Shoulder, Elbow, Wrist, and Hand Chapters 16, 17, 18 Shoulder, Elbow, Wrist, and Hand

Shoulder Bones Scapula (anterior & posterior views) Acromion Process: B1 Acromioclavicular Joint: B2 Coracoid Process: B3 Glenoid Fossa: B4 Spine: B5 Supraspinous Fossa: B6 Infraspinous Fossa: B7 Subscapular Fossa: B8 Medial Border: B9 Lateral Border: B10 Superior Border: B11 Inferior Angle: B13 Superior Angle: B14

Bones of the Shoulder Humerus (anterior view) Head: A1 Anatomical Neck: A5 Surgical Neck: A6 Coronoid Fossa: A10 Medial Epicondyle: A12 Trochlea: A14 Capitulum: A13 Lateral Epicondyle: A11 Radial Fossa: A9 Shaft: A7 Made up of three bones: Humerus, Clavicle, and Scapula. Bony parts to know: Humerus: Head of humerus, Greater Tubercle, Lesser Tubercle, Intertubercular groove Scapula: Acromion Process, Coracoid Process, Glenoid Fossa, Spine of scapula, Medial border, Lateral border, Superior border Clavicle: Acromial end, sternal end

Bones of the Elbow 3 bones: Humerus, Radius, Ulna (radius and ulna pictured) Study Anterior View! Head of the radius: A1 Neck of the radius: A2 Radial Tuberosity: A3 Ulnar Notch: A5 Styloid Process: A6 Trochlear Notch: B1 Coronoid Process: B2 Ulnar Tuberosity: B3 Radial Notch: B4 Short Styloid Process: B5 Olecranon Process: B6 Interosseous Membrane: C 3 bones – Humerus (Yellow Arrow), Ulna (Aqua Arrow), and Radius (Dk. Green Arrow) Parts of the bones: Humerus – Medial Epicondyle (Orange Arrow), Lateral Epicondyle (Blue Arrow), Coronoid Fossa (Black Arrow), Trochlea (Red Arrow), Capitulum (Dk. Blue Arrow), Olecranon Fossa (not pictured) Ulna – Olecranon Process (not pictured), Trochlear Notch (Lgt. Green Arrow), Coronoid Process (Lgt. Purple Arrow), Radial Notch (Dk. Purple Arrow) Radius – Head of Radius (Purple Arrow), Radial Tuberosity (Brown Arrow)

Bones of the Wrist and Hand Anterior Diagram Carpals: C 8 carpal bones (proximal row/ distal row Scaphoid: C1 Lunate: C2 Triquetal: C3 Pisiform: C4 Trapezium: C5 Trapezoid: C6 Capitate: C7 Hamate: C8 Metacarpals: D 5 metacarpals Phalanges: E 14 phalanges Proximal(E1), Middle (E2), Distal (E3)

Ranges of Motion Elbow Shoulder Wrist 1 2 3 4 5 6 1 2 3 4 5 6 7 8 9 10 11 12 13

Muscles of the Shoulder Rotator Cuff Muscles: AKA “SITS” muscles Subscapularis (not on diagram) Origin: subscapular fossa of the scapula Insertion: Lesser tubercle of the humerus Action: Infraspinatus: a-posterior Origin: Infraspinous fossa of scapula Insertion: Greater tubercle of the humerus Teres Minor: b-posterior Origin: upper 2/3 of dorsal surface of the lateral border of the scapula Supraspinatus (not on diagram) Origin: supraspinous fossa of scapula Insertion: greater tubercle of the humerus Subscapularis: Origin: subscapular fossa of the scapula. Insertion: Lesser tubercle of the humerus. Function: Medially rotates the arm; draws the humerus toward the glenoid fossa, strengthening the shoulder joint. Infraspinatus: Origin: Infraspinous fossa of scapula Insertion: Greater tubercle of the humerus Function: Laterally rotates the arm; draws humerus towards the glenoid fossa, strengthening the shoulder joint. Teres Minor: Origin: upper 2/3 of dorsal surface of the lateral border of the scapula Function: Laterally rotate the arm and weakly adducts it; draws the humerus towards the glenoid fossa, strengthening the shoulder joint. Supraspinatus: Origin: supraspinous fossa of scapula Insertion: greater tubercle of the humerus Function: Abducts the arm; draws the humerus towards the glenoid fossa, strengthening the shoulder joint.

Rotator Cuff

Pectoralis Muscles Pectoralis Major Pectoralis Minor: B Action: Origin: Medial half of the clavicle, sternum, upper six or seven ribs Insertion: Lateral lip of the intertubercular groove of humerus Action: Pectoralis Minor: B Origin: Origin: 3rd, 4th, and 5th ribs Insertion: Coracoid process of the scapula Pectoralis Muscles Pectoralis Major: Origin: Medial half of the clavicle, sternum, upper six or seven ribs. Insertion: Lateral lip of the intertubercular groove of humerus. Function: Flexes, adducts, and rotates the arm medially. Pectoralis Minor: Origin: 3rd, 4th, and 5th ribs. Insertion: Coracoid process of the scapula. Function: Stabilizes the scapula by drawing it forward and downward.

Subclavius: A-anterior and posterior Origin: 1st rib and its costal cartilage Insertion: inferior surface of the clavicle Action: Subclavius: Origin: 1st rib and its costal cartilage Insertion: inferior surface of the clavicle Function: draws the shoulder forward and downward.

Trapezius D-Anterior and Posterior Origin: Superior nuchal line and external occipital protuberance of occipital bone, ligamentum nuchae, spinous processes of C7 – T12 vertebrae Insertion: Lateral 1/3 of clavicle, acromion and spine of the scapula Action: Shoulder Extension, adduction, and internal rotation Trapezius: Origin: Superior nuchal line and external occipital protuberance of occipital bone, ligamentum nuchae, spinous processes of C7 – T12 vertebrae Insertion: Lateral 1/3 of clavicle, acromion and spine of the scapula Function: Steadies, raises, retracts, and rotates the scapula; acting together, all parts raise the point of the shoulder in full abduction and flexion of the arm; acting together, the upper parts extend the head.

Latissimus Dorsi Not on diagram Origin: spinous processes of the lower 6 thoracic vertebrae and thoracolumbar fascia, lumbar and sacral spinous processes, and the lower 3 - 4 ribs Insertion: Floor of the intertubercular groove of the humerus Action: Latissimus Dorsi: Origin: spinous processes of the lower 6 thoracic vertebrae and thoracolumbar fascia, lumbar and sacral spinous processes, and the lower 3 - 4 ribs. Insertion: Floor of the intertubercular groove of the humerus. Function: Extends, adducts, and medially rotates the humerus at shoulder joint.

Scapular Rotators Levator Scapulae: E-anterior and posterior Origin: Transverse processes of the first 3 – 4 cervical vertebrae Insertion: Medial border of the scapula between the spine and the superior angle Action: Rhomboid Major: F-anterior and post. Origin: Ligamentum nuchae and the spinous processes of T2 – T5 vertebrae Insertion: Medial border of the scapula between the spine and the inferior angle Scapular Rotators Levator Scapulae: Origin: Transverse processes of the first 3 – 4 cervical vertebrae. Insertion: Medial border of the scapula between the spine and the superior angle. Function: Elevates and slightly retracts the scapula. Rhomboid Major: Origin: Ligamentum nuchae and the spinous processes of T2 – T5 vertebrae. Insertion: Medial border of the scapula between the spine and the inferior angle. Function: Retracts and elevates the scapula; the lower part depresses the lateral angle, assisting in adduction of the arm.

Scapular Rotators cont. Rhomboid Minor: G-posterior Origin: Ligamentum nuchae and spinous processes of C7 – T1 vertebrae Insertion: Medial border of the scapula at the root of the spine Action: Teres Major: c-posterior Origin: Dorsal surface of the lateral border of the scapula, near the inferior angle Insertion: Medial lip of the intertubercular groove of the humerus Scapular Rotators cont. Rhomboid Minor: Origin: Ligamentum nuchae and spinous processes of C7 – T1 vertebrae. Insertion: Medial border of the scapula at the root of the spine. Function: Retracts and elevates the scapula. Teres Major: Origin: Dorsal surface of the lateral border of the scapula, near the inferior angle. Insertion: Medial lip of the intertubercular groove of the humerus. Function: Adducts, extends, and medially rotates the arm.

Deltoid Muscles I-posterior Origin: lateral 1/3 of the clavicle, lateral border of the acromion process, and spins of the scapula Insertion: Deltoid tuberosity of the humerus Action: 3 Parts: Anterior, Middle, Posterior Deltoid: Origin: lateral 1/3 of the clavicle, lateral border of the acromion process, and spins of the scapula. Insertion: Deltoid tuberosity of the humerus. Function: Abducts the arm; some flexion and extension, some medial and lateral rotation.

Biceps Brachii a-anterior superficial view Origin Short Head: Apex of coracoid process of the scapula Long Head: Supraglenoid tubercle of scapula Insertion: tuberosity of the radius Function: Biceps Brachii: Origin: Short Head: Apex of coracoid process of the scapula (medial origin) Origin: Long Head: Supraglenoid tubercle of scapula (lateral origin). Insertion: tuberosity of the radius. Function: flexes arm, flexes forearm, supinates hand.

Triceps Brachii posterior diagram Origin Long Head: Infraglenoid tubercle of scapula Lateral Head: posterior surface of the humerus above the radial groove Medial Head: posterior surface of humerus below the radial groove Insertion: olecranon of the ulna Function: Triceps Brachii: Origin: Long Head: Infraglenoid tubercle of scapula Origin: Lateral Head: posterior surface of the humerus above the radial groove Origin: Medial Head: posterior surface of humerus below the radial groove. Insertion: olecranon of the ulna. Function: Extends forearm; the long head extends and adducts the arm.

Brachialis b-Anterior Superficial View Origin: distal half of anterior surface of the humerus Insertion: Tuberosity and coronoid process of the ulna Action: Brachialis: Origin: distal half of anterior surface of the humerus. Insertion: Tuberosity and coronoid process of the ulna. Function: Flexes the forearm.

Anconeus d-posterior superficial view Origin: Lateral epicondyle of the humerus Insertion: Olecranon of the ulna and synovial membrane of the elbow joint Action: Anconeus: Origin: Lateral epicondyle of the humerus. Insertion: Olecranon of the ulna and synovial membrane of the elbow joint. Function: Extends the forearm.

Superficial Wrist Flexor Muscles Flexor Carpi Radialis: A-anterior Origin: the medial epicondyle of the humerus Insertion: base of the 2nd metacarpal bone Action: Palmaris Longis: B-Anterior Origin: medial epicondyle of the humerus Insertion: palmar aponeurosis Flexor Carpi Ulnaris: C-both Insertion: Pisiform bone and base of the 5th metacarpal bone Flexor Digitorum Superficialis: D-anterior Insertion: shafts of the middle phalanges of medial four fingers Flexor Carpi Radialis: Origin: the medial epicondyle of the humerus. Insertion: base of the 2nd metacarpal bone. Function: flexes the hand and helps with radial deviation. Palmaris Longis: Origin: the medial epicondyle of the humerus. Insertion: palmar aponeurosis Function: Flexes the hand. Flexor Carpi Ulnaris: Origin: the medial epicondyle of the humerus. Insertion: Pisiform bone and base of the 5th metacarpal bone. Function: flexes hand and helps with ulnar deviation. Flexor Digitorum Superficialis: Origin: the medial epicondyle of the humerus. Insertion: shafts of the middle phalanges of medial four fingers. Function: flexes the middle phalanx of each finger; by continued action, flexes the proximal phalanx and hand.

Deep Wrist Flexor Muscles Flexor Pollicis Longus: F-anterior Origin: Ventral surface of the radius and the interosseous membrane Insertion: base of the distal phalanx of the thumb Action: Flexor Pollicis Longus: Origin: Ventral surface of the radius and the interosseous membrane. Insertion: base of the distal phalanx of the thumb Function: flexes the distal phalanx of the thumb; by continued action, flexes the proximal phalanx.

Superficial Wrist Extensor Muscles Extensor Digiti Minimi: J-posterior Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: extensor expansion of the little finger Action: Extensor Carpi Radialis Longus: Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: dorsal surfacce of the base of the 2nd metacarpal bone Function: Extends and helps with radial deviation. Extensor Carpi Radialis Brevis: Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: Dorsal surface of base of 3rd metacarpal bone. Extensor Digitorum: Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: extensor expansions of the fingers Function: extends the phalanges; by continued action, extends the hand. Extensor Digiti Minimi: Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: extensor expansion of the little finger Function: extends the little finger Extensor Carpi Ulnaris: Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: Base of the 5th metacarpal bone Function: extends and helps with ulnar deviation.

Deep Wrist Extensor Muscles Abductor Pollicis Longus: L-both Origin: Posterior surface of the middle of the radius and ulna, and the interosseous membrane Insertion: base of the 1st metacarpal bone Action: Extensor Pollicis Brevis: M-posterior Origin: Posterior surface of the middle of the radius, and the interosseous membrane Insertion: base of the proximal phalanx of the thumb Abductor Pollicis Longus: Origin: Posterior surface of the middle of the radius and ulna, and the interosseous membrane. Insertion: base of the 1st metacarpal bone Function: abducts the thumb; and by continued action, helps with radial deviation. Extensor Pollicis Brevis: Origin: Posterior surface of the middle of the radius, and the interosseous membrane. Insertion: base of the proximal phalanx of the thumb Function: extends the proximal phalanx of the thumb; by continued action, helps with radial deviation. Extensor Pollicis Longus: Origin: Posterior surface of the middle of the ulna, and the interosseous membrane. Insertion: base of the distal phalanx of the thumb Function: Extends the distal phalanx of the thumb; by continued action, abducts the hand. Extensor Indicis: Origin: Posterior surface of the distal end of the ulna, and the interosseous membrane Insertion: extensor expansion of the index finger Function: extends the index finger

Brachioradialis P-both Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: lateral side of the base of the styloid process of the radius Action: Brachioradialis: Origin: lateral epicondyle and supracondylar ridge of the humerus Insertion: lateral side of the base of the styloid process of the radius. Function: flexes the forearm.

Pronator Teres S-anterior Origin: two heads: 1 medial epicondyle of humerus 2 coronoid process of ulna Insertion: Lateral surface of the radius Action: Pronator Quadratus: Origin: Distal ventral surface of the ulna Insertion: anterior surface of the distal part of the radius. Function: Pronates the hand Pronator Teres: Origin: two heads: 1/ medial epicondyle of humerus, 2/ coronoid process of ulna. Insertion: Lateral surface of the radius Function: Pronate the hand.

Shoulder Injuries Acromioclavicular Sprain Rotator Cuff Strain Shoulder Impingement Bicipital Tendonitis Shoulder Subluxation Shoulder Dislocation Labral Tear Clavicular Fracture

Elbow Injuries Ulnar Collateral Ligament Sprain Lateral Epicondylitis aka Tennis Elbow Medial Epicondylitis aka Little League Elbow Radial/Ulnar Fractures

Hand/Wrist Injuries Lunate Dislocation Gamekeeper’s Thumb Mallett Finger Jersey Finger Boutonniere Deformity Boxer’s Fracture Bennet’s Fracture Scaphoid Fracture