Transcript Anatomy UE Forum 2011

Describe the lymphatic circulation of the mammary gland
Describe the characteristic features of Erb-Duchenne palsy and Klumpke’s paralysis
Describe the arterial supply of the hand and layers of the palmar region
Describe the cutaneous innervation of the upper limb
Describe the rotator cuff muscles and the avulsion fracture of the greater tubercle
Describe the scapular arterial anastomosis and its clinical importance
Describe the pathogenesis of claw hand, ape hand, hand of benediction and wrist drop
Describe the borders and content of the cubital fossa, medial and lateral axillary spaces
Describe the carpal tunnel syndrome and the Dupuytren’ s contracture
Describe the anatomical snuff box – borders, content
Describe the spinal chord levels associated with upper limb movements and reflexes
Describe the lymphatic circulation of the mammary
gland
• Mammary gland, pectoreal (anterior lymph
node), central, apical nodes
• To sublcavian trunk, to right subclavian
trunk, jugular vein (on right; thoracic duct
on left)
Describe the characteristic features of Erb-Duchenne
palsy and Klumpke’s paralysis
• Clinical correlates; pages 38-42 in lab book
• Erb is waiter’s tip
– No abduction, lateral rotation, arm flexors
• Klumpke’s is claw HAND
Describe the arterial supply of the hand and layers of
the palmar region
• Deep (radial a.) and superficial (ulnar a.) palmar arches
– Branches of the radial/ulnar arteries
• Radial is more the deep side
– supplies index, thumb as well
• SUper DR
– Superficial ulnar
– Deep Radial (interossei, lumbricals, deep muscles)
• Superficial branch splits into common digital arteries,
which go up to become the proper digital arteries
Describe the cutaneous innervation of the upper limb
• Cutaneous innervation map
Describe the rotator cuff muscles and the avulsion
fracture of the greater tubercle
• Subscapularis goes to the lesser tubercle
– Other 3 go to the greater tubercle
– Subscapularis would not be affected and would
medially rotate your arm; lateral rotators lost
• Not attached to lesser tubercle
– Originates from the subscapular fossa
• Medial rotators of arm
– 2 Majors and a Sexy Lady
• Pec/teres major, subscapularis, latissimus dorsi
Describe the scapular arterial anastomosis and its
clinical importance
• Transverse cervical (dorsal scapular artery)
– From subclavian
• Suprascapular artery
– From subclavian
• Circumflex scapular artery
– From the subscapular artery
• Importance= if one of the arteries is
blocked, there will still be a blood supply to
the muscles in the area
Describe the borders and content of the cubital fossa,
medial and lateral axillary spaces
• Tendon of biceps, brachial artery, median nerve
• Pronator teres on medial side, brachioradialis on
lateral side
• Triangular Space (t. minor over t. major)
– Circumflex scapular artery
• Quadrangular Space (long head of biceps
medially, humorous lat, t. minor superior, t. major
inferior)
– Axillary nerve, posterior circumflex artery
Describe the carpal tunnel syndrome and the
Dupuytren’ s contracture
• 3 benediction
– Dupuytren’s (palmar aponeurosis) Ulnar claw,
median (Ape hand)
• median nerve; dig. Superficialis, dig.
Profundus, flexor pollicis longus
– 10 things through the carpal tunnel
Describe the anatomical snuff box – borders, content
• Extensor pollicis longus (medial border),
extensor pollicis brevis (lateral), abductor
pollicis longus (lateral)
• Floor is scaphoid and trapezium
• Radial artery, nerve and cephalic vein are in
there
Describe the spinal chord levels associated with
upper limb movements and reflexes
• C5 (for biceps) tap the cubital fossa
• C6 (for brachioradialis) tap radial nerve
– Right before the distal portion of the radius
• C7 (for triceps) tap right above elbow joint
• C5-C6 is shoulder
• C5 is abduction (up), C6 is flexing, C7 is
extension of arm/forearm, C8 is wrist, T1 is
ab/adduction of fingers