OP1

Question 1

Occipitofrontalis origin, insertion, innervation, action, Palpation

Answer 1

Origin
Occipital Belly- Superior Nuchal Line of the Occipital and Mastoid Process of Temporal Bone

Insertion
Occipital belly- Epicranial aponeurosis.
Frontal Belly- Skin superior to
supraorbital margin.

Innervation- Facial (VII) nerve.

Action
Occipital Belly- Draws scalp posteriorly.
Frontal Belly- Draws scalp anteriorly, raises eyebrows, and wrinkles skin of forehead
horizontally as in look of surprise.

Palpation-
1. With the client prone or supine, place palpating fingers over the occipital bone and feel for the occipitalis, over the parietal bone and feel for the galea aponeurotica,
and over the frontal bone and feel for the frontalis.
2. Ask the client to wrinkle the skin of the forehead, and feel for the contraction of the
muscle.

Question 2

Masseter origin, insertion, innervation, action, Palpation

Answer 2

Origin- Maxilla and zygomatic arch

Insertion- Angle and ramus of
mandible.

Innervation- Mandibular division of
trigeminal (V) nerve.

Action- .

1. Elevates the mandible at the TMJ
2. Protrusion of the mandible @TMJ

Palpation-
1. With the client supine, place palpating fingers between the zygomatic arch and the
angle of the mandible.
2. Have the client alternately clench the teeth and relax and feel for contraction and
relaxation of the masseter. When the masseter contracts, the muscle may visibly
bulge out.

Question 3

Temporalis origin, insertion, innervation, action, Palpation

Answer 3

Origin- Temporal bone

Insertion- Coronoid process and
ramus of mandible.

Innervation- Mandibular division of
trigeminal (V) nerve.

Action-

1. Elevates the mandible at the TMJs
2. Retracts the mandible at the TMJs

Palpation-

1. With the client supine, place palpating fingers over the temporal fossa.
2. Have the client alternately clench and relax the teeth and feel for the contraction and relaxation of the temporalis. In this manner the majority of the temporalis superior to the zygomatic arch can be easily palpated.

Question 4

Platysma origin, insertion, innervation, action, Palpation

Answer 4

Origin- Subcutaneous Fascia over deltoid and
pectoralis major muscles

Insertion- Mandible and the subcutaneous fascia of the lower face. blends with muscles around angle of mouth, and skin of lower
face.

Innervation-Facial (VII) nerve.

Action-Draws outer part of lower lip inferiorly and posteriorly as in pouting; depresses mandible.

Palpation-
1. With the client seated or supine, place palpating fingers on the anterolateral neck.
2. Ask the client to forcefully contract the platysma by depressing and drawing the
lower lip laterally, while keeping the mandible fixed in a position of slight depression. Observe and feel for the ridges of skin of the neck caused by the
contraction of the platysma.

Question 5

Sternocleidomastoid origin, insertion, innervation, action, Palpation

Answer 5

Origin- Sternal head: manubrium of
sternum
clavicular head: medial third
of clavicle.

Insertion- Lateral surface of mastoid process of the temporal bone, Lateral half of superior nuchal line of the occipital bone

Innervation- Spinal Accessory Nerve (XI), C2, and C3.

Action-

1. Contralateral rotation of the head @ AAJ
2. Contralateral rotation of the neck @ Spinal
3. Extension of the head @ antlanto-occipital
4. Extension of the upper neck @ spinal
5. Flexion of the lower neck @ spinal
6. Lateral flection of head @AOJ
7. Lateral flexion of neck @ Spinal
8. Elevation of sternum and clavicle (during forced inhilation)

Palpation-

1. Have the client supine with the neck and head rotated contralaterally.
2. Then have the client lift the head and neck up into the air toward the ceiling and the SCM will visibly contract.
3. Palpate the SCM from attachment to attachment.

Question 6

Trapezius origin, insertion, innervation, action, Palpation

Answer 6

Origin-
UPPER: the external occipital protuberance, the medial ⅓ of the superior nuchal line of the occiput, the nuchal ligament, and the spinous process of C7
MIDDLE: the spinous processes of T1-T5
LOWER: the spinous processes of T6-T12

Insertion-
UPPER: lateral ⅓ of the clavicle and the acromion process of the scapula
MIDDLE: acromion process and spine of the scapula
LOWER: the tubercle at the root of the spine of the scapula

Innervation- Spinal Accessory (XI) nerve

Action-

1. Extension / Lateral flexion of Head @ AOJ (upper)
2. Extension / Lateral flexion of neck @ Spinal Joint (upper)
3. Contralateral rotation of head @ AAJ (upper)
4. Contralateral rotation of neck @ Spinal Joint (upper)
5. Elevation of Scapula @Scapulocostal Joint (upper)
6. Upward Rotation of Scapula (upper)
7. Retraction of Scapula @ Scapulocostal Joint (middle)
8. Depression/Upper Rotation of Scapula (lower)

Palpation-
1. With the client prone, place palpating hand over the trapezius.
2. Ask the client to actively abduct the arm at the glenohumeral joint and slightly
retract the scapula at the scapulocostal joint.
3. Palpate all three parts of the trapezius, lower, middle, and upper, by strumming
perpendicular to the fibers.
4. To further bring out the upper trapezius, have the client perform slight extension of
the head and neck at the spinal joints.

Question 7

Rhomboid major & minor origin, insertion, innervation, action, Palpation

Answer 7

Origin-
Minor- SP’s of C7 and T1
Major- SP’s of T2 - T5

Insertion-
minor- Medial (vertebral) border of scapula at root of spine
Major- Medial (vertebral) border of scapula inferior of spine

Innervation- Dorsal Scapular Nerve

Action-

1. Retraction (adduction) of Scapula @ Scapulocostal Joint
2. Downward Rotation of Scapula @ Scapulocostal Joint
3. Elevation of Scapula @ Scapulocostal Joint

Palpation-
1. With the client seated or prone and the hand placed in the small of the back, place
palpating hand between the scapula (at a level that is between the inferior angle and
the root of the spine of the scapula) and the spine.
2. Ask the client to move the hand away from the back and feel for the contraction of
the rhomboids.
3. Palpate the entirety of the rhomboids.

Question 8

Levator scapulae origin, insertion, innervation, action, Palpation

Answer 8

Origin- TP’s of C1 - C4

Insertion- Medial border of scapulae (superior spine of scapula)

Innervation- Dorsal Scapular Nerve

Action-

1. Elevation of Scapula @ Scapulocostal Joint
2. Lateral flexion of the neck @ Spinal Joints
3. Extension of the neck @ Spinal Joints
4. Downward Rotation of scapula @ Scapulocostal Joint
5. Ipsilateral Rotation of Neck @ Spinal Joints

Palpation-
1. With the client seated and the hand in the small of the back (to relax the trapezius),
place palpating hand just superior to the superior angle of the scapula.
2. Ask the client to perform a short, gentle range of motion of elevation of the scapula
and feel for the contraction of the levator scapulae.
3. Continue palpating the levator scapulae superiorly into the posterior triangle of the
neck (the area between the sternocleidomastoid and the upper trapezius). When palpating in the posterior triangle of the neck, the client’s hand does not need to be in the small of the back and the client can contract more forcefully, and against resistance if desired.

Question 9

Pectoralis major origin, insertion, innervation, action, palpation

Answer 9

Origin-
Clavicular Head: medial half of clavicle
Sternocostal Head: sternum, costal cartilages of R1 - R7

Insertion- Lateral Lip of the Bicipital Groove (Intertubercular sulcus) of the
Humerus

Innervation- Medial & lateral pectoral nerves

Action-

1. Medial Rotation of humerus @ glenohumeral joint
2. Adduction of the arm @ glenohumeral joint
3. Horizontal Adduction @ glenohumeral joint
4. Flexion of Arm @ glenohumeral Joint (clavicular head)

Palpation-
1. With the client seated with the arm raised to 90 degrees of abduction at the GH
joint, place palpating hand on the belly of the pectoralis major.
2. Have the client horizontally flex the arm against resistance and feel for the
contraction of the pectoralis major.
3. Continue palpating the pectoralis major medially and superiorly toward its
attachments on the trunk and distally toward its humeral attachment.
4. Note: The anterior axillary fold of tissue is created by the pectoralis major

Question 10

Pectoralis Minor origin, insertion, innervation, action, palpation

Answer 10

Origin- R3 - R5

Insertion- Coracoid Process

Innervation- The Medial and Lateral Pectoral Nerves

Action-

1. Protraction of Scapula @ Scapulocostal Joint
2. Depression of Scapula @ Scapulocostal Joint
3. Elevation of R3 - R5 @ Sternocostal / Costospinal Joint (during forced inhalation when scapula is fixed)
4. Downward Rotation @ Scapulocostal Joint

Palpation-
Protract shoulder
Or
1. With the client seated and the hand relaxed in the small of the back, place palpating
fingers just inferior to the coracoid process of the scapula.
2. Have the client lift the hand away from the back and feel for the contraction of the
pectoralis minor.
3. Palpate the entirety of the muscle.

Question 11

Serratus anterior origin, insertion, innervation, action, palpation

Answer 11

Origin- R1 - R9

Insertion- Anterior surface of vertebral (medial) border of scapula between scapula and ribs

Innervation- Long Thoracic Nerve

Action-

1. Protraction of the Scapula at Scapulocostal Joint
2. Upward rotation of Scapula @ Scapulocostal Joint

Palpation-
1. With the client supine and the arm flexed to 90 degrees at the shoulder joint (hand
pointed toward the ceiling), place palpating hand on the rib cage on the lateral trunk
between the anterior and posterior axillary folds of tissue.
2. Have the client protract the scapula by pushing the hand toward the ceiling and feel for the contraction of the serratus anterior. Resistance may be added.
3. Once located, try to follow the serratus anterior as far anterior as possible (deep to
the pectoralis major) and as far posterior as possible (deep to the latissimus dorsi
and the scapula).

Question 12

Subclavius origin, insertion, innervation, action, palpation

Answer 12

Origin- R1

Insertion- Subclavian Groove of Clavicle

Innervation- subclavian nerve

Action-

1. Depression of Clavicle @ Sternoclavicular Joint and Acromioclavicular Joint
2. Protraction of clavicle @ Sternoclavicular J and Acromioclavicular J
3. Elevates the 1st Rib at the Sternocostal and Costospinal Joints

Palpation-
1. With the client supine and the arm medially rotated (to relax and slacken the
pectoralis major) and resting at the side of the body, place palpating fingers slightly
inferior to the middle ⅓ of the clavicle.
2. Now curl your fingers under the clavicle and feel for the subclavius against the
inferior surface of the clavicle.
3. To engage the subclavius, have the client depress the shoulder girdle and feel for its
contraction.

Question 13

Latissimus dorsi origin, insertion, innervation, action, palpation

Answer 13

Origin- SP of T7 to L5, Crest of Ilium and Sacrum, Lowest four ribs

Insertion- Floor of the Bicipital Groove (Intertubercular sulcus) of the
Humerus

Innervation- Thoracodorsal Nerve (C6, C7, C8)

Action-

1. Extension of arm @ shoulder joint
2. Adduction of arm @ shoulder joint
3. Medial rotation of arm @ shoulder joint
4. Anterior tilt of the pelvis @ lumbrosacral Joint

Palpation-
1. Both the client and therapist are standing; the therapist is standing to the front and
side of the client.
2. Have the client place his or her arm on your shoulder and place your palpating hand
on the client’s posterior axillary fold.
3. Have the client attempt to adduct and extend the arm at the GH joint with your
shoulder providing resistance, and feel for the contraction of the latissimus dorsi.
4. Continue palpating the latissimus dorsi distally into the axilla toward the humeral
attachment and inferiorly toward the lumbar/pelvic attachment.

Question 14

Deltoid origin, insertion, innervation, action, palpation

Answer 14

Origin- Lateral 1/3 of clavicle (anterior fibres), Acromion (lat or middle fibers), Spine of scapula (post fibres)

Insertion- Deltoid tuberosity of humerus

Innervation- Axillary Nerve (close to surgical neck of humerus)

Action-

1. Flexion of arm at shoulder joint (anterior fibres)
2. Medial rotation of arm at shoulder joint (anterior fibres)
3. Horizontal adduction (anterior fibres)
4. Abduction of arm at shoulder joint (all fibres)
   * main function of deltoid*
5. Extension of arm at shoulder joint (posterior fibres)
6. Lateral rotation of arm at shoulder joint (posterior fibres)
7. Horizontal abduction (posterior fibres)

Palpation-
1. With the client seated, place palpating hand just distal to the acromion process of
the scapula.
2. Have the client abduct the arm at the GH joint and feel for the contraction of the
deltoid. Resistance can be added.
3. Continue palpating the deltoid anteriorly for the anterior fibers and posteriorly for
the posterior fibers. Palpate all fibers distally to the deltoid tuberosity of the
humerus.
4. Note: Horizontal flexion can be used for the anterior fibers; horizontal extension can
be used for the posterior fibers.

Question 15

Teres major origin, insertion, innervation, action, palpation

Answer 15

Origin- Inferior lateral border of scapula

Insertion- Medial Lip of the Bicipital Groove (Intertubercular sulcus) of the
Humerus

Innervation- Lower subscapular

Action-

1. Adduction of arm at shoulder joint
2. Medial rotation of arm at shoulder joint
3. Extension of arm at shoulder joint

Palpation-
1. With the client prone with the arm on the table and the forearm hanging off the
table, place palpating hand just lateral to the inferior lateral border of the scapula.
2. Have the client medially rotate the arm at the GH joint (this requires the client’s
hand to swing posteriorly and up) and feel for the contraction of the teres major.
Resistance can be added.
3. Continue palpating the teres major distally into the axilla toward the medial lip of the bicipital groove on the anterior surface of the humerus.

Question 16

Teres minor origin, insertion, innervation, action, palpation

Answer 16

Origin- Superior Lateral border of scapula

Insertion- inferior facet of greater tubercle of humerus

Innervation- Axillary Nerve

Action-

1. Lateral Rotation of the arm at the shoulder joint
2. Adducts the arm at the GH joint

Palpation-
1. With the client prone with the arm on the table and the forearm hanging off the
table, place palpating hand just lateral to the superior lateral border of the scapula
and feel for the round belly of the teres minor.
2. Have the client laterally rotate the arm at the GH joint (this requires the client’s
hand to swing anteriorly and up) and feel for its contraction. Resistance can be
given. (Note: It can be challenging to discern the teres minor from the infraspinatus.)
3. Palpate the teres minor distally to the greater tubercle of the humerus.

Question 17

Subscapularis origin, insertion, innervation, action, palpation

Answer 17

Origin- Subscapular fossa under scapula anteriorly

Insertion- Lesser tubercle of humerus

Innervation- Upper and Lower Subscapular Nerves

Action-
1. Medial Rotation of the arm at the shoulder joint

Palpation-
1. Have the client supine with the arm that is on the side of the target muscle being
palpated crossed on the chest such that the elbow is lying on the abdomen and the
hand is holding onto the opposite-side shoulder (the arm will be slightly flexed and
adducted at the GH joint, and the forearm will be flexed at the elbow joint). Further,
have the client place the opposite-side hand on top of the elbow of the arm that is
crossed on the chest, gently holding the elbow down.
2. Place your superior (cephalad) hand under the scapula, grasping the medial border
of the scapula and pulling the scapula laterally (protracting the scapula at the
scapulocostal joint).
3. With your inferior (palpating) hand, press in between the scapula and the ribcage of
the client and then press with your finger pads oriented posteriorly against the
anterior surface of the scapula for the subscapularis.
4. To engage the subscapularis, have the client medially rotate the arm at the GH joint

Question 18

Supraspinatus origin, insertion, innervation, action, palpation

Answer 18

Origin- Supraspinous Fossa

Insertion- Superior facet of greater tubercle of humerus

Innervation- Suprascapular Nerve

Action-
1. Abduction of arm at GH Joint

Palpation-
1. With the client seated and the arm hanging at the side, place palpating hand just
superior to the spine of the scapula.
2. Have the client perform a short, gentle range of motion of the arm at the GH joint that is approximately 30–35 degrees anterior to pure abduction (i.e., an oblique
motion that is a combination of abduction and flexion) and feel for the contraction
of the supraspinatus. (Note: If the client is prone, a short, gentle range of pure
abduction of the arm can be done.)
3. Palpate the entirety of the belly in the supraspinous fossa and then palpate the distal tendon on the greater tubercle of the humerus (note: the portion deep to the
acromion process cannot be palpated).

Question 19

Infraspinatus origin, insertion, innervation, action, palpation

Answer 19

Origin- Infraspinous Fossa

Insertion- Middle facet of greater tubercle of humerus

Innervation- Suprascapular Nerve

Action-
1. Lateral rotation of the arm at the shoulder joint

Palpation-
1. With the client prone with the arm on the table and the forearm hanging off the
table, place palpating hand on the infraspinous fossa. (Make sure you are inferior to the deltoid.)
2. Have the client laterally rotate the arm at the GH joint (this requires the client’s
hand to swing anteriorly and up) through a small range of motion and feel for the
contraction of the infraspinatus. Resistance can be given. (Note: It can be
challenging to discern the infraspinatus from the teres minor.)
3. Palpate the infraspinatus in the infraspinous fossa and then follow it distally to the greater tubercle of the humerus.

Question 20

CORACOBRACHIALIS origin, insertion, innervation, action, palpation

Answer 20

Origin- Coracoid Process of Scapula

Insertion- Middle portion of the medial surface of the humerus

Innervation- musculocutaneous nerve

Action-

1. Flexion of the arm @ glenohumeral joint
2. Horizontal adduction @ glenohumeral joint

Palpation-
1. With the client seated with the arm abducted to 90 degrees and laterally rotated, and
the forearm flexed at the elbow joint to 90 degrees, place palpating fingers on the
medial side of the humerus, approximately halfway down the shaft.
2. Have the client horizontally flex the arm at the GH joint against resistance and feel
for the contraction of the coracobrachialis. (Note: It can be challenging to discern
the coracobrachialis from the short head of the biceps brachii; the biceps brachii
also contracts with flexion of the forearm at the elbow joint.)
3. Note: Be careful with palpation in the medial arm because the median and ulnar
nerves and brachial artery are superficial here.

Question 21

Biceps brachii origin, insertion, innervation, action, palpation

Answer 21

Origin-
Short Head: Coracoid Process of scapula
Long Head: Supraglenoid tubercle of scapula

Insertion- Radial Tuberosity and the bicipital aponeurosis

Innervation- musculocutaneous nerve

Action-

1. Flexion of the forearm @ the elbow joint
2. Flexion of the arm @ the glenohumeral joint
3. Supination of the forearm @ elbow joint
   * biceps is main supinator muscle*

Palpation-
1. With the client seated or supine and the forearm supinated, place palpating hand on
the anterior arm and feel for the biceps brachii.
2. Have the client flex the forearm at the elbow joint and feel for the contraction of the biceps brachii. Resistance can be added.
3. Continue palpating the biceps brachii proximally and distally toward its
attachments.
4. Note: Be careful with palpation in the medial arm, because the median and ulnar
nerves and brachial artery are superficial here.

Question 22

Brachialis origin, insertion, innervation, action, palpation

Answer 22

Origin- Distal half of anterior surface of humerus

Insertion- Ulnar tuberosity, coronoid process of ulna

Innervation- musculocutaneous nerve

Action-
1. Flexion of forearm @ elbow joint

Palpation-
1. With the client seated or supine and the forearm fully pronated at the radioulnar
joints, place palpating hand on the distal lateral arm.
2. Have the client flex the forearm further with a short, gentle range of motion and feel
for the contraction of the brachialis. If resistance is added, add only gentle
resistance.
3. The brachialis can be palpated on the lateral side of the arm and the medial side of
the arm. It can also be palpated anteriorly through the biceps brachii.
4. Note: Be careful with palpation in the distal medial arm, because the median and
ulnar nerves and brachial artery are superficial here.

Question 23

Brachioradialis origin, insertion, innervation, action, palpation

Answer 23

Origin- proximal 2.3 of lateral supracondylar ridge of humerus

Insertion- superior to styloid process of radius

Innervation- musculocutaneous nerve

Action-
1. flexion of the forearm at the elbow joint

Palpation-
1. With the client seated or supine and the forearm flexed at the elbow joint to 90
degrees and in a position halfway between full pronation and full supination, place
palpating hand on the lateral anterior forearm.
2. Resist the client from further flexing the forearm and look and feel for the
contraction of the brachioradialis.
3. Continue palpating the brachioradialis proximally toward the lateral supracondylar
ridge of the humerus and distally toward the styloid process of the radius.

Question 24

Triceps brachii origin, insertion, innervation, action, palpation

Answer 24

Origin-
Long Head Origin: Infraglenoid Tubercle
Lateral Head Origin: lateral, posterior humerus (superior to radial groove) UPPER LATERAL
Medial Head Origin: Rest of posterior surface of humerus (inferior to radial groove) LOWER MEDIAL

Insertion- Olecranon Process of Ulna

Innervation- Radial Nerve

Action-

1. Extension of arm @ glenohumeral joint (long head)
2. Extension of forearm @ elbow joint main function

Palpation-
1. With the client seated, place palpating hand on the distal, posterior arm, just
proximal to the olecranon process of the ulna.
2. Have the client extend the forearm at the elbow joint against resistance and feel for
the contraction of the triceps brachii.
3. Continue palpating the triceps brachii proximally toward the infraglenoid tubercle
of the scapula, deep to the posterior deltoid.

Question 25

Anconeus origin, insertion, innervation, action, palpation

Answer 25

Origin- lateral epicondyle of humerus Insertion- Lateral side of the Olecranon process of ulna plus proximal ¼ of posterior ulna Innervation- Radial Nerve Action- Extension of the forearm at the elbow joint Palpation- 1. With the client seated, locate the point halfway between the olecranon process of the ulna and the lateral epicondyle of the humerus, and then place your palpating finger approximately ⅓ inch (1 cm) distal to that point. 2. Have the client actively extend the forearm at the elbow joint against resistance and feel for the contraction of the anconeus. 3. Palpate the entirety of the anconeus

Question 26

Pronator teres origin, insertion, innervation, action, palpation

Answer 26

Origin- Humeral Head - medial epicondyle of humerus (via common flexor tendon) Ulnar Head - coronoid process of ulna Insertion- middle of lateral aspect of radius Innervation- Median Nerve Action- 1. Pronation of the forearm at the radioulnar joints 2. flexion of the forearm at the elbow joint Palpation- 1. With the client seated and the forearm partially flexed at the elbow joint and pronated at the radioulnar joints to a midpoint between full pronation and full supination, place palpating hand on the proximal anterior forearm and place resistance hand on the distal anterior forearm. 2. Have the client further pronate the forearm against resistance and feel for the contraction of the pronator teres. 3. Continue palpating the pronator teres proximally toward the medial epicondyle of the humerus and distally toward the lateral radius.

Question 27

Flexor carpi Radialis origin, insertion, innervation, action, palpation

Answer 27

Origin- medial epicondyle of humerus (via common flexor tendon) Insertion- base of 2nd and 3rd metacarpals Innervation- Median Nerve Action- 1. Flexion of the hand at the wrist joint (radiocarpal joint) 2. Flexion of the forearm at the elbow joint 3. Radial deviation of the hand (abduction) at the wrist joint Palpation- 1. With the client seated or supine, place palpating hand across the anterior wrist. 2. Have the client actively flex and/or radially deviate (abduct) the hand at the wrist joint and look and feel for the distal tendon of the flexor carpi radialis on the radial (lateral) side (slightly lateral to the distal tendon of the palmaris longus, which is located dead center in the anterior wrist). Resistance can be added. 3. Continue palpating the flexor carpi radialis proximally toward the medial epicondyle of the humerus. 4. To distinguish the flexor carpi radialis from the palmaris longus and the other muscles of the common flexor belly/tendon, radial deviation of the hand at the wrist joint is the best action to ask the client to perform.

Question 28

Flexor Carpi Ulnaris origin, insertion, innervation, action, palpation

Answer 28

Origin- Medial epicondyle of humerus via common flexor tendon, medial side of olecranon, superior posterior border of ulna Insertion- base of 5th metacarpal, hook of hamate, pisiform Innervation- Ulnar Nerve Action- 1. Flexion of hand at the wrist joint 2. Ulnar deviation (adduction) of hand at wrist joint 3. Flexion of the forearm at the elbow joint Palpation- 1. With the client seated or supine, place palpating hand across the anterior wrist. 2. Have the client actively flex and/or ulnar deviate (adduct) the hand at the wrist joint and feel for the distal tendon of the flexor carpi ulnaris on the ulnar (medial) side of the anterior wrist. Resistance can be added. 3. Continue palpating the flexor carpi ulnaris distally toward the pisiform, and proximally toward the medial epicondyle of the humerus and the posterior ulna. 4. To distinguish the flexor carpi ulnaris from the palmaris longus and the other muscles of the common flexor belly/tendon, ulnar deviation of the hand at the wrist joint is the best action to ask the client to perform.

Question 29

Palmaris Longus origin, insertion, innervation, action, palpation *absent in 12-15% of people*

Answer 29

Origin- medial epicondyle of humerus via common flexor tendon Insertion- palmar eponeurosis and flexor retinacalum Innervation- Median Nerve Action- 1. Flexion of the hand at the wrist joint 2. Flexion of the forearm at the elbow joint Palpation- 1. The palmaris longus is superficial and easy to palpate. 2. With the client seated or supine, place palpating hand on the anterior wrist. 3. Ask the client to cup the hand (by bringing the thenar eminence toward the hypothenar eminence) and/or flex the hand at the wrist joint against resistance with the fingers fully extended. Look and feel for the distal tendon of the palmaris longus in the center of the anterior wrist. Resistance can be added. 4. Continue palpating the palmaris longus distally into the palmar fascia and proximally toward the medial epicondyle of the humerus. It is difficult to distinguish the proximal tendon of the palmaris longus from the proximal tendons of the other muscles of the common flexor belly/tendon.

Question 30

Extensor carpi radialis longus origin, insertion, innervation, action, palpation

Answer 30

Origin- distal 1/3 of lateral supracondular ridge of humerus Insertion- Base of 2nd metacarpal bone Innervation- Radial Nerve Action- 1. Extension of the hand at the wrist joint 2. Radial deviation (abduction) of the hand at the wrist joint 3. Flexion of forearm at the elbow joint Palpation- 1. With the client seated or supine, place palpating hand posterior to the belly of the brachioradialis. 2. Ask the client to radially deviate the hand at the wrist joint and feel for the contraction of the extensor carpi radialis longus. 3. Continue palpating the extensor carpi radialis longus proximally toward the lateral supracondylar ridge of the humerus and distally to the second metacarpal. (Note: Discerning between the extensor carpi radialis longus and extensor carpi radialis brevis is challenging.)

Question 31

Extensor carpi radialis Brevis origin, insertion, innervation, action, palpation

Answer 31

Origin- lateral epicondyle of humerus via common extensor tendon Insertion- base of 3rd metacarpal bone Innervation- Radial Nerve Action- 1. Extension of the hand at the wrist joint 2. Radial deviation of the hand at the wrist joint 3. Flexion of the forearm at the elbow joint Palpation- 1. With the client seated or supine, pinch the radial group of the forearm muscles (brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis) with your thumb on one side and your index and middle fingers on the other side and pull it slightly away from the forearm. The fingers on the posterior aspect of the radial group are on the extensor carpi radialis brevis. 2. Have the client radially deviate the hand at the wrist joint and feel for the contraction of the extensor carpi radialis brevis. (Note: Discerning between the extensor carpi radialis brevis and extensor carpi radialis longus is challenging.) 3. The distal tendon of the extensor carpi radialis brevis can be visualized and easily palpated on the radial side of the posterior wrist when the client makes a fist (flexes the fingers) with the wrist in neutral position (or in slight extension).

Question 32

Extensor digitorum origin, insertion, innervation, action, palpation

Answer 32

Origin- lateral epicondyle of humerus via common extensor tendon Insertion- distal and middle phalanges of fingers #2-5 (via its dorsal digital expansion) Innervation- Radial Nerve Action- 1. Extension of fingers 2 - 5 at the MCP, PIP, DIP joints 2. Extension of the hand at the wrist joint 3. Extension of the forearm at the elbow joint Palpation- 1. With the client seated or supine, place palpating hand in the middle of the posterior forearm. 2. Have the client actively extend fingers two through five (at the metacarpophalangeal and interphalangeal joints) and feel for the contraction of the extensor digitorum. Resistance can be added. 3. Palpate the extensor digitorum proximally and distally as far as possible.

Question 33

Extensor Digiti Minimi origin, insertion, innervation, action, palpation

Answer 33

Origin- lateral epicondyle of humerus via common extensor tendon Insertion- middle and distal phalanges of the little finger (via dorsal digital expansion) Innervation- Radial Nerve Action- 1. Extension of little finger @ MCP, PIP and DIP joints 2. Extension of the hand at the wrist joint 3. Extension of the forearm at the elbow joint Palpation- 1. With the client seated or supine, place palpating hand on the posterior forearm toward the ulnar side. 2. Have the client actively extend the little finger at the fifth metacarpophalangeal and interphalangeal joints and feel for the contraction of the extensor digiti minimi. Resistance can be added. 3. Note: It is challenging to discern the extensor digiti minimi from the extensor digitorum fibers that go to the little finger. These extensor digitorum fibers are located more laterally (radially); the extensor digiti minimi fibers are located more medially (ulnar side).

Question 34

Extensor carpi ulnaris origin, insertion, innervation, action, palpation

Answer 34

Origin- lateral epicondyle of humerus via common extensor tendon / middle posterior border of ulna Insertion- base of 5th metacarpal bone Innervation- Radial Nerve Action- 1. Extension of the hand at the wrist joint 2. Extension of the forearm at the elbow joint 3. Ulnar deviation of the hand at the wrist joint Palpation- 1. With the client seated or supine, place palpating hand directly posterior to the shaft of the ulna and feel for the belly of the extensor carpi ulnaris. 2. Continue palpating the extensor carpi ulnaris proximally toward the lateral epicondyle of the humerus and distally toward the fifth metacarpal. 3. To further bring out the extensor carpi ulnaris, have the client ulnar deviate (adduct)the hand at the wrist joint.

Question 35

Supinator origin, insertion, innervation, action, palpation

Answer 35

Origin- supinator crest of ulna, lateral epicondyle of humerus Insertion- proximal of lateral surface of radius Innervation- Radial Nerve Action- 1. supination of the forearm at the radioulnar joints Palpation- 1. With the client seated and the forearm passively flexed, pronated, and resting comfortably on the lap, pinch the radial group of the forearm muscles (brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis) with your thumb on one side and your index and middle fingers on the other side, and move it anteriorly away from the posterior musculature of the forearm. 2. Sink in and palpate deeper against the radius (between the radial group of the forearm and the extensor digitorum) to locate the radial attachment of the supinator. Have the client slowly supinate the forearm at the radioulnar joints and feel for the contraction of the supinator. 3. Continue palpating the supinator proximally toward the lateral epicondyle and ulnar attachment.