Hands Up! Judith Lehman
Jan 02, 2016
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
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.
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
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
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
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
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
Opponens Pollicis Exercise
Stretch: Passively hyper-abduct the extended thumb with fingers of the opposite hand
Strengthen: Press thumb and pinky together
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
Abductor Pollicis Brevis Exercise
Strengthen/stretch: abduct with fingers in rubber band, then relax
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
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
Abductor Digiti Minimi
Origin: Pisiform
Insertion: Medial side of base of proximal phalanx of little finger
Action: Abducts little (5th) finger
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
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
Flexor Digiti Minimi Brevis Exercise
Stretch: same as thumb stretch but stretch pinky instead
Strengthen: resisted pinky flexion with rubber band
Abductor Digiti Minimi Exercise
Stretch: stretch pinky laterally
Strengthen: place rubber band around extended fingers and abduct
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
Palmaris Brevis TPs
Trigger Point: in the belly of the muscle –
Referrals: length of anterior edge of palm on pinky side and wrist
Palmaris Brevis Exercise
Stretch: stretch thumb back with other hand
Strengthen: squeeze fingers together tightly
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
Palmaris Longus TPs
Trigger Point: in the belly of the muscle
Referrals: distal to palm of hand and up forearm
Palmaris Longus Exercise
Stretch: passive stretch of palm by extending wrist with other hand
Strengthen: resisted wrist flexion with theraband
Triceps BrachiiOrigin: 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;
Triceps Brachii TPs 1-2TP1: 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.
Triceps Brachii TPs 3-4TP3: 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
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
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.
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
Anconeus TPs
Trigger Point: in the belly of the muscle close to insertion of ulna
Referrals: lateral epicondyle of humerus (tennis elbow)
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!
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