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The Hand

• We will start off at the hand. You will need an understanding of the bones that make up our hand, because they will act as insertion points for the forearm muscles

Ulna

RadiusCarpals

Metacarpals

Phalanges

The Forearm• is the area of the appendicular skeleton stretching from the elbow to the wrist

- let’s take a look at the skeletal components of the forearm

ULNA

RADIUS

Radial tuberosity

Neck

Head

Coronoid process

Olecranon process

Styloid process

Interosseus membrane

The Forearm• is the area of the appendicular skeleton stretching from the elbow to the wrist

- let’s take a look at the skeletal components of the forearm

• we need to view the movement of the forearm from 2 different angles

• At the elbow, the forearm is dominantly the ulna

• At the wrist, the forearm is dominantly the radius

Upon supination

• SUPINATION is a very important movement of the forearm

• radius spins on its axis at the elbow, but orbits around the head of the ulna at the wrist

• movement stops when radius buts up against the ulna

- The humerus is a long bone that connects the shoulder (scapula) and the lower arm (radius and ulna)

Posterior Anterior

HeadGreater Tubercle

Greater Tubercle

Anatomical neckSurgical neck

Lesser Tubercle

Deltoid Tuberosity

Olecranon fossaCoronoid

fossa

Trochlea

Medial epicondyle

Lateral epicondyle

Capitulum

Tubercle:

Fossa:

Trochlea:

A round nodule or “warty” outgrowth of a bone

A depression or hollow on a bone

A grooved structure resembling a “pulley wheel”

Posterior Muscles of the Forearm

Extensor carpi radialis longus

O: above lateral epicondyle of humerus

I: base of 2nd metacarpal

F: extend and abduct wrist

Extensor carpi ulnaris

O: lateral epicondyle of humerus and ulna

I: base of 5th metacarpal

F: extends and adducts wrist

Extensor digitum

O: lateral epicondyle of the humerus

I: all digits except thumb

F: extends interphalangeal joints (fingers)

Extensor carpi radialis brevis

O: lateral epicondyle of humerus

I: base of 3rd metacarpal

F: extends and abducts the wrist

Flexor carpi ulnaris

O: 2 heads: 1 medial epicondyle, 1 olecranon

I: base of 5th metacarpal

F: flexes and adducts the wristThenar Eminence: muscles proximal to thumb (3)

-flex, adduct and oppose thumb

Hypothenar Eminence: muscles proximal to little finger (3)

-abduct, flex, oppose little finger

Anterior Muscles of the Forearm

Biceps brachiiBrachialis

O: lower anterior humerus

I: coronoid process ulna

F: flexes elbow

Supinator

O: Lateral epicondyle humerus

I: anterior & lateral aspect of radius

F: Supinating forearm

Pronator teres

O: medial epicondyle humerus and coronoid process of ulna

I: lateral surface of mid radius

F: pronates forearm/ flex elbow

Brachioradialis

O: above lateral epicondyle humerus

I: styloid process radius

F: elbow flexor

Flexor carpi radialis

O: medial epicondyle humerus

I: second metacarpal (index)

F: flexes and abducts handFlexor carpi ulnaris

Pronator quadratus

O: anterior surface of distal ulna

I: anterior surface of distal radialis

F: pronates forearm

Forearm Flexors:

Part I -http://www.youtube.com/watch?v=DIwO1ld7vM8&feature=related

Part II -http://www.youtube.com/watch?v=QSy9MB69AkM&feature=related

Forearm Extensors:

Part I -http://www.youtube.com/watch?v=Cw3xr8_rLMU&feature=related

Part II -http://www.youtube.com/watch?v=XObJNybS1-I&feature=related

Upper Arm: http://www.youtube.com/watch?v=vnb2iTnlAN0&feature=related

Shoulder:

Part I -http://www.youtube.com/watch?v=t5sLRGQ_Ews&feature=related

Part II -http://www.youtube.com/watch?v=FDxe1hdHrHY&feature=related

. . .a hinge joint formed by the articulation of the humerus of the arm and the ulna and radius of the forearm

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Radial collateral ligament

(prevents excessive adbuction)

Ulnar collateral ligament

(prevents excessive adduction)

Elbow Ligaments

-video

(maintains articulation of radius with humerus)

Tennis Elbow (lateral epicondylitis)

-extensor carpi radialis brevis

-chronic pain on lateral side of elbow

- RICE & Physio -video

. . .three bones (clavicle, scapula and humerus) articulate forming this ball and socket joint

Inferior angle

Superior angle

Medial border

Muscles of the Upper Arm What view?

Anterior

Corachobrachialis

O: coracoid process

I: medial aspect of humerus

F: flexes and adducts arm

Biceps brachii

O: short head –coracoid process; long head –supraglenoid tubercle

I: radial tuberosity (radius)

F: flexes supined elbow, supinationBrachialis

Brachioradialis

Teres major

O: inferior lateral border of scapula

I: humerus

F: medial rotation, adduction and extension of upper arm

Triceps brachii

O: lateral head –posterior aspect of humerus; long head –infraglenoid tubercle of scapula; medial head –posterior aspect of humerus

I: olecranon process

F: extends arm

Posterior head

Lateral head

Anterior head

Deltoid

O: clavicle, acromium and spine of scapula

I: deltoid tuberosity of the humerus

F: anterior –flexes and medially rotates; lateral –abducts the arm; posterior –extends and laterally rotates arm

Forearm Flexors:

Part I -http://www.youtube.com/watch?v=DIwO1ld7vM8&feature=related

Part II -http://www.youtube.com/watch?v=QSy9MB69AkM&feature=related

Forearm Extensors:

Part I -http://www.youtube.com/watch?v=Cw3xr8_rLMU&feature=related

Part II -http://www.youtube.com/watch?v=XObJNybS1-I&feature=related

Upper Arm: http://www.youtube.com/watch?v=vnb2iTnlAN0&feature=related

Shoulder:

Part I -http://www.youtube.com/watch?v=t5sLRGQ_Ews&feature=related

Part II -http://www.youtube.com/watch?v=FDxe1hdHrHY&feature=related

-there are really 3 joints in the shoulder:

• glenohumeral

• acromioclavicular

• sternoclavicular

- The shoulder must be flexible for the wide range of motion required in the arms and hands and also strong enough to allow for actions such as lifting, pushing and pulling. The compromise between these two functions results in a large number of shoulder problems

Ligaments of the Shoulder Joint

Coracoclavicular ligament

Coracoacromial ligament

Superior glenohumeral ligament

Medial glenohumeral ligament

Inferior glenohumeral ligament

There is also a synovial fluid-filled capsule that encompasses the shoulder (attaches to the scapula, humerus and head of biceps) . The capsule is strengthened by the coracohumeral ligament

Muscles of the Rotator Cuff- a group of muscles that extend from the scapula to the humerus and wrap around the shoulder joint basically holding it in place

FRONT BACK

Subscapularis

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

O: anterior surface of the scapula

I: Lesser tubercle of the humerus

F: medially rotates humerus; stabilizes shoulder

Supraspinatus

O: posterior surface of scapula above spine

Infraspinatus

O: poseterior surface of scapula below spine

Teres Minor

O: later border of scapula

Insertion: all fuse to form tendon inserting on greater tubercle of humerus

F: stabilize the shoulder; supra–abducts shoulder, infra and teres–laterally rotate shoulder

Forearm Flexors:

Part I -http://www.youtube.com/watch?v=DIwO1ld7vM8&feature=related

Part II -http://www.youtube.com/watch?v=QSy9MB69AkM&feature=related

Forearm Extensors:

Part I -http://www.youtube.com/watch?v=Cw3xr8_rLMU&feature=related

Part II -http://www.youtube.com/watch?v=XObJNybS1-I&feature=related

Upper Arm: http://www.youtube.com/watch?v=vnb2iTnlAN0&feature=related

Shoulder:

Part I -http://www.youtube.com/watch?v=t5sLRGQ_Ews&feature=related

Part II -http://www.youtube.com/watch?v=FDxe1hdHrHY&feature=related

Rotator Cuff Tears• The rotator cuff is made up of 4 different muscles: supraspinatus, infraspinatus, subscapularis and teres minor.

•The term “cuff” refers to how the muscles cover the head of the humerus

• May be ACUTE or CHRONIC

Due to overheard

motions

Rotator Cuff Tears• The rotator cuff is made up of 4 different muscles: supraspinatus, infraspinatus, subscapularis and teres minor.

•The term “cuff” refers to how the muscles cover the head of the humerus

• May be ACUTE or CHRONIC

Due to overhead motions

• Symptoms:

-pain in front of shoulder radiating down the arm (acute) “snapping”

-pain when lifting/lowering arm

-weakness in arm

- crepitus “cracking” sound on movement

** symptoms may emerge gradually if tear is a product of overuse (chronic) **

-video

Treatment

- the vast majority of rotator cuff tears can be treated without surgery

Non-operative treatments include:

-physical therapy

-anti inflammatory medications

-cortisone shots

-reduce inflammation, strengthen uninjured muscles around joint to compensate for injured muscles

If surgery is necessary:

-different options depending on severity, location of tear, physical activity level of patient and hopes for future use

-proper rehab, stretching, avoiding movements that could reinjure the tendons