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DrNGrossTest3
Brachial plexus and extemities
| Question | Answer |
|---|---|
| What are the two soft tissue compartments of the brachium, and what do they do? | anterior (flexor) and posterior (extensor) |
| What separates the compartments of the brachium? | intermuscular septum |
| What is the purpose for body compartments? | prevents the spead of disease and allows for some function in case of an injury |
| Posterior compartment muscles | Triceps brachii (long, lateral, and medial heads) |
| Which of the triceps muscles crosses 2 joints, and what are those joints? | Long head, crosses the shoulder and elbow joints |
| In relation to the radial nerve where do the triceps muscles lie? | lateral lies above the nerve, and the medial lies below it |
| What kind of muscle are the triceps muscles? | Pennate muscles |
| Attachements of Triceps muscles | infraglenoid tubercle (long); humeral shaft (lateral and medial); insert: olecranon process of ulna (all) |
| Triceps functions | extension of the shoulder, extension of the elbow, stabilize inferior part of the shoulder joint in full abduction |
| What exercises can work the triceps muscles? | push-ups and push-downs |
| What is the function of the triceps if you reverse the attachment points? | movement of the trunk around a fixed point, in this case, the arm. |
| Anterior compartment muscles | Biceps brachii (long and short head), brachialis, and coracobrachialis |
| Which of the anterior compartment muscles cross two joints, and what are those joints? | Biceps (long and short heads) cross the elbow and ahoulder joints |
| What 3 muscles attach to the coracoid process? | pec minor, coracobrachialis, and short head of the biceps |
| Biceps attachments | O: supraglenoid tubercle and coracoid (short) I: radial tuberosity and fascia of medial forearm |
| The biceps act as an antagonist to what muscle? | triceps |
| Biceps Functions | flexion of the shoulder(short head), flexion of the elbow (forearm supinated), supination of forearm, stabilizes anterior portion of shoulder joint (tendon of the long head) |
| Supination | moiving the hand into the palm up position, radius and ulna are parallel |
| Pronation | moving of the hand into a palm down position, crossing the radius and ulna |
| Brachialis Attachments | O: anterior humeral shaft I: ulnar tuberosity |
| Brachialis lies deep to what muscle? | biceps |
| Brachialis Functions | flexion of the elbow (all positions of the forearm) |
| What exercises work the brachialis and biceps muscles? | Biceps: palm up curls Brachialis: palm down curls |
| Corachobrachialis attachments | O:coracoid of scapula I:humeral shaft |
| Coracobrachialis functions | flexion of the shoulder, elevation of the humerus |
| When flexing the shoulder, what muscle does coracobrachialis act as a synergist with? | short head of biceps |
| When elevating the humerus, the coracobrachialis acts as a synergist with what muscle? | deltoid (to prevent anterior translation of the humeral head) |
| Musculocutaneous nerve innervates__________ | the anterior brachial muscles (biceps, brachialis and coracobrachialis) |
| When the musculocutaneous nerve crosses the elbow joint it becomes the ___________ | lateral antebrachial cutaneous nerve |
| Extensor muscle origins | common extensor tendon, lateral supercondylar crest of humerus, posterior surfaces of radial and ulnar shafts, posterior surface of interosseous membrane |
| Extensor muscle insertions | MC's, phalanges, radial shaft, proximal ulna |
| Supinator and brachioradialis insertions | radial shaft |
| Anconeus insertion | proximal ulna |
| What innervates the extensor muscles? | radial nerve |
| True or False: Forearm flexors and extensors are major movers of the elbow | FALSE: forearm flexors and extensors are NOT able to move the elbow, even though they corss it |
| What is the major effect of forearm flexors and extensors on the elbow? | Stabilizers |
| Why is the brachial plexus important to OT | Because it innervates the entire upper extremity |
| What is the brachial plexus made of? | Ventral rami |
| What is the brachial plexus? | it is an intersection of cross-trading fibers of multiple spinal levels that lies deep to BOTH pec. mm. and exits between than anterior and middle scalenes |
| What structures run with the brachial plexus? | axillary a. and v. |
| Redundancy allows for__________ | continued function if there is an injury at one or more spinal levels |
| Ventral rami also form ________ | intercostal nerves |
| What causes costoclavicular Syndromes? | A depression or compression of the clavicle toward the first rib that may impinge the nerves against the rib |
| What are some effects of costoclavicular syndromes? | possible motor and sensory deficits |
| What is a common cause of costoclavicular syndromes? | heavy backpacks that compress the clavicle to the first rib |
| Ventral rami innervate: | limbs, front and side of trunk |
| Dosal rami innervate | back of trunk (erector spinae and skin)q |
| Parts of the brachial plexus | Roots, trunks, divisions, cords, and branches |
| Roots=_________ | Ventral ramiof C5-T1 (sometimes C4 & T2 are included) |
| Trunks | "1st plexus," formed by the intersection of roots: superior, middle, inferior |
| What roots make up the superior trunk? | C5+C6 |
| What roots make up the middle trunk? | C7 |
| What roots make up the inferior trunk? | C8+T1 |
| What trunk lies on rib 1? | inferior trunk |
| Which trunk is most likely to be affected by costoclavicular impingement? | Inferior trunk |
| Divisions | formed by the splitting of each trunk, forming 1 anterior and 1 posterior divisions for a total of 6 divisions (3 ant. & 3 post.) |
| When referring to divisions, their positons are relative to | their position to the axillary a. |
| Cords | formed by merger of divisions and are named due to their position around the axillary a. |
| Lateral cords | most superior, from 2 upper ant. divisions |
| Posterior Cords | behind axillary a. and formed from all 3 posterior divisions |
| Medial cords | most inferior, anterior division of lower division only |
| Branches | Named nerves, 5 major branches: musculocutaneous, median, ulnar, radial, axillary |
| Which branches for the "M" of the brachial plexus? | Musculocutaneous, median, and ulnar |
| Where is the antebrachium located? | forearm: from elbow to wrist |
| What are the soft tissue compartments of the antebrachium and what do they do? | anterior (flexor)& posterior (extensor) |
| What separeates the compartments of the antebrachium? | radius, ulna, and interosseus membrane |
| Antebrachial fascia is located_________ | below the skin but above the mm. and envelopes the entire forearm |
| What are the functions of the antebrachial fascia? | assist in venous return of blood to the heart; helps to direct/ contain muscle tendons and actions |
| How many muscles are there in the flexor compartment of the antebrchium? | 8 total |
| what are the flexor compartment muscles of the antebrachium responsible for? | flexion of the wrist and fingers; 2 pronate the forearm |
| True or False: Flexor compartment muscles have multiple tendons. | True! |
| How many forearm flexor compartment muscles cross the wrist? | 12 (6mm) |
| How many forearm flexor tendons go through the carpal tunnel? | 10 tendons (4 mm) |
| Why are the muscle bellies of the forearm extensors closer to the elbow than the wrist? | allows for more power because the bulk of the m. is close to the fulcrum (elbow) allowing for less NGR usage |
| Forearm flexor muscle origins (as a group) | common flexor tendon, medial epicondyle of humerus; ant. surfaces of radial and ulnar shafts; ant. surface of interosseus membrane |
| Forearm flexor muscle insertions (as a group) | carpals, MCs, phalanges; radial shaft |
| Innervation of the forearm flexors | median and ulnar nn |
| What are the forearm extensor compartment muscles responsible for? | extension of the wrist and fingers; supination of the forearm, flexion of the elbow, deviation of the ulna |
| Which extensor muscle supinates the forearm? | Supinator |
| Which forearm extensor flexes the elbow? | brachioradialis |
| Which forearm extensor deviates the ulna? | anconeus |
| How many forearm extensor muscles are there? | 12 |
| How many forearm extensor tendons cross the wrist? | 9mm = 12 tendons |
| What 3 forearm extensor mm. do not cross the wrist? | supinator, anconeus, and brachioradialis |
| Forearm extensor muscle origins | common extensor tendon, lateral epicondyle of the humerus; lateral supracondylar crest of humerus; post. surfaces of radial and ulnar shafts; post. surface of interosseous membrane |
| Forearm extensor muscle insertions | MCs, radial shaft (supinator & brachioradialis); proximal ulna (anconeus) |
| Innervation of the forearm extensors | radial n |
| True of False: Most forearm extensors cross the elbow, but they do not move it. | True; at most they serve as stabilizers; Exceptions: brachioradialis, anconeus(?), extensor carpi radialis longus |
| Extensor carpi radialis longus is responsible for________ | flexion of the elbow because it crosses in front of the elbow |
| Anconeus functions | extension of the elbow; radial deviation of the ulna in pronations |
| What is radial deviation? | moving toward the radius |
| What is ulnar deviation? | moving toward the ulna |
| The elbow joint is made up of the intersection of _____ bones | 3 |
| In the elbow, the radius has free rotary motion on the _________, and is restricted to ___ degree of freedom on its ________ | capitulum, 1, long axis |
| In the elbow, the articulation between the ulna and the trochlea is what kind of joint? | Condylar or hinge joint |
| The articulation of the radius on the capitulum is what kind of joint? | ball and socket |
| When are hinge joints in close-packed positions? | full stability |
| Elbow ligaments | joint capsule, ulnar lig., radial collateral lig., annular lig. |
| Where is the annular ligament located? | surronding the head of the radius , keeping it on the head of the capitulum |
| When is the radial collateral ligament slack? | in the flexed position |
| Where is the radial collateral lig. located? | on the outside of the hinge joint |
| In general, collateral ligaments___________ | are found at hinge joints in the limbs, are normally tightest in extension, stabilize the joint whe it's subjected to greatest loads |
| What are the elbow bursae? | Subtendinous bursa and subcutaneous bursa |
| The subtendinous bursa___________ | us below the tendon of the triceps and allows the radius to move easily |
| The subcutaneous bursa_____________ | act as a buffer between the humerus, radius and ulna whe the elbo is in full flexion |
| The shafts of the radius and ulna form what kind of joint along their lengths? | syndemosis joint |
| The interosseous membrane fibers are _______, and run primarily in what 2 directions? | oblique, distally toward the radius and distally toward the ulna |
| The interosseous membrane fibers are tightest in the ___________ | anatomical position |
| In the interosseous membrane, the fibers running distally to the radius are called | oblique cord (proximally) |
| The oblique cord prevents what? | traction of the radius/hand |
| When does dislocation of the radius occur during a traction injury? | when there is an impingement of the annular ligament between the radius and capitulum |
| In the interosseous membrane, the firbers running distally toward the ulna________ | make up the bulk of the membrane, prevent compression of the radius against the humerus |
| Compression of the radius occurs when | the radius is driven in front of or to the side of the humerus |
| What 2 "linked" elements comrise the forearm? | (humerus + ulna) + (radius+manus) |
| Pronation/supination is | the movementof the RM around the HU |
| What are the major grips of the hand? | power and precision |
| When would you use a power grip? | when holding/using a hammer or squeezing an object |
| When is a precision grip most often used? | writing |
| When does the strongest power grip occur? | when the wrist is slightly extended (extensor tendons are loose, flexor tendons are tight) |
| True or false: forced flexion of the wrist weakens the power grip | True |
| When is full extension of the fingers possible? | when the wrist is slightly flexed |
| How many carpals are in the wrist? | 8; 4 in the proximal row & 4 in the distal row |
| The proximal row of carpals attach to | the radius |
| The distal of the carpals ________ | supports finger |
| Proximal row carpals | scaphoid, lunate, triangular, pisiform |
| Distal row of carpals | trapezium, trapezoid, capitate, hamate |
| How many articulations are there between the carpals and metacarpals? | 4- digits 4 and 5 both articulate with the hamate |
| What are the arches of the hand? | longitudinal and transverse |
| The longitudinal arch is | the natural curve from the wrist to the fingers; concave palm; conforms to objects graspes |
| The transverse arch is | concave on the palm side, protects the nerves and vessels; runs transversely to longitudinal arch |
| What makes up the transverse arch? | wedge shaped carpals (proximal and distal) |
| Without soft tissue, what will happen to the transverse arch? | it will fall apart ("fallen arches") |
| What structure maintains the transverse arch? | flexor retinaculum |
| Attachment points of the flexor retinaculum | scaphoid tubercle, pisiform, trapezium tubercle, hook of the hamate |
| What structures are part of the radiocarpal joint? | the radius, lunate, scaphoid, triangular fibrocartilage, and triangular |
| Separates the ulna from the triangular bone | triangular fibrocartilage |
| The ulna articulates with the radius at __________ | the radius at the distal radioulnar joint |
| What kind of joint is the wrist? | Condylar (hinge) |
| Motions of the radiocarpal joint | flexion/ extension (primary), radial/ulnar deviation, circumductions |
| Which has more movement, radial or ulnar deviation? | ULNAR |
| Ligaments of the wrist | Flexor retinaculum, extensor retinaculum, collateral lig., radiocarpal lig., ulnocarpal lig., intercarpal lig. |
| True or False: Since the wrist is a hinge joint, it has the same limited movement as other hinge joints such as the knee. | FALSE: it has more movement |
| Collateral Ligaments | usually found at hinge joints |
| Collateral ligaments of the wrist | radial and ulnar collateral ligaments and run from each bones' styloid processes to the carpals |
| Function of collateral ligaments_ | prevents excessive deviation of the wrist. |
| Deep palmar ligaments | palmar radiocarpal lig., palmar ulnocarpal lig., prevents hyperEXTENSION of the wrist |
| During supination of the hand, the _________ligament tightens | radiocarpal |
| What ligaments are most frequently injured when you fall? | palmar ligaments |
| Deep Dorsal ligaments | dorsal radiocarpal, dorsal ulnocarpal, prevent hyperFLEXION of the wrist |
| When the wrist is in pronation, what ligament is the tightest? | dorsal radiocarpal lig. |
| Intercarpal ligaments | bind together adjacent carpal bones to maintain stability of the wrist |
| Fractures of the wrist | Colle's (radius), Smith's (radius), scaphoid, lunate dislocation (palmar) |
| In a Colle's fracture______ | the wrist hyperEXTENDS and the fractured fragment moves dorsally |
| In a Smith's fracture______ | the wrist hyperFLEXES and the fractures fragment moves palmarly |
| Also called a dinner fork fracture: | Colle's fracture |
| This fracture usually coincides with a Colle's fracture. | Scaphoid, usually at its narrow center. Can lead to necrosis in the upper half of the bone and must be surgically removed |
| Lunate dislocation | the lunate "pops" out of position in a hyperFLEXION injury. The ligament tears, causing an anterior dislocation into the carpal tunnel. If both ligaments tear, it can lead to necrosis and must be surgically removed |
| Joints of the fingers: | CM, MP (ball & socket), PIP (hinge), DIP (hinge), IP |
| Which joint of the hand is a saddle-shape? | Between the trapezium and MC1 (thumb) |
| The saddle shaped joint allows | the thumb the ability to oppose |
| Motions of the thumb | extension, flexion, abduction, adduction, opposition, reposition |
| Extension of the thumb | hitch-hiking |
| Flexion of the thumb | Thumb across palm |
| abduction of the thumb | thumb away from palm in plane of the index finger |
| adduction of the thumb | thumb toward the base of the index finger |
| Opposition of the thumb | pads of thumb and finger come together |
| Reposition of thumb | moves thumb back to anatomical position |
| Motions of the metacarpals | MC1: highly mobile, MC2 & 3: fixed, MC4: slight opposition, MC5: moderate opposition |
| Structural center of the hand | MC 2 &3 |
| Ligaments of the fingers | carpometacarpal, (inter)metacarpal, palmar, and collateral |
| Carpometacarpal ligaments | at palmar and dorsal CM joints |
| Intermetacarpal ligaments | between MC bases |
| Palmar ligaments | at MP & IP joints |
| Collateral ligaments | fan-like at volar plates, cord-like into bone |
| MP collateral lig. | Tightest in FLEXION, preventing abduction in power grip |
| PIP and DIP collateral lig. | tightest in EXTENSION, prevents collapse when using finger as a probe |
| Fracture of the finger | Boxer's fracture (MC4 or 5) |
| What is Boxer's fracture? | When MC 4 and/or 5 hit something off center and are fractured, bones will heal curved toward the palmar side of hand, and there will be no nerve damage |
| Intrinsic muscles of the hand arise . . . | from within the hand, but do NOT cross the wrist |
| Intrinsic muscles of the hand - GROUPS | Thenar, hypothenar, lumbricals, interossei |
| How many thenar muscles are there and what are their names? | 4: ABductor pollicus brevis, opponens pollicus, flexor pollicus brevis, ADductor pollicus |
| The thenar muscles form the ________, are responsible for _______, and are innervated by________ | thenar eminence, movement of the thumb, both ulnar and median nerves |
| The hyporthenar muscles form the _______, are responsible for ______ and ________, and are innervated by the ___________. | hypothenar eminence, moving the pinkie and corrugating the skin over the eminence, ulnar nerve |
| How many hypothenar muscles are there, and what are their names? | 4; palmaris brevis, ABductor digiti minimi, flexor digiti minimi, opponens digiti minimi |
| Palmaris brevis functions | corrugates the skin, but does NOT move the pinkie |
| Substitute for ADductor in hyporthenar eminence | palmaris brevis |
| Lumbrical attachments | O: FDP tendons; I: extensor hoods on RADIAL sides of digits 2-5 |
| Lumbrical functions | Flex MP joints and Extend IP joints |
| Lumbrical Innervation | #'s 1 and 2 - MEDIAN; #'s 3 and 4 - ULNAR |
| What dance do the lumbricals allow you to do (in part) | the chicken dance (chicken hands!) |
| How many interossei muscles are there? | 7 that are divided into two groups |
| Palmar interossei attachments | O: MC shafts facing the middle digit; I: extensor hood phalanges |
| Palmar inerossei functions | ADduct digits 2,4, and 5, EXTENDS IP joints |
| What muscle is responsible for ADduction of the thumb? | adductor pollicus |
| The middle finger only ________ | ABducts because it is the "midline" of the had |
| Dorsal interossei muscle attachments | O: MC shafts; I: extensor hoods |
| Dorsal interossei functions | ABduct digits 2, 3, and 4, assist in extension of IP joints |
| Which digit has 2 dorsal interossei muscles and why? | the middle finger (digit 3) because it can only ABduct ! |
| Innervation of dorsal interossei | ULNAR n. |
| If you damage your Ulnar nerve, how is your hand effected? | loss of fine motor movements |
| Summary of intrinsic hand innervartion | thenar- ulnar and median, hypothenar- ulnar, lumbricals- median, interossei- ulnar |
| What muscle can be considered an honorary dorsal interossei? | abductor digiti minimi |
| What muscles are closest to the extensor hood? | interosseus |
| Which muscle is more powerful in flexing the MP joint? | Lumbicals |
| On the dorsal side of the hand, the extensor digitorum tendon splits into ______, that are called__________ | 3 slips, central (inserts into mid. phalanx) and 2 lateral (inserts into distal phalanx) |
| On the palmar side, what 2 muscles control flexion | flexor digitorum superficialis(mid. phalanx) and flexor digitorum profundus (distal phalanx) |
| Fibrous digital sheaths are : | long tubular ligaments, surrond the long flexor tendons and synovial sheaths, composed of annular and cruciate ligments |
| Where are the fibrous digital sheaths located? | palmar side of fingers |
| Which is stronger, annular or cruciate ligaments? | annular |
| What does the fibrous digital sheath prevent? | Bowstringing of the flexor digitorum superficialis and profundus during flexion |
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