أسئلة الـ Muscles of back of forearm & radial nerve & ASB & extensor retinaculum

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Questions and Answers

Which of the following statements accurately describes the articulation at the superior radio-ulnar joint?

  • The head of the radius articulates with the ulnar notch of the ulna.
  • The head of the radius articulates with the radial notch of the ulna and annular ligament. (correct)
  • The interosseous border of the ulna articulates with the interosseous border of the radius.
  • The head of the ulna articulates with the radial notch of the radius and annular ligament.

What type of joint is the middle radio-ulnar joint, and how does it contribute to forearm movement?

  • Synovial pivot joint; allows for rotation of the radius around the ulna.
  • Fibrous syndesmosis; allows for limited movement and stability between the radius and ulna. (correct)
  • Synovial ellipsoid joint; allows for flexion, extension, abduction, and adduction.
  • Cartilaginous joint; provides cushioning and shock absorption between the radius and ulna.

Which muscles are primarily involved in the movement of supination?

  • Brachioradialis, biceps, and supinator (correct)
  • Pronator quadratus and brachioradialis
  • Brachioradialis and pronator teres
  • Pronator teres and pronator quadratus

Which carpal bones articulate with the radius at the wrist joint?

<p>Scaphoid and lunate (A)</p>
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What type of joint is the wrist (radio-carpal) joint, and what movements does it primarily facilitate?

<p>Synovial ellipsoid joint; facilitates flexion, extension, abduction, and adduction. (C)</p>
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Which of the following muscles contributes to wrist flexion?

<p>Flexor carpi ulnaris (C)</p>
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Which type of joint is the metacarpophalangeal joint, and what movements does it allow?

<p>Synovial condylar joint; allows flexion, extension, abduction, and adduction. (B)</p>
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With the exception of the thumb, what type of joint is the carpometacarpal joint?

<p>Synovial plane (D)</p>
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What is the primary action of the brachioradialis muscle, and what nerve innervates it?

<p>Flexion of the elbow in midprone position; radial nerve. (C)</p>
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What are the actions of the extensor carpi radialis longus and brevis muscles?

<p>Extend and abduct the wrist (D)</p>
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Which nerve innervates the extensor carpi ulnaris muscle, and what is its primary action?

<p>Posterior interosseous nerve; wrist extension and adduction. (A)</p>
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What is the origin and action of the anconeus muscle?

<p>Lateral epicondyle of humerus; extends elbow. (B)</p>
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Which nerve is responsible for innervating all the muscles in the deep group of the posterior forearm?

<p>Posterior interosseous nerve (C)</p>
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What is the origin and action of the abductor pollicis longus (APL) muscle?

<p>Back of ulna and radius; abducts wrist and thumb. (B)</p>
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What are the terminal branches of the radial nerve at the level of the lateral epicondyle?

<p>Superficial branch and posterior interosseous nerve (B)</p>
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Which condition is most likely indicated by swelling in the anatomical snuffbox?

<p>Scaphoid fracture (D)</p>
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What structures form the boundaries of the anatomical snuffbox?

<p>Abductor pollicis longus and extensor pollicis brevis tendons anteriorly, and extensor pollicis longus tendon posteriorly (C)</p>
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Which of the following structures would NOT be found passing deep to the extensor retinaculum?

<p>Cephalic vein (C)</p>
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In which compartment of the extensor retinaculum is the tendon of the extensor carpi ulnaris located?

<p>6th compartment (C)</p>
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Which muscles would be affected, resulting in the inability to extend the elbow, wrist and all joints of medial 4 fingers?

<p>Extensor digitorum (B)</p>
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How does the middle radio-ulnar joint primarily achieve stability, considering its classification as a fibrous syndesmosis?

<p>Via the interosseous border of the ulna and radius, which limits movement but provides stability. (A)</p>
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During pronation of the forearm, what is the combined action of the brachioradialis, pronator teres, and pronator quadratus muscles?

<p>They coordinate to rotate the radius over the ulna, turning the palm downwards. (C)</p>
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Considering the articulations at the wrist joint, how does the arrangement of the radius, scaphoid, lunate, and triquetrum contribute to its ellipsoid nature?

<p>The lower end of the radius articulates with the scaphoid, lunate, and triquetrum, enabling a wide range of motion characteristic of an ellipsoid joint. (C)</p>
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How do the actions of the Flexor Carpi Radialis (FCR) and Flexor Carpi Ulnaris (FCU) work in synergy with the Palmaris Longus to achieve wrist flexion effectively?

<p>The FCR and FCU provide the primary force for flexion, while the Palmaris Longus tenses the palmar fascia and assists in the movement. (B)</p>
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Considering the structure and function of the hand joints, how does the unique synovial saddle joint of the thumb's carpometacarpal joint differ from the other carpo-metacarpal joints?

<p>It allows for a wider range of motion, including opposition, which is crucial for dexterity. (D)</p>
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What functional consequence would result from damage to the radial nerve affecting the brachioradialis muscle, relative to its role in forearm positioning and elbow flexion?

<p>Weakened ability to put the forearm in a midprone position and flex the elbow, especially in this position. (A)</p>
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How does the coordinated action of the Extensor Carpi Radialis Longus (ECRL) and Brevis (ECRB) contribute to the movements of the wrist and hand?

<p>They work together to extend and abduct the wrist, stabilizing it during forceful grip. (B)</p>
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What specific loss of function would be expected following damage to the posterior interosseous nerve, concerning its innervation of the digital extensor muscles?

<p>Impaired ability to extend the medial four fingers at the metacarpophalangeal joints. (C)</p>
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What functional deficit would be most apparent following an injury that selectively impairs the abductor pollicis longus (APL) muscle?

<p>Reduced ability to abduct the wrist and thumb in a plane perpendicular to the palm. (C)</p>
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Following a fracture at the mid-shaft of the humerus, which results in wrist drop and finger drop, what nerve is most likely compromised?

<p>Radial nerve. (D)</p>
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In the event of radial nerve damage proximal to the elbow, which of the following muscles would retain its normal function?

<p>Brachioradialis. (A)</p>
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What specific anatomical feature makes the scaphoid bone vulnerable to avascular necrosis following a fracture in the anatomical snuffbox?

<p>The scaphoid has a limited number of direct arterial branches, reducing its collateral circulation. (D)</p>
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What critical maneuver might be used to assess the integrity of the radial artery within the anatomical snuffbox?

<p>Palpating for the radial pulse. (A)</p>
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What key distinctions exist between structures superficial and deep to the extensor retinaculum at the wrist?

<p>Superficial structures include cutaneous nerves and veins, while deep structures are contained within synovial sheaths. (C)</p>
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Following a laceration over the 5th compartment of the extensor retinaculum, which specific movement of the hand and wrist would be most compromised?

<p>Extension of the little finger. (A)</p>
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If a patient exhibits limited supination of the forearm following an injury, but pronation remains largely unaffected, which combination of muscle impairments is least likely to be the primary cause?

<p>Dysfunction of biceps brachii and pronator quadratus, accompanied by normal supinator and brachioradialis function. (B)</p>
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What is the consequence of a complete transection of the posterior interosseous nerve regarding the function of the wrist and fingers?

<p>Inability to extend the wrist and all joints of the medial four fingers. (A)</p>
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Considering the anatomical arrangement at the wrist, what is the most likely consequence of significant swelling within the anatomical snuffbox?

<p>Compression of the radial artery, potentially compromising blood supply to the scaphoid. (D)</p>
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Following a forceful impact to the anterior aspect of the wrist, a patient reports pain and reduced range of motion, particularly during wrist extension and abduction. Imaging reveals no fractures, but significant swelling is noted around the tendons on the radial side of the wrist. Which compartment of the extensor retinaculum is most likely affected?

<p>2nd compartment, containing the tendons of extensor carpi radialis longus and brevis. (A)</p>
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A surgeon is planning an approach to the radial artery at the wrist. What is the most important consideration regarding the location of the superficial branch of the radial nerve?

<p>The superficial branch of the radial nerve crosses the radial artery superficially near the anatomical snuffbox. (A)</p>
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Considering the actions of the muscles acting on the wrist, what would be the functional outcome of simultaneous paralysis of the flexor carpi ulnaris and extensor carpi radialis longus?

<p>Wrist would radially deviate during flexion. (D)</p>
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A patient presents with weakness in wrist extension and an inability to abduct the thumb. Which specific nerve impairment is most likely responsible for these deficits?

<p>Radial nerve injury proximal to the elbow. (B)</p>
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During a complex surgical repair involving the distal radius and ulna, there is iatrogenic damage affecting the interosseous membrane. How would this compromise the biomechanics of the forearm?

<p>Reduced ability to transmit forces from the hand to the elbow during weight-bearing activities. (A)</p>
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In a scenario involving a stab wound to the anterior forearm, a patient exhibits paralysis of the flexor digitorum profundus of the index and middle fingers, as well as the flexor pollicis longus, but maintains normal function of the flexor carpi ulnaris. Which nerve is likely affected?

<p>The anterior interosseous nerve. (C)</p>
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If a patient has difficulty with both wrist flexion and adduction, which combination of muscle impairments is most likely present?

<p>Impairment of flexor carpi ulnaris and flexor carpi radialis. (A)</p>
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What would be the most expected outcome of a surgical error during carpal tunnel release that severs the recurrent branch of the median nerve?

<p>Inability to oppose the thumb. (A)</p>
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Following a fall onto an outstretched hand, a patient experiences persistent pain and tenderness in the anatomical snuffbox, but initial radiographs are negative. If avascular necrosis of the scaphoid bone is suspected, what imaging modality would be most appropriate to confirm this diagnosis?

<p>Magnetic resonance imaging (MRI) with and without contrast. (A)</p>
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A patient presents with pain and weakness in the hand following a deep laceration on the ulnar side of the anterior forearm. Examination reveals weakened flexion of the wrist and impaired adduction. Which of the following structures is most likely injured?

<p>Ulnar nerve and flexor carpi ulnaris tendon. (D)</p>
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A patient is diagnosed with compression of the radial nerve in the spiral groove of the humerus. Which of the following muscles would retain its normal function?

<p>Triceps brachii (all heads). (C)</p>
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If there is damage to the interosseous membrane, how does this affect force transmission between the radius and ulna during weight-bearing activities such as performing a push-up?

<p>Reduces force transmission from the radius to the ulna, increasing the load on the radius. (B)</p>
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Flashcards

Radio-ulnar Joint

A joint that allows for pronation and supination movements in the forearm.

Superior Radio-Ulnar Joint

Synovial pivot joint where the head of the radius articulates with radial notch of ulna & annular ligament.

Inferior Radio-Ulnar Joint

Synovial pivot joint where the head of the ulna articulates with & ulnar notch of radius.

Middle Radio-Ulnar Joint

Fibrous syndesmosis joint articulated by inter-osseous border of ulna & radius.

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Pronation

Movement that involves Brachioradialis, Pronator teres, and Pronator quadratus.

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Supination

Movement that involves Brachioradialis, Biceps, and Supinator muscles.

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Radio-carpal Joint

A joint that connects the radius to the carpal bones, allowing wrist movement.

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Wrist (Radio-carpal) Joint

Synovial ellipsoid articulation between the lower end of radius and scaphoid, lunate, & triquetrum.

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Inter-carpal Joints

Joints between carpal bones; synovial plane joints.

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Carpo-metacarpal Joints

Joints between carpal bones and metacarpals; synovial plane joints, except thumb (saddle).

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Metacarpo-phalangeal Joints

Joints between metacarpals and phalanges; synovial condylar joints.

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Inter-phalangeal Joints

Joints between phalanges; synovial hinge joints.

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Brachio-radialis

Originates from upper 2/3 of the lateral supra-condylar line; inserts on the styloid process of radius; radial nerve supply.

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Extensor Carpi Radialis Longus

Originates from the lateral supracondylar ridge of the humerus and inserts onto the base of the second metacarpal bone.

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Extensor Carpi Radialis Brevis

Originates on the common extensor origin, inserts on 3rd metacarpal bone, supplied by posterior interosseous nerve.

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Extensor Digitorum

Originates on the common extensor origin and inserts into the middle and distal phalanges of the medial four fingers.

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Extensor Digiti Minimi

A muscle that extends the little finger; originates from the common extensor origin.

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Extensor Carpi Ulnaris

A muscle that extends and adducts the wrist; originates from the common extensor origin & posterior border of ulna.

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Anconeus

Originates from the lateral epicondyle of the humerus, inserts on the back of the ulna’s upper half, and is supplied by the radial nerve.

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Abductor Pollicis Longus

A deep muscle that abducts the wrist and thumb; originates from the back of the ulna & radius.

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Supinator Muscle

Originates from the lateral epicondyle of the humerus and inserts on the upper 1/3 of radius.

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Extensor Pollicis Longus

Extends the thumb at the metacarpophalangeal and interphalangeal joints.

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Extensor Indicis

Extends the index finger at the metacarpophalangeal joint.

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Radial Nerve

Continuation of the posterior cord of the brachial plexus, supplies the posterior arm and forearm.

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Superficial Branch (Radial Nerve)

Passes deep to brachioradialis, then through extensor retinaculum.

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Posterior Interosseous Nerve

Pierces supinator, runs between deep and superficial forearm muscles.

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Crutch Palsy

Injury causing elbow, wrist, and finger drop due to radial nerve compression.

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Anatomical Snuff Box

Depression on the lateral side of the wrist, contains radial artery.

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Anterior (Lateral) Boundary

Tendon of APL and EPB.

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Posterior (Medial) Boundary

Tendon of EPL.

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Floor

Styloid process of radius, Scaphoid, Trapezium.

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Posterior Interosseous Nerve Supply

All deep group muscles are supplied by it.

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Origin of ECRL

Originates lower 1/3 of the lateral supracondylar line, inserts onto the 2nd metacarpal bone.

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Wrist Flexion

Flexor carpi ulnaris & Palmaris longus muscles action.

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Wrist & Finger Drop

The result after a facture at mid-shaft of humerus.

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Radial Artery

Artery running through anatomical snuff box.

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Injury of Superficial Branch

Damage to this results to sensory loss to lateral 2/3 of dorsum of hand.

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Saturday Night Palsy

An injury that affects the elbow, wrist, and finger.

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Superficial branch supply

This branch supplies lateral 2/3 of dorsum of hand & dorsal surface lateral 3.5 fingers except distal phalanges

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Brachioradialis Action

This muscle puts forearm in midprone position.

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ECU Muscle Action

Extends the elbow & adducts the wrist.

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Study Notes

Radio-ulnar Joint

  • Connects the radius and ulna bones in the forearm.
  • Includes the superior, inferior, and middle radio-ulnar joints.

Superior Radio-ulnar Joint

  • Type: Synovial pivot joint
  • Articulation: The head of the radius articulates with the radial notch of the ulna and the annular ligament.

Inferior Radio-ulnar Joint

  • Type: Synovial pivot joint
  • Articulation: The head of the ulna articulates with the ulnar notch of the radius.

Middle Radio-ulnar Joint

  • Type: Fibrous syndesmosis joint.
  • Articulation: Occurs along the interosseous border of the ulna and radius.

Movement of Radio-ulnar Joints

  • Pronation: Involves the brachioradialis, pronator teres, and pronator quadratus muscles.
  • Supination: Involves the brachioradialis, biceps brachii, and supinator muscles.

Wrist "Radio-carpal" Joint

  • Type: Synovial ellipsoid joint
  • Articulation:
    • Superior: The lower end of the radius.
    • Inferior: The scaphoid, lunate, and triquetrum bones.

Movement

  • Flexion: Achieved by the flexor carpi radialis, flexor carpi ulnaris, and palmaris longus muscles.
  • Extension: Achieved by the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), and extensor carpi ulnaris muscles.
  • Abduction: Achieved by the ECRL, ECRB, and flexor carpi radialis muscles.
  • Adduction: Achieved by the extensor carpi ulnaris and flexor carpi ulnaris muscles.

Hand Joints

  • Inter-carpal: Synovial plane joint.
  • Carpo-metacarpal: Synovial plane joint, except for the thumb, which is a synovial saddle joint.
  • Metacarpo-phalangeal: Synovial condylar joint.
  • Inter-phalangeal: Synovial hinge joint.

Muscles of the Back of Forearm (Superficial Group)

Brachio-radialis

  • Origin: Upper 2/3 of the lateral supra-condylar line of the humerus.
  • Insertion: Styloid process of the radius.
  • Nerve Supply: Radial nerve
  • Action: Puts the forearm in a mid-prone position and flexes the elbow in a mid-prone position.

Extensor Carpi Radialis Longus

  • Origin: Lower 1/3 of the lateral supra-condylar line and common extensor origin.
  • Insertion: 2nd metacarpal bone.
  • Nerve Supply: Radial nerve.
  • Action: Extends the elbow and extends and abducts the wrist.

Extensor Carpi Radialis Brevis

  • Origin: Common extensor origin.
  • Insertion: 3rd metacarpal bone.
  • Nerve Supply: Posterior interosseous nerve.
  • Action: Extends the elbow and extends and abducts the wrist.

Extensor Digitorum

  • Origin: Common extensor origin.
  • Insertion: Middle and distal phalanges of the medial four fingers.
  • Nerve Supply: Posterior interosseous nerve.
  • Action: Extends the elbow, wrist, and all joints of the medial four fingers.

Extensor Digiti Minimi

  • Origin: Common extensor origin.
  • Insertion: Middle and distal phalanges of the little finger.
  • Nerve Supply: Posterior interosseous nerve.
  • Action: Extends the elbow, wrist, and all joints of the little finger.

Extensor Carpi Ulnaris

  • Origin: Common extensor origin and posterior border of the ulna.
  • Insertion: 5th metacarpal bone.
  • Nerve Supply: Posterior interosseous nerve.
  • Action: Extends the elbow and extends and adducts the wrist.

Anconeus

  • Origin: Back of the lateral epicondyle.
  • Insertion: Back of the upper half of the ulna.
  • Nerve Supply: Radial nerve.
  • Action: Extends the elbow.

Muscles of the Back of Forearm (Deep Group)

Supinator

  • Origin: Lateral epicondyle of the humerus, supinator fossa and crest, and annular ligament.
  • Insertion: Upper 1/3 of the radius.
  • Action: Supination of the forearm.

Abductor Pollicis Longus

  • Origin: Back of the ulna and back of the radius.
  • Insertion: Metacarpal bone of the thumb.
  • Action: Abducts the wrist and thumb.

Extensor Pollicis Longus

  • Origin: Back of the ulna.
  • Insertion: Distal phalanges of the thumb.
  • Action: Extends the thumb.

Extensor Pollicis Brevis

  • Origin: Back of the radius.
  • Insertion: Proximal phalanges of the thumb.
  • Action: Extends the thumb.

Extensor Indicis

  • Origin: Back of the ulna.
  • Insertion: Extensor expansion of the index finger.
  • Action: Extends the index finger.
  • Note: All muscles of the deep group are supplied by the posterior interosseous nerve.

Radial Nerve

  • Origin: Continuation of the posterior cord of the brachial plexus.
  • Root Value: C5, C6, C7, C8, T1.
  • Course: Passes in the lower triangular space with profunda brachii artery, then in the spiral groove.
  • End: At the level of the lateral epicondyle, it gives off branches.

Branches

  • Superficial: Passes deep to the brachioradialis.
  • Posterior inter-osseous: Pierces the supinator.
  • Muscular.
  • Cutaneous.

Muscular Branches

  • Radial nerve itself supplies: Brachialis (lateral ½), Triceps, Brachioradialis, ECRL, and Anconeus.
  • Posterior inter-osseous supplies: Muscles of the back of the forearm except brachioradialis and ECRL.

Cutaneous Branches

  • Radial nerve itself: Gives the lower lateral cutaneous nerve (LCN) of the arm and the posterior cutaneous nerve (PCN) of the arm and forearm.
  • Superficial branch: Supplies the lateral 2/3 of the dorsum of the hand and the dorsal surface of the lateral 3.5 fingers, except for the distal phalanges.

Injury

  • Crutch or Saturday night palsy: Causes elbow, wrist, and finger drop.
  • Fracture at the mid-shaft of the humerus: Causes wrist and finger drop.
  • Fracture of the neck of the radius: Causes finger drop.
  • Injury of the superficial branch: No motor affection, only sensory loss of the lateral 2/3 of the dorsum of the hand and the dorsal surface of the lateral 3.5 fingers.

Anatomical Snuff Box

  • Definition: A depression on the lateral side of the wrist.

Boundaries

  • Anterior (lateral): Tendon of abductor pollicis longus and extensor pollicis brevis.
  • Posterior (medial): Tendon of extensor pollicis longus.
  • Floor: Styloid process of the radius, scaphoid, and trapezium.

Content

  • Radial artery and tendon of ECRL and ECRB.

Clinical Importance

  • Any swelling in the anatomical snuff box suggests a scaphoid fracture (the most common fractured carpal bone).
  • Site for pulse detection.

Extensor Retinaculum

Attachment

  • Medially: To the anterior border of the ulna.
  • Laterally: To the anterior border of the radius.

Structures Passing (superficial to it)

  • Cephalic vein.
  • Superficial branch of the radial nerve.
  • Basilic vein.
  • Dorsal cutaneous branch of the ulnar nerve.

Structures Passing (deep to it)

  • 1st compartment: Contains tendons of abductor pollicis longus and extensor pollicis brevis.
  • 2nd compartment: Contains tendons of ECRL and ECRB.
  • 3rd compartment: Contains the tendon of extensor pollicis longus.
  • 4th compartment: Contains tendons of extensor indicis and extensor digitorum, posterior interosseous nerve and anterior interosseous artery.
  • 5th compartment: Contains the tendon of extensor digiti minimi.
  • 6th compartment: Contains the tendon of extensor carpi ulnaris.

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