6-C7
24. Short head of Biceps Brachii
Anterior Arm Arm: Flexion, Abd, and Int Rot Forearm: Flexion and Supination when flexed. Coracoid Process of scap to Radial Tuberosity Musculocutaneous n. C5-C6
25. Deltoid Mm
clavicular part-arm flexion, Int Rot, ADD / acromial part-ABD /spinal part-Ext, ext rot, ADD Lat 1/3 of clavicle, acromion, scapula spine to deltoid tuberosity of humerus Axillary n. C5-C6
Oblique elevation, depression & retraction of scapula, upward rotation of glenoid fossa Occipital bone; C1-C7 SPs, aponeurosis @ T1-T4 SPs, SPs of T5-T12 to Lat 1/3 of clavicle, acromion, scapula spine CN XI n. C3-C4
27. Latissimus Dorsi
Int Rot, ADD, Ext of Arm SPs of T7-12, thoracolumbar fascia, inferior angle of scapula, ribs 9-12, iliac crest to crest of lesser tuberosity of humerus thoracodorsal C6-C8
28. Rhomboid Major and Minor
steadies scapula, retracts scapula medially upward SPs C6, C7/ SPs T1-T4 to Medial Border of Scapula Dorsal Scapula C5
30. Levator Scapulae
Elevates Scapula Medially TPs C1-C4 to Superior angle of Scapula Dorsal Scapula C5
31. Teres Major
Internal Rotation Inferior Angle of scapula to Crest of lesser tuberosity of humerus Lower Subscapular C5-C6
32. Serratus Anterior
Draws scapula Laterally forward Ribs 1-9 to Medial border of scapula Long thoracic n. C5-C7
33. Fascia and Intermuscular Septi?Brachial Fascial
a. A sleeve of deep fascia around the arm
b. Continuous with the antebrachial fascia of the forearm
34. Fascia and Intermuscular Septi?Medial Intermuscular Septa
a. Extend from deep surface of brachial fascia to humerus
b. Divide arm into anterior (flexor) and posterior (extensor) compartments
c. medial lip of intertubercular sulcus (superiorly) ? medial epicondyle
35. Fascia and Intermuscular Septi?Lateral Intermuscular Septa
a. Extend from deep surface of brachial fascia to humerus
b. Divide arm into anterior (flexor) and posterior (extensor) compartments
c. lateral lip of intertubercular sulcus (superiorly) ? lateral epicondyle
36. Anterior Compartment ?Nerve and Mm
1. biceps brachii (long and short head)
2. coracobrachialis **pierced by the Musculocutaneous n**
3. brachialis?main forearm flexor
37. Posterior Compartment ?Nerve and Mm
1. triceps (long, medial and lateral heads)?main arm extensor
38. Flexor Wad?N and Mm
Median n. (look at table for more detail)
1. flexor carpi radialis
2. flexor carpi ulnaris
3. flexor digitorum superficialis
4. flexor digitorum profundus
5. flexor pollicis longus
39. Extensor Wad.. N and Mm
Radial n. (look at table for more detail)
1. extensor carpi radialis longus and brevis
2. extensor carpi ulnaris
3. extensor digitorum
4. abductor pollicis longus
5. extensor pollicis brevis
6. extensor pollicis longus
7. extensor indices (most distal muscle for radial innervation)
40. Pronator Teres
Superficial Anterior Forearm Compartment Median Epicondyle Median n. C6-C7 Forearm Pronation
41. Flexor Carpi Radialis
Superficial Anterior Forearm Compartment Median Epicondyle Median n. C6-C7 Wrist Flexion and Abduction
42. Palmaris Longus
Superficial Anterior Forearm Compartment Median Epicondyle Median n. C7-C8 Wrist Flexion
43. Flexor Carpi Ulnaris
Superficial Anterior Forearm Compartment Median Epicondyle Ulnar n. C7, C8 Wrist Flexion and ADduction
44. Flexor Digitorum Superficialis
Superficial Anterior Forearm Compartment Median Epicondyle Median n. C7-T1 Wrist Flexion MCP and PIP Flexion of Digits 2-5
45. Palmaris Longus Tendon
a small tendon btw the flexor carpi radialis m. & the flexor carpi ulnaris m. that partially covers the median n.
46. Dupuytren's Contracture
fixed flexion contracture of the hand due to progressive fibronodular thickening of the palmar aponeurosis. Fingers bend toward the palm & cannot be fully extended (straightened)?ring finger & little finger are most commonly affected w/ middle finger involvement in advanced cases.
1. Condition often bilateral
2. Usually affects middle-aged males of Northern European decent (hereditary predisposition??)
3. Risk Factors: alcohol, liver disease, & antiepileptic meds
4. Surgery required for Tx
47. Snuffbox...When is a fracture of the Scaphoid common?
when a person falls on the palm with the hand abducted. The bone lies on the floor of the snuffbox. If the scaphoid is fractured across its neck, there is tenderness over the snuffbox.
48. Snuffbox...What happens if there is a fracture of the Scaphoid?
The blood flow to the bone can be severed and stop the delivery of necessary oxygen and nutrients to the bone cells. Healing is slow & there is a chance for necrosis of the bone if left untreated.
radial artery, radial styloid process (proximally), base of 1st metacarpal (distally), scaphoid & trapezium (btw styloid process & 1st metacarpal)
tendons of abductor pollicis longus and extensor pollicis brevis (De Quervain?s Disease).
tendon of extensor pollicis longus.
52. Guyon's Canal
a space where the ulnar a. & n. pass btw the pisiform & hamate bones to reach the hand. Entrapment of the ulnar n. in this canal can lead to ulnar neuropathy.
53. Movements of Thumb
In anatomical Position?.Flexion: Bend; Extension: stretch out; ABD: Move ant Opposition: Touch pinky.
54. Trigger Finger
one of your fingers or your thumb gets stuck in a bent position & then straightens with a snap. This is often painful & is caused by the narrowing of the sheath that surrounds the tendon in the affected finger.
1. Work or hobbies that require repetitive actions make people more susceptible
2. More common in women & anyone w/ diabetes
55. Flexor Digitorum Superficialis
Wrist, MCP and PIP (2-5) Flexion Medial epicondyle or Coronoid process of ulna to Sides of middle phalanges of digits 2-5
56. Flexor Digitorum Profundus
Wrist, MCP, PIP, and DIP (2-5) Flexion 2/3 of flexor surface of ulna and interosseous membrane to Palmer surface of distal phalanges of digits 2-5
57. Flexor Pollicis Longus
Wrist Flexion and ABD, Carpometacarpal flexion of thumb/ MCP and IP flexion of thumb Mid-anterior surface of radius and interosseous membrane to palmar surface of distal phalanx of thumb.
58. Mallet Finger
injury of the extensor digitorum tendon of the finger at the DIP that results in hyperflexion of this tendon.
1. Usually occurs when a ball, while being caught, hits an outstretched finger & jams it
59. Boutonniere Deformity
PIP joint is permanently bent toward the palm(PIP flexion) & the DIP is bent back away (DIP hyperextension)
1. PIP flexion deformity is due to interruption in the central slip of the extensor tendon. The lateral slips separate, allowing the head of the proximal phalanx to slip through the gap. This then draws the DIP joint into hyperextension.
2. Commonly caused by injury or inflammatory condition (rheumatoid arthritis)
60. Swan Neck Deformity
PIP joint is permanently bent away from the palm (PIP hyperextension) & the DIP is bent toward the palm (PIP hyperflexion)
1. Many possible causes arising from the DIP, PIP, or MCP joints. With ALL cases, there is a stretching of the palmer/volar ligaments at the PIP to allow hyperextension. There is also some damage to the attachment of the extensor tendon to the base of the distal phalanx that allow hyperflexion
2. Commonly caused by injury or inflammatory condition (rheumatoid arthritis), sometimes familial (Ehler-Danlos Syndrome)
(4) 1st/2nd: Median n C8-T1 3rd/4th: Deep Ulnar branch C8-T1
62. Thenar mm
(3) Abd Pollicis Brevis & Opponens Pollicis- Recurrent branch of median C8-T1 Flexor Pollicis Brevis- Deep Ulnar Branch C8-T1
81. Myotome?Intrinsic Hand Motion- Finger Flexion, Finger ABD
Mainly? C8 and T1, respectively.
82. Injury... C5 and C6 or Upper Trunk @ Neck (posterior Triangle)
83. Injury... C8-T1 or Lower Trunk @ Neck (posterior Triangle)
Intrinsic Mm of hand; And assumes a "clawed" position.
84. Injury?Long Thoracic n. (C5-7) @ Axilla (superior)
85. Injury?Suprascapular n. (C5-C6) @ Neck (post triangle)
ABD of arm
86. Injury?Musculocutaneous n. (C5-C6) @ Axilla
Weakness of forearm flexion and weakness of supination (biceps)
87. Injury?Axillary n. (C5-6) @ Surgical Neck of Humerus and Quadrangular Space
Difficulty in Elevation of limb above horizontal (deltoid)
88. Injury?Radial n. (C5-T1) @ Axilla
89. Injury?Radial n. @ Radial Groove of Humerus
Little loss of forearm extension
90. Injury?Radial n. @ Neck of Radius- Deep Radial
No wrist drop since extensor carpi radialis longus and brevis are spared.
91. Injury?Median n. (C5-T1) @ Axilla or arm or elbow
Loss of forearm pronation; Severe loss of sensation in later palmar surface of hand, including tips of lateral 3 digits.
92. Injury?Median n. (C5-T1) @ Wrist
Severe loss of sensation in later palmar surface of hand, including tips of lateral 3 digits.
93. Injury?Ulnar n. (C8-T1) @ Axilla or arm or epicondyle or Wrist
Extensive motor and sensory loss to hand. Cannot flex ring or little finger (4-5) at the DIP joint when they try to straighten their fingers.
94. Injury? Median and Ulnar nn. @ proximal to elbow
Same symptoms as median and ulnar nn.
95. Neurologic Level C5?Mm Testing
The Rhomboids (scapular retraction). This makes use of the dorsal scapular nerve.
96. Neurologic Level C5?Reflex Testing
Biceps reflex or Brachioradialis reflex.
97. Neurologic Level C5?Sensation Testing
Lateral arm: axillary nerve. This neurologic level supplies sensation to the lateral arm. The purest patch of axillary nerve sensation is located on the lateral arm, in the skin covering the lateral portion of the deltoid muscle. This localized area is useful in diagnosis of injuries to the axillary nerve or of general nerve root
98. Neurologic Level C6?Mm Testing
99. Neurologic Level C6?Reflex Testing
Biceps or Brachioradialis reflex. The brachioradialis reflex is tested proximal to the wrist, where the muscle becomes tendinous just before it inserts into the radius.
100. Neurologic Level C6?Sensation Testing
Lateral forearm: musculocutaneous nerve. Sensation to the thumb pad
101. Neurologic Level C7?Mm Testing
Triceps: radial nerve. Wrist flexor group: median and ulnar nerves. The wrist flexor group is composed of two
muscles: (1) the flexor carpi radialis (median nerve), and (2) the flexor carpi ulnaris (ulnar nerve). The flexor carpi radialis is the more important of these two muscles, since it actually powers most of wrist flexion. FCU is less powerful and has dual innervation.
Finger extensors: radial nerve. Finger extension is performed by three muscles: (1) the extensor digitorum communis, (2) the extensor digiti indicis, and (3) the extensor digiti minimi. All have dual innervation.
102. Neurologic Level C7?Reflex Testing
Triceps reflex. To test the triceps reflex, tap its tendon where it crosses the olecranon fossa at the elbow.
103. Neurologic Level C7?Sensation Testing
Pad of Middle finger. Sensation is supplied to the middle finger.
104. Neurologic Level C8?Mm Testing
Finger flexors. The two muscles, which flex the fingers, are: (1) the flexor digitorum superficialis (which flexes the proximal
interphalangeal joint), and (2) the flexor digitorum profundus (which flexes the distal interphalangeal joint). The flexor digitorum superficialis receives innervation from the median nerve, while the flexor digitorum profundus receives half its innervation from the ulnar nerve (on the ulnar side) and half from the median nerve (on the radial side).
105. Neurologic Level C8?Sensation Testing
Sensation to the ring and little fingers of the hand and to the distal half of the forearm?s ulnar side. The Pad of the little finger is the purest area for ulnar nerve sensation.
106. Neurologic Level T1?Mm Testing
Finger abductors. The finger abductors, innervated by the ulnar nerve, are: (1) the dorsal interossei, and (2) the adductor digit
107. Neurologic Level T1?Sensation Testing
Medial arm: medial brachial cutaneous nerve. Sensation is supplied to the medial side of the upper half of the forearm and the arm by this n.
@C5- Biceps Reflex; Rhomboid mm; Sensation of Lateral arm by axillary n.
@C6- Brachioradialis Reflex (Biceps Reflex); Wrist Extension mm; Sensation of Thumb Pad
@C7- Triceps Reflex; Elbow Extension mm; Sensation of Middle Finger
@C8- No reflex; Finger Flexion mm and Intrinsic Hand mm; Sensation of Little Finger Pad
@T1- No reflex; Intrinsic Hand mm; Sensation via Medial arm, via medial branch of cutaneous n.
113. Tests of?Radial n.
Motor Test: Wrist and Thumb Extension Sensation Test: Dorsal Web space between thumb and index finger.
114. Tests of?Ulnar n.
Motor Test: ABD- little finger Sensation Test: Pad of Little finger
115. Tests of?Median n.
Motor Test: Thumb pinch, Opposing and Abduction of thumb Sensation Test: Pad of index finger
116. Tests of?Axillary n.
Motor Test: Deltoid Sensation Test: Proximal/Lateral Arm
117. Tests of…Musculocutaneous n.
Motor Test: Bicep Sensation Test: Lateral Forearm
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