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Lecture 27: Upper Extremities 4 – Muscles of the Forearm: Posterior compartment & Intrinsic Muscles of the Hand

Objectives

 Bones of hand and wrist

 Describe 9 muscles of posterior compartment of forearm (Table 11.13)
 Describe general organization of intrinsic muscles of hand
 Describe 4 intrinsic muscles of the hand that move the thumb

Review: Bony Features of the Hand & Wrist

 “o e lo ers tr positio s that the a ’t ha dle :

o Trapezium comes before Trapezoid
(alphabetical order)
o The phrase goes from proximal-lateral (i.e.
upper thumb) to proximal-medial (i.e. upper
pinky), then the second/distal row goes from
lateral to medial again.

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 From the carpal bones, they connect to the five

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metacarpals, which connect to the proximal phalanges

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via the metacarpophalangeal joint  middle  distal
phalange (except the thumb)

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Muscles of Posterior Compartment of Forearm
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 Be aware that the muscles of forearm posterior compartment will extend the hand (giving high-five), while the
flexor muscles flex the hand (beckoning someone to come)
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 Only 2 layers: Superficial & Deep

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1. Superficial: 2. Deep (Outcropping)

o Extensor carpi radialis brevis o Extensor indicis
o Extensor carpi radialis longus o Extensor policis brevis
o Extensor carpi ulnaris o Extensor pollicis longus
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o Extensor digitorum o Abductor pollicis longus

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o Brachioradialis o Supinator
Superficial Muscles


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Extensor Carpi Radialis Longus

o O: Lateral supracondyle
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ridge of humerus
o I: Base of 2nd metacarpal
(index)
o A: Extends and abducts
hand at wrist joint
(Crosses elbow & wrist)
o Inn: Radial nerve (C6, C7)
 Extensor Carpi Radialis Brevis
o O: Lateral epicondyle of
humerus
o I: Base of 3rd metacarpal
(middle)

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o A: Extend and abduct hand at wrist joint (same as ECR Longus)

o Inn: Deep branch of radial nerve (C7,C8)
 Extensor Digitorum
o O: Lateral Epicondyle
o I: Extensor expansion of medial 4 digits
o A: Extend 4 medial fingers (at metacarpophalangeal joints) & extend hand at wrist joint
o Inn: Posterior interosseous nerve (continuation of deep branch radial nerve)
 Note: The anterior compartment has 2 muscles for carpi digit flexion: flexor digitorum superalis & profuundus
because flexion is a powerful movement. However, there is only 1 muscle for extending (extensor digitorum)
because extensor is more passive.
 Extensor Carpi Ulnaris
o O: Lateral epicondyle + posterior border of ulna
o I: Base of 5th metacarpal (pinky)
o A: Extend & abduct hand at wrist joint (same as extensor carpi radialis longus & brevis)
o Inn: Same as extensor digitorum (posterior interosseous nerve)
 Brachioradialis

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o O: Lateral supracondylar ridge (humerus) same as extensor carpi radialis longus
o I: Lateral surface – distal end of radius (near the protrusion of radial bone under the thumb)

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o A: Flexes forearm and synergizes with other forearm flexors (anterior compartment)
o Inn: Radial nerve (C5-C7)

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 Note: Bra horadialis, tri eps, a o eus do ’t orr a out it , a d e te sor arpi radialis lo gus are the only
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muscles receiving direct innervation of the radial nerve.
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 All the other muscles of posterior compartment receive innervation from the deep branch of radial nerve.

Extensor Expansions
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Also called: Dorsal expansion/Dorsal hood

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The flattened tendons (aponeurosis) of extensor muscles running into dorsum of the hand
 Tendons of extensor muscles i.e. apo eurosis of the us les e pa d to for a hood o er the eta arpals,
the back and sides of the head of the metacarpal, and the proximal phalanx.
 Expansions divide into 3 bands:
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o 1. 2 lateral bands pass on either side of proximal phalanx and reach all the way to the distal phalanx.
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 Serve as insertion points for the: Lumbricals of the hand; dorsal interossei of the hand; and
palmar interossei.
o 2. A medial band passes down the middle and end at the base of the middle phalanx.
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o 3. Retinacular ligament runs obliquely along middle phalanx; connects fibrous digital sheath from the
anterior side of the phalanges to the extensor expansion.
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Deep Layer

 Supinator
o O: Lateral epicondyle of humerus; radial collateral & annular ligaments; supinator fossa &
crest of ulna
o I: Wraps around proximal-lateral 1/3 of radius
o A: Supinates forearm (flips it upwards)  b/c muscle wraps/inserts on the lateral side of
radius, it pulls the radius towards the other side so that supination occurs
o Inn: Deep branch of radial nerve
 Abductor Pollicis Longus
o O: Posterior surface of ulna, radius, and interosseous membrane
o I: Base of 1st metacarpal (thumb)
o A: Abducts thumb & extends it at metacarpal joint  / it’s lo ated at the ase, he it
pulls, the thumb will flick outwards
o Inn: Deep branch of radial nerve (posterior interosseous nerve)
 Extensor Indicis

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o O: Posterior surface of ulna & interosseous membrane

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o I: Extensor expansion of 2nd digit

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o A: Extends index finger & helps with hand extension.

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o Inn: Posterior interosseous nerve (deep branch of radial nerve)


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Extensor Pollicis Longus

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o O: Posterior surface of ulna (above extensor indicis) & interosseous membrane
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o I: Base of distal phalanx of thumb  TIP of thumb
o A: Extends distal phalanx of thumb at carpometacarpal and interphalangeal joints
o Inn: Posterior interosseous nerve
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 Extensor pollicis brevis

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o O: Posterior surface of radius & interosseous membrane

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o I: Base of proximal phalanx of thumb

o A: Extends proximal phalanx at carpometacarpal joint
o Inn: Posterior interosseous nerve (deep branch of radial nerve)
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Anatomical Snuffbox
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 Formed by tendons of extensor pollicis longus & brevis

 Note: The abductor pollicus longus always stops at the very base of the
thumb, while the extensor pollicis brevis continues to the distal
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phalanx.
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Clinical Note: De Quervan’s Tenosynovitis & Finkelstein Test

 De Quervan’s Tenosynovitis – Chronic inflammation and pain in

tendons of abductor pollicis longus & extensor pollicis brevis.
 Finkelstein Test – Pain felt during this test indicates De Quer a ’s
Syndrome

Opposable Thumb

 Opposa le = Ca oppose/tur a k agai st other four fi gers

 Enables hand to refine its grip in holding objects – a power grip & a precision grip
 Allowed development of fine motor skills & development of tools – allows dexterity

Muscles Acting on the Thumb

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 Extrinsic Muscles: Muscle bellies are located outside of the hand:

o Flexor pollicis longus
o Abductor pollicis longus
o Extensor pollicis longus
o Extensor pollicis brevis
 Intrinsic Muscles of the Hand (Thenar Muscles) – Divided into thenar eminence & hypothenar eminence
(pinky)
o Abductor pollicis brevis
o Flexor pollicis brevis
o Opponens pollicis
o Adductor pollicis
 2 heads:
 -Oblique head (base of 2nd – 3rd metacarpal,
capitate, and adjacent carpals)
 - Transverse head: Anterior surface of 3rd
metacarpal

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Intrinsic Muscles of the Hand

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 Responsible for fine movements of hand: Pinky & Thumb – Abduction, adduction, flexion

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& opposition

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 3 Groups of muscles:
o Thenar muscles (4) rs e
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o Hypothenar muscles (3) – Act on the pinky
 Abductor digiti minimi
 Opponens digiti minimi
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 Flexor digiti minimi

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 Palmaris brevis (ignore)

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 **All are innervated by ulnar nerve

o Palmar muscles:
 1. Interosseus (between bones)
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 4 DAB (dorsal interossei)

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 3 PAD (palmar interossei)

 2. Lumbricals (worm-like) (4)

Palmar Muscles
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 4 Dorsal Interossei
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o Abduct fingers away

from middle finger
o Bi-pennate msucles
 3 Palmar Interossei
o Adduct fingers
towards middle
finger
o Assist lumbricals
o Uni-pennate
muscles (i.e. single
muscle belly)
 Lumbricals

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o Allow flexion at metacarpophalangeal joints & maintaining extension

at interphalangeal joints (i.e. proximo-middle-distal joints)  I.e.
aki g the L shape ith our ha d
o Do NOT directly attach to bones – attach:
 Proximally to tendons of the flexor digitorum profundus
(recall: FDP extends to distal fingers) &
 Distally to extensor expansions on dorsal surface of hand

Innervation of Intrinsic Muscles of the Hand

 Median Nerve
o 3 Lateral Thenar muscles
o 2 Lateral Lumbricals
 Ulnar Nerve
o 2 Medial Lumbricals
o All other intrinsic muscles of the hand (PAD, DAB)
 Radial Nerve

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o No motor functions
o Sensory functions only

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