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UPPER LIMB PowerPoint PPT Presentation


UPPER LIMB. What is a limb? Skeleton Joints Shoulder/Scapula muscles Brachial plexus—getting spinal nerves out onto limb Muscles—anterior and posterior compartments Sensory innervation Surface anatomy. From Royal Collection da Vinci drawings. What is a limb?.

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UPPER LIMB

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Upper limb l.jpg

UPPER LIMB

  • What is a limb?

  • Skeleton

  • Joints

  • Shoulder/Scapula muscles

  • Brachial plexus—getting spinal nerves out onto limb

  • Muscles—anterior and posterior compartments

  • Sensory innervation

  • Surface anatomy

From Royal Collection da Vinci drawings

Frolich, Human Anatomy,UpprLimb


What is a limb l.jpg

What is a limb?

  • Ventral somatic outgrowth of outer tube

    • Bones (made of bony tissue, cartilage, and other tissues)

    • Joints

    • Muscles

    • Nerves (with motor neurons to muscles, sensory neurons to skin, proprioceptors)

  • No viscera--all innervation is somatic (motor or sensory) from ventral ramus of spinal nerve (except autonomics to blood vessels)

Frolich, Human Anatomy,UpprLimb


Upper limb skeleton l.jpg

Upper Limb Skeleton

  • Scapula

  • Humerus

  • Radius, ulna

  • Carpals--proximal, distal

  • Digits

    • Metacarpals

    • Phalanges

Frolich, Human Anatomy,UpprLimb


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Joints

Frolich, Human Anatomy,UpprLimb


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Frolich, Human Anatomy,UpprLimb


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Muscle origins and insertions

  • Muscle crosses joint

  • Origin is usually proximal and insertion is usually distal

  • Origin is considered fixed in analyzing muscle action

  • Muscle action (concentric) is given by movement of insertion relative to origin across joint

  • Remember:

    • Sometimes insertion might be fixed

    • Muscle may be active isometrically and concentrically giving different real function during real activity

Frolich, Human Anatomy,UpprLimb


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Muscles of Scapula

  • If INSERTION on scapula, muscle moves scapula

    • Trapezius

    • Rhomboids

    • Pectoralis Minor

    • Serratus Ventralis

    • Levator Scapulae

  • If ORIGIN on scapula, muscle moves arm

    • Teres Major

    • Latissimus Dorsi (partially on scapula)

Frolich, Human Anatomy,UpprLimb


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Rotator Cuff

  • Supraspinatus

  • Infraspinatus

  • Teres minor

  • Subscapularis

  • Muscles originate on fossae of scapula

  • Help support “open socket” of shoulder joint

  • Insert around ball of femur

  • Medial and lateral rotation of upper limb

  • Typical baseball pitcher injury

Frolich, Human Anatomy,UpprLimb


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Axilla = Armpit

  • Region between arm and chest

  • Boundaries

    • Ventral - pectoral muscles

    • Dorsal = latissimus dorsi, teres major subscapularis

    • Medial = serratus ventralis

    • Lateral = bicipital groove of humerus

  • Contents

    • Axillary nerves and blood vessels

    • Axillary lymph nodes

    • And….the……Brachial plexus

Frolich, Human Anatomy,UpprLimb


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Frolich, Human Anatomy,UpprLimb


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Brachial Plexus

  • Posterior Compartment—posterior cord

  • Anterior compartment—medial, lateral cords

  • Name of cord is relative to axillary artery

Frolich, Human Anatomy,UpprLimb


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Brachial plexus organizes nerves out to muscles of upper limb

  • One posterior nerve

    • Radial n.

  • Three anterior nerves

    • Musculocutaneous n.

    • Median n.

    • Ulnar n.

Frolich, Human Anatomy,UpprLimb


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Muscles and nerves by compartment

Frolich, Human Anatomy,UpprLimb


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POSTERIOR AND ANTERIOR COMPARTMENTS

Frolich, Human Anatomy,UpprLimb


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  • Biceps—anterior compartment, flexion (M-C n.)

  • Triceps—posterior compartment, extension (radial n.)

Frolich, Human Anatomy,UpprLimb


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Anterior Compartment Forearm--flexors

Medial Epicondyle

Brachioradialis

Pronator Teres

Flexor Carpi Radialis

Flexor Carpi Ulnaris

Flexor Retinaculum

Flexor Digitorum Superficialis is deep to other flexors

Anterior View

Frolich, Human Anatomy,UpprLimb


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Posterior Compartment of Forearm--extensors

Lateral Epicondyle

Brachioradialis

Extensor digitorum

Ext Carpi Radialis Longus

Extensor carpi ulnaris

Posterior View

Frolich, Human Anatomy,UpprLimb


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ANTERIOR MUSCLES

  • M-C nerve

    • Biceps

    • brachialis

  • Median nerve

    • Forearm flexors

    • Thumb intrinsics (1M$ nerve)

  • Ulnar nerve

    • Flexor carpi ulnaris

    • Hand intrinsics

POSTERIOR MUSCLES

  • Muscles (radial nerve)

    • Triceps

    • Anconeus

    • Brachioradialis

    • Carpal, digit extensors

Frolich, Human Anatomy,UpprLimb


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Sensory from limb (dermatomes/sensory skin segments from spine)

  • Dermatomes extend over limbs

  • Twisted orientation reflects twisting of limb during development

  • Named nerves generally innervate skin over muscles that they innervate

Frolich, Human Anatomy,UpprLimb


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Sensory territory of nerves

REMEMBER: Brachial plexus re-directs spinal routes into named nerves covering certain territory

Cutaneous branches of medial cord/ulnar nerve

Frolich, Human Anatomy,UpprLimb


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Routes of nerves (in human)

  • M-C: between biceps brachii and brachialis

  • Median: medial/posterior to biceps, branches into forearm flexors at elbow then to hand through carpal tunnel

    • Recurrent median (1M$) superficial at wrist to thumb over thenar emminence) deficit - ape’s hand

  • Ulnar: medial in arm, posterior to medial epicondle of humerus (funny bone) down medial forearm medial to carpal tunnel into palm

  • Radial: deep posterior arm around lateral epicondyle of humerus to forearm (deep and superficial branches)

Frolich, Human Anatomy,UpprLimb


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Median Nerve

Ulnar Nerve

Brachial Artery

Musculocutaneous Nerve

UlnarArtery

Where’s Radial Nerve?

Radial Artery

Median Nerve

Ulnar Nerve

Frolich, Human Anatomy,UpprLimb


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Surface Anatomy of Upper Limb

  • Biceps + Triceps brachii

  • Olecranon Process

  • Medial Epicondyle

  • Cubital Fossa

    • Anterior surface elbow

    • Contents

      • Brachial Artery

      • Median Nerve

    • Boundaries

      • Medial = Pronator teres

      • Lateral = Brachioradialis

      • Superior = Line between epicondyles

Frolich, Human Anatomy,UpprLimb


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Surface Anatomy of Upper Limb

  • 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)

Frolich, Human Anatomy,UpprLimb


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Suggestion: a muscle table organized byJoint crossed?Nerve innervating?Action?Compartments?All of the above?

Frolich, Human Anatomy,UpprLimb


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Frolich, Human Anatomy,UpprLimb


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