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Arm and Forearm
Unit 4 - Lecture 5 - Arm and Forearm - Dr. Berg - SUNY Upstate - Fall 2011
129
Anatomy
Graduate
11/19/2011

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Term
Lecture 5 - Arm and Forearm
Definition
Press Space
Term
Upper and Lower limbs are organized into two things. What are they?
Definition
Compartments and Transition zones
Term
Deep fascia of upper limb divides arm and forearm into 2 ..........?
Definition
2 Muscular Compartments
Term
2 Functional Muscular Compartments of ARM are?
Definition
Anterior/Flexor Compartment
Posterior/Extensor Compartment
Term
Anterior/Flexor compartment of ARM has...
Definition
...muscles that FLEX elbow joint and SUPINATE the proximal radioulnar joint
Term
Posterior/Extensor Compartment of ARM has...
Definition
...muscles that EXTEND the elbow joint
Term
2 Functional Muscular Compartments of FOREARM are?
Definition
Anterior/Flexor Compartment
Posterior/Extensor Compartment
Term
Anterior/Flexor compartment of FOREARM has...
Definition
...muscles that FLEX wrist joint, PRONATE the radioulnar joints, and FLEX digits
Term
Posterior/Extensor Compartment of FOREARM has...
Definition
...muscles that EXTEND the wrist joint, SUPINATE the radioulnar joint, and EXTEND and ABDUCT digits
Term
What is a Transition Zone?
Definition
Area that provides passage of nerves/vessels/etc from one area to the next.
Term
Why are TZ susceptible to injury?
Definition
TZ's are close to moveable joints, which are susceptible to injury
Term
What are the 3 Transition Zones in the Arm and Forearm?
Definition
1. Axilla (neck --> upper limb)
2. Cubital Fossa (Arm --> Forearm)
3. Wrist (Forearm --> wrist)
Term
In which TZ would you do a venapuncture?
Definition
The Cubital Fossa
Term
Bone(s) of the arm
Definition
Humerus (only!)
Term
Muscles of Anterior compartment of Humerus are...
Definition
The Flexor muscles!
1) Biceps brachii
2) Bracialis
3) Coracobrachialis
Term
The Biceps Brachii's Action is?
Nerve Innervation is?
Arterial supply?
Definition
1) Flex Elbow Joint with hand supine (bicep curls)!
2) Musculocutaneous n. (C5, C6, C7)
3) Brachial Artery
Term
What are the attachments of the Biceps?
Definition
1) Long Head from the supraglenoid
tubercle
2) Short head from coracoid
process
3) Tuberosity on shaft of RADIUS (must be supinated before flexion!)
Term
What does the Brachialis m. do?
Definition
Flex elbow joint when hand is PRONE (reverse curls)
(attachement: from anterior humerus --> coronoid process of Ulna)
Term
What innervates the Brachialis m.?
Definition
The Musculocutaneous nerve (C5,6,7)
Term
What muscle allows for flexion of elbow when forearm is between prone and supine?
Definition
The brachioradialis muscle
Term
Brachioradalis m. nerve innervation is?
Definition
Radial Nerve (C5,6,7,8)
Term
Coracobrachialis m. works on which joint?
Definition
Shoulder joint! not the elbow
Term
What is the action/nerve innervation of the Coracobrachialis m.?
Definition
1) Flex and ADDUCT shoulder joint
2) Musculocutaneous n. (C5,C6,C7)
Term
What is the nerve of the Anterior Compartment of the ARM?
Definition
Musculocutaneous nerve (C5,C6,C7)
Term
What spinal segment is the MAJOR contributor to the MC nerve?
Definition
C6
Term
The MC nerve branches from the...
Definition
Lateral cord of the brachial plexus (C5, C6,C7)
Term
The MC nerve innervates these muscles
Definition
Anterior compartment muscles of ARM!
1) Biceps brachii
2) Brachialis m.
3) Coracobrachialis m.
Term
What is the SENSORY innervation of the MC nerve?
Definition
C6 dermatome (lateral/radial forearm)
Term
Anterior Compartment of Arm gets blood from...
Definition
the BRACHIAL ARTERY
Term
The branches of the BRACHIAL ARTERY are...
Definition
1) Muscular branches (Ant. Arm)
2) Collateral (Anastomotic) branches in elbow
3) Deep Brachial artery (extensor/posterior compartment)
Term
Muscles of the Posterior Compartment are the...
Definition
Extensor muscles of the Arm that EXTEND the elbow joint!
1) Triceps brachii
2) Anconeus
Term
The nerve of the posterior (extensor) compartment is the ...
Definition
RADIAL NERVE (C5,C6,C7,C8,T1) => Posterior Cord
Term
What are the major spinal segment contributors to the Radial nerve
Definition
C5,C6,C7
Term
We know the Radial nerve gives motor to triceps and anconeus. What is the Sensory innervation?
Definition
part of C5 dermatome
1) Posterior lateral arm
2) Lateral dorsum of hand
Term
The Triceps has how many heads? Where is the proximal attachment (origin)?
Definition
3 heads!
1) Long Head - Infraglenoid
tubercle
2) Lateral Head - Posterior
lateral surface of humeral shaft
3) Medial Head - Posterior surface of
humeral shaft
Term
What is the DISTAL (insertion) attachment ?
Definition
Olecranon process of Ulna (hook like, used for extension)
Term
Most common LESION of ARM is ?
Definition
fracture to mid-humeral Shaft
Term
What may be compressed? What is the syndrome called?
Definition
The Radial nerve within axilla (Saturday Night Palsy)
Term
How can one get Saturday Night Palsy?
Definition
Falling asleep with one's arm hanging over the arm rest of a chair, compressing the radial nerve at the spiral groove.
Term
What are the symptoms of SNP?
Definition
1) Drop wrist with hand in prone position (can't extend wrist).
2) Cannot make tight fist.
Term
Flexor compartment muscles get blood supply from?
Definition
Brachial Artery
Term
Extensor compartment muscles get blood supply from?
Definition
Deep brachial artery
Term
Brachial artery's two terminal branches are in the ...(1)... and the branches are ...(2)...
Definition
1) Cubital Fossa
2) Ulnar and Radial artery
Term
The anastomoses around the elbow joint is among these arteries
Definition
Brachial, Deep Brachial, Ulnar and Radial a.a.
Term
Discuss 3 things about the Cubital fossa
Definition
1) Transition zone between arm and forearm.
2) Cutaneous veins - site of vena puncture
3) Measure blood pressure - transition where brachial artery divides into radial and ulnar arteries.
Term
What are the boundaries of the Cubital fossa?
Definition
1) Lateral = Brachioradialis muscle
2) Medial = Pronator teres muscle
3) Floor = Insertion of the biceps and brachialis muscles
4) Superior = imaginary line connectiong epicondyles
5) Roof = Fascia and skin
Term
List contents of Cubital Fossa from Medial to Lateral
Definition

Median Nerve, Brachial Artery/vein, Tendon of Biceps, Radial Nerve Mnemonic: MBTR -> My Bottoms Turned Red

 

Know that the Brachial Artery is MEDIAL to the biceps tendon and it will be easy to find the Brachial Pulse (and know the order)

Term
What are the 2 main cutaneous veins that drain the upper limb?
Definition
Basilic and Cephalic veins
(BC veins)
Term
The BC veins are derived from where?
Definition
Venous arch of dorsum of hand
Term
The BASILIC vein drains into axillary vein from venous arch from which part of arm/forearm?
Definition
Ulnar side

Memorize how?
BC (medial/ulnar to lateral/radial) alphabetically)
Term
The CEPHALIC vein drains into axillary vein from venous arch from which part of arm/forearm?
Definition
Radial Side

Memorize how?
BC (medial/ulnar to lateral/radial) alphabetically)
Term
What vein is the usual site for a venapuncture?
Definition
Median Cubital vein (starts off where basilic vein left off and travels to MEDIAN of forearm)
Term
[image]
Definition

Ulna: Proximal end (top) --> Olecranon, Coronoid, Radial Notch, Trochlear notch

Distal End (bottom) --> Head of Ulna, Styloid Process


Which forearm is represented here?

Yup, the right  forearm

Term
[image]
Definition

Radius: 

Proximal end (Top) - Head, Neck, Radial tuberosity

Distal end (Bottom) - Styloid process

 

Which forearm is this?

 

Again, the right side.

Term
[image]
Definition

1) Pronator muscles (teres, quadratus)

2) Wrist flexors (Flexor Carpi ulnaris/radialis, Palmaris Longus)

3) Digital Flexors (flexor digitorum superficialis/profundus, flexor pollicis longus) 

Term
Where do most of the flexor muscles of the forearm originate from?
Definition
Medial Epicondyle
Term
What are the Pronator muscles and their function?
Definition
They get the "Palms down" Pronator teres - pronates proximal radioulnar joint. Pronator Quadratus - pronates distal radioulnar joint. Each of these is attached to BOTH the ulna and the radius!
Term
What nerve innervates the pronator muscles?
Definition
Median Nerve (C6,7,8,T1) => lateral and medial chords
Term
What are the wrist (carpi) flexor muscles? Put in order from lateral to medial
Definition
1) Flexor carpi radialis
2) Palmaris longus
3) Flexor carpi ulnaris
Term
Flexor carpi radialis attaches to the...and is innervated by the ....
Definition
2nd metacarpal...MEDIAN nerve (C6,7,8,T1)
Term
Flexor carpi ulnaris attaches to the...and is innervated by the ....
Definition
Pisiform bone and 5th metacarpal...Ulnar nerve (C8, T1) => Medial Cord
Term
Palmaris longus attaches to the...and is innervated by the ....
Definition
Flexor retinaculum and palmar aponeurosis (main funtion to keep p.a. it tight)...Median nerve
Term
What are the digital flexors?
Definition
Extrinsic muscles of hand (flex all 5 digits)
1. Flexor digitorum superficialis
2. Flexor digitorum profundus
3. Flexor pollicis longus
Term
Only ....muscle has an attachment to the medial epicondyle of humerus
Definition
Flexor digitorum superficialis, other 2 do NOT!
Term
3 phalangeal joints are? Put in order of most proximal to distal
Definition
MCP --> PIP --> DIP

Metacarpal phalangeal --> Proximal interphalangeal --> Distal interphalangeal joints
Term
Digit vs. Finger
Definition
Digit - all 5 (including thumb) thumb = 1st digit, pinky = 5th digit

Finger- 4 fingers, thumb isn't finger, index = 1st finger, pinky = 4th finger
Term
Flexor Digitorum Superficialis muscle has ...tendons.
Definition
4 tendinous slips 1 per FINGER (doesn't go to thumb! That's F. pollicis longus!)
Term
True or False: Flexor Digitorum Superficialis splits into a V like shape and inserts into middle phalanx
Definition
True
Term
T/F: F. Digitorum Superficialis is the prime flexor of the DIP joint
Definition
False, it flexes the PIP joint.
Term
How is the Flexor Digitorum Profundus different from the F. Digitorum Superficialis. Give at least 2 differences
Definition
1) Does not attach to medial epicondyle
2) Inserts onto distal phalanx (not middle phalanx)
3) Prime mover for flexion of DIP joint (not PIP joint)
4) Deep to the F.D. Superficialis
Otherwise, it's fundamentally the same (doesn't go to thumb, only the 4 fingers)
Term
Flexor pollicis longus inserts onto the...and does what?
Definition
Phalanx of thumb
Flexes Interphalangeal (IP) joint of thumb.
Note: it only has 1 IP joint!
Term
What are the POSTERIOR FOREARM
MUSCLES
Definition
1. Brachioradialis
2. Wrist Extensors
3. Digital Extensors
4. Deep Thumb/Outcropping muscles
5. Supinator
Term
The common attachment site for the posterior forearm muscles is...
Definition
Lateral Epicondyle of Humerus
Term
BRACHIORADIALIS m. action and nerve
Definition
1) Flex elbow (i.e. when drinking)
2) Radial nerve
Term
The 3 wrist extensor muscles are?
Definition
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Extensor Carpi Ulnaris
Term
Extensor Carpi Radialis Longus and Extensor Carpi Radialis Brevis do what? What are they innervated by?
Definition
Action: Extend wrist and radial deviation
Nerve: Radial Nerve (C5,6,7,8)
Term
Extensor Carpi Ulnaris does what? nerve?
Definition
1) Extend Wrist and assists with ulna deviation of wrist
2) Radial Nerve!!! not Ulnar nerve!
Term
If it has the word EXTEND in it, the nerve is ...
Definition
Radial nerve (or its branches) --> C5,6,7,8
Term
2nd metacarpal bone is attachment site for ...muscle
Definition
Extensor Carpi Radialis Longus
Term
3rd metacarpal bone is attachment site for ...muscle
Definition
Extensor Carpi Radialis Brevis
Term
5rd metacarpal bone is attachment site for ...muscle
Definition
Extensor Carpi Ulnaris

Ulnar = think pinky area
Term
What are the Thumb muscles?
Definition
Abductor Pollicis longus
Extensor Pollicis brevis
Extensor Pollicis longus
Tendons = Snuff Box, you should palpate 3 tendons
Term
Which muscle inserts into the 1st metacarpal?
Definition
Abductor Pollicis longus
Term
Abductor Pollicis longus action and innervation are?
Definition
1. Abduct 1st carpometacarpal joint and radial deviation
2. Radial nerve (C5,6,7,8)
Term
Which muscle inserts into the proximal phalanx?
Definition
Extensor Pollicis brevis
Term
Extensor Pollicis brevis action and nerve?
Definition
1. Extend MCP joint of thumb
2. Posterior interossius nerve
Term
Which muscle inserts into the distal phalanx?
Definition
Extensor Pollicis Longus
Term
T/F Action of extensor pollicis longus is to flex interphalangeal (IP joint) of thumb
Definition
FALSE! It extends
Term
What are the Finger Extensor Muscles?
Definition
Extensor Digitorum
Extensor Digiti Minimi
Extensor Indicis
Term
Why does it make sense that the finger extensors extend the MCP joints?
Definition
Extending the MCP joint would mean a whole FINGER will be moving, thus it's logical to think that the MCP joint is doing the work.
Note: the THUMB is not a FINGER, thus not affected by the 3 muscles from the last card
Term
The first 3 (or 4) fingers (index, middle, and ring, and sometimes pinky) are connected to the tendons of which muscle?
Definition
Extensor Digitorum
Term
The 4th finger (pinky) ?
Definition
Extensor Digiti Minimi
Term
The 1st finger (index finger) ?
Definition
Extesor Digiti Indicis
Term
Which 2 muscles supinate radio-ulnar joint?
Definition
Biceps and Supinator muscle
Term
T/F Biceps and Supinator are both innervated by the Musculocutaneous nerve
Definition
False! Biceps --> Musculocutaneous nerve (C5,6,7)
Supinator --> Radial nerve (C5,6,7,8)
Term
[image]
Definition

Extensor tendons cross wrist in 6

synovial tunnels.

 

Tendons and sheath bound to

wrist by extensor retinaculum.

Term
What does each compartment contain?
Definition
1 or more extrinsic extensor tendon
Term
Compartment 1
Definition
Abductor Pollicis Longus
Extensor Pollicis Brevis
Term
Compartment 2
Definition
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
Term
Compartment 3
Definition
Extensor Pollicis Longus
Term
Compartment 4
Definition
Extensor Digitorum
Extensor Indicis
Term
Compartment 5
Definition
Extensor digiti minimi (V)
Term
Compartment 6
Definition
Extensor Carpi Ulnaris
Term
T/F Compartments are numbered from 1 - 6 from Radial to Ulnar
Definition
True!
Term
Compartment 1 is the most clinically significant. Why?
Definition
DeQuervain’s Disease =>
narrowing of 1st compartment.
Term
What is a positve test for DeQuervain's Disease?
Definition
Basically, hurts when patient "pulls" on the thumb to ulnar side
1. Patient folds (flexes) thumb under fingers
2. Deviate wrist to ulnar side (ulnar deviation)
Positive if pain of dorsal lateral surface of wrist reproduced
Term
Describe path of Radial nerve
Definition
Branches off Posterior cord (C5,6,7) --> travels on dorsum of arm --> winds around and over the Lateral epicondyle --> Enters cubital fossa where it supplies brachioradialis (drink muscle) and wrist extensors --> Divides into superficial (cutaneous) and deep (motor) branch.
Term
The superficial branch of the radial nerve supplies...
Definition
Sensory from dorsum of hand on radial side
part of C6 dermatome
Term
Deep branch of radial nerve ...
Definition
...pierces supinator muscle to
innervate forearm extensor muscles
Term
What is the most common symptom of radial nerve damage? Why does that make sense?
Definition
Drop wrist --> Can not ACTIVELY extend wrist with
forearm in prone position.
Radial n supplies the extensor muscles and if it's damaged, wrist cannot extend --> dropped wrist
Term
What are the 4 radial nerve lesion sites?
Definition
1 Axilla
2 Fractured Humeral Shaft
3 Cubital Fossa
4 Entrapped in Supinator muscle
Term
Blood supply to posterior compartment of forearm comes from the...
Definition
Posterior interosseous branch of the common interosseous artery.
Term
Describe path of Median nerve
Definition
Lateral and Medial cords (C6,7,8,T1) --> anterior arm --> passes thru cubital fossa --> forearm --> heads of pronator teres muscle --> carpal tunnel
Term
Median nerve is sensory from?
Definition
Lateral (radial) palm, thumb, and 2.5 digits
(thumb, index, middle, half of ring and half of palm)
Term
Median nerve is motor to?
Definition
Flexor muscles and pronation:
1) Flexor carpi radialis
2) Flexor digitorum superficialis
3) Palmaris longus
4) Flexor pollicis longus
5) Pronator teres and quadratus
6) Flexor digitorum profundus to 1st and 2nd fingers (b/c that's the radial half, ulnar got fingers 3 and 4)
Term
Name 3 types of Median Nerve lesions
Definition

1) Cubital Fossa 2) entrapped w/in Pronater Teres 3) Carpal Tunnel Syndrome

 

Whenever asked about lesions to nerves, think about the PATH the nerve takes!  

Term
What lesion would result in complete loss of Median nerve function?
Definition
Cubital fossa
Term
What may an entrapped median nerve w/in Pronater Teres result in?
Definition
1) Pronator Teres Syndrome
2) Weakness of hand and wrist
Term
Carpal Tunnel Syndrome would most likely result in the loss of which muscle group?
Definition
Thenar muscles
Term
Describe path of Ulnar Nerve
Definition
Medial Cord (C8,T1) --> runs on medial arm --> passes thru cubital tunnel behind the medial epicondyle (funny bone area)
Term
Ulnar nerve sensation is from?
Definition
Ulnar (medial) side of palm and medial 1.5 fingers (pinky and half of ring finger).
The other fingers are by median nerve
Term
Ulnar nerve is motor to ?
Definition
Flexor Carpi Ulnaris
Flexor Digitorum profundus to 3rd and 4th fingers (ring and pinky, respectively)
Term
See cutaneous innervation of forearm on page 209 (#3)
Definition
Left blank
Press Space
Term
Describe Brachial Artery path after arm
Definition
Brachial artery medial to bicep tendon --> Radial + Ulnar a.a. within Cubital fossa
Term
Radial artery supplies?
Definition
...muscles on radial side of forearm. Compressed against distal radius
to take “pulse”.
Term
Ulnar artery supplies?
Definition
...muscles on ulnar side of
forearm.
Term
What is a branch of the Ulnar artery?
Definition
Common interosseous artery
Term
What are the branches of the Common interosseous artery? What do each supply?
Definition
Anterior interosseous a. --> deep flexor muscles
Posterior interosseous a. --> extensor muscles
Term
What happens around the elbow area with the arteries?
Definition
Anastomotic connection b/w radial and ulnar reccurent branches (as well as with any superior arteries in the area)
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