Exam 3

Gen techinques for palpation

• start away from the pain and work in

Gen techiques for ROM

• Passive

  • Helps establish health and function of inert structures (joint capsules and ligaments)

  • laying down

• Active

  • Helps establish health and function of dynamic stabilizers and prime movers

  • Helps identify balance and potential imbalance between muscles that bend and turn arm and grasp and release objects

  • sitting

ROM

• finger

  • Finger flexion (PIP 100-115, DIP 80-90, MP joint 85-90)

  • Finger extension (PIP 0, DIP 20, MP 30-45)

  • Finger adduction (0)

  • Finger abduction (20-30)

• Thumb

  • Flexion (IP 85-90, MP 50-55, 45-50)

  • extesnion (IP 0-5, MP 0)

  • adduction (touching rest of hand) (30)

  • abduction (technically foward) (60-70)

  • opposition (touching another finger)

  • reposition (open palm)

• Wrist

  • Writst flexion (80-90)

  • Wrist extesnion (70-90)

  • radial deviation (15)

  • ulnar devation (30-45)

• elbow

  • Elbow flexion (140)

  • Elbow extsetion (0)

  • forarm supination (85-90)

  • forarm pronation (85-90)

Wrist Flexor/Pronators

• Pronator teres

  • O: humeral head (medial epicondyle) Ulnar head (medial aspect of conroniod process)

  • I: Middle 1/3rd of lateral radius

  • F: pronates forearm, assits in flexing elbow

  • inner: median nerve, C6-C7

• Pronator quadratus

  • O: Medial side and anterior surface of distal ¼ of the ulna

  • I: Lateral side and anterior surface of distal ¼ of the raidus

  • F: pronates the forarm

  • inner: Median nerve C8-T1

• Flexor carpi radialis

  • O: medial epicondyle of the hymerus

  • I: base of 1st and 2nd metacarpals, plamar side

  • F: flexes wrist, radialy devates (abducts) the wrist, slightly flexes the elbow, slightly pronates the forearm

  • inner: median nerve

• palmaris longus

  • O: medial epicondyle of the humerus

  • I: Flexor retinaculum and plamar aponeurosis

  • F: tenses the palmar fascia, flexes the wrist, slightly flexes teh elbow

  • inner: Median nerve

Wrist Extensors

• Brachioradialis

  • O: Proximal 2/3rds of lateral supracondylar ridge of the hummerus

  • I: Lateral side of radial styloid process

  • F: Flexes the elbow, pronates forarm to supenated to nutral, supentates the forarm from pronated to nutral

  • inner: radial nerve

• Extensor carpi radialis longus

  • O: Distal 1/3rd of lateral supracondylar ridbge of the hummerus

  • I: base of 2nd metacarpal dorsal side

  • F: Exends the wirst, radially deveates (abductus) the wirst, assists in flexing the elbow, slightly supinates the forarm

  • Inner: Radial nerve

• Extensor carpi radialis brevis

  • O: Lateral epicondyle of the hummerus

  • I: Base of 3rd metacarpal, dorsal side

  • F: Extends the wrist, radially devatates abducts the wirst, assits in extending the elbow

  • Inner: raidal nerve

• extensor carpi ulnaris

  • O: lateral epicondyle of the humerus and the middle one- third posterior border of the ulna

  • I: base of 5th metatcarpal, dorsal side

  • F: exstends the wrist, ulnarly devates (adducts) he wrist, slightly extends elbow

  • Inner: Posterior interosseous nerve

Finger flexors

• Flexor digitorum superficialis

  • O: Humeral head (medial epicondyle and ulnar collateral ligament), ulnar head (medial aspect of corotroid process), Raidal head (proximal ½ of anterior shaft distal to radial tuberosity

  • I: sides of middle phlangies of digits 2-5 by 4 seprate tendons

  • F: flexes proximal interphalngeal joints 2-5 by 4 seprate tendons

  • Inner: mediam nerve

• flexor digitorum profundis

  • O: Anterior and medial surfaces of proximal 3/4ths of the ulna and interossious membrane

  • I: Bases of distal phalanges of digits 2-5, palmar side by 4 seprate tendons

  • F: Flexes distal interphalangeal joints of digits 2-5, Assists in flexing proximal interphalangeal joints (2-5)

  • Inner: median nerve (digits 2-3) ulnar nerve (digits 4-5)

• flexor pollicis longus

  • O: Anterior surface of body of the radius and intersousious membrane

  • I: Base of 1st distal phalananx, palmar side

  • F: Flexes the thumb @ carpometacarpal, metacarpophalangeal, and intercarpal joints

  • Inner: median nerve

Finger extensors

• Extensor digitorum

  • O: lateral epicondyle of the hummerus

  • I: Middle and distal phalanges of digits 2-5, dorsal side

  • F: extends digits 2-5 @ metacarpophalageal, prox interphalangeal, & distal interphalageal joints

  • Inner: Posterior interossoeous nerve

• ext. digiti minimi (pinki or mini finger)

  • O: lateral epicondyle of the hummerus

  • I: Base of 5th proximal phalanx, dorsal side

  • F: Extends the 5th digit @ metacarpophealgeal and interpholangeal joints, extends wrist, slightly extends elbow

  • Inner: Posterior interossoeous nerve

• ext. pollicis longus

  • O: Middle 1/3 of posterior surface of the ulna and interosseous membrane

  • I: Base of 1st distal phalanx (dorsal side)

  • F: Extends the thumb @ carpometacarpal, metacarpophealgeal and interpholangeal joints, Slightly abducuts the wrist, slightly extends the wrist

  • Inner: Posterior interosseous nerve

• ext. indicis (pointer finger or indicator)

  • O: Ulna (posterior serface of body) interossous membrane

  • I: Base of 2nd proximal phalanx and into tendon of extensor digitorum to the 2nd digit

  • F: Extends 2nd digit @ metacarpophalageal joint & interphalageal joints, extends the wrist, slighly supinates the forarm

  • Inner Posterior interosseous nerve

• abductor pollicis

  • O: Middle 1/3 of posterior surface of the ulna, radius, and interosseous membrane

  • I: Base of 1st metacarpal, dorsal side

  • F: Abducts the 1st metacarpal joint, extends the 1st capometacarpal joint, abducts the wrist, slightly flexes the wrist

  • Inner: Posterior interosseous nerve

Synergist/agonist list on 193

• antagonist: opposes prime mover

• agonist: prime mover

• synergist: muscles that work with the prime movers

Label

• Surface

  • Palmaris Longus- pinky side, muscle body is near elbow, connects from head of ulna to carpals (173)

  • Flexor carpi ulnaris- side of arm, pinky side, connects from top of ulnar to carpals (174)

  • Flexor carpi radialis- center of arm, connects from carpals to medal humaral condyle (172)

  • Olecranon process- ulna hook, creates elbow (141)

  • Thenar eminence- meaty part of palm under thumb (138)

  • Hypothenar eminence- meaty part of the palm near pinky (138)

  • Wrist crease- lowest crease that connects arm and hand (138)

  • MCP joints- knuckles (139)

• ligaments

  • Annular ligament- on top of radius(thumb side towards elbow), holds radius to the ulna (ligament above all the others and holds them in place) (149)

  • Ulnar collateral ligament- connects humerus and ulna, medial side (148)

  • Interosseous membrane (ulna/radius)- inbetween ulna and radius (fills in the gap) (149)

  • Radial collateral ligament- connects hummerus and radius, small short tendon, thumb side, under anngular ligament (149)

  • Flexor retinaculum (carpal tunnel “roof”)- along inner wrist (157)

• Bones

  • Humeral condyles, epicondyles (medial & lateral)- upper elbow, antomical pos towards body medal, away from body lat (139)

  • Radius- big bone in foream thumb side (139)

  • Ulna- big bone in forearm pinky side (33)

  • Proximal radioulnar joint- radius and ulnar meet towards the elbow (139)

  • Distal radioulnar joint- radius and ulnar meet towards the wrist (139)

  • Radiocarpal joint- radius (thumb side big bone) meet carpal bones (139)

  • Carpal bones- small square bones towards base of hand (139)

  • Metacarpals- back of palm of hands, bones, fingers to nuckle (138)

  • Phalanges- finger bones (knuckle to finger tips)

  • Olecranon fossa- on distal part of humerus, is the grove the holds the ulna in place (makes elbow) (140)

  • Styloid processes – radius (towards wrist, right above it in anotomical position, thumb side), ulna (towards wrist, right above it in anotomical position, pinky side) (138)

  • Radial head- towards elbow, little lower than elbow (140)

  • Lister’s Tubercle- Is on the radius, back of hand, towards middle of wrist (143)

• Muscles

  • general: extensor back/knucle side, flexors palm side

    • Biceps brachii – muscle belly (anotmical pos) top front of upper arm (near boob, so like side front) (111)

    • Biceps – long head (anaotomal pos) a little more towards ribs though still at front also connects more up in shoulder

    • Brachialis- middle body of arm (right above elbow) towards front in anotomical pos (thumb side), connects from sligtly above base of hummerus (bump) to radus near wrist (170)

    • Brachioradialis-thumb side, body of muscle is a little below elbow (off to the side towards the air) anotomical pos (171)

    • Pronator Teres- connects from medial (pinkey) side of the humerus condyle to the radius bone maybe an .5-1 inch below the elbow, short, crosses over ulna (178)

    • Extensor carpi ulnaris- connects from next to the Olrecreanion process (hook of elbow) to base of 5th metatarsal (pinky) (184)

    • Extensor carpi radialis (182-183)

      • longus- connects from slightly distal humeral base (bumb) to base of second metatarsal (pointer finger) towards lateral side of arm (thumb side) on knucke side of arm

      • brevius- connects from distal base of hummerus (elbow bumb) to base of 3rd metatarsal (middle finger) is on knuckle side of arm

    • Triceps brachii- dorsal side of arm connects from scapula to elbowish (little above) big muscle takes up most of the back of the upper arm (126)

    • Anconeus- connects from inner elbow to back of upper lower arm right below elbow dorsal side (goes from middle of inner elbow into upper arm pinkey side, not very long (181)

    • Supinator- knucle side of arm, right under elbow goes down towards radidus, short, touches ulnar radius and humerus (180)

    • Flexor digitorum (generally), palm side of lower arm, slightly off center towards pinkey, is in the main part of lower arm, big muscle, reaches into 4 digits (176)

    • Flexor pollicis longus- next to flexor digitorum, mainly on radius, goes into thumb (177)

    • Extensor digitorum- knucle side , connects from humerus base (bumb), down to 4 digits, big muscle on back of lower arm (185)

    • Extensor digiti minimi- knucle side of hand, connects from lower humeral bump to 5th metatarsal (pinkey) (178)

    • Extensor indicis- connects from ulna (little above wrist) to 2nd digit (pointer finget) knucle side (186)

    • Extensor pollicis longus- Knucle side, in between ulnar and radius goes into thumb, just abouve wrist (190)

    • Abductor pollicis longus- knucle side in midle of the lower arm, goes into thumb , conects from ulna to thumb (188)

      *muscles only in hand (intrinsic muscles on pg 191-192)

Movements

• pg 195 of book

  • lifiting

  • shooting

  • twisting

  • grasping