Transcript Elbow and Hand

PTA 106 Fall 2008
Chanel
Kyle
Sandra
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Lateral Epicondyle
Medial Epicondlye
Olcranon
Ulnar Styloid Process
Cubital Fossa
Site of Median Nerve
Tendon of Palmaris
Longus
Tendon of Flexor
Carpi Radialis
Distal Wrist Crease
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Anatomical Snuff
Box
Thenar Eminance
Hypothenar
Eminence
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Medial Epicondyle
Lateral Epicondyle
Capitulum- on lateral
edge of condyle
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Trochlea-
medial and
mid section of condyle
Coronoid Fossa
Olecranon Fossa
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Olecranon Process
Trochlear Notch
Coronoid Process
Radial Notch
Ulnar Tuberosity
Styloid Process
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Head
Neck
Radial Tuberosity
Ulnar Notch
Styloid Process
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Scaphoid, Lunate,
Triquetrum, Pisiform,
Trapezium, Hamate,
Trapezoid, Capitate
Metacarpals:
Numbered 1-5, starting
at thumb
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Phalangeal: Numbered
1-5
◦ Distal, Middle, Proximal
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A. Ligaments
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◦ Elbow
Articular Capsule
Radial anular ligament
Interosseous membrane
Ulnar collateral
ligament
 Radial collateral
ligament
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◦ Hand
 Palmar aponeurosis
 Common Flexor sheath
 Flexor retinaculum
B. Bursae
◦ Subcutaneous
olecranon bursa
◦ Subtendinous
olecranon bursa
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C. Cartilage, articular
cartilage
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D. Articular Capsule
◦ Synovial membrane
◦ Fibrous layer
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Articular Capsule
Radial Anular
ligament
Interosseous
membrane
Ulnar collateral
ligament
Radial collateral
ligament
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All provide strength
and support to the
joint as do the
surrounding muscles
Two ligaments found
in the elbow joint are:
◦ the ulnar collateral
ligament and the
radial collateral
ligament.
◦ They are strong, fan
shaped
condensations of the
fibrous joint capsule
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Movements of the
elbow joint
◦ Flexion and extension
occur at the elbow joint
◦ The long axis of the
fully extended ulna
makes an angle of
approximately 170°
with the long axis of
the humerus
◦ Called the carrying
angle for the way the
forearm angles away
from the body when
something is carried
 The obliquity of the
angle is more
pronounced in
women than in men
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Articular capsule
◦ A sac enclosing a
joint, formed by an
outer fibrous
membrane and an
inner synovial
membrane. Also
called joint capsule
◦ The synovial fluid
nourishes the
fibrocartilage and
lubricates the joint
surface
◦ Weak anteriorly and
posteriorly, the capsule
strengthened on each
side by the ulnar and
radial collateral ligaments
◦ The fibrous layer of the
capsule is continuous
with the fibrous layer of
the elbow joint
◦ It attaches to the
humerus at the margins
of the lateral and medial
ends of the articular
surfaces of the capitulum
and trochlea
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Fig 6.35
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Radial anular
ligament
◦ Encircles and holds
the head of the
radius in the radial
notch of the ulna
◦ Forms the proximal
radioulnar joint
◦ Allows pronation and
supination of forearm
◦ In
pronation/supination
it is the radius that
rotates
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Figure 6.33E, 6.36C
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Ulnar collateral
ligament
◦ Located on the
medial side of the
joint, it extends
from the medial
epicondyle of the
humerus to the
proximal portion of
the ulna
◦ Prevents excessive
abduction of the
elbow joint
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Radial collateral
ligament
◦ Located on the
lateral side of the
joint, extending
from the lateral
epicondyle of the
humerus to the
head of the radius.
◦ Prevents excessive
adduction of the
elbow joint.
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Interosseous
membrane
◦ Connects the shafts of
the ulna and the radius
throughout most of their
length
◦ Classified as a fibrous
joint, or syndesmosis
◦ Note: The ulnar and radial
collateral ligaments of the
proximal humeroulnar
joint are not to be
confused with the
ligaments of the same
name at the distal
radioulnar joint
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Fig 6.20A,B
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Fascia of the palm
is continuous with
the antebrachial
fascia, and the
fascia of the
dorsum of the hand
◦ Palmar aponeurosis
◦ Common Flexor
Sheath
◦ Flexor retinaculum
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Palmar aponeurosis
◦ Strong, well-defined,
central part of the
palmar fascia
◦ Covers soft tissues and
overlies long flexor
tendons
◦ Proximal end is
continuous with the
flexor retinaculum and
palmaris longus
tendon
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Fig 6.25C
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Palmar aponeurosis
◦ The end distal to
apex forms four
longitudinal bands
that radiate from the
apex
◦ These attach distally
to the bases of the
proximal phalanges
◦ Forming the fibrous
digital sheaths of
individual digits
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Flexor Retinaculum
◦ Or transverse carpal
ligament
◦ Continuous with the
antebrachial fascia
◦ Fibrous band that
extends between the
anterior prominences
of the outer carpal
bones
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Flexor retinaculum
◦ and converts the
anterior concavity of
the carpus into the
carpal tunnel
◦ Through which the
flexor tendons and
median nerve pass
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Common Flexor
Sheath
◦ Deep to the Flexor
retinaculum
◦ Together with the
digital sheaths
enables the tendons
to slide freely past
each other during
movement
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Bursa
◦ closed sacs containing
fluid which prevent
friction, and enable
structures to move freely
over one another
◦ Subcutaneous olecranon
bursa-Located in the
subcutaneous connective
tissue over the olecranon
◦ Subtendinous olecranon
bursa-Located between
the olecranon and triceps
tendons, just proximal to
its attachment
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Articular cartilage
◦ Caps the articulating
surfaces of bones
participating in a
synovial joint
◦ Provides a smooth,
low-friction gliding
surface
◦ Avascular, nourished
by diffusion (synovial
fluid)
Biceps Brachii
O: Scapula: Long Head: Supraglenoid
Tubercle; Short Head: Coracoid
Process.
I: Radial Tuberosity of Raidus.
A: Elbow Flexion, Forearm
Supination.
I: Musculocutaneous Nerve
Vascular: Brachial Artery
Triceps Brachii
O: Long Head- Infraglenoid Tubercle of
Scapula,
Lateral Head- Inferior to Great
Tubercle on Posterior Humerus
Medial Head- Posterior Surface of
Humerus
I: Olecranon Process of Ulna
A: Elbow Extension
I: Radial Nerve
Vascular: Deep Brachial Artery
Coracobrachialis
O: Apex of the Coracoid Process
I: Middle of the medial Surface and
border of the Humerus.
A: Flexes and adducts the arm.
I: Musculocutaneous Nerve (C6 and C7)
Vascular: Brachial Artery
Brachialis
O: Distal Half of Humerus, Anterior Surface
I: Coronoid Process and Ulnar Tuberosity of
the Ulna
A: Elbow Flexion
I: Musculocutaneous Nerve
Vascular: Brachial Artery
Brachioradialis
O: Lateral Supracondylar Ridge on the Humerus
I: Styloid Process of the Radius
A: Elbow Flexion
I: Radial Nerve
Vascular: Radial Artery
Supinator
O: Later Epicondyle of Humerus and adjacent
Ulna
I: Anterior Surface of the Proximal Radius
A: Forearm Supination
I: Radial Nerve
Vascular: Recurrent Interosseous Artery
1) Pronator Teres
O: Medial Epicondyle of Humerus and
Coranoid Process of Ulna
I: Lateral aspect of Radius at its
midpoint
A: Forearm Pronation, Assistive in
elbow flexion
I: Median Nerve
Vascular: Ulnar Artery
2) Pronator Quadratus
O: Distal Fourth of Ulna
I: Distal Forth of Radius
A: Forearm Pronation
I: Median Nerve
Vascular: Anterior Interosseous
Artery
Flexor Carpi Radialis
O: Medial Epicondyle of the Humerus
I: Base of Second and Third Metacarpals
A: Wrist Flexion, Radial Deviation
I: Median Nerve
Vascular: Radial and Ulnar Arteries
Flexor Carpi Ulnaris
O: Medial Epicondyle of Humerus
I: Pisiform and base of Fifth
Metacarpal
A: Wrist Flexion, Ulnar Deviation
I: Ulnar Nerve
Vascular: Ulnar Artery
Extensor Carpi Radialis
Longus
O: Supracondylar Ridge of Humerus
I: Base of Second Metacarpal
A: Wrist extension, Radial Deviation
I: Radial Nerve
Vascular: Radial Artery
Extensor Carpi Radialis
Brevis
O: Lateral Epicondyle of Humerus
I: Base of Third Metacarpal
A: Wrist Extension
I: Radial Nerve
Vascular: Radial Artery
Extensor Digitorum
O: Lateral Epicondyle of Humerus
I: Base of distal Phalanx of the SecondFifth Fingers
A: Extends all three joints of the Fingers
I: Radial Nerve
Vascular: Recurrent Interosseous Artery
Extensor Carpi Ulnaris
O: Lateral Epicondyle of Humerus
I: Medial Side of Base of 5th Metacarpal
A: Extends and Adducts Wrist
I: Deep Radial Nerve
Vascular: Ulnar Artery
Flexor Digitorum
Superficialis
O: Common Flexor tendon, Coronoid
Process and Radius
I: Sides of the Middle Phalanx of the Four
Fingers
A: Flexes MP and PIP joints of the
Fingers
I: Median Nerve
Vascular: Ulnar Artery
Flexor Digitorum
Profundus
O: Upper three-fourths of Ulna
I: Distal Phalanx of the Four
Fingers digits (2-5)
A: Flexes all three joints of the
Fingers
I: Median and Ulnar Nerves
Vascular: Ulnar Artery
Flexor Pollicis Longus
O: Radius, Anterior Surface
I: Distal Phalanx of Pollex
A: Flexes all joints of the Pollex or
Thumb
I: Median Nerve
Vascular: Radial Artery
Abductor Pollicis
Longus
O: Posterior radius, Interosseous
Membrane, Middle Ulna
I: Base of the First Metacarpal
A: Abducts Pollex
I: Radial Nerve
Vascular: Posterior Interosseous
Artery
Extensor Digiti Minimi
O: Lateral Epicondyle of Humerus
I: Base of Distal Phalanx of Fifth Finger
A: Extends all joints of Fifth Finger
I: Radial Nerve
Vascular: Recurrent Interosseous Artery
Extensor Pollicis Brevis
O: Posterior Distal Radius
I: Base of the Proximal Phalanx of Pollex
A: Extends MP joint of Thumb
I: Radial Nerve
Vascular: Posterior Interosseous Artery
Extensor Pollicis Longus
O: Middle Posterior Ulna and Interosseous
Membrane
I: Base of Distal Phalanx of Pollex
A: Extends MP and IP joints of the Thumb
I: Radial Nerve
Vascular: Posterior Intercosseous Artery
Palmaris Longus
O: Medial Epicondyle of Humerus
I: Palmar Fascia
A: Assistinve in Wrist Flexion
I: Median Nerve
Vascular: Ulnar Artery
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What Is It?
◦ Happens when the median
nerve becomes squeezed or
pressed at the wrist
◦ Sometimes caused by
thickening of irritated
tendons that go through the
tunnel.
◦ The result being pain that
goes it to the hand and can
even radiate up in to the
forearm.
◦ Most common of the
entrapment neuropathies
where the peripheral nerves
are traumatized or
compressed.
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How Is It Caused?
◦ Predisposition
◦ Trauma, Injury, Swelling,
Spain, Fracture.
◦ Hormones
 Overactivity of pituitary,
Hypothyroidism
◦ Mechanical Problems
 Work stress, vibrating
hand tools
◦ Development of Cyst or
Tumor in Canal
◦ Some times there is no
origin
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Symptoms
◦ Frequent burning,
tingling, itching,
numbness in palm of
hand and fingers.
◦ Fingers feel worthless
and swollen.
◦ Decreased grip
strength; difficult to
form a fist, grasp small
objects,
◦ Can differentiate
between hot and cold.
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Treatment
◦ Surgical
 Open Release
 Endoscopic
◦ Non-Surgical
 Drugs:NSAID,
Corticosteroids, and
Vitamin B6
 Exercise: Stretching and
strenthening
 Alternative:
acupuncture, yoga and
chiropractic services
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What is Tennis
Elbow?
◦ Is inflammation
around the lateral
epicondyle
◦ It occurs when the
muscle attachment,
tendons, become
irritated.
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Causes
◦ Tennis or any racket
sport
◦ Anything that involves
extending your wrist or
rotating his forearm,
such as twisting a
screwdriver or lifting a
heavy object with your
palm down.
◦ With age irritation
becomes inflamed more
easily.
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Symptoms
◦ Pain that radiates
from epicondyle in to
forearm and wrist.
◦ Pain with extension
of wrist.
◦ Forearm weakness.
◦ Painful grip with
activities such as
shaking hands and
turning door knobs.
◦ Inability to hold
objects such as
coffee cups.
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Treatment
◦ Use of a brace to let
muscles rest.
◦ Corticosteroid
injections.
◦ PT: Stretching and
ROM exercises.
◦ Surgery is Rare