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Kaan Yücel M.D., Ph.D. 26.December.2012 Wednesday 2 Elbow joint FOREARM Wrist joint Most major structures (nerves,veins,arteries) via cubital fossa, anterior to elbow joint Exception ulnar nerve posterior to the medial epicondyle of humerus Lateral intermuscular septum from the anterior border of the radius to deep fascia surrounding the limb Interosseous membrane links borders of the radius and ulna Attachment of deep fascia along the posterior border of the ulna Muscles in the anterior compartment Flex the wrist & digits Pronate the hand Muscles in the posterior compartment Extend the wrist & digits Supinate the hand Muscles of the anterior compartment Mainly by median nerve The one and a half exceptions by ulnar nerve Muscles of the posterior compartment All by radial nerve (directly or by its deep branch) 7 8 Superficial 4 muscles Intermediate Deep 3 muscles 1. flexor carpi radialis 2. flexor carpi ulnaris 3. palmaris longus 4. pronator teres two heads Ulnar head Humeral head Medial epicondyle 1. flexor carpi radialis Medial epicondyle of humerus Base of metacarpals II & III 2. flexor carpi ulnaris Humeral head: Medial epicondyle of humerus Ulnar head: Olecranon & Posterior border of ulna •Pisiform & hamate •5th metacarpal 3. palmaris longus Medial epicondyle of humerus Flexor retinaculum &palmar aponeurosis 4. pronator teres Humeral head: Medialepicondyle& adjacentsupraepicondylarridge Ulnar head: Coronoid process Lateral surface of radius flexor digitorum superficialis Humeroulnar head • Medial epicondyle of humerus • Adjacent margin of coronoid process Radial head Superior half of anterior border Shafts of middle phalanges of medial four digits 12 flexor digitorum profundus flexor pollicis longus •Proximal¾ of medial& anteriorsurfaces of ulna •Interosseousmembrane • Anteriorsurfaceof radius • Adjacentinterosseous membrane Bases of distal phalanges of 4th &5th digits Bases of distal phalanges of 2nd &3rd digits Base of distal phalanx of thumb pronator quadratus Distal ¼ of anterior surface of ulna Distal ¼ of anterior surface of radius Flexion of forearm @ the elbow joint Pronator teres Flexion of hand @ the wrist joint Flexor carpi radialis et ulnaris- Palmaris longus Abduction (radial deviation) of hand @ the wrist joint Flexor carpi radialis Adduction (ulnar deviation) of hand @ the wrist joint Flexor carpi ulnaris Pronation of forearm Pronator teres – Pronator quadratus Flexor digitorum superficialis Flexes proximal interphalangeal joints of the index, middle, ring, & little fingers Flexes metacarpophalangeal joints of the same fingers and the wrist joint Flexor digitorum profundus Flexes distal phalanges 4 & 5 at distal interphalangeal joints Flexes distal phalanges 2 and 3 at distal interphalangeal joints Flexor pollicis longus Flexes phalanges of thumb All the muscles by median nerve Except 1.5 muscles by ulnar nerve Flexor carpi ulnaris full Flexor digitorum profundus medial half part associated w/ring & little fingers Brachial artery deep venous palmar arch in the hand principal nerve no branches in the arm other than small twigs to the brachial artery. Its major branch in the forearm anterior interosseous nerve Leaves cubital fossa by passing between 2 heads of pronator teres & humero-ulnar &radial heads of flexor digitorum superficialis Enters the anterior compartment by passing posteriorly around medial epicondyle of humerus & between humeral & ulnar heads of flexor carpi ulnaris muscle Two small cutaneous branches palmar branch & dorsal branch motor and sensory functions in both arm & forearm but onlysensoryfunctionsin thehand Superficial (sensory) deep to brachioradialis Deep (motor) between two heads of supinator Continuation of musculocutaneous nerve Branch of medial cord of brachial plexus Branch of radial nerve 23 An important area of transition between the arm and the forearm. seen superficially as a depression on the anterior aspect of the elbow. Deeply, it is a space filled with a variable amount of fat anterior to the most distal part of the humerus and the elbow joint. 24 Superiorly imaginary line connecting medial &lateral epicondyles. Medially pronator teres. Laterally brachioradialis. 25 1) Terminal part of the brachial artery,radial and ulnar arteries 2) Biceps brachii tendon 3) Median nerve 4) Radial nerve 5) (Deep) accompanying veins of the arteries 26 Superficially, in the subcutaneous tissue overlying the fossa median cubital vein, medial and lateral antebrachial cutaneous nerves basilic and cephalic veins. 27 median nerve lies immediately medial to the brachial artery and leaves the fossa by passing between the ulnar and humeral heads of the pronator teres radial nerve lies under brachioradialis (lateral margin of the fossa) gives off deep branch of the radial nerve and continues as superficial radial nerve. 28