The Upper Extremity Bones, Muscles, Vessels,. Bones 30 bones!!!! Appendicular skeleton Pectoral...

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The Upper Extremity Bones, Muscles, Vessels,
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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

Glenoid cavity Allows for mobility

Attachments Upper extremity:

Arm humerus

Forearm Radius, ulna (interosseous

membrane) Hand

Carpals, metacarpals, phalanges Review bones and landmarks

studied in lab!!!

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

Arm Muscles

Cross elbow, move forearm

2 compartments Anterior

Flexors of forearm

Posterior Extensors of forearm

Arm Muscles

Anterior compartment Brachialis Biceps brachii Coracobrachialis Bracioradialis

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

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 Armpit!! Where axillary hairs grow Boundaries

Ventral Pectoral muscles

Dorsal Latissimus dorsi, teres major,

subscapularis Medial

Serratus ventralis Lateral

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)

Put it all together……..

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)

Suprascapular Runs with suprascapular artery and vein {C5, C6} Innervates

Supraspinatus Infraspinatus

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 to lateral palmar intrinsics

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