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    Upper Extremity

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    Marco Alsanero
    The document discusses the anatomy of the upper extremity, including bones, joints, muscles, nerves and vasculature. It provides details on the bones that make up the pectoral girdle, arm, forearm and hand. It describes the many synovial joints of the upper limb and their classifications. The document outlines the muscles of the upper extremity, grouping them by location and function. It discusses the brachial plexus, describing its formation, parts and branches, and the structures each branch innervates. Finally, it reviews the cutaneous innervation and blood supply of the upper limb.

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    © All Rights Reserved
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    Upper Extremity

    Uploaded by

    Marco Alsanero
    52 views37 pages
    The document discusses the anatomy of the upper extremity, including bones, joints, muscles, nerves and vasculature. It provides details on the bones that make up the pectoral girdle, arm, forearm and hand. It describes the many synovial joints of the upper limb and their classifications. The document outlines the muscles of the upper extremity, grouping them by location and function. It discusses the brachial plexus, describing its formation, parts and branches, and the structures each branch innervates. Finally, it reviews the cutaneous innervation and blood supply of the upper limb.

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    Upper Extremity

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    The document discusses the anatomy of the upper extremity, including bones, joints, muscles, nerves and vasculature. It provides details on the bones that make up the pectoral girdle, arm, forearm and hand. It describes the many synovial joints of the upper limb and their classifications. The document outlines the muscles of the upper extremity, grouping them by location and function. It discusses the brachial plexus, describing its formation, parts and branches, and the structures each branch innervates. Finally, it reviews the cutaneous innervation and blood supply of the upper limb.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    52 views37 pages

    Upper Extremity

    Uploaded by

    Marco Alsanero
    The document discusses the anatomy of the upper extremity, including bones, joints, muscles, nerves and vasculature. It provides details on the bones that make up the pectoral girdle, arm, forearm and hand. It describes the many synovial joints of the upper limb and their classifications. The document outlines the muscles of the upper extremity, grouping them by location and function. It discusses the brachial plexus, describing its formation, parts and branches, and the structures each branch innervates. Finally, it reviews the cutaneous innervation and blood supply of the upper limb.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 37

    The Upper Extremity

    Arm Muscles, Axilla, Brachial Plexus

    Bones of Upper Extremity


    Appendicular Skeleton
    Pectoral Girdle = scapula,clavicle
    Upperlimb

    Arm: humerus
    Forearm: radius, ulna
    Interosseus membrane

    Hand: carpals, metacarpals,


    phalanges

    Review Bones + 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

    Joints of the
    Upper Extremity

    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

    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

    Refer to tables in chapter 11 of text for muscle O + I


    (Table 11.8-11.13)
    Know at least 1 action of every muscle

    If ORIGIN on scapula = Move Arm

    Muscles
    of Scapula

    Subscapularis
    Rotator
    Supraspinatus
    Cuff
    Infraspinatus
    Teres Minor
    Teres Major
    Latissimus Dorsi (partial O on scap)
    Coracobrachialis

    If INSERTION on scapula = Move


    scapula

    pg 283

    Rhomboids
    Trapezius
    Pectoralis Minor
    Serratus Ventralis
    Levator Scapulae

    Use location of Insertion to determine movement!!

    Innervation of Scapula Muscles

    Origin on Scapula:

    Latissimus dorsi = Thoracodorsal nerve


    Subscapularis, Teres Major = Subscapular nerves
    Supraspinatus, Infraspinatus = Suprascapular nerves
    Teres Minor = Axillary nerve

    Insertion on Scapula

    Levator Scapular, Rhomboids = Dorsal Scapular nerve


    Pectoralis Minor = Pectoral n.
    Serratus Ventralis = Long Thoracic n.
    Trapezius = Accessory n.
    Refer to tables in chapter 11 of text for muscle O + I
    Know at least 1 action of every muscle

    Muscles of Arm: Cross


    elbow, Move forearm

    2 Compartments

    Anterior: Flexors of forearm


    Posterior: Extensors of forearm

    Anterior Compartment

    Biceps brachii = MC nerve


    Brachialis
    = MC nerve
    Brachioradialis = Radial nerve

    Coracobrachialis = MC nerve

    O = coracoid process of scapula


    I = medial side humeral shaft
    A = flex, adduct arm

    Posterior Compartment

    Triceps brachii =
    Anconeus
    =

    Radial nerve
    Radial nerve

    MC = musculocutaneous nerve

    Muscles of forearm: Cross wrist + finger


    joints, moves hand
    Cross Wrist = flex, extend, abduct, adduct hand
    Cross Fingers = flex, extend fingers
    Most muscles fleshy proximally, long tendons distally
    Flexor + Extensor Retinacula

    wristbands keep tendons from bowing


    thick, deep fascia

    Anterior Flexor Compartment (Superficial + Deep layers)


    Most flexors have common tendon on medial epicondyle
    Contains 2 pronators
    Innervated by *Median, Ulna nerves
    Posterior Extensor Compartment (Superficial + Deep layers)

    Innervated by Radial nerve (or branches of)

    Innervation of Anterior
    Compartment-Forearm Muscles
    Muscle

    Nerve

    Superficial Muscles

    Flexor digitorum superficialis Median


    Flexor carpi radialis Median
    Pronator teres Median
    Palmaris longus Median
    Flexor carpi ulnaris
    Ulnar

    Deep Muscles

    Pronator quadratus
    Median
    Flexor pollicis longus Median
    Flexor digitorum profundus Ulnar (med 1/2)
    Median (lat 1/2)

    Anterior Compartment Forearm


    pg 302
    Medial Epicondyle
    Brachioradialis
    Pronator Teres
    Flexor Carpi Radialis
    Flexor Carpi Ulnaris
    Flexor Retinaculum

    Anterior View

    Flexor Digitorum Superficialis


    is deep to other flexors

    Innervation of Posterior
    Compartment-Forearm Muscles
    Muscle

    Nerve

    Superficial

    Extensor carpi radialis longus


    Extensor digitorum
    Extensor carpi ulnaris

    Radial
    Radial
    Radial

    Deep

    Supinator
    Abductor pollicis longus
    Extensor pollicis longus + brevis
    Extensor indicus

    Radial
    Radial
    Radial
    Radial

    Posterior Compartment of Forearm

    Lateral Epicondyle
    Extensor digitorum
    Extensor carpi ulnaris

    Posterior View

    Brachioradialis
    Ext Carpi Radialis Longus

    Intrinsic Muscles of 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 InterosseiUlnar


    Lumbricals Median, Ulnar

    pg 297

    Intrinsic Muscles of Hand


    Palmar
    Interossei

    Dorsal
    Interossei

    ADDuction

    ABduction

    Lumbricals
    3rd
    2nd

    4th

    1st

    Interossei help the lumbricals to extend IP joints and flex MC-P joints

    Blood Supply: Veins


    SUPERFICIAL
    Cephalic (arm-forearm)
    Basilic (arm-forearm)
    Median Cubital (elbow)
    Median Vein
    SF. Palmar Venous Arch
    Digital

    pg 547

    DEEP
    Subclavian (neck)
    Axillary (axilla)
    Brachial (arm-elbow)
    Radial (forearm)
    Ulnar (forearm)
    Deep Palmous Venous arch

    Blood Supply: Arteries


    Subclavian (neck)
    Axillary (armpit)

    Subscapular

    Brachial (arm)

    Deep brachial

    Radial (forearm)
    Ulnar (forearm)

    Common Interosseous

    Superficial & Deep


    Palmar arches
    Pg 536

    Digital

    Axilla = Armpit
    Region between arm and chest
    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
    Upper
    Limb
    Biceps + Triceps brachii
    Olecrenon Process
    Medial Epicondyle
    Cubital Fossa

    Anterior surface elbow


    Contents
    Median Cubital Vein
    Brachial Artery
    Median Nerve

    Boundaries
    Medial= Pronator teres
    Lateral= Brachioradialis
    Superior= Line between epicondyles

    pg 748

    Carpal Tunnel

    Surface Anatomy
    of Upper Limb

    Carpals concave anteriorly


    Carpal ligament covers it
    Contains: long tendons,
    Median nerve
    Inflammation of tendons =
    compression of Median
    nerve

    Anatomical Snuffbox

    pg 749

    Lateral = E. pollicis brevis


    Medial = E. pollicis longus
    Floor = scaphoid, styloid of
    radius
    Contains Radial Artery
    (pulse)

    Brachial Plexus
    Network of nerves; part in
    neck, part in axilla
    Muscles of upper limb
    receive innervation from
    nerves of the brachial plexus
    Formed from Ventral Rami
    of Inferior 4 Cervical Nerves
    (C5-8) and T1

    Where Ventral Rami Come From


    Dorsal Root
    Dorsal Ramus of
    spinal nerve

    Ventral Ramus
    of spinal nerve
    spinal nerve

    Pg 381

    Ventral Root

    Parts of Brachial Plexus

    Really Tired? Drink Coffee Buddy!

    R = ROOTS (ventral rami)


    T = TRUNKS
    D = DIVISIONS
    C = CORDS
    B = BRANCHES

    Roots join to form Trunks! (in neck)


    Ventral Rami

    Trunks

    C5Upper Trunk
    C6
    C7 Middle Trunk
    C8
    T1 Lower Trunk

    Trunks Split to form Divisions! (in neck)


    Trunks
    Upper

    Divisions
    Anterior

    Posterior

    Middle Anterior

    Posterior

    Lower

    Posterior

    Anterior

    Divisions Join to form Cords! (in axilla)


    Trunks

    U
    M

    Divisions

    A
    P
    A
    P
    A
    P

    Cords

    LATERAL CORD

    MEDIAL CORD

    POSTERIOR CORD

    Cords Give off Branches!! (in axilla)


    Lateral

    Musculocutaneous

    Median
    Medial Ulnar
    PosteriorRadial
    (subscapular)

    Axillary

    (thoracodorsal)

    PUT IT ALL TOGETHER...

    pg 416

    Learn Figure 14.11c in textbook!

    Innervation by Posterior Cord


    Radial Nerve (largest branch)

    Course: Through arm, around humerus, around lateral


    epicondyle, then divides

    Innervates: all 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)

    Damage to Radial Nerve = wristdrop


    Inability to extend the hand, st inability to fully extend forearm

    Innervation by Posterior Cord (continued)


    Axillary Nerve (runs w/ caudal humeral circumflex a.)

    Innervates:
    Deltoid and Teres minor (motor inn)
    Capsule of shoulder, skin of shoulder (sensory inn)

    Subscapular Nerve {branches of C5 + C6 rami}

    Innervates: Subscapularis, Teres major

    Thoracodorsal Nerve (runs w/thoracodorsal a+v)

    Innervates: Latissimus dorsi

    Innervation by Lateral Cord


    Musculocutaneous

    Course: branches to arm, distal to elbow becomes


    cutaneous for lateral forearm skin
    Innervates
    Biceps brachii, brachialis, coracobrachialis (motor inn)
    Skin distal to elbow (sensory)

    Suprascapular (runs w/suprascapular a+v) {C5, C6}

    Innervates: Supraspinatus, Infraspinatus

    Innervation by both Lateral and


    Medial Cords
    Median

    Course: middle of brachial plexus, 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: most muscles of anterior forearm (motor inn)


    (eg) most flexors, some intrinsics (thumb)

    Innervates: skin of lateral 2/3 hand on palm side,


    dorsum of fingers 2+3 (sensory inn)
    Nerve Damage = Ape Hand
    Inability to Oppose Thumb

    Innervation by Medial Cord


    Ulnar

    Course: runs along medial side of arm, behind medial


    epicondyle, superficial to carpal tunnel into hand,
    branches to supply intrinsics and skin

    Innervates:
    FCU and part of FDP, most intrinsics (motor inn)
    Skin of medial 2/3 of hand A+P (sensory inn)

    Nerve Damage: Clawhand


    Inability to extend fingers at interphalangeal joints,
    results in permanent flexion = claw

    Cutaneous Innervation to the Hand

    Median Nerve

    Ulnar Nerve

    Brachial Artery
    Musculocutaneous Nerve

    UlnarArtery

    Wheres Radial Nerve?

    Radial Artery
    Median Nerve

    Ulnar Nerve

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