UE Practical

UE bones & bony landmarks in the shoulder complex, elbow, wrist, hand + O/I/A/N for muscles in the shoulder complex, elbow, wrist, hand (including actions of intrinsic/extrinsic muscles of the hand + concentric/eccentric/isometric exercises isolating a muscle in the shoulder complex, elbow, wrist, hand + arthrokinematics of a joint in the shoulder complex, elbow, wrist, hand (bones in the joint, which bone is concave/convex, slide/glide based on movement) + kinetic chain + pathologies

SHOULDER COMPLEX — upper trapezius

• SYNDAVER

O/I/A/N: upper trapezius

• O: superior nuchal line, external occipital protuberance, ligamentum nuchae

• I: lateral 1/3 of the clavicle + acromion of scapula

• A: scapular elevation + scapular upward rotation

• N: accessory nerve

Concentric, Eccentric, Isometric action — upper trapezius

• concentric = shoulder shrugs w/ dumbbells

• eccentric = slowly lowering shoulders from top of shrug w/ DBs

• isometric = holding the shrug at the midrange point w/ DBs

SHOULDER COMPLEX — middle trapezius

• SYNDAVER

O/I/A/N: middle trapezius

• O: spinous process of thoracic vertebrae T1-T4

• I: acromion & superior surface of spine of scapula

• A: scapular retraction

• N: accessory nerve

Concentric, Eccentric, Isometric action — middle trapezius

• concentric = TB rows

• eccentric = slowly lowering a DB to starting position after DB row

• isometric = prone T hold

SHOULDER COMPLEX — lower trapezius

• SYNDAVER

O/I/A/N: lower trapezius

• O: spinous process of thoracic vertebrae T4-T12

• I: medial border of scapula

• A: scapular depression + scapular upward rotation

• N: accessory nerve

Concentric, Eccentric, Isometric action — lower trapezius

• concentric = Y raise (thumb up) w/ TB (TB down)

• eccentric = slowly lowering TB Y raise

• isometric = holding TB Y position halfway

O/I/N: trapezius (as a whole)

• O: external occipital protuberance, superior nuchal line, ligaments nuchae, spinous processes of C7-T-12

• I: lateral 1/3 of the clavicle, acromion, & spine of the scapula

• N: accessory nerve

SHOULDER COMPLEX — levator scapulae

• SYNDAVER

O/I/A/N: levator scapulae

• O: transverse processes of cervical vertebrae C1-C4

• I: medial border of scapular (aka between superior angle & superior portion of spine of scapula)

• A: extends head/neck, rotates head, lateral flexion

• N: cervical nerve

Concentric, Eccentric, Isometric action — levator scapulae

• concentric = lateral flexion (side bends)

• eccentric = slowly coming up to center from lateral flexion

• isometric = LS isometrics (LS stretch position & resist against your arm)

SHOULDER COMPLEX — rhomboids (combined major & minor)

• SYNDAVER

O/I/A/N: rhomboids (combined major & minor)

• O: spinous processes of C7-T5

• I: medial border of the scapula

• A: scapular retraction

• N: dorsal scapular nerve

Concentric, Eccentric, Isometric action — rhomboids (combined major & minor)

• concentric = TB row

• eccentric = slowly lengthening arms after squeezed TB row position

• isometric = scap squeeze hold

SHOULDER COMPLEX — serratus anterior

• SYNDAVER

O/I/A/N: serratus anterior

• O: external surfaces of upper 8 or 9 ribs (ribs 1-8/9)

• I: anterior surface of medial border of scapula

• A: scapular protraction

• N: long thoracic nerve

Concentric, Eccentric, Isometric action — serratus anterior

• concentric = supine serratus punches w/ DBs

• eccentric = slowly lowering serratus punch

• isometric = holding punched position

SHOULDER COMPLEX — pectoralis major

• SYNDAVER

O/I/A/N: pectoralis major

• O: medial half of clavicle + sternum + cartilage of ribs 1-6

• I: crest of greater tubercle of humerus

• A: shoulder IR + shoulder ADDuction

• N: lateral & medial pectoral nerve

Concentric, Eccentric, Isometric action — pectoralis major

• concentric = IR w/ TB

• eccentric = slowly coming to neutral w/ TB

• isometric = holding midrange of IR w/ TB

SHOULDER COMPLEX — pectoralis minor

• SYNDAVER

O/I/A/N: pectoralis minor

• O: 3rd, 4th, & 5th ribs

• I: medial surface of coracoid process of the scapula

• A: scapular protraction + shoulder ABDuction

• N: medial pectoral nerve

Concentric, Eccentric, Isometric action — pectoralis minor

• Concentric = chest press w/ TB (PT stands behind pt)

• Eccentric = slowly bringing TB back to bent elbow

• Isometric = hold it halfway

SHOULDER COMPLEX — supraspinatus (RTC muscle)

• SYNDAVER

O/I/A/N: supraspinatus (RTC muscle)

• O: supraspinous fossa of the scapula

• I: greater tubercle of the humerus

• A: shoulder ABDuction

• N: suprascapular nerve

Concentric, Eccentric, Isometric action — supraspinatus (RTC muscle)

• concentric = scaption raise

• eccentric = slowly going down from scaption raise

• isometric = shoulder ABD iso @ wall

SHOULDER COMPLEX — infraspinatus (RTC muscle)

• SYNDAVER

O/I/A/N: infraspinatus (RTC muscle)

• O: infraspinous fossa of scapula

• I: greater tubercle of the humerus

• A: shoulder ER + shoulder ADDuction

• N: suprascapular nerve

Concentric, Eccentric, Isometric action — infraspinatus (RTC muscle)

• concentric = ER w/ TB

• eccentric = slowly bringing it back to neutral

• isometric = holding halfway

SHOULDER COMPLEX — teres minor (RTC muscle)

• SYNDAVER

O/I/A/N: teres minor (RTC muscle)

• O: upper 2/3 of lateral border of the scapula

• I: greater tubercle of the humerus

• A: shoulder ER

• N: axillary nerve

Concentric, Eccentric, Isometric action — teres minor (RTC muscle)

• concentric = ER w/ TB

• eccentric = bringing it back to neutral slowly

• isometric = holding it halfway

SHOULDER COMPLEX — subscapularis (RTC muscle)

• SYNDAVER

O/I/A/N: subscapularis (RTC muscle)

• O: subscapular fossa of the scapula

• I: lesser tubercle of the humerus

• A: shoulder IR

• N: upper & lower subscapular nerve

Concentric, Eccentric, Isometric action — subscapularis (RTC muscle)

• concentric = shoulder IR w/ TB

• eccentric = slow shoulder IR w/ TB back to neutral

• isometric = holding the IR w/ TB at mid range

SHOULDER COMPLEX — teres major

• SYNDAVER

O/I/A/N: teres major

• O: inferior angle + lower 1/3 of lateral border of the scapula

• I: crest of lesser tubercle of humerus

• A: shoulder ADDuction + shoulder ER

• N: lower subscapular nerve

Concentric, Eccentric, Isometric action — teres major

• concentric = ER w/ TB

• eccentric = slowly returning to neutral from ER w/ TB

• isometric = holding ER at midrange point w/ TB

SHOULDER COMPLEX — latissimus dorsi

• SYNDAVER

O/I/A/N: latissimus dorsi

• O: inferior angle of the scapula + spinous process of last 6 thoracic vertebrae + last 3 or 4 ribs + thoracolumbar fascia + posterior iliac crest

• I: bicipital groove of humerus

• A: shoulder ADDuction + shoulder extension

• N: thoracodorsal nerve

Concentric, Eccentric, Isometric action — latissimus dorsi

• Concentric = TB lat pulldown

• Eccentric = pulling up slowly

• Isometric = holding halfway

SHOULDER COMPLEX — biceps brachii

• SYNDAVER

O/I/A/N: biceps brachii

long head:

• O: supraglenoid tubercle of glenoid fossa (scapula)

short head:

• O: coracoid process of scapula

---

• I: radial tuberosity + aponeurosis of biceps brachii

• A: elbow flexion + shoulder flexion + forearm supination (synergist)

• N: musculocutaneous

Concentric, Eccentric, Isometric action — biceps brachii

• concentric = bicep curl w/ DB

• eccentric = slowly lowering the DB in bicep curl

• isometric = holding the bicep curl halfway

SHOULDER COMPLEX — corachobrachialis

• SYNDAVER

O/I/A/N: coracobrachialis

• O: coracoid process of scapula

• I: medial surface of mid-humeral shaft

• A: shoulder ADDuction + shoulder flexion (dabbing)

• N: musculocutaneous nerve

Concentric, Eccentric, Isometric action — coracobrachialis

• concentric = D1/ D2 flex w/ TB

• eccentric = slowly lowering TB

• isometric = holding the TB halfway

SHOULDER COMPLEX — triceps

• SYNDAVER

O/I/A/N: triceps

long head:

• O: infraglenoid tubercle of scapula

lateral head:

• O: posterior surface of proximal half of the humerus

medial head:

• O: posterior surface of the distal half of the humerus

---

• I: olecranon process of the ulna

• A: elbow extension + (long head) shoulder extension & shoulder ADDuction

• N: radial nerve

Concentric, Eccentric, Isometric action — triceps

• concentric = tricep extension w/ DB

• eccentric = coming back from tricep ext. slowly

• isometric = tricep ext. hold

SHOULDER COMPLEX — anterior deltoid

• SYNDAVER

O/I/A/N: anterior deltoid

• O: lateral 1/3 of the clavicle

• I: deltoid tuberosity of humerus

• A: shoulder flexion + horizontal ADD + shoulder ABD + shoulder IR

• N: axillary nerve

Concentric, Eccentric, Isometric action — anterior deltoid

• concentric = frontal raise w/ DB

• eccentric = lowering the DB front raise slowly

• isometric = holding the frontal raise

SHOULDER COMPLEX — medial deltoid

• SYNDAVER

O/I/A/N: medial deltoid

• O: acromion process of scapula

• I: deltoid tuberosity of humerus

• A: shoulder ABD

• N: axillary nerve

Concentric, Eccentric, Isometric action — medial deltoid

• concentric = lateral raise w/ DB

• eccentric = lowering lateral raise slowly

• isometric = holding lateral raise w/ DB

SHOULDER COMPLEX — posterior deltoid

• SYNDAVER

O/I/A/N: posterior deltoid

• O: spine of scapula

• I: deltoid tuberosity

• A: shoulder extension + horizontal ABD + shoulder ABD + shoulder ER

• N: axillary nerve

Concentric, Eccentric, Isometric action — posterior deltoid

• concentric = rear delt fly w/ DB

• eccentric = lowering DB slowly from rear delt fly

• isometric = holding the DB up at peak

Explain the arthrokinematics of GH shoulder flexion and extension.

Both occur in the sagittal plane about a medial-lateral axis of rotation; the convex humeral head spins on the glenoid fossa around a relatively fixed axis

• Flexion — the convex humeral head rolls posteriorly (towards the back) & slides inferiorly (down into the glenoid fossa) as the arm elevates

• Extension — the convex humeral head rolls anteriorly (towards the front) & slides superiorly as the arm moves backward

Explain the arthrokinematics of GH shoulder internal & external rotation

Both occur in the transverse (horizontal) plane about a vertical (longitudinal) axis of rotation

• IR — anterior surface of the humeral head glides medially

• ER — anterior surface of the humeral head glides laterally

Explain the arthrokinematics of GH shoulder abduction & adduction

Both occur in the frontal plane about an anterior-posterior axis of rotation

• ABD — the convex humeral head rolls superiorly while simultaneously sliding inferiorly

• ADD — the convex humeral head rolls inferiorly while simultaneously sliding superiorly

When does the medial end of the clavicle become concave/convex on an SC joint? When does the clavicular notch on the sternum become concave/convex on the SC joint?

1. If we’re trying to do movement in the frontal plane (depression & elevation), the clavicle is convex, while the sternum is concave

   1. Elevation — convex clavicle rolls up (superiorly), & glides down (inferiorly) on the concave manubrium

   2. Depression — convex clavicle rolls down (inferiorly), & glides up (superiorly) on the concave manubrium

2. If we’re trying to do movement in the transverse plane (protraction & retraction), the sternum is convex, while the clavicle is concave

   1. Protraction — concave clavicle rolls & glides anteriorly (towards the front) on the convex manubrium

   2. Retraction — concave clavicle rolls & glides posteriorly (towards the back) on the convex manubrium

Name the 4 muscles that make up the rotator cuff (RTC).

1. Supraspinatus

2. Infraspinatus

3. Teres minor

4. Subscapularis

How are the RTC muscles involved in shoulder ABDuction?

1. Supraspinatus initiates abduction for the first 15°, compressing humeral head into glenoid fossa; deltoid then becomes prime mover for additional ABD movement

2. Infraspinatus, teres minor, & subscapularis produce an inferiorly directed force to counteract the deltoid force going upwards → this allows the humeral head to glide inferiorly into the glenoid fossa + prevents it from hitting acromion

3. Infraspinatus & teres minor externally rotate the humeral head to also prevent the greater tubercle from hitting the acromion, causing impingement

What is a rotator cuff tear (RTC tear)?

An injury where one or more of the tendons or muscles that stabilize the shoulder joint become frayed or damaged; Most tears occur in the supraspinatus tendon because of its position in the subacromial space

What is frozen shoulder (adhesive capsulitis)?

• Idiopathic (aka it can just happen) chronic synovial inflammation

• 3 stages: Freezing, Frozen, Thawing

• Too much scar tissue builds up, restricting movement inside the joint. This causes pain and severe limiting of ROM

ELBOW COMPLEX — radial notch of the ulna

• SKELETON

ELBOW COMPLEX — ulnar notch of the radius

• SKELETON

ELBOW COMPLEX — brachialis

• SYNDAVER

O/I/A/N: brachialis

• O: distal half of the anterior surface of the humerus

• I: coronoid process of the ulna + ulnar tuberosity

• A: elbow flexion

• N: musculocutaneous nerve

Concentric, eccentric, isometric activation — brachialis

• concentric = pronated bicep curl w/ DB

• eccentric = slowly lowering the pronated bicep curl w/ DB

• isometric = holding the halfway point of a pronated bicep curl w/ DB

ELBOW COMPLEX — brachioradialis

• SYNDAVER

O/I/A/N: brachioradialis

• O: proximal 2/3 of the lateral supracondylar ridge of the humerus

• I: radial styloid process

• A: elbow flexion of the neutral wrist (hammer curl) + pronation (synergist)

• N: radial nerve

Concentric, eccentric, isometric activation — brachioradialis

• concentric = neutral grip bicep curl w/ DB (hammer curls)

• eccentric = slowly lowering the hammer curl w/ DB

• isometric = holding hammer curl at the halfway point

ELBOW COMPLEX — supinator

• SYNDAVER

O/I/A/N: supinator

• O: lateral epicondyle of the humerus, RCL/LCL, annular ligament, & supinator crest of the ulna

• I: lateral surface of proximal 1/3 of radial shaft

• A: forearm supination

• N: radial nerve

Concentric, eccentric, isometric activation — supinator

• concentric = TB supination

• eccentric = slowly moving back into neutral from supination w/ TB

• isometric = holding the midrange point between neutral & supination w/ TB

ELBOW COMPLEX — pronator teres

• SYNDAVER

O/I/A/N: pronator teres

• O: common flexor tendon (CFT) from medial epicondyle of humerus + coronoid process of the ulna

• I: middle of lateral aspect of radius

• A: forearm pronation + elbow flexion (synergist)

• N: median nerve

Concentric, eccentric, isometric activation — pronator teres

• concentric = TB pronation

• eccentric = slowly moving back into neutral from pronation w/ TB

• isometric = holding midrange point between neutral & pronation w/ TB

ELBOW COMPLEX — pronator quadratus

• SYNDAVER

O/I/A/N: pronator quadratus

• O: medial, anterior surface of distal ulna

• I: lateral, anterior surface of distal radius

• A: forearm pronation

• N: median nerve

Concentric, eccentric, isometric activation — pronator quadratus

• concentric = TB pronation

• eccentric = slowly moving back into neutral from pronation w/ TB

• isometric = holding midrange point between neutral & pronation w/ TB

Describe the arthrokinematics of the humeroulnar joint during flexion/extension.

The concave trochlear notch rotates on the convex trochlea:

• Flexion: concave trochlear notch rolls and glides anteriorly on the concave trochlea

• Extension: concave trochlear notch rolls and glides posteriorly on the concave trochlea

Describe the arthrokinematics of the humeroradial joint during elbow flexion/extension.

The concave fovea of the radius rotates on the convex capitulum of the humerus.

Describe the arthrokinematics of the proximal radioulnar joint during pronation.

The convex radial head spins/pivots within the concave radial notch of the ulna opposite direction.

Describe the arthrokinematics of the distal radioulnar joint during supination/pronation.

The concave ulnar notch of the radius rolls and slides in the same direction over the convex ulnar head.

O/I/A/N: extensor carpi radialis longus (ECRL)

• O: distal 1/3 of lateral supracondylar ridge of humerus

• I: base of 2nd metacarpal

• A: extends wrist + wrist radial deviation + elbow flexion (synergist)

• N: radial nerve

O/I/A/N: extensor carpi radialis brevis (ECRB)

• O: common extensor tendon (CET) from the lateral epicondyle of the humerus

• I: base of 3rd metacarpal

• A: extends wrist + wrist radial deviation

• N: radial nerve

O/I/A/N: extensor carpi ulnaris (ECU)

• O: common extensor tendon (CET) from the lateral epicondyle of the humerus

• I: base of the 5th metacarpal

• A: extends wrist + wrist ulnar deviation

• N: radial nerve

O/I/A/N: extensor digitorum (ED)

• O: common extensor tendon (CET) from the lateral epicondyle of the humerus

• I: bases of middle & distal phalanxes 2-5

• A: extends digits 2-5 (not the thumb!)

• N: radial nerve

O/I/A/N: extensor indicis (EI)

• O: posterior surface of distal shaft of the ulna + interosseous membrane

• I: base of middle & distal 2nd phalanx via extensor digitorum tendon

• A: extends digit #2 (index finger)

• N: radial nerve

O/I/A/N: extensor pollicis longus (EPL)

• O: posterior surface of the ulna + interosseous membrane

• I: base of distal phalanx of thumb

• A: extends the thumb at the interphalangeal (IP) joint

• N: radial nerve

O/I/A/N: extensor pollicis brevis (EPB)

• O: posterior surface of radius + interosseous membrane

• I: base of proximal phalanx of thumb

• A: extends the thumb @ MCP & carpometacarpal joints

• N: radial nerve

What 3 muscles make up the Wad of 3?

1. Brachioradialis

2. Extensor carpi radialis longus (ECRL)

3. Extensor carpi radialis brevis (ECRB)

O/I/A/N: flexor carpi radialis (FCR)

• O: common flexor tendon (CFT) from medial epicondyle of the humerus

• I: base of 2nd & 3rd metacarpal

• A: flexes wrist & wrist radial deviation

• N: median nerve

O/I/A/N: flexor carpi ulnaris (FCU)

• O: common flexor tendon (CFT) from the medial epicondyle of the humerus

• I: base of 5th metacarpal, pisiform, & hook of hamate

• A: flexes the wrist + wrist ulnar deviation

• N: ulnar nerve