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The Upper Extremity Bones, Muscles, Vessels,
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Bones 30 bones!!!! Appendicular skeleton Pectoral girdle
Scapula Clavicle Allows for mobility Ball and socket attachments Upper extremity: Arm humerus Forearm Radius, ulna (interosseous membrane) Hand Carpals, metacarpals, phalanges Review bones and landmarks studied in lab!!! Glenoid cavity
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Joints of Upper Extremity
Sternoclavicular Synovial-saddle Diarthrosis Acromioclavicular Synovial-plane Glenohumeral joint Synovial-ball&socket Many ligaments Muscle reinforcement Great Mobility
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Joints of the Upper Extremity
Elbow Joint Synovial – hinge Diarthrosis Articulations Humerus & Ulna Humerus & Radius Many Ligaments
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Joints of Upper Extremity
Proximal Radioulnar joint Synovial - pivot Diarthrosis Distal Radioulnar joint Synovial – pivot Allows pronation and supination of forearm
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Joints of the Upper Extremity
Radiocarpal joint Synovial-condyloid Distal radius with proximal row of carpals Intercarpal joints Synovial-plane Carpal-metacarpal (2-5) Trapezium-metacarpal 1 Synovial-saddle Metacarpal-phalangeal Interphalangeal Synovial-hinge ALL DIARTHROSES
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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
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Scapula Muscles If the origin is on the scapula – moves the arm
Subscapularis Supraspinatus Infraspinatus Teres Minor Teres Major Latissimus Dorsi (partial attachment) Coracobrachialis Rotator Cuff
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Scapula Muscles If the insertion is on the scapula – moves the scapula
Rhomboids Trapezius Pectoralis Minor Serratus Ventralis Levator Scapulae Use location of Insertion to determine movement!!
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Scapula Innervation Origin on scapula Insertion on scapula
Subscapularis and teres major Subscapular Supraspinatus and Infraspinatus Suprascapular Teres Minor Axillary Latissimus Dorsi Thoracodorsal Coracobrachialis Musculocutaneous Insertion on scapula Rhomboids and Levator Scapulae Dorsal scapular Trapezius Accessory Pectoralis Minor Medial and Lateral Serratus Ventralis Long thoracic
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Muscles of the Rotator Cuff All INSERT on the humerus
Origin Action Subscapularis Subscapular fossa Medial rotator of the humerus infraspinatus Infraspinous fossa Lateral rotator of the humerus Teres minor Lateral border of scapula (upper 2/3) supraspinatus Supraspinous fossa Abducts the humerus
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Muscles of the Scapula *All these muscles INSERT on the scapula
Origin Action Trapezius Ligamentum nuchae and C7-T12 Elevates, adducts, rotates, and depresses the scapula Levator Scapulae ventralis C1-C4 Elevates the scapula, flexes neck laterally Rhomboids C7-T5 Adduct, elevate, and rotate the scapula Pectoralis minor Ribs 3-5 Depresses and rotates the scapula Serratus anterior Ribs 1-9 Protracts and rotates the scapula
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Arm Muscles Cross elbow, move forearm 2 compartments Anterior
Flexors of forearm Posterior Extensors of forearm
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Arm Muscles Anterior compartment Brachialis Biceps brachii
Coracobrachialis Brachioradialis
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Arm Muscles Posterior compartment Triceps brachii Anconeus
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Arm Muscle Innervation
Anterior compartment Radial nerve Bracioradialis Musculocutaneous nerve Coracobrachialis Brachialis Biceps brachii Posterior compartment Triceps brachii Anconeus
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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
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Forearm Muscles Anterior flexor compartment
Superficial and Deep Most flexors have common tendon on medial epicondyle Contains 2 pronators Posterior extensor compartment
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Anterior Compartment of Forearm
Muscles Nerves Superficial Flexor digitorum superficialis Median Flexor carpi radialis Median Pronator teres Median Palmaris longus Median Flexor carpi ulnaris Radial Deep Flexor pollicis longus Median Flexor digitorum profundus Ulnar (med 1/2) Median (lat 1/2)
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Anterior Compartment Forearm
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Posterior Compartment of Forearm
Muscles Nerves Superficial Extensor carpi radialis longus Radial Extensor digitorum Radial Extensor carpi ulnaris Radial Deep Supinator Radial Abductor pollicis longus Radial Extensor pollicis longus + brevis Radial Extensor indicus Radial
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Posterior Compartment of Forearm
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Hand Bones Carpus (8) Metacarpus (5) Phalanges (14) “True” wrist
Distal to radius/ulna Metacarpus (5) Distal to carpus Phalanges (14) Distal to metacarpus
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Intrinsic Muscles of the Hand
Muscle Nerve 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
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Muscles of the Upper Limb *All INSERT on the humerus (*)
Origin Action Deltoid Lateral ½ of clavicle, acromion and spine of scapula Prime flexor, abducts and extends the humerus. Laterally and medially rotates arm. Pectoralis major Sternum and ribs 2-6 Adducts, flexes, and medially rotates humerus Latissimus dorsi Iliac crest, T7-T12 and lumbar fascia Extends, adducts, and medially rotates the humerus Teres major Lateral border of scapula (lower 1/3) Coracobrachialis Coracoid process Flexes and adducts the humerus.
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Muscles Crossing the Elbow
Origin Insertion Action Triceps Brachii (radial nerve) Infraglenoid tubuercle and shaft of humerus Olecranon process of ulna Forearm extensor Anconeus Lateral epicondyle of humerus Lateral aspect of olecranon process of ulna Abducts ulna during forearm pronation Biceps Brachii (musculocutaneous nerve) Supraglenoid tubercle and coracoid process Radial tuberosity Flex forearm and supinate hand Brachialis Anterior surface of humerus Coronoid process of ulna and capsule of elbow Forearm flexor and hand supinator Brachioradialis (radial nerve)* Supracondylar ridge of the humerus Styloid process of radius Synergist in forearm flexion *Exception: radial nerve usually serves extensor muscles
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Muscles of the Forearm Muscle Origin Insertion Action
Pronator Teres (median nerve) Humerus Coronoid process of ulna Lateral raidus Pronate forearm Weak flexor of elbow Flexor Carpi Radialis Humerus-medial epicondyle Base of 2nd and 3rd metacarpals Flexor of wrist, abduct hand Palmaris Longus Palmar fascia Weak wrist flexor Flexor Carpi Ulnaris (ulnar nerve) Olecranon process Pisiform and hamate bones, base the 5th metacarpal Powerful flexor of wrist, adductor of hand Flexor Digitorum Superficialis Humerus-medial epicondyle, coronoid process of ulna, shaft of radius Four tendons into middle phalange of fingers 2-5 Flexes wrist ANTERIOR Superficial Muscles
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Muscles of the Forearm Muscle Origin Insertion Action
Flexor Pollucis Longus (median nerve) Radius and interosseous membrane Distal phalanx of thumb Flexes distal phalanx of thumb Flexor Digitorum Profundus (ulnar and median nerves) Ulna and interosseous membrane Four tendons into distal phalanges of fingers 2-5 Flexor of the fingers Pronator Quadratus ulna radus Forearm pronation ANTERIOR Deep Muscles
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Muscles of the Forearm Muscle Origin Insertion Action
Extensor Carpi Radialis Longus (radial nerve) Humerus-lateral epicondyle Base of 2nd metacarpal Extends and abducts wrist Extensor Carpi Radialis Brevis (deep branch of radial nerve) Base of 3rd metacarpal Extends wrist Extensor Digitorum humerus Four tendons into extensor expansions and distal phalanges of fingers 2-5 Prime mover of finger extension Extensor Carpi Ulnaris (posterior interosseous nerve) Humerus-lateral epicondyle and ulna Base of fifth metacarpal Extends wrist and adducts wrist POSTERIOR Superficial Muscles
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Muscles That Move the Forearm
Origin Insertion Action Supinator (post. Interosseous nerve) Humerus, ulna Radius proximal end Supinate forearm Abductor Pollucis Longus (post. Inter. Nerve) Post. Radius and ulna Base of 1st metacarpal and trapezium Abducts and extends thumb Extensor Pollucis Brevis and longus Shaft of radius and ulna, interosseous membrane Base proximal phalanx (brevis) and distal phalanx (longus) of thumb Extends thumb Extensor Indicis (post. Inter. Nerve) Distal ulna, interosseous membrane Extensor expansion of index finger Extends index finger POSTERIOR Deep Muscles
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http://bio.bd.psu.edu/cat/Muscular_System/deep_muscles.htm# Upper Arm
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1. Clavodeltoid 2. Biceps Brachii 3. Triceps Medial Head 4. Epitrochlearis 5. Triceps Long Head Upper Arm –Medial View
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1. Acromiotrapezius 2. Levator Scapulae Ventralis 3. Teres Major 4. Triceps Lateral Head (Reflected) 5. Triceps Long Head 6. Triceps Medial Head 7. Brachialis 8. Clavodeltoid 9. Anconeus Upper Arm – Lateral View
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1’ Long Head of Triceps 7. Extensor Digitorum Communis 2. Lateral Head of Triceps 8. Extensor Digitorum Lateralis 3. Brachialis 9. Extensor Carpi Ulnaris 4. Brachioradialis 10. Flexor Carpi Ulnaris 5. Extensor Carpi Radialis Longus 11. Anconeus 6. Extensor Carpi Radialis Brevis
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1. Brachioradialis 8. Clavodeltoid 2. Extensor Carpi Radialis Longus 9. Biceps Brachii 3. Extensor Carpi Radialis Brevis 10. Epitrochlearis 4. Pronator Teres 11. Long Head of Triceps 5. Flexor Carpi Radialis 12. Medial Head of Triceps 6. Palmaris Longus 13. Flexor Digitorum Superficialis 7. Flexor Carpi Ulnaris
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Intrinsic Muscles of the Hand Thenar Eminence
Origin Insertion Action Abductor Pollucis Brevis (median nerve) Flexor retinaculum, Carpal bones Base of first proximal phalanx Abducts thumb Flexor Pollucis Brevis Same as above Flex thumb Opponens Pollucis Flexor retinaculum and trapezium Anterior side of first metacarpal Oppostion Adductor pollucis (ulnar nerve) Capitate bone and bases of metacarpals 2-4 Medial side of base of first proximal phalanx Adducts and opposes the thumb
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Intrinsic Muscles of Hand Hypothenar Eminence
Origin Insertion Action Abductor Digiti Minimi (ulnar nerve) pisiform Medial side of proximal phalanx of 5th finger Abducts little finger at MPJ. Flexor digiti minimi brevis Hamate and flexor retinaculum Same as above Flexes little finger Opponens digiti minimi Medial side of metacarpal 5 opposition
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Muscles of the Hand Midpalmar Muscles
Origin Insertion Action Lumbricals (median and ulnar nerve) Lateral side of each tendon of the deep flexor Lateral edge of extensor expansion of fingers 2-5 Flex the MPJ Extend IPJ’s Palmar Interossei (ulnar nerve) Midaxial side of each metacarpal except of met. #3 Extensor expansion Adduction of fingers Dorsal interossei Sides of metacarpals Extensor expansions Abduct fingers
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Intrinsic Muscles of the Hand
Lumbrical Muscles Interossei Muscles
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Blood Supply - Veins Deep veins Superficial Veins
Deep palmar venous arches Radial - forearm Ulnar - forearm Brachial – arm/elbow Subclavian - neck Axillary – axilla Superficial Veins Cephalic – arm/forearm Basilic – arm/forearm Median cubital – elbow Blood draws!! Median - forearm Superficial palmar venous arches Digital
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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
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Axilla Between arms and chest Where axillary hair grow Boundaries
Ventral Pectoral muscles Dorsal Latissimus dorsi, teres major, subscapularis Medial Serratus ventralis Lateral Intertubercular (Bicipital) groove of humerus Contents Axillary lymph nodes, Axillary vessels, brachial Plexus
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Surface Anatomy of Arm Biceps brachii Triceps brachii
Olecrenon Process Medial Epicondyle Lateral Epicondyle
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Surface Anatomy of Elbow
Cephalic vein Cubital Fossa Anterior surface elbow Contents Median Cubital Vein Brachial Artery Median Nerve Boundaries Medial= Pronator teres Lateral= Brachioradialis Superior= Line between epicondyles
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Surface Anatomy of Hand
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)
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Brachial Plexus Nerve plexus Lies partly in neck and partly in axilla
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
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Ventral Rami
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Really Tired? Drink Coffee Buddy!
Brachial Plexus Really Tired? Drink Coffee Buddy! R = RAMI (ventral) (5) T = TRUNKS (3) D = DIVISIONS (2) C = CORDS (3) B = BRANCHES (Many!!)
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Rami join to form Trunks! (in neck)
Ventral Rami Trunks C5 Upper Trunk C6 C7 Middle Trunk C8 T1 Lower Trunk
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Trunks Split to form Divisions! (in neck)
Trunks Divisions Upper Anterior Posterior Middle Anterior Posterior Lower Anterior Posterior
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Divisions Join to form Cords! (in axilla)
Trunks Division Cords U A Lateral P M A Medial L A Posterior
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Cords Give off Branches!! (in axilla)
Lateral Musculocutaneous Median Medial Ulnar Posterior Radial Axillary Thoracodorsal Subscapular
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1. Vagus Nerve 2. Brachial Plexus 3. Radial Nerve 4. Axillary Nerve 5. Median Nerve 6. Ulnar Nerve
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Brachial Plexus – Cords and Branches
Lateral Musculocutaneous Median Medial Ulnar Posterior Radial Axillary Thoracodorsal Subscapular
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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)
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Medial Cord Ulnar nerve Course: Innervates: 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)
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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 Innervates: Anterior forearm (motor) Most flexors, some intrinsics (thumb) 2/3 Lateral palm (sensory) Dorsum of fingers 2 and 3 (sensory)
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Posterior Cords 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 E. carpi radialis L + B)
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Posterior Cord Axillary nerve Subscapular nerve Thoracodorsal 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 Subscaplaris, Teres major Thoracodorsal nerve Runs with thoracodorsal artery and nerve Latissimus dorsi
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Cutaneous Innervation to Hand
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Nerve Damage Ulnar nerve Median nerve Radial 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
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Carpal Tunnel Syndrome At A Glance
Carpal tunnel syndrome is caused by irritation of the median nerve at the wrist. Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. Symptoms of carpal tunnel syndrome include numbness and tingling of the hand. Diagnosis of carpal tunnel syndrome is suspected based on symptoms, supported by physical examination signs, and confirmed by nerve conduction testing. Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.
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