upper power p..ppt

8/22/2019 upper power p..ppt

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UPPER LIMB

PROF : EZZ ELDIN

USIM


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Clavipectoral Fascia

Definition: Is continuation of the deep fascia from theneck to front of chest.

Character: a) The fascia descends and split (divide) tosurround the clavicle

and the subclavius muscle. b) Then join (fuse) to form single layer again

and descend to the

Upper border of the pectoralis minormuscle.

c) Then split again to enclose (surround)pectoralis minor muscle.

d) Below pectoralis minor the fascia fusesagain and descends as

one layer (suspensory ligament of axilla)

attach to floor of axilla


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Clavipectoral fascia 2

Structures pierce clavipectoral fascia:

VERY 1) V: Vein (cephalic vein).

Lazy 2) L: Lymph vessels and lymph

nodes).

And 3) A: Artery (thoracoacromial

artery.

Naughty 4) N: Nerve (lateral pectoral

nerves) .


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Deltopectoral Groove

Site: Between pectoralis major

muscle and deltoid muscle.

Contents: 1) Artery: deltoid branchof thoracoacromial artery. Ahmed

2) Vein : Cephalic vein.

Very

3) Lymph: Deltpectoral

lymph nodes. Lazy


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MAMMARY GLAND (BREAST)

@) Is a type of subcutaneous exocrine gland (has nocapsule).

@) Site: At superficial fascia function:secrets milk

@) Structure: 1) formed of 12-15 lobes that formed ofsmaller lobules.

2) Fibrous tissue septa that separated thelobes and lobules.

3) Fatty tissue between the lobules.

@) Shape: Is conical shape on its top present darkbrown area called areola On the top of the areolapresent the nipple

at level of 4th space.

Part of the breast extends in front of the axilla called

axillary tail.


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Breast 2

Surface marking: from above downward: Itextends from 2 to 6 costal Cartilage

.

Laterally: from midaxillary line to Sternalmargin medial.

Muscles deep to breast: 70% of the breast

lies on pectoralis major m. 30% onSerratus

anterior m. and external oblique abdominism.


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Breast 3

Nerve supply: Intercostal nerves. Blood supply: a) Intercostal arteries.

b) Lateral thoracic artery

c) Internal mammary (thoracic) artery: perforatingbranches.

Lymph drainage: a) Medial part to parasternallymph nodes of both sides

b) Lateral part to axillary lymphnodes (apical and Pectoral groups)

Applied: cancer breast spread to axillary lymph

nodes.


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Pectoral muscles They are three Pectoralis major ,pectoralis minor and Serratus

anterior A) :

PECTORALIS MAJOR

===================

. Origin: clavicular head :from the front of the

medial 1/3 of the clavicle

Sternocostal head: from anterior surface sternum

And upper six costal cartilages.

Insertion: At lateral lip of the bicipital groove

Nerve supply: medial and lateral pectoral nerves.

Action: Adduction and medial rotation of the arm

And Clavicular head is main flexor of

The shoulder.


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Pectoral muscle
http://www.bartleby.com/107/illus410.html


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Origin: from the 3rd -4th and fifthcostal cartilage near the ribs.

Insertion :At the upper surface of thecoracoid process of The scapula.

Action: depress and protract theshoulder.

Nerve supply: medial and lateral

pectoral nerves

Pectoralis minor


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Pectoralis minor and Serratus


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SERRATUS ANTERIOR:

Origin: from the outer surface of upper eightribs.

Insertion: At deltoid tuberosity of the humerus.

Action: protract the scapula and rotate itlaterally during Abduction above 90degree (as

trapezius).

Nerve supply: long thoracic nerve (its injuryresults In winging of the scapula).


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PECTORAL GIRDLE

FORMED OF THREE BONES:

Sternum, clavicle and scapula.

andTHREE JOINTS:

a)sternoclavicular joint

b) Acromioclavicular

c) Shoulder joint.


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SHOULDER JOINT

Type: Ball and socket synovial

Bones: Glenoid cavity of the scapula andthe head of the humerus.

Capsule: Attach around the Glenoidinclude the supraglenoid tubercle

at the humerus attach around the neck

and medially descend to the level ofsurgical of the humerus

Synovial membrane: lines the innersurface of the capsule.


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Shoulder 2

Ligaments: 1) GlenohumeralLigament: to lesser tubercle of the

humerus.

2) Coracohumeral

ligament: to greater tuberosity of

humerus. 3) Transverse humeral

ligament: between two tubercles of

the Humerus.


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Shoulder 3

Movement of the shoulder :

a) Flexion : Clavicular head of pectoralis major andcoracobrachialis.

b) Extension: Latissmus dorsi, teres major. c) Adduction: pectoralis major, Latissmus dorsi.

d) Abduction: from 0 - 15 by Supraspinatus m.

15- 90 by deltoid m.

90 -180 by Trapezius and serattusanterior m.

e) Medial rotation: Pectoralis major, latissmus dorsiand teres

major. f) Lateral rotation: Teres minor and infraspinatus m.


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Shoulder stability

5) Coracoacromial arch: formed by: coracoidprocess, acromion and

Coracoacromial ligament.

6) Labrum glenoidale: A cartilage around theglenoid to increase its depth

it is intracapsular structure and alsoextrasynovial.

Nerve supply: Medial and lateral pectoralnerves, axillary nerve.

. (According to Hiltons law: the muscle acts onthe joint its nerve supply Will supply that joint).


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FACTORS STABILIZE

(SUPPORT) SHOULDER JOINT 1) The capsule of the joint

2) The ligaments of the joints (coracohumeral,glenohumeral ligaments)

3) Tendon of the biceps muscle inside thecapsule prevent upward

Dislocation of the head of the humerus(intracapsular, extrasynovial).

4) Rotator cuff muscles: surround the capsule

they are: a)subscapularis m.

b) Supraspinatus m.

c) Infraspinatus m.

d)teres minor m.


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AXILLA

Definition and site: is a conical spaceat the arm pit between the upper armand the trunk.

Boundaries:a) Anterior wall: skin, superficial

fascia and Platysma muscle.

1) Pectoralis major muscle. 2) clavipectoral fascia at the upper

part.

3) Pectoralis minor at middle part.


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Axilla 2

N.B: Pectoralis major only forming anterioraxillary fold at the lower part.

b) Posterior wall: from above downward 1) Subscapularis muscle.

2) Teres major muscle.

3) Latissmus dorsi muscle.

N.b: teres major and Latissmus dorsi form theposterior Axillary fold.


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Axilla 3

c) Lateral wall: mainly formed byintertubercular groove (bicipital groove).

d) Medial wall: formed by

1) Serratus anterior muscle. 2) Nerve supply of Serratus (long

thoracic nerve )on the Serratus

anterior. 3) Upper five ribs and intercostal

muscles in

Between the ribs.


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Axilla 4

e) Apex of axilla: behind the clavicle formingpassage

Called cervico axillary canal that

bounded by : 1) Clavicle anterior 2) posterior by upper

border

Of the scapula 3) medial by outer

border of First rib.

f) Base of the axilla: formed of skin, superficialfascia

And deep axillary fascia


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Contents of the axilla

1) Axillary artery: enter through the apexand descend To leave the axilla

at lower border of teres major Where it

continue as brachial artery.

At the axilla it Is divided by pectoralisminor muscle into three parts.

2) Braches of the axillary artery at axiila.


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Contents of axilla 2

3) Axillary vein medial to the artery. 4) Axillary lymph nodes.

5) Cords of the brachial plexus and its

branches. 6) Intercostbrachial nerve (th.2) cross the

floor of the Axilla and supply skin of the

floor of axilla.

7) Fatty areolar connective tissue thatsupport the Contents of axilla.


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Spaces of the axilla

Quadrangular space

Upper triangular

Lower triangular


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Spaces of axilla 2

1) quadrangular space : Boundaries :

a) inferior :teres major m.

b) superior :subscapularis m. c)Medially:long head of

triceps.

d) lateral: surgical neck.

Content :axillary nerve and posterior

circumflex humeral artery.


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Spaces of axilla 3

2)Uppr triangular space:

a) above :teres minor .

b) below :teres major. c) lateral: long head of triceps.

Contents : CICUMFLEX SCAPULAR

ARTERY.


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Spaces of axilla 4

3) Lower triangular space :

Boundaries :a) above:teres major

b) lateral : shaft of humerus .

c) medial: long head of triceps .

CONTENTS : RADIAL NERVE AND BROFUNDA BRACHIIARTERY.


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ANATOMY OF AXILLARY

ARTERY

Begin: As a continuation of thesubclavian artery at the

Outer border of the first rib.

End: continue as brachial artery atlower border of teres Major muscle.

Course: the artery divided by the

pectoralis minor into Three parts.


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Axillary artery 2 Relation:1) First part: related

a) medially : axillary veinb) Posteriorly: medial cord.

c) Laterally: lateral and posterior cord.

d) Anterior: pectoralis major and clavi-

Pectoral fascia. 2) Second part :a) medial: axillary vein and

medial cord.

b) Lateral: lateral cord of the brachial

Plexus.

c) Posterior: posterior cord.

d) Anterior: pectoralis major and

minor.


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Axillary artery 3

3) Third part: related to the branches of thecords;

a) Anterior: pectoralis major .

b) Posterior: Radial and axillary nerve. c) Medial: ulnar nerve and axillary vein.

d) Lateral: musculo-cutaneous nerve and

Formation of median nerve (the medial

Root of the median nerve cross in front

Of the artery from medial to lateral to

Join the lateral root).


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Branches of axillary artery

1) First part gives one branch: 1) superior thoracic A.Supplies the upper

part of chest wall and breast.

2) Second part: gives two branches 1) Thoracoacromial artery: divided into

a) Acromial branch:

b) Pectoral branch: supply pectoral m. and breast.

c) Clavicular branch

d) Deltoid branch:at Deltopectoral groove

2) Lateral thoracic artery: supply the lateral part of

The breast and chest wall.


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Branches of the artery 2

3) Third part: gives three branches

1) Subscapular artery: pass along lower of

Subscapularis muscle and gives circumflex

Scapular artery that share at anastmosisaround

The scapula.

2) Anterior circumflex humeral artery. And

3) Posterior circumflex humeral artery.

Both share at the anastmosis aroundsurgical neck

Of the humerus.


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BRACHIAL PLEXUS

Formation and root value: ---------------------------------------------

Formed by the union of the ventral rami ofcervical nerves 5-6-7-8 Th.1 (may receive from

c.4 or th.2).

Site: The plexus formed of four stages; the firsttwo Stages present at the neck (inside theposterior Triangle) . called supraclavicularstages.

The third Stage at cervico-axillary canal.

The fourth stage Of cords present at axilla


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Brachial plexus 2

STAGES:

----------------1) First stage of roots: the ventralrami C.5, 6, 7,8th1 present at posterior triangleof the neck between scalenus anterior andscalenus medius m.

2) Second stage of trunks: where C.5, 6 formupper

Trunk. C.7 only forms the middle trunk. C.8and Th.1

Forms the lower trunk. This stage alsopresent at

Posterior triangle.


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Brachial plexus 3

3) Third stage (stage of division of thetrunks):

each Trunk divides into anterior andposterior division, at Cervico-axillary canal

behind the clavicle.

4) Stage of cord and its branches: presentat the axilla

a) The anterior division of the upper andmiddle trunk Join to form lateral cord C. 5,

6, and 7


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Brachial plexus 4

b) The anterior division of the lower

trunk form the Medial cord C. 8 th.1

c) The posterior divisions of all the

trunks join to Form the posterior cord

has a root value of: C. 5, 6, 7, 8, Th.1


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Brachial plexus


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BRANCHES OF THE PLEXUS

A) Branches of the roots: 1) dorsal scapularnerve: that

Supply rhomboids minor andmajor.

2) Long thoracic nerve (c.5, 6, 7)supply

Serratus anterior muscle.

B) Branches of the trunks (from upper trunk):

1) Nerve to subclavius muscle c.5, 6. 2) Suprascapular nerve c.5, 6 passes atthe Suprascapular foramen to supply twomuscles Supraspinatus and Infraspinatus

f


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Branches of B.plexus 2

C) Branches of lateral cords at axilla: 3

a) Lateral pectoral nerve: pierce clavi-pectoral Fascia to supply pectoralismajor muscle

b) Lateral root of median nerve: join themedial Root of medial cord to form mediannerve .

c) Musculo-cutaneous nerve: supply flexorsof At the front of the arm.


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B .plexus branches 3

2) Branches of the medial cord: are 5 branches a) Medial pectoral nerve: pierce the pectoralis Minor to end at

the major supplying both musc le.

b) Medial root of median nerve: crosses in front of Third part axillary artery from medial to lateral

To join the lateral root forming median nerve

c) Medial cutaneous nerve of the arm: supply skin

At medial side of the arm.

d) Medial cutaneous nerve of the forearm: supply

Medial side of the forearm cutaneous supply.

e) Ulnar nerve.


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B . Plexus branches 4

3) Branches of the posterior cord: are 5 branches a) upper subscapular nerve : supply Subscapularis m.

b) Lower subscapular nerve: supply Subscapularis

And teres major muscles.

c) Thoracodorsal nerve: called nerve to Latissmus Dorsi muscle supplying that muscle

d) Axillary (circumflex) nerve: passes through the

Quadrangular space of axilla to the back of

Surgical neck to supply the deltoid and teres

Minor muscles, it gives upper lateral cutaneous

Nerve of the arm supplying sensory to skin over

Lower part of deltoid muscle

e) Radial nerve c5, 6, 7, 8, th.1.


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CUBITAL FOSSA Definition: Triangular intramuscular space in front of the

elbow.

Shape: triangular with apex below, and the base above.

Boundaries: a) Lateral: Brachioradialis m.

b) Medial: Pronator teres muscle.

c) Apex: meeting of pronator teres and brachioradialis m. with

brachioradialis overlie the pronator teres m .

d) Floor: Brachialis and supinator muscles from above down.

e) Roof: Skin, superficial fascia and bicipital aponeurosis.

FLEXOR OF FORE ARM


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FLEXOR OF FORE ARM

and cubital fossa


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SUPERFICIAL CONTENT
http://upload.wikimedia.org/wikipedia/commons/b/ba/Gray574.png


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Cubital fossa 2 Contents of the fossa:

---------------------------

a) Superficial content: laterally cephalic vein and

Lateral cutaneous nerve of the forearm .Medially basilic

vein and medial cutaneous nerve of the forearm .

The median cubital vein connects the basilic to

cephalic vein. M b) Deep contents: 1) Tendon of biceps muscle

A 2) Three arteries: the brachial artery and

Its two terminal branches radial and ulnar

N 3) Median nerve: medial to the artery

And radial nerve is most lateral ln the fossa.(The contents are 1 tendon, 2 nerves and 3 arteries).


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DEEP CONTENTS
http://upload.wikimedia.org/wikipedia/commons/e/e7/Gray528.png


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CARPAL BONE

Carpal bones:

S. Scaphoid

L. Lunate

T. TriquetrumP. Pisiform

Tm. Trapezium

Td. TrapezoidC. Capitate

H. Hamate (*=hook)


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FLEXORS OF THE FOREARM


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FLEXORS OF THE FOREARM

THEY ARE TWO GROUPS OF MUSCLES:

1) Superficial group Formed of Pronator teres,Flexor carpi radialis, Palmaris longus, Flexorcarpi ulnaris and Flexor Digitorum superficialis.

2) Deep group: Flexor pollicis longus, Flexor

digitorum profundus and Pronator quadratus muscles

N.B.: For origin and insertion look at the tables.


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http://www.bartleby.com/107/illus213.htmlhttp://www.bartleby.com/107/illus415.html


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MEDIAN NERVE AT FOREARM


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MEDIAN NERVE AT FOREARM

Root value: C.5, 6, 7, 8 and Th. 1

Course: 1) Leave the cubital fossa by passing between the two heads OF Pronator teres muscle to enter the forearm.

2) Descend at the forearm on flexor digitorum Profunduscovered by flexor digitorum superficialis

3) Above the wrist it comes from under the cover of F.D.SUP.

and lies between F.C.Radialis and F.D.Superficialis tendons.

4) enter the hand deep to flexor retinaculum (through carpal

tunnel). End: At the hand as medial and lateral terminal branches at the hand


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Median nerve 2


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Median nerve 2

Branches at forearm: 1) Muscular: to pronator

teres, F.carpi.radialis, palmar Longus andflexor digitorum superficialis.

2) Anterior interosseous nerve: Supply deep

flexors: Flexor pollicis longus ,

pronator quadratus and Lateral half of the F.D.Profundus .

3) Palmar coetaneous: supply sensory for lateral

2/3 of the palm of the hand. N.B.: Branches of the median in the hand later

on (at the hand lectures).


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RADIAL ARTERY


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RADIAL ARTERY

Begin: As one of the two terminalbranches of the brachial artery at level

of neck of radius ,inside cubital fossa (Itleave the fossa above the two heads ofpronator teres) .

End: At the hand as large deep and small

superficial palmar branches (shareIn the formation of pal mar arches at thehand).


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Radial artery 2 Course: 1) At forearm it descend on the the muscle

attach to front of covered by bracioradialis

So it descends on: Supinator, biceps, pronataor teres, F.digitorum Superficialis, flexor pollicis longus and pronatorquadratus m.

Then descend on the lower end of the radius bonewhere the pulse can felt.

2) Then passes to the anatomical snuff box at back of wristthen

3) Enter the hand between the two heads of the first dorsalinterosseous m.


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Radial artery 3


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Radial artery 3 End: At the palm it forms mainly the deep palmar arch.

Branches: a) radial recurrent anastmose around the elbow.

b) Muscular to the muscles in front of the forearm.

c) Anterior and Posterior carpal branches share at

anastmosis around wrist joint

.AT the hand it gives 1) first dorsal metacarpal at back of wrist .

2) Princips pollicis to thumb at the palm to thumb.

3) Radialis indices to index at the palm supply index finger.

4) Then ends as deep and superficial palmar branches.


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Radial artery

ULNAR ARTERY


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ULNAR ARTERY Begin :Similar to the radial artery.

End: As large superficial and small deep palmar branches.

Course: 1) At upper 1/3of its course it descend obliquedownward medially To leave the cubital fossa deep to

pranator teres muscle two heads.

2) At lower 2/3 descend it descend vertically downwardon flexor Digitorum profundus covered by flexor carpi ulnarismuscle.

The ulnar nerve descend medial to lower 2/3 of the artery .

3) Above the wrist it comes from under the cover of flexor carpi Ulnaris to lie between the tendons

of flexor carpi ulnaris medially and flexor digitorum

superficialis muscle lateral.


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Ulnar artery 2

4) It enters the hand superficial to the flexor retinaculum. N.B: the ulnar artery descends at the lateral side of the lower 2/3 of the

artery.

Branches: 1) Ulnar recurrent artery (ant. and post.)anastmose aroundelbow.

2) Common interosseous A.: that divides into anterior and posteriorInterosseous branches descend in front and back of interosseousmembrane.

3) Anterior and posterior carpal branches share at the anastmosis

around wrist joint.

4) Then terminates at the hand as deep and superficial palmar

branches both share at the palmar arches at the hand (for the ulnar artery

Share mainly at formation of superficial palmar arch).

Posterior interosseous artery


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Posterior interosseous artery

to the back of fore arm

ULNAR NERNE


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ULNAR NERNE

Root value and origin: C.7-8-th1 from the medial cord of the brachial Plexus.

Course in the forearm:

1) it comes from behind the medial Epicondile of The humerus toenter the forearm between the two heads of flexor Carpi ulnaris m .

.

2) At the forearm it descend on F.D.Profundus covered by flexor

carpi ulnaris. (Medial to the lower 2/3 of the ulnar artery ).

3) Above the wrist it comes from under the cover of flexor carpiulnaris enter the hand superficial to the flexor retinaculum.


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Ulnar nerve 2


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Ulnar nerve 2 Branches at forearm:

a) 2 muscular branches :to flexor carpi ulnaris and the medial

half of the flexor digitorum profundus. b) 2 cutaneous branches :1) palmar cutaneous to medial 1/3 of the

palm descend superficial to flexor retinaculum

2) Dorsal cutaneous: to the medial 1/3 of the back of the hand and dorsaldigital branches to media 1 fingers.

Branches at the hand: here it ends as superficial and deep branches

1) Deep branch: Supply all the short muscles of the hand EXCEPT thefirst and second lumbricals and and three thenar muscles of the thumb .

.

2) Superficial branch: supply Palmaris brevis muscle and sensory to

Medial 3 fingers by its palmar digital branches.

FLEXOR RETINACULUM


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FLEXOR RETINACULUM

Definition: Thickening of the deep

fascia in front of the wrist.

Shape: quadrangular in shape.Function: 1) keep the tendons at their

position .

2)Protect structures deep to

it (nerves and vessels).

F ti l


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F.retinaculum


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F R ti l 2


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F. Retinaculum 2

Attachment: Medially: at pisiform andhook of hamate.

Laterally: Scaphoid and crest of thetrapezium.

Proximally: Continue with deep

fascia of the forearm. Distally: Gives attachment to the

palmar aponeurosis

PALMAR d DORSAL


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PALMAR and DORSAL

F RETINACULUM 3


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F. RETINACULUM 3

Relation to the retinaculum:Superficial: 1) Ulnar nerve and ulnar

artery . 2) 2 palmar cutaneous branches: of

the median and ulnar nerves.

3) Two tendons (tendon ofPalmaris longus and flexor carpi

ulnaris most medial.

F. RETINACULUM 4


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F. RETINACULUM 4

Structures deep to the retinaculum: (AT THE CARPAL ----------------------------------------- TUNNEL) .

1)Tendons of the flexor digitorum superficialis andprofundus They are surrounded by common synovialsheath (ulnar bursa).

2)Tendon of flexor pollicis longus surrounded by its own

synovial sheath forming (radial bursa ).

3) Tendon of the flexor carpi radialis in front of thetrapezium.

4) MEDIAN NERVE.


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F RETINACULUM 5


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F .RETINACULUM 5

Applied (surgical anatomy): Compression on the mediannerve deep to the Flexor retinaculum called

Carpal tunnel syndrome results in (Ape hand).

1)Motor effect: weakness of three thenar muscles and 1-2nd lumbricals thumb become adducted by adductorpollicis muscle.

Results in: (Thumb adduction, loss of opposition and

flat thenar eminence due to atrophy of thenar muscle). Weak sensation at lateral2/3 of the palm and lateral 31/2

Fingers .

PALMAR APONEUROSIS


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PALMAR APONEUROSIS

Definition: Thickening of the deepfascia at the palm of hand.

Shape: Triangular shape with BASE

distally at level head of metacarpal

bone and the

APEX: proximal attach to flexor

retinaculum.

Function: protection of the structures

deep to it

P l i


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Palmar aponeurosis

PALMAR APONEUROSIS 2


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PALMAR APONEUROSIS 2

Attachment:a) Apex: At flexor retinaculum and provide insertion Forthe tendon of Palmaris longus muscles.

b) Distally: It gives 4 slips attach to the fibrous flexor

sheath and head of metatarsal bone and base of theproximal phalanx .

c) Medially: Gives attachment to Palmaris brevis muscle.

D) Laterally: Continue with deep fascia at lateral side ofhand That covers the thenar muscles.

MUSCLES OF THE HAND


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They are four groups:

1) THENAR MUSCLES: They are the short muscles ofthe thumb:

a) Abductor pollicis brevis. b)Flexor pollicis

brevis .

c) Opponens pollicis. (These three muscles

form thenar eminence). d) Adductor pollicis muscle.

2) HYPOTHENAR MUSCLES: Are 3

a) Abductor digiti minimi

b) Flexor digiti minimi c) Opponens digiti

minimi.

Muscles of the hand


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Muscles of the hand


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Muscles of the hand 2


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3) Four lumbricals muscles arises from thetendon of the flexor digitorum Profundus

(1st-2nd are unipennate the 3rd - 4th arebiennale muscles).

4) Interossei they are two groups: fourdorsal Interossei and three palmarInterossei sometimes four

The palmer Interossei are Unipennatewhile the dorsal Interossei are bipennate.

N.B.: For origin and insertion look at thediagrams.

Interossei


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Interossei

Dorsal palmar



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Action: the lumbricals flex the metacarpophalangealjoints and extend The interphalangeal joints (writingposition) helped by interossei .

@The Interossei: are two groups palmar and dorsal

1)the palmar (pad) adduct the fingers while the from theaxis at middle finger .

2)the dorsal (dab) abduct the fingers, and both assist thelumbricals.

Nerve supply: All short muscles of the hand supplied byULNAR nerve deep branch, EXCEPT three thenar and1st - 2nd lumbricals muscle by the median nerve .

MEDIAN NERVE in the hand


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MEDIAN NERVE in the hand

Median nerve in the hand: It enter the hand deep to the flexorretinaculum Through the carpal tunnel at the hand it divides into twoterminal branches:

a) Lateral branch: supply three thenar muscles and first lumbricals

muscle.

b) Medial branch: supply the second lumbricals.

Sensory: For the lateral 2/3 of the palm (from the palmarcutaneous).

Palmar digital branches from its two terminal branches supply thelateral 3 fingers palmar surface and the dorsal surface of Theterminal phalanx.

FLEXOR SYNOVIAL SHEATH


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FLEXOR SYNOVIAL SHEATH Definition: a serous membrane surround flexor tendons formed of

inner Visceral and outer parietal layers.

There are two synovial sheathes:

1) Radial bursa or synovial sheath for the tendon of flexorpollicis Longus extend from above the wrist to thumb

2) Ulnar bursa or common synovial sheath for the tendons of flexor

Digitorum superficialis and profundus. it starts above the wrist

Down to the middle of the palm except that for little finger extend tothe insertion at little finger.

3) tendon of index, middle and ring fingers have separate sheath

Applied anatomy : infection of the common synovial results inspread of infection to the thumb due to connection between the twosynovial burse


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Superficial extensor of fore arm


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Superficial extensor of fore arm

They are : 1)brachoiradialis 2)extensor carpiradialis longus

3) extensor carpi radialis brevis .

4) extensor digitorum

5) extensor digiti minimi .

6) extensor carpi ulnaris .

7) anconeus muscle :at back of elbow

From back of lateral epiconyle of humerus toback of olecranon and upper part of ulna .


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Deep extensor of forearm


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Deep extensor of forearm

They are : 1)abductor pollicis longus

2) extensor pollicis brevis .

3) extensor pollicis longus . 4) extensor indicis .

5) supinator


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RADIAL NERVE


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Root value: c.5-6-7-8-th1 Origin: is a branch of posterior cord.

Course: 1) In the axilla it descend on subscapularis m. posterior to3rd part Of the axillary artery to pass through the lower triangularspace with Profunda brachii

artery.

2) At upper arm descend at the back of the humerus at

the radial or (Spiral) groove also with profunda brachii artery.

3) Then at front of the arm at cubital fossa (at level of lateralEpicondile of the humerus ) it ends as deep and superficial branch.

(posterior interosseous nerves and radial)


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Radial nerve 2


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Branches of radial nerve: 1) At the axilla: nerve to longhead of triceps

Sensory: posterior cutaneous of the arm

2) At spiral (radial) groove: supply medial and lateral

heads of triceps and nerve to ancoeus muscle . Sensory: posterior cutaneous nerve of the

forearm and lower lateral cutaneous nerve of the arm.

3) At cubital fossa: muscular branches to brachioradialis,also nerve to extensor carpi radialis longus m. andlateral part of Brachialis.


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Radial nerve 3


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Radial nerve 3

4) Superficial branch: Supply sensory to lateral 2/3 of theback (dorsum)

Of the hand and lateral 3 fingers proximalphalanges (dorsal digital).

5) Deep branch (posterior interosseous nerve): pierce

the supinator muscle And reach back of forearm to supply: supinator, ext.

Capri. radialis brevis, ext.digitorum, ext. digiti minimi ,ext. Carpi ulnaris.

in addition to all the deep extensors (abductor

Pollicis longus, extensor pollicis brevis, extensor pollicislongus and extensor indicis ) .

EXTENSOR RETINACULIUM


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Definition: thickening of the deep

fascia at the back of wrist.

Attachment: Laterally: at lower part of

the anterior border of radiusMedially : at pisiform and trequetrum

bone From the deep surface of the

retinaculum Descend 5 septa forming6 extensor compartments deep to

the retinaculum.

:

Extensor retinaculum


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Extensor retinaculum

Extensor retinaculum 2


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Extensor retinaculum 2 From lateral:

1st compartment contain: Abductor pollicis

longus and extensor pollicis brevis.2nd comp: Extensor carpi radialis longus and

brevis. 3rd comp: extensor pollicis longus.

4th comp: Extensor digitorum and extensor

indicis. 5th comp: Extensor digiti minimi.

6th comp: related to ulna for extensor carpiulnaris.


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BLOOD SUPPLY OF THE HAND


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Superficial palmar arch: Site: deep to

palmar aponeurosis. Surface marking: At the level of distal

border of abducted thumb

Formation: superficial palmar branch of

the ulnar artery mainly With the small superficial palmar branch

of the radial artery

Branches: three common palmar digitalthat divides into palmar branches thatsupply

adjacent sides of digits.

Blood supply of the hand 2


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pp y

Deep palmar arch: Site:deep to the flexor tendons on the base of themetacarpal bones.

Formation: mainly deep palmar branch of theradial artery and small deep palmar branch

of the ulnar artery.

Level: 1 finger breadth proximal to superficial

arch.Branches: 3 palmar metacarpal arteries supplythe digits.

ANATOICAL SNUFF BOX


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ANATOICAL SNUFF BOX

CONTENTS OF ANATOMICAL

SNUFF BOX


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SNUFF BOX

1) CEPHALIC VEIN .

2) RADIAL ARTERY .

3) SUPERFICIAL BRANCH OF RADIAL

NERVE .

4) TENDON OF EXTENSOR CARPI

RADIALIS LONGUS AND BREVIS.

Vein of upper limb


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Vein of upper limb

Superficial veins : 1) DORSAL VENOUS ARCH:-

PRESENT AT DORSUM OF THE HAND ,IT RECEIVES DORSAL DIGITAL VEINFROM THE FINGERSFROM ITS MEDIAL END BEGIN THEBASILIC VEIN ,AND FROM THELATERAL END BEGINS THE CEPHALIC

VEIN.
http://www.bartleby.com/107/172.html


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Dorsal venous

Arch .

VEINS 2


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VEINS 2

2) CEPHALIC VEIN : ASCEND FROMTHE LATERAL END OF DORSAL

VENOUS ARCH AT SUPERFICIAL

FASCIA AT ANATOMICAL SNUFF BOXTHEN LATERAL SIDE OF FOREARM

AND ARM TO REACH THE

DELTOPECTORAL GROOVE WHERE IT

PIERCE CLAVIPECTORAL FASCIA END

AT AXILLARY VEIN .


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VEINS OF

UPPERLIMB

VEINS 3


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VEINS 3

3) BASILIC VEIN ; BEGINS AT THEMEDIAL END OF THE DORSAL VENOUS

ARCH ASCEND ALONG THE MEDIAL

SIDE OF THE UPPER LIMB AND JOINEDBY BRACHIAL VEIN (DEEP VEIN) THEN

AT LOWER BORDER OF TERES MAJOR

IT CONTINUE AS AXILLARY VEIN

VEINS


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VEINS BASILIC VEIN

CONTINUE

AS AXILLARY

Nerve injury

1) i j f th b hi l l


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1) injury of the brachial plexus

All the injuries of the plexus are commonduring the delivary of the baby theincludes : two types

A) upper trunk (C.5-6)lesion : known as Erbs Duschan paralysis (police

man tip position)1)the arm adducted and rotated medial

2) elbow extended .

3)hand pronated with flexed fingers .

Lower trunk lesionC.8 th1


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Known as klumpeks paralysis ; result in case of complete claw hand

with flexed fingers and abducted thumb .

This is due to paralysis of all short

muscles of the hand .

N.B: ALL SHORT MUSCLES OF THE

HAND SUPPLIED BY C.8 AND Th .1

Axillary nerve injury


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y j y

commonly due to fracture of thesurgical neck of the humerus .

Results : paralysis of deltoid and teres

minor muscles results in failure ofabduction of shoulder and flatshoulder.

sensory loss over the lower part ofshoulder.

Long thoracic nerve


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g

Paralysis of nerve to Serratus anterior

C.5-6-7 results in winged scapula

(The scapula retracted and rotated ).

Ulnar nerve injury


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commonly due to fracture of medial Epicondile results in partial claw

hand:

motor effect : paralysis of shortmuscles of the hand except thenarand 1st and 2nd lumbricals muscles .

sensory effect : sensory loss atmedial 1/3 and medial 11/2 fingers .

Median nerve injury


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Results in paralysis most of the flexor of forearm , thenar muscles and1st

and 2nd lumbricals .

PICTURE OF APE HAND with adducted

thumb and flat thenar eminence.

Sensory loss at lateral 2/3 of the palm

And lateral 31/2 fingers .

Radial nerve injury


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commonly due to fracture of the shaft

Of the humerus of the spiral groove

Results in paralysis of extensors ofwrist and fingers .

PICTURE OF DROP HAND

NERVE INURIES


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1)PARTIAL 2)Drop wristClaw hand

3)APE HAND

upper power p..ppt

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