Exam 2

humerus and forearm

the carrying angle is between what two landmarks?

10-15

carrying angle for women

5

carrying angle for men

medial (ulnar) collateral ligament

• important for stability of elbow

• tommy john surgery is reconstruction of this ligament

• use palmaris longus, patellar tendon, or cadaver ligament to reinforce ligament

interosseous membrane

holds radius and ulna together

biceps brachii

prime mover for supinated elbow flexion

brachialis

prime mover for pronated elbow flexion

brachioradialis

prime mover for neutral elbow flexion

triceps

prime mover for elbow extension

radius around ulna

for pronation, does the radius rotate around the ulna or does the ulna rotate around the radius?

pronator teres, pronator quadratus

prime movers for pronation

medial

do the pronators originate on the lateral or medial epicondyle?

lateral

do the supinators originate on the lateral or medial epicondyle?

biceps, supinator

prime movers for supination

compartment syndrome

• pressure within a fascial compartment

• contents become ischemic, damaged

• pressure in the nerves around the elbow

volkmann’s ischemic contracture

• finger/wrist flexors become contracted

• continuous pressure of nerves around the elbow

medial epicondylosis

• golfers elbow

• degeneration of common flexor tendon

lateral epicondylosis

• tennis elbow

• degeneration of common extensor tendon

radiocarpal joint

• where wrist motion occurs

• convex carpus (scaphoid/lunate/triquetrum) fits into concave radius

• proximal carpal row moves opposite of hand

2

how many degrees of freedom does the raidocarpal joint have?

80%

how much weight bearing forces of the UE go through the radoiocarpal joint?

ulnocarpal joint

• takes 20% of weightbearing force

• contains articular disc

• TFCC = ligamentous stability and shock absorber

mid carpal joint

• irregular, complex joint

• stability important

• ~50% of flexion and extension occurs here

lunate and capitate

60% of wrist flexion occurs between which two carpals?

flexor retinaculum

• this is also the Carpal Tunnel ligament

• helps provide stability and holds ligaments close

FCR, palmaris longus, FCU

prime movers for wrist flexion

medial

are the wrist flexors on the medial or lateral epicondyle?

anterior/volar

the wrist flexors are on what surface of the forearm?

ECRB, ECRL, ECU

prime movers for wrist extension

colles fracture

• break in the distal radius

• often from falling on outstretched hand

greenstick fracture

• does not break completely through bone

• fracture of radius is more proximal than colles

• more prominent in children

ganglion cyst

• benign

• fluid filled cyst often on dorsum of wrist

• can come and go, change size quickly

• only treat if interferes with function or painful

scapholunate

what is the most common ligament that is affected with a wrist sprain?

FCR, ECRL

prime movers for radial deviation

FCU, ECU

prime movers for ulnar deviation

FDP, FDS

prime movers for finger flexion

EDC, EI, EDM

prime movers for finger extension

lateral

the finger extensors are on the posterior aspect of the forearm and off of what epicondyle?

ulnarly

in finger adduction, digit 2 glides in what direction?

radially

in finger adduction, digits 4 & 5 glide in what direction?

palmar interossei

prime mover for finger adduciton

dorsal interossei

prime mover for finger abduction of digits 2-4

digiti minimi

prime mover for finger abduction of the 5th digit

lumbricals

prime mover for MCP flexion and IP extension

FPL, FPB

prime movers for thumb flexion (thenar eminence)

EPL, EPB, APL

prime movers for thumb extension

anatomical snuffbox

between EPB and EPL/APL

APB, APL

prime movers for thumb abduction

adductor pollicis

prime mover for thumb adduction

abduction, flexion, rotation

what 3 actions make up thumb opposition?

ulnar drift

• loss of ligamentous stability typically due to RA

• MCP joints deviate ulnarly and often sublux volarly

  significantly alters function and ROM

ulnar drift tx

place hand on table, have pt walk fingers over to radial side

scapula and clavicle

shoulder girdle

scapula, clavicle, humerus

shoulder complex

sternoclavicular (SC) joint

• only bony attachment of UE to trunk

• only joint that attaches the arm to the body

3

how many degrees of freedom does the SC joint have?

3

how many degrees of freedom does the acrominoclavicular (AC) joint have?

2-7

the resting position of the scapula is between what two ribs?

scapula rest position

• rests at a position on the posterior thorax, approx. 2 in. from midline

• spine of this bone is slightly rotates so the medial border is not straight up and down in resting position

hyperextended

scapular tilt only occurs when the arms are in what position?

serrates anterior

if scapular winging is present, what mm is weak?

shoulder girdle

functions:

• to produce movement of the scapula

• stabilize scapula

  • stable proximal base for distal movement

scapulohumeral rhythm

• for the first 30 degrees of GH flexion and abduction only

• for every 2 degrees of shoulder flex, there is 1 degree of upward rotation

upper trap, levator scapulae, rhomboid minor

mm for scapular elevation

cervical flexion with some lateral flexion

how to stretch shoulder elevators

lower trap, pec minor

mm for scapular depression

prone superman

exercise to strengthen shoulder depressors

serratus anterior, pec minor

mm for scapular protraction

middle trap, rhomboid minor and major

mm for scapular retraction

force couple

what is needed to complete scapular rotation?

upper and lower trap, serrates anterior

mm for scapular upward rotation

levator scapula, rhomboid minor and major, pec minor

mm for scapular downward rotation

SITS

• GH stability is provided by what mm?

• creates stability of GH joint

• responsible for motion at the GH joint

• increasing strength of these mm = pain and injury free shoulder motion

glenohumeral joint

• one of the most mobile = least stable

• 3 degrees of freedom

• glenoid cavity

  • size of quarter

• labrum

  • helps with stability

  • creates larger and deeper socket

convex

is the head of the humerus convex or concave?

anterior delt, pec major (clavicular), coracobrachialis

mm for shoulder flexion

pec major

• functionally 2 portions

  • generally work in opposite ranges and antagonistically

• clavicular portion

  • effective when sh in ext and becomes less as reaches 90 degrees flex

• sternal portion

  • more effective near end range flex and less so as reach 90 degrees of ext to pull arm back down

90 degree position

to stretch the clavicular portion of the pec major, what position do you have to be in?

Y positon, >90

to stretch the sternal portion of the pec major, what position do you have to be in?

posterior delt, lats, tres major

mm for shoulder extension

rhomboids, levator scapulae, pec minor

mm for scapular down rotates and depresses

supraspinatus tendon

• what tendon of the SITS mm is most commonly injured?

• slight external rotation can avoid impingement

middle delt, supraspinatus

mm for shoulder abduciton

adductors

are adductors or abductors usually stronger?

pec major, teres major, lats

mm for shoulder adduction

posterior delt, infraspinatus, teres minor

mm for shoulder horizontal abduciton

pec major, anterior delt

mm for shoulder horizontal adduction

infraspinatus, teres minor, posterior delt

mm for shoulder ER

lats, teres major, subscap, pec major, anterior delt

mm for shoulder IR

subluxation

• most often seen as result of CVA

• paralysis of RTC mm = loss of stability

• gravity on arm cause humeral head to drop away from glenoid fossa

• not painful itself, >80% of sublux develop chronic pain

tx for sublux

• Abduction (supra), ER (infra), IR (subscap), maybe flexion

• No resistance right away

• Keep in position until mm can get strong enough

• Tape

  • Tape is not entry level, so make sure their shoulder is supported when sitting

flexion and abduction

when you have a rotator cuff tear, what two movements are painful to reach into?

impingement

• compression of soft tissues (ligaments, bursa, tendons, long head of biceps)

• often due to faulty posture, mechanics, or kinematics

conditions that can affect sh. pain

• Repetitive overhead or away from the body

• sustained activities away from the body like driving

• trauma from fall or wrenching

• weakened tendon from systemic issues as obesity and smoking

• Age

  poor posture for long periods of time

muscle imbalances

• result in abnormal mechanics of the shoulder, risk for injury

• look at alignment of scapula at rest, scapulohumeral rhythm, position of scap/shoulder at end range

• do not allow hiking of sh with overhead mvmt

• encourage proper posture

labrum

in younger individuals, what is the weakest part of the shoulder?

subscap and capsule

in older individuals, what is the weakest part of the shoulder?

dequervain’s tenosynovitis

• cumulative trauma disorder or overuse of the abductor pollicus longus and extensor pollicus brevis

• pain over anatomical snuffbox near end of radius bone

• pain with ulnar deviation

dequervains

conservative tx:

• remove the cause (scoop baby instead of lift)

• long thumb spica splint

• kinesiotape

• ADL modification

• ergonomics assessment & recommendations

• anti-inflammatory modalities

• proximal stabilizing/posture exercises

• ROM and PRE after symptoms are well managed

post op tx:

• continue pre-op tx

• maybe immobilized <2 weeks

• tendon glides

• scar mobilization

• scar desensitization PRN

carpal tunnel

• median nerve compression

• overuse or cumulative trauma

• parathesias in D1

• pain at night

• thenar atrophy (weakness)

• decreased coordination