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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 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 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 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 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 All digiti minimi (Flexor, Abductor, Opponens) Nerve Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Adductor pollicis Median Median Median Ulnar Other Intrinsic Muscles 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 Deep veins Deep palmar venous arches Radial - forearm Ulnar - forearm Brachial – arm/elbow Axillary – axilla Subclavian - neck Superficial Veins Digital Superficial palmar venous arches Median – forearm Median cubital – elbow Blood draws!! Cephalic – arm/forearm Basilic – arm/forearm pg 675 Blood Supply - Arteries Subclavian (neck) Axillary (armpit) Brachial (arm) Deep brachial Radial (forearm) Ulnar (forearm) Subscapular Circumflex humeral arteries Common Interosseous Superficial & Deep Palmar arches Digital Axilla 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 Cephalic Vein Biceps brachii Triceps brachii Olecrenon Process Medial Epicondyle Lateral Epicondyle pg 686 Surface Anatomy of Elbow Cubital Fossa Anterior surface elbow Contents Median Cubital Vein Brachial Artery Median Nerve Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles pg 715 Surface Anatomy of Hand Carpal Tunnel Carpals concave anteriorly Carpal ligament covers it Contains: long tendons, Median nerve Inflammation of tendons = compression of Median nerve Anatomical Snuffbox Lateral = E.pollicis brevis Medial = E. pollicis longus Floor = scaphoid, styloid of radius Contains Radial Artery (pulse) pg 618 Brachial Plexus Nerve plexus 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!!) Rami join to form Trunks! (in neck) Ventral Rami Trunks Upper Trunk C5 C6 C7 Middle Trunk C8 T1 Lower Trunk Trunks Split to form Divisions! (in neck) Trunks Divisions 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 Musculocutaneous nerve Off lateral cord Course: Innervates: 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: 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: 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: 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