LABORATORY Antebrachium, Hand, 5 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 Distal – pivot, synovial diarthrotic joint annular ligament triangular ligament (articular disc) radial/ulnar collateral ligaments (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 Muscle Origin Insertion Innervation Blood Supply Action Pronator Teres Medial Mid-lateral Median N Ulnar A Pronate epicondyle of Radius (C6-C7) forearm Humerus weak forearm coranoid flexor process of Ulna Flexor Carpi Medial 2nd Metacarpal Median N Ulnar A Flex and abduct Radialis epicondyle of (C6-C7) hand at wrist Humerus Palmaris Longus Medial Palmar Median N Ulnar A Flex hand at epicondyle of aponeurosis (C7-C8) wrist and Humerus Tighten palm Flexor Carpi Humeral: Pisiform bone Ulnar N Ulnar A Flex and adduct Ulnaris medial Hook of (C7-C8) hand at wrist epicondyle of Hamate Humerus 5th Metacarpal Ulnar: olecranon and posterior Ulna Layer 2 Muscle Origin Insertion Innervation Blood Supply Action Flexor Medial Middle Median N Ulnar A Flex wrist, Digitorum epicondyle of phalanges of (C7-T1) interphalangeal, Superficialis Humerus, medial 4 digits and metacarpo- coronoid process phalangeal of Ulna and joints superoanterior Radius 30 Laboratory 5 • Antebrachium, Hand, and Joints Layer 3 Muscle Origin Insertion Innervation Blood Supply Action Flexor Proximal, Distal phalanges Medial – Ulnar A Flex wrist, distal Digitorum medial, anterior of medial Ulnar N Anterior interphalangeal Profundus Ulna and 4 digits (C8-T1) Interosseus A and metacarpo- interosseus Lateral – phalangeal membrane Median N joints (C8-T1) Flexor Pollicis Anterior Radius Base of distal Median N Radial A Flex distal Longus and interosseus phalanx of (C8-T1) Anterior thumb membrane thumb (anterior Interosseus A phalanges interosseous) Layer 4 Muscle Origin Insertion Innervation Blood Supply Action Pronator Distal antero- Distal antero- Median N Radial A Pronate forearm Quadratus medial Ulna lateral Radius (C8-T1) Anterior (proximal (distal attach) (anterior Interosseus A attach) interosseous) 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. Posterior Antebrachium Muscles Superficial - Layer 1 Muscle Origin Insertion Innervation Blood Supply Action Brachioradialis Lateral supra- Lateral distal Radial N Deep A of Arm Flex forearm at condylar ridge Radius (C5-C7) (profunda elbow of Humerus brachii) Extensor Carpi Lateral supra- 2nd Metacarpal Radial N Deep A of Arm Extend and Radialis Longus condylar ridge (C6-C7) (profunda Abduct hand at of Humerus brachii) wrist Extensor Carpi Lateral 3rd Metacarpal Radial N Deep A of Arm Extend and Radialis Brevis epicondyle of (C7-C8) (profunda Abduct hand at Humerus (posterior brachii) wrist interosseous) Extensor Lateral Medial 4 digits Radial N Posterior Extend Digitorum epicondyle of extensor (C7-C8) Interosseus A phalangeal Humerus expansion (posterior joints & extend interosseous) wrist Extensor Digiti Lateral 5th digit Radial N Posterior Extend 5th digit Minimi epicondyle of extensor (C7-C8) Interosseus A at metacarpo- Humerus expansion (posterior phalangeal/ interosseous) interphalangeal joint Extensor Carpi Lateral 5th Metacarpal Radial N Posterior Extend and Ulnaris epicondyle of (C7-C8) Interosseus A Adduct hand at Humerus, (posterior wrist posterior Ulna interosseous) 32 Laboratory 5 • Antebrachium, Hand, and Joints Deep - Layer 2 Muscle Origin Insertion Innervation Blood Supply Action Supinator Lateral Proximal Radial N Radial A Supinate epicondyle of Posterolateral (C5-C6) Deep A of Arm forearm Humerus, Radius (posterior (profunda elbow liga- interosseous) brachii) ments, Ulnar crest Abductor Posterior Ulna, 1st Metacarpal Radial N Posterior Abduct, Extend Pollicis Longus Radius and (C7-C8) Interosseus A thumb at Interosseous (posterior carpometacarpal membrane interosseous) joint Extend Extensor Posterior Radius Proximal Radial N Posterior proximal thumb Pollicis Brevis and interosseous Phalanx of (C7-C8) Interosseus A phalanx at membrane thumb (posterior carpometacarpal interosseous) joint Extensor Posterior mid- Distal Phalanx Radial N Posterior Extend distal Pollicis Longus Ulna and of thumb (C7-C8) Interosseus A thumb phalanx interosseous (posterior at carpo- membrane interosseous) metacarpal & interphalangeal joints Extensor Indicis Posterior Ulna 2nd digit Radial N Posterior Extend 2nd and interosseous extensor (C7-C8) Interosseus A digit, extend membrane expansion (posterior hand at wrist interosseous) 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 Muscle Origin Insertion Innervation Blood Supply Action Abductor Flexor Lateral proximal Recurrent Palmar Arches Abduct and Pollicis Brevis retinaculum, Phalanx of branch of (superfic/deep) Oppose thumb Scaphoid & thumb Median N (toward palm) Trapezium (C8-T1) Flexor Pollicis Flexor Lateral proximal Recurrent branch Palmar Arches Flex thumb at Brevis retinaculum, Phalanx of of Median N (superfic/deep) interphalangeal Scaphoid & thumb (C8-T1) joint Trapezium Opponens Flexor Lateral Recurrent branch Palmar Arches Oppose thumb Pollicis retinaculum, 1st Metacarpal of Median N (superfic/deep) (toward palm) Scaphoid & (C8-T1) Trapezium Hypothenar Muscles Muscle Origin Insertion Innervation Blood Supply Action Abductor Pisiform Medial proximal Deep branch of Palmar Arches Abduct 5th digit Digiti Minimi Phalanx of Ulnar N (superfic/deep) 5th digit (C8-T1) Flexor Digiti Hook of Medial proximal Deep branch of Palmar Arches Flex proximal Minimi Brevis Hamate Phalanx of Ulnar N (superfic/deep) phalanx of Flexor 5th digit (C8-T1) 5th digit Retinaculum Opponens Hook of Medial Deep branch of Palmar Arches Oppose Digiti Minimi Hamate 5th Metacarpal Ulnar N (superfic/deep) 5th digit Flexor (C8-T1) (toward palm) Retinaculum 34 Laboratory 5 • Antebrachium, Hand, and Joints Adductor Muscles Muscle Origin Insertion Innervation Blood Supply Action Adductor Oblique: Medial proximal Deep branch of Palmar Arches Adduct thumb Pollicis 2-3 Metacarpal Phalanx of Ulnar N (superfic/deep) toward middle & Capitate thumb (C8-T1) digit Trans: 3rd Metacarpal Central Muscles Muscle Origin Insertion