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Anatomy 103 OSCE Landmark About Ligaments Muscles To palpate Medial Border of Scapula • boney ridge on the scapula (flat bone)- medial bony ridge • superior- superior angle of the scapula and inferiorinferior angle of the scapula • root of the spine of the scapula on the medial border • site of muscle attachment • medial: spine • lateral: fossa- infra/supraspinous fossas, spine of the scapula • superior: neck musculature • rhomboid major & minor • levator scapula • serratus anterior • prone- place hand in the small of the back to pop up scapula Inferior Angle of the Scapula • boney corner of the scapula • created by medial and lateral borders of the scapula • superior: infraspinous fossa • inferior: ribs/back musculature • medial: spine/musculature * latissimus doris • prone- place hand in the small of the back to pop up scapula • activate: lat resist arm pull into butt Lateral Border of the Scapula • boney lateral ridge of the scapula • created by inferior angle and lateral angle of the scapula • site of muscle attachment • superior: superior angle • inferior: inferior angle • medial: fossa • lateral GH • teres major • teres minor • arm at 90°- prone • activate: teres major/minor of internal/external rotation Spine of the Scapula • boney ridge across the scapula • root at the medial border of the scapula to the acromion process of the scapula (laterally) • divides supraspinous fossa and infraspinous fossa • site of muscle attachment • middle/lower trapezius • posterior deltoid • activates posterior deltoid- resist horizontal cross extension Coracoid Process of the Scapula • finger like projection- projecting forward • site of attachment • superior: AC joint • inferior: chest musculature • coraco-acromial ligament • coraco-clavicular ligament (conoid & trapizoid) • coracobrachialis • pectoralis minor • short head of biceps brachii • active pec minor w cross pec fly Acromion Process of the Scapula • boney end of the spine of scapula (lateral) • articulates with the clavicle anteriorly to create the AC joint • medial: clavicle • lateral: GH joint • acromioclavicula r ligament & joint capsule • upper trapezius • mid deltoid • active: upper trap w shoulder shrug Humerus • long bone of the upper arm • articulates proximally with glenoid fossa of the scapula • distal end articulates with olecranon fossa • coracohumeral ligament • capsular ligament • coracobrachialis • brachialis • triceps brachii • activate: tricepsresist extension Bicipital Groove Intertubercular Sulcus • groove btw greater & lesser tubercle of the humerus • houses the LH biceps tendon • superficial: deltoids • Pectoralis Major (lateral lip) • latissimus dorsi (medial lip) • teres major (medial lip) • activate: internal/ external rotation of the humerus Greater Tubercle • located on the proximal end/head of the humerus • bony projection • paired with the more medial lesser tubercle • bicipital groove btw tubercles • superficial: deltoids • site of muscle attachment • supraspinatus • infraspinatus • internal/external rotation Landmark About Lesser Tubercle • located on the proximal end/head of the humerus • bony projection • paired with the more lateral greater tubercle • bicipital groove btw tubercles • superficial: deltoids • site of muscle attachment Lateral Epicondyle * boney projection on the lateral/distal end of the humerus * superior: lateral supracondylar ridge * inferior: radius * medial: olecranon & fossa * site of muscle/tendon attachment Lateral Supracondylar Ridge • bony ridge superior to the lateral epicondyle • site of muscle attachment Medial Epicondyle • bony projection on the medial/distal humerus • superior: medial supracondylar ridge • inferior: ulna • lateral: olecranon & fossa • site for muscle/tendon attachment • medial: ulnar nerve- tinels at the elbow Radius Ligaments Muscles To palpate • subscapularis • internal/external rotation • anconeus • supinator • common extensor tendon: • extensor carpi radialis brevis • extensor carpi ulnaris • extensor digitorum • extensor digiti minimi • activate: extensors • palpate down the humerus to the epicondyle • brachioradialis • extensor carpi radialis longus • find lateral epicondyle and come superior • activate bracioradialis • medial collateral ligament • pronator teres • flexor pollicis longus • common flexor tendon: • flexor carpi radialis • palmaris longus • flexor carpi ulnaris • flexor digitorum superficialis • activate: flexors • long bone located on the forearm- lateral bone • articulates with the ulna proximally and distallyradioulnar joints • radiocarpal joint (the wrist); radius articulates w scaphoid, lunate, triquetrium • has a tuberosity at proximal end- medial • has head, tuberosity, shaft, and styloid process at distal end- articulates with ulna and carpal bones (scaphoid & lunate) • does not articulate w carpal bones • ulnar notch- distally • annular ligament • interosseous membrane • oblique cord • palmar/dorsal radiulnar ligaments • wrist: radial collateral • palmar radiocarpal (volar) • dorsal radiocarpal * tuberosity: biceps brachii * posterior: abductor pollicis longus, extensor pollicis brevis • activate: biceps brachii Ulna * long bone located on the forearm, parallel with radius- longer than the radius * olecranon process at proximal end- w fossaarticulates with the humerus to create the hinge elbow joint * coronoid process inferior to olecranon fossa, shaft, and small styloid process at the distal endarticulates w the radius * medial forearm bone * proximal end: articulates w * distal end: articulates w radius • ulnar collateral ligaments • palmar/dorsal radioulnar ligaments • wrist: ulnar collateral • palmar ulnocarpal (volar) • cornoid process: flexor pollicis longus • tuberosity: brachilais flexor digitorum profundus * posterior: abductor pollicis longus • start proximal and run distal Flexor Reintaculum • band of tissue laying over top of the carpal tunnel • distal radioulnar joint/proximal row of carpal bones • creates the top of the carpal tunnel over the carpal bones- contains the flexor tendons • not contractile • abductor pollicis brevis • flexor pollicis brevis • flexor digiti minimi • opponens digiti minimi • palmaris brevis • not contractile • palpate from DRUJ to the carpal bones • radial collateral ligament Landmark About Ligaments Muscles To palpate Interosseous membrane • membrane creating the middle joint btw the radius/ ulna- from proximal to distal • has holes for nerve/artery supply to pass through • connects the two bones along their entire length by this flat, flexible ligament • abductor pollicis longus • extensor pollicis brevis • extensor pollicis longus • flexor digitorum profundus • no contractile • activate: flexors (elbow bent) Dorsal Digital Expansion • fibrous aponeurotic expansion of the distal attachment of the extensor digitorum muscle on the fingers that serves as a moveable hood of tissue when the fingers flex & extend • begins on dorsal/lateral/medial side of proximal phalanx of each finger- attaches onto dorsal side of the middle & distal phalanges • any muscle that attaches into it can create extension of these phalanges at the IP joints • extensor pollicis longus • extensor digiti minimi • extensor digitorum • extensor indicis • abductor pollicis brevis • abductor digiti minimi • adductor pollicis activate: extensors Scaphoid • in 1st row of carpal bones • articulates with lunate/trapezium • can be fx • helps create the anatomical snuff box- floor • abductor pollicis brevis • anatomical snuff box-palpate the floor Trapezium • carpal bone in the distal row • superior to the scaphoid • flexor pollicis brevis • opponens pollicis • find scaphoid and come superior Pisiform • pea size bone on top of the triquetrium • tunnel of gyuon btw pisiform & hook of hamatecontains the ulnar nerve • abductor digiti minimi • find triquetriumcome onto pisiform Hook of Hamate • located on the hamate • creates the tunnel of gyuon w the pisform- contains the ulnar nerve • flexor digiti minimi • opponens digiti minimi • find pisform followed by hamate 1st MTC • thumb- shortest, most mobile • occupies more anterior position • joint btw 1st MT & trapezium unique saddle joint that allows for opposition • articulates w the trapezium, proximal phalanx • small long bone - base articulates with the carpals proximally and each other medially and laterally • heads articulate w proximal phalanx • making a fist- the heads of the MTC become prominent as your knuckles • abductor pollicis longus • opponens pollicis • dorsal interossei • find carpal rows and come distally 2nd MTC • index finger • articulates w trapezoid, capitate, & 3rd MTC, proximal phalanx • adductor pollicis • lumbricals • palmar interossei • dorsal interossei 3rd MTC • middle finger • articulates with capitate, & 2/4th MTC, proximal phalanx • adductor pollicis • lumbricals • dorsal interossei 4th MTC • ring finger • articulates w hamate, 3/5th MTC, proximal phalanx • lumbricals • palmar interossei • dorsal interossei 5th MTC • pinkie finger • articulates w hamate, 4th MTC, proximal phalanx • abductor digiti minimi • flexor digiti minimi • lumbricals • palmar interossei • dorsal interossei • dorsal & palmar & interosseous ligaments
