1. HUMEROULNAR/ELBOW JOINT & HAND
Regional Anatomy 106
Presented by: Antonina, Benji, Jarrett, & Shannon

2. Clinical Concerns of the Humeroulnar Joint & Hand
Elbow Tendonitis or Lateral Epicondylitis: Also known as tennis elbow, a painful musculoskeletal condition that may follow repetitive use of the superficial extensor muscles of the forearm. Pain is felt over the lateral epicondyle and radiates down the posterior surface of the forearm. People with elbow tendonitis often feel pain when they open a door or lift a glass. Repeated forceful flexion and extension of the wrist strain the attachment of the common extensor tendon, producing inflammation of the periosteum of the lateral epicondyle. (Lateral Epicondylitis)

5. Humeroulnar Joint & Hand Clinical Concerns (cont.)
Carpal Tunnel Syndrome: Results from any lesion that significantly reduces the size of the carpal tunnel or, more commonly, increases the size of some structures (or their coverings) that pass through it (e.g., inflammation of the synovial sheaths). The median nerve is the most sensitive structure in the carpal tunnel and, therefore, is the most affected. The median nerve has two terminal sensory branches that supply the skin of the hand; hence paresthesia (tingling), hypothesia (diminished sensation) or anesthesia (absence of tactile sensation) may occur in the lateral three and a half digits. Recall however, that the palmar cutaneous branch of the median nerve arises proximal to and does not pass through the carpal tunnel; thus the sensation in the central palm remains unaffected. This nerve also has one terminal motor branch, the recurrent branch, which innervates the three thenar muscles.
Wasting of the thenar eminence and progressive loss of coordination and strength in the thumb may occur if the compression is not alleviated. Individuals with CTS are unable to oppose the thumb. To relieve the compression and symptoms, partial or complete surgical division of the flexor retinaculum, a procedure called carpal tunnel release, may be necessary. The incision for carpal tunnel release is made toward the medial side of the wrist and flexor retinaculum to avoid possible injury to the recurrent branch of the median nerve.

7. Surface Anatomy Anatomical Snuff Box Thenar Eminence
Hypothenar Eminence

8. Surface Anatomy Tendon of Palmaris Longus
Tendon of Flexor Carpi Radialis

9. Surface Anatomy Medial Epicondyle Lateral Epicondyle
Radial Styloid Process
Ulnar Styloid Process

10. Surface Anatomy
Olecranon
Cubital Fossa

11. Surface Anatomy
Distal Wrist Crease
Site of the Median Nerve

13. The humerus is a long bone in the arm that runs from the shoulder to the elbow.

14. It connects the scapula and the radius
Body of humerus - cylindrical in its upper portion, and more prismatic below.

15. Lower extremity of humerus - consisting of a faceted condyle that articulates with the radius.

16. Upper extremity of humerus - consisting of a rounded head, a narrow neck, and two short processes, or "tuberosities".
Distally, the capitulum of the humerus articulates with the head of the radius, and the trochlea of the humerus articulates with the olecranon process of the ulna.

17. The grooved surface at the lower end articulating with the trochlear notch of the ulna.
Above the back of the trochlea is a deep triangular depression, the olecranon fossa, in which the summit of the olecranon is received in extension of the forearm.

18. A bony prominence of the outer aspect is the lateral epicondyle that provides origin for the muscles which dorsiflex the wrist. Inflammation at this site is known as tennis elbow.
medial epicondyle is larger and more prominent than the lateral epicondyle that gives attachment to the ulnar collateral ligament of the elbow-joint and ulnar nerve runs in a groove on the back of this epicondyle.

19. Above the front part of the trochlea is a small depression, the coronoid fossa, which receives the coronoid process of the ulna during flexion of the forearm.

20. The radius is the bone of the forearm that extends from the lateral side of the elbow to the thumb side of the wrist. The radius is situated on the lateral side of the ulna, It is a long bone, prism-shaped and slightly curved. The radius articulates with the capitulum of the humerus.
Radius connects the elbow to the forearm.

21. Head of Radius, disk shaped prominence at proximal end of bone, forms articulating surface with capitulum of humerus.
Radial tuberosity is a round projection that serves as an attachment point for Biceps Brachii muscle.
Ulnar notch of Radius, slide depression that articulates with Ulna.
Styloid process of Radius is the lateral projection at distal end of bone that forms lateral portion of wrist joint.

22. Ligaments of the elbow Radial anular ligament Interosseous memebrane
Ulnar collateral ligament
Radial collateral ligament

24. Ligaments of the hand
Palmar aponeurosis
Flexor retinaculum

25. Common flexor sheath

26. Bursae
Subcutaneous olecranon bursa
Subtendinous olecranon bursa

27. Cartilage
Articular cartilage

28. Articular Capsule
Synovial membrane
Fibrous layer (fibrous capsule)

29. Biceps
O: Scapula: Long head, supraglenoid tubricle, Short head, coracoid process
I: Radial tuberosity of radius
Brachialis
O: Distal half of humerus, anterior surface
I: Corocoid process and ulnar tuberosity
Pronator Teres
O: Medial epicondyle of humerus
I: Lateral aspect of radius at its midpoint
Brachioradialis
O: Lateral supracondylar ridge of humerus
I: Styloid process of radius
Supinator
O: Lateral epicondyle of humerus and adjacent ulna
I: Anterior surface of the proximal radius

30. Palmaris Longus
O: Medial epicondyle of humerus
I: Palmar fascia
Flexor Carpi Radialis
I: Base of second and third metacarpals
Flexor Carpi Unlaris
I: Pisiform, and the base of 5th metacarpal
Flexor Digitorum porfundus
O: Upper three-fourths of ulna
I: Distal phalanx of the four fingers
Pronator Teres
O: Medial epicondyle of humerus and coranoid process of ulna
I: Lateral aspect of radius at its midpoint

31. Flexor digitorum superficialis
O: Common flexor tendon, coronoid process and radius
I: Sides of the middle phalanx of the 4 fingers
Flexor Pollicis longus
O: Radius, anterior surface
I: Distal phanlanx of pollex
Abductor pollicis longus
O: Posterior radius, interosseous membrane, middle ulna
I: Base of the first metacarpal
Pronator Quadratus
O: Distal fourth of ulna
I: Distal fourth of radius

32. Extenson carpi radialis longus
O: Supracondylar ridge of humerus
I: Base of second metacarpal
Extensor carpi Ulnaris
O: Lateral epicondyle of humerus
I: Medial side of base of 5th metacarpal
Extensor Digitorum
I: Base of distal phanlanx of the 2nd-5th fingers
Extensor carpi radialis brevis
I: Base of 3rd metacarpal
Extensor digiti minimi
O: Lateral epicondyle of humerous
I: Base of distal phalanx of 5th finger
Extensor pollicis brevis
O: Posterior Distal radius
I: Base of proximal phalanx of pollex
Extensor pollicis longus
O: Middle posterior ulna and interosseous membrane
I: Base of distal phalanx of pollex

33. Triceps
O: Long Head: infraglenoid tubrecle of scapula, Lateral Head: Inferior to greater tubericle on posterior humerus, Medial Head: posterior surface of humerus
I: Olecranon process of ulna

35. Biceps: A: Elbow Flexion, forearm supination I: Musculocaneous nerve V:Brachial artery
Triceps: A: Elbow extention I: radial nerve, V:Deep brachial artery
Brachialis A: Elbow flexion I: Musculocutaneous nerve, V:brachial Atery
Brachioradialis: A: Elbow flexion I: Radial nerve, V:radial artery
Supinator: A: Forearm supination I: radial nerve, recurrent interosseous

36. Pronator teres: A: forearm pronation, asstive in elbow flexion I:median nerve V:ulnar artery
Pronator quadratus: A: forearm pronation I: median nerve V: anterior interosseous artery
Flexor carpi radialis: A: wrist flexion, radial deviation I: median nerve V: radial and ulnar arteries
Flexor carpi ulnaris: A: wrist flexion, ulnardeviation I: ulnar nerve V: ulnar artery
Extensor carpi radialis longus: A: wrist extension, radial deviation I: radial nerve V: radial artery

37. Extensor carpi raialis brevis: A: wrist extension I: radial nerve V: radial artery
Extensor digitorum: A: extends all three joints of the fingers I:radial nerve V: recurrent interosseous artery
Extensor carpi ulnaris: a: extens and adducts wrist I: deep radial nerve V: ulnar artery
Flexor digitorum superficialis: A: Flexes MP and PIP jpints of the fingers I: Medial Nerve V: Ulnar artery
Flexor digitorum profundus: A: flexes all three joints of the fingers I: Median and ulnar nerve A: Ulnar atrety

38. Flexor pollicis longus A: flexes all joints of the thumb I: Radial nerve V: posteriorinterosseous artery
Abductor pollicis longus: A: abducts pollucs I: radial nerve V: posterior interosseous artery
Extensor digiti minimi :A: extends all joints of the fifth finger I: Radial nerve V: Recurrent interosseous artery
Extensor pollicis brevis: A: Extends MP joint of thumb I: radial nerve V: Posterior interosseous artery
Extensor Pollicis longus: A: extends the Mp and IP joints of the thumb I: Radial nerve V: Posrterior interosseous artery
Palmaris longus : A: Assistive in wrist flection I: Median nerve V: Ulnar artery