Transcript 9 - bYTEBoss

The Upper Extremity
Bones,
Muscles,
Vessels,
Bones



30 bones!!!!
Appendicular skeleton
Pectoral girdle



Ball and socket attachments
Upper extremity:

Arm
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humerus
Forearm
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Radius, ulna (interosseous
membrane)
Hand
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Glenoid cavity
Allows for mobility

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Scapula
Clavicle
Carpals, metacarpals, phalanges
Review bones and landmarks
studied in lab!!!
Joints of Upper Extremity
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Sternoclavicular
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Acromioclavicular
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Synovial-saddle
Diarthrosis
Synovial-plane
Diarthrosis
Glenohumeral joint
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Synovial-ball&socket
Diarthrosis
Many ligaments
Muscle reinforcement
Great Mobility
Joints of the Upper Extremity
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Elbow Joint
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Articulations
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Synovial – hinge
Diarthrosis
Humerus & Ulna
Humerus & Radius
Many Ligaments
Joints of Upper Extremity
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Proximal Radioulnar
joint
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Distal Radioulnar joint
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Synovial - pivot
Diarthrosis
Synovial – pivot
Diarthrosis
Allows pronation and
supination of forearm
Joints of the Upper Extremity
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Radiocarpal joint
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Synovial-condyloid

Distal radius with proximal row of
carpals
Intercarpal joints
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Synovial-plane
Carpal-metacarpal (2-5)

Synovial-plane
Trapezium-metacarpal 1

Synovial-saddle
Metacarpal-phalangeal

Synovial-condyloid
Interphalangeal

Synovial-hinge
ALL DIARTHROSES
Review of Naming…..

What do the following names TELL
you about the muscle?

Naming

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Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor pollicis longus
Pronator quadratus
Extensor carpi radialis brevis
Scapula Muscles

If the origin is on the
scapula – moves the arm
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Subscapularis
Rotator
Supraspinatus
Cuff
Infraspinatus
Teres Minor
Teres Major
Latissimus Dorsi (partial
attachment)
Coracobrachialis
Scapula Muscles

If the insertion is
on the scapula –
moves the scapula
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Rhomboids
Trapezius
Pectoralis Minor
Serratus Ventralis
Levator Scapulae
Use location of Insertion to determine movement!!
Scapula Innervation

Origin on scapula

Subscapularis and
teres major



Suprascapular
Axillary
Latissimus Dorsi



Thoracodorsal
Coracobrachialis
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Musculocutaneous
Rhomboids and Levator
Scapulae
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Accessory
Pectoralis Minor
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Dorsal scapular
Trapezius
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Teres Minor
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Insertion on scapula
Subscapular
Supraspinatus and
Infraspinatus
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Medial and Lateral
Serratus Ventralis
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Long thoracic
Muscles of the Rotator Cuff
All INSERT on the humerus
Muscle
Origin
Subscapularis
Subscapular fossa Medial rotator of
the humerus
Infraspinous
Lateral rotator of
fossa
the humerus
Lateral border of Lateral rotator of
scapula (upper
the humerus
2/3)
Supraspinous
Abducts the
fossa
humerus
infraspinatus
Teres minor
supraspinatus
Action
Muscles of the Scapula
*All these muscles INSERT on the scapula
Muscle
Origin
Action
Trapezius
Ligamentum nuchae and
C7-T12
Elevates, adducts, rotates,
and depresses the scapula
Levator Scapulae
ventralis
C1-C4
Elevates the scapula,
flexes neck laterally
Rhomboids
C7-T5
Adduct, elevate, and
rotate the scapula
Pectoralis minor
Ribs 3-5
Depresses and rotates the
scapula
Serratus anterior
Ribs 1-9
Protracts and rotates the
scapula
Arm Muscles
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Cross elbow, move
forearm
2 compartments
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Anterior
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Flexors of forearm
Posterior
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Extensors of forearm
Arm Muscles
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Anterior
compartment
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Brachialis
Biceps brachii
Coracobrachialis
Brachioradialis
Arm Muscles
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Posterior
compartment
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Triceps brachii
Anconeus
Arm Muscle Innervation
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Anterior compartment
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Radial nerve
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Musculocutaneous nerve
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Bracioradialis
Coracobrachialis
Brachialis
Biceps brachii
Posterior compartment
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Radial nerve
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Triceps brachii
Anconeus
Forearm Muscles
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Cross elbow, wrist and
finger joints
Movement of hand and
fingers
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Cross Wrist
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Cross Fingers
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flex, extend, abduct,
adduct hand
flex, extend fingers
Proximally are fleshy
Distally have long tendons
Flexor and extensor
retinacula
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“wristbands”
Keep tendons from
jumping outwards when
tensed
Forearm Muscles
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Anterior flexor
compartment
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Superficial and Deep
Most flexors have
common tendon on
medial epicondyle
Contains 2 pronators
Posterior extensor
compartment
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Superficial and Deep
Anterior Compartment of Forearm
Muscles
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Superficial
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Nerves
Flexor digitorum superficialis
Flexor carpi radialis
Pronator teres
Palmaris longus
Flexor carpi ulnaris
Median
Median
Median
Median
Radial
Deep
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Flexor pollicis longus
Flexor digitorum profundus
Median
Ulnar (med 1/2)
Median (lat 1/2)
Anterior Compartment
Forearm
Posterior Compartment of Forearm
Muscles
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Superficial
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Nerves
Extensor carpi radialis longus
Extensor digitorum
Extensor carpi ulnaris
Radial
Radial
Radial
Deep
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Supinator
Abductor pollicis longus
Extensor pollicis longus + brevis
Extensor indicus
Radial
Radial
Radial
Radial
Posterior Compartment of Forearm
Hand Bones
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Carpus (8)
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Metacarpus (5)
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“True” wrist
Distal to radius/ulna
Distal to carpus
Phalanges (14)
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Distal to
metacarpus
Intrinsic Muscles of the Hand
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Muscle
Pinky (little finger)
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Ulnar
Thumb
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All digiti minimi
(Flexor, Abductor, Opponens)
Nerve
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis
Median
Median
Median
Ulnar
Other Intrinsic Muscles
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Palmar + Dorsal Interossei
Lumbricals
Ulnar
Median, Ulnar
Muscles of the Upper Limb
*All INSERT on the humerus (*)
Muscle
Origin
Action
Deltoid
Lateral ½ of clavicle, acromion Prime flexor, abducts and
and spine of scapula
extends the humerus.
Laterally and medially rotates
arm.
Pectoralis major
Sternum and ribs 2-6
Adducts, flexes, and medially
rotates humerus
Latissimus dorsi
Iliac crest, T7-T12 and lumbar
fascia
Extends, adducts, and medially
rotates the humerus
Teres major
Lateral border of scapula
(lower 1/3)
Extends, adducts, and medially
rotates the humerus
Coracobrachialis
Coracoid process
Flexes and adducts the
humerus.
Muscles Crossing the Elbow
Muscle
Origin
Insertion
Action
Triceps Brachii
(radial nerve)
Infraglenoid
tubuercle and shaft
of humerus
Olecranon process
of ulna
Forearm extensor
Anconeus
(radial nerve)
Lateral epicondyle of
humerus
Lateral aspect of
olecranon process of
ulna
Abducts ulna during
forearm pronation
Biceps Brachii
(musculocutaneous
nerve)
Supraglenoid tubercle Radial tuberosity
and coracoid process
Flex forearm and
supinate hand
Brachialis
(musculocutaneous
nerve)
Anterior surface of
humerus
Coronoid process of
ulna and capsule of
elbow
Forearm flexor and
hand supinator
Brachioradialis
(radial nerve)*
Supracondylar ridge
of the humerus
Styloid process of
radius
Synergist in forearm
flexion
*Exception: radial nerve usually serves extensor muscles
ANTERIOR
Superficial Muscles
Muscles of the Forearm
Muscle
Origin
Insertion
Action
Pronator Teres
(median nerve)
Humerus
Coronoid process of
ulna
Lateral raidus
Pronate forearm
Weak flexor of elbow
Flexor Carpi Radialis
(median nerve)
Humerus-medial
epicondyle
Base of 2nd and 3rd
metacarpals
Flexor of wrist,
abduct hand
Palmaris Longus
(median nerve)
Humerus-medial
epicondyle
Palmar fascia
Weak wrist flexor
Flexor Carpi Ulnaris
(ulnar nerve)
Humerus-medial
epicondyle
Olecranon process
Pisiform and hamate
bones, base the 5th
metacarpal
Powerful flexor of
wrist, adductor of
hand
Flexor Digitorum
Superficialis
(median nerve)
Humerus-medial
epicondyle, coronoid
process of ulna, shaft
of radius
Four tendons into
middle phalange of
fingers 2-5
Flexes wrist
ANTERIOR Deep Muscles
Muscles of the Forearm
Muscle
Origin
Insertion
Action
Flexor Pollucis
Longus
(median nerve)
Radius and
interosseous
membrane
Distal phalanx of
thumb
Flexes distal
phalanx of thumb
Flexor Digitorum
Profundus
(ulnar and median
nerves)
Ulna and
interosseous
membrane
Four tendons into
distal phalanges of
fingers 2-5
Flexor of the
fingers
radus
Forearm pronation
Pronator Quadratus ulna
(median nerve)
POSTERIOR Superficial
Muscles
Muscles of the Forearm
Muscle
Origin
Insertion
Action
Extensor Carpi
Radialis Longus
(radial nerve)
Humerus-lateral
epicondyle
Base of 2nd
metacarpal
Extends and abducts
wrist
Extensor Carpi
Radialis Brevis
(deep branch of
radial nerve)
Humerus-lateral
epicondyle
Base of 3rd
metacarpal
Extends wrist
Extensor Digitorum
(radial nerve)
humerus
Four tendons into
extensor expansions
and distal phalanges
of fingers 2-5
Prime mover of
finger extension
Extensor Carpi
Ulnaris
(posterior
interosseous nerve)
Humerus-lateral
epicondyle and ulna
Base of fifth
metacarpal
Extends wrist and
adducts wrist
POSTERIOR Deep Muscles
Muscles That Move the
Forearm
Muscle
Origin
Insertion
Action
Supinator
(post. Interosseous
nerve)
Humerus, ulna
Radius proximal
end
Supinate forearm
Abductor Pollucis
Longus
(post. Inter. Nerve)
Post. Radius and
ulna
Base of 1st
metacarpal and
trapezium
Abducts and
extends thumb
Extensor Pollucis
Brevis and longus
(post. Inter. Nerve)
Shaft of radius and
ulna, interosseous
membrane
Base proximal
Extends thumb
phalanx (brevis) and
distal phalanx
(longus) of thumb
Extensor Indicis
(post. Inter. Nerve)
Distal ulna,
interosseous
membrane
Extensor expansion
of index finger
Extends index
finger
http://bio.bd.psu.edu/cat/Muscular_System/
deep_muscles.htm# Upper Arm
1. Clavodeltoid
2. Biceps Brachii
3.
Triceps
Medial Head
4. Epitrochlearis
5.
Upper Arm –Medial View
Triceps Long
Head
1. Acromiotrapezius
2.
Levator Scapulae
Ventralis
3. Teres Major
4.
Triceps Lateral
Head (Reflected)
5. Triceps Long Head
6.
Triceps Medial
Head
7. Brachialis
8. Clavodeltoid
9. Anconeus
Upper Arm – Lateral View
1’
Long Head of Triceps
7.
Extensor Digitorum
Communis
2.
Lateral Head of Triceps
8.
Extensor Digitorum
Lateralis
3.
Brachialis
9.
Extensor Carpi Ulnaris
4.
Brachioradialis
1
0.
Flexor Carpi Ulnaris
5.
Extensor Carpi Radialis
Longus
11
.
Anconeus
6.
Extensor Carpi Radialis
Brevis
1.
Brachioradialis
8.
Clavodeltoid
2.
Extensor Carpi Radialis Longus
9.
Biceps Brachii
3.
Extensor Carpi Radialis Brevis
10. Epitrochlearis
4.
Pronator Teres
11. Long Head of Triceps
5.
Flexor Carpi Radialis
12. Medial Head of Triceps
6.
Palmaris Longus
13. Flexor Digitorum Superficialis
7.
Flexor Carpi Ulnaris
Intrinsic Muscles of the Hand
Thenar Eminence
Muscle
Origin
Insertion
Action
Abductor Pollucis
Brevis
(median nerve)
Flexor retinaculum,
Carpal bones
Base of first
proximal phalanx
Abducts thumb
Flexor Pollucis
Brevis
(median nerve)
Same as above
Same as above
Flex thumb
Opponens Pollucis
(median nerve)
Flexor retinaculum
and trapezium
Anterior side of first Oppostion
metacarpal
Adductor pollucis
(ulnar nerve)
Capitate bone and
Medial side of base
bases of metacarpals of first proximal
2-4
phalanx
Adducts and
opposes the thumb
Intrinsic Muscles of Hand
Hypothenar Eminence
Muscle
Origin
Insertion
Action
Abductor Digiti
Minimi
(ulnar nerve)
pisiform
Medial side of
proximal phalanx of
5th finger
Abducts little finger
at MPJ.
Flexor digiti minimi
brevis
(ulnar nerve)
Hamate and flexor
retinaculum
Same as above
Flexes little finger
Opponens digiti
minimi
(ulnar nerve)
Same as above
Medial side of
metacarpal 5
opposition
Muscles of the Hand
Midpalmar Muscles
Muscle
Origin
Insertion
Action
Lumbricals
(median and ulnar
nerve)
Lateral side of each
tendon of the deep
flexor
Lateral edge of
extensor expansion
of fingers 2-5
Flex the MPJ
Extend IPJ’s
Palmar Interossei
(ulnar nerve)
Midaxial side of
each metacarpal
except of met. #3
Extensor expansion
Adduction of
fingers
Dorsal interossei
(ulnar nerve)
Sides of metacarpals Extensor expansions Abduct fingers
Intrinsic Muscles of the Hand
Interossei Muscles
Lumbrical Muscles
Blood Supply - Veins
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Deep veins
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Deep palmar venous arches
Radial - forearm
Ulnar - forearm
Brachial – arm/elbow
Subclavian - neck
Axillary – axilla
Superficial Veins



Cephalic – arm/forearm
Basilic – arm/forearm
Median cubital – elbow



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Blood draws!!
Median - forearm
Superficial palmar venous
arches
Digital
Blood Supply - Arteries


Subclavian (neck)
Axillary (armpit)



Brachial (arm)



Deep brachial
Radial (forearm)
Ulnar (forearm)


Subscapular
Circumflex humeral arteries
Common Interosseous
Superficial & Deep Palmar
arches

Digital
Axilla



Between arms and chest
Where axillary hair grow
Boundaries

Ventral


Dorsal


Serratus ventralis
Lateral


Latissimus dorsi, teres major,
subscapularis
Medial


Pectoral muscles
Intertubercular (Bicipital) groove
of humerus
Contents

Axillary lymph nodes, Axillary
vessels, brachial Plexus
Surface Anatomy of Arm

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Biceps brachii
Triceps brachii
Olecrenon
Process
Medial Epicondyle
Lateral Epicondyle
Surface Anatomy of Elbow


Cephalic vein
Cubital Fossa


Anterior surface elbow
Contents

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Median Cubital Vein
Brachial Artery
Median Nerve
Boundaries
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Medial= Pronator teres
Lateral= Brachioradialis
Superior= Line between epicondyles
Surface Anatomy of Hand

Carpal Tunnel
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
Carpals concave anteriorly
Carpal ligament covers it
Contains: long tendons, Median
nerve
Inflammation of tendons =
compression of Median nerve
Anatomical Snuffbox

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
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Lateral = E.pollicis brevis
Medial = E. pollicis longus
Floor = scaphoid, styloid of radius
Contains Radial Artery (pulse)
Brachial Plexus

Nerve plexus




Network of nerves formed by
ventral rami
Lies partly in neck and partly
in axilla
Gives rise to almost all
nerves that supply upper limb
Formed by intermixing of
ventral rami of spinal nerves
C5-C8 and T1

Small contributions from C4 and
T2
Ventral Rami
Brachial Plexus

Really Tired? Drink Coffee Buddy!

R = RAMI (ventral) (5)
T = TRUNKS (3)
D = DIVISIONS (2)
C = CORDS (3)
B = BRANCHES (Many!!)
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Rami join to form Trunks! (in neck)
Ventral Rami
Trunks
Upper Trunk

C5
C6

C7
Middle Trunk

C8
T1
Lower Trunk


Trunks Split to form Divisions! (in neck)
Trunks
Divisions

Upper
Anterior
Posterior

Middle
Anterior
Posterior

Lower
Anterior
Posterior
Divisions Join to form Cords! (in axilla)
Trunks
U
M
L
Division
A
P
A
P
A
P
Cords
Lateral
Medial
Posterior
Cords Give off Branches!! (in axilla)

Lateral
Musculocutaneous
Median

Medial
Ulnar

Posterior
Radial
Axillary
Thoracodorsal
Subscapular
1.
Vagus Nerve
2.
Brachial Plexus
3.
Radial Nerve
4.
Axillary Nerve
5.
Median Nerve
6.
Ulnar Nerve
Brachial Plexus – Cords and Branches

Lateral



Medial


Musculocutaneous
Median
Ulnar
Posterior




Radial
Axillary
Thoracodorsal
Subscapular
Lateral Cord

Musculocutaneous nerve


Off lateral cord
Course:



Anterior arm
Becomes cutaneous and gives skin sensation to lateral forearm
Innervates:




Corocobrachialis (motor)
Biceps brachii (motor)
Brachialis (motor)
Skin distal to the elbow (sensory)
Medial Cord

Ulnar nerve

Course:







Comes off medial cord
Descends along medial side of arm
Passes posterior to medial epicondyle
Follows the ulna
Superficial to carpal tunnel into hand
Branches to supply intrinsics and skin
Innervates:




Flexor carpi ulnaris (motor)
Flexor digitorum profundus (motor)
Most intrinsic hand muscles (motor)
Dorsal branch supplies skin of medial 2/3 of hand (sensory)
Both Medial and Lateral Cords

Median nerve

Course:





Middle of brachial plexus (from lateral and medial cords)
Does not branch in arm
Distal to elbow provides many branches to most forearm flexors
Passes through carpal tunnel to hand
Innervates:

Anterior forearm (motor)



Most flexors, some intrinsics (thumb)
2/3 Lateral palm (sensory)
Dorsum of fingers 2 and 3 (sensory)
Posterior Cords

Radial nerve



Largest branch of brachial plexus
Comes from posterior cord
Course:




Through arm
Around humerus
Around lateral epicondyle (then divides)
Innervates:

Posterior muscles of arm and forearm


Triceps brachii, anconeus, supinator, brachioradialis
Divides in forearm:

Superficial


Skin of arm and dorsolateral surface of hand
Deep

Extensor muscles of forearm (eg E. carpi radialis L + B)
Posterior Cord

Axillary nerve


Branches off posterior cord
Course:



Innervates:



Deltoid and teres minor (motor)
Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve

Innervates:


Runs posterior to humerus
Runs with caudal humeral circumflex artery
Subscaplaris, Teres major
Thoracodorsal nerve

Course:


Runs with thoracodorsal artery and nerve
Innervates:

Latissimus dorsi
Cutaneous Innervation to Hand
Nerve Damage

Ulnar nerve

“Claw hand”


Median nerve

“Ape hand”

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Inability to extend fingers at
interphalangeal joints,
results in permanent flexion
= claw
Inability to oppose thumb
Radial nerve
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“Wrist drop”
Inability to extend the hand,
inability to fully extend forearm
Carpal Tunnel Syndrome At A Glance
•Carpal tunnel syndrome is caused by irritation of the
median nerve at the wrist.
•Any condition that exerts pressure on the median nerve
can cause carpal tunnel syndrome.
•Symptoms of carpal tunnel syndrome include
numbness and tingling of the hand.
•Diagnosis of carpal tunnel syndrome is suspected
based on symptoms, supported by physical examination
signs, and confirmed by nerve conduction testing.
•Treatment of carpal tunnel syndrome depends on the
severity of symptoms and the underlying cause.