Unit 4 Objectives – Upper Limb  NOTE: References noted in blue can be found in the BMS301 Lecture Notes  book.  In addition, do not forget to look at the syllabus, which includes  recommended readings which may correspond with some of these  objectives.  Pectoral girdle and shoulder joints  1) List the bones, anatomical names and common names for the different parts  of the upper limb. (p.85, 86, 94) Area Name Bones Shoulder (Between thorax and  neck, out to arm) Shoulder Clavicle + Scapula  = Pectoral Girdle Arm (Between shoulder and  elbow) Brachium Humerus Forearm (Between elbow and  hand) Antebrachium Radius and Ulna Hand (Wrist, palm/dorsum,  fingers) Manus -carpus, metacarpus,  digits Manus -carpal bones,  metacarpal bones, and  phalanges

What are vena comitantes?

2) List the bones involved in the shoulder girdle. (p.85)  a) Clavicle b) Scapula  c) Humerus  3) List a general function of each of the bones in #2.  a) Clavicle i) Projects our upperlimb away from midline laterally ii) Transfers weight and energy from appendicular skeleton to axial  skeleton iii) Is the most frequently broken bone in the body b) Scapula i) Has a high amount of muscle attachments ii) Floats on the thorax  iii) Allows for increased movement of the upperlimb c) Humerus i) Site for muscle attachment  4) List the four articulations of the shoulder region, their classification and  movements. (p.3)  a) Sternoclavicular joint i) multiaxial joint (3 or more axes of rotation) (1)similar to ball and socket, but not a TRUE ball and socket ii) Saddle joint iii) Strong sternoclavicular ligaments which limits movement at this  joint  b) Acromioclavicular joint i) Acromial process, scapula  acromial part, Clavicle ii) Ligaments: (1)Acromial clavicular ligaments = joint capsule (2)Coracoacromial ligaments = stabilize the scapulas processes (3)Coracolavicular ligament = stabilizes clavical to acromian (a)Tears = shoulder separation  c) Scapulathoracic “joint” i) Between scapula and posterior thoracic wall ii) Movement of scapula= increases movement of upper limb iii) Abduct, and adduct iv) Upwardly rotate scapula after 90 degrees v) Downwardly rotatation of scapula d) Glenohumeral joint 5) Describe the glenohumeral joint in terms of its structure and strength.  a) between the glenoid fossa of the scapula, and the head of the  Humerusb) true ball and socket joint c) multi axial d) 1/3 head of Humerus is in glenoid fossa which means there is a  decrease in stability, and an increae in mobility.  i) lip of cartilage on glenoid fossa is the glenoid labrum. Which helps  deepen glenoid fossa  6) Describe the differences between the shoulder joint and hip joint.  Pectoral and shoulder muscles  1) Describe the differences between axiohumeral (p.85, 86), axioscapular (p.85, 86, 87) and scapulohumeral (p.86,87,88) muscles.  a) Axiohumeral muscles i) Attach from the axial skeleton, to the humerus b) Axioscapular muscels i) Attach from the axial skeleton, to the scapula  c) Scapulohumeral muslces  i) Act on the glenohumeral joint (true shoulder joint) 2) List the attachments, actions and nerve supply of the muscles in #1.  Axiohumeral muscles Clavicular head  of the Pectoralis  Major m P: Clavicle  D: intertubercular groove, humerus Medial and  lateral pectoral  nn Flexion of the  shoulder

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Sternal head of  the Pectoralis  major m P: sternum D: intertubercular groove, humerus Medial and  lateral pectoral  nn Extension of the  shoulder  Together: medial  rotation, and  adduction of the  shoulder Latissimus Dorsi  m P: spinous  processes of T7- L5 vertebrae D: intertubercular groove, humerus Thoracodorsal n Extend, adduct,  and medially  rotate the  shoulder

Axioscapular Muscles Pectoralis minor  m P: ribs 3,4,5 D: coracoid  process, scapula Medial and  lateral pectoral  nn Mm of  respiration,  depresses  scapula,  stabilizes scapula onto body wall Upper portion of  the trapezius P: skull D: acromian,  scapula, and  clavicle Accessory n XI Elevate, and  upward rotation  of scapula Middle part of  the trapezius P: spinous  processes of  thoracic  vertebrae Accessor n XI Adduct, and  retract the  scapula

What is the "true" elbow joint?

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D: medial edge  of the scapula

Lower portion of  the Trapezius P: spinous  processes of  inferior thoracic  vertebrae D: spine, scapula Accessory CN XI Depress, and  upward rotation  of scapula Levator scapulae m P: cervical  vertebrae D: medial border  of the scapula Dorsal scapular n Elevate &  downward  rotation of the  scapula Rhomboid P: spinous  processes of  thoracic  vertebrae D: medial border  of scapula Dorsal scapular n Adduction/  retraction of the  scapula Serratus Anterior m P: upper 8 ribs D: medial border  of the scapula Long thoracic n Keeps scapula on body wall Helps in rotation  and abduction of  scapula

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3) List the muscles of the rotator cuff and their effect on the glenohumeral joint. (p.88) Axilla and Breast  1. Describe the boundaries and contents of the axilla. a. Anterior boundary:  i. Pectoralis major and minor mm b. Posterior boundary:  i. Latissimus dorsi m ii. Teres major m iii. Subscapularis m  c. Medial boundary i. Ribs and serratus anterior m  d. Contents: i. Brachial plexus ii. Axillary artery, and axillary vein iii. Lymph tissue – axillary lymph nodes  iv. Fat  v. Everything going to and from the upper limb 2. Define the breast. a. A group of modified sweat glands, packed in fat, and supported  by fibrous ligament that are borrowed from superficial fascia,  covered in delicate skin  3. Describe the difference between the breast and mammary gland. a. A mammary gland is a structure inside the breast, that is a  modified sweat gland, innervated by the autonomic nervous  system, they are accessory sex glands of the female  reproductive system.  4. Describe the structure of the breast, include glands, ducts, ligaments  and general characteristics. a. Mammary glands i. Produce milk, there about 15-20 present in each breast.  b. Lactiferous ducts i. Transports mild from mammary glands to the nipple c. Lactiferous sinusesi. Reserve of milk  d. Nipple i. Site where milk is secreted, and site of a high number of  receptors with an autonomic reflex e. Areola i. Pigmented skin with a high number of sweat glands f. Suspensory ligaments i. Attatch from superficial fascia to skin  5. List 2-3 risk factors for breast cancer. (need to look up on own) a. Genetic i. Gender, age, race, family history, menstrul history, dense  breast tissue, genome changes b. Environmental and lifestyle  i. Lack of physical activity, poor diet, obesity, drinking  alcohol, radiation, hormone replacement therapy  6. List 2-3 types of breast cancer screening. a. Mammography i. the most common screaning test for breast cancer.  ii. Its an x ray of the breat that finds tumors that are too  small to feel. It may also find ductal carcinoma in situ  where there are abnormal cells in the lining of the breast  duct, which may become invasive cancer in some women.  iii. Mammograms are less likely to find breast tumors in  women younger than 50 years old. This may be because  younger women have denser breast tissue that appears  white on a mammogram. Because tumors also appear  white on a mammogram, they can be harder to find when  there is dense breast tissue.  b. Clinical breast exam i. An exam of the breast by a doctor who will carefully feel  the breasts and under the arms for lumps.  ii. Self exams may be done by checking yourself for lumps or  anything that feels unusual.  c. MRI  i. Uses magnetic radio waves and a computer to make a  series of detailed pictures of areas inside the breast. ii. MRI’s find breast cancer more often than mammograms  do, but it is common for results to appear abnormal even  when there is no cancer.  d. Thermography e. Tissue sampling 7. Describe fibrocystic "changes" a. Fibrocystic changes occur in lactiferous ducts. They are moveable and non-cancerous  8. Understand how breast cancer can spread to the axilla, opposite breast or lungs.  a. The venous drainage of the breast is mainly to the axillary vein,  but there is some drainage to the internal thoracic vein b. The lymphatic drainage of the breast is important because of its  role in the spread of cancer cells. Lymph passes from lobules of  the gland, nipple, and areola to the subareolar lymphatic plexus.  i. Most lymph drains into the axillary lymph nodes ii. Most of the lymph first drains to the pectoral nodes.  However some lymph may drain directly to other axillary  nodes or to interpectoral nodes.  iii. Lymph from the medal breast drains to the parasternal  lymphnodes iv. Lymph from the inferior breast may pass deeply to  abdominal lymph nodes v. Lymph from the axillary nodes drains to infraclavicular and  supraclavicular nodes and from them to the subclavian  lymphatic truk.  vi. Lmph from the parastenal nodes enters the  bronchomediastinal trunks which ultimately drain into the  thoracic lyphatic duct.  Brachial plexus  1) Describe the components of the brachial plexus. a) The brachial plexus is a major network of nerves supplying the upper  limb. It egins in the lateral cervical cregion and extends into the axilla. The brachial plexus Is formed by the union of the anterior rami  of the C5-T1 nerves, which constitute the roots of the brachila plexus.  b) The roots usually pass through the gap between the anterior ad  middle scalene muscles with the subclavian artery.  c) The sympathetic fiers carried by each root of the plexus are received  from the gray rami of the middle an inferior cervical ganglia as the  roots pass between the scalene muscles.  d) In the inferior part of the neck, the roots of the beachial plexus unit to form three trunks i) Superior trunk – from the union of the C5 and C6 roots ii) A middle trunk – which is a continuation of the C7 root iii) An inferior trunk- from the union of C8 and T1 roots e) Each trunk of the brachial plexus divides into anterior and posterior  divisions as the plexus passes though the cervicoaxillary canal  posterior to the clavicle. Anterior divisions of the trunks supply the  anterior (flexor) compartments of the upper limb, and posterior  ddivisions of the trunks supply the posterior (extensor) compartments  of the upper limb.  f) The divisions of the three trunks form three cords of the brachial  plexus within the axilla i) Anterior divisions of the superior ad middle trunks untite for form  the ateral cord ii) The anterior division of the inferior turnk continues as the medial  cord iii)Posterior divisions of all three trunks nite to form the posterior  cord 2. Be able to differentiate between trunks, divisions, cords and terminal  branches of the brachial plexus. (p.89, 90)3. Describe the nerve branches of the roots, trunks and cords of the brachial  plexus (p.89, 90).  4. Describe the terminal nerves of the plexus and their areas of  responsibilities. I. Musculocutaneous n a. Anterior arm mm II. Axillary n a. Shoulder mm III. Radial n a. Posterior arm m b. Posterior forearm mm IV. Median n a. Anterior forearm mm b. Thumb mmV. Ulnar n  a. Hand mm  5. Differentiate between paralysis, paresis, anesthesia and parathesia. I. Anesthesia a. Complete loss of all sensation  II. Paralysis a. Complete loss of motor function III. Paresis a. Partial loss of motor function IV. Parathesia a. Partial loss of sensation  6. Describe the effects of nerve damage to roots, trunks, cords and terminal  nerves of the brachial plexus.  I. Peripheral innervation a. Combination of spinal nerves b. Sensory innervation for patches of skin c. Motor innervation for entire muscles and groups of muscles  II. Segmental innervation a. Individual spinal nn  b. Sensory innervation for strips of skin called dermatome c. Motor innervation for strips of muscle called myotome  III. Peripheral nerve damage  a. Musculocutaneous n i. Motor loss to all of brachialis m ii. Motor loss to all of biceps brachii m  iii. = paralysis of elbow flexion  iv. sensory loss to pathc of sin on lateral forearm v. = Complete loss of all sensation (anesthesia) IV. Segmental nerve damage a. C5 spinal nervei. Motor loss of part of the brachialis m ii. Motor loss of part of biceps brachii m iii. =Paresis of elbow flexion iv. Sensory loss to strip of anterior chest, anterior arm, and  anterior forearm Clinical Box 1) Enlargement of axillary lymph nodes a) An infection in the upper limb can cause the axillary nodes to enlarge  and become tender and inflamed, a condition called lymphangitis. The  humeral group of nodes is usually the first ones to be involved.  Lymphangitis is characterized by warm, red streaks in the skin of the  limb. Infections in the pectoral region and breast, including the  superior part of the abdomen, can also produce enlargement of the  axillary nodes. These nodes are also the most common site of spread  of cancer to the breast.  2) Brachial plexus injuries a) Injuries to the brachial plexus affect movements and cutaneous  sensations in the upper limb. Disease, stretching, and wounds in the  lateral cervical region, or in the axilla may produce brachial plexus  injuries. Signs and symptoms depend on what part of the plexus is  involved. Injuries to the brachial plexus result in loss of muscular  movement (paralysis), and loss of cutaneous sensation (anesthesia).  b) Injuries to the superior parts of the brachial plexus (C5 and C6) usually  result from an excessive increase in the angle between the neck and  the shoulder. These injuries can occur in a person who is thrown from a motorcycle ora horse and lands on the shoulder in a way that widely  separates the neck and shoulder. When throw, the parson’s sjoulder  often hits something and stops, but the head and trunk continue to  moe. This stretches or ruptures superior parts of the brachial plexus or  tears the roots of thee plesus from the spinal cord. Injury to the  superior trunk is apparent by the characteriec position of the limb in  which the limb hags by the side in medial rotation c) Upper brachial plexus injuries can also occur in a newborn when  excessive strechin of the neck occurs during delivery.. d) As a result of injuries to the superior parts of the brachial plexus,  paraklysis of the muscles of the soulder and sarm supplied by C5-C6  occurs. The usual clinical appearance is an upper witmb with an  adducted shoulder, medially rotated arm, and extended elbow. The  lateral aspect of the upper limb also experiences loss of sensation.  e) Chromic microtrauma to the superior trunk from carried a heavy  backback and produce moto and sendory dificits in the districution of  the muesulocutaneous and radial neres f) Injuries to inferior portion are much less common. These injuris may  odccur when the upper limb is suddenly pulled superiorly- for example when someone graps something to brack a fall or when a babys limb is pulled exessibely uring delivivery. These events injure the inferior trunk of the plexus (C8-T1) and may avulse the roots of the spinal nerves  from the spinal cord. The short mucles of the had are affected and the  claw hand results.  3) Injury to musculocutaneous n  a) Usually inflicted by a weapon and results in paralysis of the  coracobrachialis, biceps, and brachialis. So, flexion of the elbow, and  supination of the forearm are greatly weekend. Loss of sensation may  occur on the lateral surface of the forearm supplied by the lateral  cutaneous nerve of the forearm.  4) Injury to radial n  a) Superior to the origin of its branches to the tracipes brachii results in  paralysis of the tricps, brachioradialis, supinator, and extensor muscles of the wrist and fingers. Loss of sensation occurs in areas of skin  supplied by this nerve. When the radial nerve s injured in the radial  groove, the triceps is cusually only weakened because only the medial  head is affected; however, the muslces in the posterior compartment  of the brrearm are paralyzed.  b) The characteristic sign of radil nerve injury is wrist drop. Inability to  extend the wrist and fingers at the metacarpophalangeal joints. The  wrist just flexed because of unopposed tonus of the flexor muscles and  gravity.  Arterial supply and venous return of the upper limb 1. Define collateral circulation and anastomoses. a. Collateral circulation is the circulation in the arms  that is formed form collateral vessels and  anastomoses which are the joining of vessels with  different origins  2. List the origins of the arterial supply to the upper limb. 3. List the major arterial vessels of the upper limb. (p.91) a. Subclavian artery b. Axillary artery c. Brachial artery  d. Radial artery  e. Ulnar artery  4. List the major branches of the vessels in #3 and their area of  responsibilities. (p.91) Subclavian artery Vertebral a -Brain

Thyrocervical trunk a ­ Cervical viscera and scapular m

Internal thoracic a ­ anterior thoracic wall and breast Axillary a Thoracoacromial trunk a ­ pectoralis minor & pectoralis major  mm, scapular mm, and shoulder joint

Lateral thoracic artery ­ serratus anterior and lateral thoracic  wall

Subscapular artery - Lattisimus Dorsi m & lateral thoracic  wall - Posterior shoulder mm Brachial artery Profunda brachii artery ­ Arm mm ­ Posterior arm muscles (triceps  brachialis) Radial artery  ­ Lateral  forearm ­ Posterior  forearm ­ Wrist and  digit  extendors Ulnar artery ­ Medial forearm ­ Anterior forearm ­ Wrist and digit flexor mm Deep palmar Superficial palmar arteries

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arteries

Metacarpal  arteries Metacarpal arteries Digital arteries Digital arteries

5. Describe the differences between deep and superficial veins. a. Deep veins run with their accompanying arteries that have the  same name as their arteries, and form vena comitantes b. Superficial veins have their own name, are variable, and begin on dorsum of the hand. They do not run with arteries  6. What are vena comitantes? a. Deep veins on either side of an artery surrounded by a  connective sheath.  b. As arteries pulse, the pressure pushes blood back up the veins 7. List the major superficial veins of the upper limb and their destinations. (p.92) I. Cephalic Vein a. Blood from lateral forearm b. Runs in lateral forearm and medial arm c. Runs between clavicular head of deltoid and pectoralis major  II. Basilic v a. Blood from medial forearm b. Runs in medial forearm and III. Median cubital vein a. Communication between cephalic and basilica veins  IV. Brachial vein a. Blood from arm  V. Axillary vein a. Basilica vein meets with brachial vein  8. What is the clinical significance of the median cubital vein? a. The median cubital vein in on midline sitting on the cubital fossa, and is the  communication between cephalic and basilica v where doctors  usually insert IVs  Elbow and muscles of the arm  1. Describe the elbow joint in terms of its sub-articulations.  i. The elbow joint is a compound joint that has three articulations in one  joint capsule.  a. Humerus  Ulna b. Humerus  Radius c. Proximal Radius and ulna 2. What is the "true" elbow joint? (p.3) i. Articulation: elbow ii. Axes of movement: Synovial Uniaxial iii. Articulation Type: Hinge  iv. The true elbow joint is between the head of the radius and the  capitulum of the Humerus, also between the trochlear notch of the  ulna, and the trochlea of the Humerus 3. Describe the collateral ligaments of the elbow. I. Radial collateral ligament of the elbow a. Limits elbow adduction II. Ulnar collateral ligament of the elbow a. Limits elbow abduction  4. Describe the proximal and distal radioulnar joints.  i. They are synovial pivot joints that supinate and pronate the arm which is accomplished by movement of the radius around the ulna. Any  muscle attached to the radius can help supinate or pronate the  forearm.  5. What is the annular ligament?ii. The annular ligament attaches from the ulna, wraps around the  entirety of the radius, and back to the ulna. Allowing for the radius to  spin or pivot in that joint.  6. Describe supination and pronation in terms of the bones and joints  involved. iii. Supination is turning of the palm anteriorly to be in anatomical  position iv. Pronation is turning of the palm posteriorly, opposite of anatomical  position.  v. These movements occur around the proximal and distal radioulnar  joints, when the radius rotates around the ulna. The radius is kept in  place by the annular ligament 7. Describe the two compartments of the forearm muscles and their general  functions/nerve  supply. (p.93) Superficial flexors Pronator Teres m P: Medial  Epicondyle,  Humerus D: Lateral Radius Median n Pronation; flexion of elbow Flexor Carpi  Radialis m P: Medial  Epicondyle,  Humerus D: Anterior 2nd and 3rd metacarpals Median n Flexes and  Abducts the wrist Palmaris Longus  m P: Medial  Epicondyle, Median n Flexes wrist;  tenses palmar

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Humerus D: Palmar  Aponeurosis

aponeurosis Flexor Carpi  Ulnaris m P: Medial  Epicondyle,  Humerus D: Pisiform bone Ulnar n Flexes and  adducts the wrist

Deep Flexors Flexor Digitorum  Superficialis m P: Medial  Epicondyle,  Humerus;  Proximal  Humerus D: Middle  Phalanx of Digits  2-5 Median n Flexes proximal  interphalangeal  joints and  metacarpophalan geal joints of  digits 2-5 Flexor Pollicis  Longus m P: Anterior  Radius D: Distal Phalanx of digit 1 Median n Flexes  interphalangeal,  metacarpophalan geal, and  carpometacarpal  joints of the  thumb Flexor Digitorum  Profundus m P: Proximal Ulna D: Distal Phalanx of digits 2-5 ½ median ½ ulnar nn Flexes all  interphalangeal,  and  metacarpophalan geal joints of

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digits 2-5 Pronator  Quadratus m P: Distal Ulna D: Distal Anterior Radius Median n Pronates forearm

8. List the muscles in #7 in terms of their attachments, actions and nerve  supply. (p.93)  Articulations of the wrist and hand  1. Describe the distal radioulnar articulation. 2. Describe the wrist articulation and the bones involved. (p.3) I. Radiocarpal joint a. Between the radius and scaphoid and lunate bones b. A synovial joint (Biaxial) c. The movements include: flexion & extension, Abduct (radial  flexion) & Adduct (ulnar flexion) II. The scaphoid bone has the best articulation with the radius and  transfers most of the energy from the manus to the radius, so it is the  most commonly broken carpel bone. Proximal portion does not have a  good blood supply, so if this is separated from the blood supply it can  decay and die off.  III. Radial fractures normally dislocate the radius to a posterior position for the distal radius called the colles fracture, aslo known as the dinner  fork difformity.  3. Describe the intercarpal joints. (p.3 = midcarpal)I. Between 2 rows of carpel bones II. Compound joint – all share the same  joint cavity, disadvantageous because  infection can spread easily throughout  III. Synovial (gliding) joint – increased the  range of movement of the wrist joint  IV. Held together by the 2 layers of flexor  retinaculum made of deep fascia  a. Proximal flexor retinaculum  (Palmar Carpel Ligament) i. Holds down all the flexor tendons from the forearm to help  anchor them and provide a pulley system  b. Deep flexor retinaculum (Transverse Carpel Ligament) i. Runs from lateral to medial carpel bones  ii. Helps form a fibrosseous tunnel (tunnel made of CT and  bone)  iii. Holds the digital flexor tendons, and the median n.  iv. Inflammation of tendons within this fibrosseous tunnel,  there is not a lot of give in the tunnel, so they push against the median nerve causing Carpel Tunnel Syndrome.   1. To fix this syndrome, you must cut the Transverse  Carpel Ligament, and the scar will provide more  room for those ligaments. 4. Describe the carpometacarpal joints. (p.3) I. Between the distal row of carpel bones and the  metacarpals  II. Metacarpals 2-5 a. Synovial joints (gliding joint) b. Share a joint cavity with the intercarpal joints c. Metacarpals 4-5 have increased movement for  increased grip strength  III. Metacarpal 1  Trapezium bone a. Synovial joint (multiaxial joint) = saddle joint  b. Flexion & extension, abduction & adduction,  Rotation, opposition  5. Describe the metacarpophalangeal joints. (p.3) I. Kuckles  II. Between metacarpals and the phalanges  III. Digits 2-5 a. Synovial joints (biaxial) – Flexion & extension, Abduction &  adduction b. To flex the MP joint, the collateral ligaments get very tight  decreasing the amount of abduction and adduction for increased  grip strength  IV. Digit 1a. Synovial (uniaxial)  i. Flex and extend  ii. NO adduction or Abduction at this joint.  6. Describe the interphalangeal joints. (p.3) I. Between phalangeal bones II. Digits 2-5 a. 3 phalangeal bones (proximal, middle, distal) b. 2 IP joints (proximal and distal) c. Proximal interphalangeal joint is between the proximal and middle phalanx d. Distal interphalangeal joint is between middle and distal phalanx  7. Describe the articulation between the trapezium and the 1st metacarpal.  (p.3)  I. Metacarpal 1  Trapezium bone a. Synovial joint (multiaxial joint) = saddle joint  b. Flexion & extension, abduction & adduction,  Rotation, opposition  8. Describe the movements of the thumb. (p.99)  II. Circumduction is also possible and medial rotation  occurs during the complex movement of opposition.  Because the metacarpal of the thumb is set at a right  angle to those of the other digits, all movements of the  thumb take place at right angles to the corresponding movements of the fingers.  III. Movements of the thumb are very important. You are  unable to do much with your hand without them. 50% of hand actions are performed by the thumb.   Flexor Pollicis  longus m P: Anterior  radius D: distal  phalanx digit 1 Median n. Flexes IP, MP,  CM joints of the thumb Abductor  Pollicis Longus P: Posterior  Radius/ ulna D: 1st metacarpal Radial n. Abducts and  extends digit 1  at  Carpometacarp al joint Extensor  pollicis brevis  m P: Posterior  Radius D: proximal  phalanx of  digit 1 Radial n Extends digit 1  at metacarpal  and  carpometacarp al joint Extensor  Pollicis Longus  m P: Posterior  Ulna D: Distal  phalanx of  digit 1 Radial n. Extends digit 1  at  interphalangeal ,  metacarpophal angeal, and  carpometacarp al joint.

Hand intrinsic working on the thumb Abductor  Pollicis Brevis  m P: Flexor  Retinaculum;  Scaphoid &  Trapezium D: Proximal  phalanx of  digit 1 Median n Abducts thumb Flexor Pollicis  Brevis m P: Flexor  Retinaculum;  trapezium D: Proximal  phalanx of  digit 1 Median n Flexes thumb Adductor  Pollicis P: Metacarpal  of digits 2 & 3;  Capitate D: Proximal  phlanx of digit  1 Ulnar n Adducts  thumb; aids in  opposition Opponens  Pollicis m P: Flexor  Retinaculum;  Trapezium  D: Metacarpal  of digit 1 Median n Opposes  thumb

Forearm  1. Describe the flexor and extensor retinacula found in the forearm. a. The antebrachial fascia thickens posteriorly over the distal ends  of the radius and ulna to form a transverse band, the extensor retinaculum, which hold the extensor tendons in place b. Immediately distal, but at a deeper level to the latter, the  antebrachial fascia is continued as the flexor retinaculum. This  fibrous band extends between the anterior prominence of the  outer carpal bones and converts the anterior concavity of the  carpus into the carpal tunnel though with the flexor tendons and median nerve pass.  2. Describe the attachments, actions and nerve supply of the muscles in  the forearm that act on the forearm. (p.94, 95, 96) The muscles that act of the forearm cross the radioulnar joint, and act in supination and pronation.   Brachioradi alis m P: lateral supercondylar ride, Humerus D: styloid process,  radius Radial n Beer drinkers m  Supinate to mid prone position, then flexes  the elbow at that mid  prone position Supinator  m P: lateral epicondyle,  Humerus D: proximal radius Radial n Supination of forearm Pronator  Teres m P: medial epicondyle,  Humerus D: proximal radius Media n n Pronate the forearm Flex the elbow Pronator  Quadratus  m P: distal radius D: distal ulna Media n n Pronation of the  forearm

3. Describe the attachments, actions and nerve supply of the muscles in  the forearm that act on the wrist. (p.94, 96, 97) Flexor carpi  radialis m P: Medial  epicondyle,  Humerus D: 2nd & 3rd metacarpal  bones Median n Flex the wrist Abduct (radial  flex) the wrist Flexor carpi  ulnaris m P: medial  epicondyle,  Humerus D: pisiform and  hook of the  hamate and the  5th metacarpal Ulnar n Flex the wrist Adduction of the  wrist Palmaris longus  m P: medial  epicondyle,  Humerus D: palmar  aponeurosis Median n Flex the wrist Tightens palmar  aponeurosis and  increases the  palm grip Extensor carpi  radialis longus m P: lateral  epicondyle,  Humerus D: 2nd metacarpal Radial n Extends the  wrist, adducts  the wrist Extensor carpi  radialis brevis m P: lateral  epicondyle,  Humerus D: 3rd metacarpal Radial n Extends and  abducts the wrist Extensor carpi  ulnaris m P: lateral  epicondyle, Radial n Extends and  adducts the wrist

Humerus D: 5th metacarpal

4. Describe the attachments, actions and nerve supply of the muscles in  the forearm that act on the digits. (p.95, 96, 97) Flexor Digitorum  Superficialis m P: medial  epicondyle,  Humerus D: middle  phalanx of digits  2-5 Median n Flex the MP &  proximal IP joints of digits 2-5 Flexor Digitorum  Profundus m Medial  epicondyle,  Humerus D; middle  phalanx of digits  2-5 ½ median n  ½ ulnar n Flexes the wrist,  MP, proximal and distal IP joints of  digits 2-5 Extensor  Digitorum m P: lateral  epicondyle,  Humerus D: middle and  distal phalanx of  digits 2-5 Radial n Extends wrist,  MP, proximal and distal IP joints Extensor digiti  minimi m P: lateral  epicondyle,  Humerus D: extensor  digitorm on 5th Radial n Extends MP of  the 5th digit, and  extends the  proximal and  distal IP joints

digit

5. Describe the attachments, actions and nerve supply of the muscles in  the forearm that act on the thumb. (p.95, 98) Flexor Pollicis  longus m P: radius D: distal phalanx  of digit 1 Median n Flexes the wrist  and CM joint Abductor pollicis  longus m P: between  radius and ulna D: 1st metacarpal joint Radial n Abduct the 1st digit at the CM  joint Extends the CM  joint Extensor pollicis  brevis m P: radius D: proximal  phalanx of digit 1 Radial n Extends CM and  MP joint of digit 1 Extensor policis  longus P: ulna D: distal phalanx  of digit 1 Radial n Extends CM, MP,  and IP joints of  digit 1

6. Describe the extensor expansion. 7. Describe "synergistic action" of the muscles in #3 in terms of "pure" wrist  movement.  Flexor carpi radialis m ( flex wrist & abducts wrist) and Flexor Carpi ulnaris m  ( flex wrist and adducts wrist). When they work together they create pure  wrist flexion because the abduction and adduction gets cancelled out8. What is meant by "ulnar deviation" and "radial deviation".  Ulnar deviation = adduction Radial deviation = abduction  Hand  1. Describe the attachments, actions and nerve supply of the thenar muscles of the hand.  (p.100)   Adductor pollicis  m P: between MC 2  &3 D: proximal  phalanx of digit 1 Ulnar n Adducts digit 1 Opponens  pollicis m P: deep flexor  retinaculum D: 1st metacarpal Median n Opposition Flexor pollicis  brevis m P: deep flexor  retinaculum D: proximal  phalanx of digit 1 Median n Flexion of digit 1 Abductor pollicis  brevis m P: deep flexor  retinaculum D: proximal  phalanx of digit 1 Median n Abduct the  pollicis

2. Describe the attachments, actions and nerve supply of the hypothenar  muscles of the hand. (p.100) Opponens digiti  minimi m P: deep flexor  retinaculum &  hamate D: 5th metacarpal Ulnar n Opposition of 5th digit Abductor digiti  minimi m P: deep flexor  retinaculum &  pisiform D: proximal  phalanx of digit 5 Unlar n Abduct the 5th digit Flexor digiti  minimi m P: deep flexor  retinaculum D: proximal  phalanx of digit 5 Ulnar n Flex digit 5

3. Describe the attachments, actions and nerve supply of the interossei and  lumbricales.  (p.101,102) Dorsal interossei P:each two  adjacent  metacarpal  bones 2-5 D: extensor  expansion  sheath and  proximal phalanx of digits 2,3,4 Ulnar n Abducts digits  Flex MP  Extends IP Palmar interossei m P: metacarpals  2,4,5 D: extensor  expansion  sheath and  proximal phalanx of digits 2,4,5 Ulnar n Adducts digits Flex MP Extends IP

4. What is the "real" function of the interossei and lumbricals?  “Starred” shit 1) Is the clavicle a part of the appendicular, or axial skeleton? a) Appendicular skeleton  2) What gives blood supply to pectoralis major m? a) Thoracoacromial trunk a  3) Is the Ventral root sensory, motor, or both? a) Motor only

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