Actions/Movement of Forearm, Arm, Elbow and wrist

Cubitus Valgus

(Elbow Arthrology) When distal segment laterally oriented in relation to the more proximal segment VALGUS --- think "L" for lateral.

Cubitus Varus (Varum)

(Elbow Arthrology) When distal segment of arm is medially oriented in relation to proximal segment

Finger Flexion (digits 2 though 5)

*Lumbricals (at MCP joints) *Flexor Digitorum Superficialis {remember the bye-bye bc attch middle phalanges} - PIP JOINT *Flexor Digitorum Profundus flexes DIP of fingers and secondary flexor at PIP/MCP joints Fingers 2-4: Dorsal Interossei assist Fingers 2,4 and 5 (NOT 3) - Palmar Interossei asst 5th (little finger: hypothenar muscles -flexor digiti minimi brevis (prox phalanx) and adductor digiti minimi assists at MCP Little finger

Muscles to supinate forearm

*Supinator *Biceps Brachii (strong supinator agst resistsance -- when forearm pronated to midrange 90 degrees) *Brachioradialis ASSISTS in extremes -extensor carpi radialis longus --weak supinator

Wrist Extension Muscles

*much like flexion of wrist look to the radialis and ulnaris. Just two radialis with extension -Extensor Carpi Radialis Longus -Extensor Carpi Radialis Brevis -Extensor Carpi Ulnaris ASSIST - Extensor digitorum

Flexion of little finger

-flexor digiti minimi brevis - a hypothenar muscle ....flex at prox phalanx *plus our Flexor digitorum profundus distal phalanges at DIPs) and Superficialis flex middle phalanges at PIPs_ Assist: adductor digiti minimi assists at MCP (hypothenar muscle)

Ulnar deviation/Adduction & Radial Deviation/Abduction of wrist .. what is movement

Adduction = ULNAR DEVIATION So (plane of hand) move toward little finger (Ulnar bone) *In coronal plane *BUT if wrist in neutral (like soldier @ attention) then in Sagittal plane Abduction = RADIAL DEVIATION So (plane of hand) move toward thumb/radius *In coronal plane *Same above if wrist in neutral (soldier) then sagittal plane Note: Position remains same regardless if forearm pronated or supinated. But can be confusing (see separate flash card)

This muscle supports the elbow joint

Anconeus

Atrophy vs hypertrophy (elbow)

Atrophy is to waste away. Sets in if immobilized for a week; longer immobilized = smaller the size. If a prime mover atrophy; then lose strength so need use agonists more. Hypertrophy - building muscle by continued use of muscle beyond the norm. Especially when against resistance.

Elbow flexion (ie forearm at elbow)- muscles and ROM

Average ROM 140 to 0 *Biceps Brachii (unless pronated then disengaged i.e. biceps a supinator) *Brachialis (attach to ulna so still engaged and primary when arm pronated) *Brachioradialis Assist by Pronator Teres

Flexion Arm (at shoulder)

Biceps Brachii assists when EXTERNALLY ROTATED Coracobrachialis Deltoid (anterior fibers) Pec Major (upper fibers)

Radial/Ulnar deviation wrist- with pronation & supination

Both adduction (Ulnar deviation) & abduction (Radial Deviation) remain same regardless of forearm position. For instance - if pronate forearm (palm towards floor) and then ADDUCT @ wrist, your hand will move away from centerline of body (might think abduction). It isn't visualize the hand as if it was anatomical (ie rotated around)

Arm adduction

Corracobrachialis Assist by Triceps brachii (long head) from last test: dont forget Lat Dorsi, Teres Major and Minor, Infraspinatus, Pec Major

Abduction Fingers - the muscles

DABs ... the Dorsal Interossei abducts 2 though 4th digit. The 3rd digit/middle finger abducts Both ulnarly and radially Little finger: also has abductor digit minimi {hypothenar muscle) at MCP joint

Dislocation

Dislocation also called luxation. Moving alignment segment COMPLETELY out of joint

Opposition of thumb describe and muscles

Drawing 1st metacarpal across palm of hand and rotating it palmarly ..to opposition with little finger *Opponens Pollicis (thenar muscle) ASSIST: Adductor Pollics & Flexor Pollicis both thenar muscles

Brachialis actions are

Elbow flexor. Regardless if Pronated or Supinator bc only on ULNA ... nothing to do with radius --also musculocutaneous C5, C6

Thumb Extension: describe & what muscles

Extension is out from hand in SAME plane (like shaking a hand or a dog shadow puppet) Extension of thumb = SNUFF box {ie brevis sandwich} -Abductor Pollicis longus [IP and MCP jts] -Extensor Pollicis brevis [MCP & assist CMC Jt) -Extensor pollicis longus ASSIST - by Palmaris Interossei

Muscles for Radial Deviation (wrist abduction) DRAFT

Extensor Carpi radialis longus Extensor carpi radialis brevis Flexor carpi radialis *It is the radialis muscles need both flexors/extensors to keep it in that uniplanar motion. SNUFF Box Assists Extensor pollicis longus Extensor pollics brevis Abductor pollicis longus

Extends the little finger

Extensor Digiti Minimi (extends MCP and IP joints of 5th digit) AND Extensor Digitorum

This muscle is big at extension of wrist and phalanges

Extensor Digitorum (bc tendons attach to distal phalanx of phalanges ie extensor hood ) Why a large dermatome (spinal level) C6, C7, C8

Extension of fingers (digits) 2-5

Extensor Indicis - for 2nd digit (index finger) only Lumbricals - extension at IP joints ASSIST: Dorsal Interossei (2-4) at IP joint Palmar Interossei (2,4 and 5 NOT 3rd) with IP joint extension of digits

Muscles for Ulnar Deviation (wrist Adduction)

Extensor carpi ulnaris Flexor carpi ulnaris

If just fire the Flexor Carpi Radialis what happens?

Flexion and bit of radial deviation bc its tendon splits and attaches to base of 2nd and 3rd metacarpals.

If just fire the Flexor Carpi Ulnaris what happens?

Flexion and ulnar deviation bc it attaches to few carpals and Base 5th metacarpal.

Name muscles of wrist flexion

Flexor Carpi Radialis Flexor Carpi Ulnaris (two fire same time for pure flexion w/o deviation) - Palmaris Longus (little flexion from worthless muscle) - Abductor Pollicis Longus (hand) ASSIST: Flexor Digitorum Superficialis and Flexor Digitorum Profundus

Pure Wrist flexion (without any deviation) requires

Flexor Carpi Radialis and Flexor Carpi Ulnaris firing at the same time.

This muscle is great for GRIP STRENGTH

Flexor Digitorum Profundus

Pronation/supination forearm:

Head of radius spins on the radial notch of the ulna that allows pronation/supination *Radius is moving (so actually moving anteriorly to move medially as well [as pronates] PRONATION: forearm pronates so palm towards floor. Pronator Teres & Pronator quadratus SUPINATION: palm up (bowl soup) Supinator Biceps Brachii **Brachioradialis assists BOTH pronation and supination AT EXTREMES Uses proxima & distal radioulnar joints

Coracobrachialis does

Horizontal adDuction little flexion Innervated by musculocutaneous (goes right through it) C5, C7. Smallest muscle most innervation.

Close Packed

Joint has most articulation and most congruency (ie most bone on bone); most stable but least mobility. Exp is FULL extension of elbow (no way test valgus or varus)

Muscles of Tennis Elbow

Lateral epicondylitis "tennis elbow" are Extensor Carpi Radialis Longus (to 2nd digit metacarpal) Extensor Carpi Radialis Brevis. To 3rd digit metacarpal

Loose/Open Packed

Least congruency of bone on bone articulation; varies on ROM; Position you mobilize and least painful. Most MOBILITY but LEAST stability

Opposition 5th digit (little finger)- describe and muscle

Opponens digiti minimi (hypothenar) draws little finger anteriorly, out of palm, and rotates it radially bringing into opposition with thumb

Adduction Fingers - muscles

PADs - Palmar adducts. IE Palmar Interossei. Only digits 2, 4 and 5 (remember 3rd digit ONLY abducts) Extensor Indicis for only the 2nd digit (index finger)

Muscles PRONATE forearm

Pronator Teres Pronator Quadratus ASSIST: both Flexor carpi radialis and if in extreme the Brachioradialis. Anconeus??

Thumb Adduction describe and muscles involved

Return thumb to palm from abduction Muscles: -Adductor Pollicis @1st metacarpal (thenar muscle) ASSIST: flexor pollicis brevis (thenar muscle)

**Test Question: Which forearm extensor muscle does not cross wrist joint and thus doesn't move wrist/hand?

TEST QUESTION: When contract Brachioradialis DOES NOT cross wrist joint AND DOES NOT directly move the hand!! other: --Will flex forearm at elbow. DOES NOT do wrist extension called extensor bc attach to common extensor tendon --Mechanical advantage is WRIST NEUTRAL so if Super supinated position will want to pronate wrist to neutral and if super pronate will want to supinate wrist. **Thus supinator and pronator depending position wrist in. {Same is true for Flexor and extensor carpi radialis muscles}

This allows better articulation with hand bones (carpals)

The Styloid process of the Radius. This is especially true during ulnar deviation.

Describe movement of Abduction/Adduction Thumb

The thumb has to be OUTSIDE the plane of the hand.

Anconeus -- what does it do

Think of Troy Drumming Extension of elbow (at 90 degrees - is best mechanical advantage)

Describe Wrist Extension

Toward Dorsal surface : -doesn't change if supinated or pronated. If beyond then hyperextension

Describe Wrist Flexion

Toward palmar surface -doesn't change if supinated or pronated Pure wrist flexion w/ NO deviation - needs flexor carpi radialis and flexor carpi ulnaris to fire at same time.

Elbow Extension (ie forearm at elbow)- muscles and ROM

Triceps Brachii (all heads) Anconeous Assists *Avg 120 to 170 degrees

Extension of Arm

Triceps Brachii LONG HEAD Assists other muscles : deltoid, lat Dorsi, and the two majors (Pec Major's lower fibers and Teres Major)

What is difference in Osteokinematic and Arthrokinematic motion

Two ways to describe movement at the joints. 1. Osteokinematic --> movement between two bones [Exp. between humerus and ulnar/radius with elbow flexion] 2. Arthrokinematic - describes motion between two JOINT services. takes into account shape of joint surfaces & direction of motion of the opposing joint surfaces.

Thumb Abduction describe and what muscles

a perpendicular axis to thumb. Puppet hand or a C Abductor Pollicis Longus (of snuff box) Abductor Pollicis Brevis (thenar muscle ASSIST: Flexor Pollicis Brevis

Arm Abduction who is involved

last test: know it is Deltoid and supraspinatus. BUT when arm externally rotated - biceps brachii assists

Subluxation

out of ideal alignment but not completely out of joint

Thumb Flexion describe and what muscles

same plane (back to digits; uni-planar, towards straightened fingers). Muscles: -Flexor pollicis longus [IP joint] -Flexor pollicis brevis (thenar) MCP jt ASSIST: -abductor pollicis (thenar @mcp jt) -adductor policis (thenar @carpometacarpal jt) -1st palmar interossei