L 5 A B O R A T O R Y Antebrachium, Hand, and Joints ELBOW JOINT Classify the elbow joint according to structural and functional criteria Hinge, synovial (diarthrotic) joint Identify the bony articulations. Humeroradial: (radial collateral) capitulum of humerus articulates with the head of the radius Humeroulnar: (ulnar collateral) trochlea of humerus articulates with the trochlear notch of the ulna olecranon process of the ulna articulates with the olecranon fossa of the humerus Proximal radioulnar: Head of radius articulates with the radial notch of the ulna Held in place by the annular ligament Identify the ligaments associated with the elbow joint. radial collateral ligament ulnar collateral ligament annular ligament Identify the primary sources of vascularization to the elbow joint. superior/inferior ulnar collateral arteries anterior/posterior interosseous arteries Identify the primary innervation sources to the elbow and radioulnar joints. Elbow musculocutaneous, radial, ulnar nerves Radioulnar musculocutaneous, median, radial nerves
28 Laboratory 5 Antebrachium, Hand, and Joints Identify the structures associated with the cubital fossa. brachial artery median nerve median cubital vein biceps brachii tendon Discuss the venous return from the brachial region. cephalic vein basilic vein median cubital vein axillary vein RADIOULNAR JOINTS Proximal radioulnar: Head of radius articulates with the radial notch of the ulna Distal radioulnar: Head of the ulna articulates with the ulnar notch on the radius Allows radius to move anteriorly across the ulna during pronation Classify the radioulnar joints according to structural and functional criteria, and identify the associated ligaments. Proximal pivot, synovial diarthrotic joint annular ligament radial/ulnar collateral ligaments Distal pivot, synovial diarthrotic joint triangular ligament (articular disc) (fibrocartilage complex) radial/ulnar collateral ligaments WRIST JOINT Classify the wrist joint according to structural and functional criteria diarthrotic, synovial condyloid. Identify the ligaments associated with the wrist joint. radial collateral ligament ulnar collateral ligament palmar carpal ligament dorsal carpal ligament triangular ligament (fibrocartilage complex) flexor retinaculum extensor retinaculum
Laboratory 5 Antebrachium, Hand, and Joints 29 ANTERIOR ANTEBRACHIUM Identify the superficial and deep muscles located in the anterior compartment of the antebrachium. Describe the attachment points of all of the anterior antebrachial muscles. Describe the primary action of each of these muscles. Identify the primary source of innervation of ALL of these muscles. Identify the primary source of vascularization for all of these muscles. Anterior Antebrachium Muscles Layer 1 Pronator Teres Carpi Radialis Medial coranoid process of Ulna Medial Mid-lateral Radius (C6-C7) 2 nd Metacarpal (C6-C7) Ulnar A Ulnar A Pronate forearm weak forearm flexor Flex and abduct hand at wrist Palmaris Longus Medial Carpi Ulnaris Humeral: medial Ulnar: olecranon and posterior Ulna Palmar aponeurosis Pisiform bone Hook of Hamate 5 th Metacarpal Ulnar A Ulnar A Flex hand at wrist and Tighten palm Flex and adduct hand at wrist Layer 2 Digitorum Superficialis Medial, coronoid process of Ulna and superoanterior Radius Middle phalanges of medial 4 digits (C7-T1) Ulnar A Flex wrist, interphalangeal, and metacarpophalangeal joints
30 Laboratory 5 Antebrachium, Hand, and Joints Layer 3 Digitorum Profundus Proximal, medial, anterior Ulna and interosseus membrane Distal phalanges of medial 4 digits Medial Lateral Ulnar A Anterior Flex wrist, distal interphalangeal and metacarpophalangeal joints Pollicis Longus Anterior Radius and interosseus membrane Base of distal phalanx of thumb (anterior Radial A Anterior Flex distal thumb phalanges Layer 4 Pronator Quadratus Distal anteromedial Ulna (proximal attach) Distal anterolateral Radius (distal attach) (anterior Radial A Anterior Pronate forearm
Laboratory 5 Antebrachium, Hand, and Joints 31 POSTERIOR ANTEBRACHIUM Identify the superficial and deep muscles located in the posterior compartment of the forearm. Describe the attachment points of all of the posterior antebrachial muscles. Describe the primary action of each of these muscles. Identify the primary source of innervation and vascularization of all of these muscles. Identify the flexor and extensor retinaculums and be able to describe their anatomical significance. Identify the basilic and cephalic veins, which originate in the antebrachial region. Antebrachium Muscles Superficial - Layer 1 Brachioradialis Lateral supracondylar ridge of Lateral distal Radius (C5-C7) Deep A of Arm (profunda brachii) Flex forearm at elbow Extensor Carpi Radialis Longus Lateral supracondylar ridge of 2 nd Metacarpal (C6-C7) Deep A of Arm (profunda brachii) Extend and Abduct hand at wrist Extensor Carpi Radialis Brevis Lateral 3 rd Metacarpal Deep A of Arm (profunda brachii) Extend and Abduct hand at wrist Extensor Digitorum Lateral Medial 4 digits extensor expansion Extend phalangeal joints & extend wrist Extensor Digiti Minimi Lateral 5 th digit extensor expansion Extend 5 th digit at metacarpophalangeal/ interphalangeal joint Extensor Carpi Ulnaris Lateral, posterior Ulna 5 th Metacarpal Extend and Adduct hand at wrist
32 Laboratory 5 Antebrachium, Hand, and Joints Deep - Layer 2 Supinator Lateral, elbow ligaments, Ulnar crest Proximal Posterolateral Radius (C5-C6) Radial A Deep A of Arm (profunda brachii) Supinate forearm Abductor Pollicis Longus Extensor Pollicis Brevis Ulna, Radius and Interosseous membrane Radius and interosseous membrane 1 st Metacarpal Proximal Phalanx of thumb Abduct, Extend thumb at carpometacarpal joint Extend proximal thumb phalanx at carpometacarpal joint Extensor Pollicis Longus mid- Ulna and interosseous membrane Distal Phalanx of thumb Extend distal thumb phalanx at carpometacarpal & interphalangeal joints Extensor Indicis Ulna and interosseous membrane 2 nd digit extensor expansion Extend 2 nd digit, extend hand at wrist
Laboratory 5 Antebrachium, Hand, and Joints 33 MUSCLES OF THE HAND Describe the carpal tunnel. Identify the muscles associated with the thenar, hypothenar, lumbricals, and interossei muscles. Attachment points do NOT have to be identified for specific muscles within the hand. Identify the actions of the hand muscles. Identify the primary innervation source for the hand muscles. Describe the blood flow in the hand, including the superficial, deep palmar, and dorsal carpal arches. Thenar Muscles Abductor Pollicis Brevis retinaculum, Scaphoid & Trapezium Lateral proximal Phalanx of thumb Recurrent branch of Abduct and Oppose thumb (toward palm) Pollicis Brevis Opponens Pollicis retinaculum, Scaphoid & Trapezium retinaculum, Scaphoid & Trapezium Lateral proximal Phalanx of thumb Lateral 1 st Metacarpal Recurrent branch of Recurrent branch of Flex thumb at interphalangeal joint Oppose thumb (toward palm) Hypothenar Muscles Abductor Digiti Minimi Pisiform Medial proximal Phalanx of 5 th digit Abduct 5 th digit Digiti Minimi Brevis Opponens Digiti Minimi Hook of Hamate Retinaculum Hook of Hamate Retinaculum Medial proximal Phalanx of 5 th digit Medial 5 th Metacarpal Flex proximal phalanx of 5 th digit Oppose 5 th digit (toward palm)
34 Laboratory 5 Antebrachium, Hand, and Joints Adductor Muscles Adductor Pollicis Oblique: 2-3 Metacarpal & Capitate Trans: 3 rd Metacarpal Medial proximal Phalanx of thumb Adduct thumb toward middle digit Central Muscles Lumbricals 1 & 2 Lateral 2 tendons of flexor digitorum profundus Lateral extensor expansions of digits 2-5 Flex at metacarpophalangeal joints; Extend at interphalangeal joints Lumbricals 3 & 4 Medial 3 tendons of flexor digitorum profundus Lateral extensor expansions of digits 2-5 Flex at metacarpophalangeal joints; Extend at interphalangeal joints Palmar interossei PAD 3 2, 4, 5 Metacarpals (palmar surface) Extensor expansions & proximal phalanx of digits 2, 4, 5 Deep Palmar Arch Adduct digits 2, 4, 5 & Assist lumbricals Dorsal interossei DAB 4 Metacarpal sides Extensor expansions & proximal phalanx of digits 2, 3, 3, 4 Deep Palmar & Dorsal Carpal Arches Abduct digits 2, 3, 3, 4 & Assist lumbricals
Laboratory 5 Antebrachium, Hand, and Joints 35 UPPER EXTREMITY REVIEW (SELF STUDY) SHOULDER List the muscles of the back that connect the upper limb to the axial skeleton. Describe the muscles of the back and discuss their attachment points, action, blood supply, and innervation. List the pectoral muscles. Describe the pectoral muscles and discuss their attachment points, action, blood supply, and innervation. List the rotator cuff muscles. Describe the muscles of the shoulder, including their attachment points, blood supply, actions, and innervation. Classify the joints of the pectoral girdle according to structural/functional criteria and describe the ligaments. Identify bony landmarks on real bone, models, and x-rays. BRACHIUM Identify the muscles of the brachial region and discuss their attachment points, actions, blood supply, and innervation. Locate and describe the anatomical significance of the bicipital aponeurosis. Identify the trunks, cords, and branches of the brachial plexus and discuss the targets of the nerves. Discuss the blood vessels of the arm, including both superficial and deep vessels. Identify bony landmarks on real bone, models, and x-rays.
36 Laboratory 5 Antebrachium, Hand, and Joints ANTEBRACHIUM Identify the muscles located in the forearm and discuss their attachment points, action, blood supply, and innervation. Identify the retinacula and be able to describe their anatomical significance. Classify the elbow and radioulnar joints according to structural/functional criteria and describe ligaments. Discuss the blood vessels of the forearm, including both superficial and deep vessels. Identify bony landmarks on real bone, models, and x-rays. HAND Describe the carpal tunnel. Identify the muscles associated with the thenar, hypothenar, lumbricals, and interossei muscles. Attachment points do NOT have to be identified for specific muscles within the hand. Identify the actions, innervation, and blood supply of the hand muscles. Discuss the blood vessels of the hand, including both superficial and deep vessels. Identify bony landmarks on real bone, models, and x-rays.
Laboratory 5 Antebrachium, Hand, and Joints 37 Page Intentionally Left Blank
38 Laboratory 5 Antebrachium, Hand, and Joints Page Intentionally Left Blank