Transcript The Upper Extremity

The Upper Extremity
Bones,
Muscles,
Vessels,
Medical ppt http://hastaneciyiz.blogspot.com
Bones
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30 bones!!!!
Appendicular skeleton
Pectoral girdle
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Allows for mobility
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Glenoid cavity
Attachments
Upper extremity:
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Arm
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Forearm
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Radius, ulna (interosseous
membrane)
Hand
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humerus
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
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Distal radius with proximal row of
carpals
Intercarpal joints
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Synovial-plane
Carpal-metacarpal (2-5)
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Synovial-plane
Trapezium-metacarpal 1
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Synovial-saddle
Metacarpal-phalangeal
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Synovial-condyloid
Interphalangeal
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Synovial-hinge
ALL DIARTHROSES
Review of Naming…..
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What do the following names TELL
you about the muscle?
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Naming
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Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor pollicis longus
Pronator quadratus
Extensor carpi radialis brevis
Scapula Muscles
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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
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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
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Origin on scapula
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Subscapularis and
teres major
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Suprascapular
Axillary
Latissimus Dorsi
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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
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
Bracioradialis
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
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
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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
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Subclavian (neck)
Axillary (armpit)
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Brachial (arm)
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Deep brachial
Radial (forearm)
Ulnar (forearm)
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Subscapular
Circumflex humeral arteries
Common Interosseous
Superficial & Deep Palmar
arches
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Digital
Axilla
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Armpit!!
Where axillary hairs grow
Boundaries
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Ventral
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Dorsal
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Serratus ventralis
Lateral
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Latissimus dorsi, teres major,
subscapularis
Medial
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Pectoral muscles
Bicipital groove of humerus
Contents
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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
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Cephalic vein
Cubital Fossa
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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
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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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Lateral = E.pollicis brevis
Medial = E. pollicis longus
Floor = scaphoid, styloid of radius
Contains Radial Artery (pulse)
Brachial Plexus
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Nerve plexus
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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
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Small contributions from C4 and
T2
Ventral Rami
Brachial Plexus
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Really Tired? Drink Coffee Buddy!
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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
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C5
C6
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C7
Middle Trunk
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C8
T1
Lower Trunk
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Trunks Split to form Divisions! (in neck)
Trunks
Divisions
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Upper
Anterior
Posterior
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Middle
Anterior
Posterior
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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)
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Lateral
Musculocutaneous
Median
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Medial
Ulnar
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Posterior
Radial
Axillary
(thoracodorsal)
(subscapular)
Put it all together……..
Brachial Plexus – Cords and Branches
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Lateral
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Medial
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Musculocutaneous
Median
Ulnar
Posterior
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Radial
Axillary
Thoracodorsal
Subscapular
Lateral Cord
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Musculocutaneous nerve
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Off lateral cord
Course:
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Innervates:
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Anterior arm
Becomes cutaneous and gives skin sensation to lateral forearm
Corocobrachialis (motor)
Biceps brachii (motor)
Brachialis (motor)
Skin distal to the elbow (sensory)
Suprascapular
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Runs with suprascapular artery and vein {C5, C6}
Innervates
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Supraspinatus
Infraspinatus
Medial Cord
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Ulnar nerve
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Course:
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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:
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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
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Median nerve
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Course:
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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 to lateral palmar intrinsics
Innervates:
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Anterior forearm (motor)
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Most flexors, some intrinsics (thumb)
2/3 Lateral palm (sensory)
Dorsum of fingers 2 and 3 (sensory)
Posterior Cords
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Radial nerve
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Largest branch of brachial plexus
Comes from posterior cord
Course:
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Through arm
Around humerus
Around lateral epicondyle (then divides)
Innervates:
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Posterior muscles of arm and forearm
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Triceps brachii, anconeus, supinator, brachioradialis
Divides in forearm:
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Superficial
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Skin of arm and dorsolateral surface of hand
Deep
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Extensor muscles of forearm (eg E. carpi radialis L + B)
Posterior Cord
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Axillary nerve
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Branches off posterior cord
Course:
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Innervates:
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Deltoid and teres minor (motor)
Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve
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Innervates:
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Runs posterior to humerus
Runs with caudal humeral circumflex artery
Subscaplaris, Teres major
Thoracodorsal nerve
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Course:
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Runs with thoracodorsal artery and nerve
Innervates:
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Latissimus dorsi
Cutaneous Innervation to Hand
Nerve Damage
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Ulnar nerve
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“Claw hand”
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Median nerve
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“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
Medical ppt http://hastaneciyiz.blogspot.com