The Upper Extremity Bones, Muscles, Vessels,. Bones 30 bones!!!! Appendicular skeleton Pectoral...
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Transcript of The Upper Extremity Bones, Muscles, Vessels,. Bones 30 bones!!!! Appendicular skeleton Pectoral...
The Upper Extremity
Bones, Muscles, Vessels,
Bones 30 bones!!!! Appendicular skeleton Pectoral girdle
Scapula Clavicle
Allows for mobility Ball and socket attachments
Upper extremity: Arm
humerus Forearm
Radius, ulna (interosseous membrane)
Hand Carpals, metacarpals, phalanges
Review bones and landmarks studied in lab!!!
Glenoid cavity
Joints of Upper Extremity
Sternoclavicular Synovial-saddle Diarthrosis
Acromioclavicular Synovial-plane Diarthrosis
Glenohumeral joint Synovial-ball&socket Diarthrosis Many ligaments Muscle reinforcement Great Mobility
Joints of the Upper Extremity
Elbow Joint Synovial – hinge Diarthrosis
Articulations Humerus & Ulna Humerus & Radius
Many Ligaments
Joints of Upper Extremity
Proximal Radioulnar joint Synovial - pivot Diarthrosis
Distal Radioulnar joint Synovial – pivot Diarthrosis
Allows pronation and supination of forearm
Radiocarpal joint Synovial-condyloid Distal radius with proximal row of
carpals Intercarpal joints
Synovial-plane Carpal-metacarpal (2-5)
Synovial-plane Trapezium-metacarpal 1
Synovial-saddle Metacarpal-phalangeal
Synovial-condyloid Interphalangeal
Synovial-hinge ALL DIARTHROSES
Joints of the Upper Extremity
Review of Naming…..
What do the following names TELL you about the muscle? Naming
Flexor carpi ulnaris Flexor digitorum superficialis Flexor pollicis longus Pronator quadratus Extensor carpi radialis brevis
Scapula Muscles If the origin is on the
scapula – moves the arm Subscapularis Supraspinatus Infraspinatus Teres Minor Teres Major Latissimus Dorsi (partial
attachment) Coracobrachialis
RotatorCuff
Scapula Muscles
If the insertion is on the scapula – moves the scapula Rhomboids Trapezius Pectoralis Minor Serratus Ventralis Levator Scapulae
Use location of Insertion to determine movement!!
Scapula Innervation
Origin on scapula Subscapularis and
teres major Subscapular
Supraspinatus and Infraspinatus Suprascapular
Teres Minor Axillary
Latissimus Dorsi Thoracodorsal
Coracobrachialis Musculocutaneous
Insertion on scapula Rhomboids and Levator
Scapulae Dorsal scapular
Trapezius Accessory
Pectoralis Minor Medial and Lateral
Serratus Ventralis Long thoracic
Muscles of the Rotator CuffAll INSERT on the humerus
MuscleMuscle OriginOrigin ActionAction
SubscapularisSubscapularis Subscapular fossaSubscapular fossa Medial rotator of Medial rotator of the humerusthe humerus
infraspinatusinfraspinatus Infraspinous Infraspinous fossafossa
Lateral rotator of Lateral rotator of the humerusthe humerus
Teres minorTeres minor Lateral border of Lateral border of scapula (upper scapula (upper 2/3)2/3)
Lateral rotator of Lateral rotator of the humerusthe humerus
supraspinatussupraspinatus Supraspinous Supraspinous fossafossa
Abducts the Abducts the humerushumerus
Muscles of the Scapula *All these muscles INSERT on the scapula
MuscleMuscle OriginOrigin ActionActionTrapeziusTrapezius Ligamentum Ligamentum
nuchae and C7-T12nuchae and C7-T12Elevates, adducts, Elevates, adducts, rotates, and rotates, and depresses the depresses the scapulascapula
Levator Scapulae Levator Scapulae ventralisventralis
C1-C4C1-C4 Elevates the Elevates the scapula, flexes scapula, flexes neck laterallyneck laterally
RhomboidsRhomboids C7-T5C7-T5 Adduct, elevate, Adduct, elevate, and rotate the and rotate the scapulascapula
Pectoralis minorPectoralis minor Ribs 3-5Ribs 3-5 Depresses and Depresses and rotates the scapularotates the scapula
Serratus anteriorSerratus anterior Ribs 1-9Ribs 1-9 Protracts and Protracts and rotates the scapularotates the scapula
Arm Muscles
Cross elbow, move forearm
2 compartments Anterior
Flexors of forearm
Posterior Extensors of forearm
Arm Muscles
Anterior compartment Brachialis Biceps brachii Coracobrachialis Brachioradialis
Arm Muscles
Posterior compartment Triceps brachii Anconeus
Arm Muscle Innervation
Anterior compartment Radial nerve
Bracioradialis Musculocutaneous nerve
Coracobrachialis Brachialis Biceps brachii
Posterior compartment Radial nerve
Triceps brachii Anconeus
Forearm Muscles
Cross elbow, wrist and finger joints
Movement of hand and fingers Cross Wrist
flex, extend, abduct, adduct hand
Cross Fingers flex, extend fingers
Proximally are fleshy Distally have long tendons Flexor and extensor
retinacula “wristbands” Keep tendons from
jumping outwards when tensed
Forearm Muscles
Anterior flexor compartment Superficial and Deep Most flexors have
common tendon on medial epicondyle
Contains 2 pronators
Posterior extensor compartment Superficial and Deep
Anterior Compartment of Forearm
Muscles Nerves Superficial
Flexor digitorum superficialis Median Flexor carpi radialis Median Pronator teres Median Palmaris longus Median Flexor carpi ulnaris Radial
Deep Flexor pollicis longus Median Flexor digitorum profundus Ulnar (med
1/2) Median (lat 1/2)
Anterior Compartment Forearm
Posterior Compartment of Forearm
Muscles Nerves Superficial
Extensor carpi radialis longus Radial Extensor digitorum Radial Extensor carpi ulnaris Radial
Deep Supinator Radial Abductor pollicis longus Radial Extensor pollicis longus + brevis Radial Extensor indicus Radial
Posterior Compartment of Forearm
Hand Bones
Carpus (8) “True” wrist Distal to radius/ulna
Metacarpus (5) Distal to carpus
Phalanges (14) Distal to
metacarpus
Intrinsic Muscles of the Hand
Muscle Nerve Pinky (little finger)
All digiti minimi Ulnar(Flexor, Abductor, Opponens)
Thumb Abductor pollicis brevis Median Flexor pollicis brevis Median Opponens pollicis Median Adductor pollicis Ulnar
Other Intrinsic Muscles Palmar + Dorsal Interossei Ulnar Lumbricals Median, Ulnar
Muscles of the Upper Limb*All INSERT on the humerus (*)
MuscleMuscle OriginOrigin ActionAction
DeltoidDeltoid Lateral ½ of clavicle, acromion Lateral ½ of clavicle, acromion and spine of scapulaand spine of scapula
Prime flexor, abducts and Prime flexor, abducts and extends the humerus. Laterally extends the humerus. Laterally and medially rotates arm.and medially rotates arm.
Pectoralis majorPectoralis major Sternum and ribs 2-6Sternum and ribs 2-6 Adducts, flexes, and medially Adducts, flexes, and medially rotates humerusrotates humerus
Latissimus dorsiLatissimus dorsi Iliac crest, T7-T12 and lumbar Iliac crest, T7-T12 and lumbar fasciafascia
Extends, adducts, and medially Extends, adducts, and medially rotates the humerusrotates the humerus
Teres majorTeres major Lateral border of scapula Lateral border of scapula (lower 1/3)(lower 1/3)
Extends, adducts, and medially Extends, adducts, and medially rotates the humerusrotates the humerus
CoracobrachialisCoracobrachialis Coracoid processCoracoid process Flexes and adducts the Flexes and adducts the humerus.humerus.
Muscles Crossing the Elbow
MuscleMuscle OriginOrigin InsertionInsertion ActionActionTriceps BrachiiTriceps Brachii
(radial nerve)(radial nerve)Infraglenoid Infraglenoid tubuercle and tubuercle and shaft of shaft of humerushumerus
Olecranon Olecranon process of ulnaprocess of ulna
Forearm Forearm extensorextensor
AnconeusAnconeus
(radial nerve)(radial nerve)Lateral Lateral epicondyle of epicondyle of humerushumerus
Lateral aspect Lateral aspect of olecranon of olecranon process of ulnaprocess of ulna
Abducts ulna Abducts ulna during forearm during forearm pronationpronation
Biceps BrachiiBiceps Brachii
(musculocutane(musculocutaneous nerve)ous nerve)
Supraglenoid Supraglenoid tubercle and tubercle and coracoid coracoid processprocess
Radial Radial tuberositytuberosity
Flex forearm Flex forearm and supinate and supinate handhand
BrachialisBrachialis
(musculocutane(musculocutaneous nerve)ous nerve)
Anterior surface Anterior surface of humerusof humerus
Coronoid Coronoid process of ulna process of ulna and capsule of and capsule of elbowelbow
Forearm flexor Forearm flexor and hand and hand supinatorsupinator
BrachioradialisBrachioradialis
(radial nerve)(radial nerve)**Supracondylar Supracondylar ridge of the ridge of the humerushumerus
Styloid process Styloid process of radiusof radius
Synergist in Synergist in forearm flexionforearm flexion*Exception: radial nerve usually serves extensor muscles
Muscles of the Forearm
MuscleMuscle OriginOrigin InsertioInsertionn
ActionAction
Pronator TeresPronator Teres
(median nerve)(median nerve)HumerusHumerus
Coronoid Coronoid process of ulnaprocess of ulna
Lateral raidusLateral raidus Pronate forearmPronate forearm
Weak flexor of Weak flexor of elbowelbow
Flexor Carpi Flexor Carpi RadialisRadialis
(median nerve)(median nerve)
Humerus-medial Humerus-medial epicondyleepicondyle
Base of 2Base of 2ndnd and and 33rdrd metacarpals metacarpals
Flexor of wrist, Flexor of wrist, abduct handabduct hand
Palmaris LongusPalmaris Longus
(median nerve)(median nerve)Humerus-medial Humerus-medial epicondyleepicondyle
Palmar fasciaPalmar fascia Weak wrist Weak wrist flexorflexor
Flexor Carpi Flexor Carpi UlnarisUlnaris
(ulnar nerve)(ulnar nerve)
Humerus-medial Humerus-medial epicondyleepicondyle
Olecranon Olecranon processprocess
Pisiform and Pisiform and hamate bones, hamate bones, base the 5base the 5thth metacarpalmetacarpal
Powerful flexor Powerful flexor of wrist, of wrist, adductor of handadductor of hand
Flexor Digitorum Flexor Digitorum SuperficialisSuperficialis
(median nerve)(median nerve)
Humerus-medial Humerus-medial epicondyle, epicondyle, coronoid process coronoid process of ulna, shaft of of ulna, shaft of radiusradius
Four tendons Four tendons into middle into middle phalange of phalange of fingers 2-5fingers 2-5
Flexes wristFlexes wrist
AN
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Muscles of the Forearm
MuscleMuscle OriginOrigin InsertionInsertion ActionAction
Flexor Pollucis Flexor Pollucis LongusLongus
(median nerve)(median nerve)
Radius and Radius and interosseous interosseous membranemembrane
Distal phalanx of Distal phalanx of thumbthumb
Flexes distal Flexes distal phalanx of thumbphalanx of thumb
Flexor Digitorum Flexor Digitorum ProfundusProfundus
(ulnar and median (ulnar and median nerves)nerves)
Ulna and Ulna and interosseous interosseous membranemembrane
Four tendons into Four tendons into distal phalanges of distal phalanges of fingers 2-5fingers 2-5
Flexor of the Flexor of the fingersfingers
Pronator QuadratusPronator Quadratus
(median nerve)(median nerve)
ulnaulna radusradus Forearm pronationForearm pronation
AN
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Mus
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Muscles of the ForearmMuscleMuscle OriginOrigin InsertionInsertion ActionActionExtensor Carpi Extensor Carpi Radialis LongusRadialis Longus
(radial nerve)(radial nerve)
Humerus-Humerus-lateral lateral epicondyleepicondyle
Base of 2Base of 2ndnd metacarpalmetacarpal
Extends and Extends and abducts wristabducts wrist
Extensor Carpi Extensor Carpi Radialis BrevisRadialis Brevis
(deep branch of (deep branch of radial nerve)radial nerve)
Humerus-Humerus-lateral lateral epicondyleepicondyle
Base of 3Base of 3rdrd metacarpalmetacarpal
Extends wristExtends wrist
Extensor Extensor DigitorumDigitorum
(radial nerve)(radial nerve)
humerushumerus Four tendons Four tendons into extensor into extensor expansions and expansions and distal distal phalanges of phalanges of fingers 2-5fingers 2-5
Prime mover of Prime mover of finger finger extension extension
Extensor Carpi Extensor Carpi UlnarisUlnaris
(posterior (posterior interosseous interosseous nerve)nerve)
Humerus-Humerus-lateral lateral epicondyle and epicondyle and ulnaulna
Base of fifth Base of fifth metacarpalmetacarpal
Extends wrist Extends wrist and adducts and adducts wristwrist
PO
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Mus
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Muscles That Move the ForearmMuscleMuscle OriginOrigin InsertionInsertion ActionActionSupinatorSupinator
(post. (post. Interosseous Interosseous nerve)nerve)
Humerus, ulnaHumerus, ulna Radius Radius proximal endproximal end
Supinate Supinate forearmforearm
Abductor Abductor Pollucis Pollucis LongusLongus
(post. Inter. (post. Inter. Nerve)Nerve)
Post. Radius Post. Radius and ulnaand ulna
Base of 1Base of 1stst metacarpal and metacarpal and trapeziumtrapezium
Abducts and Abducts and extends thumbextends thumb
Extensor Extensor Pollucis Brevis Pollucis Brevis and longusand longus
(post. Inter. (post. Inter. Nerve)Nerve)
Shaft of radius Shaft of radius and ulna, and ulna, interosseous interosseous membranemembrane
Base proximal Base proximal phalanx phalanx (brevis) and (brevis) and distal phalanx distal phalanx (longus) of (longus) of thumbthumb
Extends thumbExtends thumb
Extensor Extensor IndicisIndicis (post. (post. Inter. Nerve)Inter. Nerve)
Distal ulna, Distal ulna, interosseous interosseous membranemembrane
Extensor Extensor expansion of expansion of index fingerindex finger
Extends index Extends index fingerfinger
PO
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http://bio.bd.psu.edu/cat/Muscular_System/deep_muscles.htm# Upper Arm
1. Clavodeltoid
2. Biceps Brachii
3. Triceps Medial Head
4. Epitrochlearis
5.Triceps Long HeadUpper Arm –Medial View
1. Acromiotrapezius
2. Levator Scapulae Ventralis
3. Teres Major
4. Triceps Lateral Head (Reflected)
5. Triceps Long Head
6. Triceps Medial Head
7. Brachialis
8. Clavodeltoid
9. Anconeus
Upper Arm – Lateral View
1’ Long Head of Triceps 7.Extensor Digitorum Communis
2. Lateral Head of Triceps 8.Extensor Digitorum Lateralis
3. Brachialis 9. Extensor Carpi Ulnaris
4. Brachioradialis10.
Flexor Carpi Ulnaris
5.Extensor Carpi Radialis Longus
11.
Anconeus
6. Extensor Carpi Radialis Brevis
1. Brachioradialis 8. Clavodeltoid
2. Extensor Carpi Radialis Longus 9. Biceps Brachii
3. Extensor Carpi Radialis Brevis10.
Epitrochlearis
4. Pronator Teres11.
Long Head of Triceps
5. Flexor Carpi Radialis12.
Medial Head of Triceps
6. Palmaris Longus13.
Flexor Digitorum Superficialis
7. Flexor Carpi Ulnaris
Intrinsic Muscles of the HandThenar Eminence
MuscleMuscle OriginOrigin InsertionInsertion ActionActionAbductor Abductor Pollucis BrevisPollucis Brevis
(median nerve)(median nerve)
Flexor Flexor retinaculum,retinaculum,
Carpal bonesCarpal bones
Base of first Base of first proximal proximal phalanxphalanx
Abducts thumbAbducts thumb
Flexor Pollucis Flexor Pollucis BrevisBrevis
(median nerve)(median nerve)
Same as aboveSame as above Same as aboveSame as above Flex thumbFlex thumb
Opponens Opponens PollucisPollucis
(median nerve)(median nerve)
Flexor Flexor retinaculum retinaculum and trapeziumand trapezium
Anterior side of Anterior side of first metacarpalfirst metacarpal
OppostionOppostion
Adductor Adductor pollucispollucis (ulnar (ulnar nerve)nerve)
Capitate bone Capitate bone and bases of and bases of metacarpals 2-4metacarpals 2-4
Medial side of Medial side of base of first base of first proximal proximal phalanxphalanx
Adducts and Adducts and opposes the opposes the thumbthumb
Intrinsic Muscles of HandHypothenar Eminence
MuscleMuscle OriginOrigin InsertionInsertion ActionAction
Abductor Digiti Abductor Digiti MinimiMinimi
(ulnar nerve)(ulnar nerve)
pisiformpisiform Medial side of Medial side of proximal proximal phalanx of 5phalanx of 5thth fingerfinger
Abducts little Abducts little finger at MPJ.finger at MPJ.
Flexor digiti Flexor digiti minimi brevisminimi brevis
(ulnar nerve)(ulnar nerve)
Hamate and Hamate and flexor flexor retinaculumretinaculum
Same as aboveSame as above Flexes little Flexes little fingerfinger
Opponens digiti Opponens digiti minimiminimi
(ulnar nerve)(ulnar nerve)
Same as aboveSame as above Medial side of Medial side of metacarpal 5metacarpal 5
oppositionopposition
Muscles of the HandMidpalmar Muscles
MuscleMuscle OriginOrigin InsertionInsertion ActionActionLumbricalsLumbricals
(median and (median and ulnar nerve)ulnar nerve)
Lateral side of Lateral side of each tendon of each tendon of the deep flexorthe deep flexor
Lateral edge of Lateral edge of extensor extensor expansion of expansion of fingers 2-5fingers 2-5
Flex the MPJFlex the MPJ
Extend IPJ’sExtend IPJ’s
Palmar Palmar InterosseiInterossei
(ulnar nerve)(ulnar nerve)
Midaxial side of Midaxial side of each each metacarpal metacarpal except of met. except of met. #3#3
Extensor Extensor expansion expansion
Adduction of Adduction of fingersfingers
Dorsal Dorsal interosseiinterossei
(ulnar nerve)(ulnar nerve)
Sides of Sides of metacarpalsmetacarpals
Extensor Extensor expansionsexpansions
Abduct fingersAbduct fingers
Intrinsic Muscles of the Hand
Interossei Muscles Lumbrical Muscles
Blood Supply - Veins Deep veins
Deep palmar venous arches Radial - forearm Ulnar - forearm Brachial – arm/elbow Subclavian - neck Axillary – axilla
Superficial Veins Cephalic – arm/forearm Basilic – arm/forearm Median cubital – elbow
Blood draws!! Median - forearm Superficial palmar venous
arches Digital
Blood Supply - Arteries Subclavian (neck) Axillary (armpit)
Subscapular Circumflex humeral arteries
Brachial (arm) Deep brachial
Radial (forearm) Ulnar (forearm)
Common Interosseous Superficial & Deep Palmar
arches Digital
Axilla Between arms and chest Where axillary hair grow Boundaries
Ventral Pectoral muscles
Dorsal Latissimus dorsi, teres major,
subscapularis Medial
Serratus ventralis Lateral
Intertubercular (Bicipital) groove of humerus
Contents Axillary lymph nodes, Axillary
vessels, brachial Plexus
Surface Anatomy of Arm
Biceps brachii Triceps brachii Olecrenon
Process Medial Epicondyle Lateral Epicondyle
Surface Anatomy of Elbow Cephalic vein Cubital Fossa
Anterior surface elbow Contents
Median Cubital Vein Brachial Artery Median Nerve
Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles
Surface Anatomy of Hand
Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median
nerve Inflammation of tendons =
compression of Median nerve Anatomical Snuffbox
Lateral = E.pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse)
Brachial Plexus Nerve plexus
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
Small contributions from C4 and T2
Ventral Rami
Brachial Plexus
Really Tired? Drink Coffee Buddy!
R = RAMI (ventral) (5) T = TRUNKS (3) D = DIVISIONS (2) C = CORDS (3) B = BRANCHES (Many!!)
Rami join to form Trunks! (in neck)
Ventral Rami Trunks
C5 Upper Trunk C6
C7 Middle Trunk
C8 T1 Lower Trunk
Trunks Split to form Divisions! (in neck)
Trunks Divisions
Upper AnteriorPosterior
Middle AnteriorPosterior
Lower Anterior Posterior
Divisions Join to form Cords! (in axilla)
Trunks Division Cords
U A LateralP
M A MedialP
L A PosteriorP
Cords Give off Branches!! (in axilla) Lateral Musculocutaneous
Median
Medial Ulnar
Posterior RadialAxillary
Thoracodorsal
Subscapular
1. Vagus Nerve
2. Brachial Plexus
3. Radial Nerve
4. Axillary Nerve
5. Median Nerve
6. Ulnar Nerve
Brachial Plexus – Cords and Branches
Lateral Musculocutaneous Median
Medial Ulnar
Posterior Radial Axillary Thoracodorsal Subscapular
Lateral Cord Musculocutaneous nerve
Off lateral cord Course:
Anterior arm Becomes cutaneous and gives skin sensation to lateral forearm
Innervates: Corocobrachialis (motor) Biceps brachii (motor) Brachialis (motor) Skin distal to the elbow (sensory)
Medial Cord Ulnar nerve
Course: 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: 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
Median nerve Course:
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
Innervates: Anterior forearm (motor)
Most flexors, some intrinsics (thumb)
2/3 Lateral palm (sensory) Dorsum of fingers 2 and 3 (sensory)
Posterior Cords Radial nerve
Largest branch of brachial plexus Comes from posterior cord Course:
Through arm Around humerus Around lateral epicondyle (then divides)
Innervates: Posterior muscles of arm and forearm
Triceps brachii, anconeus, supinator, brachioradialis Divides in forearm:
Superficial Skin of arm and dorsolateral surface of hand
Deep Extensor muscles of forearm (eg E. carpi radialis L + B)
Posterior Cord Axillary nerve
Branches off posterior cord Course:
Runs posterior to humerus Runs with caudal humeral circumflex artery
Innervates: Deltoid and teres minor (motor) Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve Innervates:
Subscaplaris, Teres major Thoracodorsal nerve
Course: Runs with thoracodorsal artery and nerve
Innervates: Latissimus dorsi
Cutaneous Innervation to Hand
Nerve Damage
Ulnar nerve “Claw hand”
Inability to extend fingers at interphalangeal joints, results in permanent flexion = claw
Median nerve “Ape hand”
Inability to oppose thumb
Radial nerve “Wrist drop” Inability to extend the hand,
inability to fully extend forearm
Carpal Tunnel Syndrome At A Glance
•Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. •Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. •Symptoms of carpal tunnel syndrome include numbness and tingling of the hand. •Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing. •Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.