4. Wrist (radiocarpal and midcarpal joints) *radiocarpal joints (radius ...
4. Wrist (radiocarpal and midcarpal joints) *radiocarpal joints (radius and scaphoid, lunate) (synovial condyloid…flex/ext and aDd/aBd) *greater flex than MidC **midcarpal joints (synovial complex plane…gliding) *greater extend than RC ***intercarpal joints (synovial plane…minimal movement) Ligaments: *extensor and flexor retinacula (transverse carpal ligs…analogous to eyelets of fishing pole…prevent bow-stringing) **radial and ulnar collateral ligs (prevent excessive ulnar and radial deviation, respectively) a. extensors: ECRL, ECRB, ECU *ED, EDMi, EI, EPL, EPB…by virtue of the fact that they cross the wrist joint these muscles play a minor role in wrist extension…not on EXAM nerves: radial (C6,7), deep branch radial (C7, 8), PIN (C7, 8) *PIN (C7,8) b. flexors: FCR, FCU, Palmaris Longus, *FDS, FDP, FPL…by virtue of the fact that they cross the wrist joint these muscles play a minor role in wrist flexion…not on EXAM nerves: median (C6,7), ulnar (C7,8) , median (C7,8) *median, ½ median—AIN—(C8, T1)( (digits 2,3) ½ ulnar (C8, T1) (digits 4,5), AIN (C8, T1) **both ECRL and ECRB are active during fist clenching (flexion) c. aBductors (radial deviatrion): ECRL, ECRB, FCR nerves: radial (C6,7), deep branch radial (C7, 8), median (C6,7) d. aDductors (ulnar deviation): ECU, FCU nerve: PIN (C7, 8), ulnar (C7,8) 5. CMc joints *thumb: saddle synovial joint (triaxial movment…aBd/aDd, flex/ext, opposition) **digits2-5: plane synovial…gliding) *EPB, aBdPL**, OP** (extrinsic, ext, intrinsic) **actual Mc attachment nerves: PIN (C7,8), PIN, recurrent branch of median (C8, T1)
6. MP joints *thumb: hinge synovial (flex/ext) **digits 2-5: condyloid synovial (flex/ext, aBd/aDd, opposition) a. flexion: FDS, FDMb(intrinsic hand), dorsal (1-4) and palmar (1-3) interossei, Lumbricals (intrinsic hand)(1,2 unipennate)(3,4 bipennate), nerves: median (C7,8, T1), ulnar (C8, T1), ½ median (C8,T1) and ½ ulnar (C8, T1) b. extension: ED, EI, EDM, EPB, nerves: PIN (C7, 8) *juncturae tendinum couples the actions of ED digits 2-5 **ED, EI, EDM attach to extensor expansion which enables extension at both PIP and DIP c. aBduction: dorsal interossei (1-4, bipennate) nerve: ulnar (C8, T1) *middle finger—axial line—(digit 3) aBducts in both medial and lateral directions **digiti minimi is not aBd d. aDduction: palmar interossei (1-3, unipennate…1:medial surface index and 2,3:lateral surface ring and minimi) nerves: ulnar (C8, T1) *middle finger—axial line—(digit 3) does not aDduct, therefore no palmar interossei attachment 7. PIP joints *hinge synovial (flex/ext) **thumb has only IP *** extension occurs via attachment to extensor hood (mechanism, expansion) which causes extension at both IP joints a. flexion: FDS, FDP(minor), FPL nerves: median (C7,8, T1), ½ AIN—median (C8,T1) and ½ ulnar (C8, T1), AIN (C8, T1) b. extension: ***ED, ***EI, ***EDM, EPL, dorsal (1-4) and palmar (1-3) interossei, ***Lumbricals (intrinsic hand)(1,2 unipennate)(3,4 bipennate) nerves: PIN (C7, 8), ulnar (C8, T1), ½ median (C8,T1) and ½ ulnar (C8, T1)
8. DIP joints *hinge synovial (flex/ext) a. flexion: FDP nerve: ½ AIN—median (C8,T1) and ½ ulnar (C8, T1) b. extension: ***occurs via attachment to extensor expansion*** ED, EDMi, EI EPL nerves: PIN (C7, 8) #####Thumb (pollux, digit 1): 1. MC: saddle synovial (flex/ext, aBd/aDd, opposition) a. flexion: FPB (recurrent median C8, T1) b. extension: EPB (PIN (C7, 8)) c. aBduction: AbPL—extrinsic—(PIN (C7, 8)), AbPB—intrinsic—(recurrent median (C8, T1)) EPL, *EPB (PIN (C7, 8))—extrinsics d. aDduction: AdP (ulnar (C8, T1))—intrinsic hand f. opposition: OP ((recurrent median (C8, T1)—intrinsic hand, AbPB (assists) ((recurrent median (C8, T1)—intrinsic hand 2. IP: hinge synovial (flex/ext) a. flexion: FPB—intrinsic—((recurrent median (C8, T1), FPL—extrinsic—(AIN of median (C8, T1) b. extension: EPL—extrinsic—(PIN (C7, 8))
%%%%Digiti minimi (digit 5): 1. CM: plane synovial (gliding) 2. MP: condyloid synovial (flex/ext, aBd/aDd, opposition) a. flexion: FDMb—intrinsic—(ulnar (C8, T1)), lumbrical 4—intrinsic—(ulnar (C8, T1)) palmar (3) and dorsal (4) in b. extension: EDMi—extrinsic—(PIN (C7, 8)) and ED digit 5 tendon—extrinsic—(PIN (C7, 8)) c. aBd: ADMi—intrinsic—(ulnar (C8, T1)) d. aDd: palmar interossei(3)—intrinsic—(ulnar (C8, T1)) e. opposition: ODMi—intrinsic—(ulnar (C8, T1)) !@#$% palmaris brevis (ulnar (C8, T1)) tightens and corrugates skin over palm to improve grip
Nerves and associated forearm and extrinsic hand muscles 1. Radial nerve: Brachioradialis (weak flexor) ECRL (extends/abd wrist; clench fist) Anconeus (extends forearm) 2. Deep branch of radial nerve: ECRB (extends/abd wrist; clench fist) Supinator (supinates forearm/rotates radius) 3. Posterior interosseous nerve (PIN)(from deep branch of radial n.): ECU (extends/add wrist) ED (extends MP joints/assists ext of IP joints) EI (extends 2nd dig independently/assist hand ext at wrist) EDM (extends 5th dig at MP/assists ext of IP joint) EPL (extends thumb at IP/abd and ext thumb/ ext MP and CM) EPB (extends thumb at MP and CM joints/abd and ext thumb) APL (ab thumb at CM joint) 4. Median nerve: Pronator Teres (pronates and flexes forearm) Palmaris Longus (PL) (flexes wrist/tightens palmar aponeurosis) FCR (flexes wrist/ab wrist) FDS (flexes pIP/assist flex of MP) 5. Ulnar nerve: FCU (flexes/ad wrist) FDP ***medial part***(flexes dIP joints) 6. Anterior interosseous nerve (AIN)(from median n.) Pronator quadratus (pronated forearm/deep fibers bind radius and ulna) FDP ***lateral part*** (flexes dIP joints) FPL (flexes thumb at IP joint)
Nerves and associated intrinsic hand muscles 1. Ulnar nerve: Palmar interossei (1-3) (aDd digits 2,4,5 to axial line—dig 3; flex MP and extend IP…tata!) Dorsal interossei (1-4) (aBd digits 2-5…digit 3 in both med and lat directions…flex MP and extend IP…tata!) Lumbricals (3,4 lateral surfaces of dig 4,5) (flex MP and extend IP…tata!) Hypothenars: AbDM, FDM, ODM (aBducts, flexes MP, opposes DM to Thumb) ADductor pollicis (medial part of phalanx…aDd thumb) FDM (prox phalanx) (flex DM at MP) ODM (mcarpal) (opposes DM to thumb) 2. Median (recurrent branch) nerve: (LOAbF) Lumbricals (1,2 lateral surfaces of dig 2,3) (flex MP and extend IP…tata!) Opponens pollicis (lateral mcarpal of 1) (opposes and medially rotates thumb) ABductor pollicis brevis (lateral prox phalanx) (aBd and assists opposition) Flexor pollicis brevis (lateral prox phalanx) (flex thumb)
Hand Compartments: 1. hypothenar: AbDM, FDM, ODM (ulnar n.) 2. thenar: AbPB, FPB, OP (recurrent median n.) 3. central lumbricals—1,2 and 3,4—median n. and ulnar n. (anterior or palmar surface FDP tendons…lateral surfaces), palmar interossei—3 and dorsal interossei—4 (not to digit 5)(ulnar n.) 4. aDductor: AdP transverse (mc 3) and oblique (carpal) (ulnar n.)
Upper extremity circulation: R: brachiocephalic a.
L: arch of aorta / \ /
\ Subclavian a. / Thyrocervical trunk: trans cerv a., suprascapular a. \ Dorsal scapular a. / Rib 1 Axillary a (1) / Superior thoracic a. \ Medial(superior) pec. minor Axillary a. (2) / Thoracoacromial trunk: ACPD: acromial, clavicular, pectoral, deltoid branches \ Lateral thoracic a. / Lateral (inferior) pec minor Axillary a. (3) \ Supscapular a. (branches: circumflex scapular a. and thoracodorsal) a. / Anterior circumflex humeral a. \ Posterior circumflex humeral a. / Inferior teres major m. Brachial a. \ / /\ / \ / \
/
\
/ \ Deep brachial a. Brachial a. / \ \ / / \ Radial collateral a. mid collateral a. /\ / / / superior ulnar collateral a. / / Brach a. \ / / / \ / / / \ \ \ /\ \ / / / \ \ Radial recurrent a recurrent Brach a inf ulnar coll a \ / Interosseous a / \ \ \ \ \(CF) \ \ \ \ /\ \ \ Radial a. radial ulnar ant ulnar rec pst ulnar rec \ { \ / / / } \ / / \ { \ / / / } } --------------/ \ { Ulnar a / } / \ \ { / \ / } / \ \ / common inteross a \ / / / \ \ Radial posterior inteross ant inteross ulnar *dp palm arch from radial and suprfl palm arch from ulnar Radial Ulnar / \ \ / \ / \____________ Radial a suprfl palm brnch rad dp palm brnch ulnar to suprfl arch / \ \ \ \ \ \ \ dp palm arch* suprfl palm arch# dp palm arch* supfl palm arch# / / \ / Princip pollicis common palmar dig a. and palmar metacarpal \ / / \ Proper palmar dig a. / Proper dig a to thumb from princip poll
6. MP joints *thumb: hinge synovial (flex/ext) **digits 2-5: condyloid synovial (flex/ext, aBd/aDd, opposition) a. flexion: FDS, FDMb(intrinsic hand), dorsal (1-4) and palmar (1-3) interossei, Lumbricals (intrinsic hand)(1,2 unipennate)(3,4 bipennate), nerves: median (C7,8, T1), ulnar (C8, T1), ½ median (C8,T1) and ½ ulnar (C8, T1) b. extension: ED, EI, EDM, EPB, nerves: PIN (C7, 8) *juncturae tendinum couples the actions of ED digits 2-5 **ED, EI, EDM attach to extensor expansion which enables extension at both PIP and DIP c. aBduction: dorsal interossei (1-4, bipennate) nerve: ulnar (C8, T1) *middle finger—axial line—(digit 3) aBducts in both medial and lateral directions **digiti minimi is not aBd d. aDduction: palmar interossei (1-3, unipennate…1:medial surface index and 2,3:lateral surface ring and minimi) nerves: ulnar (C8, T1) *middle finger—axial line—(digit 3) does not aDduct, therefore no palmar interossei attachment 7. PIP joints *hinge synovial (flex/ext) **thumb has only IP *** extension occurs via attachment to extensor hood (mechanism, expansion) which causes extension at both IP joints a. flexion: FDS, FDP(minor), FPL nerves: median (C7,8, T1), ½ AIN—median (C8,T1) and ½ ulnar (C8, T1), AIN (C8, T1) b. extension: ***ED, ***EI, ***EDM, EPL, dorsal (1-4) and palmar (1-3) interossei, ***Lumbricals (intrinsic hand)(1,2 unipennate)(3,4 bipennate) nerves: PIN (C7, 8), ulnar (C8, T1), ½ median (C8,T1) and ½ ulnar (C8, T1)
8. DIP joints *hinge synovial (flex/ext) a. flexion: FDP nerve: ½ AIN—median (C8,T1) and ½ ulnar (C8, T1) b. extension: ***occurs via attachment to extensor expansion*** ED, EDMi, EI EPL nerves: PIN (C7, 8) #####Thumb (pollux, digit 1): 1. MC: saddle synovial (flex/ext, aBd/aDd, opposition) a. flexion: FPB (recurrent median C8, T1) b. extension: EPB (PIN (C7, 8)) c. aBduction: AbPL—extrinsic—(PIN (C7, 8)), AbPB—intrinsic—(recurrent median (C8, T1)) EPL, *EPB (PIN (C7, 8))—extrinsics d. aDduction: AdP (ulnar (C8, T1))—intrinsic hand f. opposition: OP ((recurrent median (C8, T1)—intrinsic hand, AbPB (assists) ((recurrent median (C8, T1)—intrinsic hand 2. IP: hinge synovial (flex/ext) a. flexion: FPB—intrinsic—((recurrent median (C8, T1), FPL—extrinsic—(AIN of median (C8, T1) b. extension: EPL—extrinsic—(PIN (C7, 8))
%%%%Digiti minimi (digit 5): 1. CM: plane synovial (gliding) 2. MP: condyloid synovial (flex/ext, aBd/aDd, opposition) a. flexion: FDMb—intrinsic—(ulnar (C8, T1)), lumbrical 4—intrinsic—(ulnar (C8, T1)) palmar (3) and dorsal (4) in b. extension: EDMi—extrinsic—(PIN (C7, 8)) and ED digit 5 tendon—extrinsic—(PIN (C7, 8)) c. aBd: ADMi—intrinsic—(ulnar (C8, T1)) d. aDd: palmar interossei(3)—intrinsic—(ulnar (C8, T1)) e. opposition: ODMi—intrinsic—(ulnar (C8, T1)) !@#$% palmaris brevis (ulnar (C8, T1)) tightens and corrugates skin over palm to improve grip
Nerves and associated forearm and extrinsic hand muscles 1. Radial nerve: Brachioradialis (weak flexor) ECRL (extends/abd wrist; clench fist) Anconeus (extends forearm) 2. Deep branch of radial nerve: ECRB (extends/abd wrist; clench fist) Supinator (supinates forearm/rotates radius) 3. Posterior interosseous nerve (PIN)(from deep branch of radial n.): ECU (extends/add wrist) ED (extends MP joints/assists ext of IP joints) EI (extends 2nd dig independently/assist hand ext at wrist) EDM (extends 5th dig at MP/assists ext of IP joint) EPL (extends thumb at IP/abd and ext thumb/ ext MP and CM) EPB (extends thumb at MP and CM joints/abd and ext thumb) APL (ab thumb at CM joint) 4. Median nerve: Pronator Teres (pronates and flexes forearm) Palmaris Longus (PL) (flexes wrist/tightens palmar aponeurosis) FCR (flexes wrist/ab wrist) FDS (flexes pIP/assist flex of MP) 5. Ulnar nerve: FCU (flexes/ad wrist) FDP ***medial part***(flexes dIP joints) 6. Anterior interosseous nerve (AIN)(from median n.) Pronator quadratus (pronated forearm/deep fibers bind radius and ulna) FDP ***lateral part*** (flexes dIP joints) FPL (flexes thumb at IP joint)
Nerves and associated intrinsic hand muscles 1. Ulnar nerve: Palmar interossei (1-3) (aDd digits 2,4,5 to axial line—dig 3; flex MP and extend IP…tata!) Dorsal interossei (1-4) (aBd digits 2-5…digit 3 in both med and lat directions…flex MP and extend IP…tata!) Lumbricals (3,4 lateral surfaces of dig 4,5) (flex MP and extend IP…tata!) Hypothenars: AbDM, FDM, ODM (aBducts, flexes MP, opposes DM to Thumb) ADductor pollicis (medial part of phalanx…aDd thumb) FDM (prox phalanx) (flex DM at MP) ODM (mcarpal) (opposes DM to thumb) 2. Median (recurrent branch) nerve: (LOAbF) Lumbricals (1,2 lateral surfaces of dig 2,3) (flex MP and extend IP…tata!) Opponens pollicis (lateral mcarpal of 1) (opposes and medially rotates thumb) ABductor pollicis brevis (lateral prox phalanx) (aBd and assists opposition) Flexor pollicis brevis (lateral prox phalanx) (flex thumb)
Hand Compartments: 1. hypothenar: AbDM, FDM, ODM (ulnar n.) 2. thenar: AbPB, FPB, OP (recurrent median n.) 3. central lumbricals—1,2 and 3,4—median n. and ulnar n. (anterior or palmar surface FDP tendons…lateral surfaces), palmar interossei—3 and dorsal interossei—4 (not to digit 5)(ulnar n.) 4. aDductor: AdP transverse (mc 3) and oblique (carpal) (ulnar n.)
Upper extremity circulation: R: brachiocephalic a.
L: arch of aorta / \ /
\ Subclavian a. / Thyrocervical trunk: trans cerv a., suprascapular a. \ Dorsal scapular a. / Rib 1 Axillary a (1) / Superior thoracic a. \ Medial(superior) pec. minor Axillary a. (2) / Thoracoacromial trunk: ACPD: acromial, clavicular, pectoral, deltoid branches \ Lateral thoracic a. / Lateral (inferior) pec minor Axillary a. (3) \ Supscapular a. (branches: circumflex scapular a. and thoracodorsal) a. / Anterior circumflex humeral a. \ Posterior circumflex humeral a. / Inferior teres major m. Brachial a. \ / /\ / \ / \
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/ \ Deep brachial a. Brachial a. / \ \ / / \ Radial collateral a. mid collateral a. /\ / / / superior ulnar collateral a. / / Brach a. \ / / / \ / / / \ \ \ /\ \ / / / \ \ Radial recurrent a recurrent Brach a inf ulnar coll a \ / Interosseous a / \ \ \ \ \(CF) \ \ \ \ /\ \ \ Radial a. radial ulnar ant ulnar rec pst ulnar rec \ { \ / / / } \ / / \ { \ / / / } } --------------/ \ { Ulnar a / } / \ \ { / \ / } / \ \ / common inteross a \ / / / \ \ Radial posterior inteross ant inteross ulnar *dp palm arch from radial and suprfl palm arch from ulnar Radial Ulnar / \ \ / \ / \____________ Radial a suprfl palm brnch rad dp palm brnch ulnar to suprfl arch / \ \ \ \ \ \ \ dp palm arch* suprfl palm arch# dp palm arch* supfl palm arch# / / \ / Princip pollicis common palmar dig a. and palmar metacarpal \ / / \ Proper palmar dig a. / Proper dig a to thumb from princip poll
