FPM 3250 Week 8 Reading Notes - Elbow, Radioulnar Joint, and Wrist
Wrist and Hand Muscles - location
*anteromedial at the elbow and forearm and anterior at the hand*: primarily wrist flexion - flexor carpi radialis - flexor carpi ulnaris - parlmaris longus primarily wrist and phalangeal flexion -flexor digitorum superficialis - flexor digitorum profundus - flexor pollicis longus *posterolateral at the elbow and forearm and posterior at the hand*: primarily wrist extension - extensor carpi radialis longus - extensor carpi radialis brevis - extensor carpi ulnaris primarily wrist and phalangeal extension: - extensor digitorum - extensor indicis - extensor digiti minimi - extensor pollicis brevis - abductor pollicis longus
Bones - Wrist/hand
- 29 bones including radius and ulna - 8 carpal bones in 2 rows of 4 bones form the wrist - proximal row consists from the radial (thumb) side to the ulnar (little finger) side, of the scaphoid (boat-shaped) or navicular as it commonly called, the lunate (moon-shaped), the triquetrum (three-cornered), and the pisiform (pea-shaped) bones - the distal row, from radial to the ulnar side, consists of the trapezium (greater multangular), trapezoid (lesser multangular), capitate (head-shaped) and hamate (hooked) bones - these bones form a 3-sided arch that is concave on the palmar side -this bony arch is spanned by the transverses carpal and volar carpal ligaments creating the *carpal tunnel*, which is frequently a source of problems known as carpal tunnel syndrome
Muscles - wrist/hand
- all of the wrist flexors generally have their origins on the anteromedial aspect of the proximal forearm and the medial epicondyle of the humerus, whereas their insertions are on the anterior aspect of the wrist and hand - all of the flexor tendons except for the flexor carpi ulnaris and palmaris longus pass through the carpal tunnel, along with the median nerve - conditions leading to swelling and inflammation in this area can result in increased pressure in the carpal tunnel, which interferes with normal function of the median nerve, leading to reduced motor and sensory function of its distribution (*carpal tunnel syndrome*; particularly common with repetitive use of the hand and wrist in manual labor and clerical work such as typing and keyboarding - the wrist extensors generally have their origins on the posterolateral aspect of the proximal forearm and the lateral humeral epicondyle, whereas their insertions are located on the posterior aspect of the wrist and hand
Synergy among the glenohumeral, elbow, and radioulnar joint muscles
- as RU joint goes through its ROM the GH and elbow muscles contract to stabilize or assist in the effectiveness of movement at the RU joints - EX: when attempting to fully tighten (with the right hand) a screw with a screwdriver that involved RU supination, we tend to externally rotate and flex the GH and elbow joints, respectvely - conversely, when attempting to loosen a tight screw with pronation, we tend to internally rotate and extend the elbow and GH joints, respectively. in either case, we depend on both the the agonists and the antagonists in the surrounding joints to provide an appropriate amount of stabilization and assistance with the required task
Joints - wrist/hand
- condyloid-type joint, allowing flexion, extension, abduction (radial deviation), and adduction (ulnar deviation) - wrist motion occurs primarily between the distal radius and the proximal carpal row, consisting of the scaphoid, lunate, and triquetrum - as a result, the wrist is often referred to as the radiocarpal joint - allows 70-90 degrees of flexion; 65-85 degrees extension; 15-25 degrees abduction; 25-40 degrees adduction
Bones
- ulna is much larger proximally than radius - radius is larger distally than ulna - scapula and humerus serve as proximal attachments for muscles that flex and extend the elbow - ulna and radius serve as distal attachments for same muscles - scapula, humerus, and ulna serve as proximal attachments for muscles that pronate and supinate the RU joint - distal attachments fo RU joint muscles are located on radius
medial epicondylitis
An elbow problem associated with the medial wrist flexor and pronator group near their origin on the medial epicondyle; frequently referred to as golfer's elbow.
Where can the flexor carpi radialis muscle be palpated?
Anterior surface of the wrist, slightly lateral, in line with the second and third metacarpals
Elbow and Radioulnar Joint Muscles - Location
Anterior: - primarily flexion & pronation - biceps brachii - brachialis - brachioradialis - pronator teres - pronator quadratus Posterior: - primarily extension & supination - triceps brachii - anconeus - supinator
Where can the palmaris longus muscle be palpated?
Anteromedial and central aspect of the anterior forearm just proximal to the wrist
Where can the pronator teres muscle be palpated?
Anteromedial surface of the proximal forearm
What is the point of insertion of the flexor digitorum profundus muscle?
Base of the distal phalanxes of the four fingers
What is the point of insertion of the flexor carpi radialis muscle?
Base of the second and third metacarpals
Which of the following exercises strengthens the biceps brachii?
Curling
Where can the brachialis muscle be palpated?
Deep on either side of the biceps tendon during flexion/extension
What is the point of origin of the pronator quadratus muscle?
Distal fourth of the anterior side of the ulna
What is the point of origin of the brachialis muscle?
Distal half of the anterior shaft of the humerus
Identify an exercise that strengthens the brachioradialis muscle.
Elbow curls
Identify an action performed by all the heads of the triceps brachii muscle.
Extension of the elbow
Only supination and pronation are possible in the elbow joint.
False
Match the movements that occur in the hand and wrist joints with their corresponding descriptions. Instructions
Flexion = Movement of the palm of the hand toward the anterior or volar aspect of the forearm Extension = Movement of the back of the hand toward the posterior or dorsal aspect of the forearm Abduction = Movement of the thumb side of the hand toward the lateral aspect or radial side of the forearm Adduction = Movement of the little finger side of the hand toward the medial aspect or ulnar side of the forearm
Identify an action performed by the flexor digitorum superficialis muscle.
Flexion of the fingers at the metacarpophalangeal and proximal interphalangeal joints
Where can the flexor digitorum superficialis muscle be palpated?
In the depressed area between palmaris longus and flexor carpi ulnaris tendons
Identify an accurate statement about the carrying angle.
It permits the forearms to clear the hips in the swinging movements during walking.
What is the point of origin of the supinator muscle?
Lateral epicondyle of the humerus and neighboring posterior part of the ulna
Match the two muscular disorders with their corresponding features. Instructions
Lateral epicondylitis = Associated with the extensor digitorum muscle near its origin on the lateral epicondyle Medial epicondylitis = Associated with the wrist flexor and pronator group near their origin on the medial epicondyle
What is the point of insertion of the brachioradialis muscle?
Lateral surface of the distal end of the radius at the styloid process
The palmaris longus muscle can be stretched by
Maximal elbow and wrist extension
What is the point of insertion of the triceps brachii muscle?
Olecranon process of the ulna
Match the movements of the thumb with their corresponding descriptions. Instructions
Opposition = Movement of the thumb across the palmar aspect to oppose any or all of the phalanges Reposition = Movement of the thumb as it returns to the anatomical position from opposition with the hand
Triceps Brachii Muscle
Origin: - long head: infraglenoid tubercle below inferior lip of glenoid fossa of scapula. - lateral head: upper half of the posterior surface of the humerus - medial head: distal two-thirds of posterior surface of the humerus application/strengthening/flexibility: - typical action is shown in push-ups when there is a powerful extension of the elbow - used in hand balancing and in any pushing movement involving the upper extremity - the long head is an important extensor of the GH joint - 2 muscles extend the elbow (triceps brachii and anconeus); push-ups demand strenuous contraction of these muscles - dips on parallel bars are more difficult to perform - bench pressing a BB or DB - overhead presses and tricep curls (elbow extensions from an overhead position) - stretched with both the shoulder and elbow in maximal flexion
Supinator Muscle
Origin: lateral epicondyle of the humerus and neighboring posterior part of the ulna application/strengthening/flexibility: - used in movements of extension and supination (when turning a screwdriver) - the curve in throwing a baseball uses the supinator as the elbow is extended just before the ball release - most isolated in activities that require supination with elbow extension bc the biceps assist with supination when the elbow is flexed - hands should be grasped and forearms extended in an attempt to supinate the forearms against the grip of the hands; this localizes to a degree, the action of the supinator - the hammer exercise (PT) may be modified to develop the supinator; in the beginning the forearm is supported and the hand is free off the table edge; the hammer is again held suspended out of the ulnar side of the hand hanging toward the floor; the forearm is then supinated to the palm-up position to strengthen the muscle - stretched when forearm is maximally pronated
Anconeus Muscle
Origin: posterior surface of lateral condyle of humerus application/strengthening/flexibility: - chief function is to pull synovial membrane of elbow joint out of the way of the advancing olecranon process during extension of the elbow - contracts along with triceps - strengthened with any elbow extension exercise against resistance - maximal elbow flexion stretches the anoconeus
What is the point of insertion of the palmaris longus muscle?
Palmar aponeurosis of the second, third, fourth, and fifth metacarpals
Where does the anconeus muscle originate?
Posterior surface of the lateral condyle of the humerus
Identify an action performed by the brachioradialis muscle?
Pronation of the forearm
Identify an action performed by the pronator quadratus muscle.
Pronation of the forearm
What is the point of origin of the flexor digitorum profundus muscle?
Proximal three-fourths of the anterior and medial ulna
Identify an action performed by the supinator muscle.
Supination of the forearm
Identify the bones that form the proximal row of the carpal bones. (Check all that apply.)
The scaphoid bone The lunate bone The triquetrum bone The pisiform bone
Identify an accurate statement about the elbow and radioulnar joints.
There is synergy between the glenohumeral joint, elbow joint, and the radioulnar joints.
In the context of movement in the elbow or the radioulnar joints, we depend on both the agonists and the antagonists in the surrounding joints to provide an appropriate amount of stabilization and assistance with the required task.
True
What is the point of insertion of the biceps brachii muscle?
Tuberosity of the radius and bicipital aponeurosis
Muscles
a common problem associated w elbow muscles: - "tennis elbow" = involves the extensor digitorum muscle near its origin on the lateral epicondyle aka *lateral epicondylitis* ; frequently associated with gripping and lifting activities - more recently depending upon the specific pathology, this condition may b e termed lateral epicondylagia or lateral epicondylosis
The chief function of the ______ muscle is to pull the synovial membrane of the elbow joint out of the way of the advancing olecranon process during extension of the elbow.
anconeus
______ muscle has its point of insertion in the posterior surface of the lateral olecranon process and proximal one-fourth of the ulna.
anconeus
All of the wrist flexors of the wrist and hand joints generally have their points of insertion on the
anterior aspect of the wrist and hand
Where can the biceps brachii be palpated?
anterior humerus
All of the wrist flexors of the wrist and hand joints generally have their origins on the _____ and the medial epicondyle of the humerus.
anteromedial aspect of the proximal forearm
______ muscle pulls on the ulna, which does not rotate, thus making this muscle the only pure flexor of this joint.
brachialis
______ is one of three muscles, sometimes known as the mobile wad of three, on the lateral forearm.
brachioradialis
______ muscle is favored in its action of flexion when the neutral position between pronation and supination is assumed.
brachioradialis
The bones of the hand and wrist joint form a bony arch that is spanned by the transverse carpal and volar carpal ligaments creating the
carpal tunnel
Conditions leading to swelling and inflammation in the carpal tunnel can result in increased pressure, which interferes with normal function of the median nerve, leading to reduced motor and sensory function of its distribution. This is known as
carpal tunnel syndrome
In an anatomical position, it is common for the forearm to deviate laterally from the arm from 5 to 15 degrees. This is referred to as the
carrying angle
The wrist joint is classified as a______ joint, allowing flexion, extension, abduction, and adduction.
condyloid-type
Joints
elbow joint: - ginglymus or hinge-type joint that allows only flexion and extension - in the anatomical position it is common for the forearm to deviate laterally from the arm between 5-15 degrees (*carrying angle*; permits the forearms to clear the hips in the swinging movements during walking. it is also important when carrying objects) radioulnar joint: - trochoid or pivot-type joint - radial head rotates around in its location at the proximal ulna. this rotary movement is accompanied by rotation of the distal radius around the distal ulna - the radial head is maintained in its joint by the annular ligament. the RU joint can supinate approximately 80-90 degrees from the neutral position. pronation varies from 70-90 degrees
In the context of elbow movements, the movement of the forearm away from the shoulder by straightening the elbow to increase its angle is known as
extension
The brachialis muscle can be stretched by
extension of the elbow with the shoulder relaxed and flexed
______ is the only muscle involved in extension of all four fingers.
extensor digitorum
______ muscle can be palpated on the posterior surface of the distal forearm immediately medial to the extensor pollicis longus tendon and lateral to the extensor carpi ulnaris and extensor digiti minimi.
extensor digitorum
______ muscle has its four tendons inserted to the bases of the middle and distal phalanxes of the four fingers.
extensor digitorum
to stretch the ______, the fingers must be maximally flexed at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints while the wrist is fully flexed.
extensor digitorum
In the context of elbow movements, the movement of the forearm to the shoulder by bending the elbow to decrease its angle is known as
flexion
Movements - wrist/hand
flexion (palmar flexion): movement of the palm of the hand and/or the phalanges toward the anterior or volar aspect of the forearm extension (dorsiflexion): movement of the back of the hand and/or the phalanges toward the posterior or dorsal aspect of the forearm; sometimes referred to as a hyperextension abduction (radial deviation, radial flexion): movement of the thumb side of the hand toward the lateral aspect or radial side of the forearm; also movement of the fingers away from the middle finger adduction (ulnar deviation, ulnar flexion): movement of the little finger side of the hand toward the the medial aspect or ulnar side of the forearm; also, movement of the fingers back together toward the middle finger opposition: movement of thumb across the palmar aspect to oppose any or all of the phalanges reposition: movement of the thumb as it returns to the anatomical position from opposition with the hand and/or fingers
Elbow Movements
flexion: movement of the forearm to the shoulder by bending the elbow to decrease its angle extension: movement of the forearm away from the shoulder by straightening the elbow to increase its angle
______ is used in any type of gripping, squeezing, or hand-clenching activity, such as gripping a racket or climbing a rope.
flexor digitorum profundus
______ muscle assists in wrist flexion because of its palmar relationship to the wrist.
flexor digitorum profundus
______ muscle is stretched by passively extending the elbow, wrist, metacarpophalangeal, and proximal interphalangeal joints while maintaining the forearm in full supination.
flexor digitorum superficialis
______ muscle, also known as the flexor digitorum sublimis, divides into four tendons on the palmar aspect of the wrist and hand to insert on each of the four fingers.
flexor digitorum superficialis
The flexor carpi radialis is one of the most powerful of the wrist
flexors
The pronator teres muscle is stretched by
full extension of the elbow while taking the forearm into full supination
The metacarpophalangeal (MCP) joints are classified as condyloid, whereas the proximal interphalangeal (PIP) joints and the distal interphalangeal (DIP) joints are classified as
ginglymus
The elbow joint is classified as a ______ joint.
hinge-type
In the elbow and radioulnar joints, the scapula and ______ serve as the proximal attachments for the muscles that flex and extend the elbow.
humerus
extensor digitorum muscle
insertion: 4 tendons to bases of middle and distal phalanxes of the 4 fingers (dorsal surface) application/strengthening/flexibility: - ED aka extensor digitorum communis, only muscle involved in extension of all 4 fingers. divides into 4 tendons on the dorsum of the wrist to insert on each of the fingers. it also assists with wrist extension movements. it may be developed b y applying manual resistance to the dorsal aspect of the flexed fingers and then extending the fingers fully. when performed with wrist in flexion, this exercise increases the workload on the extensor digitorum - to stretch ED, the fingers must be maximally flexed at the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints while the wrist is fully flexed
flexor digitorum superficialis muscle
insertion: each tendon splits and attaches to the sides of the middle phalanx of the 4 fingers (palmar surface) application/strengthening/flexibility: - FDS aka flexor digitorum sublimis, divides into 4 tendons on the palmar aspect of the wrist and hand to insert on each of the 4 fingers. FDS and FDP are the only muscles involved in flexion of all four fingers. both of these muscles are vital in any type of gripping activity - squeezing a sponge rubber ball in the palm of the hand, along with other gripping and squeezing activities, can be used to develop these muscles - stretched by passively extending the elbow, wrist, metacarpophalangeal and proximal interphalangeal joints while maintaining the forearm in full supination
A common problem associated with the muscles of the elbow is tennis elbow, known technically as ______ _____ , and is quite frequently associated with gripping and lifting activities.
later epicondylitis
The biceps brachii muscle can be stretched by
maximal extension of the elbow with the shoulder in full extension
The triceps brachii can be stretched by
maximal flexion of both the shoulder and the elbow
The anconeus muscle can be stretched by
maximal flexion of the elbow
The brachioradialis muscle can be stretched by _____.
maximally extending the elbow with the shoulder in flexion and the forearm in maximal pronation
The supinator muscle is stretched by
maximally pronating the forearm
Biceps Brachii
origin: - long head: supraglenoid tubercle above the superior lip of the glenoid fossa - short head: coracoid process of the scapula and upper lip of the glenoid fossa in conjunction with the proximal attachment of the coracobrachialis application/strengthening/flexibility: - forearm flexion with a BB in hands ("curling"); can be performed one arm at a time with DB or both arms simultaneously w BB - powerful forearm flexion with chinning and rope climbing - due to multiarticular orientation of biceps brachii, all 3 joints must be positioned appropriately to achieve optimal stretching; elbow must be extended maximally with the shoulder in full extension - biceps also stretched by beginning with full elbow extension an d progressing in to full horizontal abduction at ~ 70-110 degrees of shoulder abduction - in all cases, the forearm should be fully pronated to achieve maximal lengthening of biceps brachii
Pronator Teres Muscle
origin: Distal part of medial condyloid ridge of humerus and medial side of proximal ulna application/strengthening/flexibility: - typical movement of pronator teres is with forearm pronating as elbow flexes - movement is weaker in flexion w supination - use of PT alone in movements tends to bring the back of the hand to the face as it contracts - pronation of the forearm w a DB in the hand localizes action and develops the PT - holding a hammer in the hand with the hammer head suspended from the ulnar side of the hand while the forearm is supported on a disk or table helps strengthen PT; hammer should be hanging toward the floor, followed by fully pronating to a palm-down position against the resistance of the hammer - elbow must be fully extended while taking the forearm into full supination to stretch the pronator teres
Pronator Quadratus Muscle
origin: distal fourth of anterior side of ulna application/strengthening/flexibility: - works in. pronating forearm in combo with triceps in extending the elbow - commonly used in turning a screwdriver, as in taking out a screw (with right hand), when extension and pronation are needed - also used in throwing a screwball, when extension and pronation are needed - may be developed with similar pronation exercises against resistance, as described for PT - PQ best stretched using a partner to grasp the wrist and passively take the forearm into extreme supination
Brachialis Muscle
origin: distal half of the anterior shaft of the humerus application/strengthening/flexibility: - used along with other flexor muscles regardless of pronation or supination; it pulls on the ulna which does not rotate, thus making this muscle the only pure flexor of this joint - used whenever the elbow flexes - exercised along with elbow curling exercises, as described for biceps brachii, pronator teres, and brachioradialis - elbow flexion activities with the forearm pronated isolate the brachialis to some extent by reducing the effectiveness of biceps brachii - since its a pure flexor of the elbow, it can be stretched maximally only by extending the elbow with the shoulder relaxed and flexed - forearm positioning should not affect the stretch on the brachialis unless the forearm musculature itself limits elbow extension, in which case the forearm is probably best positioned in neutral
Brachioradialis Muscle
origin: distal two-thirds of the lateral supracondylar ridge of the humerus application/strengthening/flexibility: - 1/3 muscles known as the mobile wad of three (other two are extensor carpi radialis brevis and extensor carpi radialis longus, to which it lies directly anterior) - acts as a flexor best in mid-position or neural position between pronation and supination - in a supinated position of forearm, it tends to pronate as it flexes - in a pronated position, it tends to supinate as it flexes - favored in its action of flexion when the neutral position between pronation and supination is assumed, as previously suggested - its insertion at the end of the radius makes it a strong elbow flexor - its ability as a supinator decreases as the RU joint moves toward neutral; similarly its ability to pronate decreases as the forearm reaches neutral - bc of its action of rotating the forearm to a neutral thumb-up position, it is referred to as the hitchhiker muscle (although it has no thumb action) - nearly all muscles originating off the lateral epicondyle have some action as weak elbow extensors, this is not the case with brachioradialis due to its line of pull being anterior to the elbow's maxis of rotation - may be strengthened by performing elbow curl's against resistance, particularly with the RU joint in neutral position - may be developed by performing pronation and supination movements through the full ROM against resistance - stretched by maximally extending the elbow with the shoulder in flexion and the forearm in either maximal pronation or maximal supination
palmaris longus muscle
origin: medial epicondyle of humerus application/strengthening/flexibility: - unlike the FCR and FCU, which are not only wrist flexors but also abductors and adductors, respectively, the PL is involved only in wrist flexion from the anatomical position bc of its central location on t he anterior forearm and wrist. it can, however, assist in abducting the wrist from an extremely adducted position back to neutral. it may also assist slightly in forearm pronation bc of its slightly lateral insertion in relation to its origin on the medial epicondyle. it may be also b e strengthened with any type of wrist-curling activity, such as those described for the FCR - maximal elbow and wrist extension stretches PL
flexor carpi radialis muscle
origin: medial epicondyle of the humerus application/strengthening/flexibility: - FCR, FCU, and PL are most powerful wrist flexors; brought into play during any activity that requires wrist curling or stabilization of the wrist against resistance, particularly if the forearm is supinated - wrist curls against a handheld resistance
flexor digitorum profundus muscle
origin: proximal three-fourths of the anterior and medial ulna application/strengthening/flexibility: - both the FDP and FDS assist in wrist flexion bc of their palmar relationship to the wrist. the FDP is used in any type of gripping, squeezing, or handclenching activity, such as gripping a racket or climbing a rope
The pronator quadratus is best stretched by
passively taking the forearm into extreme supination
The flexor carpi radialis may be developed by
performing wrist curls against a handheld resistance
The radioulnar joint is classified as a _____ joint.
pivot-type
The wrist extensors of the wrist and hand joints generally have their points of insertion on the
posterior aspect of the wrist and hand
The wrist extensors of the wrist and hand joints generally have their origins on the
posterolateral aspect of the proximal forearm and the lateral humeral epicondyle
In the context of radioulnar joint movements, internal rotary movement of the radius on the ulna that results in the hand moving from the palm-up to the palm-down position is known as
pronation
Identify the movements that occur in the radioulnar joint. (More than one option may be correct.)
pronation supination
Radioulnar Joint Movements
pronation: internal rotary movement of the radius on the ulna that results in the hand moving from the palm-up to the palm-down position supination: external rotary movement of the radius on the ulna that results in the hand moving from the palm-down to the palm-up position
______ muscle works in pronating the forearm in combination with the triceps in extending the elbow.
pronator quadratus
Typical movement of the ______ muscle is with the forearm pronating as the elbow flexes.
pronator teres
______ muscle originates in the distal part of the medial supracondylar ridge of the humerus and medial side of the proximal ulna.
pronator teres
Typical action of the triceps brachii is shown in ______ when there is powerful extension of the elbow.
push-ups
In the elbow and radioulnar joints, the ulna and ____________ serve as the distal attachments for the muscles that flex and extend the elbow.
radius
In the context of radioulnar joint movements, external rotary movement of the radius on the ulna that results in the hand moving from the palm-down to the palm-up position is known as
supination
______ muscle is called into play when movements of extension and supination are required, as when turning a screwdriver.
supinator
All of the flexor tendons of the hand and wrist joints except for the flexor carpi ulnaris and palmaris longus pass through the carpal tunnel, along with the median nerve.
true
The palmaris longus is involved only in ______ from the anatomical position because of its central location on the anterior forearm and wrist.
wrist flexion