KINE 476 Exam 5

HumeroULNAR joint

articulates trochlea of humerus + trochlear notch of ulna

• convex: trochlea of the humerus

• concave: trochlear notch of ulna

• synovial joint

• hinge joint

• uniaxial- allows for flexion and extension

HumeroRADIAL joint

articulation of the capitulum of humerus + head of radius

• convex: capitulum of humerus

• concave: proximal surface of radial head

• synovial joint

• hinge joint

• uniaxial- allows for flexion and extension

Proximal radioulnar joint

proximal articulation of the radial notch of ulna + head of radius

• convex: head of radius

• concave: radial notch of ulna

• synovial joint

• uniaxial- allowing only pronation and supination of the forearm

Describe the movement happening in the proximal radioulnar joint

At the proximal end, the head of the radius pivots within the radial notch of the ulna, forming the superior or proximal radioulnar joint

Distal radioulnar joint

distal articulation of the ulna and radius

• synovial joint

• pivot joint

• uniaxial- allowing only pronation and supination of the forearm

Describe the movement happening in the distal radioulnar joint

Due to the shape of the radius, the distal end of the radius rotates around the distal end of the ulna. forming the inferior or distal radioulnar joint

Osteokinematic motions of elbow

• sagittal plane; frontal axis

• flexion: 0-150 degrees

• extension: 0 degrees, some have a few degrees of hyperextension

Osteokinematic motions of the forearm

• horizontal plane; vertical axis

• supination: palm faces anteriorly 0-80 degrees

• pronation: palm faces posteriorly 0-80 degrees

Motions of the distal radioulnar joint

The radius rolls and glides in the same direction to move over the ulna

Label this

Label this

Label this:

Capsule of the elbow

- surrounds elbow complex

- encompasses distal humerus, proximal radius, and proximal ulna

What is the carrying angle in the anatomical position?

Angle formed by the arm and forearm when in the anatomical position

The longitudinal axes of the humerus and forearm form this angle. This angle tends to be greater in women than in men.

Why does the carrying angle occur?

It occurs because the distal end of the humerus is not level. The medial side (trochlea) is lower than the lateral side (capitulum).

Therefore, as the ulna and radius move around the trochlea and capitulum of the humerus, they do not move in a straight line like a typical hinge joint

How is the first vertical line drawn to determine the carrying angle?

It is drawn parallel to and over the humerus from the shoulder and extended past the elbow

How is the second vertical line drawn to determine the carrying angle?

It is drawn parallel to and over the radius and ulna to a point proximal to the elbow

The carrying angle is measured by

the angle formed by insertion of both (first and second) lines

Which aspect of the elbow is longer in cubitus valgus?

the medial aspect of the elbow

Carrying angle in females and males (in degrees)

• females: 10 to 15 degrees

• males: 5 degrees

Radial nerve

• nerve that runs along the thumb side of the arm and the back of the hand

• innervates the posterior muscles of the wrist

Median nerve

• smallest of the three arm and hand nerves; runs along the mid forearm and extends into the hands

• innervates the anterior muscles on the lateral (radial) aspect of the wrist

Ulnar nerve

• sensory-motor nerve that, with its branches, affects the little-finger side of the arm and palm of the hand

• innervates muscles on the medial (ulnar) aspect of the wrist

Muscles crossing the anterior aspect of the elbow joint bring the anterior surfaces of the arm and forearm closer together, producing ____________-

flexion

Muscles crossing the posterior aspect of the elbow joint bring the posterior surfaces of the arm and forearm closer together, producing ______________

extension

Muscles that originate medially, crossing the anterior aspect of the joint to insert on the radius, will pull the forearm into _______________

pronation

Muscles that originate posterior, crossing the lateral side of the forearm to insert on the radius, will pull the forearm into _________________

supination

Elbow flexion

• biceps brachii

• brachialis

• brachioradialis

Elbow extension

• triceps brachii

• anconeus

forearm pronation

• pronator teres

• pronator quadratus

forearm supination

• biceps brachii

• supinator

What muscle is this?

Brachialis

What muscle is this?

Biceps Brachii

What muscle is this?

Brachioradialis

What muscle is this?

Triceps Brachii

What muscle is this?

Anconeus

What muscle is this?

Pronator Teres

What muscle is this?

Pronator Quadratus

What muscle is this?

Supinator

Anterior elbow muscle

• Biceps brachii

• brachialis

• brachioradialis

• pronator teres

• pronator quadratus

Posterior elbow muscles

• triceps brachii

• anconeus

• supinator

• brachioradialis

Radiocarpal joint (wrist joint) is the articulation between __________ and ___________ bones

• radius + proximal carpal bones (scaphoid, lunate, and triquetrum)

Radiocarpal joint

• biaxial condyloid joint — allowing for flexion and extension, radial deviation, and ulnar devation

• Two degrees of freedom

Midcarpal joint is between the _________ and ____________ row of the carpals

proximal + distal row of carpals; considered part of the wrist

Intercarpal joints are between ___________

the carpal bones in each individual row

• the shape of these joints are irregular

Intracarpal joints

• non-axial joints

• glide at each of these joints collectively contributes to movements of the wrist

Carpometacarpal joint are the articulation between ___________ and ____________

• the distal row of carpal bones + the base of each metacarpal bone

• these joints are NOT apart of wrist

Motions of the wrist

• flexion

• extension

• radial deviation

• ulnar deviation

Flexion/extension of the wrist

• sagittal plane, frontal axis

• flexion ROM: 0-80 degrees

• extension ROM: 0-70 degrees

Which is greater flexion or extension?

flexion is greater than extension because of the angulation of the distal end of the radius, where the posterior aspect is more distal than the anterior aspect

Radial deviation

• frontal plane, sagittal axis

• Slide wrist towards radius, thumb

• ROM: 0-20 degrees

Ulnar deviation

• frontal plane,sagittal axis

• Slide wrist towards ulnar pinky

• ROM: 0-30 degrees

Which is greater ulnar or radial deviation?

ulnar deviation is greater than radial because of the angulation of the distal end of the radius, where the lateral aspect is more distal than the medial aspect

Circumduction of the wrist

a circular cone-shaped movement, is a combination of all four movements

Proximal row (lateral to medial)

scaphoid, lunate, triquetrum, pisiform

Distal row (lateral to medial)

trapezium, trapezoid, capitate, hamate

A mnemonic device for the carpal bones

Some Lovers Try Positions That They Can't Handle

Proximal row: Scaphoid, Lunate, Triquetrum, Pisiform

Distal Row: Trapezium, Trapezoid, Capitate, Hamate

Hook of the hamate

projection on anterior surface of hamate

Carpal tunnel

• carpal bones form a medial/lateral arch with palmar concavity

• this arch connects by the palmar and transverse carpal ligaments

  • forming a tunnel through which external finger flexor tendons and the median nerve pass

• enclosed space

  • compression of median nerve

Palmar radiocarpal ligament

- broad thick ligament

- reinforces palmar aspect of capsule

- attaches to anterior surface of distal radius and palmar surfaces of proximal carpal bones and capitate

- limits wrist extension

Palmar ulnocarpal ligament

- broad, thick ligament

- attaches to anterior surface of distal ulnar and palmar surfaces of proximal carpal bones

- some authorities consider this ligament part of the palmar radiocarpal ligament

- reinforces palmar aspect of capsule

- limits wrist extension

Dorsal radiocarpal ligament

- attaches to dorsal surface of distal radius and to dorsal surfaces of scaphoid, lunate, and triquetrum

- reinforces posterior aspect of capsule

- limits wrist flexion

Palmar aponeurosis

- superficial, thick, triangular fascia located on palmar surface of wrist

- covers tendons of extrinsic muscle

- provides protection to structures of wrist and hand

- distal attachment of palmaris longus

Flexor retinaculum

- horizontal fibrous band of connective tissue on palmar surface of wrist

- distal border blends with transverse carpal ligament

- attaches to styloid process of radius and ulna

- holds flexor tendons close to wrist

- maintains arch of carpal bones

Extensor retinaculum

- horizontal fibrous band of connective tissue on dorsal surface of wrist

- attaches medially to styloid process of ulna, pisiform, and triquetrum and laterally o styloid process of radius

- holds extensor tendons close to wrist

Sensory dermatomes of upper extremity

Circulation

major arteries and veins of the upper extremity

Only two muscles attach to structures of the wrist

1. flexor carpi ulnaris

2. palmaris longus

Common flexor tendon

attaches to medial epicondyle of humerus

Common extensor tendon

attaches to lateral epicondyle of humerus

Wrist muscles mostly have what line of pull?

most muscles have vertical lines of pull

There are no individual wrist muscles that produce what movement

ulnar or radial deviation

Ulnar deviation is produced by the:

• flexor carpi ulnaris and extensor carpi ulnaris

• synergist —work together

Radial deviation is produced by the:

• flexor carpi radialis and extensor carpi radialis longus

• synergist — work together

Flexor Carpi Ulnaris Muscle

Flexor Carpi Radialis Muscle

Palmaris Longus Muscle

Extensor Carpi Radialis Longus Muscle

Extensor Carpi Radialis Brevis Muscle

Extensor Carpi Ulnaris Muscle

Anterior wrist muscles

flexor carpi ulnaris, flexor carpi radialis, palmaris longus

Posterior wrist muscles

extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris

Lever system of the wrist

• Force arm (FA) is less than resistance arm (RA)

• relatively more force is needed to create movement

Lever system of the wrist when carrying a heavier object

• RA (resistance arm) is increased

• greater force is needed when holding platter

The hand consists of (3):

palm, four fingers, thumb

Two types of grasp

power and precision

Hand complex

Osteokinematics: Carpometacarpal joint of the thumb (CMC)

• starting position is with the side of the thumb resting against the anterior surface of the second metacarpal

• triaxial

• saddle joint

Flexion at the CMC joint

• frontal planesagittal axis

- movement of the thumb medially across the palm, toward the little finger

- ROM: 0-15 degrees

Extension at the CMC joint

• frontal plane, sagittal axis

• movement of the thumb laterally, away from the palm and little finger

• ROM: 0-20 degrees

Abduction of the CMC joint

• sagittal plane, frontal axis

• movement of the thumb away from the palm

• ROM: 0-70 degrees

Adduction of the CMC joint

• sagittal plane, frontal axis

• movement of the thumb toward from the palm, returning to the starting position

• ROM: 0 degrees

Opposition of the CMC joint

• horizontal plane, vertical axis

• movement in which the tips of the thumb and little finger move toward one another using a combination of flexion and abduction

Reposition of the CMC joint

• horizontal plane about a vertical axis

• movement in which the tips of the thumb and little finger move away from each other using a combination of extension and adduction

The CMC joint of the thumb

arthrokinematic motions of roll and glide in the same direction

Carpometacarpal joint of the fingers

permit minimal motion

Metacarpophalangeal joints (MCP) of the thumb

• unixial joint

• synovial joint

• flexion and extension only:

  • frontal plane, sagittal axis

• distal end of metacarpal is convex, and proximal end of phalange is concave

Flexion of the MCP joint of the thumb

• frontal plane about a sagittal axis

• first phalange rolls and glides medially

• ROM: 0-50 degrees

Extension of the MCP joint of the thumb

• frontal plane about a sagittal axis

• first phalange rolls and glides laterally

• ROM: 0 degrees

Metacarpophalangeal joints (MCP) of the fingers

• synovial biaxial condyloid joint

• flexion/extension

  • sagittal plane, frontal plane

• abduction/adduction

  • frontal plane, sagittal axis

• distal end of metacarpal is convex, and proximal end of phalange is concave