Elbow & Forearm
"Carrying angle"
"necessary" to allow the forearm to clear the body
-avg: 13 degrees
-Women: up to 5 degrees greater than men
Sternoclavicular joint (SC)
-Only joint that connects the UE with the thorax
-all movement at the shoulder involves some SC movement
-clavicle will fracture rather than dislocate at the SC
-Synovial saddle joint
Joints in wrist and actions
Radio-carpal joint (primary): located between the radius, scaphoid, and lunate. Allows for flexion, extension, and radial and ulnar deviation (condyloid, ellipsoid joint)
Intercarpal joint: located between all of the carpal bones, gliding joint
Midcarpal joint: located between the proximal and distal row of the carpal bones (gliding joint, secondary) allows for flexion, extension, radial, and ulnar deviation
Thorax is composed of:
-Thoracic vertebrae, ribs, sternum
-Base of muscle attachment, protection of heart, lungs, viscera
-Ventilation
Kyphosis and Lordosis
Kyphosis: in thoracic vertebra and sacrum (increase in posterior convexity)
-hunch back in elderly people
Lordosis: cervical and lumbar vertebrae (anteriorly convex, secondary development)-typical, we want to see them in spine
Ex: pregnant women increased lordosis in lumbar
looking at high monitor in cervical
tummy time for babies helps baby develop lordosis curve
Interosseous membrane function:
-broad collagenous sheet
-binds ulna and radius
-attachment for some hand muscles
-when under tension, it provides transmission of forces between hand and wrist through forearm and elbow
Proximal stabilizers
Latissimus Dorsi
Pectoralis major
Trapezius
Serratus Anterior
Levator Scapulae
Joints in the hand:
CMC: hard to see, located btwn the carpal and metacarpal bones
D1: saddle joint allows for opposition in thumb, circumduction, and flexion and extension (thumb radial and palmar add/abd)
D2-5: gliding joint
flexion, extension
MCP: between the metacarpals and phalanges
D1: hinge joint
D2-5: condyloid and elipsoid joint
Adduction and abduction
PIP: 2nd knuckle, D2-5
flexion, extension
DIP: D2-5
flexion, extension
IP: D1 only
flexion, extension
Muscles of quiet inspiration
Diaphragm and external intercostals
Functions of posterior anatomy of vertebrae and anterior anatomy of vertebrae
Posterior Anatomy:
Protects spinal cord, processes guide limit motion and increase muscle leverage
Anterior Anatomy:
weight-bearing
shock absorption
mobility
Brachial plexus: (entire upper extremity)
Unlar nerve located where and types of syndrome?
Cubital tunnel syndrome: goes behind medial epicondyle, medial side of elbow
"hit funny bone"
Guyon's canal syndrome: runs through the wrist (4th and 5th digit)
ex: bicyclists hands on handle bars
Winging scapula
serratus anterior weakness causes scapular winging
Wrist joint advantage + disadvantage
advantage: (multi-joint operation)
-minimal movement at each joint, but collectively achieve greater range
-relative stability and mobility
Disadvantage: with presence of stability, vulnerable to misalignment
-predisposed to injury with high forces
Forced inspiration accessory muscles
Sternocleidomastoid: elevates sternum
Atlas and Axis joints
Atlas: Atlanto-occipital joint
allows for you to nod your head
cervical flexion and extension and lateral flexion
Axis: Atlanto-axial joint
allows us to shake our head no
cervical rotation/spin
Brachioradialis origin and insertion and action
origin: supracondylar ridge of humerus
insertion: styloid process of radius
Action: pronates and supinates forearm to neutral forearm position
3 muscles that help with scapular upward rotation
serratus anterior, and upper and lower trapezius work together to upwardly rotate the scapula
Arches in palm function
-stability
-manipulates objects
-holds objects
Forced expiration
internal intercostals: draws ribs inferiorly/depresses rib cage
abdominals: compresses abdominal walls, pushing diaphragm up
quadratus lumborum
Anterior and posterior longitudinal ligament
Anterior: limits too much extension
*compressed with extension
Posterior: limits too much flexion
*compressed with flexion
Pronator teres origin, insertion
origin: medial epicondyle of humerus
insertion: radius
Rotator Cuff Muscles and their actions
"S.I.T.S"
Stabilization of humeral head
Supraspinatous: shoulder abduction
Infraspinatous: shoulder external rotation
Teres Minor: shoulder external rotation
Subscapularis: shoulder internal rotation
Wrist bone injuries and fractures
lunate: most frequently dislocated
scaphoid: most frequently fractured
Radial fractures:
Colle's: falling on an extended wrist
Smiths: falling on a flexed wrist
Clinical considerations
Those with paralysis or weaknened abdominal muscles are at risk for....
choking and lung infection
-C4 SCI (phrenic nerve = diaphragm)
increased intradiscal pressure
bending down to pick up a heavy box
*too much pressure on discs can herniate it, will push annulus fibrosis out and compress nerve