Anatomy Upper Limb Continued 7-11 Slides

Proximal Wrist Bones

Scaphoid

Lunate

Triquetrum

Pisiform

Distal Wrist Bones

Trapezium

Trapezoid

Capitate

Hamate

Osteology of the Hand

Metacarpal bones (5)
Phalange bones (14)

What type of joint is the proximal radio-ulnar joint?

Pivot Joint

Annular Ligament

Keeps head of radius tight to ulna at proximal radio-ulnar ligament

What type of joint is the distal radio-ulnar joint?

Pivot joint

What type of joint is the radiocarpal joint?

Condyloid Joint

Ligaments at the radiocarpal joint

Radial collateral ligament (radial styloid to radial side carpal bone)

Ulnar collateral ligament (ulnar styloid to ulnar side carpal bone)

Dorsal & Palmar radiocarpal joints

Triangular fibrocartiladge

What wrist movement is done more at the radiocarpal joint?

Wrist flexion

What wrist movement is done more at the midcarpal joint?

Extension

Ligaments of the Intercarpal (Plane) Joints

Dorsal Ligaments

Palmar Ligaments

Interosseus Ligaments

Motions of the Midcarpal joint

Extension (some flexion)

Radial/Ulnar Deviation

Intermetacarpal (Plane) Joints

Has dorsal, palmar, and interosseous ligaments at the bases of MCs 2-5

What type of joint is the first Carpometacarpal (CMC) joint?

Sellar/Saddle Joint

What type of joint are the Carpometacarpal (CMC) joints of fingers 2-5?

Plane Joint

Ligaments of the first CMC joint

Dorsal Ligament Complex

Anterior Oblique Ligament

Ligaments of the Metacarpalphalangeal (MCP) Joint

Medial and Collateral Ligaments

Palmar Ligaments (plates)

Deep Transverse MC Ligaments (links heads of MCs 2-5)

Palmar aspects of the hand are maintained by:

Deep transverse MC ligament at the MC heads

Palmar intermetacarpal ligaments at MC bases

Transverse carpal ligament (flexor retinaculum)

Dorsal Group (Deep Layer) of the forearm

Supinator

Extensor Indicis

Extensor Pollics Longus

Extensor Pollicis Brevis

Abductor Pollicis

Supinator

P- Lateral epicondyle, radial collateral ligament, supinator crest of ulna
D- Proximal 1/3 radius, dorsal/lateral aspects
N- Radial (deep branch/Dorsal Interosseous)
S- C5, C6
A- Forearm supination

Extensor Indicis

P- Distal 1/3 dorsal ulna and membrane
D- Ulnar aspect of EDC tendon
N- Radial nerve (Deep branch)
S- C7, C8
A- Extension MCP at index finger

Extensor Pollicis Longus

P- Mid 1/3 dorsal ulna and membrane
D- Dorsal base of distal phalynx of thumb
N- Radial nerve (Deep branch)
S- C7, C8
A- Extend thumb MCP

Abductor Pollicis Longus

P- Mid 1/3 dorsal aspect radius, ulna, and membrane
D- Lateral aspect base of first MC
N- Radial nerve (deep branch)
S- C7, C8
A- Extend/Abduct thumb at MCP

Dorsal Group (Superficial Layer) of forearm

Extensor Carpi Radialis Longus

Extensor Carpi Radialis Brevis

Extensor Digitorum (Communis)

Extensor Carpi Ulnaris

Extensor Digiti Minimi

Brachioradialis

Anconeus

Extensor Carpi Radialis Longus

P- Distal 1/3 lateral supercondylar ridge, lateral epicondyle
D- Dorsal aspect base of 2nd MC
N- Radial Nerve
S- C6, C7
A- Wrist Extension

Extensor Carpi Radialis Brevis

P- Lateral epicondyle
D- Dorsal base 3rd MC
N- Radial nerve (Deep Branch)
S- C7, C8
A- Wrist Extension

Extensor Digitorum (Communis)

P- Lateral epicondyle
D- 4 tendons, each to dorsal base of middle/distal phalanges 2-5
N- Radial nerve (deep branch)
S- C7, C8
A- Extend MCP digits 2-5

Extensor Carpi Ulnaris

P- Lateral Epicondyle
D- Ulnar base 5th MC
N- Radial nerve (deep branch)
S- C7, C8
A- Wrist extension

Brachioradialis

P- Proximal 2/3 lateral supercondylar ridge
D- Radial styloid
N- Radial nerve
S- C5, C6, C7
A- Elbow flexion, accessory pronation/supination

Extensor Digiti Minimi

P- Ulnar aspect of EDC tendon and membrane
D- EDC tendon on dorsum of proximal phalynx of 5th finger
N- Radial nerve (Deep branch)
S- C7, C8
A- Extension of MCPs at 5th digit

Anconeus

P- Dorsal aspect of lateral epicondyle
D- Lateral aspect olecranon, proximal ¼ dorsilateral ulna
N- Radial nerve
S- C7, C8, T1
A- Elbow extension, traction of joint capsule

Extensor Tunnel 1

Tendons of APL and EPB

Extensor Tunnel 2

Tendons of ECRL and ECRB

Extensor Tunnel 3

Tendons of EPL

Extensor Tunnel 4

Tendons of EDC and EI

Extensor Tunnel 5

Tendons of EDM

Extensor Tunnel 6

Tendons of ECU

Palmar Group (Deep Layer) Forearm muscles

Flexor Pollicis Longus

Flexor Digitorum Profundis

Pronator Quadratus

Flexor Pollicis Longus

P- Middle ½ anterior radius and membrane
D- Palmar base of distal phalynx of thumb
N- Median nerve (Anterior interosseous branch)
S- C8, T1
A- Flex thumb IP

Flexor Digitorum Profundis

P- Proximal ¾ anteromedial ulna and membrane
D- 4 tendons to fingers 2-5 anterior base distal phalynx
N- 2 tendons ulnar: Ulnar nerve; 2 tendons radial: Median (anterior interosseous nerve)
S- C8, T1
A- Flex DIP digits 2-5

Pronator Quadratus

P- Distal ¼ anterior ulna
D- Distal ¼ anterior radius
N- Median Nerve (Anterior Interosseous Branch)
S- C8, T1
A- Forearm pronation

Palmar Group (Middle Layer) Forearm muscles

Flexor Digitorum Superificialis

Flexor Digitorum Superficialis

P- Medial epicondyle, medial coracoid process, proximal 1/3 anterior radius
D- 4 tendons to fingers 2-5, anterior bases middle phalanges
N- Median nerve
S- C7, C8, T1
A- Flexion PIPs 2-5

How many retinacular pulleys does the thumb have?

2 annular and 1 oblique

How many retinacular pulleys do the 4 fingers besides the thumb have?

5 annular and 4 cruciate

Palmar Group (Superficial Layer) Forearm muscles

Flexor Carpi Radialis

Flexor Carpi Ulnaris

Pronator Teres

Palmaris Longus

Flexor Carpi Radialis

P- Medial epicondyle
D- Anterior base of 2nd MC
N- Median neve
S- C6, C7
A- Wrist flexion

Flexor Carpi Ulnaris

P- Medial epicondyle, proximal 2/3 posteriomedial ulna
D- Pisiform and Hamate
N- Ulnar nerve
S- C7 (LUN), C8 LUN: Lateral cord ulnar nerve
A- Wrist flexion

Palmaris Longus

P- Medial epicondyle
D- Flexor retinaculum and palmar fascia
N- Median nerve
S- C7, C8
A- Wrist flexion, draws palmar fascia centrally

Pronator Teres

P- Medial epicondyle, medial coronoid
D- Middle 1/3 lateral radius
N- Median nerve
S- C6, C7
A- Forearm pronation, elbow flexion

Cubital Fossa Contents

Brachial artery and vein

Radial artery and vein

Ulnar artery and vein

Median nerve

Tendon of Biceps tendon

Base Boundary of the Cubital fossa

A line between the two humeral epicondyles

Medial boundary of the Cubital fossa

Lateral edge of pronator teres

Lateral boundary of Cubital fossa

Medial edge of brachioradialis

Floor boundary of Cubital fossa

Supinator and brachialis

Intrinsic Hand Musculature

Thenar eminance

Hypothenar eminance

Palmar Muscles

Thenar Muscles (Fat Pad of thumb)

Flexor Pollicis Brevis

Abductor Pollicis Brevis

Adductor Pollicis

Opponens pollicis

Flexor Pollicis Brevis

P- Lateral head: trapezium and flexor retinaculum, Medial head: Trapezoid and capitate
D- Radial/ulnar sides of palmar surface proximal phalynx of thumb, 2 sesmoids
N- Lateral head: Median, Medial head: Ulnar
S- C8, T1
A- Flex MCP of thumb

Abductor Pollicis Brevis

P- Trapezium, tuberosity of scaphoid
D- Radial/Palmar base of proximal phalynx of thumb
N- Median Nerve
S- C8, T1
A- Abduct thumb at CMC

Adductor Pollicis

P- Palmar capitate, palmar base 2nd MC, palmar distal 2/3 3rd MC
D- Ulnar/Palmar aspect base proximal phalynx of thumb
N- Ulnar nerve
S- C8, T1
A- Adduct thumb at CMC

Opponens Pollicis

P- Trapezium and flexor retinaculum
D- Palmar/Radial aspect 1st MC (entire length)
N- Median nerve
S- C8, T1
A- Opposition at CMC

Muscles of the Hypothenar eminance

Abductor Digiti Minimi

Flexor Digiti Minimi

Opponens Digiti Minimi

Abductor Digiti Minimi

P- Pisiform, tendon of ECU
D- Palmar/Ulnar base of proximal phalynx of 5th finger
N- Ulnar nerve
S- C8, T1
A- Abduct 5th digit at MCP

Flexor Digiti Minimi

P- Hook of hamate
D- Palmar/Ulnar base of proximal phalynx of 5th digit
N- Ulnar nerve
S- C8, T1
A- Flex 5th finger at MCP

Opponens Digiti Minimi

P- Hook of hamate
D- Ulnar/Palmar 5th MC (entire length)
N- Ulnar nerve
S- C8, T1
A- Oppose 5th finger at CMC

Palmar Group Muscles

Lumbricals (4)

Palmar Interossei (3)

Dorsal Interossei (4)

Palmaris Brevis

Lumbricals

P- #1: Radial side 1st FDP, #2: Radial side 2nd FDP, #3: adjacent sides FDP tendons 2 and 3, #4: Adjacent sides FDP tendons 3 and 4

D- Extensor hood mechanism

N- #1 & 2: Median nerve, #3 and 4: Ulnar nerve

S- C8, T1

A- Flex MCPs, Extend IPs 2-5

Palmaris Brevis

P- Palmar aponeurosis
D- Fascia/skin ulnar side of palm
N- Ulnar nerve
S- C8, T1
A- Approximates thenar and hypothenar sides

Palmar Interossei (PADS)

P- #1: Ulnar/Palmar 2nd MC, #2: Radial Palmar 4th MC, #3: Radial/Palmar 5th MC

D- #1: Ulnar base proximal phalynx 2nd digit, #2: Radial base proximal phalynx 4th digit, #3: Radial base proximal phalynx 5th digit

N- Ulnar nerve

S- C8, T1

A- Adduct digits 2-5, flex MCP, extend IPs

Dorsal Interossei (DABs)

P- Adjacent sides of metacarpals

D- #1: Radial side base of proximal phalynx 2nd digit, #2: Radial side base proximal phalynx 3rd digit, #3: Ulnar side base proximal phalynx 3rd digit, #4: Ulnar side base proximal phalynx 4th digit

N- Ulnar nerve

S- C8, T1

A- Abduct digits 2,3,4, Extend IPs 2,3,4

Bursae of the Upper Limb

Subdeltoid

Subacromial

Infraspinatus

Lat dorsi, teres major, pec major

Olecranon (deep and superficial)

Bicipitoradial

Medial and Lateral epicondylar (subcutaneous)