muscles of upperlimb

112
ANATOMY OF UPPER LIMB BY Dr.TEJASWI DUSSA PG IN MS (ORTHO) GANDHI HOSPITAL

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Transcript of muscles of upperlimb

Page 1: muscles of upperlimb

ANATOMY OF UPPER LIMB

BYDr.TEJASWI DUSSAPG IN MS (ORTHO)GANDHI HOSPITAL

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MUSCLES OF UPPER LIMB

Attachments Nerve Suply Blood Supply Actions & Clinical Testing.

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ATTACHMENTS OF UPPER LIMB TO THE AXIAL SKELETON

BONY CONNECTION -

CLAVICLE

MUSCULAR ATTACHMENTS

Trapezius, Latissmus Dorsi, Levator Scapulae, Rhomboideus

Major, Rhomboideus

Minor

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TRAPEZIUS

ORIGIN: External occipetal protuberance, Superior nuchal line of occipetal bone, Spinous processes of 7th cervical and All thoracic

vertebrae INSERTION: lateral 1/3 of clavicle, Medial margin

of acromion, spine of scapula ACTION: Elevates The Scapula , rotation of

scapula, retraction of shoulder, draw the scapula downwards and Abduction Of Shoulder Beyond 90*

N.SUPPY:XI cranial nerve (SPINAL ACCESSORY .N)

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TREPEZIUS

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LATISSIMUS DORSI ORIGIN: posterior layer of

thoraco lumbar fascia, Spinous processes of lower

6 thoracic vertebrae and Caudal most 3-4 ribs, May attach to iliac crest. INSERTION:

Intertubercular groove of the humerus.

ACTION: extends, adducts and medial rotation of arm

N.SUPPLY: THORACO DORSAL .N (C6,C7,C8)

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LEVATOR SCAPULAE

ORIGIN: transvers processes of upper 4 cervical vertebrae.

INSERTION: medial border of the scapula superior portion.

ACTION: elevation of sup.angle of scapula and draws it medially.

N.SUPPY: C3,C4,C5 Nerves

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RHOMBOIDUS MINOR

ORIGIN: ligamentum nuchae,spinous process of c7,t1 vertebrae

INSERTION : medial border of the scapula

ACTION : retracts, depress the scapula and fix it to thoracis wall

N.SUPPLY :Dorsal Scapular .N (C4,C5)

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RHOMBOIDUS MAJOR

ORIGIN: Spinous process of t2-t5

INSERTION: medial border of the scapula, inf.angle

ACTION: retracts the scapula, depress the glenoid cavity and

fix the scapula to the thoracis wall

N.SUPPLY: Dorsal Scapular .N (c4,c5)

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RHOMBOIDS (c4,c5)

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MUSCLES OF PECTORAL REGION

PECTORALIS MAJOR PECTORALIS MINOR SUBCLAVIUS

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PECTORALIS MAJOR

ORIGIN: sternal half of the clavicle, Upper half of sternum,

aponeurosis of ext.obl.muscle,

INSERTION : lateral lip of intertubercular sulcus

ACTIONS: adduction, medial rotation and flexion of the shoulder.

N.SUPPLY: Med & Lat Pectoral.N (C5-8,T1)

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PECTORALIS MAJOR

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PECTORALIS MINOR

ORIGIN: costocondral jn.of 3,4,5 ribs

INSERTION: corocoid process medial &upper surface

ACTIONS: draws the scapula forwards, depression of the shoulder.

N.SUPPLY: Med & Lat Pectoral.N (C5-C8,T1)

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SUBCLAVIUS

ORIGIN: 1st rib at the costochondral jn.

INSERTION: subclavian groove of the clavicle

ACTION:steadies the clavicle

N.SUPPLY: N.Subclavius from upper trunk of B.P (c5,c6)

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SERRATUS ANTERIOR

ORIGIN: outer and superior surface of the 1-8 ribs

INSERTION: superior angle, medial border and inferior angle of the scapula

ACTION: rotates scapula upwards,

abduction of shoulder above 90*

N.SUPPLY: Long Thoracis.N (c5,c6,c7)

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WINGING OF SCAPULA

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MUSCLES OF SHOULDER GIRDLE

Deltoid Rotator cuff muscles- Supra Spinatus

Infra

Spinatus,

Subscapularis,

Teres Minor.

Teres major

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DELTOID ORIGIN Lateral 1/3 clavicle,

sup.surface of acromion, spine of the scapula.

INSERTION: deltoid tuberosity. ACTION: abduction of arm, flx.&.ext of arm, med.& lat. rotation. N.SUPPLY: Axillary.N

(C5,c6)

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DELTOID

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SUPRASPINATUS

ORIGIN: supraspinatous fossa of the scapula

INSERTION: superior facet on the gr.tubercle of the humerus

ACTION: initiation of abduction (15*) & lat. Rotation

N.SUPPLY: Suprascapular.N From B.P (C5,C6)

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SUPRASPINATUS

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INFRASPINATUS ORIGIN: infraspinatous

fossa of the scapula INSERTION: middle

facet on the gr.tubercle of the humerus

ACTION: lat.rotation of

shoulder, strengthen the shoulder by bracing the head of humerus.

N.SUPPLY: Suprascapular .N of

B.P (C5,c6)

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INFRASPINATUS

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TERES MINOR

ORIGIN: lat.borderof the scapula

INSERTION: inf.facet on the gr.tubercle of the humerus

ACTION: ext.rotator & weak adductor

N.SUPPLY: Axillary .N.(C5,C6)

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SUBSCAPULARIS

ORIGIN: medial 2/3 subscapular fossa,

lat border of tha scapula INSERTION: lesser tubercle of

the humerus ACTION: stabilise the shoulder &

prevents anterior displacement of the shoulder (med. rotation, adduction of arm)

N.SUPPLY: Upper &Lower Subscapular .N (c5,c6)

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SUBSCAPULARIS

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ROTATOR CUFF

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TERES MAJOR

ORIGIN: dorsal surface of the inf.angle of the scapula

INSERTION: med.lip of the intetubercular groove of the humerus

ACTION: extends the arm from

flexd.position & it adducts, med.rotates the arm

N.SUPPLY: Lower Subscapular (C6,C7)

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MOVEMENTS OF THE SHOULDER Flexion Extension Abduction Adduction Internal rotation, External rotation circumduction

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FLEXION

Pect.Mojor Anterior Fibers Of

Deltoid Coraco brachialis

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EXTENSION

Lattismus Dorsi Teres Major Posterior fibers

Deltoid

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ABDUCTION

Supraspinatous (15*)

Deltoid (15-90*) Serratus Anterior

(>90*) Trapezius (>90*)

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ADDUCTION

Lattismus Dorsi Pectoralis Major Subscapularis Teres Minor Teres Major CORACO BRACHIALIS

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INTERNAL ROTATION

Pectoralis Major Ant.Deltoid Subscapularis Teres Major Lattismus Dorsi

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EXTERNAL ROTATION

Deltoid Supraspinatus Infraspinatus Teres Minor

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MUSCLES OF ARM

FLEXOR COMPARTMENT: BICEPS BRACHII

CORACO BRACHIALIS BRACHIALIS

EXTENSOR COMPARTMENT TRICEPS

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BICEPS BRACHII ORIGIN: Long head: supra glenoid

tubercle of the scapula Short head: apex of the

coracoid process INSERTION: Radial Tuberosity ACTION: flexor of supinated

forearm Powerful Supinator Of

Partially Flexed Forearm N.SUPPLY: musculo

cutaneous.N (c5,c6)

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BICEPS BRACHI

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CORACO BRACHIALIS

ORIGIN: coracoid process of the scapula

INSERTION: middle of medial surface of the humerus

ACTION: flexes and adducts the arm

N.SUPPLY: musculocutaneous .N (c6,c7)

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BRACHIALIS

ORIGIN: distal half of the anterior humerus

INSERTION :coronoid process, tuberosity of ulna

ACTION: Powerful Flexor Of Forearm

N.SUPPLY: Musculocutaneous .N (C5,C6,C7)

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MUSCULOCUTANEOUS NERVE :C5,C6,c7

Biceps Brachii

Brachialis

coracobrachialis

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TRICEPS ORIGIN: Long head: infraglenoid

tubercle of the scapula Lat.head: oblique ridge

on upper surface above the radial groove

Medial head: posterior surface of the humerus inf.to the radial groove

INSERTION: proximal olecrenon of the ulna

ACTION:extends the forearmN.SUPPLY: Radial .N.(C7,c8)

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TRICEPS

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MOVEMENTS AT ELBOW

FLEXION Brachialis Biceps

EXTENSION Triceps

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MUSCLES OF FOREARM

Anterior Compartment:

common flx.origin SUPERFICIAL 1.Pronator Teres 2.Flx Carpi Ulnaris 3.Palmaris Longus 4.Flx.Carpi Radialis 5.Flx.Digitorum Superficialis (sublimus) DEEP: 1.Flx.Digitorum Profundus 2.Flx.Pollicis Longus 3.Pronator Quadratus

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POSTERIOR COMPARTMENT

SUPERFICIAL: 1. Anconeus 2.Brachioradialis

3.Ext.Carpi Radialis Longus 4.Ext.Carpi Radialis Brevis

5.Ext.Digitorum 6.Ext.Digiti Minimi 7.Ext.Carpi Ulnaris DEEP 1.Abductor Pollicis Longus 2.Ext.Pollicis Brevis 3.Ext.Pollicis Brevis 4.Ext.Indicis 5.Supinator

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PRONATOR TERES

Insertion: midway long the lateral surface of the radius

Action: pronation,flexion of forearm

N.Supply:Median.N (C6c7)

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PRONATOR TERES

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FLX.CARPI RADIALIS

INSERTION:base of the 2nd mc bone and slip to the bace of the 3rd MC bone

ACTION: flexion and abduction of wrist

N.SUPPLY: Median.N (c6,c7)

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PALMARIS LONGUS

INSERTION: anterior aspect of the distal flx.retinaculum and palmar aponeurosis

ACTION: flx.the wrist, and tightens the palmar.aponeurosis

N.SUPPLY: Median. N (c6,c7)

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FLX CARPI ULNARIS

ORIGIN: humoral head: med

epicondyle Ulnar head:med.margin of

the olecrenon,posterior border of the ulna

INSERTION: pisiform, hook of hamate, base of the

5th MC & flx.retinaculum ACTION:flexes and adducts

the hand N.SUPPLY: Ulnar.N (C7,C8)

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FLX.CARPI ULNARIS

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FLX.DIGITORUM SUPERFICIALIS

ORIGIN: humeroulnar head:

med.epicondyle of the humerus, coronoid process

Radial head: sup.half of anterior aspect

of the radius INSERTION : bodies of the

Middle phalanges of the medial 4 digits

ACTION: flx.of all joints it crosses

N.SUPPLY :Median .N (C7,C8,T1)

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FLX.DIGITORUM PROFUNDUS

ORIGIN:prox.3/4 of the medial and anterior aspect of the ulna and from interosseous memb.

INSERTION:base of The Diatal phalanges of the medial 4 digits

ACTION: flx.DIP,,PIP,MP, wrist

N.SUPPLY: Medial-ulnar.N (C8,t1) Lateral-AIN Of Median.N

(C8,t1)

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FLX.DIGITORUM PROFUNDUS

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FLX.POLLICIS LONGUS

ORIGIN: upper 3/4 of anterior surface of radius

INSERTION: base of distal phalanx of the thumb

ACTION: flexion of proximal & distal phalnx of the thumb

N.SUPPLY:AIN (C7,C8,T1)

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FLX.POLLICIS LONGUS

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PRONATOR QUADRATUS

ORIGIN: lower 1/4th of anterior surface of ulna

INSERTION: lower 1/4th of anterior surface of radius

ACTION :pronation N.SUPPLY:AIN

(C8,T1)

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POSTERIOR COMPARTMENT OF FOREARM

SUPERFICIAL1.anconeus2.Brachioradialis3.Ext.Carpi Radialis

Longus4.Ext.Carpi Radialis

Brevis5.Ext.Digitorum6.Ext.Digiti Minimi7.Ext.Carpi Ulnaris

DEEP1.Abductor Pollicis

Longus2.Ext.Pollicis longus3.Ext.Pollicis brevis4.Ext.Indicis5.supinator

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ANCONEUS

ORIGIN: posterior surface of the lat.epicondyle

INSERTION:lateral surface of olecranon,body of ulna

ACTION: extension of forearm

N.SUPPLY: radial.n

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BRACHIORADIALIS

ORIGIN: prox.2/3rd of lat.supracondylar ridge of humerus, lateral intermuscular septum

INSERTION: lat.aspect of distal radius just prox.to the styloid process

ACTION: acc.flexor of elbow

N.SUPPLY: Radial.N (C5,C6)

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BRACHIORADIALIS

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EXT.CARPI RADIALIS LONGUS ORIGIN:

lat.supracondylar ridge of humerus

INSERTION: base of the 2nd MC bone

ACTION: extends and abducts the hand

N.SUPPLY: Radial .N (C6,C7)

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EXTENSOR CARPI RADIALIS BREVIS ORIGIN:

lat.epicondyle of the humerus

INSERTION: base of the 3rd MC bone

ACTION: extends and abducts the wrist

N.SUPPLY: deep br.of radial .N(c7c8)

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EXTENSOR DIGITORUM

ORIGIN: lat epicondyle of the humerus

INSERTION: Extensor Expansions Of The Medial 4 digits

ACTION: extension at MCP, IP joints, ext of wrist when the fingers are extended

N.SUPPLY: PIN (c7,c8)

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EXTENSOR DIGITI MINIMI

ORIGIN:lat epicondyle of the humerus

INSERTION:extensor expansion of the 5th digit

ACTION: ext.of 5th digit at MC, PIP , ext of wrist when little finger in

extension N.SUPPLY:PIN (c7,c8)

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EXT.CARPI ULNARIS

ORIGIN:2 heads lat epicondyle of

humerus, Posterior border of

ulna INSERTION:medial

side of the base of the 5th MC

ACTION: extends and adducts the hand

N.SUPPLY:PIN (c7c8)

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SUPINATOR

ORIGIN: lat epicondyle of humerus,

radial collateral lig., annular lig.,supinator

fossa, crest of ulna INSERTION:

lateral,posterior,anterior surface of prox 1/ 3rd 0f radius

ACTION:supination N.Supply: deep Br.Of

Radial.N (C5,c6)

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SUPINATOR

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ABDUCTOR POLLICIS LONGUS

ORIGIN:upper parts of the posterior surface of the radius & ulna and interosseous mem.

INSERTION:base of the 1st MC bone

ACTION: abducts,extends, lat.rotates the thumb at carpometacarpal joint, & abducts the wrist.

N.SUPPLY:PIN (c7,c8)

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EXTENSOR POLLICIS BREVIS

ORIGIN:posterior surface of the radius below the origin ofAbductor Pollicis longusand from interosseous mem.

INSERTION:base of the prox.phalanx of the thumb

ACTION:extends pox.phalanx of the thumb at MC joint, ext.at 1st carpometacarpal joint

N.SUPPLY:PIN (c7,c8)

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EXT.POLLICIS LONGUS

ORIGIN: posterior surface of middle 1/3rd of ulna

And interrosseous mem. INSERTION:base of the

diastal phalanx of the thumb ACTION:extends distal

phalanx of the thumb at MP joint,IP joint.and it can contribute abduction of the thumb

N.SUPPLY:PIN (c7,c8).

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EXTENSOR INDICIS

Origin:posterior surface of ulna m/3rd below the EPL

Insertion:extensor expansion of the 2nd finger

Action: ext of index finger and wrist.

N.supply:PIN (c7,c8)

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EXM.MOVEMENTS OF FOREARM MUSCLES

Flexion Extension Adduction Abduction

AT RADIO ULNAR JOINT Supination pronation

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FLEXION

pronator teresFlx.carpi radialisFlx.carpi ulnarisFlx.digitorum

superficialisFlx. Digitorum

profundusPalmaris longusbrachioradialis

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EXTENSION

Anconeus Ext.Carpi Radialis

Longus Ext.Carpi Radialis

Brevis Ext.Digitorum Ext.Indisis Ext.Carpi Ulnaris Ext. Digiti Minimi Abductor Pollicis

Longus

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ADDUCTION flexor carpi ulnaris extensor carpi

ulnaris

ABDUCTION flx.carpi radialis ext.carpi radialis

longus Ext.carpi radialis

brevis Abductor pollicis

longus

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PRONATION pronator teres Pronator

quadratus

SUPINATION biceps supinator

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INTRINSIC MUSCLES OF THE HAND

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Thenar muscles abductor pollicis brevis flx.pollicis brevis opponens pollicis Adductor

pollicis Hypothenar muscles- palmaris brevis abductor digiti

minimi flx.digiti minimi opponens digiti

minimi Lumbricals -4 Palmar interossei-4 Dorsal interosei-4

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THENAR MUSCLES

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ABDUCTOR POLLICIS BREVIS

ORIGIN: flx.retinaculum, tubercle of scaphoid, trapezium

INSERTION: lat.side of the base of the prox.phalax of the thumb

ACTION: abduction at carpometacarpal,MP joints

N.SUPPLY: recurrent br.of median.n (c8t1)

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ABDUCTOR POLLICIS BREVIS

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FLX.POLLICIS BREVIS

ORIGIN:2 heads suf.head: flx.retinaculum & trapezium bone Deep head: floor of carpal canal overlies the

trepezoid,capitate INSERTION: lateral side of the 1st metacarpal

bone and base of the prox phalanx ACTION: flexes the prox.phalanx of the thumb

at MCP and med.rotation at carpometacarpal joint

N.SUPPLY: SEPERFICIAL HEAD: median.n (c8,t1) DEEP HEAD: Deep Br.Of Ulnar Nerve

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FLX.POLLICIS BREVIS

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OPPONENS POLLICIS

ORIGIN: flex.retinaculum, trapezium bone

INSERTION :lat.half of the palmar surface of the 1st metacarpal bone

ACTION: oppositioin of te thumb in combination of flexion and med.rotation

N:SUPPLY: Media.N (C8,t1)

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ADDUCTOR POLLICIS

ORIGIN: 2heads oblique head : bases of 2nd 3rd

metacarpals and capitate bone Transverse head: anterior

surface of 3rd metacarpal bone INSERTION: base of

prox.phalanx of the thumb ACTIONS: adducts tha

prox.phalanx of the thumb N.SUPPLY: DEEP BR.OF ULNAR NERVE

(C8, T1)

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ADDUCTOR POLLICIS

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HYPOTHENAR MUSCLES

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PALMARIS BREVIS

ORIGIN: flx.retinaculum,palmar aponeurosis

INSERTION: skin along the medial border of the hand

ACTION:helps in gripping by wrinkling of skin over it

N.SUPPLY:Ulnar.N Suf.Br.

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ABDUCTOR DIGITI MINIMI

ORIGIN: pisiform bone,the tendon of the flx.carpi ulnaris

INSERTION :medial side of the base of the prox.phalanx of the 5th digit

ACTION:abducts th 5th digit

N.SUPPY: Deep Br.Of Ulnar .N (C8,t1)

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ABDUCTOR DIGITI MINIMI

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FLX.DIGITI MINIMI

ORIGIN : hook of hamate,flx.retinaculum

INSERTION :medial aspect of the base of the prox.phalanx of little finger

ACTION: flex theprox phalanx of 5th digit at MCP joint

N.SUPPLY: Deep Br. Of Ulnar.N (C8,T1)

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OPPONENS DIGITI MINIMI

ORIGIN:hook of hamate, flx.retinaculum

INSERTION:body of the 5th metacarpal.

ACTION: abducts, flexion,lat.rotates the 5th metacarpal

N.SUPPLY: deep br.of ulnar.N (C8,T1)

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LUMBRICALS

ORIGIN: 1&2 lumbrical arise from the 2 lateral tendon of th

flx.digitorum profundus. 2&4 arises from the medial tendons of the

flx.digitorum profundus

INSERTION : lateral side of the ext.expansion of medial 4 digits.

ACTION: flex the MCP, extends the IP N.SUPPLY: 1&2 lumbrical- Median .N (C8,t1) 3&4 lumbrical- Deep Br.Of Ulnar .N(c8,t1)

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PALMAR INTEROSSEI

ORIGIN: palmar interossei arises from palmar surface of the metacarpal bones of 2,4,5 digits

INSERTION: extensor expansion of the digit and bases of the prox.phalanx of the 2,4,5 digits

ACTION: Adduts The Fingers At

MCP, assists flexion at MCP, extension at IP

N.SUPPLY: deep br. Of unlar .n (C8,T1)

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PALMAR INTEROSSEI

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Dorsal interossei

ORIGIN: adjacent sides of the metacarpal bones

INSERTION: base of the prox.phalanx and in to the aponeurosis that forms ext.expansion

ACTION: abducts the fingers,flex the MCP

N.SUPPLY: Deep Br.Of Ulnar .N (C8,t1)

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Dorsal interossei

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Dorsal interossei

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Parts of Brachial Plexus

Really Tired? Drink Coffee

Buddy!

R = ROOTS (ventral rami) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES

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Roots join to form Trunks! (in neck)

• Ventral Rami Trunks

• C5 Upper Trunk• C6• C7 Middle Trunk• C8• T1 Lower Trunk

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Trunks Split to form Divisions : (in neck)• Trunks Divisions

• Upper AnteriorPosterior

• Middle Anterior

Posterior

• Lower Anterior Posterior

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Divisions Join to form Cords! (in axilla)

U A P

M A P

L A P POSTERIOR

CORD

LATERAL CORD

MEDIAL CORD

Trunks DivisionsCords

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Cords Give off Branches!! (in axilla)

Lateral Musculocutaneous

Median

Medial Ulnar

Posterior RadialAxillary

(thoracodorsal)(subscapular)

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Injury of the brachial plexus

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