anatomy of the arm (detailed)
TRANSCRIPT
Subject of the presentation:Anatomy-of-the-Arm
Prepared by: Prepared by: Dr. Rasekh Dr. Rasekh Ms ortho, senior consultant Ms ortho, senior consultant
Date :13/12/2015
The Humerus
The humerus bone has two parts:1-Upper part(All are insertion)
2-Lower part(All are origins)
Attachments on the Humerus
Upper part
1-Inter tubercular sulcus
2-Greater tubercle
3-Lesser tubercle
4:Deltoid tuberosity
A-Inter tubercular sulcus
1-pectoralis major(Lateral lip)
2-Latissimus dorsi(Floor)
3-Teres major(Medial lip)
Mnemonic:
( lady between two majors)
Mnemonic:( Lady between two majors)
B:Greater tubercle:
1:Supraspinatus(in upper impression)
2:Infraspinatus(in middle impression)
3:Teres minor(in lower impression)
Mnemonic:
(Minor sit)
Mnemonic:(Minor sit)
C:Lesser Tubercle:
1:Subscapularis
D:Deltoid tuberosity
Deltoid muscle
E:Medial aspect of shaft of humerus
Coracobrachialis muscle
Lower part(All are origins)
Medial• A:Pronator teres (lower
1/3 of supracondylar ridge)
• B:common flexor origin• (Epicondyle)
Lateral• A:brachioradialis(upper 2/3
Of supracondylar ridge)
B:extensor carpi radialis longus(lower 1/3 of supracondylar ridge)
C:Anconeus(posterior surface of epicondyle)
D:common extensor origin
(epicondyle)
A:Pronator teres (lower 1/3 of supracondylar ridge)
A:Pronator teres
Common flexor origin(med.Epicondyle(5)
– 1:Pronator teres
– 2:Flexor carpi radialis – 3:Palmaris longus– 4:Flexor carpi ulnaris
• 5:flexor digitorum superficials
LateralA:brachioradialis(upper 2/3
Of supracondylar ridge)
Flexor Digitorum Superficialis is deep to other flexors
pg 302
Brachioradialis
Anterior View
Extensor carpi radialis longus(lower 1/3 of supracondylar ridge)
Anconeus(posterior surface of epicondyle)
– 1:Extensor carpi radialis longus– 2:Extensor digitorum– 3:Extensor carpi ulnaris– 4:Supinator– 5: Extensor carpi radialis brevis
6:Extensor digiti minimi
Common extensor origin (lat.epicondyle(8)
Brachialis
Triceps muscle
Biceps
Fascial Septa• Divide arm into anterior and posterior Divide arm into anterior and posterior
compartments.compartments.
Medial Intermuscular Septum
• From subcutaneous sheath to humerus.
• Separates muscles of anterior arm from medial side of triceps complex.
Lateral Intermuscular Septum
• From subcutaneous sheath to humerus.
• Separates muscles of anterior arm from lateral side of triceps complex.
Arteries
• Subclavian
• Axillary
• Brachial
• Radial
• Ulnar
• Profundus Brachii
• Ant/Post Interosseus
Arch of the aorta
Ascending aorta
Descending aorta
Arch of the aorta
Left subclavian artery
Left common carotid artery
Brachiocephalic artery
Pectoralis minor
Subclavian
Internal thoracic artery
Thyrocervical trunk
Transverse cervical artery
Suprascapular artery
Vertebral artery
VIST Turkey
Mnemonic
Axilary artery• Continuation of subclavian artery at lateral border
of first rib
• Becomes brachial artery at lower border of teres major
• Divided into three parts by overlying pectoralis minor
– A:First portion, above muscle－ gives rise to 1:highest thoracic artery
– B:Second portion, behind muscle－ gives rise to
– 1:thoraco acromial artery
– 2:lateral thoracic artery. – C:Third portion, below muscle－ gives rise to
1:subscapular artery– 2: posterior and anterior humeral circumflex
artery
1:Hi 2:Tell Laila 3:Samad Passed Away!Mnemonic
Brachial Artery
• Direct continuation of axillary artery.
• Begins at inferior border of teres major.
• Main branch is deep brachial artery.
• Other branches:Superior ulnar collateral:
To posterior ulnar recurrent.
Inferior ulnar collateral:To anterior ulnar collateral.
Brachial artery
Radial Nerve
Brachial artery
Pronator teres
Brachialis tendon
Bicepital apponeurosis
Radial artery
Cephalic Vein
• Lateral continuation of dorsal venous arch.
• Ascends in superficial fascia along lateral aspect of forearm and arm.
• Passes through deltopectoral triangle.
• Empties into axillary vein.
Basilic VeinAntecubital Vein
Basilic Vein
• Medial continuation of dorsal venous arch.• Ascends in superficial fascia along medial
aspect of forearm and arm to middle of arm.• Pierces deep fascia and ascends in upper
aspect of arm in deep fascia.• Joins venae comitantes to form axillary
vein:Usually near inferior border of teres major.
Vein
Cephalic Vein
Basilic VeinAnti cubital Vein
Median Cubital Vein
• Connects cephalic and basilic vein.
• Extends diagonally across bicipital aponeurosis.
• Receives blood from median antebrachial vein.
• Drains blood from palmar hand.
Basilic VeinAntecubital Vein
Venae Comitantes
• Veins that parallel arteries:
• Usually two per artery.
Deltoid
Pectoralis major
Right brachiocephalic Vein left brachiocephalic Vein
Superior vena cava
Subclavian Vein
Nerves
• Principle Nerves are– Radial Nerve (C5-C8, T1)– Median Nerve (C6-C8, T1)– Ulnar Nerve (C7, C8, T1)– Musculocutaneous Nerve (C5-C7)
Radial Nerve
MusculocutaneousMedian Nerve
Ulnar Nerve
Auxiliary artery
pectoralis minor
Below pectoralis minor muscle
Auxiliary artery
Musculocutaneous
Radial Nerve
Median Nerve Ulnar Nerve Auxiliary artery
Musculocutaneous Nerve
• Pierces coracobrachialis in upper half or third of brachium.
• Innervates muscles of anterior brachial compartment.
• Pierces fascia lateral to biceps tendon:Continues as lateral cutaneous nerve of the
forearm.Supplies skin on lateral forearm as far as
wrist.
Musculcutaneous Nerve
Biceps Brachii
Brachialis
Corcobrachialis
Coracobrachialis muscle
Biceps
Biceps
Brachialis
Lateral cutaneous nerve of forearm
Radial Nerve
• .
• Descends posterior to the axillary artery:Spirals around the posterior surface of the
humerus in the spiral (radial) groove.
Accompanied by deep brachial artery.
Radial Nerve
• Pierces lateral intermuscular septum distal to deltoid insertion.
• Passes into forearm:Between the brachialis medially and the
brachioradialis laterally.
• Divides into superficial and deep branches near lateral epicondyle.
Radial Nerve
• Branches in the distal third of the arm:Branch to brachioradialis.
Branch to extensor carpi radialis longus (brevis?)
Articular branches to elbow joint.
Latissimus dorsi
Long head
Medial head
After removing the long head of triceps
lateral head
Medial head
Bone
lateral head
BoneBrachioradialis
lateral epicondyle
Brachioradialis
Deep branch(motor)
Superficial branch(sensory)
Median Nerve
• Supplies flexor muscles on the radial side of the forearm.
• Travels with the brachial artery:Lateral to artery in upper half of brachium.
Medial to artery in lower half of brachium.
• Crosses cubital fossa superficially:With brachial artery
Deep to bicipital aponeurosis
Median Nerve
Brachial Artery
Cubital Fossa
Radial recurrent a.
Radial a.
Radial n.
Median n.
Ulnar n.
Ulnar a.
Ulnar recurrent a.
Ulnar n.
Brachial a.
Median Nerve
Ulnar Nerve
Brachial artery
Median Nerve
Ulnar Nerve
Brachial artery
Brachial artery
Pronator teres
Brachialis tendon
Ulnar Nerve
• Supplies flexor muscles on the ulnar side of the forearm.
• Starts in anterior brachial compartment:Medial to brachial artery
Runs with superior ulnar collateral artery.
Ulnar Nerve
• Pierces medial intermuscular septum:Enters posterior compartment of the
brachium.
Passes around (superficial) medial epicondyle.
Passes into forearm between two heads of flexor carpi ulnaris muscle.
Ulnar nerve
Fibrous tunnelFlexor carpi ulnaris Triceps
Musculocutaneous n.
Median n.
Ulnar n.
Medial antebrachial cutaneous n.
Superior ulnar coleteral a.
Deep brachial a.
Median n.
Axillary a.
Brachial a.
Medial antebrachial cutaneous n.
Superior ulnar coleteral a.& Ulnar n.
Inferior ulnar coleteral a.
Nerves in the Brachium
• Medial brachial cutaneous nerve:Direct branch from medial cord.
• Medial antebrachial cutaneous nerve:Direct branch from medial cord.
CUBITAL FOSSA
Cubital Fossa Boundaries
• Lateral:
Brachioradialis muscle• Medial:
Pronator teres muscle• Superior base:
Line between two humeral epicondyles• Floor:
Supinator and brachialis muscles
Cubital Fossa Contents
• Lateral to medial:Biceps TTendon
Brachial AArtery
Median NNerveMnemonic TAN
Articulations: The site where 2 or more bones meet.
Joints are the weakest part of the skeleton.
ClassificationFunctional: Amount of movement allowed
1). Synarthroses: Immovable joints
2). Amphiarthrosis: Slightly movable joint
3). Diarthroses: Fully movable joints
FibulaTibia
Ligament
(b) Syndesmosis Joint held together by a ligament.
Fibrous tissue can vary in length, but is longer than in sutures.
ClassificationStructural: based on material binding the bone.
1). Fibrous: Bone ends united by collagenic fibers
a). Sutures
b). Syndesmoses
c). Gomphoses
Classification
2). Cartilaginous JointsBones are united by cartilage
a). Synchondrosis
b). Symphyses
Immovable Joints (synarthrosis)
• Bones united by ligament
suturesuture
Immovable Joints (synarthrosis)
• Bones united by ligament
(syndesmosis)
Immovable Joints (synarthrosis)
• Bones united by ligament
Interosseous membrane(syndesmosis)
• Ligaments hold tooth in bony socket• Immovable joint
enamel
dentin
gum
root of tooth
pulp
Socket of alveolar process
Peridontal ligament (membrane)
Slightly Movable (ampharthrosis) and Immovable (synarthrosis)
Joints
• Lacks a synovial cavity• Bones connected by fibrocartilage or
hyaline cartilage• 2 types
- synchondrosis- symphyses
Immovable Joint (synchondrosis)
Slightly Movable Joint (ampharthrosis)
pubic symphysispubic symphysis
symphysis
femur
ligaments
pelvis
(Diarthrosis)- freely moveable
femur
hyaline cartilage
synovial cavity
Shoulder joint
Ankle Joint
• Planar Joint• Hinge Joint• Pivot Joint• Saddle Joint• Ball & Socket Joint• Condyloid or Ellipsoid Joint
• Convex surface of bone fits in concave surface of 2nd bone
• Unixlateral like a door hinge• Examples:
- Knee, elbow, ankle, interphalangeal joints• Movements produced:
- flexion- extension- hyperextension
• Bone surfaces are slightly curved• Side to side movement only• Rotation prevented by ligaments• Examples:
- intercarpal to intertarsal joints- sternoclavicular joint- vertebrocostal joints
• Rounded surface of bone articulates with the ring formed by the 2nd bone & ligament
• Monoaxial since it only allows rotation around longitudinal axis
• Examples:- proximal radioulnar joint
- supination- pronation
- atlanto-axial joint- Turning head side to side “no”
• One bone saddle-shaped, other bone fits like a person riding on the saddle
• Biaxial- circumduction allows the tip of the
thumb to travel in a circle- Opposition allows thumb to touch tip
of other fingers• Examples:
- Trapezium of carpus and metacarple of thumb
• Ball fitting into a cup-like depression• Multiaxial
- flexion/extension- abduction/adduction- rotation
• Examples:- shoulder joint- hip joint
• Oval-shaped depression fits into oval depression• Biaxial= flex/extend or adduct/abduct is possible• Examples:
- Wrist and metacarpophelangeal joints for 2 to 5 digits
Figure 8.5a Movements allowed by synovial joints.
Gliding
(a) Gliding movements at the wrist
Figure 8.5b Movements allowed by synovial joints.
(b) Angular movements: flexion, extension, and hyperextension of the neck
Hyperextension Extension
Flexion
Figure 8.5c Movements allowed by synovial joints.
Hyperextension Flexion
Extension
(c) Angular movements: flexion, extension, andhyperextension of the vertebral column
Figure 8.5d Movements allowed by synovial joints.
Extension
Extension
Flexion
Flexion
(d) Angular movements: flexion and extension at theshoulder and knee
Figure 8.5e Movements allowed by synovial joints.
Abduction
Adduction
(e) Angular movements: abduction, adduction, andcircumduction of the upper limb at the shoulder
Circumduction
Figure 8.5f Movements allowed by synovial joints.Lateral
rotation
Medialrotation
Rotation
(f) Rotation of the head, neck, and lower limb
Figure 8.6a Special body movements.
Supination(radius and ulna are parallel)
(a) Pronation (P) and supination (S)
Pronation(radius rotatesover ulna)
Figure 8.6b Special body movements.
Dorsiflexion
Plantar flexion
(b) Dorsiflexion and plantar flexion
Figure 8.6c Special body movements.
EversionInversion
(c) Inversion and eversion
Figure 8.6f Special body movements.
(f) Opposition
Opposition
Type of joint movement:• Flexion- bent knee• Extension- extend knee• Hyperextension- bring leg back• Dorsi flexion- heal• Plantar flexion- toe• Abduction- leg out• Adduction-leg in• Rotation- twisting• Circumduction- circular motion• Supination- palm up• Pronation- palm down• Eversion- foot out• Inversion- foot in• Protraction- chin forward• Retraction- chin back• Elevation- shoulders up• Depression- shoulders down
Questions?
Thanks for your kind attention