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Hands Up!

Hands Up!. Judith Lehman. Carpals. “S ome L overs T ry P ositions T hat T hey C an’t H andle”. Flexor Retinaculum or Transverse Carpal Ligament. Origin : scaphoid and trapesium on thumb side Insertion : pisiform and hamate on pinky side

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Hands Up!

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  1. Hands Up! Judith Lehman

  2. Carpals “Some Lovers Try Positions That They Can’t Handle”

  3. Flexor Retinaculum or Transverse Carpal Ligament Origin: scaphoid and trapesium on thumb side Insertion: pisiform and hamate on pinky side Action: stretches across carpal bones creating carpal tunnel for flexor tendon and median nerve to pass

  4. Flexor Retinaculum Tps Trigger Points and Referrals: No Tps as it is a ligament, though injury or compression of median nerve may cause pain, numbness, lack of mobility in hand.

  5. Flexor Retinaculum Exercise Stretch: place palm on table with fingers and thumb abducted and hyperflex wrist; or hold and stretch with other hand Strengthen: curl fingers into palm and hyperflex wrist

  6. Opponens Pollicis Origin: flexor retinaculum and tubercle of trapezium bone Insertion: radial side of entire length of 1st metacarpal bone. Action: flexes and abducts the 1st metacarpal with slight medial rotation – brings thumb across palm to ring finger pad

  7. Flexor Pollicis Brevis Origin: superficial head: distal border of flexor retic and tubercle of trapezium; deep head: trapezoid and capitate Insertion: radial side of base of proximal phalanx of thumb Action: flexes proximal phalanx of thumb; flexes 1st metacarpal and rotates medially

  8. Abductor Pollicis Brevis Origin: Flexor retinaculum and tubercles of scaphoid and trapezium Insertion: Lateral side of base of proximal phalanx of thumb Action: Abducts thumb and helps oppose it

  9. Thumb Flexor TPs Trigger Point: in the belly of the muscle – “weeder’s thumb” Referrals: anterior length of thumb and medial wrist (above and beneath point); lateral side of thumb for abductors

  10. Opponens Pollicis Exercise Stretch: Passively hyper-abduct the extended thumb with fingers of the opposite hand Strengthen: Press thumb and pinky together

  11. Flexor Pollicis Brevis Exercise Stretch: Passively hyper-abduct the extended thumb with fingers of the opposite hand Strengthen: resisted thumb flex with rubber band anchored

  12. Abductor Pollicis Brevis Exercise Strengthen/stretch: abduct with fingers in rubber band, then relax

  13. Opponens digiti minimi Origin: Hamulus or hook of the hamate bone and flexor retinaculum Insertion: entire length of ulnar border of 5th metacarpal. Action: flexes and slightly laterally rotates 5th metacarpal. Helps to cup the palm of the hand

  14. Flexor Digiti Minimi Brevis Origin: Hook of hamate and flexor retinaculum Insertion: Medial side of base of proximal phalanx of little finger Action: Flexes proximal phalanx of little (5th) finger

  15. Abductor Digiti Minimi Origin: Pisiform Insertion: Medial side of base of proximal phalanx of little finger Action: Abducts little (5th) finger

  16. Abductor Digiti Minimi TPs Trigger Point: in the belly of the muscle Referrals: down posterior and lateral side of pinky; similar areas for Opponens and Flexor digiti minimi only anterior side

  17. Opponens Digiti Minimi Exercise Stretch: Passively hyper-extend the pinky with fingers of the opposite hand Strengthen: squeeze pinky and thumb together and hold for 20 sec

  18. Flexor Digiti Minimi Brevis Exercise Stretch: same as thumb stretch but stretch pinky instead Strengthen: resisted pinky flexion with rubber band

  19. Abductor Digiti Minimi Exercise Stretch: stretch pinky laterally Strengthen: place rubber band around extended fingers and abduct

  20. Palmaris Brevis Origin: flexor retinaculum and palmar apneurosis Insertion: skin of palm into dermis Action: steadies and corrugates skin of palm to help with grip; contract palm

  21. Palmaris Brevis TPs Trigger Point: in the belly of the muscle – Referrals: length of anterior edge of palm on pinky side and wrist

  22. Palmaris Brevis Exercise Stretch: stretch thumb back with other hand Strengthen: squeeze fingers together tightly

  23. Palmaris Longus Origin: Common flexor tendon from medial epicondyle of humerus Insertion:Distal half of flexor retinaculum and palmar aponeurosis Action:Flexes hand (at wrist) and tightens palmar aponeurosis

  24. Palmaris Longus TPs Trigger Point: in the belly of the muscle Referrals: distal to palm of hand and up forearm

  25. Palmaris Longus Exercise Stretch: passive stretch of palm by extending wrist with other hand Strengthen: resisted wrist flexion with theraband

  26. Triceps Brachii Origin: Long head: infraglenoid tubercle of scapula; Lateral head: posterior surface of humerus, superior to radial groove; Medial head: posterior surface of humerus, inferior to radial groove Insertion:Proximal end of olecranon process of ulna and fascia of forearm Action:Chief extensor of forearm;

  27. Triceps Brachii TPs 1-2 TP1: in the belly of the long head TP1 Referrals: strong referral to posterior deltoid and lateral condyle of the humerus. Spillover from base of neck, across shoulder, down posterior upper arm and forearm TP2: lower belly of medial head TP2 Referral: refers strongly to lateral condyle of humerus with spillover down lateral posterior forearm.

  28. Triceps Brachii TPs 3-4 TP3: upper portion of muscle belly of medial head TP3 Referrals: strong around itself with spillover surrounding it and down posterior forearm into posterior ring and pinky fingers TP4: in long, dense tendonabove insertion TP4 Referrals: strongly into olecranon process

  29. Triceps Brachii TPs 5 Tp5: in muscle belly on anterior surface of medial head. Tp5 Referrals: strong referral just below Tp on anterior surface of humerus – spills over down anterior forearm and anterior side of ring and pinky

  30. Triceps Brachii Exercise Stretch: place one hand on scapula same side and other behind back – pull towel between for stretch in upper triceps Strengthen: with theraband anchored in front at chest level, pull down and back 20 reps.

  31. Anconeus Origin: Posterior surface of lateral epicondyle of humerus Insertion:Lateral surface of olecranon and superior part of posterior surface of ulna Action: Extension and pronation of forearm at elbow

  32. Anconeus TPs Trigger Point: in the belly of the muscle close to insertion of ulna Referrals: lateral epicondyle of humerus (tennis elbow)

  33. Anconeus Exercise Stretch: Holding weight palm back, arm extended, flex and supinate arm across body Strengthen: extend and pronate forearm away from body Supinate! Pronate!

  34. Sources • Granger, Jocelyn. Neuromuscular Therapy Manual. Lippencott, 2011. • Travell, J. and Simons, D. Myofascial Pain and Dysfunction, Vol. 1. Williams and Wilkins, 1983. • Flash Anatomy flash cards: The Muscles. Bryan Edwards Publications, 1991. • http://en.wikipedia.org/wiki/Flexor_retinaculum_of_the_hand • http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body • http://ict4us.com/r.kuijt/en_carpalbones.htm

  35. Fini!

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