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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 Radius Carpals Metacarpals Phalanges

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

ULNA RADIUS Radial tuberosity Neck Head Coronoid process Olecranon process Styloid process Interosseus membrane

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 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 SUPINATION is a very important movement of the forearm 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)

PosteriorAnterior Head Greater Tubercle Anatomical neck Surgical neck Lesser Tubercle Deltoid Tuberosity Olecranon fossa Coronoid fossa Trochlea Medial epicondyle Lateral epicondyle Capitulum

Tubercle: Fossa: Trochlea: A round nodule or “warty” outgrowth of a bone A depression or hollow on a bone A grooved structure resembling a “pulley wheel”

Posterior Muscles of the Forearm Extensor carpi radialis longus O: above lateral epicondyle of humerus I: base of 2 nd metacarpal F: extend and abduct wrist Extensor carpi ulnaris O: lateral epicondyle of humerus and ulna I: base of 5 th metacarpal F: extends and adducts wrist Extensor digitum O: lateral epicondyle of the humerus I: all digits except thumb F: extends interphalangeal joints (fingers) Extensor carpi radialis brevis O: lateral epicondyle of humerus I: base of 3 rd metacarpal F: extends and abducts the wrist Flexor carpi ulnaris O: 2 heads: 1 medial epicondyle, 1 olecranon I: base of 5 th metacarpal F: flexes and adducts the wrist Thenar Eminence: muscles proximal to thumb (3) -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 O: lower anterior humerus I: coronoid process ulna F: flexes elbow Supinator O: Lateral epicondyle humerus I: anterior & lateral aspect of radius F: Supinating forearm Pronator teres O: medial epicondyle humerus and coronoid process of ulna I: lateral surface of mid radius F: pronates forearm/ flex elbow Brachioradialis O: above lateral epicondyle humerus I: styloid process radius F: elbow flexor Flexor carpi radialis O: medial epicondyle humerus I: second metacarpal (index) F: flexes and abducts hand Flexor carpi ulnaris Pronator quadratus O: anterior surface of distal ulna I: anterior surface of distal radialis F: pronates forearm

Forearm Flexors: Part I Part II Forearm Extensors: Part I Part II Upper Arm: Shoulder: Part I Part II -

...a hinge joint formed by the articulation of the humerus of the arm and the ulna and radius of the forearm -video

Radial collateral ligament (prevents excessive adbuction) Ulnar collateral ligament (prevents excessive adduction) Elbow Ligaments -video (maintains articulation of radius with humerus) Tennis Elbow (lateral epicondylitis) -extensor carpi radialis brevis -chronic  pain on lateral side of elbow - RICE & Physio-video-video

...three bones (clavicle, scapula and humerus) articulate forming this ball and socket joint

Inferior angle Superior angle Medial border

Muscles of the Upper Arm What view? Anterior Corachobrachialis O: coracoid process I: medial aspect of humerus F: flexes and adducts arm Biceps brachii O: short head –coracoid process; long head – supraglenoid tubercle I: radial tuberosity (radius) F: flexes supined elbow, supination Brachialis Brachioradialis Teres major O: inferior lateral border of scapula I: humerus F: medial rotation, adduction and extension of upper arm

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 Part II Forearm Extensors: Part I Part II Upper Arm: Shoulder: Part I Part II -

-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 FRONTBACK Subscapularis Supraspinatus Infraspinatus Teres Minor

Subscapularis O: anterior surface of the scapula I: Lesser tubercle of the humerus F: medially rotates humerus; stabilizes shoulder Supraspinatus O: posterior surface of scapula above spine Infraspinatus O: poseterior surface of scapula below spine Teres Minor O: later border of scapula Insertion: all fuse to form tendon inserting on greater tubercle of humerus F: stabilize the shoulder; supra– abducts shoulder, infra and teres– laterally rotate shoulder

Forearm Flexors: Part I Part II Forearm Extensors: Part I Part II Upper Arm: Shoulder: Part I Part II -

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 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) ** -video

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