chanel kyle sandra pta 106 fall 2008. lateral epicondyle medial epicondlye olcranon ulnar...

Elbow and Hand

Chanel Kyle

Sandra

PTA 106 Fall 2008

Lateral Epicondyle Medial Epicondlye Olcranon Ulnar Styloid Process Cubital Fossa Site of Median Nerve Tendon of Palmaris

Longus Tendon of Flexor

Carpi Radialis Distal Wrist Crease

Surface Anatomy

Anatomical Snuff Box

Thenar Eminance Hypothenar

Eminence

Medial Epicondyle Lateral Epicondyle Capitulum- on lateral

edge of condyle

Trochlea- medial and mid section of condyle

Coronoid Fossa Olecranon Fossa

The Humerus

Olecranon Process Trochlear Notch Coronoid Process Radial Notch Ulnar Tuberosity Styloid Process

Ulna

Head Neck Radial Tuberosity Ulnar Notch Styloid Process

Radius

Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Hamate, Trapezoid, Capitate

Metacarpals: Numbered 1-5, starting at thumb

Phalangeal: Numbered 1-5◦ Distal, Middle,

Proximal

Wrist/Hand

LIGAMENTS OF THE ELBOW (HUMEROULNAR JT) A. Ligaments

◦ Elbow Articular Capsule Radial anular ligament Interosseous

membrane Ulnar collateral

ligament Radial collateral

ligament

◦ Hand Palmar aponeurosis Common Flexor sheath Flexor retinaculum

B. Bursae◦ Subcutaneous

olecranon bursa◦ Subtendinous

olecranon bursa C. Cartilage,

articular cartilage D. Articular

Capsule◦ Synovial membrane◦ Fibrous layer

LIGAMENTS OF THE ELBOW (HUMEROULNAR AND HUMERORADIAL JOINTS)

Articular Capsule Radial Anular

ligament Interosseous

membrane Ulnar collateral

ligament Radial collateral

ligament

All provide strength and support to the joint as do the surrounding muscles

Two ligaments found in the elbow joint are:◦ the ulnar collateral

ligament and the radial collateral ligament.

◦ They are strong, fan shaped condensations of the fibrous joint capsule

LIGAMENTS OF THE ELBOW (HUMEROULNAR JT) Movements of the

elbow joint◦ Flexion and extension

occur at the elbow joint◦ The long axis of the fully

extended ulna makes an angle of approximately 170° with the long axis of the humerus

◦ Called the carrying angle for the way the forearm angles away from the body when something is carried

The obliquity of the angle is more pronounced in women than in men

LIGAMENTS OF THE ELBOW (HUMEROULNAR AND PROXIMAL RADIOULNAR JT) Articular capsule

◦ A sac enclosing a joint, formed by an outer fibrous membrane and an inner synovial membrane. Also called joint capsule

◦ The synovial fluid nourishes the fibrocartilage and lubricates the joint surface

LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)

◦ Weak anteriorly and posteriorly, the capsule strengthened on each side by the ulnar and radial collateral ligaments

◦ The fibrous layer of the capsule is continuous with the fibrous layer of the elbow joint

◦ It attaches to the humerus at the margins of the lateral and medial ends of the articular surfaces of the capitulum and trochlea

Fig 6.35

LIGAMENTS OF THE ELBOW (HUMEROULNAR JT) Radial anular

ligament◦ Encircles and holds

the head of the radius in the radial notch of the ulna

◦ Forms the proximal radioulnar joint

◦ Allows pronation and supination of forearm

◦ In pronation/supination it is the radius that rotates

Figure 6.33E, 6.36C

LIGAMENTS OF THE ELBOW (HUMEROULNAR JT) Ulnar collateral

ligament◦Located on the

medial side of the joint, it extends from the medial epicondyle of the humerus to the proximal portion of the ulna

◦Prevents excessive abduction of the elbow joint

LIGAMENTS OF THE ELBOW (HUMEROULNAR JT) Radial collateral ligament◦Located on the

lateral side of the joint, extending from the lateral epicondyle of the humerus to the head of the radius.

◦Prevents excessive adduction of the elbow joint.

LIGAMENTS OF THE ELBOW (HUMEROULNAR JT) Interosseous

membrane◦ Connects the shafts of the

ulna and the radius throughout most of their length

◦ Classified as a fibrous joint, or syndesmosis

◦ Note: The ulnar and radial collateral ligaments of the proximal humeroulnar joint are not to be confused with the ligaments of the same name at the distal radioulnar joint

Fig 6.20A,B

LIGAMENTS OF THE HAND Fascia of the palm

is continuous with the antebrachial fascia, and the fascia of the dorsum of the hand◦Palmar

aponeurosis◦Common Flexor

Sheath◦Flexor

retinaculum

LIGAMENTS OF THE HAND

Palmar aponeurosis◦ Strong, well-defined,

central part of the palmar fascia

◦ Covers soft tissues and overlies long flexor tendons

◦ Proximal end is continuous with the flexor retinaculum and palmaris longus tendon

Fig 6.25C

LIGAMENTS OF THE HAND Palmar

aponeurosis◦ The end distal to

apex forms four longitudinal bands that radiate from the apex

◦ These attach distally to the bases of the proximal phalanges

◦ Forming the fibrous digital sheaths of individual digits

LIGAMENTS OF THE HAND Flexor Retinaculum

◦ Or transverse carpal ligament

◦ Continuous with the antebrachial fascia

◦ Fibrous band that extends between the anterior prominences of the outer carpal bones

LIGAMENTS OF THE HAND Flexor retinaculum

◦ and converts the anterior concavity of the carpus into the carpal tunnel

◦ Through which the flexor tendons and median nerve pass

LIGAMENTS OF THE HAND Common Flexor

Sheath◦ Deep to the Flexor

retinaculum◦ Together with the

digital sheaths enables the tendons to slide freely past each other during movement

BURSAE OF THE HUMEROULNAR JT AND HAND Bursa

◦ closed sacs containing fluid which prevent friction, and enable structures to move freely over one another

◦ Subcutaneous olecranon bursa-Located in the subcutaneous connective tissue over the olecranon

◦ Subtendinous olecranon bursa-Located between the olecranon and triceps tendons, just proximal to its attachment

CARTILAGE Articular cartilage

◦ Caps the articulating surfaces of bones participating in a synovial joint

◦ Provides a smooth, low-friction gliding surface

◦ Avascular, nourished by diffusion (synovial fluid)

Biceps BrachiiO: Scapula: Long Head: Supraglenoid Tubercle; Short Head: Coracoid Process.

I: Radial Tuberosity of Raidus.

A: Elbow Flexion, Forearm Supination.

I: Musculocutaneous Nerve

Vascular: Brachial Artery

Triceps BrachiiO: Long Head- Infraglenoid Tubercle of

Scapula,Lateral Head- Inferior to Great Tubercle on Posterior HumerusMedial Head- Posterior Surface of Humerus

I: Olecranon Process of Ulna

A: Elbow Extension

I: Radial Nerve

Vascular: Deep Brachial Artery

CoracobrachialisO: Apex of the Coracoid Process

I: Middle of the medial Surface and border of the Humerus.

A: Flexes and adducts the arm.

I: Musculocutaneous Nerve (C6 and C7)

Vascular: Brachial Artery

BrachialisO: Distal Half of Humerus, Anterior Surface

I: Coronoid Process and Ulnar Tuberosity of the Ulna

A: Elbow Flexion

I: Musculocutaneous Nerve

Vascular: Brachial Artery

BrachioradialisO: Lateral Supracondylar Ridge on the Humerus

I: Styloid Process of the Radius

A: Elbow Flexion

I: Radial Nerve

Vascular: Radial Artery

SupinatorO: Later Epicondyle of Humerus and adjacent Ulna

I: Anterior Surface of the Proximal Radius

A: Forearm Supination

I: Radial Nerve

Vascular: Recurrent Interosseous Artery

1) Pronator TeresO: Medial Epicondyle of Humerus and

Coranoid Process of Ulna

I: Lateral aspect of Radius at its midpoint

A: Forearm Pronation, Assistive in elbow flexion

I: Median Nerve

Vascular: Ulnar Artery

2) Pronator QuadratusO: Distal Fourth of Ulna

I: Distal Forth of Radius

A: Forearm Pronation

I: Median Nerve

Vascular: Anterior Interosseous Artery

Flexor Carpi RadialisO: Medial Epicondyle of the Humerus

I: Base of Second and Third Metacarpals

A: Wrist Flexion, Radial Deviation

I: Median Nerve

Vascular: Radial and Ulnar Arteries

Flexor Carpi UlnarisO: Medial Epicondyle of Humerus

I: Pisiform and base of Fifth Metacarpal

A: Wrist Flexion, Ulnar Deviation

I: Ulnar Nerve

Vascular: Ulnar Artery

Extensor Carpi Radialis LongusO: Supracondylar Ridge of Humerus

I: Base of Second Metacarpal

A: Wrist extension, Radial Deviation

I: Radial Nerve

Vascular: Radial Artery

Extensor Carpi Radialis BrevisO: Lateral Epicondyle of Humerus

I: Base of Third Metacarpal

A: Wrist Extension

I: Radial Nerve

Vascular: Radial Artery

Extensor DigitorumO: Lateral Epicondyle of Humerus

I: Base of distal Phalanx of the Second-Fifth Fingers

A: Extends all three joints of the Fingers

I: Radial Nerve

Vascular: Recurrent Interosseous Artery

Extensor Carpi UlnarisO: Lateral Epicondyle of Humerus

I: Medial Side of Base of 5th Metacarpal

A: Extends and Adducts Wrist

I: Deep Radial Nerve

Vascular: Ulnar Artery

Flexor Digitorum SuperficialisO: Common Flexor tendon, Coronoid Process and Radius

I: Sides of the Middle Phalanx of the Four Fingers

A: Flexes MP and PIP joints of the Fingers

I: Median Nerve

Vascular: Ulnar Artery

Flexor Digitorum ProfundusO: Upper three-fourths of Ulna

I: Distal Phalanx of the Four Fingers digits (2-5)

A: Flexes all three joints of the Fingers

I: Median and Ulnar Nerves

Vascular: Ulnar Artery

Flexor Pollicis LongusO: Radius, Anterior Surface

I: Distal Phalanx of Pollex

A: Flexes all joints of the Pollex or Thumb

I: Median Nerve

Vascular: Radial Artery

Abductor Pollicis LongusO: Posterior radius, Interosseous Membrane, Middle Ulna

I: Base of the First Metacarpal

A: Abducts Pollex

I: Radial Nerve

Vascular: Posterior Interosseous Artery

Extensor Digiti MinimiO: Lateral Epicondyle of Humerus

I: Base of Distal Phalanx of Fifth Finger

A: Extends all joints of Fifth Finger

I: Radial Nerve

Vascular: Recurrent Interosseous Artery

Extensor Pollicis BrevisO: Posterior Distal Radius

I: Base of the Proximal Phalanx of Pollex

A: Extends MP joint of Thumb

I: Radial Nerve

Vascular: Posterior Interosseous Artery

Extensor Pollicis LongusO: Middle Posterior Ulna and Interosseous Membrane

I: Base of Distal Phalanx of Pollex

A: Extends MP and IP joints of the Thumb

I: Radial Nerve

Vascular: Posterior Intercosseous Artery

Palmaris LongusO: Medial Epicondyle of Humerus

I: Palmar Fascia

A: Assistinve in Wrist Flexion

I: Median Nerve

Vascular: Ulnar Artery

What Is It?◦ Happens when the median

nerve becomes squeezed or pressed at the wrist

◦ Sometimes caused by thickening of irritated tendons that go through the tunnel.

◦ The result being pain that goes it to the hand and can even radiate up in to the forearm.

◦ Most common of the entrapment neuropathies where the peripheral nerves are traumatized or compressed.

How Is It Caused?◦ Predisposition◦ Trauma, Injury, Swelling,

Spain, Fracture.◦ Hormones

Overactivity of pituitary, Hypothyroidism

◦ Mechanical Problems Work stress, vibrating

hand tools◦ Development of Cyst or

Tumor in Canal◦ Some times there is no

origin

Carpal Tunnel

Symptoms◦ Frequent burning,

tingling, itching, numbness in palm of hand and fingers.

◦ Fingers feel worthless and swollen.

◦ Decreased grip strength; difficult to form a fist, grasp small objects,

◦ Can differentiate between hot and cold.

Treatment◦ Surgical

Open Release Endoscopic

◦ Non-Surgical Drugs:NSAID,

Corticosteroids, and Vitamin B6

Exercise: Stretching and strenthening

Alternative: acupuncture, yoga and chiropractic services

What is Tennis Elbow?◦ Is inflammation

around the lateral epicondyle

◦ It occurs when the muscle attachment, tendons, become irritated.

Causes◦ Tennis or any racket

sport◦ Anything that involves

extending your wrist or rotating his forearm, such as twisting a screwdriver or lifting a heavy object with your palm down.

◦ With age irritation becomes inflamed more easily.

Tennis Elbow “Lateral Epicondylitis”

Symptoms◦ Pain that radiates

from epicondyle in to forearm and wrist.

◦ Pain with extension of wrist.

◦ Forearm weakness.◦ Painful grip with

activities such as shaking hands and turning door knobs.

◦ Inability to hold objects such as coffee cups.

Treatment◦ Use of a brace to let

muscles rest.◦ Corticosteroid

injections.◦ PT: Stretching and

ROM exercises.◦ Surgery is Rare

Is There Any Questions?