Upper extremity

what muscles are responsible for performing scapula elevation?

upper trapezius

Levator scapulae

What muscles are responsible for performing scapula depression?

latissimus dorsi

pectoralis major

pectoralis minor

lower trapezius

what muscles perform protraction?

pectoralis minor

serratus anterior

what muscles perform retraction?

middle trapezius

rhomboids

what muscles perform upper rotation of the scapula?

upper trapezius

lower trapezius

serratus anterior

what muscles perform downward rotation of the scapula?

levator scapulae

rhomboids

pectoralis minor

what muscles perform shoulder flexion?

anterior deltoid

coracobrachialis

pectoralis major (clavicle head)

biceps brachii

what muscles perform shoulder extension?

latissimus dorsi

posterior deltoid

teres major

triceps brachii (long head)

what muscles perform shoulder abd?

middle deltoid

supraspinatus

what muscles perform shoulder add?

pectoralis major

latissimus dorsi

teres major

what muscles perform shoulder horizontal abd?

posterior deltoid

infraspinatus

teres minor

what muscles perform shoulder horizontal add?

anterior deltoid

pectoralis major

what muscles perform shoulder lateral rotation?

teres minor

infraspinatus

posterior deltoid

what muscles perform shoulder medial rotation?

teres major

subscapularis

pectoralis major

latissimus dorsi

anterior deltoid

what muscles perform elbow flexion?

biceps brachii

brachialis

brachioradialis

what muscles perform elbow extension?

triceps brachii

anconeus

what muscles perform supination of the radioulnar joint?

biceps brachii

supinator

what muscles perform pronation of the radioulnar joint?

pronator teres

pronator quadratus

what muscles perform wrist flexion?

flexor carpi radialis

flexor carpi ulnaris

palmaris longus

what muscles perform wrist extension?

extensor carpi radialis longus

extensor carpi radialis brevis

extensor carpi ulnaris

what muscles perform wrist RD?

extensor carpi radialis longus

extensor carpi radialis brevis

flexor carpi radialis

extensor pollicis longus

extensor pollicis brevis

what muscles perform wrist UD?

extensor carpi ulnaris

flexor carpi ulnaris

what muscles perform finger flexion?

flexor digitorum profundus AND superficialis

flexor digiti minimi (5th)

interossei

lumbricals

what muscles perform finger extension?

extensor digitorum communis

extensor indicis (2nd)

extensor digiti minimi (5th)

what muscles perform finger abd?

dorsal interossei

abductor digiti minimi (5th)

what muscles perform finger add?

palmar interossei

what muscles perform thumb flexion?

flexor pollicis longus AND brevis

opponens pollicis

what muscles perform thumb extension?

extensor pollicis longus AND brevis

abductor pollicis longus

what muscles perform thumb abd?

abd pollicis longus AND brevis

what muscles perform thumb add?

adductor pollicis

what muscles perform thumb opposition?

opponens pollicis

flexor pollicis brevis

abductor pollicis brevis

opponens digiti minimi

glenohumeral joint

ball-and-socket synovial joint

formed by the convex humerus head and concave glenoid fossa of the scapula

3 degrees of freedom

why is the GH joint unstable?

because of the relatively small articular surface of the glenoid fossa in relation to the size of the humeral head

osteokinematic motions of the GH joint

it does everything!

flexion, ext, rotation, add, abd

what is the loose pack position of the GH joint?

55 dg abd

30 deg horizontal add

(SCAPTION)

what is the closed-pack position of the GH joint?

abd and lateral rotation

capsular pattern of the GH joint

lateral rotation, abd, medial rotation

Sternoclavicular joint

formed by medial end of clavicle and manubrium of sternum

saddle-shaped synovial jt 3 degrees of freedom

fibrocartilaginous disc b/w manubrium and clavicle

what does the fibrocartilaginous disc act as?

shock absorber

serves as the axis for clavicular rotation

what is the snapshot of SC joint?

osteo: does everything (scapula)

loose pack position: arm resting at side

closed pack: maximum sh elevation

capsular pattern: pain at extremes of range of motion

acromioclavicular joint

formed by acromion process and lateral end of clavicle

plane synovial jt w/ 3 degrees of freedom

function is to maintain relationship b/w scapula and clavicle during GH ROM

osteokinematic motion of AC jt

does everything in addition to tilting of scapula

loose pack position of AC jt

arm resting by side

closed pack position of AC jt

arm abd to 90 dg

capsular pattern of AC joint

pain at extremes of ROM

scapulothoracic articulation

formed by the body of scapula and the muscles of covering the posterior chest wall

motion: sliding of scapula on thorax

lacks synovial jt characteristics → articulation is not a true anatomical jt

acromioclavicular ligaments

surround acromioclavicular joint on all sides

help control horizontal mvmnts of clavicle

coracoacromial ligament

forms roof over humeral head

helps limit superior translation of the humeral head and helps prevent separation of acromioclavicular joint

coracoclavicular ligament

two different ligaments

1. conoid

2. trapezoid

acts as primary support of the AC jt, limiting superior translation of the clavicle

coracohumeral ligament

attaches proximally to the coracoid and splits between tuberosities

found between and helps to unite the supraspinatus and subscapularis tendons

limits inferior translation of humeral head

costoclavicular ligament

attaches b/w medial portion of clavicle and first rib

primary supporting ligament for the SC jt

superior glenohumeral ligament

limits adduction of shoulder and lateral rotation with sh in 0-45 dg of Abd

middle GH ligament

limits lateral rotation with sh at 45-90 dg of abd

inferior GH ligament

has and anterior and posterior band that limits lateral rotation and medial rotation, above 90 dg of abd

b/w the two bands → axillary pouch limits inferior translation when the sh is above 90 dgs of abd

glenoid labrum

fibrocartilaginous structure

serves to deepen glenoid fossa and increase size of articular surface

consist of dense fibrous connective tissue that is often damaged with recurrent sh instability

joint capsule

arises from glenoid fossa and glenoid labrum to blend with the muscles of rotator cuff

volume is twice as large as the size of the humeral head

it is reinforced by the GH ligaments and the coracohumeral ligaments

rotator interval

is a space in the anterosuperior shoulder that consists of and is bordered by the coracohumeral ligament, superior GH ligament, jt capsule, supraspinatus and subscapularis tendons

subacromial bursa

it extends over supraspinatus tendon and distal muscle belly, beneath the acromion and deltoid muscle

bursa facilitates mvmnt of deltoid muscle over fibrous capsule of the sh jt and supraspinatus tendon

its often-involved w/ impingement beneath acromial arch

transverse humeral ligament

attaches b/w greater and lesser tubercles of the humerus, spanning over bicipital groove

helps maintain the tendon of the long head of the biceps w/in the bicipital groove

what is the elbow joint classified as?

hinge joint (ulna and humerus)

it is a synovial joint

radio humeral joint

proximal joint: ball-shaped capitulum of the distal humerus

distal joint: concave head of the radius

osteokinematic motion and capsular pattern of RH jt

flexion, ext, pronation, supination

loose-packed position of RH jt

full ext, supination

close packed position of RH jt

90 dg flex, 5 dg supination

ulnohumeral joint

is formed by the hourglass-shaped trochlea of the humerus and the trochlear notch of the ulna

osteokinematic and capsular patter for ulnohumeral joint

flexion and extension

loose pack position for ulnohumeral joint

70 dg elbow flexion, 10 dg supination

closed pack position for ulnohumeral joint

extension

proximal radioulnar joint

consists of concave radial notch of the ulna and the convex rim of the radial head

osteokinematic and capsular pattern for proximal radioulnar joint

pronation, supination

supination, pronation

loose packed position for proximal radioulnar joint

70 dg elbow flex, 35 dg supination

closed pack position for proximal radioulnar jt

5 dg supination

annular ligament

consists of a band of fibers that surrounds the head of the radius

it allows the head of the radius to rotate and retain contact with the radial notch of the ulna

anterior ligament

capsular

stretches from radial collateral ligament and attaches above the upper edge of coronoid fossa, extending just below coronoid process

cubital fossa

triangular space located anterior to elbow that is bordered by brachioradialis, pronator teres, brachialis, and a horizontal line passing through the humeral epicondyles

contains: biceps brachii tendon, median nerve, radial nerve, brachial artery, median cubital vein

cubital tunnel

space formed under ulnar collateral ligament and flexor carpi ulnaris, medial head of the triceps and medial epicondyle

where does the ulnar nerve run through?

cubital tunnel

at what position is the cubital tunnel the smallest?

when the elbow is in full flexion

olecranon bursa

lies posterior to olecranon process and is considered the main bursa of the elbow

this bursa commonly becomes inflamed with direct trauma to the elbow due to its superficial position

posterior ligament

resembles anterior ligament

on each side of collateral ligaments

attached to upper portion of olecranon fossa and just below olecranon process

radial collateral ligament (lateral collateral ligament)

extends from lateral epicondyle of humerus to the lateral border of olecranon process of the ulna and to annular ligament

fan-shaped ligament

prevents adduction of elbow and provides reinforcement for radiohumeral articulation

ulnar collateral ligament

runs from medial epicondyle of the humerus to the proximal portion of ulna

prevents excessive abduction of the elbow

what injury can lead to elbow dislocation and rupturing collateral ligament?

FOOSH injury

wrist joint

formed by the radiocarpal and midcarpal joints

radiocarpal jt attaches hand to forearm

midcarpal jt is formed by the articulations of the proximal and distal row of carpals

proximal radiocarpal joint

formed by distal radius and radioulnar articular disc (connects the medial aspect of the distal radius to the distal ulna

distal joint surface of the radiocarpal joint

formed by scaphoid, lunate, and triquetrum

osteokinematic motion of radiocarpal joint

flex, ext, RD, UD

loose-packed position of radiocarpal joint

neutral with slight UD

closed-pack position of radiocarpal joint

extension with RD

capsular pattern of radiocarpal joint

flexion and extension equally limited

midcarpal joint

complex motion between proximal and distal rows of carpals except pisiform

anatomic snuffbox

is a depression found on the dorsal surface of the wrist near the distal radius

is bordered by the tendons of the abductor pollicis, extensor pollicis brevis, and extensor pollicis longus

location often used for palpation of scaphoid

carpal tunnel

located deep surface of the flexor retinaculum

median nerve enters through here

dorsal radiocarpal ligament

only major ligament on the dorsal surface of the wrist

originates on the posterior surface of the distal radius and styloid process of the radius and attaches to the lunate and triquetrum

limits wrist flexion

extensor retinaculum

ligamentous structure that crosses the dorsal aspect of the wrist, covering the tendons of the extensor musculature

prevents the tendons from “bowstringing” as the wrist is extended

flexor retinaculum

transverse carpal ligament

ligamentous structure that crosses the palmar aspect of the wrist, forming the most anterior aspect of the carpal tunnel

prevents tendons of the flexor musculature from “bowstringing” as the wrist is flexed

serves as an attachment site for the thenar and hypothenar muscles

interosseous membrane

consists of dense band of fibrous connective tissue that runs obliquely from the radius to the ulna

structure spans from proximal radioulnar joint to the distal radioulnar joint

serves as a stabilizer against axial forces applied to the wrist

palmar radiocarpal ligament

maintains the alignment of the associated joint structures and limits hyperextension of the wrist

it originates from the anterior surface of the distal radius and attaches to the capitate, triquetrum, and scaphoid

radial collateral ligament

serves to limit UD and becomes taut when the wrist is in extremes of extension and flexion

originates from the styloid process of the radius and inserts on the scaphoid and trapezium

triangular fibrocartilage complex

cartilaginous disc that sits between the ulna, lunate, and triquetrum

the disc provides stability to the wrist joint, connecting the radius and ulnar together and allowing for better distribution of forces through the wirst