Coracobrachialis
Origin: Apex of the coracoid process
Insertion: Midway along the medial border of the humeral shaft - Can have slips onto the lesser tubercle/medial epicondyle/medial intermuscular septum
Nerve: Musculocutaneous Nerve C5-C7
Action: Flexion and horizontal adduction of the arm
Coracobrachialis - Palpation
TrPs
- Causes irritation of the musculocutaneous nerve - C5/C6 lesion spares coracobrachialis
- Related to biceps(short head), supraspinatous, triceps (long head)
- Doorway stretch helps
- Overuse/injuries from chest workouts/anything that presses arm tightly towards the body
- Pain in the arm and shoulder down to the back of the hand
- Musculocutaneous nerve can get trapped
Biceps
Origin: Short: Coracoid Apex Long: Supraglenoid Tubercle of the scapula
Insertion:Posterior Radial Tuberosity
Nerve: Musculocutaneous (C5-6)
Action: Flexion of the elbow and arm, supination of forearm
Biceps Brachii - Palpation
TrPs
- Causes superficial anterior shoulder pain
- Infraspinatous causes satellite Trps in Biceps
- Pincer type action with patient's arm bent - difference between biceps and brachialis
- Tender in adhesive capsulitis (long head reinforces GH capsule)
- Antagonist = triceps
Brachialis
Origin: Lower 1/2 of the front of the humerus + intermuscular septa
Insertion: Ulnar Tuberosity + Anterior aspect of the coronoid process
Nerve: Musculocutaneous Nerve C5-C6 + Radial Nerve C7
Action: Flexion of the elbow
TrPs
- Palpation - push the biceps medially with the forearm pronated
- Aggravated by repeated overhead lifting
Triceps
Origin: Long Head: Infraglenoid Tubercle of scapula + GH capsule Lateral Head: Posterior surface of humeral shaft + lateral intermuscular septum, above radial groove Medial head: Posterior surface of humeral shaft, below radial groove + medial intermuscular septum + lower part of lateral intermuscular septum
Insertion: Posterior olecranon
Nerve: Radial Nerve C6-C8
Action: Extension of the elbow + extension of the shoulder (long head)
TrPs
- Causes posterior upper arm and shoulder pain (usually hard to localise)
- Consider radial nerve entrapment at the Arcade of Frohse
- Can mimic C7 radicular pain
Anconeus
Origin: Posterior surface of the lateral epicondyle of the humerus
Insertion: Lateral aspect of the Olecranon + proximal quarter of the posterior surface of the shaft of the ulna
Nerve: Radial C6-C8
Action: Elbow extension
Pronator Teres
Origin: Humeral: Proximal medial epicondyle - CFO and intermuscular septum Ulnar: Medial side of coronoid process of the ulna
Insertion: Lateral surface of radial shaft
Nerve: Median nerve (C6-7)
Action: Pronation of the forearm + weak flexor of the elbow
Pronator Teres - Palpation
Pronator Teres - Trps
- Mimics Carpal Tunnel
- TrPs can be activated by broken wrist/elbow
Flexor Carpi Radialis
Origin: Medial Epicondyle (CFO) + Antebrachial Fascia + intermuscular septa
Insertion: Palmer Surface of the base of the 2nd metacarpal, slip into 3rd metacarpal
Nerve: Median Nerve (C6-7)
Action: Flexion and radial deviation of the wrist
TrPs
- Pectoralis minor can cause satellite trigger points in FCR
Flexor Carpi Ulnaris
Origin: Humeral Head: Medial Epicondyle CFO Ulnar: Medial Margin of the olecranon and proximal 2/3rds of the posterior border of the ulna
Insertion: Pisisform, Hamate, 5th metacarpal - can be attached to the flexor retinaculum + 4th and 5th metacarpal
Nerve: Ulnar Nerve (C7-T1)
Action: Flexion and ulna deviation of the wrist
TrPs
- Satellite Trps in Pecs minor, Lats, serratus posterior superior
- Can entrap ulna nerve
Palmaris Longus
Origin: Medial Epicondyle (CFO) + Intermuscular septa and deep fascia
Insertion: Palmar Aponeurosis
Nerve: Median Nerve (C7-8)
Action: Anchors the skin and fascia of the hand improving grip strength and flexion of the wrist
TrPs
- Trps can cause difficulty in handling tools - tenderness in palm
- Trps in Triceps medial head causes satellite Trps in PL
Brachioradialis
Origin: Proximal 2/3rds of supracondylar ridge of the humerus, lateral intermuscular septum
Insertion: Lateral side of the distal end of the radius
Nerve: Radial (C5-6)
Action: Flexion of the elbow - especially when forearm is in mid pronation
Brachioradialis - Palpation
Flexor Digitorum Superficialis
Origin: Medial Epicondyle of the humerus (CFO) + anterior band of the ulnar collateral ligament + intermuscular septa, medial side of the coronoid process, radial head
Insertion: Base of the middle phalanges of the finger
Nerve: Median Nerve C8-T1
Action: Flexion of the interphalangeal, metacarpophageal and wrist joints
Flexor Digitorum Profundus
Origin: Upper 3/4 of anterior and medial surfaces of the ulna, medial side of coronoid process, upper 3/4s of posterior ulnar boder + anterior surface of interousseous membrane (ulnar half)
Insertion: Palmar surfaces of bases of distal phalanges
Nerve: Medial part (Middle and Ring Finger): Ulnar Nerve C8-T1 Lateral part (Middle and Index finger) Median Nerve C8-T1
Action: Flexion of fingers - DIPs
TrPs
- Same as FDS (See above)
Flexor Pollicis Longus
Origin: Anterior surface of the radius + interosseous membrane - can originate from slip from the lateral/medial border of coronoid process/medial epicondyle of the humerus
Insertion: Palmar surface of the base of the distal phalanx of the thumb
Nerve: Anterior interosseous branch of the median nerve (C7-8)
Action: Flexion of the phalanges and metacarpophalangeal joint of the thumb
Supinator
Origin: Proximal 1/3rd of the radius , lateral epicondyle, radial colllateral ligament, annular ligament, supinator crest and posterior part of the triangular depression in front of it
Insertion: Lateral surface of proximal 1/3rd of radius
Nerve: Posterior Interosseous Nerve (radial) (C6-7)
Action: Supination
TrPs
- Lateral Elbow pain producer
- Deep radial nerve can be entraped by tight supinator (Resisted extension of middle finger with wrist straight causes pain)
Pronator Quadratus
Origin: Anterior surface of the shaft of the ulna, medial part of the surface, aponeurosis
Insertion: Distal quarter of the anterior border and surface of the shaft of the radius - deep fibres insert into the triangular area above the ulnar notch of the radius
Nerve: Anterior osseous branch of the median nerve (C7-8)
Action: Pronator
Pronator Quadratus - Palpation
- Radial artery + styloid process
- Get pt to flex and supinate wrist - relax tendons
- Get pt to pronate slightly
Extensor Carpi Radialis Longus
Origin: Distal third of lateral supracondylar ridge of the humerus + lateral intermuscular septum
Insertion: Radial side of the dorsal surface of the base of the second metacarpal -can have slips to the 1st/3rd metacarpal
Nerve: Radial Nerve (C6-7)
Action: Extension and radial deviation of the wrist
TrPs
- TrPs in scalenes and supraspinatous can lead to satellite TrPs in ECR Longus and Brevis
- TrPs are activated in ECR longus, ECR brevis and brachioradialis by reptative gripping
Extensor Carpi Radialis Brevis
Origin: Lateral epicondyle of humerus + intermuscular septa
Insertion: Dorsal Surface of third metacarpal, distal to the styloid process
Nerve: Posterior Interosseous Nerve (radial) (C7-8)
Action: Extension and Radial Deviation of the wrist
TrPs
- Can entrap Radial Nerve
- Thickest part of muscle belly most common site for trigger points
Extensor Digitorum
Origin: Lateral Epicondyle of the humerus (CEO) + adjacent intermuscular septa + antebrachial fascia
Insertion: Dorsum of proximal phalanges
Nerve: Posterior interosseous nerve (C7-8)
Action: Extension of Wrist, metacarpophalangeal , proximal and distal interphalangeal joints
Ext Digitorum - Palpation
TrPs
- Can refer pain to lateral epicondyle
- Middle finger commonly affected
Extensor Digiti Minimi
Origin: CEO + Intermuscular septa + antebrachial fascia |
Insertion: Dorsal digital expansion of the 5th digit - can be a slip onto the 4th |
Nerve: Posterior Interosseous Nerve (C7-8) |
Action: Extension of the little finger and wrist |
- Trps same as Extensor Digitorum
- Antagonist - Flexor digiti minimi brevis
Extensor Carpi Ulnaris
Origin: Humeral: Lateral epicondyleof the humerus Ulnar: CEO, Posterior border of the ulna, antebrachial fascia
Insertion: Tubercle on the medial side of the fifth metacarpal base
Nerve: Posterior Interosseous Nerve C7-8)
Action: Extension and ulnar deviation of the wrist
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