Overview of upper limb Dr. Ashraf Hussain

Upper limb  Associated with lateral aspect of the lower portion of neck and thoracic wall  Suspended from the trunk by muscles and a small skeletal articulation between the clavicle and the sternum-the sternoclavicular joint.  The upper limb is divided into Shoulder Arm Forearm Hand

Segments of upper limb  Shoulder: pectoral, scapular, lateral supra clavicular  Arm (L. brachium) : first and longest segment of the limb  Forearm (L. antibrachium): second largest segment of the limb-extends between elbow and wrist  Hand (L.manus): distal to the forearm-wrist, palm dorsum of hand, fingers

How do upper limb differs from lower limb?

Distinction from lower limb  Not involved in weight bearing  Pectoral girdle is attached to the axial skeleton only anteriorly via a very mobile joint  Paired bones of the forearm are able to be moved relative to each other  Hands have long, mobile fingers and an opposable thumb

Upper limb  Mobility  Ability to grasp  Strike  Conduct fine motor skills

Areas of Transition in upper linb

The glenohumeral joint  The glenohumeral joint allows the arm to move around three axes with a wide range of motion.  Movements of the arm at this joint are  flexion  extension  abduction  adduction  medial rotation (internal rotation)  lateral rotation (external rotation)  circumduction

Hand  Hand as a mechanical tool: grip  Hand as a sensory tool: Touch - high density of somatic sensory receptors

Movements  Scapulothoracic  Glenohumeral  Elbow  Radioulnar  wrist

Bones of upper limb  Clavicle  Scapula  Humerus  Ulna  Radius  Bones of hand: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate

Important features  Muscles of upper limb  Joints of upper limb  Axilla  Brachial plexus  Brachial artery: ulnar, radial  Nerves: musculocutaneus, radial, median ulnar  Cubital fossa  Compartments of the forearm: flexor, extensor  Hand

Joints of upper limb  Sternoclavicular  Acromioclavicular  Glenohumeral  Elbow  wrist

The deformity of shoulder dislocation.

Bones of upper limb

Danger of nerve injury in humeral fractures

The right carpus, metacarpus and phalanges.

Muscles

Four rotator cuff muscles

Principal muscles acting on the shoulder joint Abductors Adductors ◊◊supraspinatus ◊◊pectoralis major ◊◊deltoid ◊◊latissimus dorsi Flexors Extensors ◊◊pectoralis major ◊◊teres major ◊◊coracobrachialis ◊◊latissimus dorsi ◊◊deltoid (anterior fibres) ◊◊deltoid (posterior fibres) Medial rotators Lateral rotators ◊◊pectoralis major ◊◊infraspinatus ◊◊latissimus dorsi ◊◊teres minor ◊◊teres major ◊◊deltoid (posterior fibres) ◊◊deltoid (anterior fibres) ◊◊subscapularis

Relationship

Back and thoracic wall

The derivatives of the brachial plexus

Venous drainage

Lymphatic drainage

principal vessels and nerves in forearm

The structures on the anterior aspect of the wrist