On my last nerve
Musculocutaneous- biceps and brachialis
Radial - brachioradialis and brachialis
Median - pronators teres
What is the roll and glide at the radiocarpal joint during ULNAR DEVIATION?
Roll ulnarly/medially
Glide radially/laterally
What muscles provides the greatest amount of FORCE or the elbow flexor?
Brachialis! --> has largest CSA
"Workhorse"
(*Remember, greatest torque is biceps for flexion and supnation)
During wrist radial deviation what part of the distal V/palamar intercarpal ligaments is taut and what part of the proximal V is taut?
Distal V = medial leg
Proximal V = Palmar radiocarpal ligament
Your patient hurt their wrist, and now they are wearing a cast. What position would you place their wrist to provide the best amount of function?
10-15 degrees extension
10 degrees UD
Repeated activities of supination will lead to what nerve and set of muscles to be affected?
Radial N --> finger and thumb
At the humeroadial joint, what direction is the roll and glide for flexion? Name the convex and concave parts and capsule and ligaments that get taut
Fovea = concave
Capitulum of humerus = convex
Anterior roll and glide
The posterior capsule is taut
Taut ligaments: Lateral ulnar collateral ligament, posterior and anterior fibers of MCL
Which two muscles work synergistically to provide pure/full flexion of the wrist?
Flexor carpi ulnaris and flexor carpi radialis
(Antagonistically for RD and UD)
Your patient has MCP passive extension at 45 degrees, is this normal?
Yes, extension passively at MCP joint is 30-45 degrees
You want to test your pt with a handgrip dynanmometer, what position would you set them up to ensure the best outcome?
30 degrees wrist ext
5 degrees UD = MAX GRIP STRENGTH
When looking at the wrist, which muscles will primarily be affected with a radial nerve lesion? (name the muscles)
the primary wrist extensors!
ECRB, ECRL, ECU
Provide a dorsal glide to the thumb
(convex thumb on a concave trapezium)
While opening the hand, which two muscle OPPOSE each other at the MCP to allow full extension of the IP joints?
Extensor digitorum and intrinsic muscles
This position, opens for one joint and closes for another? What is it?
Loose Pack HR Joint = full ext + full supination
(Closed HR = 90 flexion +10 sup)
Closed Pack HU Joint = full ext + full supination
(Loose HU = 70 flex +10 sup)
70 degrees flexion (also closed pack)
Abd/add are limited
The median nerve in the hand, innervate which set of hand muscles? (name the muscles)
Most extrinsic flexor muscles and sensory to the lateral palm
Extrinsic Flexors:
FDS
FDP
FPL
During MCP abduction, digits 1 and 5 rolls and glides and what direction
Digit 1 = roll/glide radially
Digit 5 = roll/glide ulnarlly
What extrinsic muscles of the thumb, also are Radial Deviators?
the snuff box muscles= EPL, EPB, AbPL
Your patient is a C6 quadraplegic, what position would you place them to presevre their grip?
With the power of Tenodesis, leave the wrist at passive extension as it will flex the fingers passively
(*DO NOT STRETCH WRIST FLEXORS)
What are the degrees for normal thumb flexion, ABD, ADD and extension @ the CMC?
Flexion = 30 degrees
Extension/ADD = 0 degrees
ABD= 45 degrees
Which set of muscles in the hand are innervated by the ulnar nerve and will atrophy with a lesion?
BONUS: name test for Ulnar n lesion
Hypothenar Muscles - FDM, ODM, AbDM, PB
--> Flat thenar eminence
Two heads of adductor pollicis
--> Loss of muscle in the middle palm
Lumbricals 3-4
FROMENT'S SIGN
Anterior glide
(Proximal glides posteriorly)
What muscles pass through the head of the capitiate for wrist movements?
NO MUSCLE PASSES DIRECTLY THROUGH THE AOR :)
With a boutenniere deformity, what direction do the lateral bands slip from the AOR & what happens at finger?
Palmarly, this causes is flexion @ PIP, Hyperext @ DIP
What is the deg of PIP and DIP flexion/extension for digits 2-5?
PIP flex 100-120 (more on ulnar side)
DIP flex 70-90
PIP no passive extension
DIP little passive ext