Upper extremity

Shoulder Girdle:

Connects the upper extremity to the trunk

Clavicle: Only articulation of the upper extremity with the trunk, S-shaped, moves with the scapula, most fractured bone in the body. Movements: Elevation, depression, protraction and retraction, small amount of rotation.

Scapula: Largely suspended by muscles, Coracoid process (finger like structure), acromion process, spine and supraspinous fossa, infraspinous fossa. Subscapular fossa.

Other articulations of shoulder/torso:

Sternoclavicular joint: Synovial with a disc. Connects the shoulder girdle with the rest of the torso. Multiple ligaments to keep it in place.

Acromioclavicular: Synovial joint (gliding + rotation), multiple ligaments to hold together. Connects the clavicle to the anterior coracoid process

Shoulder separation is a rupture of these ligaments, separation between the clavicle and the scapula

Muscles of the clavicle and scapula:

Rhomboids- Insertion-medial end of scapula spine, Origin-spinous process of thoracic vertebra elevation, downward rotation, retraction (adduction).

Levator Scapulae- Elevation and downward rotation, Origin-transverse process of C-vertebra, insertion-Superior side of the scapula’s medial border

Pectoralis Minor- protraction (abduction), depression, downward rotation, Origin-Sternal end of the 3rd, 4th, and 5th ribs, near their costal cartilages, Insertion-The medial border, and superior surface of the scapula’s coracoid process

Serratus Anterior-Protraction (abduction), upward rotation, helps hold the scapula in place. Origin- posterior ribs, Insertion- anterior surface of scapula

Trapezius- Huge origin, inserts on scapula and clavicle, typically broken into three sections.

Lower fibers- depression, upward rotation, retraction

Middle fibers- elevation, upward rotation, retraction

Upper fibers- scapular and clavicular elevation, extension and rotation of the head.

Bones of the shoulder:

Glenohumeral Joint:

Humerus land marks: Humeral head, greater tubercle (muscle attachment), lesser tubercle (muscle attachment), intertubercle groove (bicipital), deltoid tuberosity

Glenoid process and Fossa: a "notch" where the head of the humorous connects to the scapula, articulating surface on the scapula for the head of the humorous

Glenoid labrum: increases depth and stability of the Glenoid fossa

Labral tears: SLAP lesion (superior labral tear, anterior to posterior), occurs where the bicep tendon anchors to the labrum

Movements: Flexion in sagittal plane, abduction and adduction in frontal plane, internal and external rotation, horizontal abduction and horizontal adduction in transverse plane.

Rotator Cuff muscles (SITS):

Supraspinatus- initiates abduction, stabilizes GH joint

Infraspinatus- external rotation, stabilizes GH joint

teres minor- same as above

Subscapularis- internal rotation, stabilizes GH joint

Olecranon Bursa: Located between the tip of the olecranon and the skin, most common site for bursitis

Olecranon Bursitis: Direct blow, constant pressure. Swelling. Compression, drainage, padding for protection, ice.

Elbow Musculature:

Elbow Flexors Biceps Brachii- flexion (main action of elbow), supination (strong), shoulder flexion (weak), musculocutaneous nerve.

Brachialis- only elbow flexion, musculocutaneous nerve.

Brachioradialis- flexion, supinate or pronate, radial nerve.

Elbow Extensors- Triceps Brachii- All heads (lateral head, long head, medial head), Elbow extension, weak shoulder extension, radial nerve.

Forearm Supinator- Supinator literally just supination, radial nerve.

Forearm pronators- Pronator Quadratus- pronation, deep and distal, median nerve.

Pronator Teres- pronation, superficial and proximal, median nerve.

Elbow and Forearm nerves:

Ulnar nerve "funny bone", radial nerve, median nerve, musculocutaneous nerve

Carpals:

Proximal row: scaphoid, lunate, pisiform, triquetrum (from thumb to pinky)

Distal row: Trapezium, trapezoid, capitate, hamate,  (from thumb to pinky)

Carpal joints:

Radiocarpal Joint- ellipsoidal, flexion and extension, radial/ulnar deviation

Intercarpal joint- gliding

Carpometacarpal joint (thumb)- saddle, flexion and extension, opposition, AB/adduction

Carpometacarpal joints (2-4)- gliding, not a lot of movement

Phalangeal Joints:

Metacarpophalangeal (thumb) joint- hinge, flexion and extension

Metacarpophalangeal (2-4) (knuckles) joints- ellipsoidal, flexion and extension, AB/adduction.

Interphalangeal joints- hinge, flexion and extension

Capal ligaments:

Ulnar collateral ligament, radial collateral ligament,

Muscles of the hand:

Extrinsic- housed in the forearm, moves the hand/fingers

Intrinsic- inside the hand, moves hand/fingers.

Medial Epicondyle: long tendons, weak elbow flexion

Flexor carpi radialis- wrist flexion, radial deviation

Palmaris longus- wrist flexion, connects to the palmar aponeurosis (doesn’t do much)

Flexor Carpi ulnaris- wrist flexion, ulnar deviation 

Flexor digitorum superficialis- tendons split, flexion of the wrist, MP, PIP (Stops right before the distal interphalangeal joints)

Flexor digitorum profundus- deep muscle, tendons pass through superficialis, flexion of wrist, MP, PIP, DIP

Muscles of arm/hand:

Extensor carpi ulnaris-

Extensor digitorum- extends the wrist, MCP

Extensor digiti minimi- wrist extension, flexion of the pinky finger

Extensor carpi radialis brevis- extension of the wrist, radial deviation

Extensor indicis- index finger extension

Thenar Eminence- the muscles on the anterior surface of the thumb

Hypothenar Eminence- the muscles on the anterior surface of the pinky

Hand muscles:

Lumbricals- flexor tendon to extensor tendon, flex MCP, Extend IP

Palmar interossei- MCP Adduction

Dorsal interossei- MCP Abduction

Carpal Tunnel syndrome:

Repetitive strain injury, compression of the median nerve by tendons and everything in the wrist, surgery is a last resort.