Transcript Lecture # 15

UPPER EXTREMITY-2
DR VINIT K ASHOK
ADJUNCT FACULTY
BLOOD SUPPLY
• ARTERIAL SUPPLY
• -SUBCLAVIAN
ARTERY(NECK)
• - AXILLARY ARTERY( UPPER
ARM;UPTO LOWER BORDER
OF TERES MAJOR)
• BRACHIAL ARTERY(LOWER
PART OF ARM)
• RADIAL ARTERY( LATERAL)
• ULNAR ARTERY(
MEDIAL),COMMON
INTEROSSEOUS
• PALMAR ARCHES
• DIGITAL
VEINS OF UPPER LIMB
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SUPERFICIAL VEINS
DORSAL VENOUS NETWORK
CEPHALIC VEIN
BASILIC VEIN
AXILLARY VEIN( BASILIC+
BRACHIAL VEIN)
MEDIAN CUBITAL VEIN
MEDIAN VEIN OF FOREARM
DEEP VEINS
NAMED ACCORDING TO
COMPANIAN ARTERIES
RADIAL VEIN
ULNAR VEIN
BRACHIAL VEIN
AXILLARY VEIN
SURFACE ANATOMY
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ACROMION
CLAVICLE
DELTOID ( IM INJECTIONS)
HUMERUS
BICEPS MUSCLE
BICIPTAL GROOVE
BRACHILA PULSE( BLOOD
PRESSURE)
TRICEPS
OLECRNON PROCESS( PT OF THE
ELBOW)
MEDIAL /LATERAL EPICONDYLES
TRIANGLE
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CUBITAL FOSSA
MEDIAN CUBITAL VEIN- IV
CEPHALIC VEIN
ULNA
RADIUS
STYLOID PROCESS
RADIAL ARTERY( PULSE)
ULNAR ARTERY
ANATOMICAL SNUFF BOX
THENAR EMINENC
HYPOTHENAR EMINENCE
CARPAL TUNNEL
CUBITAL FOSSA
CUBITAL FOSSA
STYLOID PROCESS
ANATOMICAL SNUFF BOX
AXILLA( ARMPIT)
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PYRAMIDAL SPACE BETWEEN THE
UPPER LATERAL CHEST AND THE
INNERSIDE OF THE ARM
• BOUNDARIES
-APEX –( BETWEEN THE
CLAVICLE,SCAPULA AND 1ST RIB)
-BASE-(AXILLARY FASCIA)
-ANTERIOR ( PECTORALIS MAJOR AND
MINOR MUSCLES)
-POSTERIOR(
SUBSCAPULARIS,LATISSIMUS
DORSI AND TERES MAJOR)
MEDIAL- ( FIRST 4 RIBS AND
SERRATUS ANTERIOR MUSCLE)
LATERAL-( BICEPETAL GROOVE OF
THE HUMERUS)
• CONTENTS
-AXILLARY LYMPH NODES
-AXILLARY ARTERY /VEIN
-BRACHIAL PLEXUS
BRACHIAL PLEXUS
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PLEXUS- IS A NETWORK OF
NERVES
BRACHIAL PLEXUSFOUND IN THE NECK AND AXILLA
FORMED BY VENTRAL RAMI OF C5C8 AND T1 ( THERE MAY BE
CONTRIBUTIONS FROM C4, T2)
GIVES RISE TO NERVES THAT
SUPPLY THE UPPER LIMB
FORMATION
ROOTS- C5-C8 AND TI( VENTRAL
RAMI)
TRUNKS-UPPER , MIDDLE, LOWER
DIVISONS-ANTERIOR/POSTERIOR
CORDSMEDIAL/LATERAL/POSTERIOR
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ROOTS
C5
C6
C7
C8
T1
FORMATION OF TRUNKS
UPPER
MIDDLE
LOWER
FORMED IN
THE NECK
DIVISIONS AND CORDS OF
BRACHIAL PLEXUS
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TRUNKS
UPPER TRUNK
DIVISIONS
PINKANTERIOR
DIVISION
CORDS
LATERAL CORD-ANTERIOR
DIVISIONS OF UPPER AND
MIDDLE TRUNK
POSTERIOR CORDPOSTERIOR DIVISIONS OF ALL
TRUNKS
MIDDLE TRUNK
MEDIAL CORD-ANTERIOR
DIVISION OF LOWER TRUNK
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LOWER TRUNK
BLUE POSTERIOR
DIVISION
CORDS ARE NAMED
ACCORDING TO THEIR
RELATIVE POSITIONS TO THE
AXILLARY ARTERY
BRACHIAL PLEXUS
NERVES ARISING FROM THE
CORDS
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MEDIAL CORD
MEDIAL CUTANEOUS NERVE OF ARM- CUTANEOUS SUPPLY
TO SKIN
MEDIAL CUTANEOUS NERVE OF FOREARM-CUTANEOUS
SUPPLY TO THE SKIN
MEDIAL ROOT OF MEDIAL NERVE- JOINS WITH LATERAL
ROOT TO FORM MEDIAN NERVE
ULNAR NERVE
MEDIAL PECTORAL NERVE
LATERAL CORD
LATERAL ROOT OF MEDIAN NERVE
MUSCULOCUTANEOUS NERVE
LATERAL PECTORAL NERVE
NERVES FROM THE POSTERIOR
CORD
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1. UPPER SUBSCAPULAR NERVE
2.LOWER SUBSCAPULAR NERVE
3.THORACODORSAL NERVE
4. RADIAL NERVE
5. AXILLARY NERVE
IMPORTANT NERVES AND AREA
OF SUPPLY
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1. MEDIAN NERVE( FORMED FROM BOTH MEDIAL AND LATERAL
CORD)A) SUPPLIES ALL THE FLEXORS OF THE FOREARM( EXCEPT FLEXOR
CARPI ULNARIS AND MEDIAL HALF OF FDP)
B) INTRINSIC MUSCLES IN THE LATERAL PALM INCLUDING THENAR
EMINENCE)
2. ULNAR NERVE
A) SUPPLIES THE MEDIAL HALF OF FDP AND THE FLEXOR CARPI
ULNARIS
B) SUPPLIES MOST OF THE INTRINSIC MUSCLES OF THE HAND
INCLUDING THE HYPOTHENAR EMINENCE, AND SKIN ON THE
MEDIAL SIDE OF THE HAND
CLINICAL APPLICATION
*INJURY TO MEDIAN NERVE-” APE HAND”
INJURY TO ULNAR NERVE-” CLAW HAND”
INPORTANT NERVES AND THEIR
AREA OF SUPPLY
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A)
MUSCULOCUTANEOUS NERVE
SUPPLIES THE BICEPS, CORACOBRACHIALIS AND BRACHIALIS
AXILLARY NERVE
SUPPLIES THE DELTOID AND TERES MINOR MUSCLE
SUPPLIES THE SHOULDER JOINT
RADIAL NERVE
SUPPLIES THE TRICEPS
SUPPLIES THE BRACHIORADIALIS
SUPPLIES MOST OF THE EXTENSORS OF THE FOREARM
* INJURY RESULTS IN “ WRIST DROP”
CARPAL TUNNEL
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TUNNEL FORMED BETWEEN THE CONCAVITY OF THE CARPAL
BONES AND A LIGAMENT THAT COVERS THIS( FLEXOR
RETINACULAM)
• TENDONS OF THE FLEXORS PASS THROUGH
• MEDIAN NERVE ALSO PASSES THROUGH
• CROWDED TUNNEL
CARPAL TUNNEL SYNDROME
- CAUSED DUE TO COMPRESSION OF THE NERVE IN THE TUNNEL
- CAUSES- 1. SWELLING OF THE TEDONS( OVERUSE)
- 2. PREGNANCY( EDEMA)
- 3. ARTHRITIS
SYMPTOMS- TINGLING OR NUMBNESS-LATERAL PART OF HAND,
WEAKNESS IN THUMB MOVEMENT
TREATMENT- REST, SPLINTING,ANTI-INFLAMMATORY DRUGS, SURGERY
CUBITAL FOSSA
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TRIANGULAR DEPRESSION ON
THE ANTERIOR ASPECT OF
ELBOW
BOUNDARIES
-BASE- LINE DRAWN BETWEEN THE
EPICONDYLES OF THE HUMERUS
LATERAL BOUNDARYBRACHIORADIALIS
MEDIAL BOUNDARY- PRONATOR
TERES
APEX- WHERE THE MEDIAL AND
LATREAL BOUNDARY MEET
CONTENTS
1.
MEDIAL CUBITAL VEIN
2.
BRACHIAL ARTERY
3.
TENDON OF THE BICEPS
CUTANEOUS INNERVATION
OF HAND( ANTERIORLY)
LATREAL 31/2 FINGERS
AND LATERAL PALM –
MEDIAN NERVE
MEDIAL 11/2 FINGERS AND
MEDIAL PALM- ULNAR
NERVE
CUTANEOUS NERVE SUPPLY HAND (
POSTERIORLY)
MEDIAL 11/2 FINGERS AND HAND- ULNAR
NERVE
TIPS OF FINGERS LATERAL 31/2
FINGERS- MEDIAN NERVE
REST OF LATERAL 31/2 FINGERS AND
HAND - RADIAL NERVE