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The Hand
• We will start off at the hand. You will need an understanding of the bones that
make up our hand, because they will act as insertion points for the forearm muscles
Ulna
Carpals
Metacarpals
Phalanges
Radius
The Forearm
• is the area of the appendicular skeleton stretching from the elbow to the wrist
- let’s take a look at the skeletal components of the forearm
Head
Neck
Radial tuberosity
Olecranon process
Coronoid process
ULNA
Interosseus membrane
RADIUS
Styloid process
The Forearm
• is the area of the appendicular skeleton stretching from the elbow to the wrist
- let’s take a look at the skeletal components of the forearm
• SUPINATION is a very important movement of the forearm
• we need to view the movement of the forearm from 2 different angles
• At the elbow, the forearm is dominantly the ulna
• At the wrist, the forearm is dominantly the radius
Upon supination
• radius spins on its axis at
the elbow, but orbits around
the head of the ulna at the
wrist
• movement stops when
radius buts up against the
ulna
- The humerus is a long bone that connects the
shoulder (scapula) and the lower arm (radius and
ulna)
Posterior
Greater Tubercle
Surgical neck
Anterior
Greater Tubercle
Head
Anatomical
neck
Lesser Tubercle
Deltoid Tuberosity
Olecranon fossa
Lateral epicondyle
Coronoid
fossa
Medial
epicondyle
Trochlea
Capitulum
Tubercle: A round nodule or “warty” outgrowth of a bone
Fossa:
A depression or hollow on a bone
Trochlea: A grooved structure resembling a “pulley wheel”
Posterior Muscles of the Forearm
Extensor carpi radialis longus
O: above lateral epicondyle of humerus
Extensor
I: basecarpi
of 2ndulnaris
metacarpal
F:
and
abduct wrist
Extensor
O:extend
lateral
digitum
epicondyle
of humerus and ulna
Extensor
carpi
radialis
brevis
I:O:base
of 5th
metacarpal
lateral
epicondyle
of the humerus
F:
adducts
Flexor
O:
lateral
carpi
epicondyle
ulnaris
ofwrist
humerus
I: extends
all
digitsand
except
thumb
rd 1
O:base
2 heads:
medial epicondyle,
1 olecranon
I:
of 3interphalangeal
metacarpal
F:
extends
joints (fingers)
th metacarpal
I: extends
base of 5and
F:
abducts the wrist
Thenar Eminence: muscles proximal to thumb (3)
F: flexes and adducts the wrist
-flex, adduct and oppose thumb
Hypothenar Eminence: muscles proximal to little finger (3)
-abduct, flex, oppose little finger
Anterior Muscles of the Forearm
Biceps brachii
Brachialis
Supinator
O: lower anterior humerus
Pronator
teres
I: coronoid
process
ulna
O: Lateral
epicondyle
humerus
Brachioradialis
O: medial
humerus
F:epicondyle
flexes
elbow
I: anterior
& lateral
aspect of
and coronoid
process of ulna
O: above
radius
lateral epicondyle
Flexor
carpi radialis
humerus
I: lateral
surface offorearm
mid radius
F: Supinating
O:F:
medial
epicondyle
I: styloid
process
radius humerus
pronates
forearm/
flex elbow
second
metacarpal (index)
F: I:
elbow
flexor
Flexor carpi ulnaris
F: flexes and abducts hand
Pronator quadratus
O: anterior surface of
distal ulna
I: anterior surface of distal
radialis
F: pronates forearm
Forearm Flexors:
Part I -http://www.youtube.com/watch?v=DIwO1ld7vM8&feature=related
Part II -http://www.youtube.com/watch?v=QSy9MB69AkM&feature=related
Forearm Extensors:
Part I -http://www.youtube.com/watch?v=Cw3xr8_rLMU&feature=related
Part II -http://www.youtube.com/watch?v=XObJNybS1-I&feature=related
Upper Arm: http://www.youtube.com/watch?v=vnb2iTnlAN0&feature=related
Shoulder:
Part I -http://www.youtube.com/watch?v=t5sLRGQ_Ews&feature=related
Part II -http://www.youtube.com/watch?v=FDxe1hdHrHY&feature=related
. . .a hinge joint formed by the articulation of the humerus of the arm and
the ulna and radius of the forearm
-video
Elbow Ligaments
Radial collateral ligament
Ulnar collateral ligament
(prevents excessive
adbuction)
(prevents excessive
adduction)
Tennis Elbow (lateral
epicondylitis)
-extensor carpi radialis brevis
-chronic  pain on lateral side of elbow
- RICE & Physio
-video
(maintains articulation
of radius with humerus)
-video
. . .three bones (clavicle,
scapula and humerus)
articulate forming this ball
and socket joint
Superior angle
Medial border
Inferior angle
What view?
Muscles of the Upper Arm
Anterior
Corachobrachialis
O: coracoid process
I: medial aspect of humerus
F: Teres
flexesmajor
and adducts arm
O:brachii
inferior lateral border of scapula
Biceps
humerus
O: I:
short
head –coracoid process; long head –
supraglenoid
tubercle adduction and
F: medial rotation,
extension
of upper
arm
I: radial
tuberosity
(radius)
Brachialis
F: flexes supined elbow, supination
Brachioradialis
Triceps brachii
O: lateral head –posterior aspect of
humerus; long head –infraglenoid
tubercle of scapula; medial head –
posterior aspect of humerus
I: olecranon process
F: extends arm
Posterior head
Lateral head
Anterior head
Deltoid
O: clavicle, acromium
and spine of scapula
I: deltoid tuberosity of
the humerus
F: anterior –flexes and
medially rotates;
lateral –abducts the
arm; posterior –extends
and laterally rotates
arm
Forearm Flexors:
Part I -http://www.youtube.com/watch?v=DIwO1ld7vM8&feature=related
Part II -http://www.youtube.com/watch?v=QSy9MB69AkM&feature=related
Forearm Extensors:
Part I -http://www.youtube.com/watch?v=Cw3xr8_rLMU&feature=related
Part II -http://www.youtube.com/watch?v=XObJNybS1-I&feature=related
Upper Arm: http://www.youtube.com/watch?v=vnb2iTnlAN0&feature=related
Shoulder:
Part I -http://www.youtube.com/watch?v=t5sLRGQ_Ews&feature=related
Part II -http://www.youtube.com/watch?v=FDxe1hdHrHY&feature=related
-there are really 3 joints in the shoulder:
• glenohumeral
• acromioclavicular
• sternoclavicular
- The shoulder must be flexible for the wide range of motion required in the arms
and hands and also strong enough to allow for actions such as lifting, pushing and
pulling. The compromise between these two functions results in a large number
of shoulder problems
Ligaments of the Shoulder Joint
Coracoclavicular
ligament
Coracoacromial
ligament
Superior
glenohumeral
ligament
Medial
glenohumeral
ligament
Inferior
glenohumeral
ligament
There is also a synovial fluid-filled capsule that encompasses the shoulder
(attaches to the scapula, humerus and head of biceps) . The capsule is
strengthened by the coracohumeral ligament
Muscles of the Rotator Cuff
- a group of muscles that extend from the scapula to the humerus and wrap around the
shoulder joint  basically holding it in place
Supraspinatus
Infraspinatus
Subscapularis
FRONT
BACK
Teres Minor
Supraspinatus
O: posterior surface of
scapula above spine
Insertion: all fuse to form tendon
inserting on greater tubercle of
humerus
Infraspinatus
O: poseterior surface of
scapula below spine
F: stabilize the shoulder; supra–
abducts shoulder, infra and teres–
laterally rotate shoulder
Teres Minor
O: later border of scapula
Subscapularis
O: anterior surface of the scapula
I: Lesser tubercle of the humerus
F: medially rotates humerus; stabilizes
shoulder
Forearm Flexors:
Part I -http://www.youtube.com/watch?v=DIwO1ld7vM8&feature=related
Part II -http://www.youtube.com/watch?v=QSy9MB69AkM&feature=related
Forearm Extensors:
Part I -http://www.youtube.com/watch?v=Cw3xr8_rLMU&feature=related
Part II -http://www.youtube.com/watch?v=XObJNybS1-I&feature=related
Upper Arm: http://www.youtube.com/watch?v=vnb2iTnlAN0&feature=related
Shoulder:
Part I -http://www.youtube.com/watch?v=t5sLRGQ_Ews&feature=related
Part II -http://www.youtube.com/watch?v=FDxe1hdHrHY&feature=related
Rotator Cuff Tears
• The rotator cuff is made up of 4 different muscles: supraspinatus, infraspinatus,
subscapularis and teres minor.
•The term “cuff” refers to how the muscles cover the head of the humerus
• May be ACUTE or CHRONIC
Due to
overheard
motions
Rotator Cuff Tears
-video
• The rotator cuff is made up of 4 different muscles: supraspinatus, infraspinatus,
subscapularis and teres minor.
•The term “cuff” refers to how the muscles cover the head of the humerus
• May be ACUTE or CHRONIC
Due to
overhead
motions
• Symptoms:
-pain in front of shoulder radiating
down the arm (acute) “snapping”
-pain when lifting/lowering arm
-weakness in arm
- crepitus “cracking” sound on
movement
** symptoms may emerge
gradually if tear is a product of
overuse (chronic) **
Treatment
- the vast majority of rotator cuff tears can be treated without surgery
Non-operative treatments include:
-physical therapy
-anti inflammatory medications
-cortisone shots
-reduce inflammation,
strengthen uninjured
muscles around joint to
compensate for injured
muscles
If surgery is necessary:
-different options depending on severity, location of tear,
physical activity level of patient and hopes for future use
-proper rehab, stretching, avoiding movements that could
reinjure the tendons