Chanel Kyle Sandra PTA 106 Fall 2008. Lateral Epicondyle Medial Epicondlye Olcranon Ulnar...
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Transcript of 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?