bones of upper limb appendicular skeleton pectoral girdle = scapula,clavicle upperlimb – arm:...
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Bones of Upper Limb
• Appendicular Skeleton• Pectoral Girdle =
scapula,clavicle• Upperlimb – Arm: humerus– Forearm: radius, ulna• Interosseus membrane
– Hand: carpals, metacarpals, phalanges
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Joints of Upper Extremity• Sternoclavicular– Synovial of saddle– Diarthrosis
• Acromioclavicular– Synovialof plane– Diarthrosis
• Shoulder joint (Glenohumeral j )– Synovial of ball&socket– Many ligaments– Muscle reinforcement– Great Mobility !
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Joints of the Upper Limb• Elbow Joint :
Synovial of hinge
• Articulations–Humerus with
Ulna & Radius
• Collateral Ligaments
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Joints of Upper Limb
• Sup.Radioulnar joint– Synovial of pivot
• Inf. Radioulnar joint– Synovial – pivot
• Allows pronation and supination of forearm
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Joints of the Upper Limb
• Radiocarpal joint– Synovial of condyloid– Distal radius with
scaphoid and Lunate• Intercarpal joints– Synovial of plane
• Carpometacarpal (2-5)– Synovial of plane
• Trapezium-metacarpal 1– Synovial of saddle
• Metacarpo-phalangeal– Synovial of condyloid
• Interphalangeal– Synovial of hinge
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Review of Naming
• Naming–Flexor carpi ulnaris–Flexor digitorum superficialis–Flexor pollicis longus–Pronator quadratus–Extensor carpi radialis brevis
What do the following names TELL you about the muscle?
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Muscles of Scapula
• If ORIGIN on scapula = Move Arm– Subscapularis– Supraspinatus– Infraspinatus– Teres Minor– Teres Major– Latissimus Dorsi (partial O on scap)– Coracobrachialis
• If INSERTION on scapula = Move If INSERTION on scapula = Move • scapulascapula– Rhomboids– Trapezius– Pectoralis Minor– Serratus Ventralis– Levator Scapulae
Rotator Cuff
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Nerve supply of Scapula Muscles• Origin on Scapula:– Latissimus dorsi = Thoracodorsal nerve– Subscapularis, Teres Major = Subscapular nerves– Supraspinatus, Infraspinatus = Suprascapular nerves– Teres Minor = Axillary nerve
• Insertion on Scapula– Levator Scapular, Rhomboids = Dorsal Scapular nerve– Pectoralis Minor = Pectoral n.– Serratus Ventralis = Long Thoracic n.– Trapezius = Accessory n.
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Muscles of Arm: Cross elbow, Move forearm• 2 Compartments
– Anterior: Flexors of forearm– Posterior: Extensors of forearm
• Anterior Compartment– Biceps brachii = MC nerve– Brachialis = MC nerve– Brachioradialis = Radial nerve
• Coracobrachialis = MC nerve– O = coracoid process of scapula– I = medial side humeral shaft– A = flex, adduct arm
• Posterior Compartment– Triceps brachii = Radial nerve– Anconeus = Radial nerve
N.B. MC = musclocutaneous nerve
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Muscles of forearm: Cross wrist & finger joints, flexes hand &
fingers• Cross Wrist = flex, extend, abduct, adduct hand• Cross Fingers = flex, extend fingers• Most muscles fleshy proximally, long tendons distally• Flexor + Extensor Retinacula :– The retinaculum is a thick band of deep fascia has bony
attachment ; it keeps tendons in position during movements– Under the retinaculum, tendons are surrounded by synovial
sheathes
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Compartments of the forearm : 1.Anterior Flexor Compartment : (Superficial + Deep layers)Most of superficial flexors originate by a common origin from medial epicondyleContains 2 pronators, are supplied by Median and Ulnar nerves2.Posterior Extensor Compartment : (Superficial + Deep layers) Are supplied by Radial and post. Interosseus nerves
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Anterior Compartment of Forearm s
• Superficial Muscles– Flexor digitorum superficialis Median– Flexor carpi radialis Median– Pronator teres Median– Palmaris longus Median– Flexor carpi ulnaris Ulnar
• Deep Muscles– Pronator quadratus Median– Flexor pollicis longus Median– Flexor digitorum profundus Ulnar (med 1/2)
Median (lat 1/2)
Muscle Nerve
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Anterior Compartment Forearm
Flexor Carpi Radialis
Flexor Retinaculum
Medial Epicondyle
Flexor Digitorum Superficialis is deep to other flexors
Flexor Carpi Ulnaris
BrachioradialisPronator Teres
Anterior View
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Posterior Compartment of Forearm
• Superficial– Extensor carpi radialis longus Radial– Extensor digitorum Radial– Extensor carpi ulnaris Radial
• Deep– Supinator Radial– Abductor pollicis longus Radial– Extensor pollicis longus + brevis Radial– Extensor indicus Radial
Muscle Nerve
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Posterior Compartment of Forearm
Extensor digitorum
Extensor carpi ulnaris Ext Carpi Radialis Longus
Brachioradialis
Lateral Epicondyle
Posterior View
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Muscles of Hand
• Pinky (little finger)– All digiti minimi Ulnar
(Flexor, Abductor, Opponens)
• Thumb– Abductor pollicis brevis Median– Flexor pollicis brevis Median– Opponens pollicis Median– Adductor pollicis Ulnar
• Other Intrinsic Muscles– Palmar & Dorsal Interossei Ulnar– 4 Lumbricals Median, Ulnar
Muscle Nerve
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Muscles of Hand
ABduction
Palmar Interossei
Lumbricals
ADDuction
1st
2nd
3rd
4th
Dorsal Interossei
Interossei help the lumbricals to extend I P joints and flex MC-P joints
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Blood Supply of U.L: 1. The Veins
•Cephalic (arm-forearm)•Basilic (arm-forearm)
•Median Cubital (elbow)•Median Vein
•SF. Palmar Venous Arch•Digital
SUPERFICIAL
•Subclavian (neck)•Axillary (axilla)
•Brachial (arm-elbow)
•Radial (forearm)•Ulnar (forearm)•Deep Palmous Venous arch
DEEP
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Blood Supply of the U.L: 2.Arteries• Subclavian A (neck)• Axillary A (armpit)– Subscapular A
• Brachial A (arm)– Deep brachial
• Radial A (forearm)• Ulnar A (forearm)
Common Interosseous A
• Superficial & Deep Palmar arches
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Axilla = Armpit• Region between arm and chest• Boundaries– Ventral - pectoral muscles– Dorsal = latissimus dorsi, teres major
subscapularis– Medial = serratus ventralis– Lateral = bicipital groove of humerus
• Contents– Axillary lymph nodes, Axillary vessels
Brachial Plexus
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The Axilla
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Surface Anatomy of Upper Limb• Biceps + Triceps brachii• Olecrenon Process• Medial Epicondyle• Cubital Fossa– Anterior surface elbow– Contents
• Median Cubital Vein• Brachial Artery• Median Nerve
– Boundaries• Medial= Pronator teres• Lateral= Brachioradialis• Superior= Line between epicondyles
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Surface Anatomy of Upper Limb
• Carpal Tunnel– Carpals concave anteriorly– Carpal ligament covers it– Contains: long tendons,
Median nerve– Inflammation of tendons =
compression of Median nerve
• Anatomical Snuffbox– Lateral = E. pollicis brevis– Medial = E. pollicis longus– Floor = scaphoid, styloid of
radius– Contains Radial Artery
(pulse)
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Brachial Plexus• Network of nerves starts in
in the neck, then to the axilla
• Is motor to muscles of upper limb except trapezius
• Sensory to skin of U.L except tip of shoulder & upper part of skin covers deltoid.
• Root value : C5,6,7,8,T1
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Where Ventral Rami Come FromDorsal Root
Ventral Root
spinal nerve
Dorsal Ramus of spinal nerve
Ventral Ramus of spinal nerve
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Structure of the Spinal nerve
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Parts of Brachial Plexus
• Really Tired? Drink Coffee Buddy!
• R = ROOTS (ventral rami)• T = TRUNKS• D = DIVISIONS• C = CORDS• B = BRANCHES
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Roots join to form Trunks! (in neck)
• Ventral Rami Trunks
• C5 Upper Trunk• C6• C7 Middle Trunk• C8• T1 Lower Trunk
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Trunks Split to form Divisions : (in neck)• Trunks Divisions
• Upper AnteriorPosterior
• Middle Anterior
Posterior
• Lower Anterior Posterior
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Divisions Join to form Cords! (in axilla)
U A P
M A P
L A P POSTERIOR CORD
LATERAL CORD
MEDIAL CORD
Trunks Divisions Cords
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Cords Give off Branches!! (in axilla)
• Lateral Musculocutaneous
Median
• Medial Ulnar
• Posterior RadialAxillary(thoracodorsal)(subscapular)
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Parts of the brachial plexus…..
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Injury of the brachial plexus
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Branches of the Posterior Cord• Radial Nerve : • ( is the largest branch of the post. cord) – Course: Through arm, spiral groove of the humerus, then in
front of lat. epicondyle, then divides :– Divides in the forearm to give : • Superficial = skin of arm and dorsolateral surface of hand• Deep ( post interosseus nerve ) = extensor muscles of
forearm (eg E. carpi radialis L , B., …)
– Innervates: posterior muscles of arm Triceps brachii, anconeus, supinator, brachioradialis
– Sensory :……, skin of back
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The Radial nerve• 1.from post. cord• 2.artificai triangular
space• 3.spiral groove• 4.pireces lat. I.M.S• 5.in front of lat.
epicondyle, and divides into : ……..
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Damage to Radial Nerve = wrist dropInability to extend the hand
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Branches of the Posterior Cord (continued)
• Axillary Nerve ( w . Circumflex vs..)– Supplies: • Deltoid and Teres minor (motor supply )• Capsule of shoulder• skin of lower part covering deltoid (sensory supply)
• Subscapular Nerves {branches of C5 + C6 rami}
– Innervates: Subscapularis, Teres major
• Thoracodorsal Nerve (runs w. thoracodorsal vs) supplies: Latissimus dorsi
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The brachial plexus
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The Lateral Cord gives :• .Lat. Root of median nerve• .Lat.pectoral nerve• Musculocutaneous :–Course: branches to arm, distal to
elbow becomes cutaneous :sensory to skin of lateral side of forearm .–Motor :• Biceps brachii, brachialis, coracobrachialis
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The Median nerve• The Median nerve : is formed by 2 roots :…..– Course: middle of brachial plexus, distal to elbow provides
many branches to most forearm flexors, passes through carpal tunnel to hand to lateral palmar intrinsics
– Motor supply to: most muscles of anterior of the forearm flexors
thenar eminence (thumb), lat.2 Lumbrichals
– Sensory : skin of lateral 2/3 of palm ,lat. Three & half fingers to back of middle phalanges
– Nerve Damage = “Ape” Hand• Inability to Oppose Thumb
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The median nerve
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The median nerve : C5,6,7,8,T1
.Is formed by 2 roots
.Has 3 relations w. brachial A
.Enters forearm by piercing pronator teres( supplies it 1st )
.Enters hand deep to flexor retinaculum ( Carpal tunnel )
. In the it gives deep & superficial branches
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The median nerve
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Branches of the Medial Cord : 5 • The Ulnar nerve :– Course: runs along medial side of arm, behind medial
epicondyle ( site of its injury )– Enters the hand :superficial to flexor retinaculum .
– Supplies : • Motor :FCU and medial part of FDP (in forearm1 1/2) Ms. Of hand except 5• Skin of medial 1/3 of hand Ant +Post + medial one &
half fingers• Nerve Damage: Partial Claw hand• Inability to extend fingers at interphalangeal joints,
results in permanent flexion = claw
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The Ulnar nerve C7,8,T1
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Ulnar nerve injury : Partial Claw hand
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Dermatomal supply of the hand