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上肢肌肉檢查 - Coggle Diagram
上肢肌肉檢查
- Patient places palm up on the thigh and abducts the thumb.
- Examiner applies pressure to adduct the thumb towards the index finger.
- Function: Thumb abduction (80°–90°)
- Nerve Supply: Median nerve (C8, T1)
- Origin: Flexor retinaculum, scaphoid, trapezium
- Insertion: Base of the proximal phalanx of the thumb
- Note: Affected by carpal tunnel syndrome
- Patient touches thumb and little finger together and flexes the wrist.
- Examiner observes whether the tendon stands out.
- Function: Flexes wrist, tenses the palmar aponeurosis
- Nerve Supply: Median nerve (C7, C8)
- Origin: Medial epicondyle
- Insertion: Palmar aponeurosis, flexor retinaculum, pisiform bone
- Note: Clinically, check for the presence of the muscle. Approximately 16% of individuals have no palmaris longus on one side, and 9% have none bilaterally.
- Patient flexes and radially deviates the wrist.
- Examiner resists wrist extension and ulnar deviation, palpating the tendon tension.
- Action: Wrist flexion, radial deviation.
- Innervation: Median Nerve (C6, C7)
- Origin/Insertion: Origin: Medial epicondyle; Insertion: Base of 2nd metacarpal
- Patient flexes and ulnarly deviates the wrist.
- Examiner resists wrist extension and radial deviation, palpating tendon tension.
- Action: Wrist flexion, ulnar deviation.
- Innervation: Ulnar Nerve (C7, C8)
- Origin/Insertion: Origin: Medial epicondyle, olecranon process; Insertion: Hook of hamate, 5th metacarpal, pisiform bone
- Extensor Carpi Radialis Longus and Brevis
- Patient places wrist on examiner's wrist.
- Patient extends and radially deviates wrist with light fist.
- Examiner resists wrist flexion and ulnar deviation.
- Action: Wrist extension, radial deviation.
- Innervation: Radial Nerve (C6, C7)
- Origin/Insertion: Origin: Lateral epicondyle; Insertion: Long: Base of 2nd metacarpal, Short: Base of 3rd metacarpal
- Flexor Digitorum Superficialis
- Examiner stabilizes the index, ring, and little fingers in full extension.
- Patient flexes middle phalanges at PIP joint.
- Examiner resists PIP extension.
- Action: Flexes MCP, PIP joints, aids wrist and elbow flexion.
- Innervation: Median Nerve (C7, C8, T1)
- Origin/Insertion: Origin: Medial epicondyle, ulnar coronoid process, upper half of radius; Insertion: Middle phalanges of fingers 2-5
- Flexor Digitorum Profundus
- Examiner stabilizes PIP joint and resists DIP extension.
- Patient flexes DIP joint.
- Action: Flexes MCP, PIP, DIP joints, aids wrist flexion.
- Innervation: Index and middle fingers: Median Nerve (C7, C8, T1); Ring and little fingers: Ulnar Nerve (C7, C8, T1)
- Origin/Insertion: Origin: 2/3 of ulnar anterior surface, interosseous membrane; Insertion: Distal phalanges of fingers 2-5
- Patient extends the index finger.
- Examiner applies pressure to flex the MCP joint.
- Function: Extends MCP, PIP, DIP, assists wrist extension.
- Nerve Supply: Radial nerve posterior interosseous nerve (C7, C8)
- Origin: Ulnar dorsal distal end, interosseous membrane
- Insertion: Tendon of extensor indicis
- Examiner stabilizes the thumb MCP joint, keeping it extended.
- Patient flexes the thumb IP joint.
- Examiner applies pressure to extend the IP joint.
- Function: Flexes the thumb IP, MCP joints.
- Nerve Supply: Median nerve anterior interosseous nerve (C8, T1)
- Origin: Radius anterior surface, interosseous membrane
- Insertion: Distal phalanx of the thumb
- Extensor Pollicis Longus and Brevis
- Patient places the palm flat on the table and extends the thumb.
- Examiner applies pressure to flex the MCP joint of the thumb.
- Longus: Extends thumb MCP, IP joints
- Brevis: Extends thumb MCP joint
- Nerve Supply: Radial nerve posterior interosseous nerve (C7, C8)
- Longus: Origin: Ulnar dorsal middle part, interosseous membrane; Insertion: Distal phalanx of the thumb
- Brevis: Origin: Radius distal end, interosseous membrane; Insertion: Proximal phalanx of the thumb
- Patient makes a fist, holding a piece of paper between the thumb and index finger.
- Examiner pulls the paper to observe whether the thumb IP joint flexes (Froment Sign).
- Function: Thumb adduction
- Nerve Supply: Ulnar nerve deep branch (C8, T1)
- Oblique head: Capitate bone, second and third metacarpals
- Transverse head: Third metacarpal
- Insertion: Medial sesamoid bone, proximal phalanx of the thumb
- First Dorsal Interosseous
- Patient abducts the index finger.
- Examiner applies pressure to adduct the index finger.
- Function: Index finger abduction
- Nerve Supply: Ulnar nerve deep branch (C8, T1)
- Origin: First and second metacarpals
- Insertion: Proximal phalanx of the index finger
- Patient abducts the little finger.
- Examiner applies pressure to adduct the little finger.
- Function: Little finger abduction
- Nerve Supply: Ulnar nerve deep branch (C8, T1)
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- Insertion: Proximal phalanx of the little finger
- Patient extends fingers and brings them together.
- Examiner applies pressure to separate the fingers.
- Function: Adducts the index, ring, and little fingers
- Nerve Supply: Ulnar nerve deep branch (C8, T1)
- Origin: Second, fourth, fifth metacarpals
- Insertion: Proximal phalanges, extensor tendon sheaths
- Patient sitting, shrug shoulder upwards and backward.
- Examiner applies downward pressure to assess resistance.
- Function: Elevates and retracts scapula, upward rotation of glenoid.
- Nerve Supply: Accessory nerve (CN XI)
- Patient prone or leaning forward, arm abducted to 120°.
- Observe scapula motion, apply downward pressure.
- Function: Retracts scapula, upward rotation of glenoid.
- Nerve Supply: Accessory nerve (CN XI)
- Patient prone or leaning forward, shoulder flexed to 170° (like diving position).
- Observe scapula position, apply downward pressure.
- Function: Depresses and retracts scapula.
- Nerve Supply: Accessory nerve (CN XI)
- Patient sitting, shoulder abducted to 90°, elbow fully flexed.
- Examiner applies downward pressure to assess resistance.
- Function: Shoulder abduction.
- Nerve Supply: Axillary nerve (C5, C6)
- Patient elbow flexed, shoulder flexed to 90°, arm adducted inward.
- Examiner stabilizes the shoulder and applies outward pressure.
- Function: Horizontal adduction and internal rotation of shoulder.
- Nerve Supply: Lateral pectoral nerve (C5–C7), Medial pectoral nerve (C8, T1)
- Patient prone, back of hand on lower back, arm raised.
- Examiner applies pressure downward.
- Function: Scapular elevation, retraction, downward rotation of glenoid.
- Nerve Supply: Dorsal scapular nerve (C5)
- Patient flexes shoulder to 90°, elbow forward.
- Examiner applies downward pressure.
- Function: Protracts scapula, upward rotation of glenoid.
- Nerve Supply: Long thoracic nerve (C5–C7)
- Subscapularis (Internal Rotation)
- Patient arm naturally hanging, elbow flexed to 90°, forearm internally rotated.
- Examiner applies external rotation force.
- Function: Shoulder internal rotation and adduction.
- Nerve Supply: Subscapular nerve (C5, C6)
- Shoulder External Rotation (SIT: Supraspinatus, Infraspinatus, Teres Minor)
- Patient elbow flexed to 90°, forearm externally rotated.
- Examiner applies internal rotation force.
- Function: Shoulder external rotation and stabilization of humeral head.
- Nerve Supply: Supraspinatus, Infraspinatus: Suprascapular nerve (C5, C6); Teres Minor: Axillary nerve (C5, C6)
- Patient elbow flexed to 90°, forearm supinated.
- Examiner applies extension force to assess resistance.
- Function: Elbow flexion, forearm supination.
- Nerve Supply: Musculocutaneous nerve (C5, C6)
- Patient elbow flexed to 90°, forearm supinated.
- Examiner applies flexion force to assess resistance.
- Function: Elbow extension.
- Nerve Supply: Radial nerve (C6–C8)
- Patient elbow flexed to 90°, forearm pronated.
- Examiner applies supination force to assess resistance.
- Function: Forearm pronation.
- Nerve Supply: Median nerve (C6, C7)
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