Bones of Upper Limb Appendicular Skeleton Pectoral Girdle = scapula,clavicle Upperlimb – Arm: humerus – Forearm: radius, ulna Interosseus membrane – Hand: carpals, metacarpals, phalanges

Joints of Upper Extremity Sternoclavicular – Synovial of saddle – Diarthrosis Acromioclavicular – Synovialof plane – Diarthrosis Shoulder joint (Glenohumeral j ) – Synovial of ball&socket – Many ligaments – Muscle reinforcement – Great Mobility !

Joints of the Upper Limb Elbow Joint : Synovial of hinge Articulations – Humerus with Ulna & Radius Collateral Ligaments

Joints of Upper Limb Sup.Radioulnar joint – Synovial of pivot Inf. Radioulnar joint – Synovial – pivot Allows pronation and supination of forearm

Joints of the Upper Limb Radiocarpal joint – Synovial of condyloid – Distal radius with scaphoid and Lunate Intercarpal joints – Synovial of plane Carpometacarpal (2-5) – Synovial of plane Trapezium-metacarpal 1 – Synovial of saddle Metacarpo-phalangeal – Synovial of condyloid Interphalangeal – Synovial of hinge

Review of Naming Naming – Flexor carpi ulnaris – Flexor digitorum superficialis – Flexor pollicis longus – Pronator quadratus – Extensor carpi radialis brevis What do the following names TELL you about the muscle?

Muscles of Scapula If ORIGIN on scapula = Move Arm – Subscapularis – Supraspinatus – Infraspinatus – Teres Minor – Teres Major – Latissimus Dorsi (partial O on scap) – Coracobrachialis If INSERTION on scapula = Move If INSERTION on scapula = Move scapula scapula – Rhomboids – Trapezius – Pectoralis Minor – Serratus Ventralis – Levator Scapulae Rotator Cuff

Nerve supply of Scapula Muscles Origin on Scapula: – Latissimus dorsi = Thoracodorsal nerve – Subscapularis, Teres Major = Subscapular nerves – Supraspinatus, Infraspinatus = Suprascapular nerves – Teres Minor = Axillary nerve Insertion on Scapula – Levator Scapular, Rhomboids = Dorsal Scapular nerve – Pectoralis Minor = Pectoral n. – Serratus Ventralis = Long Thoracic n. – Trapezius = Accessory n.

Muscles of Arm: Cross elbow, Move forearm 2 Compartments – Anterior: Flexors of forearm – Posterior: Extensors of forearm Anterior Compartment – Biceps brachii = MC nerve – Brachialis = MC nerve – Brachioradialis = Radial nerve Coracobrachialis = MC nerve – O = coracoid process of scapula – I = medial side humeral shaft – A = flex, adduct arm Posterior Compartment – Triceps brachii = Radial nerve – Anconeus = Radial nerve N.B. MC = musclocutaneous nerve

Muscles of forearm: Cross wrist & finger joints, flexes hand & fingers Cross Wrist = flex, extend, abduct, adduct hand Cross Fingers = flex, extend fingers Most muscles fleshy proximally, long tendons distally Flexor + Extensor Retinacula : – The retinaculum is a thick band of deep fascia has bony attachment ; it keeps tendons in position during movements – Under the retinaculum, tendons are surrounded by synovial sheathes

Compartments of the forearm : 1.Anterior Flexor Compartment : ( Superficial + Deep layers ) Most of superficial flexors originate by a common origin from medial epicondyle Contains 2 pronators, are supplied by Median and Ulnar nerves 2. Posterior Extensor Compartment : (Superficial + Deep layers) Are supplied by Radial and post. Interosseus nerves

Anterior Compartment of Forearm s Superficial Muscles – Flexor digitorum superficialisMedian – Flexor carpi radialisMedian – Pronator teresMedian – Palmaris longusMedian – Flexor carpi ulnarisUlnar Deep Muscles – Pronator quadratusMedian – Flexor pollicis longusMedian – Flexor digitorum profundusUlnar (med 1/2) Median (lat 1/2) MuscleNerve

Anterior Compartment Forearm Flexor Carpi Radialis Flexor Retinaculum Medial Epicondyle Flexor Digitorum Superficialis is deep to other flexors Flexor Carpi Ulnaris Brachioradialis Pronator Teres Anterior View

Posterior Compartment of Forearm Superficial – Extensor carpi radialis longusRadial – Extensor digitorumRadial – Extensor carpi ulnarisRadial Deep – SupinatorRadial – Abductor pollicis longus Radial – Extensor pollicis longus + brevis Radial – Extensor indicus Radial Muscle Nerve

Posterior Compartment of Forearm Extensor digitorum Extensor carpi ulnaris Ext Carpi Radialis Longus Brachioradialis Lateral Epicondyle Posterior View

Muscles of Hand Pinky (little finger) – All digiti minimiUlnar (Flexor, Abductor, Opponens) Thumb – Abductor pollicis brevisMedian – Flexor pollicis brevisMedian – Opponens pollicisMedian – Adductor pollicisUlnar Other Intrinsic Muscles – Palmar & Dorsal InterosseiUlnar – 4 LumbricalsMedian, Ulnar MuscleNerve

Muscles of Hand ABduction Palmar Interossei Lumbricals ADDuction 1st 2nd 3rd 4th Dorsal Interossei Interossei help the lumbricals to extend I P joints and flex MC-P joints

Blood Supply of U.L: 1. The Veins Cephalic (arm-forearm) Basilic (arm-forearm) Median Cubital (elbow) Median Vein SF. Palmar Venous Arch Digital SUPERFICIAL Subclavian (neck) Axillary (axilla) Brachial (arm-elbow) Radial (forearm) Ulnar (forearm) Deep Palmous Venous arch DEEP

Blood Supply of the U.L: 2.Arteries Subclavian A (neck) Axillary A (armpit) – Subscapular A Brachial A (arm) – Deep brachial Radial A (forearm) Ulnar A (forearm) Common Interosseous A Superficial & Deep Palmar arches

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 lymph nodes, Axillary vessels Brachial Plexus

The Axilla

Surface Anatomy of Upper Limb Biceps + Triceps brachii Olecrenon Process Medial Epicondyle 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 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)

Brachial Plexus Network of nerves starts in in the neck, then to the axilla Is motor to muscles of upper limb except trapezius Sensory to skin of U.L except tip of shoulder & upper part of skin covers deltoid. Root value : C5,6,7,8,T1

Where Ventral Rami Come From Dorsal Root Ventral Root spinal nerve Dorsal Ramus of spinal nerve Ventral Ramus of spinal nerve

Structure of the Spinal nerve

Parts of Brachial Plexus R eally T ired? D rink C offee B uddy! R = ROOTS (ventral rami) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES

Roots join to form Trunks! (in neck) Ventral Rami Trunks C5Upper Trunk C6 C7 Middle Trunk C8 T1 Lower Trunk

Trunks Split to form Divisions : (in neck) Trunks Divisions UpperAnterior Posterior MiddleAnterior Posterior LowerAnterior Posterior

Divisions Join to form Cords! (in axilla) U A P M A P L A P POSTERIOR CORD LATERAL CORD MEDIAL CORD TrunksDivisions Cords

Cords Give off Branches!! (in axilla) Lateral Musculocutaneous Median MedialUlnar PosteriorRadial Axillary (thoracodorsal) (subscapular)

Parts of the brachial plexus…..

Injury of the brachial plexus

Branches of the Posterior Cord Radial Nerve : ( is the largest branch of the post. cord) – Course: Through arm, spiral groove of the humerus, then in front of lat. epicondyle, then divides : – Divides in the forearm to give : Superficial = skin of arm and dorsolateral surface of hand Deep ( post interosseus nerve ) = extensor muscles of forearm (eg E. carpi radialis L, B., …) – Innervates: posterior muscles of arm Triceps brachii, anconeus, supinator, brachioradialis – Sensory :……, skin of back

The Radial nerve 1.from post. cord 2.artificai triangular space 3.spiral groove 4.pireces lat. I.M.S 5.in front of lat. epicondyle, and divides into : ……..

Damage to Radial Nerve = wrist drop Inability to extend the hand

Branches of the Posterior Cord (continued) Axillary Nerve ( w. Circumflex vs..) – Supplies: Deltoid and Teres minor (motor supply ) Capsule of shoulder skin of lower part covering deltoid (sensory supply) Subscapular Nerves {branches of C5 + C6 rami} – Innervates: Subscapularis, Teres major Thoracodorsal Nerve (runs w. thoracodorsal vs) supplies: Latissimus dorsi

The brachial plexus

The Lateral Cord gives :.Lat. Root of median nerve.Lat.pectoral nerve Musculocutaneous : – Course: branches to arm, distal to elbow becomes cutaneous :sensory to skin of lateral side of forearm. – Motor : Biceps brachii, brachialis, coracobrachialis

The Median nerve The Median nerve : is formed by 2 roots :….. – Course: middle of brachial plexus, distal to elbow provides many branches to most forearm flexors, passes through carpal tunnel to hand to lateral palmar intrinsics – Motor supply to: most muscles of anterior of the forearm flexors thenar eminence (thumb), lat.2 Lumbrichals – Sensory : skin of lateral 2/3 of palm,lat. Three & half fingers to back of middle phalanges – Nerve Damage = “Ape” Hand Inability to Oppose Thumb

The median nerve

The median nerve : C5,6,7,8,T1.Is formed by 2 roots.Has 3 relations w. brachial A.Enters forearm by piercing pronator teres( supplies it 1 st ).Enters hand deep to flexor retinaculum ( Carpal tunnel ). In the it gives deep & superficial branches

The median nerve

Branches of the Medial Cord : 5 The Ulnar nerve : – Course: runs along medial side of arm, behind medial epicondyle ( site of its injury ) – Enters the hand :superficial to flexor retinaculum. – Supplies : Motor :FCU and medial part of FDP (in forearm1 1/2) Ms. Of hand except 5 Skin of medial 1/3 of hand Ant +Post + medial one & half fingers Nerve Damage: Partial Claw hand Inability to extend fingers at interphalangeal joints, results in permanent flexion = claw

The Ulnar nerve C7,8,T1

Ulnar nerve injury : Partial Claw hand

Dermatomal supply of the hand