Transcript Elbow, forearm and wrist

Elbow, forearm and wrist
THIS IS AN AXIAL IMAGE ABOVE THE LEVEL OF THE ELBOW JOINT,
MEDIAL IS THE BOTTOM OF THE IMAGE, LATERAL IS THE TOP OF
THE IMAGE, VENTAL (ANTERIOR) IS TO THE RIGHT AND DORSAL
(POSTERIOR) IS TO THE LEFT
FIRST, LETS TRY AND IDENTIFY
SOME OF THE MAJOR MUSCLE
WE ARE LOOKING AT.
IF YOU FLEX YOU ARM WHAT
MUSCLE DO YOU FEEL? HOW
ABOUT WHEN YOU EXTEND IT?
GO AHEAD GIVE YOUR ARM A
GRAB
BICEPS ON FLEXION AND
TRICEPS ON EXTENSION
IF YOU FEEL THE MEDIAL
SIDE OF YOU BICEPS, DO
YOU FEEL A PULSE? WHAT
VESSEL IS THIS? AND FOR
EXTRA CREDIT WHAT
NERVE RUNS WITH IT?
BRACHIAL ARTERY AND VEIN
WITH THE MEDIAN NERVE
T
B
WE ARE JUST ABOVE THE ELBOW JOINT
WHAT HAS HAPPENED TO THE BICEPS
MUSCLE? AGAIN GIVE YOUR ARM A FEEL.
IT IS NOW TENDON, NOTE ITS
RELATIONSHIP TO THE MEDIAN
NERVE AND BRACHIAL
NEUROVASCULAR BUNDLE
WHAT OTHER MAJOR NERVES DO
YOU EXPECT TO SEE IN THE ARE
AT THIS LEVEL?
RADIAL AND ULNAR NERVES. CAN
YOU FIND THEM?
TENDON
RADIAL (WHITE ARROW)
ULNAR (BLACK ARROW)
FOR EXTRA CREDIT WHAT ARE THE
2 MUSCLES THE BORDER THE
RADIAL NERVE?
BRACHIORADIALIS AND
BRACHIALIS, CAN YOU FIND THEM?
NVB
NOW WE ARE JUST ABOVE THE LEVEL OF THE
ELBOW JOINT, AGAIN IDENTIFY THE BICEPS TENDON,
THE BRACHIAL ARTERY AND VEIN, MEDIAN NERVE
AND THE BICEPS TENDON AND THE RADIAL ARTERY.
WHERE IS THE ULNAR NERVE
AND WHAT DO WE CALL IT IN
THIS AREA? HINT IT IS NOT
FUNNY.
THIS IS THE ULNAR NERVE IN
THE CUBITAL TUNNEL ALSO
KNOWN AS YOUR “FUNNY BONE”.
THE NERVE IS VERY
SUPERFICIAL IN THIS AREA, TRY
AND FEEL YOURS
WHY DOES IT LOOK LIKE THIS
PATIENT HAS CRACKS IN HIS
BONES?
THESE ARE GROWTH PLATES
IN A SKELETALLY IMMATURE
PERSON, THERE ARE A LOT
AROUND THE ELBOW
HERE WE ARE AT THE LEVEL OF THE JOINT, AGAIN
IDENTIFY ALL OF THE PREVIOUSLY IDENTIFIED
STRUCTURES. BRACHIAL ARTERY AND VEINS,
MEDIAN NERVE, BICEPS TENDON, RADIAL ARTERY
AND ULNAR NERVE IN THE CUBITAL TUNNEL.
VENOUS ANATOMY IS EXTREMELY
VARIABLE BUT SEE IF YOU CAN
IDENTIFY THE CEPHALIC VEIN,
MEDIAL CUBITAL VEIN AND THE
BASILIC VEIN
C
B
M
HERE WE ARE BELOW THE LEVEL OF THE
ELBOW JOINT. WHAT IS HAPPENING TO THE
BICEPS TENDON AND THE BRACHIAL ARTERY?
THE BICEPS TENDON IS
INSERTING ON TO THE RADIAL
TUBEROSITY
THE BRACHIAL ARTERY IS
SPLITTING INTO THE RADIAL AND
ULNAR ARTERIES
RADIAL ARTERY
ULNAR ARTERY
THIS IS AN IMAGE IN THE PROXIMAL FOREARM.
TO ORIENT YOU THE RADIUS AND THE ULNA AS
WELL AS THE FLEXOR (VOLAR) AND EXTENSOR
(DORSAL) SURFACES ARE LABELED.
CAN YOU FIND THE RADIAL
ARTERY?
EXTENSOR
HOW ABOUT THE ULNAR
ARTERY?
CAN YOU IDENTIFY SOME OF
THE EXTENSOR MUSCLES
BRACHIORADIALIS
EXTENSOR CARPI RADIALIS LONGUS
BRACHIO
ECRL
ECRB
ED
EDM
R
ECU
U
EXTENSOR CARPI RADIALIS BREVIS
EXTENSOR DIGITORUM
EXTENSOR DIGITI MINIMI
EXTENSOR CARPI ULNARIS
FLEXOR
NOW WE ARE AT THE LEVEL OF THE MID
FOREARM. AGAIN IDENTIFY THE REGIONS OF
THE ULNAR AND RADIAL ARTERIES. WHAT
NERVES RUN WITH THESE VESSELS?
ULNAR ARTERY => ULNAR NERVE
RADIAL ARTERY => SUPERFICIAL
BRANCH OF THE RADIAL NERVE
WHAT ARE THESE OTHER 2
NEUROVASCULAR BUNDLES?
GREEN =>ANTERIOR
INTEROSSEOUS ARTERY AND
NERVE FROM MEDIAN NERVE
YELLOW => POSTERIOR
INTEROSSEOUS ARTERY AND
NERVE FROM DEEP BRANCH OF
THE
NOW WE ARE IN THE DISTAL FOREARM,
AGAIN NOTE THE POSITIONS OF THE ULNAR
AND RADIAL ARTERIES. LET’S TAKE A LOOK
AT SOME OF THE MUSCLES OF THE FLEXOR
COMPARTMENT AT THIS LEVEL. FIND THE
FLEXOR POLLICIS LONGUS AND THE FLEXOR
CARPI RADIALIS
FLEXOR DIGITORUM
SUPERFICIALIS AND
PROFUNDUS
FLEXOR CARPI ULNARIS
FPL
FCR
FDP
FDS
FCU
NOW WE ARE A FEW CMS PROXIMAL TO THE
WRIST JOINT, AGAIN THE RADIUS AND ULNA
ARE LABELED FOR YOU. CAN YOU DETERMINE
MEDIAN
WHICH IS THE FLEXOR AND EXTENSOR
NERVE
SURFACES BY THE SIZE OF THE MUSCLES.
HINT, FEEL YOUR WRIST
NOW TRY AND FIND BOTH THE
RADIAL AND ULNAR ARTERIES.
FEEL YOUR OWN RADIAL AND
ULNAR PULSES AS A GUIDE
NOW THAT YOU HAVE YOUR
BEARINGS, WHAT IS THIS
ROUND TUBULAR
STRUCTURE BETWEEN THE
FLEXOR POLLICIS LONGUS,
FLEXOR CARPI RADIALIS
TENDON AND THE FLEXOR
DIGITORUM SUPERFICIAILIS
HINT, IT CAUSES
PROBLEMS WITH CARPAL
TUNNEL SYNDROME
EXTENSOR
R
FPL
U
R
FCR
FDS
U
FLEXOR
NOW WE ARE JUST PROXIMAL TO THE LEVEL OF THE WRIST
JOINT. THE EXTENSOR TENDON ARE DIVIDED INTO 6
COMPARTMENTS #1 BEING ON THE RADIAL SIDE AND #6 BEING
ON THE ULNAR SIDE. THERE IS A BONY RIDGE IN THE DORSAL
ASPECT OF THE RADIUS THAT HELPS US DIVIDE THESE
COMPARTMENTS CALLED LISTER’S TUBERCLE DO YOU SEE IT?
NOW TRY AND DIVIDE THE EXTENSOR COMPARTMENTS.
COMPARTMENT 1
COMPARTMENT 2
COMPARTMENT 3
COMPARTMENT 4
COMPARTMENT 5
COMPARTMENT 6
TO REVIEW YOUR ANATOMY LOOK
UP THE COMPONENTS OF THESE
EXTENSOR COMPARTMENTS
LT
NOW WE ARE JUST DISTAL TO THE WRIST
JOINT. TRY AND LOCATE THE RADIAL
ARTERY, ULNAR ARTERY, ULNAR NERVE AND
MEDIAN NERVE
CAN YOU FIND THE FLEXOR
RETINACULUM? HINT IT IS
JUST SUPERFICIAL TO THE
MEDIAN NERVE
Radial artery
THIS THIN BLACK
LINE IS THE FLEXOR
RETINACULUM AND
THIS IS WHAT IS CUT
WITH A CARPAL
TUNNEL RELEASE
Median nerve
Ulnar artery and nerve
NOW WE ARE MORE DISTAL IN THE
CARPUS AT THE LEVEL OF THE HOOK OF
THE HAMATE. DO YOU SEE THE HOOK?
NOTE THE POSITIONS OF THE
RADIAL AND ULNAR ARTERIES AT
THIS LEVEL AND APPRICIATE HOW
THEY CONTRIBUTE TO THE
PALMAR ARCHES IN THE HAND
RADIAL ARTERY
HERE ARE THE
SUPERFICIAL AND DEEP
ULNAR ARTERIES AND
NERVES
HERE IS AN INJECTION OF A
RADIAL ARTERY FROM AN
ANGIOGRAM. NOW THAT
YOU HAVE SEEN ITS
APPEARANCE ON AXIAL
IMAGES, TRY AND
APPRECIATE ITS
RELATIONS SHIPS ON THIS
ANGIOGRAPHIC IMAGE
HERE IS AN INJECTION OF A
ULNAR ARTERY FROM AN
ANGIOGRAM. NOW THAT
YOU HAVE SEEN ITS
APPEARANCE ON AXIAL
IMAGES, TRY AND
APPRECIATE ITS RELATIONS
SHIPS ON THIS
ANGIOGRAPHIC IMAGE