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Antebrachium Flexors Bony, soft landmarks • 1. humerus – a. lateral epicondyle - radial side – b. medial epicondyle - ulnar side • 2. radius - head, neck, tuberosity, styloid process (more distal than ulnar's styloid) – interosseous border (medial edge, attachment of interosseous mb); distal tubercle • 3. ulna - olecranon process, coronoid process & tuberosity, styloid process, trochlear notch interosseous border (lateral edge); head (distal end of ulna) • 4. flexor retinaculum: thick section of deep fascia at wrist -holds forearm tendons in place Vessels • Brachial artery: extension/continuation of axillary artery (barely reaches into forearm) • Radial artery: lateral, anterior to elbow; partially overlapped by brachioradialis muscle – a. radial recurrent (around elbow, anastomoses with branch from deep brachial artery) – b. superficial palmar branch to form the superficial palmar arch (anastomoses with ulnar branch) – c. palmar carpal branch arch (joins with palmar carpal branch from ulnar artery to form the palmar carpal arch) – d. dorsal carpal branch (joins with dorsal carpal branch from ulnar artery to form dorsal arch, more later) Ulnar artery • ulnar artery: medial, anterior to elbow, deep to pronator teres muscle – a. anterior ulnar recurrent anastomoses with inferior ulnar collateral artery – b. posterior ulnar recurrent anastomoses with superior ulnar collaterals around elbow – c. common interosseous artery. - in cubital fossa (branch into anterior, posterior branches) – d. palmar carpal branch arch (anastomoses with radial branch, see above) – e. dorsal carpal branch arch – f. superficial branch to form the superficial palmar arch – g. deep palmar branch arch (anastomoses with radial artery) Forearm Nerves • Median & Ulnar - both are on the anterior side, supply essentially all the flexors with few exceptions • 1. Median - on anterior side – a. articular branches: to elbow – b. muscular branches: to all flexors (except flexor carpi ulnaris & medial part of digitorum profundus by ulnar nerve) – c. anterior interosseous nerve: to flexor digitorum profundus (lateral 1/2) pollicis longus & pronator quadratus – d. palmar cutaneous branch: - to skin of lateral palm Ulnar • a. articular branches: to elbow • b. muscular branches: to flexor carpi ulnaris & medial part of digitorum profundus • c. palmar cutaneous branch: - to skin of posterior, medial part of hand Radial Nerve • Radial - to posterior (supplies only extensors + brachioradialis, its one and only flexor) – a. superficial branch = continuation of radial - to skin on lateral dorsal wrist, hand, thumb, lateral 1+1/2 digits (index, middle) – b. deep branch - is larger, exclusively muscular & articular - to extensor muscles; supinator – c. posterior interosseous - a branch of the deep radial - to deep extensors Muscles • 3 functional groups: • flex wrist at hand = flexor carpi radialis; flexor carpi ulnaris; palmaris longus • flex fingers = flexor digitorum superficialis; flexor digitorum profundus; flexor pollicis longus • pronate hand = pronator teres; pronator quadratus layers • Superficial layer – pronator teres; flexor carpi radialis; flexor carpi ulnaris; palmaris longus – share a common tendon from humerus (medial epicondyle) – & deep fascia that covers proximal parts of the muscles – then separate from each other as they extend distal to the humerus • 2. intermediate layer = flexor digitorum superficialis • 3. deep layer = flexor digitorum profundus; flexor pollicis longus; pronator quadratus PRONATOR TERES • ORIGIN – Origin of humeral head: Immediately above medial epicondyle of humerus, common flexor tendon, and deep antebrachial fascia – Origin of ulnar head: medial side of coronoid process of ulna • INSERTION medial of lateral surface of radius • ACTION pronates forearm • NERVE median nerve – C6, 7 FLEXOR CARPI RADIALIS • ORIGIN common flexor tendon from medial epicondyle of humerus, and deep antebrachial fascia • INSERTION base of second metacarpal bone and a slip to base of third metacarpal bone • ACTION flexes, abducts the wrist and may assist in pronation of the forearm and flexion of the elbow • NERVE median nerve - C6, C7, C8 PALMARIS LONGUS • ORIGIN common flexor tendon from medial epicondyle of humerus, and deep antebrachial fascia • INSERTION flexor retinaculum, and palmar aponeurosis. • ACTION tenses the palmar fascia, flexes the wrist, and may assist in flexion of the elbow • NERVE median nerve – C(6), C7, C8, T1 PALMARIS BREVIS • ORIGIN ulnar border of palmar aponeurosis and palmar surface of flexor retinaculum • INSERTION Skin on ulnar border of hand • ACTION Corrugates the skin on ulnar side of hand • NERVE ulnar, C7, 8, T1 FLEXOR CARPI ULNARIS • ORIGIN – humeral head: common flexor tendon from medial epicondyle of humerus – ulnar head: by aponeurosis from the medial margin of olecranon, proximal two thirds of posterior border of ulna, and from the deep antebrachial fascia • INSERTION pisiform bone and by ligaments, to hamate and fifth metacarpal bones • ACTION flexes and adducts the wrist and may assist in flexion of the elbow • NERVE ulnar nerve - C7, C8, T1 FLEXOR DIGITORUM SUPERFICIALIS • ORIGIN – Origin from humeral head: common flexor tendon from medial epicondyle of humrus, ulnar collateral ligament of elbow joint, and deep antebrachial fascia – Origin from ulnar head: medial side of coronoid process – Origin from radial head: obique line of radius • INSERTION by four tendons into sides of middle phalanges of second through fifth digits • ACTION flexes the proximal interphalangeal joints of second through fifth digits, assists in flexion of the metacarpophalangeal joints and in flexion of the wrist • NERVE median nerve - C7, C8, T1 FLEXOR DIGITORUM PROFUNDUS • ORIGIN Anterior and medial surfaces of proximal three fourths of ulna, interosseus membrane, and deep antebrachial fascia • INSERTION by four tendons into bases of distal phalanges, anterior surface • ACTION flexes distal interphalangeal joints of index, middle, ring, and little fingers, and assists in flexion of proximal interphalangeal and metacarpophalangeal joints, may assist in flexion of the wrist • NERVE Profundus I, II median nerve C7, C8, T1 Profundus III, IV: ulnar nerve C7, C8, T1 FLEXOR POLLICIS LONGUS • ORIGIN Anterior surface of body of radius below tuberosity, interosseus membrane, medial border of coronoid process of ulna, and/or medial epicondyle of humrus • INSERTION Base of distal phalanx of thumb, palmar surface • ACTION flexes the interphalangeal joint of the thumb, assists in flexion of the metacarpophalangeal and carpometacarpal joints, and may assist in flexion of the wrist • NERVE median nerve, C(6),C7, C8, T1 PRONATOR QUADRATUS • ORIGIN Medial side, anterior surface of distal one fourth of ulna • INSERTION Lateral side, anterior surface of distal one fourth of radius • ACTION pronate the forearm • NERVE median nerve, C7, C8, T1