F

Extensor Indicis Muscle (Fig. 19.56) Origin

• Backside of the ulna (distal section)

• Interosseous membrane

Insertion

Radiates into the dorsal aponeurosis of the index finger

Action

Extension of the index finger

Supinator Crest

Extensor retinaculum

Extensor digiti minimi

Extensor digitorum

Muscle Chains

TP of the extensor indicis

Supinator

Extensor pollicis brevis

Extensor pollicis longus

Abductor pollicis longus

Extensor indicis

Extensor retinaculum

TP of the extensor indicis

Extensor digiti minimi

Extensor digitorum

Supinator

Extensor pollicis brevis

TP of the extensor carpi radialis longus

TP of the extensor carpi radialis brevis

TP of the extensor carpi ulnaris--

Extensor carpi radialis longus TP of the extensor digitorum

Extensor carpi radialis brevis

Extensor carpi ulnaris

Extensor pollicis longus

Abductor pollicis longus

Extensor indicis

Innervation

Radial nerve (C7-C8)

Trigger Point Location

In the distal half of the muscle in the middle of the forearm between the radius and ulna (see Fig. 19.55)

Referred Pain

Radial side of the wrist and back of hand

Associated Internal Organs

None

Origin

• Supinator crest of the ulna

• Lateral epicondyle of the humerus

• Radial collateral ligament

• Annular ligament of the radius

Insertion

Neck and shaft of the radius (between the tuberosity of the radius and the insertion of the pronator teres)

Action

Supination of the forearm

Innervation

Radial nerve

Trigger Point Location

Slightly lateral and distal of the biceps tendon in the superficial part of the muscle on the ventral side of the radius

Referred Pain

• Lateral epicondyle and in the lateral area of the elbow

• Dorsal back of the hand between the metacarpal bones I and II

• Dorsal proximal phalanx of the thumb

Associated Internal Organs

None

Fig. 19.57

Flexor -

digitorum superficialis

Brachio-radialis

carpi radialis

Tendons of the flexor digitorum superficialis

Brachialis

Biceps brachii

Pronator teres

Common head of the stretchers

Supinator

Palmaris longus

Flexor carpi ulnaris

Common Flexor Tendon Elbow

Biceps brachii

-Flexor pollicis longus head of the flexors

TPs of the flexor digitorum superficialis

Pronator quadratus

-Flexor carpi ulnaris

Pronator teres

Flexor -

digitorum superficialis

Brachio-radialis

carpi radialis

Tendons of the flexor digitorum superficialis

Brachialis

Biceps brachii

Pronator teres

Common head of the stretchers

Supinator

Palmaris longus

Flexor carpi ulnaris

Biceps brachii

-Flexor pollicis longus

Pronator quadratus

-Flexor carpi ulnaris head of the flexors

Pronator teres

TPs of the flexor digitorum superficialis

Reffered Pain

Origin

Medial epicondyle of the humerus Insertion

• Flexor retinaculum

• Palmar aponeurosis

Action

Stretching the palmar aponeurosis Innervation Median nerve (C7-C8) Trigger Point Location

At the transition from the proximal to the medial third of the ventral forearm

Referred Pain

• Distal half of the anterior forearm

None

Fig. 19.60

■ Flexor Carpi Radialis and Ulnaris, Flexor Digitorum Superficialis and Profundus, Flexor Pollicis Longus, and Pronator Teres Muscles

Flexor Carpi Radialis Muscle (Fig. 19.6ial) Innervation

Origin Ulnar nerve (C6-C7)

Medial epicondyle of the humerus

Insertion

• Base of the metacarpal bones II and III

• Scaphoid bone

Action

• Palmar flexion

• Radial abduction

Innervation

Median nerve (C6-C7)

Trigger Point Location

In the center of the muscle belly (in the center of the ventral forearm in the proximal half)

Referred Pain

• Ventral wrist area between the thenar and the hpyothenar eminence

• Proximal half of the palm

• Narrow band in the distal half of the forearm

Associated Internal Organs

None

Flexor Carpi Ulnaris Muscle (Fig. I9.6la2) Origin

• Medial epicondyle of the humerus

• Posterior border of the ulna

• Antebrachial fascia

Insertion

• Piriform bone

• Via the pisohamate and pisometacarpal ligaments at the base of the metacarpal bone V

Action

• Palmar flexion

• Ulnar abduction

Muscles Chains

Trigger Point Location

In the center of the muscle belly at the ulnar rim of the ventral forearm in the proximal half (see Figs. 19.51 and 19.61)

Referred Pain

• Ventral wrist area in the area of the ulnar edge of the hypothenar eminence

• Proximal half of the palm (hypothenar area)

• Narrow band in the distal half of the forearm (hypothenar area)

Associated Internal Organs

None

Flexor Digitorum Superficialis Muscle

Origin

• Medial epicondyle of the humerus (up to the medial collateral ligaments of the elbow)

• Coronoid process of the ulna (medial rim)

• Front side of the radius along the oblique line Insertion

Laterally at the medial phalanges of fingers 2-5 Action

• Flexion of the intermediate and proximal joints of fingers 2-5

• Flexion in the wrist

Innervation

Flexor Digitorum Profundus Muscle

Origin

• Anterior and medial side of the ulna

• Interosseous membrane

Insertion

Distal phalanx of fingers 2-5 Action

• Flexion of all finger joints ■ Flexion of the wrist

Innervation

Fig. 19.62

Trigger Point Location for Both Muscles

Ventral forearm in the proximal half on one line with the trigger points of the flexor carpi radialis and ul-naris (see Fig. 19.61al, a2)

Referred Pain for Both Muscles

Plantar side of fingers 3-5 (they can also hurt individually).

Associated Internal Organs

None

Flexor Pollicis Longus Muscle (Fig. 19.62) Origin

• Anterior fascia of the radius (distal to the oblique line)

• Interosseous membrane Insertion

Base of the distal phalanx of the thumb Action

Flexion of the thumb's distal phalanx

Innervation

Median nerve (C7-C8)

TP of the flexor pollicis longus

Pronator quadratus

TP of the flexor pollicis longus

TP of the flexor digitorum profundus

Flexor pollicis longus Flexor digitorum profundus

Pronator quadratus

Trigger Point Location

Slightly proximal of the wrist and radial of the median line of the forearm

Referred Pain

Ventral side of the thumb

Associated Internal Organs

None

Pronator Teres Muscle (Fig. 19.63) Origin

• Medial epicondyle of the humerus

• Medial intermuscular septum

• Coronoid process of the ulna

Insertion

Pronator tuberosity Action

• Pronation of the forearm

• Flexion in the elbow joint

Innervation

Median nerve (C6-C7)

Trigger Point Location

Near the inside of the elbow, ulnar to the bicipital aponeurosis of the biceps brachii (see Fig. 19.40)

■ Adductor and Opponens Pollicis Muscles

Adductor Pollicis Muscle

Origin

• Base of the metacarpal bones ll-lil

• Trapezoid bone

• Capitate bone

• Body of the metacarpal bone III Insertion

• Ulnar sesamoid bone

• Proximal phalanx of the thumb (ulnar side)

• Tendon of the extensor pollicis longus

Action

Adduction of the thumb

Referred Pain

• Ventral and radial area of the wrist

• Radial, ventral half of the forearm

Associated Internal Organs

None

Innervation

Ulnar nerve (T1)

Trigger Point Location

Near the skin fold between the thumb and index finger in the muscle belly. Easily palpated with a pinching grip.

Referred Pain

• Radial side of the base joint of the thumb up to the thumb's saddle joint

• Thenar eminence

• Dorsal back of the hand in the area of the thumb

None

Oblique Muscle Chains

Interosseous muscles

Opponens — digiti minimi

Flexor-

digiti minimi

Abductor digiti minimi

Tendon of -the flexor carpi ulnaris

Carpal tunnel

Tendons of the flexor digitorum superficialis

Palmar ligaments

Deep transverse metacarpal ligaments

Flexor Digitorum Profundus Tendon

- Tendons of the flexor digitorum profundus

-Flexor pollicis longus

— Abductor pollicis brevis

Lumbrical muscles

Transverse head Oblique head

- Tendons of the flexor digitorum profundus

Interosseous muscles

Opponens — digiti minimi

Flexor-

digiti minimi

Abductor digiti minimi

Tendon of -the flexor carpi ulnaris

Carpal tunnel

- Opponens pollicis

- Flexor retinaculum

— Tendon of the flexor carpi radialis

Tendons of the flexor digitorum superficialis

Palmar ligaments

Flexor digiti minimi Abductor digiti minimi

Deep transverse metacarpal ligaments

-Flexor pollicis longus

Superficial head Deep head

Flexor pollicis brevis

— Abductor pollicis brevis

Lumbrical muscles

Transverse head Oblique head

Ad-■ ductor pollicis

Fig. 19.64

Opponens Pollicis Muscle

Opponens Pollicis Muscle (Fig. 19.66) Origin

• Flexor retinaculum

• Tubercle of trapezium bone

Insertion

Metacarpal bone I (radial) Action

Opposition of the thumb

Innervation

Trigger Point Location

In the muscle belly near the wrist 1g 66

Referred Pain

• Palmar side of the thumb

• Radial and plantar half of the wrist

Associated Internal Organs

Abductor Digiti Minimi Muscle (Figs. 19.67.19.68)

Origin

Pisiform bone Insertion

Ulnar base of the proximal phalanx and dorsal aponeurosis of finger 5

Action

* Flexion and abduction in the proximal joint of the little finger

Extension in the intermediate and distal joints of the little finger

Tendons of the flexor digitorum superficialis

Lumbrical muscles

TP of the abductor digiti minimi

Tendons of the flexor digitorum profundus

Tendon of -the flexor carpi ulnaris

Adductor Longus Referred Pain

— Tendon of the flexor pollicis longus

Adductor pollicis

— Abductor pollicis brevis

Opponens pollicis

- TP of the opponens pollicis

-Flexor retinaculum

— Tendon of the flexor carpi radialis

— Tendon of the flexor pollicis longus

Flexor pollicis brevis

Tendons of the flexor digitorum superficialis

Lumbrical muscles

Abductor — digit! minimi

Flexor-

digiti minimi

Opponens — digiti minimi

TP of the abductor digiti minimi

Tendons of the flexor digitorum profundus

Tendon of -the flexor carpi ulnaris

Tendons of the flexor digitorum profundus

— Tendon of the flexor pollicis longus

Adductor pollicis

— Abductor pollicis brevis

Opponens pollicis

- TP of the opponens pollicis

-Flexor retinaculum

— Tendon of the flexor carpi radialis

— Tendon of the flexor pollicis longus

Deep head

Superficial head

Flexor pollicis brevis

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