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The Upper Extremity. Bones, Muscles, Vessels, . pg 608. 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

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The Upper Extremity


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the upper extremity

The Upper Extremity

Bones, Muscles, Vessels,

pg 608

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!!!

Bones

pg 612

joints of upper extremity
Joints of Upper Extremity

pg 626-7

  • 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
Joints of the Upper Extremity

pg 681-2

  • Elbow Joint
    • Synovial – hinge
    • Diarthrosis
  • Articulations
    • Humerus & Ulna
    • Humerus & Radius
  • Many Ligaments
joints of upper extremity5
Joints of Upper Extremity

pg 691

  • Proximal Radioulnar joint
    • Synovial - pivot
    • Diarthrosis
  • Distal Radioulnar joint
    • Synovial – pivot
    • Diarthrosis
  • Allows pronation and supination of forearm
joints of the upper extremity6
Joints of the Upper Extremity

Pg 711

  • 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
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

Scapula Muscles

pg 614

Rotator

Cuff

scapula muscles9
If the insertion is on the scapula – moves the scapula

Rhomboids

Trapezius

Pectoralis Minor

Serratus Ventralis

Levator Scapulae

Scapula Muscles

pg 614

Use location of Insertion to determine movement!!

arm muscles
Cross elbow, move forearm

2 compartments

Anterior

Flexors of forearm

Posterior

Extensors of forearm

Arm Muscles

pg 667

arm muscles12
Anterior compartment

Brachialis

Biceps brachii

Coracobrachialis

Arm Muscles

pg 651

pg 671

arm muscle innervation
Arm Muscle Innervation
  • Anterior compartment
    • Musculocutaneous nerve
      • Coracobrachialis
      • Brachialis
      • Biceps brachii
  • Posterior compartment
    • Radial nerve
      • Triceps brachii
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

pg 694

forearm muscles17
Anterior flexor compartment

Superficial and Deep

Most flexors have common tendon on medial epicondyle

Contains 2 pronators

Posterior extensor compartment

Superficial and Deep

Most extensors in superficial layer have common origin on lateral epicondyle

Forearm Muscles

pg 688

anterior compartment of forearm
MusclesNerves

Superficial

Flexor digitorum superficialis & brevis Median

Flexor carpi radialis Median

Pronator teres Median

Palmaris longus Median

Flexor carpi ulnaris Ulnar

Deep

Pronator quadratus Median

Flexor pollicis longus Median

Flexor digitorum profundusUlnar (med 1/2) Median (lat 1/2)

Anterior Compartment of Forearm

pg 696

posterior compartment of forearm
Posterior Compartment of Forearm

pg 702

MusclesNerves

  • Superficial
    • Brachioradialis Radial
    • Anconeus Radial
    • Extensor carpi radialis longus & brevis Radial
    • Extensor digitorum Radial
    • Extensor carpi ulnaris Radial
    • Extensor digiti minimi 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

Hand Bones

pg 711

intrinsic muscles of the hand
Intrinsic Muscles of the Hand

MuscleNerve

  • 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
intrinsic muscles of the hand22
Intrinsic Muscles of the Hand

pg 718

pg 723

Dorsal

Palmar

Lumbrical Muscles

Interossei Muscles

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

Blood Supply - Veins

pg 677

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

Blood Supply - Arteries

pg 675

axilla
Armpit!!

Where axillary hairs grow

Boundaries

Ventral

Pectoral muscles

Dorsal

Latissimus dorsi, teres major, subscapularis

Medial

Serratus ventralis

Lateral

Inetrtubercular (Bicipital) groove of humerus

Contents

axillary lymph nodes, axillary vessels, brachial plexus

Axilla

pg 688

surface anatomy of arm
Cephalic Vein

Biceps brachii

Triceps brachii

Olecrenon Process

Medial Epicondyle

Lateral Epicondyle

Surface Anatomy of Arm

pg 688

surface anatomy of elbow
Surface Anatomy of Elbow

pg 686

  • 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, Mediannerve

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)

Surface Anatomy of Hand

pg 715

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

pg 618

pg 21

brachial plexus30
Brachial Plexus

pg 660

  • 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
Rami join to form Trunks! (in neck)

Ventral RamiTrunks

  • C5 Upper Trunk
  • C6
  • C7Middle Trunk
  • C8
  • T1 Lower Trunk
trunks split to form divisions in neck
Trunks Split to form Divisions! (in neck)

TrunksDivisions

  • UpperAnteriorPosterior
  • MiddleAnteriorPosterior
  • LowerAnterior Posterior
divisions join to form cords in axilla
Divisions Join to form Cords! (in axilla)

TrunksDivisionCords

U A Lateral

P

M A Medial

P

L A Posterior

P

cords give off branches in axilla
Cords Give off Branches!! (in axilla)
  • Lateral Musculocutaneous

Median

  • Medial Ulnar
  • Posterior Radial Axillary (thoracodorsal) (subscapular)
brachial plexus cords and branches
Brachial Plexus – Cords and Branches
  • Lateral
    • Musculocutaneous n.
    • Median n.
  • Medial
    • Ulnar n.
  • Posterior
    • Radial n.
    • Axillary n.
    • Thoracodorsal n.
    • Subscapular n.
lateral cord
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 (not part of lateral cord)
    • Runs with suprascapular artery and vein {C5, C6}
    • Innervates
      • Supraspinatus
      • Infraspinatus
medial cord
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
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
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, supinator, brachioradialis
    • Divides in forearm:
      • Superficial
        • Skin of arm and dorsolateral surface of hand
      • Deep
        • Extensor muscles of forearm (eg ext. carpi radialis L + B)
posterior cord continued
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 nerve
    • Innervates:
      • Latissimus dorsi
nerve damage
Ulnar nerve

“Claw hand”

Inability to extend fingers at interphalangeal joints, results in permanent flexion = claw

Median nerve

“Ape hand”

Inability to oppose thumb

Radial nerve

“Wrist drop”

Inability to extend the hand, inability to fully extend forearm

Nerve Damage

pg 737-8