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Anatomy for Health Care Professionals
NUR469: Lecture 2
September 14, 2009
Curtis L. Whitehair, MD
Georgetown University
School of Nursing & Health Studies
Graduate Program
Upper Arterial Supply
LAB
Veins
Brachial Plexus
Robert Taylor Drinks Cold Beer
Brachial Plexus
Brachial Plexus Injuries



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Injuries to the brachial plexus affects movement and cutaneous sensations in
the upper limb.
Erb-Duchenne Palsy: Upper Trunk or C5,6 Roots – results in waiters tip.

Shoulder
Adducted
Medially
rotated
arm
Extend
Elbow
Brachial Plexus Injuries

Compression of cords of the brachial plexus from prolonged hyperabduction of
the arm. Results in pain radiating down the arm with hand weakness.
Brachial Plexus Injuries

Klumpke Palsy: Less common, inferior brachial plexus injury(C8-T1), may be
from trying to break a fall. Intrinsic muscle of the hand affected, develops claw
hand.
Brachial Plexus Injuries





Injuries to the brachial plexus affects movement and cutaneous sensations in
the upper limb.
Erb-Duchenne Palsy: Upper Trunk or C5,6 Roots – results in waiters tip.
Compression of cords of the brachial plexus from prolonged hyperabduction of
the arm. Results in pain radiating down the arm with hand weakness.
Klumpke Palsy: Less common, inferior brachial plexus injury(C8-T1), may be
from trying to break a fall. Intrinsic muscle of the hand affected, develops claw
hand.
Acute Brachial Plexus Neuritis (Parsonage Turner Syndrome): sudden on
set of severe shoulder pain then is followed by weakness. Inflammation is
often preceded by some event (URI, Vaccination or Non-specific Trauma)
Anterior muscles of the Arm
Biceps Brachii
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Musculocutaneous (C5,C6)
(bi, two + L. caput, head) – 2 heads

Short head
 Tip of coracoid process

Long head
 Supraglenoid tubercle of scapula
Single distal tendon attached to Radius with
biceps tendon
Bicipital aponeurosis runs from biceps
tendon across the cubital fossa

Protects structures of cubital fossa
No attachment to Humerus
“Three joint muscle”

Glenohumeral joint

Elbow joint

Radioulnar joint
When elbow is extended – flexor of elbow
Elbow 90o :

Supinated – flexor

Pronated – primary supinator of the arm

Semiprone – active with resistance only
Bicipital Myotatic Reflex
Deep Tendon Reflex / Muscle Stretch
Reflex – C5
Biceps Tendonitis
Wear and tear, usually long head of the
biceps
Speed’s test – flexion pain at insertion
Yergason test – elbow 90o resisted
supination

Rupture of the
Tendon usually long
head, rare distally.
Brachialis



Musculocutaneous
C5, C6
Flexes forearm all
positions – not
effected by position
MAIN flexor of the
forearm
LAB
Coracobrachialis

Musculocutaneous C5, C6, C7
 Flexes arm
 Helps arm adduction

Stabilizes glenohumeral joint
from inferior dislocation
 Carrying suitcase
LAB
Posterior muscles of the Arm
Triceps brachii




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

Radial nerve (C6,C7, C8)
3 heads
Long head
Crosses glenohumeral joint
Helps Adduct and extend
Arm
Stabilizes inferior dislocation
Medial head


Workhorse of forearm
extension
Lateral head

Strongest but is recruited
against resistance
LAB
Anconeus

Radial C7, C8, T1

Tenses the capsule
of the elbow joint
preventing its being
pinched during
extension.
Muscles of the forearm flexor


The flexors are arranged in three layers
Superficial layer



Intermediate layer



4 muscles
Crosses elbow
1 muscle
Crosses elbow
Deep layer


3 muscles
Crosses wrist and phalanges
Superficial Layer – forearm LAB

Pronator Teres



Median nerve C6,
C7
pronates forearm
medial boarder
cubital fossa
Superficial Layer – forearm LAB

Flexor carpi
radialis



Median nerve C6,
C7
Flexes wrist
Helps abducts
wrist
Superficial Layer – forearm LAB

Palmaris Longus






Median nerve
Absent in 14% of
people (usually left)
Tendon passes
superficial to the
flexor retinaculum
Attaches to palmar
aponeurosis
Median nerve runs
lateral to tendon
CTS Injection medial
Superficial Layer – forearm LAB

Flexor Carpi
Ulnaris



Most medial flexor
Flexes and adducts
the wrist if acting
alone
Ulnar C7, C8
Intermediate layer – forearm LAB



Flexor digitorum
superficialis
Distal end four tendons
go through carpal tunnel
to middle phalanges
Flexes four fingers




PIP
MCP – stronger
Median C7, C8, T1
Test – one finger flexed
PIP, others extended
Deep Layer – forearm


Flexor Digitorum Profundus
Only muscle that flex the DIP




Medial part – Ulnar C8, T1
Lateral part - Median (anterior
interosseous) C8, T1
Flexor Pollicis Longus
Only muscle to flex the 1st IP, MCP
and CMC joints

Median (anterior interosseous) C8,
T1
LAB
Deep Layer – forearm




Pronator quadratus
Deepest muscle of anterior
forearm
Sometimes considered fourth
layer
Median (anterior
interosseous) C8, T1
LAB
Posterior muscle of the forearm
Superficial layer
Deep layer and Outcropping muscles of deep layer
Extensor muscle of the forearm

Divided into 3 functional groups



Extend, abduct, adduct the hand at the wrist
 Extensor carpi radialis longus
 Extensor carpi radialis brevis
 Extensor carpi ulnaris
Extend the medial four fingers
 Extensor digitorum
 Extensor indicis
 Extensor digiti minimi
Extend or abduct the thumb
 Abductor pollicis longus
 Extensor pollicis brevis
 Extensor pollicis longus
Superficial

Extensor carpi
radialis longus

Extensor carpi
radialis brevis


Extend and abduct
wrist
Radial nerve C6, C7
LAB
Superficial

Extensor digitorum


Extensor digiti minimi


5th finger
Extensor carpi ulnaris


Four tendons to extensor
hood of 4 fingers
Extend and adducts wrist
joint
Radial nerve C7, C8
(posterior interosseous
nerve)
LAB
Deep Layer

Supinator



Prime supinator with arm
extended
Radial (deep branch)
Extensor indicis


Independent extensor of
2nd finger
Radial C7, C8 – (PI)
LAB
Deep Layer - Outcropping LAB

Abductor pollicis longus


Base of 1st metacarpal
Extensor pollicis brevis

Base of 1st proximal phalanx

De Quervain’s Tenosynovitis

Extensor pollicis longus

Base of 1st distal phalanx
Radial nerve C7, C8
Medial & Lateral Epicondylitis

Medial – Common Flexor
Tendon

Pitcher’s (Little League)
Elbow

Lateral – Common Extensor
Tendon

Tennis Elbow

Treatment

Splint

Physical Therapy

NSAIDs

Steroids Oral

Steroid Injection at the
common flex/ext tendon
Intrinsic muscle of the hand

Thenar muscle

Abductor pollicis brevis


Median nerve C8, T1
Flexor pollicis brevis


Superficial head –
Median C8, T1
Deep head – Ulnar C8,
T1
Intrinsic muscle of the hand

Thenar muscle

Opposes thumb


Median nerve C8,
T1
Adductor pollicis

Ulnar nerve C8, T1
Intrinsic muscle of the hand

Hypothenar
muscle



Abductor digiti
minimi
Flexor digiti minimi
Opponens digiti
minimi

Ulnar nerve C8, T1
Intrinsic muscle of the hand
Short Muscles

Lumbricals – Ulnar
 Flex fingers at the MCP
joint
 Extend fingers at IP
joint

Interossei
 Dorsal – Abduct from
axial line
 Palmar – Adduct to
axial line

DAB with a PAD
Arteries of forearm and hand
Nerves of the hand
Nerves of the hand
Shoulder Joint
Rotator Cuff
Nursemaid’s Elbow
Preschool children
Particularly girls
Transient subluxation
•Treatment consists of manipulating the child's arm
so that the annular ligament and radial head return
to their normal anatomic positions.
•Immobilize the elbow and palpate the region
of the radial head with one hand.
•The other hand applies axial compression at
the wrist while supinating the forearm and
flexing the elbow.
•As the arm is manipulated, a click or snap
can be felt at the radial head.
Next Week

Must know
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559 - Bones of the LE
Fig 5.6, 5.7, 5.8 and 5.9
Dermatomes Fig 5.13
Fig 5.15 – Tensor fascia lata
Sartorius
Rectus Femoris
Adductor longus
Vastus medialis / lateralis
Gracilis
Fig 5.17 – Neurovascular
structure
Fig 2.3 – Gluteal Region
Biceps femoris
Semi-tendinosus
Semi-mebranosus
Gluteus Medius / Maximus
Piriformis
Popliteal fossa





Tibial nerve
Popliteal vein
Popliteral artery
Common fibular (peroneal)
nerve
Sural nerve

Should know
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Fig 5.15 – Pectinues
Adductor brevis
Superior gemellus
Obturator internus
Inferior gemellus
Obturator externus
Great to know

Table 5.1