HUMAN ANATOMY Date discussed: 2 / 23 / 24

LESSON # | CLINICAL NOTES + REVIEW

PT13 - C | Maynard Aparicio

MOINA TIPS ACCORDING TO SIR (except Opponens Digit ➔ Pisiform

Be specific daw! Minimi)

Rule:
Rotates the shoulder medially - NOT CORRECT _______________________________________
Rotates the scapula medially - CORRECT
In the book lahi ang origin, pero ganahan si sir ani
All the thenar eminence OAF
❖ How many intrinsic muscles are there in the - Come from: flexor retinaculum, tubercle of the
hand? trapezium and scaphoid
- 20 muscles (if mu ans kag Flexor retinaculum only, chaktu ra
daw
❖ How many muscles are innervated by the
median nerve? Hypothenar eminence
- 5 muscles - Abductor digiti mini
Other book: Flexor retinaculum
❖ Meaning, out of the 20 muscles of the hand Other Other book: Pisiform
- 15 are innervated by the ulnar nerve
- According to sir,
REVIEW “Basing on that, therefore the muscles of the
Muscles of the Thenar Eminence thenar eminence and hypothenar eminence – all
(All Innervated by the Median Nerve) of them will come from the flexor retinaculum.
- Opponens Pollicis EXCEPT Opponens Digiti Minimi which comes
- Abductor Pollicis Brevis from the pisiform”
- Flexor Pollicis Brevis
- Lumbricals 1 and 2 “So probably sa inyung book,
- (Also innervates 3 ½ of sensorium of palm) Ang abductor pollicis originates in the tubercle of the
trapezium and the scaphoid…highly probable.”
Muscles of the Hypothenar Eminence ___________________________________________
(Primarily innervated by the Ulnar Nerve)
- Abductor Digiti Minimi
- Flexor Digiti Minimi
- Opponens Digiti Minimi Note: This is a SUMMARIZED TABLE I based this sa
discussion ni sir
Please refer to the transcription below to read exact
words gi ingon ni sir
Note: This is a SUMMARIZED TABLE I based this sa
discussion ni sir Muscles Insertion
Please refer to the transcription below to read exact
words gi ingon ni sir All of them insert in the proximal
phalanx either on the
Muscles Origin pollex or the digiti minimi.

All the Thenar ➔ Flexor Opponens attached on the shaft of

eminence retinaculum the pollex or digiti minimi
(OAF) ➔ Tubercle of the
Trapezium and For instance; (Opponens Insertion)
Scaphoid
Opponens digiti minimi metacarpal shaft of the
5th digit
All the Hypothenar ➔ Flexor
eminence retinaculum Opponens pollicis insert the shaft of the 1st
metacarpal.
– –

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 HUMAN ANATOMY Date discussed: 2 / 23 / 24
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio

For instance; (Majority of the muscle)
Abductor Digiti Minimi anterior surface of the
base of the proximal
phalanx of the little finger
Flexor Digiti Minimi anterior surface of the
base of the proximal
phalanx of the little finger
Abductor Pollicis attached on the
Brevis anterolateral surface of
the base of the proximal
phalanx of the thumb via
sesamoid bone
Flexor Pollicis Brevis attached on the
anterolateral surface of
the base of the proximal
phalanx of the thumb via
sesamoid bone
______________________
All of them insert in the proximal phalanx either on the
pollex or the digiti minimi. However, your opponens will
attached on the shaft of the pollex or digiti minimi
So your Opponens digiti minimi will attached on the
metacarpal shaft of the 5th digit and the Opponens
pollicis will attach or insert the shaft of the 1st
metacarpal.
Therefore, the Abductor and Flexor digiti minimi will
attached on the proximal phalanx anterior surface of the
base of the proximal phalanx of the little finger.
Dri, Abductor pollicis brevis and Flexor pollicis brevis will
attached on the anterolateral surface of the base of the
proximal phalanx of the thumb via sesamoid bone
*So naa sya dri* duha gyud na sila. It is the reason
why your Opponens can flex and your flexor can
also abduct

So all your hypothenar muscles are innervated by the

Lumbricals insert on the extensor
expansion via the tendon
Origin: from the tendon of of the EDC
the FDP
“inser– rather will pass on
the lateral side because it
will insert on the extensor
expansion via the tendon
of the EDC”
Ulnar, thenar muscles are innervated by the Median
Nerve
This muscle (?) comes from the tendon of the FDP and
will insert on the extensor expansion via the tendon of
the EDC
So this is your First, second, third, and fourth lumbrical
Notice that all the lumbricals are inser– rather will pass
on the lateral side because it will insert on the extensor
expansion via the tendon of the EDC

Adductor Pollicis Base of proximal phalanx

(Oblique Head) of thumb So meaning ana if I remove this, kani sya is
Origin - the shaft of the already your palmar interossei.
third metacarpal bone,
specifically on the number sa model
anterior surface 72 - volar/ palmar interossei (3rd)
73 - artery
(Transverse Head)
Origin - second and third Oblique head will come on the shaft of the 3rd
metacarpal metacarpal. (Dapat ANTERIOR SURFACE of the 3rd
metacarpal)
— Idk pero lahi ang _____________________
discussion ni sir sa
google ;-;
Q: What nerve innervates the adductor pollicis
A: Ulnar nerve
Hypothenar Muscles - Ulnar nerve
Thenar Muscles - Median nerve Q: What muscle do we used the froment’s test

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 HUMAN ANATOMY Date discussed: 2 / 23 / 24
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio

A: Adductor pollicis

= That is why ang FROMENT’S TEST is

pathognomonic for ulnar nerve innervation

Ulnar nerve
- will pass by the (1) cubital tunnel.
- And then (2) arcade of struthers then (3) cubital
tunnel then ang next niya kay (4) tunnel of
guyon.

Median nerve -
(1) TOS then
(2) ligament of struthers then
(3) tendon of biceps of brachii – if there is trauma, then
ni contract sya…this median nerve will impinge –
(4) then ang pronator teres mu hypertrophy then
(5)sublimis (head coming from the medial epicondyle
that came from the coronoid process) that is why it is
called sublimis arcade – MEDIAN NERVE

Meaning ana, supposedly –

Q: If you have Anterior Interosseous Nerve Syndrome,

will you lose the lateral sensation of the sensorium of
the palm?
A: NO

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 HUMAN ANATOMY Date discussed: 2 / 23 / 24
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio

in px
(Especially, if you
REVIEW asked the patient to
“Dapat everybody should be able to draw the push the upper
brachial plexus by now, If you know how to draw the extremity against the
brachial plexus, you will be able to categorize sets of wall)
nerves” TIPP FROM SIR MAYNARD!
Will have difficulty in
“Katung mga bright dapat mag tutor sa mga ga lisod ABduction because
na classmate WAHAHHA” you need the scapula
to upwardly rotate.
BRACHIAL PLEXUS (This is because you
(proximal to distal insertion) need the glenoid to
(need to be specific!) act as a platform
while the head of the
ROOTS (2) humerus will stand)
- Long Thoracic Nerve
- Dorsal Scapular Nerve If it won't rotate, it will
be difficult because
TRUNKS (2) the head will hit the
- Suprascapular acromion.
- Nerve to subclavius
Dorsal (Superficial If the dorsal scapular
Scapular Back Muscles) nerve is affected, the
LATERAL CORD (3)
Nerve muscles that it
- Lateral pectoral nerve
- Levator innervates will end
- Musculocutaneous nerve
Scapulae
- Lateral cord branch to median
The position of the
- Rhomboid scapula is in lateral
POSTERIOR CORD (5)
Major winging and
- Upper Subscapular
upward winging
- Thoracodorsal
- Rhomboid ( Because this nerve,
- Lower Subscapular
Minor innervates the
- Axillary
muscles that
- Radial
downwardly rotate
the scapula )
MEDIAL CORD (5)
- Medial pectoral nerve
If the trapezius is
- MCNA (brachial)
weak,
- MCNFA (antebrachial)
-then the scapula will
- Ulnar
be in lateral winging
- Medial cord branch to Median
with downward
rotation = DROP
SHOULDER
(Very Important: Enumerate the muscles that this
Note: Once the
nerve innervates)
tendon of the biceps
NERVE MUSCLE THAT Remarks: gets heavy, it will
IT contract. It will
INNERVATES maintain the position
of the head of the
ROOTS humerus against the
Long Thoracic Serratus If SA is weak glenoid. If you have a
Nerve Anterior -medial winging of drop shoulder, it will
scapula is observed also drop. That is

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 HUMAN ANATOMY Date discussed: 2 / 23 / 24
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio

why weakness of the Therefore, you

trapezius will also cannot do sitting
result to subluxation push up
of the head of the
humerus Axillary Deltoid Fracture associated
with: Surgical neck
TRUNKS of the humerus Fx
Lesion:
Suprascapular Supraspinatus You will have ● Difficult
difficulty in ABduction
Infraspinatus ABduction
especially in you can still initiate
Teres Minor shifting(?) abduct but it will not
be enough to bring
NOTE: Because you the upper extremity
need the above your head
supraspinatus for the
first 30 degrees of Radial Nerve Fracture associated
protraction with: Humeral shaft
fx/ spiral groove &
Fracture associated Supracondylar Fx
with: Clavicle Fx
Nerve to Subclavius In the nerve to
Subclavius subclavius, it is okay.
Because you have FRACTURE:
many depressors Axillary nerve - Surgical neck of the humerus Fx
LATERAL CORD Suprascapular nerve - Clavicle Fx
Radial - Humeral shaft Fx ; Spiral groove
Lateral Pectoralis Weakness of the Radial, Ulnar and Median - Supracondylar Fx
Pectoral Nerve Major Pectoralis Major (the
same with medial
pectoral nerve) —----------------------
– Bare with me –
● Difficulty in ULNAR NERVE
Horizontal
ADduction. Thoracic Outlet Syndrome (TOS) {1}
- It will go out between Anterior and middle
Musculocutaneous Coracobrachialis Problem: scalene and it will enter the Axilla area and then
Elbow Flexion Pectoral area
Biceps Supination (because - Pathway of the neurovascular bundle from the
Brachii the BB is the root of the neck until the pectoral area
strongest supinator
Brachialis of the forearm) - Can be either:
- Vasogenic (involve ang blood supply)
POSTERIOR CORD - Neurogenic (dli involve ang blood
Upper Subscapular Difficulty: supply)
Subscapular ● Internal
Rotation - Symptoms may include:
- Pain (heaviness)
Thoracodorsal Latissimus Difficulty: - Pallor (violet, or white [circulation])
Dorsi ● Cannot - Paresthesia (“Binhod” or “pins and
ADduct needles”)
(Latissimus Dorsi is a
vv strong ADductor) - Common points of compression include;
- Scalene Triangle (Scalenus anticus
and medius)
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 HUMAN ANATOMY Date discussed: 2 / 23 / 24
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio

- Costoclavicular (first rib and clavicle)

- Retroclavicular/ Retropectoral
(underneath/behind the pectoral minor)

For the Common points of compression of TOS

If you…

● Do the Last part of Eden’s Test or

Hyperadduct - retroclavicular/retropectoral

*Eden’s test will test first the costoclavicular and then

the retropectoral
- because the second is to hyperadduct while
taking note if there is pulselessness or So wala pa sya kaabot sa elbow,
reproduction signs and symptoms.
Before the elbow, you have the Arcade of Struthers
Do the Military Brace or first part of Eden’s Test or Arcade of Struthers {2}
Depress - costoclavicular - A aponeurosis or fascia sheath that is a
passageway for your ulnar nerve
Eden’s test will test first the costoclavicular and the
retropectoral
- because the second is to hyperadduct while
taking note if there is pulselessness or
reproduction signs and symptoms.

Do the Adson’s Test or the Neck and look at affected

area- interscalene triangle

So tan.nan (all nerves) can be affected by the TOS

(For examples, axillary has a weakness pero wala
syay surgical intervention so you test it in TOS. So
patient will feel pain and paresthesia in the deltoid
area. And if you test it and it worsen, we can conclude
that the axillary nerve is compressed at the TOS (So it
can be either sa TULO na compression points)
-- So, as physical therapist, we need to localize where
is the area is affected because we can do certain
maneuvers or manual therapy to widen the area. Very
important that we can assess.
So meaning ana, whether arcade struthers or TOS,
both have the same manifestation or same
symptoms.
Q: How do you differentiate whether it is affected in the
TOS or arcade of struthers
- Use the 5 maneuvers to determine TOS. Once
you duplicate or replicate the sign and
symptoms, then you are sure that the affectation
is in the TOS
- And if there is no replication of symptoms during
those maneuvers, then you can surmise that the
affectation is in the arcade struthers

5 Manuevers:
- ULTT’s test
- Adson’s
- Wright’s Test
- Eden’s Test
- Roos Test (?)

https://www.physio-pedia.com/Thoracic_Outlet_Syndr

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 HUMAN ANATOMY Date discussed: 2 / 23 / 24
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio

Adductor Pollicis
ome_(TOS)
Lumbricals 3 & 4
ELBOW
Interrossei (Palmar & Dorsal)
Cubital Tunnel [3]
- Depression between the olecranon and medial Sensorium to medial 1 ½ Palmar and Dorsal
epicondyle
- Excess in the cubital angle, whatever the angle (Sensorium - sensation in the skin)
is that is the cubital angle
- (Value: 5 degrees to 15 degrees) If you go Example:
beyond 15 degrees, there is a possibility the At the tunnel of Guyon, if you extend you can bend
ulnar nerve will be stretched or there is arthritis because you have the FDP, You can have claw hands,
or trauma in the area. prevalent in avictation in intrinsic dorsal.
- Called Tardy Ulnar Palsy
Pero if it is in the cubital tunnel, claw hand is not
prevalent
Ulnar ___
(wa dyud ko kasabut) 52:03

Q: What nerve supplies the skin medial ½ dorsum

A: Palmar cutaneous nerve which is a branch of the
ulnar nerve

“Sometimes other nerves are separated that will enter

FCU the tunnel of Guyon pero sometimes the tunnel of Guyon
is not affected, pero most of the time affected dyud daw
FDP (medial 1/2) siya. SO it really depends. You have anatomical
variations.”
After that you are in at the WRIST
—-
Tunnel of Guyon Bare with me pt2
- Hook of the Hamate and Pisiform with the MEDIAN NERVE
palmar carpal ligament.
START WITH TOS AREA (1)

ELBOW
Can be affected in the supracondylar ridge however it
is not impingement, it is trauma

Prior to elbow, (rare case)

We have the ligament of struthers (2)
- Same manifestation with TOS

Same below the elbow or distal to elbow, Bicipital

aponeurosis or lacertus fibrosus syndrome (3)

Hypothenar “OAF” The difference:

- Opponens Digiti Minimi All three of them have the same manifestations
- Abductor Digiti Minimi meaning weakness of all the muscle that the nerve will
- Flexor Digiti Minimi innervate

Palmaris Brevis

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 HUMAN ANATOMY
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio
Question: How will we know whether the affectation is
in the TOS, Bicipital aponeurosis, or ligament of
struthers
Answer: inclination of the forearm area distal to the
elbow or trauma – there is a possibility the bicipital
aponeurosis will contract. The bicipital aponeurosis
approaches the ulnar side. Together with the pronator
teres, “force padulong”
Expansion of the tendon of the BB, so it will
approach the ulnar side. If the area has a wound or
whatever, as long as it thickens or it contracts, it will
impinge or compress the structures below it.
Therefore, the median nerve is affected. So all the
muscles of the median nerve will also be affected.
YET, the difference is that there is Trauma or
inflammation
If there is no trauma or inflammation, there is a
possibility it is TOS. Utilize the maneuvers.
If there is no conslessness (idkkk) , no replication of
signs and symptoms, then it is possible ligament of
struthers
If there is conslessness (iddkkk) or replication of
signs and symptoms upon implementing the
maneuvers. Therefore, it is in the TOS
For example, retropectoral = stretch the pectoralis
minor so the it can decompress the area
(WE NEED TO HAVE A PRECISE DIAGNOSIS)
Pronator Teres
Pronator Teres syndrome
- If the pronator teres will hypertrophy, then it
can compress the median nerve beneath it
(only the pronator teres is sparred)
Flexor Carpi Radialis
Palmaris Longus
Flexor Digitorum Superficialis
Take note: we have Sublimis Arcade or Flexor
Digitorum syndrome
So what will happen here is that, if it is impinge you will
have “Anterior Interosseous Nerve Syndrome”
→ because you have 3 nerves that are affected and the
➢ first one will be the Flexor Pollicis Longus,
➢ Flexor Digitorum Profundus,
Date discussed: 2 / 23 / 24
➢ Lateral ½ and
➢ Pronator Quadratus
Now prior to that,
You have a nerve, continuation to your median nerve but
this nerve will innervate… INNERVATION
➢ Muscles of your thenar eminences “OAF”,
➢ lumbricals 1 and 2, and
➢ sensorium at lateral 3 and ½ of palm.
This nerve can be compressed at the the carpal tunnel
Note: If you have an Anterior Interosseous Nerve
Syndrome, you have this three muscles only
Q: Affected ba ang muscles of the thenar eminence if
you have Anterior Interroseus Nerve?
A: No
Q: Now if you have carpal tunnel syndrome, are the
three muscles affected?
A: No
Q: If you have a carpal tunnel syndrome, can you still
do okay sign
A: Yes, because intact ang muscles, legal muscle
anterior FPL and FDP
Q: If you have pronator teres syndrome, can I do okay
sign
A: No
Q: How will I determine if pronator teres syndrome or
flexor digitorum syndrome? How do you test
A: Pronate forearm and supinate. Makapronate sya
because naa pa syay pronator teres.
Determine Flexor Digitorum Superficialis, (action of
Flexor digitorum superficialis) flexion of the proximal
interphalangeal joint (so naay gibuhat si sir, I don't
remember what)
RADIAL NERVE
(Bare with me pt3)
TOS
Axilla (before the elbow)
Axillary branches. Axillary crutch improper use.
If walay radial nerve, then the next is axillary nerve.
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 HUMAN ANATOMY Date discussed: 2 / 23 / 24
LESSON # | CLINICAL NOTES + REVIEW
PT13 - C | Maynard Aparicio

All the muscles that the radial nerve will innervate will be
affected. Muscles include:
➢ Long head of biceps
➢ Triceps medial head AFTER INTRAMS UE2
➢ Triceps lateral head Questions that will draw higher order thinking skills
➢ Triceps medial head Bones and muscles (para easier)
➢ Anconeus
➢ Brachialis

Spiral groove - Honeymoon or saturday night Q: If you have Posterior Interosseous Nerve, will you
If you have spiral groove, the triceps long head is lose the sensation of the lateral 3 ½
basically impaired. You can still extend but there is little A: No
weakness
Q: If you have posterior Interosseous Nerve
Brachioradialis Syndrome, can I still do this *IDK the action*
A: Because the muscle need here is the Extensor
ECR Pollicis Longus

ELBOW

Prior to the supinator, Pathognomonic of which Lesion

There is another Superficial radial nerve can be
impinch in the wrist *** Thumbs up sign (can also be wrist drop) - PIN

Supinator (wrist drop - ECU, EDC, ECRB are all affected. Wrist
- You have arcade of FROHSE also known as drop can be 0 - 3. For example, 0 ang strength for
Posterior Interosseous Nerve Syndrome extension, pero naa tay strength sa ulnar deviation
compared to your radial because you still have your
ECRB FCU. On the other side, you still have your ECRL and
FCR; hence, the radial deviation is much stronger
EDC compared to your ulnar deviation in PIN syndrome )

EDM Okay sign and Khion ___ (abnormal okay sign) - AIN

ECU Froment’s test - Ulnar Nerve

- Test for ulnar nerve. If there is a lesion of the
APL ulnar nerve, you can see the froment’s sign.
The froments sign is the flexion of the DIP of
EPB the thumb. You can flex the thumb because it
is the function of the flexor pollicis longus
EPL which is innervated by the median nerve
-
EIP Phalen’s test or Prayer’s test (or Reverse) - Impinge
Median nerve as it passes the carpal tunnel

Wrist drop - Radial nerve

*** → can impinge at the wrist.
If it is impinge at the wrist, you have your “cheralgia
prothetica or wartenberg syndrome

Chestergia prothetica or wartenberg syndrome

- You noticed walay muscle, but you have your
sensorium at dorsum at lateral 3 ½
- If you have, you have no motor deficits (no
weakness). Loss of sensation on the lateral 3
½ of the dorsum of the hand

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