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The Upper Extremity Bones, Muscles, Vessels, Bones 30 bones!!!! Appendicular skeleton Pectoral girdle Ball and socket attachments Upper extremity: Arm humerus Forearm Radius, ulna (interosseous membrane) Hand Glenoid cavity Allows for mobility Scapula Clavicle Carpals, metacarpals, phalanges Review bones and landmarks studied in lab!!! Joints of Upper Extremity Sternoclavicular Acromioclavicular Synovial-saddle Diarthrosis Synovial-plane Diarthrosis Glenohumeral joint Synovial-ball&socket Diarthrosis Many ligaments Muscle reinforcement Great Mobility Joints of the Upper Extremity Elbow Joint Articulations Synovial – hinge Diarthrosis Humerus & Ulna Humerus & Radius Many Ligaments Joints of Upper Extremity Proximal Radioulnar joint Distal Radioulnar joint Synovial - pivot Diarthrosis Synovial – pivot Diarthrosis Allows pronation and supination of forearm 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 Scapula Muscles If the origin is on the scapula – moves the arm Subscapularis Rotator Supraspinatus Cuff Infraspinatus Teres Minor Teres Major Latissimus Dorsi (partial attachment) Coracobrachialis 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!! Scapula Innervation Origin on scapula Subscapularis and teres major Suprascapular Axillary Latissimus Dorsi Thoracodorsal Coracobrachialis Musculocutaneous Rhomboids and Levator Scapulae Accessory Pectoralis Minor Dorsal scapular Trapezius Teres Minor Insertion on scapula Subscapular Supraspinatus and Infraspinatus Medial and Lateral Serratus Ventralis Long thoracic Muscles of the Rotator Cuff All INSERT on the humerus Muscle Origin Subscapularis Subscapular fossa Medial rotator of the humerus Infraspinous Lateral rotator of fossa the humerus Lateral border of Lateral rotator of scapula (upper the humerus 2/3) Supraspinous Abducts the fossa humerus infraspinatus Teres minor supraspinatus Action Muscles of the Scapula *All these muscles INSERT on the scapula Muscle Origin Action Trapezius Ligamentum nuchae and C7-T12 Elevates, adducts, rotates, and depresses the scapula Levator Scapulae ventralis C1-C4 Elevates the scapula, flexes neck laterally Rhomboids C7-T5 Adduct, elevate, and rotate the scapula Pectoralis minor Ribs 3-5 Depresses and rotates the scapula Serratus anterior Ribs 1-9 Protracts and rotates the scapula Arm Muscles Cross elbow, move forearm 2 compartments Anterior Flexors of forearm Posterior Extensors of forearm Arm Muscles Anterior compartment Brachialis Biceps brachii Coracobrachialis Brachioradialis Arm Muscles Posterior compartment Triceps brachii Anconeus Arm Muscle Innervation Anterior compartment Radial nerve Musculocutaneous nerve Bracioradialis Coracobrachialis Brachialis Biceps brachii Posterior compartment Radial nerve Triceps brachii Anconeus 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 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 Anterior Compartment of Forearm Muscles Superficial Nerves Flexor digitorum superficialis Flexor carpi radialis Pronator teres Palmaris longus Flexor carpi ulnaris Median Median Median Median Radial Deep Flexor pollicis longus Flexor digitorum profundus Median Ulnar (med 1/2) Median (lat 1/2) Anterior Compartment Forearm Posterior Compartment of Forearm Muscles Superficial Nerves Extensor carpi radialis longus Extensor digitorum Extensor carpi ulnaris Radial Radial Radial Deep Supinator Abductor pollicis longus Extensor pollicis longus + brevis Extensor indicus Radial Radial Radial Radial Posterior Compartment of Forearm 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 Muscles of the Upper Limb *All INSERT on the humerus (*) Muscle Origin Action Deltoid Lateral ½ of clavicle, acromion Prime flexor, abducts and and spine of scapula extends the humerus. Laterally and medially rotates arm. Pectoralis major Sternum and ribs 2-6 Adducts, flexes, and medially rotates humerus Latissimus dorsi Iliac crest, T7-T12 and lumbar fascia Extends, adducts, and medially rotates the humerus Teres major Lateral border of scapula (lower 1/3) Extends, adducts, and medially rotates the humerus Coracobrachialis Coracoid process Flexes and adducts the humerus. Muscles Crossing the Elbow Muscle Origin Insertion Action Triceps Brachii (radial nerve) Infraglenoid tubuercle and shaft of humerus Olecranon process of ulna Forearm extensor Anconeus (radial nerve) Lateral epicondyle of humerus Lateral aspect of olecranon process of ulna Abducts ulna during forearm pronation Biceps Brachii (musculocutaneous nerve) Supraglenoid tubercle Radial tuberosity and coracoid process Flex forearm and supinate hand Brachialis (musculocutaneous nerve) Anterior surface of humerus Coronoid process of ulna and capsule of elbow Forearm flexor and hand supinator Brachioradialis (radial nerve)* Supracondylar ridge of the humerus Styloid process of radius Synergist in forearm flexion *Exception: radial nerve usually serves extensor muscles ANTERIOR Superficial Muscles Muscles of the Forearm Muscle Origin Insertion Action Pronator Teres (median nerve) Humerus Coronoid process of ulna Lateral raidus Pronate forearm Weak flexor of elbow Flexor Carpi Radialis (median nerve) Humerus-medial epicondyle Base of 2nd and 3rd metacarpals Flexor of wrist, abduct hand Palmaris Longus (median nerve) Humerus-medial epicondyle Palmar fascia Weak wrist flexor Flexor Carpi Ulnaris (ulnar nerve) Humerus-medial epicondyle Olecranon process Pisiform and hamate bones, base the 5th metacarpal Powerful flexor of wrist, adductor of hand Flexor Digitorum Superficialis (median nerve) Humerus-medial epicondyle, coronoid process of ulna, shaft of radius Four tendons into middle phalange of fingers 2-5 Flexes wrist ANTERIOR Deep Muscles Muscles of the Forearm Muscle Origin Insertion Action Flexor Pollucis Longus (median nerve) Radius and interosseous membrane Distal phalanx of thumb Flexes distal phalanx of thumb Flexor Digitorum Profundus (ulnar and median nerves) Ulna and interosseous membrane Four tendons into distal phalanges of fingers 2-5 Flexor of the fingers radus Forearm pronation Pronator Quadratus ulna (median nerve) POSTERIOR Superficial Muscles Muscles of the Forearm Muscle Origin Insertion Action Extensor Carpi Radialis Longus (radial nerve) Humerus-lateral epicondyle Base of 2nd metacarpal Extends and abducts wrist Extensor Carpi Radialis Brevis (deep branch of radial nerve) Humerus-lateral epicondyle Base of 3rd metacarpal Extends wrist Extensor Digitorum (radial nerve) humerus Four tendons into extensor expansions and distal phalanges of fingers 2-5 Prime mover of finger extension Extensor Carpi Ulnaris (posterior interosseous nerve) Humerus-lateral epicondyle and ulna Base of fifth metacarpal Extends wrist and adducts wrist POSTERIOR Deep Muscles Muscles That Move the Forearm Muscle Origin Insertion Action Supinator (post. Interosseous nerve) Humerus, ulna Radius proximal end Supinate forearm Abductor Pollucis Longus (post. Inter. Nerve) Post. Radius and ulna Base of 1st metacarpal and trapezium Abducts and extends thumb Extensor Pollucis Brevis and longus (post. Inter. Nerve) Shaft of radius and ulna, interosseous membrane Base proximal Extends thumb phalanx (brevis) and distal phalanx (longus) of thumb Extensor Indicis (post. Inter. Nerve) Distal ulna, interosseous membrane Extensor expansion of index finger Extends index finger http://bio.bd.psu.edu/cat/Muscular_System/ deep_muscles.htm# Upper Arm 1. Clavodeltoid 2. Biceps Brachii 3. Triceps Medial Head 4. Epitrochlearis 5. Upper Arm –Medial View Triceps Long Head 1. Acromiotrapezius 2. Levator Scapulae Ventralis 3. Teres Major 4. Triceps Lateral Head (Reflected) 5. Triceps Long Head 6. Triceps Medial Head 7. Brachialis 8. Clavodeltoid 9. Anconeus Upper Arm – Lateral View 1’ Long Head of Triceps 7. Extensor Digitorum Communis 2. Lateral Head of Triceps 8. Extensor Digitorum Lateralis 3. Brachialis 9. Extensor Carpi Ulnaris 4. Brachioradialis 1 0. Flexor Carpi Ulnaris 5. Extensor Carpi Radialis Longus 11 . Anconeus 6. Extensor Carpi Radialis Brevis 1. Brachioradialis 8. Clavodeltoid 2. Extensor Carpi Radialis Longus 9. Biceps Brachii 3. Extensor Carpi Radialis Brevis 10. Epitrochlearis 4. Pronator Teres 11. Long Head of Triceps 5. Flexor Carpi Radialis 12. Medial Head of Triceps 6. Palmaris Longus 13. Flexor Digitorum Superficialis 7. Flexor Carpi Ulnaris Intrinsic Muscles of the Hand Thenar Eminence Muscle Origin Insertion Action Abductor Pollucis Brevis (median nerve) Flexor retinaculum, Carpal bones Base of first proximal phalanx Abducts thumb Flexor Pollucis Brevis (median nerve) Same as above Same as above Flex thumb Opponens Pollucis (median nerve) Flexor retinaculum and trapezium Anterior side of first Oppostion metacarpal Adductor pollucis (ulnar nerve) Capitate bone and Medial side of base bases of metacarpals of first proximal 2-4 phalanx Adducts and opposes the thumb Intrinsic Muscles of Hand Hypothenar Eminence Muscle Origin Insertion Action Abductor Digiti Minimi (ulnar nerve) pisiform Medial side of proximal phalanx of 5th finger Abducts little finger at MPJ. Flexor digiti minimi brevis (ulnar nerve) Hamate and flexor retinaculum Same as above Flexes little finger Opponens digiti minimi (ulnar nerve) Same as above Medial side of metacarpal 5 opposition Muscles of the Hand Midpalmar Muscles Muscle Origin Insertion Action Lumbricals (median and ulnar nerve) Lateral side of each tendon of the deep flexor Lateral edge of extensor expansion of fingers 2-5 Flex the MPJ Extend IPJ’s Palmar Interossei (ulnar nerve) Midaxial side of each metacarpal except of met. #3 Extensor expansion Adduction of fingers Dorsal interossei (ulnar nerve) Sides of metacarpals Extensor expansions Abduct fingers Intrinsic Muscles of the Hand Interossei Muscles Lumbrical Muscles Blood Supply - Veins Deep veins Deep palmar venous arches Radial - forearm Ulnar - forearm Brachial – arm/elbow Subclavian - neck Axillary – axilla Superficial Veins Cephalic – arm/forearm Basilic – arm/forearm Median cubital – elbow Blood draws!! Median - forearm Superficial palmar venous arches Digital 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 Between arms and chest Where axillary hair grow Boundaries Ventral Dorsal Serratus ventralis Lateral Latissimus dorsi, teres major, subscapularis Medial Pectoral muscles Intertubercular (Bicipital) groove of humerus Contents Axillary lymph nodes, Axillary vessels, brachial Plexus Surface Anatomy of Arm Biceps brachii Triceps brachii Olecrenon Process Medial Epicondyle Lateral Epicondyle Surface Anatomy of Elbow Cephalic vein Cubital Fossa Anterior surface elbow Contents Median Cubital Vein Brachial Artery Median Nerve Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles 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) 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 Ventral Rami 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 1. Vagus Nerve 2. Brachial Plexus 3. Radial Nerve 4. Axillary Nerve 5. Median Nerve 6. Ulnar Nerve Brachial Plexus – Cords and Branches Lateral Medial Musculocutaneous Median Ulnar Posterior Radial Axillary Thoracodorsal Subscapular Lateral Cord Musculocutaneous nerve Off lateral cord Course: Anterior arm Becomes cutaneous and gives skin sensation to lateral forearm Innervates: Corocobrachialis (motor) Biceps brachii (motor) Brachialis (motor) Skin distal to the elbow (sensory) 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 Innervates: Anterior forearm (motor) Most flexors, some intrinsics (thumb) 2/3 Lateral palm (sensory) Dorsum of fingers 2 and 3 (sensory) Posterior Cords 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 E. carpi radialis L + B) Posterior Cord 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 Subscaplaris, Teres major Thoracodorsal nerve Course: Runs with thoracodorsal artery and nerve Innervates: Latissimus dorsi Cutaneous Innervation to Hand 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 Carpal Tunnel Syndrome At A Glance •Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. •Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. •Symptoms of carpal tunnel syndrome include numbness and tingling of the hand. •Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing. •Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.
