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

2. Bones of the Shoulder Joint
Shoulder Bones
Parts of the Bones
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

3. Bones of the Elbow Joint
Parts of the bones
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)

4. Bones of the Wrist and Hand
Carpals
8 carpal bones
Metacarpals
5 metacarpals
Phalanges
14 phalanges

5. Ranges of Motion Elbow Shoulder Wrist Flexion Extension Supination
Pronation
Wrist
Radial Deviation
Ulnar Deviation
Shoulder
Abduction
Adduction
Flexion
Extension
Internal Rotation
External Rotation
Horizontal Abduction
Horizontal Adduction
Circumduction
Elevation
Depression
Protraction
Retraction

6. Muscles of the Shoulder
Rotator Cuff Muscles:
AKA “SITS” muscles
Subscapularis
Origin
Insertion
Function
Infraspinatus
Teres Minor
Supraspinatus
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.

7. Pectoralis Muscles Pectoralis Major Pectoralis Minor Origin Insertion
Function
Pectoralis Minor
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.

8. Subclavius Muscle Origin Insertion Function
Subclavius: Origin: 1st rib and its costal cartilage
Insertion: inferior surface of the clavicle
Function: draws the shoulder forward and downward.

9. Serratus Anterior Origin Insertion Function
Both red and purple areas in the illustration
Serratus Anterior: Origin: Outer surfaces of the upper 8-9 ribs.
Insertion: Anterior surface of the medial border of the scapula
Function: rotates scapula, raising the point of the shoulder in full flexion and abduction of the arm; draws the scapula forward as in the act of pushing.

10. Trapezius and Latissimus Dorsi
Origin
Insertion
Function
Latissimus Dorsi
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: Origin: spinous processes of the lower 6 thoracic vertebrae and thoracolumbar fascia, lumbar and sacral spinous processes, and the lower ribs.
Insertion: Floor of the intertubercular groove of the humerus.
Function: Extends, adducts, and medially rotates the humerus at shoulder joint.

11. Scapular Rotators Levator Scapulae Origin Insertion Function
Rhomboid Major
Rhomboid Minor
Teres Major
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.
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.

12. Deltoid Muscles Origin Insertion Function
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.

13. Biceps Brachii Origin Insertion Function Short Head Long Head
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.

14. Triceps Brachii Origin Insertion Function Long Head Lateral Head
Medial Head
Insertion
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.

15. Brachialis Origin Insertion Function
Brachialis: Origin: distal half of anterior surface of the humerus.
Insertion: Tuberosity and coronoid process of the ulna.
Function: Flexes the forearm.

16. Coracobrachialis Origin Insertion Function
Coracobrachialis: Origin: Apex of the coracoid process of the scapula.
Insertion: Middle 1/3 of the medial surface of the humerus.
Function: flexes and adducts the arm.

17. Muscles of the Elbow, Wrist, and Hand Anconeus
Origin
Insertion
Function
Anconeus: Origin: Lateral epicondyle of the humerus.
Insertion: Olecranon of the ulna and synovial membrane of the elbow joint.
Function: Extends the forearm.

18. Superficial Wrist Flexor Muscles
Flexor Carpi Radialis
Origin
Insertion
Function
Palmaris Longis
Flexor Carpi Ulnaris
Flexor Digitorum Superficialis
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.

19. Deep Wrist Flexor Muscles
Flexor Digitorum Profundus
Origin
Insertion
Function
Flexor Pollicis Longus
Flexor Digitorum Profundus: Origin: Medial epicondyle of the humerus and the coronoid process of the ulna, the interosseous membrane, and the ventral surface of the ulna.
Insertion: bases of the distal phalanges of the medial four fingers
Function: flexes the distal phalanx of each finger; by continued action flexes the other phalanges and to some extent the hand.
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.

20. Superficial Wrist Extensor Muscles
Extensor Carpi Radialis Longus
Origin
Insertion
Function
Extensor Carpi Radialis Brevis
Extensor Digitorum
Extensor Digiti Minimi
Extensor Carpi Ulnaris
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.

21. Deep Wrist Extensor Muscles
Abductor Pollicis Longus
Origin
Insertion
Function
Extensor Pollicis Brevis
Extensor Pollicis Longus
Extensor Indicis
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

22. Brachioradialis Origin Insertion Function
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.

23. Supinator Origin Insertion Function
Supinator: Origin: lateral epicondyle of humerus, ulna and annular ligament.
Insertion: lateral surface of the proximal part of the radius.
Function: Supinates the hand.

24. Pronator Muscles Pronator Quadratus Pronator Teres Origin Insertion
Function
Pronator Teres
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.

25. Common Injuries Shoulder Elbow
Acromioclavicular Ligament Sprain (Shoulder Separation)
Glenohumeral Ligament Sprain
Rotator Cuff Strain
Impingement Syndrome
Bicipital Tendinitis
Biceps Tendon Rupture
Clavicular Fracture
Humeral Fracture
Epiphysis Injury (epiphyseal fracture)
Avulsion Fracture
Glenohumeral Dislocation and Subluxation
Elbow
Ulnar Collateral Ligament Sprain
Elbow Flexor Strain
Elbow Extensor Strain
Wrist Flexor Strains
Wrist Extensor Strains
Tennis Elbow (Lateral Epicondylitis)
Little League Elbow (Medial Epicondylitis)
Ulna Dislocation
Elbow Hyperextension
Olecranon Bursitis

26. Common Injuries (Continued)
Wrist Sprains
Dislocation of the Lunate
Interphalangeal Collateral Ligament Sprain
Dislocation of the Interphalangeal Joint or the Metacarpal Phalangeal Joint
Gamekeeper’s Thumb
de Quervain’s Tendinitis
Mallet Finger
Jersey Finger
Boutonniere Deformity
Scaphoid Fracture
Radial Collateral Ligament Sprain (Thumb Sprain)

27. Ulna Dislocation Etiology Signs and Symptoms Treatment
Etiology: high incidence in sports activities. Most often caused by a fall on an outstretched hand with the elbow in hyperextension, or by a severe twist while the elbow is in a flexed position. Most common is a posterior dislocation. Can be distinguished from the supracondylar fracture by observing that the lateral and medial epicondyles are normally aligned with the shaft of the humerus.
Signs and symptoms: profuse hemorrhage and swelling, severe pain and disability, may include injury to median and radial nerves as well as the blood vessels in the area. A radial head fracture often occurs with this dislocation.
Treatment: apply cold and pressure immediately, sling for support and refer to physician immediately (can activate EMS, or if stable can be transported with family). Check neurovascular status in extremity. Athlete will be x-rayed and reduced at the hospital.

28. Dislocated Finger Etiology Signs & Symptoms Treatment
Etiology – The phalanges are prone to dislocation, sprain, and fractures. Usually caused by a blow to the finger or violent twisting of the finger.
Signs & Symptoms – Obvious deformity, loss of function, pain, swelling.
Treatment – Splint in position found, DO NOT ATTEMPT TO REDUCE, ice, elevate and send to physician for x-ray and reduction.

29. Gamekeeper’s Thumb Etiology Signs & Symptoms Treatment
Etiology – sprain to the ulnar collateral ligament of the MCP joint of the thumb. Common in skiers and tackle football players. Mechanism is usually a forceful abduction of the proximal phalanx, which is occasionally combined with hyperextension.
Signs & Symptoms – The athlete c/o pain over the ulnar collateral ligament in addition to weak and painful pinch. Tenderness and swelling present over medial aspect of the thumb.
Treatment – Any laxity present in the joint = automatic referral to physician. If joint is stable, x-ray to rule out fracture, thumb splint should be applied for at least 3 weeks or until pain free. Thumb spica taping should be used during participation in sports.

30. de Quervain’s Tendinitis
Etiology
Signs & Symptoms
Treatment
Etiology: condition brought on by irritation or swelling of the tendons found along the thumb side of the wrist. The irritation causes the compartment (lining) around the tendon to swell, changing the shape of the compartment; this makes it difficult for the tendons to move as they should. The swelling can cause pain and tenderness along the thumb side of the wrist, usually noticed when forming a fist, grasping or gripping things, or turning the wrist.
Signs and Symptoms: Pain over the thumb side of the wrist is the main symptom. The pain may appear either gradually or suddenly. It is felt in the wrist and can travel up the forearm. The pain is usually worse with use of the hand and thumb, especially when forcefully grasping things or twisting the wrist. Swelling over the thumb side of the wrist is noticed and may be accompanied by a fluid-filled cyst in this region. There may be an occasional "catching" or "snapping" when moving the thumb. Because of the pain and swelling, it may be difficult to move the thumb and wrist, such as in pinching. Irritation of the nerve lying on top of the tendon sheath may cause numbness on the back of the thumb and index finger. (Finkelstein Test)
Treatment: The goal is to relieve the pain caused by the irritation and swelling. In some cases, your doctor may recommend resting the thumb and wrist by wearing a splint. Anti-inflammatory medication taken by mouth or injected into that tendon compartment may help reduce the swelling and relieve the pain. In some cases, simply not doing the activities that cause pain and swelling may allow the symptoms to go away on their own. When symptoms are severe or do not improve, surgery may be recommended.

31. Mallet Finger Etiology Signs & Symptoms Treatment:
Etiology: common in sports, sometimes called baseball or basketball finger. Caused by a blow from a thrown ball that strikes the tip of the finger, jamming and avulsing the extensor tendon from its insertion along with a piece of bone.
Signs and symptoms: pain at the DIP joint. X-ray may reveal avulsion fracture. Unable to extend finger, carrying it at approximately a 30-degree angle. Point tenderness at the site of injury and the avulsed bone can often be palpated.
Treatment: PRICE for pain and swelling. If no fracture present, the finger should be splinted immediately in a position of extension for 6-8 weeks. If fracture is present, surgery may be required to repair.

32. Jersey Finger Etiology Signs & Symptoms Treatment
Etiology: rupture of the flexor digitorum profundus tendon from its insertion on the distal phalanx. Most often occurs with the ring finger when trying to grad an opponent’s jersey. Can also result in an avulsion fracture.
Signs & Symptoms: DIP joint can not be flexed, finger remains in the extended position; pain and point tenderness over distal phalanx.
Treatment: Surgery is required to repair tendon, otherwise athlete will not be able to flex DIP joint. This can cause weakness in the grip.

33. Boutonniere Deformity
Etiology
Sign & Symptoms
Treatment
Etiology: caused by a rupture of the extensor tendon dorsal to the middle phalanx. Trauma occurs at the tip of the finger, which forces the DIP joint into extension and the PIP joint into flexion.
Signs & Symptoms: pain and inability to extend the DIP joint. Swelling, point tenderness, and obvious deformity present.
Treatment: cold application to control pain and swelling. Splinting of the PIP joint for 5-8 weeks is necessary. While splinted the athlete is encouraged to flex the distal phalanx.

34. Scaphoid Fracture Etiology Signs & Symptoms Treatment
Etiology: Most frequently fractured of the carpal bones. Caused by a force on an outstretched hand, which compresses the scaphoid bone between the radius and the second row of carpal bones. Often fails to heal properly because there is not an adequate supply of blood to this area.
Signs & Symptoms: Swelling in the area of the carpal bones severe point tenderness of the scaphoid bone in the anatomical snuffbox, and scaphoid pain that is elicited by upward pressure exerted on the long axis of the thumb by radial flexion.
Treatment: Cold should be applied, and referred to physician for x-ray and splinting. If fracture is present will be splinted for at least 6 weeks.