Transcript Elbow and Hand

HUMEROULNAR/ELBOW JOINT &
HAND
Regional Anatomy 106
Presented by: Antonina, Benji,
Jarrett, & Shannon
Clinical Concerns of the Humeroulnar Joint
& Hand
 Elbow Tendonitis or Lateral Epicondylitis: Also known as
tennis elbow, a painful musculoskeletal condition that may
follow repetitive use of the superficial extensor muscles of the
forearm. Pain is felt over the lateral epicondyle and radiates
down the posterior surface of the forearm. People with elbow
tendonitis often feel pain when they open a door or lift a
glass. Repeated forceful flexion and extension of the wrist
strain the attachment of the common extensor tendon,
producing inflammation of the periosteum of the lateral
epicondyle. (Lateral Epicondylitis)
Humeroulnar Joint & Hand
Clinical Concerns (cont.)
 Carpal Tunnel Syndrome: Results from any lesion that significantly reduces the size of the
carpal tunnel or, more commonly, increases the size of some structures (or their coverings)
that pass through it (e.g., inflammation of the synovial sheaths). The median nerve is the
most sensitive structure in the carpal tunnel and, therefore, is the most affected. The median
nerve has two terminal sensory branches that supply the skin of the hand; hence paresthesia
(tingling), hypothesia (diminished sensation) or anesthesia (absence of tactile sensation) may
occur in the lateral three and a half digits. Recall however, that the palmar cutaneous branch
of the median nerve arises proximal to and does not pass through the carpal tunnel; thus the
sensation in the central palm remains unaffected. This nerve also has one terminal motor
branch, the recurrent branch, which innervates the three thenar muscles.
 Wasting of the thenar eminence and progressive loss of coordination and strength in the thumb may
occur if the compression is not alleviated. Individuals with CTS are unable to oppose the thumb. To
relieve the compression and symptoms, partial or complete surgical division of the flexor
retinaculum, a procedure called carpal tunnel release, may be necessary. The incision for carpal
tunnel release is made toward the medial side of the wrist and flexor retinaculum to avoid possible
injury to the recurrent branch of the median nerve.
Surface Anatomy
 Anatomical Snuff Box
 Thenar Eminence
 Hypothenar Eminence
Surface Anatomy
 Tendon of Palmaris
Longus
 Tendon of Flexor Carpi
Radialis
Surface Anatomy
 Medial Epicondyle
 Lateral Epicondyle
 Radial Styloid Process
 Ulnar Styloid Process
Surface Anatomy
 Olecranon
 Cubital Fossa
Surface Anatomy
 Distal Wrist Crease
 Site of the Median
Nerve
The humerus
is a long bone
in the arm
that runs
from the
shoulder to
the elbow.
It connects the scapula
and the radius
Body of humerus cylindrical in its
upper portion, and
more prismatic
below.
Lower extremity
of humerus consisting of a
faceted condyle
that articulates
with the radius.
Upper extremity of
humerus - consisting
of a rounded head, a
narrow neck, and
two short processes,
or "tuberosities".
Distally, the capitulum of
the humerus articulates
with the head of the
radius, and the trochlea
of the humerus
articulates with the
olecranon process of the
ulna.
The grooved surface
at the lower end
articulating with the
trochlear notch of
the ulna.
Above the back of the
trochlea is a deep
triangular depression,
the olecranon fossa, in
which the summit of
the olecranon is
received in extension
of the forearm.
A bony prominence of the
outer aspect is the lateral
epicondyle that provides
origin for the muscles
which dorsiflex the wrist.
Inflammation at this site is
known as tennis elbow.
medial epicondyle is larger
and more prominent than the
lateral epicondyle that gives
attachment to the ulnar
collateral ligament of the
elbow-joint and ulnar nerve
runs in a groove on the back
of this epicondyle.
Above the front
part of the
trochlea is a small
depression, the
coronoid fossa,
which receives the
coronoid process
of the ulna during
flexion of the
forearm.
The radius is the bone of
the forearm that extends
from the lateral side of
the elbow to the thumb
side of the wrist. The
radius is situated on the
lateral side of the ulna, It
is a long bone, prismshaped and slightly
curved. The radius
articulates with the
capitulum of the
humerus.
Radius connects the
elbow to the forearm.
Head of Radius, disk shaped
prominence at proximal end of
bone, forms articulating surface
with capitulum of humerus.
Radial tuberosity is a round
projection that serves as an
attachment point for Biceps
Brachii muscle.
Ulnar notch of Radius, slide
depression that articulates with
Ulna.
Styloid process of Radius is the
lateral projection at distal end of
bone that forms lateral portion
of wrist joint.
Ligaments of the
elbow
• Radial anular
ligament
• Interosseous
memebrane
• Ulnar collateral
ligament
• Radial collateral
ligament
Ligaments of the hand
• Palmar aponeurosis
• Flexor retinaculum
Common
flexor sheath
Bursae
• Subcutaneous olecranon bursa
• Subtendinous olecranon bursa
Cartilage
• Articular cartilage
Articular Capsule
• Synovial membrane
• Fibrous layer (fibrous
capsule)
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Biceps
– O: Scapula: Long head, supraglenoid
tubricle, Short head, coracoid process
– I: Radial tuberosity of radius
Brachialis
– O: Distal half of humerus, anterior
surface
– I: Corocoid process and ulnar
tuberosity
Pronator Teres
– O: Medial epicondyle of humerus
– I: Lateral aspect of radius at its
midpoint
Brachioradialis
– O: Lateral supracondylar ridge of
humerus
– I: Styloid process of radius
Supinator
– O: Lateral epicondyle of humerus and
adjacent ulna
– I: Anterior surface of the proximal
radius
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Palmaris Longus
– O: Medial epicondyle of humerus
– I: Palmar fascia
Flexor Carpi Radialis
– O: Medial epicondyle of humerus
– I: Base of second and third
metacarpals
Flexor Carpi Unlaris
– O: Medial epicondyle of humerus
– I: Pisiform, and the base of 5th
metacarpal
Flexor Digitorum porfundus
– O: Upper three-fourths of ulna
– I: Distal phalanx of the four fingers
Pronator Teres
– O: Medial epicondyle of humerus
and coranoid process of ulna
– I: Lateral aspect of radius at its
midpoint
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Flexor digitorum superficialis
– O: Common flexor tendon,
coronoid process and radius
– I: Sides of the middle phalanx of
the 4 fingers
Flexor Pollicis longus
– O: Radius, anterior surface
– I: Distal phanlanx of pollex
Abductor pollicis longus
– O: Posterior radius, interosseous
membrane, middle ulna
– I: Base of the first metacarpal
Pronator Quadratus
– O: Distal fourth of ulna
– I: Distal fourth of radius
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Extenson carpi radialis longus
– O: Supracondylar ridge of humerus
– I: Base of second metacarpal
Extensor carpi Ulnaris
– O: Lateral epicondyle of humerus
– I: Medial side of base of 5th metacarpal
Extensor Digitorum
– O: Lateral epicondyle of humerus
– I: Base of distal phanlanx of the 2nd-5th
fingers
Extensor carpi radialis brevis
– O: Lateral epicondyle of humerus
– I: Base of 3rd metacarpal
Extensor digiti minimi
– O: Lateral epicondyle of humerous
– I: Base of distal phalanx of 5th finger
Extensor pollicis brevis
– O: Posterior Distal radius
– I: Base of proximal phalanx of pollex
Extensor pollicis longus
– O: Middle posterior ulna and
interosseous membrane
– I: Base of distal phalanx of pollex
• Triceps
– O: Long Head: infraglenoid
tubrecle of scapula, Lateral
Head: Inferior to greater
tubericle on posterior
humerus, Medial Head:
posterior surface of
humerus
– I: Olecranon process of
ulna
• Biceps: A: Elbow Flexion, forearm
supination I: Musculocaneous nerve
V:Brachial artery
• Triceps: A: Elbow extention I: radial nerve,
V:Deep brachial artery
• Brachialis A: Elbow flexion I:
Musculocutaneous nerve, V:brachial Atery
• Brachioradialis: A: Elbow flexion I: Radial
nerve, V:radial artery
• Supinator: A: Forearm supination I: radial
nerve, recurrent interosseous
• Pronator teres: A: forearm pronation, asstive
in elbow flexion I:median nerve V:ulnar artery
• Pronator quadratus: A: forearm pronation I:
median nerve V: anterior interosseous artery
• Flexor carpi radialis: A: wrist flexion, radial
deviation I: median nerve V: radial and ulnar
arteries
• Flexor carpi ulnaris: A: wrist flexion,
ulnardeviation I: ulnar nerve V: ulnar artery
• Extensor carpi radialis longus: A: wrist
extension, radial deviation I: radial nerve V:
radial artery
• Extensor carpi raialis brevis: A: wrist extension I:
radial nerve V: radial artery
• Extensor digitorum: A: extends all three joints of
the fingers I:radial nerve V: recurrent
interosseous artery
• Extensor carpi ulnaris: a: extens and adducts
wrist I: deep radial nerve V: ulnar artery
• Flexor digitorum superficialis: A: Flexes MP and
PIP jpints of the fingers I: Medial Nerve V: Ulnar
artery
• Flexor digitorum profundus: A: flexes all three
joints of the fingers I: Median and ulnar nerve A:
Ulnar atrety
• Flexor pollicis longus A: flexes all joints of the thumb I:
Radial nerve V: posteriorinterosseous artery
• Abductor pollicis longus: A: abducts pollucs I: radial
nerve V: posterior interosseous artery
• Extensor digiti minimi :A: extends all joints of the fifth
finger I: Radial nerve V: Recurrent interosseous artery
• Extensor pollicis brevis: A: Extends MP joint of thumb I:
radial nerve V: Posterior interosseous artery
• Extensor Pollicis longus: A: extends the Mp and IP
joints of the thumb I: Radial nerve V: Posrterior
interosseous artery
• Palmaris longus : A: Assistive in wrist flection I: Median
nerve V: Ulnar artery