the upper extremity bones, muscles, vessels,. bones 30 bones!!!! appendicular skeleton pectoral...
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Bones 30 bones!!!! Appendicular skeleton Pectoral girdle
Glenoid cavity Allows for mobility
Attachments Upper extremity:
Arm humerus
Forearm Radius, ulna (interosseous
membrane) Hand
Carpals, metacarpals, phalanges Review bones and landmarks
studied in lab!!!
Joints of Upper Extremity
Sternoclavicular Synovial-saddle Diarthrosis
Acromioclavicular Synovial-plane Diarthrosis
Glenohumeral joint Synovial-ball&socket Diarthrosis Many ligaments Muscle reinforcement Great Mobility
Joints of the Upper Extremity
Elbow Joint Synovial – hinge Diarthrosis
Articulations Humerus & Ulna Humerus & Radius
Many Ligaments
Joints of Upper Extremity
Proximal Radioulnar joint Synovial - pivot Diarthrosis
Distal Radioulnar joint Synovial – pivot Diarthrosis
Allows pronation and supination of forearm
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
Joints of the Upper Extremity
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 Supraspinatus Infraspinatus Teres Minor Teres Major Latissimus Dorsi (partial
attachment) Coracobrachialis
RotatorCuff
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 Subscapular
Supraspinatus and Infraspinatus Suprascapular
Teres Minor Axillary
Latissimus Dorsi Thoracodorsal
Coracobrachialis Musculocutaneous
Insertion on scapula Rhomboids and Levator
Scapulae Dorsal scapular
Trapezius Accessory
Pectoralis Minor Medial and Lateral
Serratus Ventralis Long thoracic
Arm Muscles
Cross elbow, move forearm
2 compartments Anterior
Flexors of forearm
Posterior Extensors of forearm
Arm Muscle Innervation
Anterior compartment Radial nerve
Bracioradialis Musculocutaneous nerve
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
flex, extend, abduct, adduct hand
Cross Fingers 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 Nerves Superficial
Flexor digitorum superficialis Median Flexor carpi radialis Median Pronator teres Median Palmaris longus Median Flexor carpi ulnaris Radial
Deep Flexor pollicis longus Median Flexor digitorum profundus Ulnar (med
1/2) Median (lat 1/2)
Posterior Compartment of Forearm
Muscles Nerves Superficial
Extensor carpi radialis longus Radial Extensor digitorum Radial Extensor carpi ulnaris Radial
Deep Supinator Radial Abductor pollicis longus Radial Extensor pollicis longus + brevis Radial Extensor indicus Radial
Hand Bones
Carpus (8) “True” wrist Distal to radius/ulna
Metacarpus (5) Distal to carpus
Phalanges (14) Distal to
metacarpus
Intrinsic Muscles of the Hand
Muscle Nerve Pinky (little finger)
All digiti minimi Ulnar(Flexor, Abductor, Opponens)
Thumb Abductor pollicis brevis Median Flexor pollicis brevis Median Opponens pollicis Median Adductor pollicis Ulnar
Other Intrinsic Muscles Palmar + Dorsal Interossei Ulnar Lumbricals Median, Ulnar
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)
Subscapular Circumflex humeral arteries
Brachial (arm) Deep brachial
Radial (forearm) Ulnar (forearm)
Common Interosseous Superficial & Deep Palmar
arches Digital
Axilla Armpit!! Where axillary hairs grow Boundaries
Ventral Pectoral muscles
Dorsal Latissimus dorsi, teres major,
subscapularis Medial
Serratus ventralis Lateral
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
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
C5 Upper Trunk C6
C7 Middle Trunk
C8 T1 Lower Trunk
Trunks Split to form Divisions! (in neck)
Trunks Divisions
Upper AnteriorPosterior
Middle AnteriorPosterior
Lower Anterior Posterior
Divisions Join to form Cords! (in axilla)
Trunks Division Cords
U A LateralP
M A MedialP
L A PosteriorP
Cords Give off Branches!! (in axilla) Lateral Musculocutaneous
Median
Medial Ulnar
Posterior RadialAxillary(thoracodorsal)(subscapular)
Brachial Plexus – Cords and Branches
Lateral Musculocutaneous Median
Medial 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)
Suprascapular 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 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:
Runs posterior to humerus Runs with caudal humeral circumflex artery
Innervates: Deltoid and teres minor (motor) Capsule of shoulder, skin of shoulder (sensory)
Subscapular nerve Innervates:
Subscaplaris, Teres major Thoracodorsal nerve
Course: Runs with thoracodorsal artery and nerve
Innervates: Latissimus dorsi
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