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Chanel Kyle Sandra PTA 106 Fall 2008.  Lateral Epicondyle  Medial Epicondlye  Olcranon  Ulnar Styloid Process  Cubital Fossa  Site of Median Nerve.

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Presentation on theme: "Chanel Kyle Sandra PTA 106 Fall 2008.  Lateral Epicondyle  Medial Epicondlye  Olcranon  Ulnar Styloid Process  Cubital Fossa  Site of Median Nerve."— Presentation transcript:

1 Chanel Kyle Sandra PTA 106 Fall 2008

2  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

3  Anatomical Snuff Box  Thenar Eminance  Hypothenar Eminence

4  Medial Epicondyle  Lateral Epicondyle  Capitulum- on lateral edge of condyle  Trochlea- medial and mid section of condyle  Coronoid Fossa  Olecranon Fossa

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

6  Head  Neck  Radial Tuberosity  Ulnar Notch  Styloid Process

7  Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Hamate, Trapezoid, Capitate  Metacarpals: Numbered 1-5, starting at thumb  Phalangeal: Numbered 1-5 ◦ Distal, Middle, Proximal

8  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

9  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

10  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

11  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

12 ◦ 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

13  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

14  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

15  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.

16  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

17  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

18  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

19  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

20  Flexor Retinaculum ◦ Or transverse carpal ligament ◦ Continuous with the antebrachial fascia ◦ Fibrous band that extends between the anterior prominences of the outer carpal bones

21  Flexor retinaculum ◦ and converts the anterior concavity of the carpus into the carpal tunnel ◦ Through which the flexor tendons and median nerve pass

22  Common Flexor Sheath ◦ Deep to the Flexor retinaculum ◦ Together with the digital sheaths enables the tendons to slide freely past each other during movement

23  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

24  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)

25 Biceps Brachii O: 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

26 Triceps Brachii O: Long Head- Infraglenoid Tubercle of Scapula, Lateral Head- Inferior to Great Tubercle on Posterior Humerus Medial Head- Posterior Surface of Humerus I: Olecranon Process of Ulna A: Elbow Extension I: Radial Nerve Vascular: Deep Brachial Artery

27 Coracobrachialis O: 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

28 Brachialis O: Distal Half of Humerus, Anterior Surface I: Coronoid Process and Ulnar Tuberosity of the Ulna A: Elbow Flexion I: Musculocutaneous Nerve Vascular: Brachial Artery

29 Brachioradialis O: Lateral Supracondylar Ridge on the Humerus I: Styloid Process of the Radius A: Elbow Flexion I: Radial Nerve Vascular: Radial Artery

30 Supinator O: Later Epicondyle of Humerus and adjacent Ulna I: Anterior Surface of the Proximal Radius A: Forearm Supination I: Radial Nerve Vascular: Recurrent Interosseous Artery

31 1) Pronator Teres O: 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 Quadratus O: Distal Fourth of Ulna I: Distal Forth of Radius A: Forearm Pronation I: Median Nerve Vascular: Anterior Interosseous Artery

32 Flexor Carpi Radialis O: 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

33 Flexor Carpi Ulnaris O: Medial Epicondyle of Humerus I: Pisiform and base of Fifth Metacarpal A: Wrist Flexion, Ulnar Deviation I: Ulnar Nerve Vascular: Ulnar Artery

34 Extensor Carpi Radialis Longus O: Supracondylar Ridge of Humerus I: Base of Second Metacarpal A: Wrist extension, Radial Deviation I: Radial Nerve Vascular: Radial Artery

35 Extensor Carpi Radialis Brevis O: Lateral Epicondyle of Humerus I: Base of Third Metacarpal A: Wrist Extension I: Radial Nerve Vascular: Radial Artery

36 Extensor Digitorum O: 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

37 Extensor Carpi Ulnaris O: Lateral Epicondyle of Humerus I: Medial Side of Base of 5 th Metacarpal A: Extends and Adducts Wrist I: Deep Radial Nerve Vascular: Ulnar Artery

38 Flexor Digitorum Superficialis O: 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

39 Flexor Digitorum Profundus O: 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

40 Flexor Pollicis Longus O: Radius, Anterior Surface I: Distal Phalanx of Pollex A: Flexes all joints of the Pollex or Thumb I: Median Nerve Vascular: Radial Artery

41 Abductor Pollicis Longus O: Posterior radius, Interosseous Membrane, Middle Ulna I: Base of the First Metacarpal A: Abducts Pollex I: Radial Nerve Vascular: Posterior Interosseous Artery

42 Extensor Digiti Minimi O: 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

43 Extensor Pollicis Brevis O: Posterior Distal Radius I: Base of the Proximal Phalanx of Pollex A: Extends MP joint of Thumb I: Radial Nerve Vascular: Posterior Interosseous Artery

44 Extensor Pollicis Longus O: 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

45 Palmaris Longus O: Medial Epicondyle of Humerus I: Palmar Fascia A: Assistinve in Wrist Flexion I: Median Nerve Vascular: Ulnar Artery

46  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

47  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

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49  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.

50  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

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