The Upper Extremity Bones, Muscles, Vessels,

pg 650

  pg 654

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 pg 668 pg 669

Joints of the Upper Extremity

  

Elbow Joint

 Synovial – hinge  Diarthrosis

Articulations

  Humerus & Ulna Humerus & Radius

Many Ligaments

pg 725 pg 726

Joints of Upper Extremity

   Proximal Radioulnar joint  Synovial - pivot  Diarthrosis Distal Radioulnar joint  Synovial – pivot  Diarthrosis Allows pronation and supination of forearm pg 735

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

pg 656  If the

origin

is on the scapula – moves the arm 

Subscapularis

     

Supraspinatus Infraspinatus

Rotator Cuff

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!!

pg 656

Innervation of Muscles Moving Arm

Muscle

Subscapularis Teres Major Infraspinatus Supraspinatus Teres Minor Coracobrachialis

Innervation

Subscapular N.

Suprascapular N.

Axillary N.

Musculocutaneous N.

Arm Muscles



Arm Compartments

  Anterior Compartment (3 muscles)  Flexors of forearm and arm Posterior Compartment (1 muscle)  Extensor of forearm and arm pg 667

Remember: If you cross the shoulder, you move the arm; if you cross the elbow, you move the forearm

Arm Muscles

 Anterior compartment    Brachialis Coracobrachialis Biceps brachii   Long head Short head pg 718 pg 715

Arm Muscles

 Posterior compartment  Triceps brachii    Long head Medial head Lateral head pg 717

Muscle

Anterior

Brachialis

Muscles of Arm

Origin Insertion Action Innerv Biceps Brachii Coracobrachialis Ant shaft , distal humerus Long: supraglenoid tubercle (scapula) Short: coracoid proc (scapula) Coracoid proc (scapula) Coronoid process /ulnar tuberosity (ulna) Radial Tuberosity (radius) Flex forearm Flex forearm, Supination Medial surface midshaft (humerus) Flex arm, Adduct arm Musculo cutaneous Musculo cutaneous Musculo cutaneous

Posterior

Triceps Brachii Long: Infraglenoid tubercle (scapula) Medial: Posterior Shaft (middle humerus) Lateral: Posterior Shaft (proximal humerus) Common tendon to olecranon (ulna) Extend forearm Radial

Forearm Muscles

     Cross elbow, wrist and finger joints Movement of hand and fingers Proximally are fleshy Distally have long tendons Flexor and extensor retinacula  “wristbands”  Keep tendons from jumping outwards when tensed pg 738

Forearm Muscles

  Anterior compartment  Superficial and Deep layers    Flexors of hand and fingers Most flexors have common origin on

medial epicondyle

Contains 2 pronator muscles Posterior compartment     Superficial and Deep layers Extensors of hand and fingers Most extensors have common origin on

lateral epicondyle

Contains a supinator muscle pg 732

Anterior Compartment of Forearm

  Muscles Superficial      Flexor digitorum superficialis Flexor carpi radialis Pronator teres Palmaris longus Flexor carpi ulnaris Deep    Pronator quadratus Flexor pollicis longus Flexor digitorum profundus pg 738, 740 Nerves Median Median Median Median Ulnar Median Median Ulnar (med 1/2) Median (lat 1/2)

pg 746

Posterior Compartment of Forearm

Muscles   Superficial  Brachioradialis      Anconeus Extensor carpi radialis longus & brevis Extensor digitorum Extensor carpi ulnaris Extensor digiti minimi Deep     Supinator Abductor pollicis longus Extensor pollicis longus + brevis Extensor indicus Nerves Radial Radial Radial Radial Radial Radial Radial Radial Radial Radial

Hand Bones

   Carpus (8)  “True” wrist  Distal to radius/ulna Metacarpus (5)  Distal to carpus Phalanges (14)  Distal to metacarpus pg 753

Intrinsic Muscles of the Hand

   Muscle Pinky = Hypothenar muscles  All digiti minimi (Flexor, Abductor, Opponens) Thumb = Thenar muscles     Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Adductor pollicis Other Intrinsic Muscles   Palmar + Dorsal Interossei Lumbricals Nerve Ulnar Median Median Median Ulnar Ulnar Median, Ulnar

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 pg 719

Blood Supply - Veins

 Deep veins  Deep palmar venous arches      Radial - forearm Ulnar - forearm Brachial – arm/elbow Axillary – axilla Subclavian - neck  Superficial Veins       Digital Superficial palmar venous arches Median – forearm Median cubital – elbow  Blood draws!!

Cephalic – arm/forearm Basilic – arm/forearm pg 664

pg 651

Axilla

   Armpit!!

Boundaries    Ventral  Pectoral muscles Dorsal  Latissimus dorsi, teres major, subscapularis Medial  Serratus ventralis  Lateral  Intertubercular (Bicipital) groove of humerus Contents  axillary lymph nodes, axillary vessels, brachial plexus

Surface Anatomy of Arm

      Cephalic Vein Biceps brachii Triceps brachii Olecrenon Process Medial Epicondyle Lateral Epicondyle pg 651

Surface Anatomy of Elbow

 Cubital Fossa    Anterior surface elbow Contents    Median Cubital Vein Brachial Artery Median Nerve Boundaries    Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles pg 730

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) pg 759

Brachial Plexus

    Nerve plexus 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 C 5 -C 8 and T 1 pg 700

Brachial Plexus



R

eally

T

ired?

D

rink

C

offee

B

uddy!

    

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

  C5 C6  C7   C8 T1

Trunks

Upper Trunk Middle Trunk Lower Trunk

Trunks Split to form Divisions! (in neck)

Trunks Divisions

 Upper  Middle  Lower Anterior Posterior Anterior Posterior 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  Medial  Posterior Median Ulnar Radial Axillary Thoracodorsal Subscapulars

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 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 Cord

 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, brachioradialis Divides in forearm:  Superficial  Skin of arm and dorsolateral surface of hand  Deep  Supinator & Extensor muscles of forearm (eg ext. carpi radialis L + B)

Posterior Cord (continued)

   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:  Subscapularis, Teres major Thoracodorsal nerve   Course:  Runs with thoracodorsal artery and vein Innervates:  Latissimus dorsi

pg 782 pg 783

Nerve Damage

   Ulnar nerve  “Claw hand”  Inability to extend fingers at interphalangeal joints, results in permanent flexion of hand = claw Median nerve  “Ape hand”  Inability to oppose thumb Radial nerve  “Wrist drop”  Inability to extend the hand, inability to fully extend forearm