Download The Upper Extremity

The Upper Extremity
Bones,
Muscles,
Vessels,
pg 608
pg 612
Bones



30 bones!!!!
Appendicular skeleton
Pectoral girdle


Allows for mobility


Glenoid cavity
Attachments
Upper extremity:

Arm


Forearm


Radius, ulna (interosseous
membrane)
Hand


humerus
Carpals, metacarpals, phalanges
Review bones and landmarks
studied in lab!!!
pg 626-7
Joints of Upper Extremity

Sternoclavicular



Acromioclavicular



Synovial-saddle
Diarthrosis
Synovial-plane
Diarthrosis
Glenohumeral joint





Synovial-ball&socket
Diarthrosis
Many ligaments
Muscle reinforcement
Great Mobility
pg 681-2
Joints of the Upper Extremity

Elbow Joint



Articulations



Synovial – hinge
Diarthrosis
Humerus & Ulna
Humerus & Radius
Many Ligaments
pg 691
Joints of Upper Extremity

Proximal Radioulnar joint



Distal Radioulnar joint



Synovial - pivot
Diarthrosis
Synovial – pivot
Diarthrosis
Allows pronation and
supination of forearm
Pg 711
Joints of the Upper Extremity


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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



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Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor pollicis longus
Pronator quadratus
Extensor carpi radialis brevis
pg 614
Scapula Muscles

If the origin is on the
scapula – moves the arm







Subscapularis
Supraspinatus
Rotator
Cuff
Infraspinatus
Teres Minor
Teres Major
Latissimus Dorsi (partial
attachment)
Coracobrachialis
pg 614
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!!
Innervation of Muscles Moving Arm
Muscle
Innervation
Subscapularis
Teres Major
Subscapular N.
Infraspinatus
Supraspinatus
Suprascapular N.
Teres Minor
Axillary N.
Coracobrachialis
Musculocutaneous N.
Arm Muscles


Cross elbow, move forearm
2 compartments

Anterior


Flexors of forearm
Posterior

Extensors of forearm
pg 667
pg 651
Arm Muscles

Anterior
compartment



Brachialis
Biceps brachii
Coracobrachialis
pg 671
pg 636
Arm Muscles

Posterior compartment

Triceps brachii
Muscles of Arm
Muscle
Origin
Insertion
Action
Brachialis
Ant shaft , distal humerus
Coronoid
proc/tuberosity
(ulna)
Flex forearm
Biceps Brachii
Long: supraglenoid tubercle
(scapula)
Short: coracoid proc (scapula)
Radial Tuberosity
(radius)
Flex forearm,
Supination
Coracobrachialis
Coracoid proc (scapula)
Medial surface
midshaft (humerus)
Flex arm
Long: Infraglenoid tubercle
Short: Posterior shaft
(middle humerus)
Lateral: Posterior Shaft
(proximal humerus)
Common tendon to
olecranon (ulna)
Extend forearm
Anterior
Posterior
Triceps Brachii
Arm Muscle Innervation

Anterior compartment

Musculocutaneous nerve




Coracobrachialis
Brachialis
Biceps brachii
Posterior compartment

Radial nerve

Triceps brachii
pg 694
Forearm Muscles


Cross elbow, wrist and finger
joints
Movement of hand and fingers

Cross Wrist


Cross Fingers




flex, extend, abduct, adduct
hand
flex, extend fingers
Proximally are fleshy
Distally have long tendons
Flexor and extensor retinacula


“wristbands”
Keep tendons from jumping
outwards when tensed
pg 688
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
Most extensors in superficial layer have common origin on
lateral epicondyle
pg 696
Anterior Compartment of Forearm
Muscles

Superficial
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
Nerves
Flexor digitorum superficialis & brevis
Flexor carpi radialis
Pronator teres
Palmaris longus
Flexor carpi ulnaris
Median
Median
Median
Median
Ulnar
Deep



Pronator quadratus
Flexor pollicis longus
Flexor digitorum profundus
Median
Median
Ulnar (med 1/2)
Median (lat 1/2)
Posterior Compartment of Forearm
pg 702
Muscles

Superficial
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Nerves
Brachioradialis
Anconeus
Extensor carpi radialis longus & brevis
Extensor digitorum
Extensor carpi ulnaris
Extensor digiti minimi
Radial
Radial
Radial
Radial
Radial
Radial
Deep




Supinator
Abductor pollicis longus
Extensor pollicis longus + brevis
Extensor indicus
Radial
Radial
Radial
Radial
pg 711
Hand Bones

Carpus (8)



Metacarpus (5)


“True” wrist
Distal to radius/ulna
Distal to carpus
Phalanges (14)

Distal to metacarpus
Intrinsic Muscles of the Hand

Muscle
Pinky (little finger)


Ulnar
Thumb

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


All digiti minimi
(Flexor, Abductor, Opponens)
Nerve
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
Adductor pollicis
Median
Median
Median
Ulnar
Other Intrinsic Muscles
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
Palmar + Dorsal Interossei
Lumbricals
Ulnar
Median, Ulnar
Intrinsic Muscles of the Hand
pg 718
pg 723
Dorsal
Interossei Muscles
Palmar
Lumbrical Muscles
pg 677
Blood Supply - Veins
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Deep veins
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Deep palmar venous arches
Radial - forearm
Ulnar - forearm
Brachial – arm/elbow
Axillary – axilla
Subclavian - neck
Superficial Veins
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Digital
Superficial palmar venous
arches
Median – forearm
Median cubital – elbow


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Blood draws!!
Cephalic – arm/forearm
Basilic – arm/forearm
pg 675
Blood Supply - Arteries
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Subclavian (neck)
Axillary (armpit)



Brachial (arm)


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Deep brachial
Radial (forearm)
Ulnar (forearm)


Subscapular
Circumflex humeral arteries
Common Interosseous
Superficial & Deep Palmar
arches

Digital
Axilla
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

Armpit!!
Where axillary hairs grow
Boundaries

Ventral


Dorsal


Serratus ventralis
Lateral


Latissimus dorsi, teres major,
subscapularis
Medial


Pectoral muscles
Inetrtubercular (Bicipital) groove
of humerus
Contents

axillary lymph nodes, axillary
vessels, brachial plexus
pg 688
pg 688
Surface Anatomy of Arm


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Cephalic Vein
Biceps brachii
Triceps brachii
Olecrenon
Process
Medial Epicondyle
Lateral Epicondyle
pg 686
Surface Anatomy of Elbow

Cubital Fossa


Anterior surface elbow
Contents

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Median Cubital Vein
Brachial Artery
Median Nerve
Boundaries
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Medial= Pronator teres
Lateral= Brachioradialis
Superior= Line between epicondyles
pg 715
Surface Anatomy of Hand
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Carpal Tunnel

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Carpals concave anteriorly
Carpal ligament covers it
Contains: long tendons, Median nerve
Inflammation of tendons =
compression of Median nerve
Anatomical Snuffbox
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Lateral = E.pollicis brevis
Medial = E. pollicis longus
Floor = scaphoid, styloid of radius
Contains Radial Artery (pulse)
pg 618
Brachial Plexus
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Nerve plexus
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
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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
pg 21
pg 660
Brachial Plexus

Really Tired? Drink Coffee Buddy!

R = RAMI (ventral) (5)
T = TRUNKS (3)
D = DIVISIONS (2)
C = CORDS (3)
B = BRANCHES (Many!!)
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Rami join to form Trunks! (in neck)
Ventral Rami
Trunks
Upper Trunk
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C5
C6

C7
Middle Trunk
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C8
T1
Lower Trunk
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
Trunks Split to form Divisions! (in neck)
Trunks
Divisions
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Upper
Anterior
Posterior

Middle
Anterior
Posterior

Lower
Anterior
Posterior
Divisions Join to form Cords! (in axilla)
Trunks
U
M
L
Division
A
P
A
P
A
P
Cords
Lateral
Medial
Posterior
Cords Give off Branches!! (in axilla)

Lateral
Musculocutaneous
Median

Medial
Ulnar

Posterior
Radial
Axillary
(thoracodorsal)
(subscapular)
Brachial Plexus – Cords and Branches

Lateral



Medial


Musculocutaneous n.
Median n.
Ulnar n.
Posterior




Radial n.
Axillary n.
Thoracodorsal n.
Subscapular n.
Lateral Cord
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Musculocutaneous nerve


Off lateral cord
Course:
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

Innervates:

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
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Anterior arm
Becomes cutaneous and gives skin sensation to lateral forearm
Corocobrachialis (motor)
Biceps brachii (motor)
Brachialis (motor)
Skin distal to the elbow (sensory)
Suprascapular (not part of lateral cord)


Runs with suprascapular artery and vein {C5, C6}
Innervates


Supraspinatus
Infraspinatus
Medial Cord

Ulnar nerve

Course:
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
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:


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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 Cord

Radial nerve



Largest branch of brachial plexus
Comes from posterior cord
Course:

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

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 ext. carpi radialis L + B)
Posterior Cord (continued)

Axillary nerve


Branches off posterior cord
Course:



Innervates:



Deltoid and teres minor (motor)
Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve

Innervates:


Runs posterior to humerus
Runs with caudal humeral circumflex artery
Subscapularis, Teres major
Thoracodorsal nerve

Course:


Runs with thoracodorsal artery and nerve
Innervates:

Latissimus dorsi
Cutaneous
Innervation to Hand
pg 620, 727, 729
pg 737-8
Nerve Damage

Ulnar nerve

“Claw hand”


Median nerve

“Ape hand”


Inability to extend fingers at
interphalangeal joints,
results in permanent flexion
= claw
Inability to oppose thumb
Radial nerve


“Wrist drop”
Inability to extend the hand,
inability to fully extend forearm