FDN Level 2 - Hand & Forearm

Muscle Chart

Supinator

O: (superficial) Lateral epicondyle, (deep) ulnar supinator crest

I: lateral surface of radius

N: C6-7 posterior interosseous nerve

A: supination

T: supine with arm in a pronated position

Pronator Teres

O: (humeral head) medial epicondyle, (ulnar head) medial side of coronoid process

I: lateral mid shaft radius

N: C6-7 median nerve

A: pronation

T: supinated position, find biceps tendon, unload into flexion, pull medially into pronator, test pronation, maintain grasp on pronator

C: median nerve lives between 2 heads

Median Nerve

Passes between 2 heads of Pronator Teres

Top of flexor digitorum profundus, lateral to palmaris longus

Lateral to hook of hamate

Radial Nerve

Divides into superficial radial + posterior interosseous

Superficial radial travels with brachioradialis

Radial Artery

Deep to brachioradialis

Travel down forearm

slopes over anatomical snuff box

pass between 2 heads of the 1st dorsal Interosseus and adductor Pollicis

Ulnar Nerve

Beneath the FCU

enters hand at radial side of pisiform

Lies over hook of hamate

Ulnar Artery

Lateral to the ulnar nerve

Carpal Tunnel Syndrome

Formed by scaphoid, trapezium, pisiform and hook of hamate

Pain/paresthesia in median nerve sensory (palmar radial 3.5 digits)

Motor weakness thenar

Tx of Carpal Tunnel Syndrome

C/S and scapular dysfunction

1st, 2nd rib and clavicular mobility

Neuropathodynamic dysfunction

Palpate muscular dysfunction in UQ

-scalene, pec minor, biceps brachii, pronator teres, forearm flexors

Evaluate muscles attached to flexor retinaculum

-Abductor Pollicis Brevis

-opponens digiti minimi

-abductor digiti minimi

-flexor digiti minimi

1st Dorsal Interosseus

(Lateral) O: 1st MC I: proximal phalanx of index

(Medial) O: 2nd MC I: proximal phalanx of index

N: C8-T1 ulnar nerve

A: abd index

2-4 Dorsal Interossei (DAB)

O: adjacent side of MC

I: base of prox phalanges of 3 and 4th digits

N: C8-T1 ulnar nerve

A: abd of 3 and 4 (away from midline)

DT: grasp ray with thumb dorsal and fingers palmar

TT: grasp like above, drop below knuckle, redirect towards wrist

Interossei Muscle Considerations

PAD arise from middle finger side of MC bones

DAB arise from adjacent MC bones

Dorsal Interossei more powerful than Palmar Interossei

Thumb has own adductor (AP)

Middle finger have no Palmar Interossei (cannot adduct towards itself)

Thumb and little finger have own abducting muscles, so no DAB’s

All Interossei supplied by deep branch of ulnar nerve (C8-T1)

Palmar Interossei (PAD)

O: middle finger side of the metacarpals 2, 4 and 5

I: ext hood & base of prox phalanx of 2, 4, 5

N: C8-T1 deep branch of ulnar nerve

A: adduct towards midline

T: go dorsally, splay metacarpals, feel for other end on palmar side D or T

Adductor Pollicis

(oblique) O: capitate I: base 1st phalanx

(transverse) O: 3rd MC I: base 1st phalanx

N: C8-T1 ulnar

A: adduct thumb

T: go dorsally closer to the insertion point to get both heads, quite sore after. Palmar only if tissue doesn’t move as well or chronic conditions.

Abductor Pollicis Brevis

O: scaphoid, trapezium

I: base of 1st phalanx radially

N: C8-T1 median nerve (recurrent)

A: abd thumb

T: come at it closer to the dorsal side, may hit periosteum

Flexor Pollicis Brevis

(Lateral) O: transverse carpal lig’t I: base of 1st phalanx

(medial) O: capitate & trapezium I: base of 1st phalanx

N: C8-T1 median nerve (current)

A: flex thumb

T: In supination, grasp thenar eminence and thread laterally.

Opponens Pollicis

O: trapezium

I: palmar surface of 1st MC

N: C8-T1 median (recurrent)

A: medially rotates thumb, opposition

T: laterally or palmarly, great for CTS as it pulls on the flexor retinaculum

Abductor Digiti Minimi

O: pisiform

I: ulnar side of 5th prox phalanx

N: C8-T1 ulnar

A: abd 5th digit, assist flexing 5th prox phalanx

Flexor Digiti Minimi

O: hook of hamate

I: Prox phalanx of 5th

N: C8-T1 ulnar

A: flex 5th at MCP

Opponens Digiti Minimi

O: hamate

I: medial aspect of 5th MC

N: C8-T1 ulnar

A: laterally rotate 5th (deepen hollow of palm)