Download • Overview of the function of the muscles of the elbow and radioulnar

TCCD MASSAGE THERAPY PROGRAM
NOTES: MUSCLES OF THE WRIST AND FOREARM, PART 1
MSSG 2013: KINESIOLOGY
Slides #1 through #8
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Overview of the function of the muscles of the elbow and radioulnar
joints, the wrist and fingers
Learn the attachments, actions, innervation and palpation for the wrist
flexor group.
If a muscle crosses the elbow joint anteriorly with a vertical direction to its fibers, it
can flex the forearm at the elbow joint by moving the anterior surface of the
forearm toward the anterior surface of the arm.
If a muscle crosses the elbow joint posteriorly with a vertical direction to its fibers,
it can extend the forearm at the elbow joint by moving the posterior surface of
the forearm toward the posterior surface of the arm.
Reverse actions at the elbow joint involve moving the arm toward the forearm at
the elbow joint. This movement usually occurs when the hand (and therefore the
forearm) is fixed by holding onto an immovable object.
If a muscle crosses the radioulnar joints anteriorly with a horizontal orientation to
its fibers, it will pronate the forearm at the radioulnar joints by crossing the radius
over the ulna.
If a muscle crosses the radioulnar joints posteriorly with a horizontal direction to its
fibers, it will supinate the forearm at the radioulnar joints by moving the radius to
be parallel with the ulna.
Reverse actions of these standard mover actions at the radioulnar joints involve
moving the ulna toward the radius at the radioulnar joints. This movement usually
occurs when the hand (and therefore the radius) is fixed by holding onto an
immovable object.
If a muscle crosses the wrist joint anteriorly with a vertical direction to its fibers, it
can flex the hand at the wrist joint by moving the palmar (anterior) surface of the
hand toward the anterior surface of the forearm.
If a muscle crosses the wrist joint posteriorly with a vertical direction to its fibers, it
can extend the hand at the wrist joint by moving the dorsal (posterior) surface of
the hand toward the posterior surface of the forearm.
If a muscle crosses the wrist joint on the radial side (laterally) with a vertical
direction to its fibers, it can radially deviate (abduct) the hand at the wrist joint
by moving the radial side of the hand toward the radial side of the forearm.
If a muscle crosses the wrist joint on the ulnar side (medially) with a vertical
direction to its fibers, it can ulnar deviate (adduct) the hand at the wrist joint by
moving the ulnar side of the hand toward the ulnar side of the forearm.
Reverse actions of these standard mover actions involve the forearm being
moved toward the hand at the wrist joint. These reverse actions usually occur
when the hand is fixed, such as when holding onto an immovable object.
Fingers two through five can move at three joints: (1) MCP, (2) PIP, and (3) DIP
joints. If a muscle crosses only the MCP joint, it can move the finger only at the
MCP joint. If the muscle crosses the MCP and PIP joints, it can move the finger at
both of these joints. If the muscle crosses the MCP, PIP, and DIP joints, it can
move the finger at all three joints.
The thumb (finger one) can move at three joints: the CMC, MCP, and
interphalangeal (IP) joints. Similarly, a muscle can only move the thumb at a joint
or joints that it crosses.
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TCCD MASSAGE THERAPY PROGRAM
NOTES: MUSCLES OF THE WRIST AND FOREARM, PART 1
MSSG 2013: KINESIOLOGY
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If a muscle crosses the MCP, PIP, or DIP joints of fingers two through five on the
anterior side, it can flex the finger at the joint(s) crossed; if a muscle crosses the
MCP, PIP, or DIP joints of fingers two through five on the posterior side, it can
extend the finger at the joint(s) crossed.
If a muscle crosses the MCP joint of fingers two, four, or five on the side that faces
the middle finger, it can adduct the finger at the MCP joint. If a muscle crosses
the MCP joint of fingers two, three, or four on the side that is away from the
middle finger side, it can abduct the finger at the MCP joint (the middle finger
abducts in both directions—radial and ulnar).
Muscles that cross the CMC, MCP, and IP joints of the thumb on the medial side
can flex the thumb at the joint(s) crossed. Muscles that cross the CMC, MCP, and
IP joints of the thumb on the lateral side can extend the thumb at the joint(s)
crossed.
Muscles that cross the CMC joint of the thumb on the anterior side can abduct
the thumb at the CMC joint. Muscles that cross the CMC joint of the thumb on
the posterior side can adduct the thumb at the CMC joint.
Reverse actions involve the proximal attachment moving toward the distal
attachment. This movement occurs when the fingers are holding onto a fixed,
immovable object.
#9
The following slides are views containing all the muscles that make up the working forearm
from the anterior and posterior and medial views at the superficial, intermediate and deep depths.
Note that many of the muscles of the anterior side of the forearm attach proximally to
the medial epicondyle of the humerus via the common flexor tendon.
#10
Note that many of the muscles of the anterior side of the forearm attach proximally to
the medial epicondyle of the humerus via the common flexor tendon.
#11
Note that many of the muscles of the anterior side of the forearm attach proximally to
the medial epicondyle of the humerus via the common flexor tendon.
#12
Note that many of the muscles of the posterior side of the forearm attach proximally to
the lateral epicondyle of the humerus via the common extensor tendon.
#13
Note that many of the muscles of the posterior side of the forearm attach proximally to
the lateral epicondyle of the humerus via the common extensor tendon.
#14
#15
#16
Question: How are the thenar muscles similar to the hypothenar muscles?
Answer: Each group contains an abductor, flexor, and opponens; both are superficial to
deep in that order.
#17
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TCCD MASSAGE THERAPY PROGRAM
NOTES: MUSCLES OF THE WRIST AND FOREARM, PART 1
MSSG 2013: KINESIOLOGY
#18
#19
#20
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
#21
#22
#23
Question: What are the relative positions of the distal tendons of the wrist flexor group?
Answer: The palmaris longus is dead center; the flexor carpi radialis is fairly close the
midline; and the flexor carpi ulnaris is far to the ulnar side.
#24
Question: How can knowing the actions of radialis deviation and ulnar deviation be
helpful when palpating the wrist flexor group?
Answer: Using only wrist joint flexion to engage the wrist flexors engages all three of
them, which makes discerning their proximal bellies where they lie next to each other
difficult. Radial deviation can be used to engage only the flexor carpi radialis; ulnar
deviation can be used to engage only the flexor carpi ulnaris.
#25
Question: Why does abduction of the little finger engage the flexor carpi ulnaris (FCU)?
Answer: The FCU contracts isometrically to stabilize the pisiform (its distal attachment
and the proximal attachment of the abductor digiti minimi manus) so the abductor digiti
minimi manus more efficiently abducts the little finger at the metacarpophalangeal joint .
#26
Resist the client from flexing the hand at the wrist joint and look for the distal tendons of
all three wrist flexors to become visible (Be sure that you do not contact the fingers
when offering resistance because that causes finger flexor muscles to be engaged also,
which makes discerning the muscles of the wrist flexor group more difficult.).
If they do not become visible, they should be palpable by strumming perpendicularly
across them.
Continue palpating the flexor carpi radialis proximally to the medial epicondyle by
strumming across its fibers. Repeat this for the other two wrist flexors.
Once the wrist flexors have been located, have the client relax them; palpate to assess
their baseline tone.
#27
Palpation of the flexor carpi radialis as the client radially deviates the hand against
resistance.
Palpation of the flexor carpi ulnaris as the client ulnar deviates the hand against
resistance.
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TCCD MASSAGE THERAPY PROGRAM
NOTES: MUSCLES OF THE WRIST AND FOREARM, PART 1
MSSG 2013: KINESIOLOGY
The palmaris longus is engaged when the client cups his hand.
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#28
Learn the attachments, actions, innervation and palpation of the
pronator group, brachioradialis and flexors digitorum and pollicis groups.
#29
Pronator teres
Pronator quadratus
#30
#31
#32
#33
#34
The client is seated with the arm relaxed and the forearm flexed at the elbow joint and in
a position that is halfway between full pronation and full supination; the forearm is
resting on the client’s thigh. Place your palpating thumb or finger pads on the proximal
anterior forearm, and gently but firmly grasp the client’s distal forearm just proximal to
the wrist joint with your support/resistance hand.
With moderate force, resist the client from pronating the forearm at the radioulnar joints
and feel for the contraction of the pronator teres.
#35
The client is seated or supine with the forearm fully supinated. Place your palpating
finger pads on the distal forearm, just proximal to the wrist.
Ask the client to pronate the forearm actively at the radioulnar joints, and feel for the
contraction of the pronator quadratus. Resistance can be added if necessary.
#36
#37
Question: How can the brachioradialis both pronate and supinate the forearm at the
radioulnar joints?
Answer: Often, the joint action of a muscle changes if the position of the joint changes
because the line of its pull changes relative to the joint when the bones of the joint
change their position. This is true with the brachioradialis. One way to see this is to
realize that if the brachioradialis concentrically contracts and shortens, it brings its distal
attachment, the styloid process of the radius, closer to the proximal attachment, the
lateral supracondylar ridge of the humerus. If the forearm is fully supinated, bringing the
styloid process closer involves pronating the forearm; if the forearm is fully pronated,
bringing the styloid process closer involves supinating the forearm.
#38
#39
The client is seated with the arm relaxed and the forearm flexed at the elbow joint and in
a position that is halfway between full pronation and full supination; the forearm is
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TCCD MASSAGE THERAPY PROGRAM
NOTES: MUSCLES OF THE WRIST AND FOREARM, PART 1
MSSG 2013: KINESIOLOGY
resting on the client’s thigh. Place your support/resistance hand on the client’s anterior
distal forearm, just proximal to the wrist joint.
Ask the client to try to flex the forearm with moderate force against your resistance. First
look for the contraction of the brachioradialis and then feel for its contraction at the
proximal anterolateral forearm (Fig. 7-14).
Strumming perpendicular to the fibers, palpate proximally to the lateral supracondylar
ridge of the humerus and then distally to the styloid process of the radius.
#40
#41
Question: Does the name “flexor digitorum superficialis” tell us that this muscle is
superficial?
Answer: No, not really. It tells us that its position is superficial relative to the flexor
digitorum profundus.
#42
#43
#44
Question: Does the flexor digitorum superficialis flex the distal phalanges of fingers two
to five at the distal interphalangeal joints?
Answer: No. Only the flexor digitorum profundus does that action.
Question: If the flexor digitorum profundus (FDP) is the only muscle that flexes the distal
phalanges of fingers two to five at the distal interphalangeal joints, how can we use that
knowledge to palpate and discern the FDP?
Answer: If the client can isolate flexion of the distal phalanges, the FDP is the only
muscle to engage, and palpating and discerning it is much easier.
Question: Given the attachments of the flexor pollicis longus (FPL), why is keeping the
elbow joint extended when stretching it important?
Answer: If the elbow joint is flexed, it allows the FPL to slacken and it is not stretched as
well.
#45
#46
The client is seated with the arm relaxed; the forearm is flexed at the elbow joint and
fully supinated and resting on the client’s thigh.
Place your palpating finger pads on the proximal medial forearm, slightly distal and
anterior to the medial epicondyle of the humerus. Ask the client to flex the proximal
phalanges of fingers two through five at the MCP joints.
Feel for the contraction of the flexor digitorum superficialis. Palpate the flexor digitorum
superficialis by strumming perpendicular to the fibers from the proximal attachment at
the medial epicondyle to the distal tendons at the anterior wrist.
#47
The client is seated with the arm relaxed; the forearm is flexed at the elbow joint and
fully supinated and resting on the client’s thigh.
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TCCD MASSAGE THERAPY PROGRAM
NOTES: MUSCLES OF THE WRIST AND FOREARM, PART 1
MSSG 2013: KINESIOLOGY
Place your palpating finger pads on the proximal medial forearm, slightly distal and
posterior to the medial epicondyle and against the shaft of the ulna. Ask the client to flex
the middle and distal phalanges of fingers two through five at the proximal and distal IP
joints and feel for the contraction of the flexor digitorum profundus.
Palpate the flexor digitorum profundus as far distally as possible by strumming
perpendicular to the fibers.
#48
The client is seated with the arm relaxed, and the forearm is flexed at the elbow joint
and fully supinated and resting on the client’s thigh. Place your palpating finger pads
just proximal to the wrist joint on the radial side.
Ask the client to flex the distal phalanx of the thumb at the IP joint. With gentle pressure,
feel for the contraction of the flexor pollicis longus near the wrist.
#49
#50
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
#51
#52
#53
#54
#55
#56
The client is seated with the arm relaxed and the forearm flexed at the elbow joint and in
a position that is halfway between full pronation and full supination; the forearm is
resting on the client’s thigh.
The radial group is pinched with the palpating fingers and separated from the rest of the
musculature of the forearm. Pinch the radial group of muscles between your thumb on
one side and your index finger (or index and middle fingers) on the other side; gently
pull them away from the forearm.
Move your palpating finger pads onto the extensors carpi radialis longus and brevis
(posterior to the brachioradialis) and feel for their contraction as the client radially
deviates the hand at the wrist joint. Resistance to radial deviation can be added with
your support/resistance hand, if desired.
Continue palpating the extensor carpi radialis muscles toward their distal attachments
by strumming perpendicularly across them.
#57
The client is seated with the arm relaxed; the forearm is flexed at the elbow joint, fully
pronated at the radioulnar joints, and resting on the client’s thigh.
Place your palpating finger pads immediately posterior to the shaft of the ulna.
15 September 2012
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TCCD MASSAGE THERAPY PROGRAM
NOTES: MUSCLES OF THE WRIST AND FOREARM, PART 1
MSSG 2013: KINESIOLOGY
Ask the client to ulnar deviate the hand at the wrist joint and feel for the contraction of
the extensor carpi ulnaris. If resistance is given, place your resistance hand on the ulnar
side of the client’s hand, proximal to the fingers.
Palpate proximally toward the lateral epicondyle and distally toward the fifth metacarpal
by strumming perpendicular to the fibers as the client alternately contracts and relaxes
the muscle.
#58
#59
#60
#61
Question: Why might discerning the border between the extensor digitorum and
extensor digiti minimi be difficult?
Answer: The fibers of the extensor digitorum that border the extensor digiti minimi do
the same action as the extensor digit minimi (extension of the little finger), so they both
engage, making discerning the border difficult.
#62
#63
The client is seated with the arm relaxed; the forearm is flexed at the elbow joint, fully
pronated at the radio-ulnar joints, and resting on the client’s thigh. Place your palpating
finger pads on the middle of the posterior proximal forearm.
Ask the client to extend fingers two through five fully at the MCP and IP joints (be sure
that the client is not attempting to also extend the hand at the wrist joint), and feel for
the contraction of the extensor digitorum and extensor digiti minimi.
Note: Discerning the border of these two muscles is difficult.
If resistance is given, place your resistance hand on the posterior side of the fingers, not
over the metacarpals of the hand.
Continue palpating toward the insertion and then the origin (distal and proximal
attachments) by strumming perpendicular to the fibers of these two muscles.
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