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Main point study guide for anatomy lab class...

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WHAT TO STUDY On moodle for more information - elbow/forearm arthrology ppt, wrist and hand ppt (ligaments), arthology shoulder complex, shoulder intro and osteology, spaces and nerves courses ● Upper extremity muscles - PA, DA, innervation, actions ○ Shoulder, upper arm, forearm, wrist CATEGORIZING MUSCLES INNERVATIONS: ○ Nerve to subclavius (C5,C6): subclavius ○ Spinal accessory nerve (CNXI): trapezius ○ Dorsal scapular nerve (C5): levator scapula, rhomboid major, rhomboid minor ○ Branch of C3, C4, spinal nerves: levator scapula ○ Suprascapular nerve (C5,C6): supraspinatus, infraspinatus ○ Subscapular nerve - upper (C5, C6): subscapularis ○ Subscapular nerve - lower (C5, C6): subscapularis, teres major ○ Long thoracic nerve (C5, C6, C7): Serratus anterior “SALT” ○ Medial pectoral nerve (C8, T1): pectoralis major, pectoralis minor ○ Lateral pectoral nerve (C5, C6, C7): pectoralis major, pectoralis minor ○ Axillary nerve (C5, C6): teres minor, posterior deltoid, middle deltoid, anterior deltoid ○ Thoracodorsal nerve (C6, C7, C8): latissimus dorsi ○ Musculocutaneous N. (C5, C6, C7): coracobrachialis, ○ Musculocutaneous N. (C5, C6): Biceps brachii, brachialis ○ Median N. (C6, C7): pronator teres, flexor carpi radialis, ○ Median N. (C7,C8): palmaris longus, ○ Median N (C8, T1): flexor digitorum superficialis (intermediate), abductor pollicis brevis, opponens pollicis, flexor pollicis brevis (superficially), lumbricals (1 and 2) ○ Median N. (later ½ digits 2 &3) ulnar n. (medial ½, digits 5 &5) (C8, T1): flexor digitorum profundus ○ Ulnar N. (C7, C8, T1): flexor carpi ulnaris ○ Ulnar N (C8, T1): Flexor pollicis brevis (deep), palmaris brevis, abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, abductor pollicis, lumbricals (3 and 4), palmar interossei, dorsal interossei ○ Radial n (C7): brachialis ○ Radial n (C5, C6): Brachioradialis ○ Radial n (C6, C7): extensor carpi radialis longus ○ Radial n (C7, C8): extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, ○ Radial n. (C6, C7, C8): anconeus, triceps brachii ○ Posterior interosseous n (PIN), branch of radial n. (C6, C7): Supinator ○ Posterior interosseous n (PIN), branch of radial n. (C7, C8): abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis ○ Anterior interosseous branch of median n (AIN) (c7, c8): flexor pollicis longus, pronator quadratus, abductor pollicis longus, extensor indicis

Movements at the Glenohumeral Joint (to move the humerus, a muscle must attach to the humerus):

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○ Flexes GH joint: coracobrachialis, biceps brachii Flexion of the humerus: anterior delt, clavicular fibers of pec maj Extension of the humerus: post delt, sternal fibers of pec major, lat dorsi, teres major Abduction of the humerus: middle deltoid, supraspinatus Adduction of the humerus: pec major, lat dorsi, Shoulder adduction and extension: triceps brachii (long head) Internal/medial rotation of the humerus: lat dorsi, teres major, pec major, subscapularis, ant deltoid, External/lateral rotation of the humerus: teres minor, infraspinatus, post deltoid

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Movements at the Scapula (to move the scapula, a muscle must attach to the scapula):

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○ Elevation of the scapula: upper trap, levator scapulae Depression of the scapula: lower trap, pec minor Protraction of the scapula: pec minor, serratus anterior, Retraction of the scapula: rhomboid min/maj, middle trap Upward rotation of the scapula: upper and lower trap, serratus anterior

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Downward rotation of the scapula: pec minor, levator scapulae, rhomboid min/maj

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Movements at Elbow joint: ○ ○ ○ ○

Elbow flexion: brachioradialis (in neutral), biceps brachii, brachialis Secondary elbow flexor: pronator teres Elbow extension: triceps brachii, anconeus

Movements at wrist and hand

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Pronate forearm: pronator teres, pronator quadratus Supinate forearm: supinator, biceps brachii Wrist flexion: flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, Wrist extension: extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, extensor carpi radialis longus Ulnarly deviates wrist: flexor carpi ulnairs, extensor carpi ulnaris Radially deviate wrist: flexor carpi radialis, brachioradialis, extensor carpi radialis brevis, extensor carpi radialis longus PROFUNDUS = DEEP MUSCLE POLLICIS = THUMB BREVIS = SHORT LONGUS = LONG CARPI = BETWEEN HAND AND FOREARM PIP = PROXIMAL INTERPHALANGEAL LIGAMENT DIP = DISTAL INTERPHALANGEAL LIGAMENT MCP = METACARPOPHALANGEAL

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Flex DIP digits 2-5: flexor digitorum profundus Flex PIP and MCP joints digits 2-5: flexor digitorum superficailis Secondarily flex PIP, MCP, wrist: flexor digitorum profundus Assist in 2nd digit extension: extensor indicis Extend IP and MCP of 4 lesser digits: extensor digitorum Extend 5th digit IP, MCP: extensor digiti minimi Flex MCP and extend IP digit 2-5: Lumbricals Adduct 2, 4, 5 toward 3rd: palmar interossei Abduct 2, 3, 4: dorsal interossei Wrinkles skin on medial hand: palmaris brevis Abduct 5th digit at MCP: abductor digiti minimi Flexes 5th digit: flexor digiti minimi Opposes 5th digit: opponens digiti minimi

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Abduct thumb at carpometacarpal joint: abductor pollicis longus, abductor pollicis brevis Adduct at CMC: adductor pollicis Opposition: opponens pollicis

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○ Flex MCP and CMC: flexor pollicis brevis ○ Extend IP, MCP, CMC joints of thumb: extensor pollicis longus ○ Extend 1st MCP and CMC joints: extensor pollicis brevis ○ Flexes IP joint of thumb: flexor pollicis longus Common PA of forearm and hand ○ Humerus proximal to medial epicondyle: pronator teres ○ CFT: pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis, ○ CET: extensor carpi radialis brevis (lateral epicondyle), extensor carpi radialis longus, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris ○ Coronoid process: pronator teres, flexor digitorum superficialis, flexor digitorum profundus, extensor digitorum, extensor digiti minimi, ○ Intermuscular septum: flexor carpi radialis, palmaris longus, ○ Medial olecranon: flexor carpi ulnaris ○ Ulna: flexor carpi ulnaris, flexor digitorum profundus (anterior and medial, posterior border), pronator quadratus (anterior distal surface), extensor carpi ulnaris (posterior border), supinator (supinator crest), abductor pollis longus (middle posterior), extensor pollis longus (posterior surface), extensor indicis (distal posterior surface) ○ Radius: flexor pollis longus, extensor carpi radialis brevis (radial collateral ligament), supinator (radial collateral and annular ligs), abductor (middle posterior), extensor pollis brevis (posterior radial shaft) ○ Oblique line: flexor digitorum superficialis ○ Humerus: brachioradialis (proximal ⅔ of lateral supracondylar ridge), extensor carpi radialis longus (distal ⅓ lateral supracondylar ridge, lateral epicondyle), supinator (lateral epicondyle) ○ FDP tendons: lumbricals ○ Captivate bone: adductor pollicis ○ Base of 2 and 3 MC: adductor pollicis ○ Palmar 3 mc shaft: adductor pollicis ○ Pisiform: abductor digiti minimi ○ Fcu tendon: abductor digiti minimi ○ Hook of hamate: flexor digiti minimi, opponens digiti minimi ○ Scaphoid: abductor pollicis brevis ○ trapezium: abductor pollicis brevis, opponens pollicis, flexor pollicis brevis ○ trapezoid : flexor pollicis brevis ○ Flexor retinaculum: abductor pollicis brevis, opponens pollicis, palmaris brevis, flexor digiti minimi, opponens digiti minimi ○ Palmar aponeurosis: palmaris brevis (medial aspect) Common DA of forearm and hand ○ Radius: pronator teres (midway along lateral shaft), PQ ( distal ¼ anterior), brachioradialis (distal lateral aspect, proximal to styloid), Anconeus (lateral

olecranon, proximal ¼ post shaft and annular lig), supinator (proximal ⅓ shaft posteriorly, laterally and anteriorly) ○ Phalanges: FDS (middle), FDP (distal),ED (dorsal bases of middle and distal) ○ 5th phalange: EDM (dorsal base of middle and distal), ABDM (base of proximal phalanx ulnar side, dorsal digital expansion), FDM (base of proximal phalanx ulnar side, dorsal digital expansion), ○ Thumb: FPL (distal phalanx), EPB (base of proximal phalanx dorsally), EPL (distal phalanx on dorsal surface), APB (base of proximal phalanx lateral side), OP (MC along lateral border and lateral palmar surface), FPB (base proximal phalanx), AP (base proximal phalanx ulnar side) ○ Dorsal digital expansion 2-5: lumbricals (lateral) ○ 1 MC base: APL (radial side) ○ 2 MC base: FCR (palmar), ECRL (dorsal base) ○ 3 MC base: FCR (palmar), ECRB (dorsal base) ○ 5 MC base: EXU (dorsal base), ODM (MC along length of medial border palmar surface), FCU ○ Extensor digitorum: EI (to 2nd digit along medial side) ○ Flexor retinaculum: PL ○ Palmar aponeurosis: PL ○ Trapezius: APL ○ Pisiform: FCU ○ Hook of hamate: FCU ○ Dermis of hand: PB (medial border) Muscles with two head ○ Pronator teres ○ Flexor carpi ulnaris ○ Flexor digitorum superficialis ○ Flexor pollicis brevis ○ Adductor pollicis ● Upper extremity osteology and arthrology - understand where bone markings are located and the muscles that innervate the areas, borders of bones (use separate powerpoints) ○ Shoulder, forearm, upper arm, wrist ●

ARTHROLOGY

A. Types of Joints a. Synarthrosis: i. Characteristics: 1. Permit slight to no movement 2. Reinforced by fibrous or cartilaginous connective tissue ii. Type: Fibrous Joint 1. Sutures of skull 2. Distal tibiofibular joint (syndesmosis)

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3. Interosseous membrane reinforcing radioulnar joint Type: Cartilaginous Joint 1. Pubic symphysis 2. Interbody joint of vertebral column (includes intervertebral disc) 3. Manubriosternal joint

b. Diarthrosis: i. Characteristics: 1. Permit moderate to extensive movement 2. Possess a synovial fluid-filled cavity 3. Types: a. Hinge b. Pivot c. Ellipsoidal d. Ball and Socket e. Planar f. Saddle g. Condyloid 4. Examples: glenohumeral joint, apophyseal joints of spine, tibiofemoral joint (knee), talocrural joint (ankle)... B. Components of a Typical Synovial Joint a. Fibrous Joint Capsule b. Synovial membrane c. Synovial fluid d. Articular (hyaline) cartilage e. Subchondral bone f. Blood vessels g. Sensory nerves h. Ligaments i. Functions: 1. Join bone to bone 2. Limit joint motion 3. Maintain joint alignment and congruity of bones ii. Intrinsic ligaments: thickenings of joint capsule iii. Extrinsic: separate from joint capsule 1. Intracapsular: inside the joint space (ex: ACL) 2. Extracapsular: outside the joint space (ex: LCL of knee) i. Other potential components: i. Intraarticular meniscus ii. Fat pad iii. Labrum iv. Bursa

II. ARTHROLOGY OF THE SHOULDER REGION A. Sternoclavicular (SC) Joint a. Articulation between manubrium and medial end of clavicle b. Direct connection of upper limb to axial skeleton c. Has an articular disc i. Fibrocartilage ii. Improves joint congruency iii. Absorbs shock d. Synovial, modified saddle joint e. Components i. Sternal end of clavicle ii. Clavicular notch of manubrium iii. Costal cartilage of first rib iv. Articular disc f. Capsule and Ligaments i. Anterior and posterior sternoclavicular 1. Anterior = prevents excessive retraction and elevation 2. Posterior = prevents excessive protraction and elevation ii. Interclavicular 1. Prevents excessive retraction and depression 2. Runs across manubrium iii. Costoclavicular 1. Prevents excessive elevation 2. Clavicle and ribs g. Movement i. Elevation/depression of clavicle ii. Protraction/retraction of clavicle iii. Rotation of clavicle B. Acromioclavicular (AC) Joint a. Articulation between acromion process of scapula and lateral end of clavicle b. Synovial, planar joint, nonaxial c. Components i. Acromial end of clavicle ii. Medial margin of acromion iii. Articular disc (sometimes) d. Capsule and Ligaments i. Acromioclavicular 1. Superior and inferior thickenings in the joint capsule 2. Holds ac joint together

3. Medial pull ii. Coraclavicular 1. Conoid 2. Trapezoid 3. Prevents Elevation e. Movement i. Elevation/depression of scapula ii. Protraction/retraction of scapula C. Glenohumeral (GH) Joint a. Articulation between head of humerus and glenoid fossa of scapula b. Sacrifices stability for mobility c. Synovial, ball and socket joint d. Components i. Head of humerus ii. Glenoid fossa and glenoid labrum 1. Fibrocartilagous rim around the perimeter of the glenoid cavity helps deepen the socket e. Capsule and Ligaments i. Loose fibrous capsule, with axillary recess ii. Glenohumeral ligaments: intrinsic ligaments; supraglenoid tubercle to lesser tubercle of humerus 1. Superior 2. Middle 3. Inferior a. Only part of capsule not reinforced by rotator cuff b. Lax at anatomical position iii. Coracohumeral: coracoid process to greater tubercle of humerus 1. Runs from lateral aspect of coracoid process to greater tubercle of humerus 2. Strong broad lig that is related to gh capsule 3. Provides anterior stability 4. Blends with supraspinatus tendon f. Rotator cuff muscles i. Supraspinatus ii. Infraspinatus iii. Teres Minor iv. Subscapularis g. Tendon of long head of biceps i. Synovial tendon sheath ii. Transverse humeral ligament; 1. spans greater and lesser tubercles of humerus over bicpitial groove and superficial to long head of biceps tendon 2. Holds tendon in place

h. Bursae - flattened sac containing synovial fluid that reduces friction between moving structures i. Becomes fluid filled when inflamed ii. Subtendinous bursa of subscapularis 1. Located between subscapula and coracoid process iii. Subdeltoid/subacromial 1. Located inferior to coracoacromial arch and superior to supraspinatus tendon 2. Continues with subacromial bursa i. Superohumeral arch i. Osteoligamentous structure formed by acromion process ii. Prevents superior translation of humerus iii. Acromion iv. Coracoacromial ligament; v. coracoid process to acromion process vi. Shoulder impingement problems or rotator cuff problems j. Movement i. Flexion/extension ii. Abduction/adduction iii. Internal/external rotation iv. Horizontal abduction/adduction v. Circumduction III. Arthrology of the Elbow and Forearm A. Elbow Joint a. Synovial hinge joint b. Components i. Humeroulnar articulation 1. Trochlea of humerus with... 2. Trochlear notch of ulna ii. Humeroradial articulation 1. Capitulum of humerus with… 2. Head of radius c. Capsule and Ligaments i. Capsule ii. Ulnar collateral ligament of elbow: triangular in nature; medial epicondyle of humerus to coronoid process and olecranon of ulna 1. Resists valgus force (abducts distal part of extremity) 2. Anterior band a. Med epi to med coronoid 3. Posterior band a. Med epi to medial olecranon 4. Oblique band

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a. Olecranon to coronoid process Radial collateral ligament: lateral epicondyle of humerus to radial notch of ulna and annular ligament

d. Bursae i. Subcutaneous ii. Subtendinous e. Movement i. Flexion/extension B. Proximal Radio-Ulnar Joint a. Synovial pivot joint b. Components i. Head of radius ii. Anterior aspect of Radial notch of ulna to medial periphery of radial head c. Capsule and Ligaments i. Capsule continuous with elbow joint ii. Annular Ligament: surrounds radial head and radial notch of ulna d. Movement i. Pronation/supination C. Middle Radio-Ulnar Joint a. Fibrous joint joined by interosseous (IO) membrane; prevents distraction of radius b. IO joins interosseous borders of radius and ulna to interosseous membrane c. Ligament i. Oblique cord: lateral ulnar tuberosity to medial radius distal to tuberosity D. Distal Radio-Ulnar Joint a. Pivot joint b. Palmar and dorsal RU ligaments i. Distal radius to distal ulna c. Components i. Head of ulna to... ii. Ulnar notch of radius iii. Proximal surface of articular disc d. Ligaments: i. Palmar radioulnar: limits supination ii. Dorsal radioulnar: limits pronation e. Movement i. Pronation/supination LIGAMENTS OF WRIST ● Palmar radiocarpal ligament ● Dorsal radiocarpal ligament ● Palmart ulnocarpal lig

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Ulnar carpal collateral lig Radial carpal collateral lig Intercarparl lig TFCC - triangular fibrocartilage complex ○ Articular disc between distal ulna and triquetrum ○ Palmar ulnocarpal ligament ○ Ulnar carpal collateral ligament Ligaments of distal hand ○ Deep transverse metacarpal lig ■ Connects metacarpal heads 2-5 ■ Limit abduction of metacarpals ○ Palmart plates/ligaments of MCPs and IPs ■ Support palmar side of joint ■ Limit movement in sagittal plane (flexion and extension) ■ Deep transverse metacarpal ligs ○ Collateral ligaments of MCPs and IPs ■ Support and stabilize medial/lateral sides of joints ■ Limit movement in frontal plane (abduction and adduction) ■ Radial and ulnar collaterals - MCPs, PIPs, DIPs ■ Ulnar carpal collateral lig ■ Radial carpal collateral lig ■ accessory/fan portion - attach to palmar plate ■ Cord portion - taut in flex ● Attach to base of phalanx Connective tissue structures of palmar sie of hand ○ Palmar aponeurosis ■ Continuous with the palmaris longus tendon ■ Continuous with fibrous digital sheaths ○ Fibrous digital sheaths ■ Tunnels composed of dense regular connective tissue that enclose flexor tendons ■ Holds tendons close to bone preventing bowstringing of tendons with active motion ● 5 annular ● 3 cruciate ● A1 = trigger finger ● A2 and A4 = critical for flexor tendon function ■ Vinculae ● Connects FDS/FDP tendons to bone ○ Synovial tendon sheaths ■ Ulnar - surrounds tendons of FDS and FDP ■ Radial - surrounds tendon of FPL ○ Flexor retinaculum aka transverse carpal lig

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Connective tissue structures of dorsal side of hand ○ Extensor retinaculum ■ Continuous with fascia of forearm ■ Prevents bowstringing with active motion ■ Provides proper alignment for specific motion distallu ■ Divides dorsum of wrist into 6 fibro-osseous compartments ○ Synovial tendon sheaths ○ Dorsal digital expansions ● Extensor mechanism ○ aponeurosis/intersection of extensor tendons with the interossei and lumbrical tendons ○ ED (EDM + EI) +lumbricals +OI = EM ○ Digits 2-5 ■ Present in thumb but less organized ○ Synonyms ■ Extensor expansion, extensor apparatus, extensor assembly, extensor hood ○ Anatomy ■ Hood ● Located at head of MC/MCP joining ■ Central band ● Extensor tendon trifurcates… ● Central band attaches to dorsal base of middle phalanx ■ Lateral bands ● Extensor tendon trifucates… ● Lateral bands/running along sides of PIP ■ Terminal tendon ● Continuation of lateral bands which join and attach at dorsal distal phalanx ○ Functions ■ MCPs - extend or flex ■ IPs - extend ○ Specific functions ■ Hood ● ED extends, lumbricals and interossei flex MCP ■ Central band ● Extend PIP ■ Lateral band ● Stabilize lat bands at sides of PIP ■ Terminal tendon ● Extend DIP Osteokinematics - movements, planes, axis ○ Sagittal plane - right and left of body

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■ Axis - anterior posterior axis ○ Frontal plane - front and back of body ■ Axis - medial lateral axis ○ Transverse plane - top and bottom of body ■ Axis - posterior inferior axis ○ Abduction, adduction, flexion, extension, upward rotation, downward rotation, supination, pronation, radial deviation, ulnar deviation ○ Planes are different for actions of the thumb Understand muscle fiber directions - PA to DA Axilla/brachial plexus - understand the brachial plexus, be able to identify structures and parts, know names of nerves and the nerve roots that make up the nerves

AXILLA / BRACHIAL PLEXUS ● Ramii of brachial plexus are found anterior and middle scalene muscles ● Found alongside the subclavian artery ● Dorsal scapular nerve lesion or ramus of C5 ○ Rhomboids and levator scapula ■ Scapular retraction and elevation effected ● Long thoracic nerve ○ Serratus anterior ■ Protraction ■ upward rotation ■ This nerve most commonly gets damaged from mastectomy ■ Damage = win...