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Lecture24:Upperlimb2Summary Attheshoulderjoint: o movementinanumberofplanesispossible o Thisisbecausetheglenohumeraljointisaball-andsocketsynovialjoint o Thisjointcanabductandadduct,flexandextend, laterallyandmediallyrotateand,ofcourse, undergocircumduction. AttheElbow:(reftobottomrightphotoforlabels) 1.ElbowJoint: o Itisahingejointsocannotundergothebroadrangeofmovementsthattheshoulderjointcan o Itcanonlymoveinoneplane,flexingandextending 2.Theradioulnarjoint: o Thisjointisdistinctfromtheelbowjointitself o Involvesarticulationbetweentheulnaandtheradius o Thesetwobonesnormallymoveintandem—theyarealsoabletoundergosupinationand pronation. Atthewrist: RadiocarpalJoint: o Flexionandextension,abductionandadductionpossible o Flexionlikewaving,extensiontheoppositedirection o Abductionistowardsthemidline,whilstadductionislateralmovement Atthe fingers: o o o o o Therangeofmovementsavailabletothefingersdependsontheindividualfinger Thumbsaregoingtohaveadifferentrangeofmovementsduetodifferencesintheir metacarpophalangealjoints FordigitsII-V,flexionandextensionANDabductionandadductionpossible Flexioninvolvesbendingthefingertowardsthepalm,whilstextensionistheopposite. Abductionisspreadingthefingersout,whilstadductionisputtingthemintogether Atthethumb: o Technically,flexionandextensionofthethumbhappeninadifferentplanetotherestofthe upperlimb(buttrynottothinkofitlikethis) o Likethefingers,bringingthethumbintowardsthepalmisflexion,whilsttakingitoutisthe extension o Abductionandadductionistheleftandrightmovementofthethumb o Thecapacityforabductionandadductionisrelativelyrestricted o Touchingyourfingerswithyourthumbiscalledopposition,henceopposablethumb. Fascia: o Themusclesoftheupperlimbarealllinedwiththeconnectivetissuedeepfascia. o Brachialfascia:Fasciaoftheupperarm o Antebrachialfascia:fasciaoftheforearm ThereareSpecialisedfascialstructuresintheupperarm: Interosseusmembrane: o Fasciathatbindstheulnaandtheradiustogether o Helpsthemtomoveintandem o Italsoprovidesasiteformuscleattachment Retinacula: o Importantinboththeupperandlowerlimb o Intheupperlimbàthistypeoffascialstructureisfoundatthewrist o Itactsasananchor,preventingthetendonssupplyingthedigitsfrom bowstringing. o Italsoprotectsnervesandvessels Aponeuroses: o Theyactliketendonsinsheet-likemusclescoveringbroadareas o Eg.palmaraponeurosi(palmofhands) Muscles: o Musclesoftheupperlimbcanplaypracticallyanyrole o They’resynergists,primemovers,fixatorsandantagonists Back Muscles *don’tworrytoomuchaboutattachmentofeachmuscle.Knowwheretheyare Superficial(Extrinsic)musclesoftheback: o They’renot“true”backmuscles o Theyallhaveattachmentsatboththebackandtheupperlimb o Inc.trapezius,Latissimusdorsi,LevatorScapulae,Rhomboidminor/major Trapezius o Itisalarge,triangularmuscle o Itprovidesanattachmentofthepectoralgirdletothetrunk o Itisinvolvedmainlyinmovingthescapula o Thesuperiorfibresofthetrapeziuspullthescapulaup,themiddlefibresretractthe scapula(thatistopullitposteriorly)andtheinferiorfibrespullthescapuladown. LatissimusDorsi: o Dorsimeans“oftheback”.Latissimusmeans“broadest” o Solatissimusdorsiisthebroadestmuscleoftheback o Itcoversawideareaofthebackandisfanshaped o Ithastheeffectofextending,retractingandrotatingthehumerusaswellasrotatingthe scapula. o Ititattachesbetweenthehumerusandtheback Levatorscapulae: o helptorotatethescapula&extendingtheneck Rhomboidmajor&minor: o helptoretractandrotatethescapula Shoulder Girdle: Attachtoandactontheupperlimb Includes:pectoralmuscles,serratusanterior,deltoid,TeresMajor PectoralMuscles: o Includes:pectoralismajorandpectoralisminor(bothfoundattheshouldergirdle Serratusanterior: o Attachestothescapulaandtheribcage,helpingtoanchorthescapula Deltoid: o Muscleissaidtoresemblecapitaldelta(∆) o Thismusclehelpstoswingthearm Teresmajor: o isthelastoftheintrinsicshouldermuscles Scapulo-humeralmuscles:includesdeltoid,biceps,rotator cuffmuscles RotatorCuffMuscles: o TheyincludetheSITSmuscles:supraspinatus, infraspinatus,teresminor,subscapularis o Bicepsbrachiiisalsoinvolvedintherotatorcuf o Itsheadisovertheglenohumeraljoint,whilstits otherheadisovertheelbowjoint.Thismuscleis theelbowflexor Fixatormusclesintheshoulder:blendwiththecapsuleoftheshoulderjoint,pulltheheadofthehumerus towardstheglenoid,makingitfitinthereniceandsnug Primemovers:involvedinrotationandabduction Arm Muscles: Musclesinboththebrachiumandtheforearmarecompartmentalisedbyfascia Therearetwomajorcompartments: o Theanteriorcompartmentand o Posteriorcompartment Musclesoftheanteriorcompartment-elbowflexors Musclesoftheposteriorcompartment-elbowextensors AnteriorCompartmentofarm: o Therearethreemuscles–allworktogetheraselbowflexors o Inc:Bicepsbrachii,brachialis,coracobrachialis Posteriorcompartmentofarm o Thereisonlyonemuscls—tricepsbrachii o Itistheonlyelbowextensor.Tricepsbrachiiisalarge,fusiformmuscle.