Upper Extremity
Hand Musculature and Vasculature, Cross sections,
Review
Presentation

Wrist Biomechanics
Objectives

Describe the gross anatomy for each system (circulatory, muscular, nervous,
and skeletal) in the upper extremity.

Integrate the systems to discuss the upper extremity stability and mobility
functions.

Analyze common injuries in the upper extremities.

For each muscle, describe how the attachment sites result in an action
around a joint.

For each muscle, identify the innervation (peripheral nerve and nerve roots).
The brachioradialis:
m
t..
in
ed
ne
.
ia
rv
le
at
pi
ed
co
ac
nd
b
ts
yt
...
at
he
bo
ra
th
di
al
th
ne
e
el
rv
bo
e.
w
an
d
w
ex
ris
te
t..
nd
.
st
he
el
bo
w
.
se
sd
ee
p
pa
s
is
th
e
o
st
E.
th
at
D.
at
ta
ch
e
C.
20%20% 20% 20% 20%
te
nd
on
B.
has a tendon that passes deep
to the flexor retinaculum.
attaches to the medial
epicondyle of the humerus.
is innervated by the radial
nerve.
acts at both the elbow and
wrist joints.
extends the elbow.
ha
sa
A.
You are assisting in the emergency room when the attending
physician examines a patient after an elbow injury. The
physician holds the proximal interphalangeal joint of the
little finger and asks the patient to flex the distal phalanx.
This procedure tests the functionality of what nerve? 20% 20% 20% 20% 20%
D.
E.
m
po
ed
st
ia
er
n
io
ri
nt
er
os
se
an
ou
te
s
r io
ri
nt
er
os
se
ou
s
C.
ul
na
r
B.
radial
ulnar
median
posterior interosseous
anterior interosseous
ra
di
al
A.
Elbow tendonitis (tennis elbow) is
associated with:
pe
rio
st
eu
o
in
ft
fla
m
h
...
e
m
m
m
ed
at
io
ia
n
lc
ru
o
ol
pt
ft
l..
he
ur
.
e
an
of
nu
th
la
e
tr
rl
te
an
i..
n
sie
do
.
nt
n
of
su
th
bl
ux
e
ex
at
...
io
n
of
th
e
hu
...
m
m
at
io
n
E.
of
th
e
D.
in
fla
C.
20%20%20% 20% 20%
m
m
at
io
n
B.
inflammation of the periosteum of
the lateral epicondyle of the
humerus.
inflammation of the medial collateral
ligament.
inflammation of the annular
ligament.
rupture of the tendon of the extensor
digitorum.
transient subluxation of the humeroradial-ulnar joint.
in
fla
A.
Clinical Relevance

Dupuytren Contracture

Tenosynovitis

Carpal Tunnel
Syndrome
Clinical Relevance

Carpal Tunnel Syndrome

Ulnar Nerve Injury

Radial Nerve Injury

Raynaud’s disease
Enter your lecture team number!
10%
10%
10
10%
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10%
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10%
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10%
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10%
5
10%
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10%
3
10%
2
1
2
3
4
5
6
7
8
9
10
1
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Which of the following is incorrect
pertaining to the clavicle?
s..
..
nt
sw
Pa
t ie
sa
re
vic
le
cla
fra
ct
ur
ed
it h
al
m
os
t
al
w
ay
s
ac
.
...
m
ed
ia
ls
th
e
fra
ct
ur
e,
ra
Af
te
It
is
at
ta
ch
ed
vi
a
lig
am
en
t
st
o
t..
.
25% 25% 25% 25%
Fr
ac
tu
re
It is attached via ligaments to
the coracoid process.
B. After a fracture, the medial
segment is raised by the
sternocleidomastoid muscle.
C. Fractures are almost always
accompanied by
acromioclavicular dislocation.
D. Patients with fractured clavicles
typically need to support the
ipsilateral upper limb with the
contralateral one.
A.
The ridge indicated by the arrow in the
following photograph overlies the tendon of
which of the following muscles?
br
ev
xo
is
r
le
ca
xo
rp
rd
ir
ad
ig
ito
ia
lis
ru
m
su
pe
ab
rfi
du
cia
ct
lis
or
po
lli
cis
lo
ng
us
E.
fle
D.
pa
lm
ar
is
C.
lo
ng
us
B.
palmaris longus
palmaris brevis
flexor carpi radialis
flexor digitorum
superficialis
abductor pollicis longus
pa
lm
ar
is
A.
20% 20% 20% 20% 20%
Which of the following statements is
incorrect pertaining to the extensors carpi
radialis longus and brevis muscles?
20%20%20% 20%20%
.
le
sa
m
he
ct
u
sc
n
...
le
th
sa
e
tw
ct
o
w
On
m
ith
us
e
...
of
cle
th
sa
e
ct
m
w
us
ith
cle
t..
si
si
Bo
nn
th
er
at
va
ta
te
ch
...
to
th
e
hu
m
er
us
m
us
c
o
tw
W
th
e
tw
o
th
e
he
n
E.
W
D.
on
ly
C.
he
n
B.
When only the two muscles act together,
wrist extension and abduction is produced.
When the two muscles act with the
extensor carpi ulnaris, only wrist extension
is produced.
When the two muscles act with the flexor
carpi ulnaris, only wrist abduction is
produced.
One of the muscles is innervated by the
ulnar and the other by the deep branch of
the radial nerve.
Both attach to the humerus.
W
A.
In the emergency room you see a 65-year-old woman who
fell on her outstretched right hand while walking on ice.
Upon examination of the right limb, you feel and see a
dorsal protrusion just proximal to the wrist. You suspect a:
20%20%20% 20%20%
fractured lunate.
B. fractured distal radius
(Colles fracture).
C. mid-radial fracture.
D. dislocated first
carpometacarpal joint.
E. dislocated midcarpal joint.
fra
ct
ur
ed
di
st
al
fra
ct
ur
ed
lu
na
ra
te
di
us
.
(C
ol
di
le
sf
slo
m
id
r ..
ca
.
ra
te
di
d
al
fir
fra
st
ca
ct
ur
rp
e.
om
di
et
slo
ac
ca
ar
te
pa
d
l.
m
..
id
ca
rp
al
jo
in
t.
A.
Following an avulsion fracture of the greater
tubercle of the humerus, the humerus would
primarily be:
20% 20% 20% 20% 20%
ex
te
nd
ed
.
xe
d.
fle
ab
du
ct
ed
.
E.
ro
ta
te
d.
D.
m
ed
ia
lly
C.
ro
ta
te
d.
B.
laterally rotated.
medially rotated.
abducted.
flexed.
extended.
la
te
ra
lly
A.
In the following axial MRI through the distal third of
the arm, the brachial artery is labeled number 1
(see thin leader line on image). What is the
structure indicated by the arrow?
20% 20% 20% 20% 20%
n
bi
ce
ps
te
nd
on
ba
sil
ic
ve
in
ve
i
of
ce
ph
al
ic
E.
sh
or
th
ea
d
D.
ne
rv
e
C.
ra
di
al
B.
ulnar artery
radial nerve
cephalic vein
short head of biceps tendon
basilic vein
ul
na
ra
rt
er
y
A.
The cephalic vein:
th
ve
pi
e
in
er
m
.
ed
ce
st
ia
ls
he
id
cla
em
e
o.
vi
pt
..
p
ec
ie
si
t
or
nt
al
o
fa
th
sc
e
ia
su
.
bc
la
via
n
ve
in
.
n
ax
ill
ar
y
ei
n.
th
e
or
ig
in
at
es
o
E.
br
ac
hi
al
v
D.
be
co
m
es
C.
20%20% 20% 20% 20%
th
e
B.
becomes the brachial vein.
becomes the axillary vein.
originates on the medial side of
the dorsal venous network at the
wrist.
pierces the clavipectoral fascia.
empties into the subclavian vein.
be
co
m
es
A.
B.
C.
D.
E.
an anteriorly dislocated glenohumeral
joint.
a posteriorly dislocated glenohumeral
joint.
a dislocated acromioclavicular joint
with intact coracoclavicular ligaments.
a dislocated acromioclavicular joint
with torn coracoclavicular ligaments.
a torn rotator cuff.
an
A.
an
te
rio
rly
di
a
slo
po
ca
st
er
te
io
d
rly
gl
en
a
di
di
o.
s
lo
slo
..
c
ca
at
ed
te
d
gle
a
cr
a
no
di
om
...
slo
i
oc
ca
la
te
vi
d
cu
ac
la
ro
rj
m
o.
io
..
cla
vi
cu
la
rj
a
oi
to
..
rn
ro
ta
to
rc
uf
f.
You examine a young male patient whose shoulder was
injured during a football game. You immediately notice that
his acromion process is abnormally prominent and inferior to
the acromial end of the clavicle. You suspect:
20%20%20% 20%20%
Scapulohumeral rhythm refers to:
E.
rti
cu
pr
la
ot
rc
ec
on
tiv
fig
e
th
ur
co
e
a.
nt
pr
..
r
ot
a
ct
ra
io
ct
ns
iv
th
e
of
e
a
nd
as
t..
so
re
cia
tr
ac
tio
tiv
th
n
e
e
b
e
...
re
tw
la
ee
tio
n
ns
th
hi
e
p
m
be
...
tw
ee
n
m
ov
...
D.
th
e
C.
20%20%20% 20% 20%
ch
an
gi
ng
a
B.
the changing articular configuration of
the humeral head in the glenoid cavity
with movement.
the protective contractions of the
rotator cuff muscles with humeral
abduction.
the protractive and retractive
movements of the scapula that occur
with humeral flexion and extension.
the association between the movements
at the glenohumeral and
acromioclavicular joints.
the relationship between movements at
the glenohumeral and scapulothoracic
"joints" during humeral abduction.
th
e
A.
Which of the following relationships at
the wrist is incorrect?
ap
ho
id
t ..
pa
lp
at
ed
in
...
ca
n
lie
Th
e
sc
rte
ry
be
to
...
sm
ed
ia
l
be
lie
ca
n
Th
e
ra
di
al
a
rte
ry
ne
rv
e
an
d
ra
di
al
a
Th
e
ar
te
ry
co
m
pr
l..
.
t ..
to
sd
ee
p
lie
ul
na
r
ne
rv
e
E.
Th
e
D.
ed
ia
n
C.
20%20% 20% 20%20%
m
B.
The median nerve lies deep to the
tendon of the palmaris longus.
The ulnar artery and nerve lie lateral
to the tendon of the flexor carpi
ulnaris.
The radial artery can be compressed
against the radius.
The radial artery lies medial to the
tendon of the flexor carpi radialis.
The scaphoid can be palpated in the
floor of the anatomical snuffbox.
Th
e
A.
Which of the following is incorrect
pertaining to carpal tunnel syndrome?
ca
in
us
Su
ed
th
rg
e.
ic a
by
..
lt
i
nf
ra
la
ns
m
ec
m
tio
at
n
i ..
of
th
ef
le
xo
r ..
.
..
be
m
ay
It
in
vo
lve
m
ay
It
pa
re
s
he
si a
th
es
ia
of
th
e.
...
th
e
in
in
vo
lve
an
es
t
ea
kn
es
s
w
m
ay
E.
It
D.
in
vo
lve
C.
20%20%20% 20%20%
m
ay
B.
It may involve weakness in the thenar
muscles.
It may involve anesthesia of the
central palm.
It may involve paresthesia in the
lateral 3½ digits.
It may be caused by inflammation of
the synovial sheaths of the flexor
tendons.
Surgical transection of the flexor
retinaculum typically relieves its
associated symptoms.
It
A.
Enter Question Text
100%
Te
xt
Answer Text
En
te
rA
ns
w
er
A. Enter
Upper arm
Lower arm
Cubital fossa
Upper forearm
Middle forearm
Objectives

Describe the gross anatomy for each system (circulatory, muscular, nervous,
and skeletal) in the upper extremity.

Integrate the systems to discuss the upper extremity stability and mobility
functions.

Analyze common injuries in the upper extremities.

For each muscle, describe how the attachment sites result in an action
around a joint.

For each muscle, identify the innervation (peripheral nerve and nerve roots).
Wednesday

Neck


Readings
Due Monday: step 1 of open topic essay (rough draft!!)