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• 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• 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

• 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)• 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• PLEXUS- IS A NETWORK OF

NERVES• BRACHIAL PLEXUS-• FOUND IN THE NECK AND AXILLA• FORMED BY VENTRAL RAMI OF C5-

C8 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• CORDS-MEDIAL/LATERAL/

POSTERIOR

• ROOTS FORMATION OF TRUNKS

• C5

• C6

• C7

• C8

• T1

UPPER

MIDDLE

LOWER

FORMED IN THE NECK

DIVISIONS AND CORDS OF BRACHIAL PLEXUS

• TRUNKS DIVISIONS CORDS

• UPPER TRUNK

• MIDDLE TRUNK

• LOWER TRUNK

PINK-ANTERIOR DIVISION

BLUE -POSTERIOR DIVISION

LATERAL CORD-ANTERIOR DIVISIONS OF UPPER AND MIDDLE TRUNK

POSTERIOR CORD-POSTERIOR DIVISIONS OF ALL TRUNKS

MEDIAL CORD-ANTERIOR DIVISION OF LOWER TRUNK

CORDS ARE NAMED ACCORDING TO THEIR RELATIVE POSITIONS TO THE AXILLARY ARTERY

BRACHIAL PLEXUS

NERVES ARISING FROM THE CORDS

• MEDIAL CORD1. MEDIAL CUTANEOUS NERVE OF ARM- CUTANEOUS

SUPPLY TO SKIN2. MEDIAL CUTANEOUS NERVE OF FOREARM-CUTANEOUS

SUPPLY TO THE SKIN3. MEDIAL ROOT OF MEDIAL NERVE- JOINS WITH LATERAL

ROOT TO FORM MEDIAN NERVE4. ULNAR NERVE5. MEDIAL PECTORAL NERVE• LATERAL CORD1. LATERAL ROOT OF MEDIAN NERVE2. MUSCULOCUTANEOUS NERVE3. LATERAL PECTORAL NERVE

NERVES FROM THE POSTERIOR CORD

• 1. UPPER SUBSCAPULAR NERVE

• 2.LOWER SUBSCAPULAR NERVE

• 3.THORACODORSAL NERVE

• 4. RADIAL NERVE

• 5. AXILLARY NERVE

IMPORTANT NERVES AND AREA OF SUPPLY

• 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

• MUSCULOCUTANEOUS NERVE

A) 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• 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 TUNNELCARPAL TUNNEL SYNDROME- CAUSED DUE TO COMPRESSION OF THE NERVE IN THE TUNNEL- CAUSES-- 1. SWELLING OF THE TEDONS( OVERUSE)- 2. PREGNANCY( EDEMA)- 3. ARTHRITISSYMPTOMS- TINGLING OR NUMBNESS-LATERAL PART OF HAND,

WEAKNESS IN THUMB MOVEMENTTREATMENT- REST, SPLINTING,ANTI-INFLAMMATORY DRUGS,

SURGERY

CUBITAL FOSSA• TRIANGULAR DEPRESSION ON

THE ANTERIOR ASPECT OF ELBOW

BOUNDARIES-BASE- LINE DRAWN BETWEEN THE

EPICONDYLES OF THE HUMERUSLATERAL BOUNDARY-

BRACHIORADIALISMEDIAL BOUNDARY- PRONATOR

TERESAPEX- WHERE THE MEDIAL AND

LATREAL BOUNDARY MEETCONTENTS1. MEDIAL CUBITAL VEIN2. BRACHIAL ARTERY3. 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