Upper Limb TopographyUpper Limb Topography

Fossa axillarisFossa axillaris

Between arm and chestBetween arm and chest BoundariesBoundaries

– Anteriorly – mm. pectoralesAnteriorly – mm. pectorales– Dorsally = latissimus dorsi, teres Dorsally = latissimus dorsi, teres

major, subscapularismajor, subscapularis– Medially = serratus anteriorMedially = serratus anterior– Laterally = sulcus bicipitisLaterally = sulcus bicipitis

ContentContent– Lymph nodes, vessels, pl. Lymph nodes, vessels, pl.

brachialisbrachialis

Foramen axillare laterale et medialeForamen axillare laterale et mediale

Surface anatomySurface anatomy

MM. triceps brachii. triceps brachii

caput longum, medialis, lateraliscaput longum, medialis, lateralis

Surface elementsSurface elements

SkinSkin thick and movablethick and movable

Subcutaneous tissueSubcutaneous tissue well expressedwell expressed

n. cutaneus brachii posteriorn. cutaneus brachii posterior

n. cutaneus brachii lateralis inferiorn. cutaneus brachii lateralis inferior

n. cutaneus antebrachii posteriorn. cutaneus antebrachii posterior

Posterior of the armPosterior of the arm

Deep structuresDeep structures

А. А. Fascia brachialis Fascia brachialis

- - Thick, thins distallyThick, thins distally

BB. . Neurovascular bundles Neurovascular bundles 1. 1. UpperUpper - in - in canalis humero-musculariscanalis humero-muscularis, , betweenbetween::

-- sulcus n. radialis sulcus n. radialis

- - medial and lateral head ofmedial and lateral head of m. triceps brachiim. triceps brachii

11.1..1. n. radialis – n. radialis – lieslies on the humeruson the humerus

-- n. cutaneus brachii lateralis inerior n. cutaneus brachii lateralis inerior

- n. cutaneus antebrachii posterior- n. cutaneus antebrachii posterior

- rr. musculres- rr. musculres

11.2. a. profunda brachii.2. a. profunda brachii

- a. collateralis media- a. collateralis media

- collateralis radialis- collateralis radialis

LowerLower neurovascular bundle neurovascular bundle behind medial epicondylebehind medial epicondyle

n. ulnarisn. ulnaris

a. collateralis ulnaris inferiora. collateralis ulnaris inferior

Elbow regionElbow region

Anterior elbowAnterior elbow

Surface anatomySurface anatomy

Three eminencesThree eminences

Two groovesTwo grooves

ElementsElements

Lateral grooveLateral groove - - v. cephalica, n. cutaneus v. cephalica, n. cutaneus

antebrachii lateralisantebrachii lateralis

Medial groove Medial groove – – v. basilica, n. cutaneus v. basilica, n. cutaneus

antebrachii medialisantebrachii medialis

V. mediana cubitiV. mediana cubiti

Deep structuresDeep structures

А. А. MusclesMuscles Flexors of forearmFlexors of forearm – – medial eminencemedial eminence

ExtensorsExtensors of forearmof forearm – – lateral eminencelateral eminence

Brachial muscles,Brachial muscles, mm. mm. bibiceps, brachialisceps, brachialis – – middle eminencemiddle eminence

Deep structuresDeep structures

BB. . Vessels and nervesVessels and nervesMedial bundleMedial bundle - - betweenbetween m. biceps brachii andm. biceps brachii and pronator pronator

teresteres

- a- a.v. brachialis, n. medianus.v. brachialis, n. medianus

Lateral bundleLateral bundle - - betweenbetween m. brachialis andm. brachialis and brachioradialisbrachioradialis

- - n. radialis, a. collateralis radialis, a. recurrens radialisn. radialis, a. collateralis radialis, a. recurrens radialis

CC. . Cubital fossaCubital fossa BoundariesBoundaries

-- m. brachioradialism. brachioradialis ( (laterallateral), ), m. pronator teres m. pronator teres ((medialmedial))

ContentContent- t- tendoendo m. brachialis,m. brachialis, m. biceps brachii, bursa bicipitoradialism. biceps brachii, bursa bicipitoradialis

Layers of the elbowLayers of the elbow

VenousVenous

1 1 v. v. cephaliccephalicaa

2 2 v. v. basilicbasilicaa

3 3 v. v. medianmedianaa cubit cubitii

ApponeuroticApponeurotic

1 aponeurosis bicipi1 aponeurosis bicipiss

2 tendo2 tendo m. m. bicepsbiceps brachii brachii

Neurovascular Neurovascular 1 1 a. a. brachialbrachialisis

2 2 n. n. medianmedianusus

MuscleMuscle 1 1 m. m. supinator supinator

2 2 m. m. brachialis brachialis

3 tendo3 tendo m. m. biceps biceps brachiibrachii

BoneBone 1 humerus 1 humerus

2 radius 2 radius

3 ulna3 ulna

The palmThe palm

Surface Anatomy of Upper Surface Anatomy of Upper LimbLimb

Carpal TunnelCarpal Tunnel– Carpals concave anteriorlyCarpals concave anteriorly– Carpal ligament covers itCarpal ligament covers it– Contains: long tendons, Contains: long tendons,

Median nerveMedian nerve– Inflammation of tendons = Inflammation of tendons =

compression of Median nervecompression of Median nerve

Anatomical SnuffboxAnatomical Snuffbox– Lateral = E.pollicis brevisLateral = E.pollicis brevis– Medial = E. pollicis longusMedial = E. pollicis longus– Floor = scaphoid, styloid of Floor = scaphoid, styloid of

radiusradius– Contains Radial Artery (pulse)Contains Radial Artery (pulse)

pg 306, 788

Muscles of the WristMuscles of the Wrist

Extensor musclesExtensor muscles– Extensor RetinaculumExtensor Retinaculum

What’s its function?What’s its function?

– Muscles innervated by Muscles innervated by radial nerveradial nerve

– There are 8 There are 8 Name them…Name them…

Flexor MusclesFlexor Muscles Flexor retinaculum Flexor retinaculum

(transverse carpal (transverse carpal ligament)ligament)

Two compartmentsTwo compartments– Superficial – 4 Superficial – 4 – Deep – 3Deep – 3– Name them…Name them…

Innervated by median and Innervated by median and ulnar nerveulnar nerve

Muscles of the WristMuscles of the Wrist

Wrist and Hand AnatomyWrist and Hand Anatomy

Nerves/VesselsNerves/Vessels– Radial & ulnar artery and veinsRadial & ulnar artery and veins– Radial, ulnar, & median nervesRadial, ulnar, & median nerves

Carpal TunnelCarpal Tunnel– Flexor Tendons - 9Flexor Tendons - 9– Median NerveMedian Nerve

Surface anatomySurface anatomy - - Medial and lateral eminenceMedial and lateral eminence and middle depressionand middle depression

- - Flexion groovesFlexion grooves - - Commissural padsCommissural pads

Surface elementsSurface elements

SkinSkin- thick- thick, , hairlesshairless

- - Attached to palmar aponeurosisAttached to palmar aponeurosis – – in the middlein the middle

- - Loose connective tissue in the eminencesLoose connective tissue in the eminences

- - r. palmaris (n. medianus)r. palmaris (n. medianus), , r. cutaneus palmaris r. cutaneus palmaris (ulnaris)(ulnaris)

- small veins- small veins

Aponeurosis palmarisAponeurosis palmaris – – thick fibrous tissuethick fibrous tissue

- - superficial layersuperficial layer – – tendinous fibers oftendinous fibers of m. palmaris m. palmaris longuslongus, ,

- - deep layerdeep layer – – transverse fiberstransverse fibers, , lig. metacarpeum lig. metacarpeum transversum superficialetransversum superficiale

- - commissural openingscommissural openings

Deep compartmentsDeep compartments

Intermuscular septaeIntermuscular septae andand

Palmar interosseous fasciaPalmar interosseous fascia formform

- - Three fascial compartmentsThree fascial compartments

LateralLateral ( (thenarthenar) ) compartmentcompartment

MuscleMuscle - - 4 4 layerslayers

- - M. abductor pollicis brevisM. abductor pollicis brevis

- M- M. opponens pollicis, m. flexor pollicis brevis (caput superfic.). opponens pollicis, m. flexor pollicis brevis (caput superfic.)

- - M. flexor pollicis brevis (caput profundus)M. flexor pollicis brevis (caput profundus)

- - MM. adductor pollicis. adductor pollicis

NervesNerves - - rr. muscularis n. medianus. muscularis n. medianus

VesselsVessels - - r. palmaris superficialis a. radialisr. palmaris superficialis a. radialis

Two connective tissue spacesTwo connective tissue spaces – – above and belowabove and below mm. adductor . adductor

pollicispollicis

MedialMedial ( (hypothenarhypothenar) ) compartmentcompartment

MusclesMuscles - - 2 2 layerslayers

- - SuperficialSuperficial - - m. abductor digiti minimi,m. abductor digiti minimi,

m. flexor digiti minimim. flexor digiti minimi

- - DeepDeep - - mm. opponens digiti minimi. opponens digiti minimi

NervesNerves – – superficial and deep branches ofsuperficial and deep branches of n. ulnarisn. ulnaris

VesselsVessels - - superficial and deep branches ofsuperficial and deep branches of aa. . ulnarisulnaris

MM. palmaris brevis. palmaris brevis - - proximalproximal

Middle compartmentMiddle compartment

Muscular tendinous layerMuscular tendinous layer::

- - mm. flexores digitorum superficialis & profundusmm. flexores digitorum superficialis & profundus

- mm. lumbricales- mm. lumbricales

- vagina synovialis communis flexorum- vagina synovialis communis flexorum

Two spacesTwo spaces

а. а. SuperficialSuperficial – – below palmar aponeurosisbelow palmar aponeurosis

- - aarcus palmaris superficialisrcus palmaris superficialis -- aa. digitales palmares communesaa. digitales palmares communes

-- n. medianusn. medianus - nn. digitales palmares communis- nn. digitales palmares communis

- - r. palmaris n. ulnarisr. palmaris n. ulnaris - - n. digitalis palmaris communis IV &n. digitalis palmaris communis IV & n. digitalis n. digitalis

palmaris proprius Vpalmaris proprius V

Interfascial canalsInterfascial canals - - distaldistal

- - mm. lumbricales, a.n. palmares digitales comm. et propriaemm. lumbricales, a.n. palmares digitales comm. et propriae

Middle compartmentMiddle compartment

bb. . Deep spaceDeep space - - belowbelow palmar interosseous fascia palmar interosseous fascia

- - communicationscommunications::

forearmforearm - - troughtrough carpalcarpal canalcanal

superficial spacesuperficial space – – interfascial canalsinterfascial canals

- - aarcus palmaris profundusrcus palmaris profundus -- a. radialis + r. profundus a. ulnarisa. radialis + r. profundus a. ulnaris

- - aa. metacarpales palmaresaa. metacarpales palmares - aa. digitales palmares communes - aa. digitales palmares communes

- - deep branchdeep branch ofof r. palmaris n. ulnarisr. palmaris n. ulnaris supplyingsupplying - -

- - mm. hypothenari, mm. interossei, m. adductor pollicis mm. hypothenari, mm. interossei, m. adductor pollicis и и mm. mm.

lumbricales II - IV.lumbricales II - IV.