Term
| Lecture 5 - Arm and Forearm |
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Definition
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Term
| Upper and Lower limbs are organized into two things. What are they? |
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Definition
| Compartments and Transition zones |
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Term
| Deep fascia of upper limb divides arm and forearm into 2 ..........? |
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Definition
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Term
| 2 Functional Muscular Compartments of ARM are? |
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Definition
Anterior/Flexor Compartment
Posterior/Extensor Compartment |
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Term
| Anterior/Flexor compartment of ARM has... |
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Definition
| ...muscles that FLEX elbow joint and SUPINATE the proximal radioulnar joint |
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Term
| Posterior/Extensor Compartment of ARM has... |
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Definition
| ...muscles that EXTEND the elbow joint |
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Term
| 2 Functional Muscular Compartments of FOREARM are? |
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Definition
Anterior/Flexor Compartment
Posterior/Extensor Compartment |
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Term
| Anterior/Flexor compartment of FOREARM has... |
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Definition
| ...muscles that FLEX wrist joint, PRONATE the radioulnar joints, and FLEX digits |
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Term
| Posterior/Extensor Compartment of FOREARM has... |
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Definition
| ...muscles that EXTEND the wrist joint, SUPINATE the radioulnar joint, and EXTEND and ABDUCT digits |
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Term
| What is a Transition Zone? |
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Definition
| Area that provides passage of nerves/vessels/etc from one area to the next. |
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Term
| Why are TZ susceptible to injury? |
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Definition
| TZ's are close to moveable joints, which are susceptible to injury |
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Term
| What are the 3 Transition Zones in the Arm and Forearm? |
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Definition
1. Axilla (neck --> upper limb)
2. Cubital Fossa (Arm --> Forearm)
3. Wrist (Forearm --> wrist) |
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Term
| In which TZ would you do a venapuncture? |
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Definition
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Term
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Definition
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Term
| Muscles of Anterior compartment of Humerus are... |
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Definition
The Flexor muscles!
1) Biceps brachii
2) Bracialis
3) Coracobrachialis |
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Term
The Biceps Brachii's Action is?
Nerve Innervation is?
Arterial supply? |
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Definition
1) Flex Elbow Joint with hand supine (bicep curls)!
2) Musculocutaneous n. (C5, C6, C7)
3) Brachial Artery |
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Term
| What are the attachments of the Biceps? |
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Definition
1) Long Head from the supraglenoid
tubercle
2) Short head from coracoid
process
3) Tuberosity on shaft of RADIUS (must be supinated before flexion!) |
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Term
| What does the Brachialis m. do? |
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Definition
Flex elbow joint when hand is PRONE (reverse curls)
(attachement: from anterior humerus --> coronoid process of Ulna) |
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Term
| What innervates the Brachialis m.? |
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Definition
| The Musculocutaneous nerve (C5,6,7) |
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Term
| What muscle allows for flexion of elbow when forearm is between prone and supine? |
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Definition
| The brachioradialis muscle |
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Term
| Brachioradalis m. nerve innervation is? |
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Definition
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Term
| Coracobrachialis m. works on which joint? |
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Definition
| Shoulder joint! not the elbow |
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Term
| What is the action/nerve innervation of the Coracobrachialis m.? |
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Definition
1) Flex and ADDUCT shoulder joint
2) Musculocutaneous n. (C5,C6,C7) |
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Term
| What is the nerve of the Anterior Compartment of the ARM? |
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Definition
| Musculocutaneous nerve (C5,C6,C7) |
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Term
| What spinal segment is the MAJOR contributor to the MC nerve? |
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Definition
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Term
| The MC nerve branches from the... |
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Definition
| Lateral cord of the brachial plexus (C5, C6,C7) |
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Term
| The MC nerve innervates these muscles |
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Definition
Anterior compartment muscles of ARM!
1) Biceps brachii
2) Brachialis m.
3) Coracobrachialis m. |
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Term
| What is the SENSORY innervation of the MC nerve? |
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Definition
| C6 dermatome (lateral/radial forearm) |
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Term
| Anterior Compartment of Arm gets blood from... |
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Definition
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Term
| The branches of the BRACHIAL ARTERY are... |
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Definition
1) Muscular branches (Ant. Arm)
2) Collateral (Anastomotic) branches in elbow
3) Deep Brachial artery (extensor/posterior compartment) |
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Term
| Muscles of the Posterior Compartment are the... |
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Definition
Extensor muscles of the Arm that EXTEND the elbow joint!
1) Triceps brachii
2) Anconeus |
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Term
| The nerve of the posterior (extensor) compartment is the ... |
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Definition
| RADIAL NERVE (C5,C6,C7,C8,T1) => Posterior Cord |
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Term
| What are the major spinal segment contributors to the Radial nerve |
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Definition
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Term
| We know the Radial nerve gives motor to triceps and anconeus. What is the Sensory innervation? |
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Definition
part of C5 dermatome
1) Posterior lateral arm
2) Lateral dorsum of hand |
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Term
| The Triceps has how many heads? Where is the proximal attachment (origin)? |
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Definition
3 heads!
1) Long Head - Infraglenoid
tubercle
2) Lateral Head - Posterior
lateral surface of humeral shaft
3) Medial Head - Posterior surface of
humeral shaft |
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Term
| What is the DISTAL (insertion) attachment ? |
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Definition
| Olecranon process of Ulna (hook like, used for extension) |
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Term
| Most common LESION of ARM is ? |
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Definition
| fracture to mid-humeral Shaft |
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Term
| What may be compressed? What is the syndrome called? |
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Definition
| The Radial nerve within axilla (Saturday Night Palsy) |
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Term
| How can one get Saturday Night Palsy? |
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Definition
| Falling asleep with one's arm hanging over the arm rest of a chair, compressing the radial nerve at the spiral groove. |
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Term
| What are the symptoms of SNP? |
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Definition
1) Drop wrist with hand in prone position (can't extend wrist).
2) Cannot make tight fist. |
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Term
| Flexor compartment muscles get blood supply from? |
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Definition
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Term
| Extensor compartment muscles get blood supply from? |
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Definition
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Term
| Brachial artery's two terminal branches are in the ...(1)... and the branches are ...(2)... |
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Definition
1) Cubital Fossa
2) Ulnar and Radial artery |
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Term
| The anastomoses around the elbow joint is among these arteries |
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Definition
| Brachial, Deep Brachial, Ulnar and Radial a.a. |
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Term
| Discuss 3 things about the Cubital fossa |
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Definition
1) Transition zone between arm and forearm.
2) Cutaneous veins - site of vena puncture
3) Measure blood pressure - transition where brachial artery divides into radial and ulnar arteries. |
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Term
| What are the boundaries of the Cubital fossa? |
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Definition
1) Lateral = Brachioradialis muscle
2) Medial = Pronator teres muscle
3) Floor = Insertion of the biceps and brachialis muscles
4) Superior = imaginary line connectiong epicondyles
5) Roof = Fascia and skin |
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Term
| List contents of Cubital Fossa from Medial to Lateral |
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Definition
Median Nerve, Brachial Artery/vein, Tendon of Biceps, Radial Nerve Mnemonic: MBTR -> My Bottoms Turned Red
Know that the Brachial Artery is MEDIAL to the biceps tendon and it will be easy to find the Brachial Pulse (and know the order) |
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Term
| What are the 2 main cutaneous veins that drain the upper limb? |
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Definition
Basilic and Cephalic veins
(BC veins) |
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Term
| The BC veins are derived from where? |
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Definition
| Venous arch of dorsum of hand |
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Term
| The BASILIC vein drains into axillary vein from venous arch from which part of arm/forearm? |
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Definition
Ulnar side
Memorize how?
BC (medial/ulnar to lateral/radial) alphabetically) |
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Term
| The CEPHALIC vein drains into axillary vein from venous arch from which part of arm/forearm? |
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Definition
Radial Side
Memorize how?
BC (medial/ulnar to lateral/radial) alphabetically) |
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Term
| What vein is the usual site for a venapuncture? |
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Definition
| Median Cubital vein (starts off where basilic vein left off and travels to MEDIAN of forearm) |
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Term
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Definition
Ulna: Proximal end (top) --> Olecranon, Coronoid, Radial Notch, Trochlear notch
Distal End (bottom) --> Head of Ulna, Styloid Process
Which forearm is represented here?
Yup, the right forearm
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Term
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Definition
Radius:
Proximal end (Top) - Head, Neck, Radial tuberosity
Distal end (Bottom) - Styloid process
Which forearm is this?
Again, the right side. |
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Term
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Definition
1) Pronator muscles (teres, quadratus)
2) Wrist flexors (Flexor Carpi ulnaris/radialis, Palmaris Longus)
3) Digital Flexors (flexor digitorum superficialis/profundus, flexor pollicis longus) |
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Term
| Where do most of the flexor muscles of the forearm originate from? |
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Definition
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Term
| What are the Pronator muscles and their function? |
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Definition
| They get the "Palms down" Pronator teres - pronates proximal radioulnar joint. Pronator Quadratus - pronates distal radioulnar joint. Each of these is attached to BOTH the ulna and the radius! |
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Term
| What nerve innervates the pronator muscles? |
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Definition
| Median Nerve (C6,7,8,T1) => lateral and medial chords |
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Term
| What are the wrist (carpi) flexor muscles? Put in order from lateral to medial |
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Definition
1) Flexor carpi radialis
2) Palmaris longus
3) Flexor carpi ulnaris |
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Term
| Flexor carpi radialis attaches to the...and is innervated by the .... |
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Definition
| 2nd metacarpal...MEDIAN nerve (C6,7,8,T1) |
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Term
| Flexor carpi ulnaris attaches to the...and is innervated by the .... |
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Definition
| Pisiform bone and 5th metacarpal...Ulnar nerve (C8, T1) => Medial Cord |
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Term
| Palmaris longus attaches to the...and is innervated by the .... |
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Definition
| Flexor retinaculum and palmar aponeurosis (main funtion to keep p.a. it tight)...Median nerve |
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Term
| What are the digital flexors? |
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Definition
Extrinsic muscles of hand (flex all 5 digits)
1. Flexor digitorum superficialis
2. Flexor digitorum profundus
3. Flexor pollicis longus |
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Term
| Only ....muscle has an attachment to the medial epicondyle of humerus |
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Definition
| Flexor digitorum superficialis, other 2 do NOT! |
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Term
| 3 phalangeal joints are? Put in order of most proximal to distal |
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Definition
MCP --> PIP --> DIP
Metacarpal phalangeal --> Proximal interphalangeal --> Distal interphalangeal joints |
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Term
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Definition
Digit - all 5 (including thumb) thumb = 1st digit, pinky = 5th digit
Finger- 4 fingers, thumb isn't finger, index = 1st finger, pinky = 4th finger |
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Term
| Flexor Digitorum Superficialis muscle has ...tendons. |
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Definition
| 4 tendinous slips 1 per FINGER (doesn't go to thumb! That's F. pollicis longus!) |
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Term
| True or False: Flexor Digitorum Superficialis splits into a V like shape and inserts into middle phalanx |
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Definition
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Term
| T/F: F. Digitorum Superficialis is the prime flexor of the DIP joint |
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Definition
| False, it flexes the PIP joint. |
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Term
| How is the Flexor Digitorum Profundus different from the F. Digitorum Superficialis. Give at least 2 differences |
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Definition
1) Does not attach to medial epicondyle
2) Inserts onto distal phalanx (not middle phalanx)
3) Prime mover for flexion of DIP joint (not PIP joint)
4) Deep to the F.D. Superficialis
Otherwise, it's fundamentally the same (doesn't go to thumb, only the 4 fingers) |
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Term
| Flexor pollicis longus inserts onto the...and does what? |
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Definition
Phalanx of thumb
Flexes Interphalangeal (IP) joint of thumb.
Note: it only has 1 IP joint! |
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Term
What are the POSTERIOR FOREARM
MUSCLES |
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Definition
1. Brachioradialis
2. Wrist Extensors
3. Digital Extensors
4. Deep Thumb/Outcropping muscles
5. Supinator |
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Term
| The common attachment site for the posterior forearm muscles is... |
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Definition
| Lateral Epicondyle of Humerus |
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Term
| BRACHIORADIALIS m. action and nerve |
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Definition
1) Flex elbow (i.e. when drinking)
2) Radial nerve |
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Term
| The 3 wrist extensor muscles are? |
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Definition
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris |
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Term
| Extensor Carpi Radialis Longus and Extensor Carpi Radialis Brevis do what? What are they innervated by? |
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Definition
Action: Extend wrist and radial deviation
Nerve: Radial Nerve (C5,6,7,8) |
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Term
| Extensor Carpi Ulnaris does what? nerve? |
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Definition
1) Extend Wrist and assists with ulna deviation of wrist
2) Radial Nerve!!! not Ulnar nerve! |
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Term
| If it has the word EXTEND in it, the nerve is ... |
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Definition
| Radial nerve (or its branches) --> C5,6,7,8 |
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Term
| 2nd metacarpal bone is attachment site for ...muscle |
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Definition
| Extensor Carpi Radialis Longus |
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Term
| 3rd metacarpal bone is attachment site for ...muscle |
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Definition
| Extensor Carpi Radialis Brevis |
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Term
| 5rd metacarpal bone is attachment site for ...muscle |
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Definition
Extensor Carpi Ulnaris
Ulnar = think pinky area |
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Term
| What are the Thumb muscles? |
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Definition
Abductor Pollicis longus
Extensor Pollicis brevis
Extensor Pollicis longus
Tendons = Snuff Box, you should palpate 3 tendons |
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Term
| Which muscle inserts into the 1st metacarpal? |
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Definition
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Term
| Abductor Pollicis longus action and innervation are? |
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Definition
1. Abduct 1st carpometacarpal joint and radial deviation
2. Radial nerve (C5,6,7,8) |
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Term
| Which muscle inserts into the proximal phalanx? |
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Definition
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Term
| Extensor Pollicis brevis action and nerve? |
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Definition
1. Extend MCP joint of thumb
2. Posterior interossius nerve |
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Term
| Which muscle inserts into the distal phalanx? |
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Definition
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Term
| T/F Action of extensor pollicis longus is to flex interphalangeal (IP joint) of thumb |
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Definition
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Term
| What are the Finger Extensor Muscles? |
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Definition
Extensor Digitorum
Extensor Digiti Minimi
Extensor Indicis |
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Term
| Why does it make sense that the finger extensors extend the MCP joints? |
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Definition
Extending the MCP joint would mean a whole FINGER will be moving, thus it's logical to think that the MCP joint is doing the work.
Note: the THUMB is not a FINGER, thus not affected by the 3 muscles from the last card |
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Term
| The first 3 (or 4) fingers (index, middle, and ring, and sometimes pinky) are connected to the tendons of which muscle? |
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Definition
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Term
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Definition
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Term
| The 1st finger (index finger) ? |
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Definition
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Term
| Which 2 muscles supinate radio-ulnar joint? |
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Definition
| Biceps and Supinator muscle |
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Term
| T/F Biceps and Supinator are both innervated by the Musculocutaneous nerve |
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Definition
False! Biceps --> Musculocutaneous nerve (C5,6,7)
Supinator --> Radial nerve (C5,6,7,8) |
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Term
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Definition
Extensor tendons cross wrist in 6
synovial tunnels.
Tendons and sheath bound to
wrist by extensor retinaculum. |
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Term
| What does each compartment contain? |
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Definition
| 1 or more extrinsic extensor tendon |
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Term
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Definition
Abductor Pollicis Longus
Extensor Pollicis Brevis |
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Term
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Definition
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis |
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Term
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Definition
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Term
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Definition
Extensor Digitorum
Extensor Indicis |
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Term
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Definition
| Extensor digiti minimi (V) |
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Term
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Definition
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Term
| T/F Compartments are numbered from 1 - 6 from Radial to Ulnar |
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Definition
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Term
| Compartment 1 is the most clinically significant. Why? |
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Definition
DeQuervain’s Disease =>
narrowing of 1st compartment. |
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Term
| What is a positve test for DeQuervain's Disease? |
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Definition
Basically, hurts when patient "pulls" on the thumb to ulnar side
1. Patient folds (flexes) thumb under fingers
2. Deviate wrist to ulnar side (ulnar deviation)
Positive if pain of dorsal lateral surface of wrist reproduced |
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Term
| Describe path of Radial nerve |
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Definition
| Branches off Posterior cord (C5,6,7) --> travels on dorsum of arm --> winds around and over the Lateral epicondyle --> Enters cubital fossa where it supplies brachioradialis (drink muscle) and wrist extensors --> Divides into superficial (cutaneous) and deep (motor) branch. |
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Term
| The superficial branch of the radial nerve supplies... |
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Definition
Sensory from dorsum of hand on radial side
part of C6 dermatome |
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Term
| Deep branch of radial nerve ... |
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Definition
...pierces supinator muscle to
innervate forearm extensor muscles |
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Term
| What is the most common symptom of radial nerve damage? Why does that make sense? |
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Definition
Drop wrist --> Can not ACTIVELY extend wrist with
forearm in prone position.
Radial n supplies the extensor muscles and if it's damaged, wrist cannot extend --> dropped wrist |
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Term
| What are the 4 radial nerve lesion sites? |
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Definition
1 Axilla
2 Fractured Humeral Shaft
3 Cubital Fossa
4 Entrapped in Supinator muscle |
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Term
| Blood supply to posterior compartment of forearm comes from the... |
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Definition
| Posterior interosseous branch of the common interosseous artery. |
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Term
| Describe path of Median nerve |
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Definition
| Lateral and Medial cords (C6,7,8,T1) --> anterior arm --> passes thru cubital fossa --> forearm --> heads of pronator teres muscle --> carpal tunnel |
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Term
| Median nerve is sensory from? |
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Definition
Lateral (radial) palm, thumb, and 2.5 digits
(thumb, index, middle, half of ring and half of palm) |
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Term
| Median nerve is motor to? |
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Definition
Flexor muscles and pronation:
1) Flexor carpi radialis
2) Flexor digitorum superficialis
3) Palmaris longus
4) Flexor pollicis longus
5) Pronator teres and quadratus
6) Flexor digitorum profundus to 1st and 2nd fingers (b/c that's the radial half, ulnar got fingers 3 and 4) |
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Term
| Name 3 types of Median Nerve lesions |
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Definition
1) Cubital Fossa 2) entrapped w/in Pronater Teres 3) Carpal Tunnel Syndrome
Whenever asked about lesions to nerves, think about the PATH the nerve takes! |
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Term
| What lesion would result in complete loss of Median nerve function? |
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Definition
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Term
| What may an entrapped median nerve w/in Pronater Teres result in? |
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Definition
1) Pronator Teres Syndrome
2) Weakness of hand and wrist |
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Term
| Carpal Tunnel Syndrome would most likely result in the loss of which muscle group? |
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Definition
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Term
| Describe path of Ulnar Nerve |
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Definition
| Medial Cord (C8,T1) --> runs on medial arm --> passes thru cubital tunnel behind the medial epicondyle (funny bone area) |
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Term
| Ulnar nerve sensation is from? |
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Definition
Ulnar (medial) side of palm and medial 1.5 fingers (pinky and half of ring finger).
The other fingers are by median nerve |
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Term
| Ulnar nerve is motor to ? |
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Definition
Flexor Carpi Ulnaris
Flexor Digitorum profundus to 3rd and 4th fingers (ring and pinky, respectively) |
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Term
| See cutaneous innervation of forearm on page 209 (#3) |
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Definition
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Term
| Describe Brachial Artery path after arm |
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Definition
| Brachial artery medial to bicep tendon --> Radial + Ulnar a.a. within Cubital fossa |
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Term
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Definition
...muscles on radial side of forearm. Compressed against distal radius
to take “pulse”. |
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Term
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Definition
...muscles on ulnar side of
forearm. |
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Term
| What is a branch of the Ulnar artery? |
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Definition
| Common interosseous artery |
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Term
| What are the branches of the Common interosseous artery? What do each supply? |
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Definition
Anterior interosseous a. --> deep flexor muscles
Posterior interosseous a. --> extensor muscles |
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Term
| What happens around the elbow area with the arteries? |
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Definition
| Anastomotic connection b/w radial and ulnar reccurent branches (as well as with any superior arteries in the area) |
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