Introduction to limbs Sanjaya Adikari Department of Anatomy

Main topics covered Skeleton Superficial nerves/veins – only the important ones Dermatomes Muscle compartments – attachment & action of muscle groups and their innervation Brachial plexus & lumbosacral plexus

Main topics…. Special regions: axilla, cubital fossa, carpal tunnel, snuff box, femoral triangle, cubital fossa, gluteal region etc. Joints with ligaments Arterial anastomoses Lymph drainage

Skeleton Axial Appendicular Skull Vertebral column & ribs Limb girdles Bones of the limbs

Upper limb

Skeleton Shoulder/pectoral girdle Arm (humerus) (radius, ulna) (carpal bones) (metacarpals, phalanges) Fore arm Wrist Hand

Superficial veins & nerves

Dermatomes

Muscles of the shoulder Flexors Extensors Internal/medial rotators External/ lateral rotators Abductors Adductors

Compartments of the right arm Anterior Coracobrachialis Biceps brachii Brachialis N: musculocutaneous C5, C6 Posterior Triceps N: Radial nerve C7, C8

Contents of the right arm compartments

Compartments of the right forearm Pronator teres………. Flexor digitorum superficialis Flexor pollicis longus Flexor digitorum profundus Pronator quadratus

Brachial plexus

Axilla Anterior wall Posterior wall Medial wall Lateral wall Apex Transverse section Anterior wall Posterior wall Medial wall Lateral wall Apex Floor

Cubital fossa

Anterior aspect of wrist Median and ulnar nerves Radial and ulnar arteries Tendons of flexor muscles Flexor retinaculum

Carpal tunnel Palmar branch of median nerve

Anatomical snuffbox

Hand Dorsum Palm

Joints with ligaments

Anastomosis around the elbow Arterial anastomoses Anastomosis around the elbow Scapular anastomosis

Axillary lymph nodes supraclavicular apical lateral central posterior To thoracic duct or right lymphatic duct supraclavicular apical lateral central posterior anterior

Lower limb

Skeleton Pelvic girdle Thigh (femur) (tibia, fibula) (tarsal bones) (metatarsals, phalanges) Leg Ankle Foot

Skeleton of the foot

Superficial veins & nerves

Posterior arch vein

Adductor canal perforator Below knee perforator Upper medial perforator Lateral perforator Middle medial perforator Lower medial perforator Level of medial malleolus

Dermatomes

Fascia Lata

Femoral sheath

Compartments of the right thigh Fascia lata

Innervation Anterior compartment Femoral nerve Medial compartment Obturator nerve Posterior compartment Sciatic nerve

Compartments of the right leg

Innervation Anterior compartment Deep peroneal nerve Lateral compartment Superficial peroneal nerve Posterior compartment Tibial nerve

Lumbosacral plexus

Femoral triangle

Gluteal region

Popliteal fossa Right SeMem SeTend Biceps Popliteal surface of femur Gastroc Gastroc Popliteus muscle

Foot Dorsum Sole

Arches of the foot Medial longitudinal arch Lateral longitudinal arch Transverse arch:

Joints with ligaments Ligaments at the ankle Ligaments at the knee joint

Trochanteric & Cruciate anastomoses

Inguinal lymph nodes Deep inguinal nodes Superficial inguinal nodes Vertical group Horizontal group