CHT Anatomy
MUSCLES INVOLVED IN HUMERAL FLEXION
1. Anterior Deltoid 2. Clavicular head of Pec.Major 3.Coracobrachialis 4.Short Head of Biceps
DESCRIBE THE STRUCTURES OF A SYNOVIAL JOINT
1. Articular cartilage ; Covers ends of bones 2. Joint cavity: space containing synovial fluid 3. Joint Capsule: Encloses ends of articulating bones - a. Outer fibrous layer - b. Inner layer of synovium: Produces synovial fluid 4. Synovial Fluid: joint lubricant - a. White glabrous fluid - b. Composed of hyaluronic acid & glycoprotein - c. Nutritional source for cartilage
WHICH COMBINATION OF PASSIVE STRUCTURES IS CRITICAL FOR MAINTAINING GLENOHUMERAL STABILITY DURING MOVEMENT OF THE SHOULDER?
1. Labrum 2. superior and inferior glenohumeral ligaments 3. joint capsule
MUSCLES INVOLVED IN HUMERAL EXTENSION
1. Sternal Head of Pec. Major 2. Lats. 3. Teres Minor 4. Posterior Deltoid Assist: 5. Infraspinatus 6. Long Head of the Triceps 7. Teres major
DESCRIBE THE ARTERY LAYOUT IN UPPER LIMB (PROXIMAL TO DISTAL)
1. Subclavian artery 2. Axillary 3. Brachial artery 4.Radial artery 5. Ulnar artery 6. Collateral and Recurrent artery 7. ant/post Interosseous artery 8. Superficial (Radial a) & Deep arch (Ulnar a) 9. Digital arteries
DESCRIBE THE VEIN LAYOUT IN UPPER LIMB (PROXIMAL TO DISTAL)
1. Subclavian vein 2. Cephalic vein 3. Basilic vein 4. Medial Cubital vein 5. Medial Antebrachial vein 6. Dorsal Venus Arc/Network vein 1. Subclavian vein 2. Cephalic vein/Axillary/Subscapular vv. 3. Basilic vein /Brachial (Deep v.) 4. Medial Cubital vein --connects w/ Cephalic & Basiclic 5. Medial Antebrachial vein 6. Dorsal Venus Arc/Network vein conects w/ cephalic and Basilic 7. Ulanr/Radial vv. from Brachial V.
LIST GUYON'S CANAL CONTENTS
1. Ulnar Nerve 2. Ulnar Artery Borders: Hook of the hamate and pisiform
MUSCLES INVOLVED IN HUMERAL ADDUCTION
1.Lats. 2.Teres Major 3. Coracobrachialis 4.Sternal head of Pec. Major 5. subscsapularis 6. Tricep long head
carpal tunnel contents
10 Structures: Median Nerve FDS (4 tendons) FDP (4 tendons) FPL
PALMARIS LONGUS IS ABSENT IN WHAT PERCENT OF THE POPULATION?
13 - 20%
AT WHAT RATE DO FINGERNAILS GROW?
2 to 3 mm/month
ACRONYM TO REMEMBER THE # OF TENDONS IN EACH OF THE DORSAL WRIST COMPARTMENTS
22,12,11 2 - EPB/APL 2- ECRL/ECRB 1- EPL 2 - EDC/EIP 1 - EDM 1- ECCU
HOW MUCH STRENGTH DO THE INTRINSIC MUSCLES CONTRIBUTE TO POWER GRASP?
50%
LIGAMENTS ABOUT THE ELBOW PROVIDE ROUGHLY WHAT PERCENT OF JOINT STABILITY?
50%
HOW LONG TO BLOOD VESSLES REQUIRE PROTECTION AFTER SURGICAL REPAIR?
7 to 14 days Most blood vessels require 1 to 2 weeks of protection.
MUSCLES INVOLVED IN SCAPULAR DOWNWARD ROTATION
Levator Scapula & Rhomboid Major & Minor Assist: Pec Major/Minor, Lats.
NAME THE WHITE AREA AT THE BASE OF THE FINGERNAIL
Lunula
MATCH THE PULLEY WITH THE JOINT: MP, PIP, DIP
MP - A1 PIP - A3 DIP - A5
WHAT IS THE MAIN STABILIZER TO VALGUS STRAIN OF THE ELBOW
Medial collateral ligament (ulnar collateral ligament)
LIST THE MUSCLES INNERVATED BY THE MEDIAN NERVE PROXIMAL TO DISTAL IN THE UPPER EXTREMITY
Median N. ( C5-T1) - Main Branch - AIN - Recurrent Br. - Superficial Br. MB 1. Pronator Teres; C7,C8 2. FCR; C6,C7 3. PL; C7,C8 4. FDS; C8,T1 AIN 5. FPL; C7,C8 6. FDP II & III; C8,T1 7. Pronator quadratus; C7,C8 RECURRENT BRANCH 8. APB; C8,T1 9. OP; C8,T1 10. FPB (superficial head); C8,T1 SUPERFICIAL BRANCH 11. Lumbricals I & II; C8,T1
THE FINGERNAILS OF DIGITS TWO AND THREE RECEIVE THEIR SENSATION FROM WHICH NERVE?
Median Nerve
WHEN PERFORMING ALLEN'S TEST, WHAT IS CONSIDERED AN ABNORMAL AMOUNT OF TIME FOR CAPILLARY REFILL?
More then 7 seconds. A positive Allen test means that the patient does not have an adequate dual blood supply to the hand, which would be a negative indication for catheterization, removal of the radial artery, or any procedure which may result in occlusion of the vessel.
PECTORALIS MAJOR
Origin: Clavicular Head: medial 1/2 clavicle Sternalcosstal H.: superior 1/2 (6 ribs) of sternum & aponeurosis of the external abdominal oblique. Insertion: Intertubercular/bicipital groove of humerus. Action: adduction, IR of humerus, horizontal adduction of the shoulder Innervation: Clavicular: medial and lateral pectoral nn. (C5, C6) Sternalcostal Head: Medial Pec n. (C8,T1)
FLEXOR CARPI ULNARIS (FCU)
Origin: Humeral Head: medial epicondyle, Ulna Head: Medial Olecranon Pr., posterior ulna Insertion: pisiform, hook of hamate, Action: flexes and adducts/UD the hand at the wrist. Innervation: ulnar nerve Nerve Root: C7,C8,
FLEXOR POLLICIS LONGUS (FPL)
Origin: Mid ant. radius and IM Insertion: base of P2 of thumb Action: flexes the P2 of thumb and assists with flexion of MP of thumb. Innervation: AIN-median nerve Nerve Root: C8, T1
Palmar Interossei
Origin: Palmar surface of the MC bones of digits 2,4, and 5 Insertion: Extensor expansion of the digits and base of the proximal phalanges of digits 2,4, and 5 Action: Adduction of the digits. Innervation: Deep branch of the ulnar nerve Nerve Root: C8 and T1
Dorsal Interossei
Origin: arise from two heads from adjacent sides of the MC bones Insertion: base of the proximal phalanx and into the aponeurosis Action: abducts the digits Innervation: deep palmar branch of the ulnar nerve Nerve Root: C8 and T1
COROCOBRACHIALIS
Origin: coracoid process of scapula Insertion: mid humerus (medial aspect) Action: flexes and humeral ADduction Innervation: musculocutaneous Nerve Root: C6, C7
PRONATOR QUADRATUS (PQ)
Origin: distal 1/4 of ant. ulna Insertion: distal 1/4 of ant. radius Action: pronates FA Innervation: median nerve Nerve Root: C8,T1
Brachialis
Origin: distal anterior shaft of humerus Insertion: coronoid Pr of ulna; tuberosity of ulna Action: Elbow flexion Innervation: musculocutaneous, radial nerve Nerve Root: C5,C6,
TERES MAJOR
Origin: dorsal inferior angle & lower 1/3 of lateral border of scap Insertion: medial lip of bicipital groove of humerus Action: extends the arm from a flexed position, adducts and medially rotates the humerus Innervation: lower subscapular nerve Nerve Root: C5, C6
Opponens Policis (OP)
Origin: flexor retinaculum and trapezium Insertion: lateral side of the first MC Action: opposes the thumb against the fingers Innervation: recurrent branch of the Median nerve Nerve Root: C8 and T1
abductor pollicis brevis
Origin: flexor retinaculum and tubercles of scaphoid and trapezium. Insertion: lateral side of proximal phalanx of the thumb Action: abducts the thumb at the CMC joint Innervation: recurrent branch of the Median nerve Nerve Root: C8 and T1
ABDUCTOR POLICIS BREVIS (APB)
Origin: flexor retinaculum, scaphoid and trapezium tubercles Insertion: radial base of P1 of thumb Action: abducts the thumb at the CMC and MP Innervation: recurrent branch - median nerve. Nerve Root: C8,T1
FLEXOR DIGITI MINIMI BREVIS
Origin: hook of the hamate and flexor retinaculum Insertion: medial base of the proximal phalanx of 5th digit Action: flexes the proximal phalanx of the 5th digit at the MPJ Innervation: deep branch of the Ulnar nerve Nerve Root: C8 and T1
Opponens Digiti Minimi (ODM)
Origin: hook of the hamate bone and flexor retinaculum Insertion: palmar surface of the body of the 5th metacarpal Action: abducts, flexes, and laterally rotates 5th MC Innervation: deep branch of the ulnar nerve Nerve Root: C8 and T1
INFRASPINATUS (RTC)
Origin: infraspinatus fossa Insertion: middle facet of greater tubercle of humerus Action: laterally rotates the humerus and humeral extension Innervation: suprascapular nerve Nerve Root: C5,C6
SUPINATOR
Origin: lat. epicondyle, RCL-elbow, annular ligament, proximnal crest of ulna. Insertion: proximal 1/3 of radius Action: supinates forearm and hand Innervation: radial nerve - deep branch Nerve Root: C7,C8
ANCONEUS
Origin: lateral epicondyle Insertion: olecranon, post. body of ulna Action: extends the forearm at the elbow Innervation: radial nerve Nerve Root: C7, C8
EXTENSOR CARPI RADIALIS BREVIS (ECRB)
Origin: lateral epicondyle Insertion: base of 3rd MC Action: extends and abducts the hand at the wrist Innervation: PIN-radial nerve Nerve Root: C6,C7
EXTENSOR DIGITI MINIMI (EDM)
Origin: lateral epicondyle Insertion: extensor hood of 5th digit Action: extends 5th digit at MCP and PIP joints Innervation: PIN-radial nerve Nerve Root: C7,C8
EXTENSOR DIGITORUM (ED)
Origin: lateral epicondyle Insertion: extensor hood of digits 2-5 Action: extends digits 2-5 at MCP and PIP joints Innervation: PIN-radial nerve Nerve Root: C7,C8
EXTENSOR CARPI ULNARIS (ECU)
Origin: lateral epicondyle, posterior proximal ulna Insertion: base of 5th MC Action: extends, UD the hand at the wrist Innervation: PIN - radial nerve Nerve Root: C7,C8
EXTENSOR CARPI RADIALIS LONGUS (ECRL)
Origin: lateral supracondylar ridge of humerus. Insertion: base of 2nd MC Action: extends and abducts/RD the hand at the wrist Innervation: radial nerve Nerve Root: C6,C7
PALMARIS LONGUS (PL)
Origin: medial epicondyle Insertion: flexor retinaculum, palmar aponeurosis Action: flexes the hand at the wrist, tightens the palmar aponeurosis. Innervation: median nerve Nerve Root: C7, C8,
FLEXOR CARPI RADIALIS (FCR)
Origin: medial epicondyle, Insertion: bases of 2nd & 3rd MCs Action: flexion and RD Innervation: median nerve Nerve Root: C6,C7
FLEXOR DIGITOUM SUPERFICIALIS (FDS)
Origin: medial epicondyle, UCL, coronoid process Insertion: side shafts of P2 of digits 2-5 Action: flexes the PIP joints of digits 2-5 Innervation: median nerve Nerve Root: C7,C8,T1
adductor pollicis (AP)
Origin: oblique head arises from the base of the MC 2&3 transverse head arises anterior surface of the 3rd MC Insertion: sesamoid bone of the ulnar MCP joint Action: adducts the proximal phalanx of the thumb Innervation: deep branch of the ulnar nerve Nerve Root: C8 and T1
abductor digiti minimi (ADM)
Origin: pisoform and FCU tendon Insertion: medial side of the base of the proximal phalanx of the 5th digit Action: abducts the 5th digit Innervation: deep branch of the ulnar nerve Nerve Root: C8 and T1
EXTENSOR POLLICIS BREVIS
Origin: posterior surface of the mid radius and IO membrane Insertion: base of the proximal phalanx of the thumb Action: extends the proximal phalanx of thumb at the MPJ Innervation: radial nerve ( posterior interosseous branch) Nerve Root: C7 and C8
EXTENSOR INDICIS (EI)
Origin: posterior ulna and IM Insertion: extensor expansion of 2nd digit. Action: extends index finger MP + assist w/ wrist ext Innervation:PIN branch- radial nerve Nerve Root: C7,C8
ABDUCTOR POLLICIS LONGUS (APL)
Origin: posterior ulna, radius, and interosseous membrane Insertion: 1st. MC base Action: Thumb CMCJ ABD + assist w/ wrist ABD Innervation: PIN-radial nerve Nerve Root: C7, C8
FLEXOR DIGITORUM PROFUNDUS (FDP)
Origin: prox. ulna and IM Insertion: base of P3 of digits 2-5. Action: flexes the DIP joints of digits 2-5 Innervation: AIN-median nerve + Ulnar Nerve Nerve Roots: C8,T1
BICEPS BRACHII
Origin: short head - coracoid process long head - supraglenoid tubercle of scap Insertion: radial tuberosity, bicipital aponeurosis Action: supinates the forearm, flexes the supinated forearm, SH: Humeral flexion Innervation: musculocutaneous nerve Nerve Root: C5, C6
SUBSCAPULARIS (RTC)
Origin: subscapular fossa Insertion: lesser tubercle of humerus Action: IR and adduction of shoulder Innervation: Upper and Lower subscapular nerve Nerve Root: C5, C6, C7
flexor pollicis brevis
Origin: superficial head arises from flexor retinaculum & trapezium. deep head arises from the floor of carpal canal Insertion: lateral side of the first MC Action: flexes the IP joint of the thumb Innervation: recurrent branch of the Median nerve Nerve Root: C8 and T1
SUPRASPINATUS (RTC)
Origin: supraspinous fossa of scapula Insertion: superior facet of greater tubercle of humerus Action: abduction, Scaption, humeral head stabilization Innervation: Suprascapular Nerve Nerve Root: C5, C6
EXTENSOR POLLICIS LONGUS (EPL)
Origin: the posterior middle third of ulna and IM Insertion: base of P2 of thumb Action: Thumb IP ext + assist w/ RD Innervation: PIN-radial nerve Nerve Root: C7,C8
LEVATOR SCAPULAE
Origin: transverse process of C1-C4 Insertion: medial border of scapula (Superor Angl - Root of spine) Action: scapular elevation, downward rotation of scapula Innervation: Dorsal Scapular N. (C5), Spinal nn (C3, C4)
TERES MINOR (RTC)
Origin: upper 2/3 lateral border of scapula Insertion: Inferior facet of the greater tubercle of humerus Action: ER and humeral extension Innervation: axillary nerve Nerve Root: C5, C6
DESCRIBE THE SCAPULOHUMERAL RHYTHM
Overall 2:1 ratio It May not apply to every degree of movement. Initial 30 degrees - 4:1 ratio Abduction 30-180 degrees 4:5 ratio
WHAT IS LINBURG'S SYNDROME?
Pain and aggravation of FPL with activity in the radiopalmar aspect of the distal forearm and thumb.
WHAT MAKES OUR FINGERPRINTS?
Papillary ridges
HOW DO YOU TEST FOR EXTINSIC EXTENSOR TIGHTNESS?
Passively hold the digits in composite flexion while passively flexing the wrist. If the digits are pulled into extension as the wrist is passively flexed, extrinsic tightness exists proximal to the wrist.
HOW DO YOU TEST FOR EXTRINSIC FLEXOR TENDON TIGHTNESS?
Passively maintain the digits in full extension and passively extend the wrist. If the digits are pulled into flexion when the wrist is passively extended, extrinsic flexor tightness exists proximal to the wrist.
SENSORY CHANGES, MOTOR CHANGES AND ATROPHY OF THE THENAR MUSCULATURE MAY INDICATE ...?
Peripheral neuritis secondary to diabetes. May be accompanied by CTS.
WHAT IS THE FUNCTION OF CLELAND'S AND GRAYSON'S LIGAMENTS?
Prevent rotary movements of the skin around the fingers. Grayson's Ligaments: run from volar flexor tendon sheath volar to the neurovascular bundle and inserts into the skin. Cleland's Ligaments: passes dorsally and inserts into the skin.
WHICH MUSCLES ORIGINATE FROM THE MEDIAL EPICONDYLE OF THE HUMERUS?
Pronator teres flexor carpi radialis Palmaris Longus flexor digitorum superficialis flexor carpi ulnaris.
LIST THE MUSCLES INNERVATED BY THE RADIAL NERVE PROXIMAL TO DISTAL IN THE UPPER EXTREMITY
RAIDAL N. (C5-T1) MAIN BR DEEP BR PIN (lateral br. & medial br.) MAIN BR 1. Triceps long head, C6-C8 2. Triceps lateral head, C6-C8 3. Anconeus, C7,C8 4. Triceps medial head, C6-C8 5. Brachioradialis; C5,C6 6. ECRL, C5-C8 DEEP BR 7. ECRB; C5,C6 8. Supinator; C7,C8 PIN (ALL mm. C7,C8) Medial Br 9. ED 10. EDM 11. ECU Lateral Br 12. APL 13. EPL 14. EPB 15. EI
WHICH NERVE INNERVATES THE EXTENSOR POLLICIS LONGUS AND EXTENSOR POLLICIS BREVIS?
Radial Nerve
WHAT ARTERY PASSES THROUGH THE ANATOMICAL SNUFFBOX?
Raidal A.
VARUS INSTABILITY OF THE ELBOW
Result of radial collateral ligament (RCL) instability. Tested with humerus in full IR with varus stress applied to the elbow joint.
WHICH NERVE AND ARTERY PASS THROUGH THE QUADRANGULAR SPACE? What mm form the quadrangular space?
Axillary nerve and posterior circumflex artery. The quadrangular space is formed by Teres minor superiorly Teres major inferiorly Humerus laterally Long head of the triceps brachii medially.
AFTER A PATIENT SUSTAINED A C5,C6 NON-OPERABLE AVULSION AND HAS LOST ELBOW FLEXION, WHICH MUSCLE GROUP WOULD THE SURGEON USE FOR A TENDON TRANSFER TO RESTORE ELBOW FLEXION?
B) Flexor-Pronator muscle group ( Steindler Procedure) In selecting a motor to use for a tendon transfer, the surgeon will always look fist at innervated muscle tendon units that cross the joint where function is being restored. In this case the only listed muscle tendon unit that crosses the elbow is the flexor- pronator group for elbow flexion.
WHAT STRUCTUES FORM THE ANATOMIC SNUFF BOX?
Base: Scaphoid Radial Border: APL, EBP Ulnar Border: EPL
WHICH THREE VEINS MAKE THE "M" SHAPE IN THE FOREARM AT THE LEVEL OF THE ELBOW?
Basilic vein, cephalic vein, and median cubital vein. Cephalic runs laterally Basilic runs medially forming an M with the Medial cubital vein.
DEFINE A CONDYLOID JOINT
Biaxial (also called condylar, ellipsoidal, or bicondylar) is an ovoid articular surface, or condyle that is received into an elliptical cavity. This permits movement in two planes, allowing flexion, extension, adduction, abduction, and circumduction Example: MP joint, radiocarpal joint of wrist POM: flexion/extension abduction/adduction circumduction
DEFINE A SADDLE /SELLAR JOINT
Biaxial A saddle joint (sellar joint, articulation by reciprocal reception) is a type of synovial joint in which the opposing surfaces are reciprocally concave and convex. It is found in the thumb, the thorax. Examples 1st CMC joint between the trapezium and the first metacarpal of the thumb SC joint POM: flexion / extension abduction / adduction cirumduction
MAJOR ARTERIAL SUPPLY TO THE FOREARM AND HAND?
Brachial Artery
WHICH MUSCLES MAKE UP THE WAD OF HENRY?
Brachioradialis ECRB ECRL
WHICH TWO MUSCLES LINE THE MEDIAL AND LATERAL BORDERS OF THE CUBITAL FOSSA?
Brachioradialis laterally and the pronator teres medially.
WHAT TWO MUSCLES CREATE THE MEDIAL AND LATERAL BORDERS OF THE CUBITAL FOSSA?
Brachioradialis laterally, and pronator teres medially.
AN INTEROSSEOUS LIGAMENT COMPLEX LINKS THE SCAPHOID AND LUNATE. THIS COMPLEX IS COMPOSED OF: A) A DORSAL AND VOLAR LIGAMENTOUS PORTION B) A CONTIGUOUS BAND LINKING BOTH BONES C) A DORSAL AND VOLAR LIGAMENTOUS PORTION AND A CENTRAL MEMBRANOUS PORTION D) A CONTIGUOUS BAND REINFORCED BY THE DORSAL RADIOCARPAL LIGAMENT.
C) A dorsal and volar ligamentous portion and a central
AN ACCUTE COMPARTMENT SYNDROME REQUIRES: A) APPLICATIONOF ICE UNTIL SWELLING SUBSIDES B) AROM EXERCISES OF THE AFFECTED MUSCULATURE FOLLOWED FIRST BY SOFT TISSUE MASSAGE AND THEN ICE C) IMMEDIATE FASCIOTOMY OF ALL COMPARTMENTS INVOLVED D) ALL OF THE ABOVE
C) Immediate fasciotomy of all compartments involved.
THE MAJOR FUNCTIONAL DEFICIT OF THE THUMB FOLLOWING LOW MEDIAN NERVE PALSY IS: A) LOSS OF IP FLEXION B) LOSS OF PALMAR ABDUCTION C) LOSS OF OPPOSITION D) LOSS OF MCP FLEXION
C) LOSS OF OPPOSITION
WHICH OF THE FOLLOWING MUSCLES IS NOT INNERVATED BY THE ULNAR NERVE? A) THE FDP TO THE SMALL AND RING FINGER B) THE DEEP HEAD OF THE FPB C) THE FOUR LUMBICAL MUSCLES D) THE VOLAR DNA DORSAL INTEROSSEI
C) The four lumbrical muscles; only lumbricals 3 and 4 are innervated by the ulnar nerve.
WHAT CONDITION IS OFTEN PRESENT WITH LINBURG'S SYNDROME?
Carpal Tunnel Syndrome: due to an anomalous interconnection between FPL and flexor digitorum.
PRIMARY PATHOLOGICAL STRUCTURE THAT PRODUCE PIP FLEXION CONTRACTURES
Check rein ligaments - an extension of the volar plate in early formation are called "swallowtails". When ligaments become shortened and hypertrophied they are termed "check rein ligaments".
WHICH OF THE FOLLOWING STRUCTURES ARE IMPLICATED IN THE DEVELOPMENT OF PIPJ FLEXION CONTRACTURES? A) CHECK-REIN LIGAMENTS B) COLLATERAL LIGAMENTS OF THE PIPJ C) THE VOLAR PLATE D) ALL OF THE ABOVE
D) All of the above contribute to PIPJ contracture.
A TERMINAL TENDON TENOTOMY FOR CORRECTION OF THE FUNCTIONAL DEFORMITY ENCOUNTERED BY PATIENTS WITH CHRONIC BOUTONNIERE DEFORMITY WILL RESTORE:
DIP Flexion
DESCRIBE THE BOUVIER TEST
Determines whether the PIP joint capsule and extensor mechanism are working normally. For interosseous n. Palsy AKA claw hand Test- block MCPs from hyperextension into slight flexion → the intrinsic mm force will transfer distally to PIP and DIP joints achieving full MP and IP extension (this is a positive result if it occurs).
WHICH POLE OF THE SCHAPHOID HAS A GENEROUS BLOOD SUPPLY?
Distal Pole Proximal Pole has poor blood supply and if injured, may result in avascular necrosis.
CORONAL (FRONTAL) PLANE
Divides the body into front and back halves.
SAGGITAL (MEDIAN) PLANE
Divides the body into right and left parts.
transverse plane
Divides the body into superior and inferior portions
WHAT IS THE MAJOR FUNCTIONAL DEFICIT FOLLOWING THE UPPER & LOWER TRUNK BRACHIAL PLEXUS INJURY? TOS & WINGED SCAP? Injury site Causes MM. Deficits Functional Deficits Presentation
see chart
List the muscles that do external rotation of the shoulder
• Infraspinatus • Teres minor • Posterior deltoid
List the muscles that do internal rotation of the shoulder
• Subscapularis • Latissimus dorsi • Teres major • Anterior deltoid • Pect. major
DURING A RESISTED MUSCLE TEST, A STRONG BUT PAINFUL CONTRACTION CAN INDICATE... Pt2 : What is the interpretation of Resisted Muscle testing.
A contractile unit problem Interpretation Strong and Painless: No lesion in the contractile structure Strong and Painful: Minor lesion in a part f the muscle or tendon and its attachment. Weak and Painless: There could be a complete rupture of the muscle or tendon, but most commonly might be a malfunction of the nerves. This impaired function of the nerve leads to muscle weakness. Weak and Painful: Serious impairment, like a secondary deposit or a fracture might be present. However, if a patient is reluctant to replicate the severe pain it may appear as apparent weakness Painful on Repetition: Intermittent claudication could be the reason a the movement is painless and strong initially but hurts on repetition. All Resisted Movements Painful: A gross lesion lying proximally, which would mostly be a capsular lesion,
VASCULARITY OF THE SCAPHOID IS ORIENTED IN A CENTRAL-DISTAL TO PROXIMAL DIRECTION. DUE TO THIS VASCULAR STRUCTURE, WHAT CONDITION IS COMMON FOLLOWING SCAPHOID FRACTURE? A) NON-UNION B) KEINBOCK'SDISEASE C) CONDROMALACIA D) OSTEOCHONDRITIS DISSECANS
A) Non-union
A PATIENT PRESENTS WITH RECOVERING FUNCTION OF THE INTRINSIC MUSCLES OF THE HAND AFTER A LOW ULNAR NERVE REPAIR. WHICH EXERCISE IS THE MOST APPROPRIATE FOR THIS PATIENT? A) PINCHING PUTTY INTO A CONE WITH THE IP JOINTS HELD IN EXTENSION B) HYPEREXTENSION OF THE MP JOINTS AGAINST RUBBER BAND TRACTION C) JOINT BLOCKING D) GRIP STRENGTHENING BY USEING A HAND HELPER WITH MILD RESISTANCE
A) Pinching putty into a cone with the IP joints in extension.
NAME THE ACCESSORY JOINT MOTIONS
A) Spin B) Roll C) Glide
WHICH PULLEY IS MOST COMMONLY AFFECTED IN TRIGGER FINGER?
A1
WHAT IS THE STRONGEST MUSCLE OF OPPOSITION OF THE THUMB?
APB
DEFINE SECRETAN'S SYNDROME
Also known as "Wall Banger's Disease" Persistent edema over the dorsum of the hand after minor hand injury. A psychological condition that results in self-infliction of harm to prolong the illness or disorder.
Martin-Gruber anastomosis
Anastomosis between median and ulnar nerve at the level of the forearm. Present in 15-20% of the population.
WHAT IS A LINBURG'S SIGN?
Anatomic interconnection between the FPL and index FDP. Present in approx. 31% of the population. The patient will have involuntary flexion of the index DIP with thumb flexion.
WHAT IS LANDMEER'S LIGAMENT
Another name for the oblique retinacular ligament
STRONGEST WRIST EXTENSOR
ECRB - Usually affected in lateral epicondylitis
LISTER'S TUBERCLE ACTS AS A PULLEY FOR WHICH MUSCLE?
Extensor pollicis longus (EPL) The EPL takes a 45 degree turn around Lister's Tubercle while on its way to the thumb.
WHAT TWO STRUCTURES FORM THE ROOF OF THE CUBITAL TUNNEL?
Fascia of FCU , and Arcuate ligament of Osborne
WHAT IS THE "QUADRIGIA PHENOMENON"?
Flexion contracture of the involved finger and a decreased amount of force in the digits next to the injured finger. The quadriga effect is characterized by an active flexion lag in fingers adjacent to a digit with a previously injured or repaired flexor digitorum profundus tendon. Diagnosis is made clinically with the inability to fully flex the fingers of the hand adjacent to the injured finger. Treatment is observation if patient is minimally symptomatic but may involve release of FDP tendon of injured digit if symptoms impact patient's activity demands. most commonly caused by a functional shortening of the FDP tendon due to over-advancement of the FDP during tendon repair >1 cm advancement associated with quadriga adhesions
NAME THE CONTENTS OF THE DORSAL WRIST COMPARTMENTS
I. APL, EPB II. ECRL, ECRB III. EPL IV. ED, EIP V. EDM VI. ECU
BEST TREATMENT FOR ACUTE COMPARTMENT SYNDROME?
Immediate fasciotomy of all involved compartments.
LATISSIMUS DORSI
Origin: Vertebral part: Spinous processes of vertebrae T7-T12, Thoracolumbar fascia Illiac part: Posterior third of crest of ilium Costal part: Ribs 9-12 Scapular part: Inferior angle of scapula Insertion: intertubercular/bicipital groove of humerus Action: extends, adducts, and IR humerus; medially (downward) rotation of scap, Innervation: thoracodorsal nerve Nerve Root: C6, C7, C8
Lumbricals
Origin: 1& 2 originate from the two lateral tendons of the flexor digitorum profundus. 3 & 4 from the 3 medial tendons Insertion: All attach to the lateral sides of the extensor expansion of digits 2-5 Action: flex the MCP joints and extend the PIP joints Innervation: 1& 2 are innervated by the Median Nerve (C8 and T1). 3&4 by the deep branch of the ulnar nerve (C8 and T1)
TRICEPS BRACHII
Origin: Long Head - infraglenoid tubercle of scap Lat. - post. humerus (above spinal groove) Med - post. humerus (Below spinal groove) Insertion: Olecranon Pr. of Ulna Action: Elbow Ext+ LH: Humeral extension Innervation: radial nerve Nerve Root: C7, C8
TRAPEZIUS
Origin: Upper: occipital protuberance, ligamentum nuchae, C1 -C7 Spinous Pr. MIddle: C7-T3 Spinous Pr. Lower: T4-T12 Spinous Pr. and all 12 thoracic vertebrae. Insertion: Upper: lat. 1/3 of clavicle, acromion Middle: scapular spine Lower: Root of Spine of Scapula Action: Upper: Elevation & upward rot of scapula Middle: ADdidcution Lower: Depression & lateral/upward rotation scapular upward rot for full abduction of humerus. Innervation: spinal accessory nerve (CN:XI) Nerve Root: C3, C4
DELTOIDS (Ant, Mid, Post)
Origin: ANT: lat. 1/3 of clavicle MID: Superior acromion POS: spine of the scapula. Insertion: deltoid tuberosity Action: ANT: Flexion. Horz. ADD, IR of Hum. MID: ABD of Hum. to 90 deg. POS: Ext, Horz. ABD, ER, scaption Innervation: axillary nerve Nerve Root: C5, C6
A PAINFUL CONDITION IN WHICH THE INTEROSSEOUS LUMBIRICAL ADHESIONS ARE IMPINGING ON THE DEEP TRANSVERSE METACARPAL LIGAMENT DURING INTRINSIC CONTRACTURE IS AN UNUSUAL CONDITION CALLED:
Saddle Syndrome
TENDERNESS IN THE ANATOMICAL SNUFFBOX MAY INDICATE WHAT INJURY?
Scaphoid Fracture
WEN FLEXING FINGERS INTO A FLAT FIST, WHAT STRUCTURE DO THEY ALL POINT TOWARD?
Scaphoid Tubercle
ATTACHMENTS SITES OF THE TRANSVERSE CARPAL LIGAMENT
Scaphoid tuberosity Crest of Trapezium Hook of the hamate Pisiform
WHAT IS THE PREFERRED TECHNIQUE TO TREAT THE STIFF PIP JOINT OR PIPJ CONTRACTURE?
Serial Casting Orthosis
THE CORACOBRACHIALIS INSERTS INTO WHICH STRUCTURE?
Shaft of the humerus.
AN INJURY TO THE JOINT WITH LIGAMENTOUS DAMAGE IS REFERED TO AS A....?
Sprain
WHAT IS THE ONLY TRUE ARTICULATION BETWEEN THE AXIAL SKELETON AND UPPER LIMB?
Sternoclavicular Joint Joint Motion: elevation, depression, protraction, retraction Joint capsule reinforced with ligaments.
THE VASCULAR STRUCTURE OF THE HAND CONSISTS OF WHAT THREE COMPONENTS?
Superficial palmar arch, deep palmar arch, common palmar arteries
MUSCLES INVOLVED IN HUMERAL ABDUCTION
Supraspinatus Lat. Deltoid
WHAT IS THE LACERTUS FIBROSUS?
Synonymous with the bicipital aponeurosis since it originates from the common tendon of the biceps brachii.
WITH THE MCP JOINT FLEXED, ARE THE COLLATERAL LIGAMENTS TAUT OR LOOSE?
TAUT The colateral ligaments prohibit lateral movement of the MP joint during flexion.
THE AXILLARY VEIN IS FORMED FROM WHICH TWO VEINS?
The basilic vein and the brachial vein. B asilic and brachial veins join at the inferior border of the teres major to form the axillary vein.
WHICH THUMB PULLEY IS THE MOST IMPORTANT?
The oblique pulley because IP joint motion will decrease if the oblique pulley is injured.
AN ABNORMAL TREMOR THAT ACCOMPANIES A VASCULAR OR CARDIAC MUMUR FELT ON PALPATION IS CALLED WHAT?
Thrill AKA: Grade 4 palpable thrill murmur
DEFINE A BALL & SOCKET JOINT
Triaxial Globular head and cup-like cavity Example: Glenohumeral Joint, Hip joint POM flexion / extension abduction / adduction rotation circumduction
TRUE OR FALSE? WITH THE MP JOINT EXTENDED THE COLLATERAL LIGAMENTS ARE LOOSE. WHEN THE MP JOINT IS FLEXED THE COLLATERAL LIGAMENTS ARE TIGHT.
True
TRUE OR FALSE? THE ADDUCTOR POLLICIS (AP) IS THE STRONGEST OF THE INTRINSIC MUSCLES
True The AP is the strongest intrinsic muscle and is actually stronger than the extrinsic FPL. It provides 50% of the adduction force of the first metacarpal.
LIST THE MUSCLES INNERVATED BY THE ULNAR NERVE PROXIMAL TO DISTAL IN THE UPPER EXTREMITY
ULNAR N. (ALL MM. C8-T1) MAIN BR. DEEP BR. MAIN BR. 1. FCU 2. FDP IV AND V DEEP BR. HYPOTHENAR MM. 3. ADM 4. ODM 5. FDM ------------------------- 6. Lumbricals IV and III 7. Palmar Interossei (#3) & Dorsal Interossei (#4) 8. FPB - deep head 9. AP 10. Palmaris Brevis.
WHICH ARTERY PROVIDES THE PRIMARY BLOOD SUPPLY TO THE HAND?
Ulnar Artery The ulnar artery is larger than the radial artery. It supplies 60% of the blood to the hand.
DEFINE A HINGE JOINT
Uniaxial Motion in one plane Also called Ginglymus Example: Humeroulnar joint, IP joints POM: flexion / extension
DEFINE A PLANE JOINT
Uniaxial AKA Gliding Joint Surfaces slightly concave and convex enabling the bones to slide over each other. Example: Carpal joints, AC joint, SC Joint POM: gliding in plane of the articular surface
DIFINE A PIVOT JOINT
Uniaxial/single axis AKA rotary joint Allows rotation w/ ligament surrounding cylindrical shaped bone POM: axial rotation Example: DRUJ wrist, atlantoaxial joint, PRUJ elbow
MUSCLES INVOLVED IN SCAPULAR UPWARD ROTATION
Upper & Lower Traps Serratus Ant.
WHAT IS THE SPACE OF POIRIER?
Weakness from an absence of ligamentous support. Absence of a volar lunocapitate ligament that can lead to wrist instability.
